Weight loss effects of circuit training interventions: A systematic review and meta‐analysis

This meta‐analysis aimed to assess the weight loss effects of circuit training interventions in adults. A computerized search was conducted using the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE online databases. The analysis was restricted to randomized controlled trials that evaluated the effects of circuit training interventions on body weight and body mass index in adults aged 18 years or older. Meta‐analyses were conducted using the random‐effect model to estimate the weighted mean difference (WMD) with 95% confidence interval (CI). Nine randomized controlled trials (837 participants) were included. Significant intervention effects were identified for body weight (WMD = ?3.81 kg, 95% CI ?5.60 to ?2.02) and body mass index (WMD = ?1.77 kg/m², 95% CI ?2.49 to ?1.04). Subgroup analysis by body mass index status showed that the intervention effect was significant only in participants with obesity or overweight (obesity: WMD = ?5.15 kg, 95% CI ?8.81 to ?1.50 and overweight: WMD = ?3.89 kg, 95% CI ?7.00 to ?0.77, respectively) but not in those with normal weight. Current evidence suggests that circuit training effectively reduces body weight and body mass index in adults with overweight and obesity.     

The effect of flaxseed supplementation on body weight and body composition: a systematic review and meta‐analysis of 45 randomized placebo‐controlled trials

Flaxseed consumption may be inversely associated with obesity; however, findings of available randomized controlled trials (RCTs) are conflicting. The present study aimed to systematically review and analyse RCTs assessing the effects of flaxseed consumption on body weight and body composition. PubMed, Medline via Ovid, SCOPUS, EMBASE and ISI Web of Sciences databases were searched up to November 2016. Mean changes in body composition indices including body weight, body mass index (BMI) and waist circumference were extracted. Effect sizes were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). Heterogeneity between studies was assessed with the I² test. Publication bias and subgroup analyses were also performed. The quality of articles was assessed via the Jadad scale. A total of 45 RCTs were included. Meta‐analyses suggested a significant reduction in body weight (WMD: ?0.99 kg, 95% CI: ?1.67, ?0.31, p = 0.004), BMI (WMD: ?0.30 kg m^?2, 95% CI: ?0.53, ?0.08, p = 0.008) and waist circumference (WMD: ?0.80 cm, 95% CI: ?1.40, ?0.20, p = 0.008) following flaxseed supplementation. Subgroup analyses showed that using whole flaxseed in doses ≥30 g d^?1, longer‐term interventions (≥12 weeks) and studies including participants with higher BMI (≥ 27 kg m^?2) had positive effects on body composition. Whole flaxseed is a good choice for weight management particularly for weight reduction in overweight and obese participants.     

Meta‐analyses of workplace physical activity and dietary behaviour interventions on weight outcomes

This meta‐analytic review critically examines the effectiveness of workplace interventions targeting physical activity, dietary behaviour or both on weight outcomes. Data could be extracted from 22 studies published between 1980 and November 2009 for meta‐analyses. The GRADE approach was used to determine the level of evidence for each pooled outcome measure. Results show moderate quality of evidence that workplace physical activity and dietary behaviour interventions significantly reduce body weight (nine studies; mean difference [MD]?1.19 kg [95% CI ?1.64 to ?0.74]), body mass index (BMI) (11 studies; MD ?0.34 kg m^?2[95% CI ?0.46 to ?0.22]) and body fat percentage calculated from sum of skin‐folds (three studies; MD ?1.12% [95% CI ?1.86 to ?0.38]). There is low quality of evidence that workplace physical activity interventions significantly reduce body weight and BMI. Effects on percentage body fat calculated from bioelectrical impedance or hydrostatic weighing, waist circumference, sum of skin‐folds and waist–hip ratio could not be investigated properly because of a lack of studies. Subgroup analyses showed a greater reduction in body weight of physical activity and diet interventions containing an environmental component. As the clinical relevance of the pooled effects may be substantial on a population level, we recommend workplace physical activity and dietary behaviour interventions, in cluding an environment component, in order to prevent weight gain.     

The enigma of increased non-cancer mortality after weight loss in healthy men who are overweight or obese

Abstract. Nilsson PM, Nilsson J‐A, Hedblad B, Berglund G, Lindgärde F. (University Hospital, Malmö, Sweden). The enigma of increased non‐cancer mortality after weight loss in healthy men who are overweight or obese. J Intern Med 2002; 252: 70?78. Objective. To study effects on non‐cancer mortality of observational weight loss in middle‐aged men stratified for body mass index (BMI), taking a wide range of possible confounders into account. Design. Prospective, population based study. Setting. Male population of Malmö, Sweden. Participants. In all 5722 men were screened twice with a mean time interval of 6 years in Malmö, southern Sweden. They were classified according to BMI category at baseline (<21, 22?25, overweight: 26?30, and obesity: 30+ kg m^?2) and weight change category until second screening (weight stable men defined as having a baseline BMI ± 0.1 kg m^?2 year^?1 at follow‐up re‐screening). Main outcome measures. Non‐cancer mortality calculated from national registers during 16 years of follow‐up after the second screening. Data from the first year of follow‐up were excluded to avoid bias by mortality caused by subclinical disease at re‐screening. Results. The relative risk (RR; 95% CI) for non‐cancer mortality during follow‐up was higher in men with decreasing BMI in all subgroups: RR 2.64 (1.46?4.71, baseline BMI <21 kg m^?2), 1.39 (0.98?1.95, baseline BMI 22?25 kg m^?2), and 1.71 (1.18?2.47, baseline BMI 26+ kg m^?2), using BMI‐stable men as reference group. Correspondingly, the non‐cancer mortality was also higher in men with increasing BMI, but only in the obese group (baseline BMI 26+ kg m^?2) with RR 1.86 (1.31?2.65). In a subanalysis, nonsmoking obese (30+ kg m^?2) men with decreased BMI had an increased non‐cancer mortality compared with BMI‐stable obese men (Fischer's test: P=0.001). The mortality risk for nonsmoking overweight men who increased their BMI compared with BMI‐stable men was also significant (P=0.006), but not in corresponding obese men (P=0.094). Conclusions. Weight loss in self‐reported healthy but overweight middle‐aged men, without serious disease, is associated with an increased non‐cancer mortality, which seems even more pronounced in obese, nonsmoking men, as compared with corresponding but weight‐stable men. The explanation for these observational findings is still enigmatic but could hypothetically be because of premature ageing effects causing so‐called weight loss of involution.     

Association between body mass index and anti–citrullinated protein antibody–positive and anti–citrullinated protein antibody–negative rheumatoid arthritis: Results from a population‐based case–control study

Objective

Being overweight or obese is associated with many chronic diseases, but previous studies of the association with rheumatoid arthritis (RA) have shown inconsistent results. The aim of this study was to investigate the association between body mass index (BMI) and the risk of developing the 2 main subtypes of RA.

Methods

At inclusion, cases and controls answered questions about their weight and height and donated blood samples. The presence of antibodies to citrullinated protein antigens (ACPAs) was analyzed among 2,748 cases and 3,444 controls (28% men). Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using conditional logistic regression.

Results

Compared to those with normal weight (BMI <25 kg/m²), the adjusted overall OR for developing ACPA‐negative RA was 1.1 (95% CI 0.9–1.3) for overweight individuals (BMI ≥25 to <30 kg/m²) and 1.4 (95% CI 1.1–1.9) for obese individuals (BMI ≥30 kg/m²). When stratified by sex, the OR for ACPA‐negative RA for obese women was 1.6 (95% CI 1.2–2.2), and there was no association between obesity and ACPA‐negative RA in men (OR 1.1, 95% CI 0.6–1.8). In obese men compared to men with normal weight, the OR for ACPA‐positive RA was 0.6 (95% CI 0.3–0.9), while there was no association between BMI and ACPA‐positive RA among women (OR 1.0, 95% CI 0.8–1.2).

Conclusion

Our findings show that obesity is associated with developing ACPA‐negative RA in women, and indicate an inverse association between BMI and ACPA‐positive RA in men.     

Effect of body mass index on mortality and clinical status in rheumatoid arthritis

Objective

To study the relative risk (RR) of all‐cause and cause‐specific mortality in rheumatoid arthritis (RA) associated with body mass index (BMI), and to quantify the clinical and outcome consequences of abnormal BMI.

Methods

We studied mortality in 24,535 patients over 12.3 years, dividing patients into 3 age groups, <50, 50–70, and >70 years and fit Cox regression models separately within each age stratum. We used BMI categories of <18.5 kg/m² (underweight), 18.5 to <25 kg/m² (normal weight, reference category), 25 to <30 kg/m² (overweight), and ≥30 kg/m² (obesity).

Results

BMI ≥30 kg/m² was seen in 63–68% and underweight in ～2%. Reduction in the RR (95% confidence interval [95% CI]) for all‐cause (AC) and cardiovascular mortality was seen for overweight (AC 0.8 [95% CI 0.8, 0.9]) and obese groups (AC 0.8 [95% CI 0.7, 0.8]), with and without comorbidity adjustment. Underweight was associated with increased mortality risk (AC 1.9 [95% CI 1.7, 2.3]). By contrast, obesity produced profound changes in clinical variables. Compared with normal weight, the odds ratio in the obese group was 4.8 for diabetes mellitus, 3.4 for hypertension, 1.3 for myocardial infarction, 1.4 for joint replacement, and 1.9 for work disability. Total semiannual direct medical costs were $1,683 greater, annual household income $6,481 less, pain scores 1.1 units higher, Health Assessment Questionnaire 0.28 higher, and EuroQol utility 0.7 units lower in the obese.

Conclusion

Overweight and obesity reduce the RR of all‐cause and cardiovascular mortality across different age groups and durations of RA. By contrast, overweight and obesity are associated with substantial increased risks of comorbidity, total joint replacement, greater pain, medical costs, and decreased quality of life.     

Third‐wave cognitive behaviour therapies for weight management: A systematic review and network meta‐analysis

This systematic review and network meta‐analysis synthesized evidence on the effects of third‐wave cognitive behaviour therapies (3wCBT) on body weight, and psychological and physical health outcomes in adults with overweight or obesity. Studies that included a 3wCBT for the purposes of weight management and measured weight or body mass index (BMI) pre‐intervention and ≥ 3 months post‐baseline were identified through database searches (MEDLINE, CINAHL, Embase, Cochrane database [CENTRAL], PsycINFO, AMED, ASSIA, and Web of Science). Thirty‐seven studies were eligible; 21 were randomized controlled trials (RCT) and included in the network meta‐analyses. Risk of bias was assessed using RoB2, and evidence quality was assessed using GRADE. Random‐effects pairwise meta‐analysis found moderate‐ to high‐quality evidence suggesting that 3wCBT had greater weight loss than standard behavioural treatment (SBT) at post‐intervention (standardized mean difference [SMD]: ?0.09, 95% confidence interval [CI]: ?0.22, 0.04; N = 19; I² = 32%), 12 months (SMD: ?0.17, 95% CI: ?0.36, 0.02; N = 5; I² = 33%), and 24 months (SMD: ?0.21, 95% CI: ?0.42, 0.00; N = 2; I² = 0%). Network meta‐analysis compared the relative effectiveness of different types of 3wCBT that were not tested in head‐to‐head trials up to 18 months. Acceptance and commitment therapy (ACT)‐based interventions had the most consistent evidence of effectiveness. Only ACT had RCT evidence of effectiveness beyond 18 months. Meta‐regression did not identify any specific intervention characteristics (dose, duration, delivery) that were associated with greater weight loss. Evidence supports the use of 3wCBT for weight management, specifically ACT. Larger trials with long‐term follow‐up are needed to identify who these interventions work for, their most effective components, and the most cost‐effective method of delivery.     

The effectiveness of sedentary behaviour interventions for reducing body mass index in children and adolescents: systematic review and meta‐analysis

Intervention studies have been undertaken to reduce sedentary behaviour (SB) and thereby potentially ameliorate unhealthy weight gain in children and adolescents. We synthesised evidence and quantified the effects of SB interventions (single or multiple components) on body mass index (BMI) or BMI z‐score in this population. Publications up to March 2015 were located through electronic searches. Inclusion criteria were interventions targeting SB in children that had a control group and objective measures of weight and height. Mean change in BMI or BMI z‐score from baseline to post‐intervention were quantified for intervention and control groups and meta‐analyzed using a random effects model. The pooled mean reduction in BMI and BMI z‐score was significant but very small (standardized mean difference = ?0.060, 95% confidence interval: ?0.098 to ?0.022). However, the pooled estimate was substantially greater for an overweight or obese population (standardized mean difference = ?0.255, 95% confidence interval: ?0.400 to ?0.109). Multicomponent interventions (SB and other behaviours) delivered to children from 5 to 12 years old in a non‐educational setting appear to favour BMI reduction. In summary, SB interventions are associated with very small improvement in BMI in mixed‐weight populations. However, SB interventions should be part of multicomponent interventions for treating obese children. © 2016 World Obesity     

Risk of hospitalization associated with body mass index and weight changes among prevalent haemodialysis patients

The impact of body mass index (BMI) and body weight on hospitalization rates in haemodialysis patients is unknown.This study hypothesizes that being either underweight or obese is associated with a higher hospitalization rate.Observational study of 6296 European haemodialysis patients with prospective data collection and follow-up every six months for three years (COSMOS study). The risk of being hospitalized was estimated by a time-dependent Cox regression model and the annual risk (incidence rate ratios, IRR) by Poisson regression. We considered weight loss, weight gain and stable weight. Weight change analyses were also performed after patient stratification according to their baseline BMI.A total of 3096 patients were hospitalized at least once with 9731 hospitalizations in total. The hospitalization incidence (fully adjusted IRR 1.28, 95% CI [1.18–1.39]) was higher among underweight patients (BMI <20 kg/m²) than patients of normal weight (BMI 20–25 kg/m²), while the incidence of overweight (0.88 [0.83–0.93]) and obese patients (≥30 kg/m², 0.85 [0.79–0.92]) was lower. Weight gain was associated with a reduced risk of hospitalization. Conversely, weight loss was associated with a higher hospitalization rate, particularly in underweight patients (IRR 2.85 [2.33–3.47]).Underweight haemodialysis patients were at increased risk of hospitalization, while overweight and obese patients were less likely to be hospitalized. Short-term weight loss in underweight individuals was associated with a strikingly high hospitalization rate.     

A retrospective study of maternal and neonatal outcomes in overweight and obese women with gestational diabetes mellitus

In pregnant women, obesity is a risk factor for multiple adverse pregnancy outcomes, including gestational diabetes mellitus (GDM), preeclampsia, and preterm birth. The aim of this study was to determine the effects of pre-pregnancy body mass index (BMI) on maternal and neonatal outcomes in women with GDM. A retrospective study of 5010 patients with GDM in 11 provinces in China was performed in 2011. Participants were divided into three groups based on BMI as follows: a normal weight group (BMI 18.5–23.9 kg/m²), an overweight group (BMI 24–27.9 kg/m²), and an obese group (BMI ≥28.0 kg/m²). Maternal baseline characteristics and pregnancy and neonatal outcomes were compared between the groups. Multiple logistic regression analysis was used to explore the relationships between BMI and the risk of adverse outcomes. Of the 5010 GDM patients, 2879 subjects were from north China and 2131 were from south China. Women in the normal weight group gained more weight during pregnancy compared with the overweight and obese GDM patients. Women in the overweight and obese groups had increased odds of hypertension during pregnancy (adjusted odds ratio (AOR)?=?1.50, 95 % confidence interval (CI)?=?1.31–1.76 and AOR?=?2.12, 95 % CI?=?1.84–3.16). The AORs for macrosomia in the overweight and obese groups were 1.46 (95 % CI?=?1.16–1.69) and 1.94 (95 % CI?=?1.31–2.98), respectively. The relative risk of delivering a baby with an Apgar score <7 at 5 min was significantly higher in women who were obese (AOR?=?2.11, 95 % CI?=?1.26–2.85) before pregnancy compared with normal weight women. Compared with the normal weight subjects, the incidence of cesarean section and emergency cesarean section among overweight and obese women with GDM was significantly higher (P?<?0.001). Overall, overweight and obese women with GDM have an increased risk of adverse outcomes, including hypertension during pregnancy, macrosomic infants, infants with low Apgar scores, and the need for an emergency cesarean section. More attention should be paid to GDM women who are obese because they are at risk for multiple adverse outcomes.     

Safety and efficacy of direct oral anticoagulants across body mass index groups in patients with venous thromboembolism: a retrospective cohort design

Current literature on the safety and efficacy of direct oral anticoagulants (DOACs) in patients of extreme weights are limited, however, they are still being prescribed in these populations. The objective of this study is to describe the safety and efficacy of DOAC therapy in patients of extreme weights for the treatment of venous thromboembolism (VTE) using body mass index (BMI) groups. A multi-site, retrospective cohort design at four hospitals was performed. Patients who experienced an initial VTE between November 2012 and August 2017 and placed on a DOAC were included. Patients were defined as: extremely obese (EO) if BMI?≥?40 kg/m², obese if BMI 30–39.9 kg/m², normal/overweight if BMI 18.5–29.9 kg/m², and underweight if BMI?<?18.5 kg/m². The primary efficacy outcome of recurrent VTE and primary safety outcome of major bleeding (MB) within 12 months were compared between weights. Univariate statistical tests and multivariate logistic regression analyses were performed. Rates of recurrent VTE showed no significant differences (p?=?0.58) across groups; 7.8% (11/142) EO, 4.7% (18/383) obese, 5.2% (27/517) normal/overweight, and 5.9% (1/17) underweight. Proportions of MB were overall significantly different (p?=?0.026); 6.3% (9/142) EO, 10.4% (40/383) obese, 10.1% (52/517) normal/overweight, and 29.4% (5/17) underweight. EO and obese patients had similar odds of MB compared to normal/overweight (OR 0.61, 95% CI [0.29, 1.26] and OR 1.04, 95% CI [0.67, 1.61]). Underweight patients showed larger odds of MB compared to normal/overweight (OR 3.73, 95% CI [1.26, 11.0]). This study found that recurrence of VTE was not associated with BMI. However, the proportions of major bleeding were statistically different among the BMI categories.

     

Systematic review and meta‐analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors

A systematic review and meta‐analysis were carried out to study the effects of low‐carbohydrate diet (LCD) on weight loss and cardiovascular risk factors (search performed on PubMed, Cochrane Central Register of Controlled Trials and Scopus databases). A total of 23 reports, corresponding to 17 clinical investigations, were identified as meeting the pre‐specified criteria. Meta‐analysis carried out on data obtained in 1,141 obese patients, showed the LCD to be associated with significant decreases in body weight (?7.04 kg [95% CI ?7.20/?6.88]), body mass index (?2.09 kg m^?2[95% CI ?2.15/?2.04]), abdominal circumference (?5.74 cm [95% CI ?6.07/?5.41]), systolic blood pressure (?4.81 mm Hg [95% CI ?5.33/?4.29]), diastolic blood pressure (?3.10 mm Hg [95% CI ?3.45/?2.74]), plasma triglycerides (?29.71 mg dL^?1[95% CI ?31.99/?27.44]), fasting plasma glucose (?1.05 mg dL^?1[95% CI ?1.67/?0.44]), glycated haemoglobin (?0.21% [95% CI ?0.24/?0.18]), plasma insulin (?2.24 micro IU mL^?1[95% CI ?2.65/?1.82]) and plasma C‐reactive protein, as well as an increase in high‐density lipoprotein cholesterol (1.73 mg dL^?1[95%CI 1.44/2.01]). Low‐density lipoprotein cholesterol and creatinine did not change significantly, whereas limited data exist concerning plasma uric acid. LCD was shown to have favourable effects on body weight and major cardiovascular risk factors; however the effects on long‐term health are unknown.     

Proof-of-concept trial on the efficacy of sodium tungstate in human obesity

Aim: Considering the poor long‐term success of current dietary and pharmacological interventions, we aimed to evaluate the potential effect of sodium tungstate in the treatment of grade I and II obesity ( ClinicalTrials.gov identifier: NCT00555074). Methods: Prospective, randomized, placebo‐controlled, double‐blind, proof‐of‐concept study was carried out. Following a 2‐week lead‐in period, 30 obese (body mass index, BMI 30.0–39.9 kg/m²), non‐diabetic subjects were randomized to receive either sodium tungstate (100 mg bid) or placebo for 6 weeks. The primary study endpoint was the absolute change in body weight relative to the time of randomization. Results: Treatment with sodium tungstate [?0.135 ± 0.268 kg (95% CI ?0.686 to +0.416 kg)] was not associated with a significant weight loss compared to placebo [?0.063 ± 0.277 kg (95% CI ?0.632 to +0.507 kg)] (p = 0.854). Likewise, treatment with sodium tungstate was not associated with significant changes in fat mass (DEXA), resting energy expenditure (indirect calorimetry) or caloric consumption (3‐day food records). Conclusion: Our data do not support sodium tungstate as a pharmacological agent in the treatment of human obesity.     

Association between physical exercise,body mass index,and risk of fibromyalgia: Longitudinal data from the Norwegian Nord‐Trøndelag Health Study

Objective

To examine the association between leisure time physical exercise, body mass index (BMI), and risk of fibromyalgia (FM).

Methods

A longitudinal study with baseline assessment of physical exercise (frequency, duration, and intensity) and BMI was used to explore the risk of having FM at 11‐year followup in a large, unselected female population (n = 15,990) without FM or physical impairments at baseline.

Results

At followup, 380 cases of incident FM were reported. A weak dose‐response association was found between level of physical exercise and risk of FM (for trend, P = 0.13) where women who reported the highest exercise level had a relative risk (RR) of 0.77 (95% confidence interval [95% CI] 0.55–1.07). BMI was an independent risk factor for FM (for trend, P < 0.001), and overweight or obese women (BMI ≥25.0 kg/m²) had a 60–70% higher risk compared with women with normal weight (BMI 18.5–24.9 kg/m²). Overweight or obese women who exercised ≥1 hour per week had an RR of 1.72 (95% CI 1.07–2.76) compared with normal‐weight women with a similar activity level, whereas the risk was >2‐fold higher for overweight or obese women who were either inactive (RR 2.09, 95% CI 1.36–3.21) or exercised <1 hour per week (RR 2.19, 95% CI 1.39–3.46).

Conclusion

Being overweight or obese was associated with an increased risk of FM, especially among women who also reported low levels of physical exercise. Community‐based measures aimed at reducing the incidence of FM should emphasize the importance of regular exercise and the maintenance of normal body weight.     

Resveratrol supplementation significantly influences obesity measures: a systematic review and dose–response meta‐analysis of randomized controlled trials

This study aimed to summarize earlier randomized controlled trials on the effects of resveratrol supplementation on body weight (BW), body mass index (BMI), waist circumference (WC) and fat mass (FM). We searched PubMed, SCOPUS, Cochrane Library and Google Scholar from inception to April 2018 using relevant keywords. All clinical trials investigating the effects of resveratrol supplementation on BW, BMI, WC and FM in adults were included. Overall, 28 trials were included. Pooled effect sizes suggested a significant effect of resveratrol administration on weight (weighted mean differences [WMD]: ?0.51 kg, 95% confidence interval [CI]: ?0.94 to ?0.09; I² = 50.3%, P = 0.02), BMI (WMD: ?0.17 kg m^?2, 95% CI: ?0.32, ?0.03; I² = 49.6%, P = 0.02) and WC (WMD: ?0.79 cm, 95% CI: ?1.39, ?0.2; I² = 13.4%, P = 0.009), respectively. However, no significant effect of resveratrol supplementation on FM was found (WMD: ?0.36%, 95% CI: ?0.88, 0.15; I² = 0.0%, P = 0.16). Findings from subgroup analysis revealed a significant reduction in BW and BMI in trials using resveratrol at the dosage of <500 mg d^?1, those with long‐term interventions (≥3 month), and performed on people with obesity. Taken together, the data suggest that resveratrol supplementation has beneficial effects to reduce BW, BMI and WC, but not FM.     

Effect of orlistat on glycaemic control in overweight and obese patients with type 2 diabetes mellitus: a systematic review and meta‐analysis of randomized controlled trials

Orlistat is an effective adjunctive treatment to lifestyle modifications in the treatment of obesity. While the majority of current evidence is on the effect of orlistat in obese patients without diabetes, some studies suggest that patients who are obese and have diabetes mellitus lose more weight and have greater improvements in diabetic outcomes when treated with orlistat plus a lifestyle intervention than when treated by lifestyle interventions alone. The aim of this study was to review the evidence of the effects of orlistat on glycaemic control in overweight and obese patients with type 2 diabetes. A systematic review of randomized controlled trials of orlistat in people with type 2 diabetes reporting diabetes outcomes in studies published between January 1990 and September 2013 was conducted. We searched for articles published in English in MEDLINE and EMBASE. Inclusion criteria included all randomized controlled trials of orlistat carried out on adult participants with a body mass index of 25 kg m^?2 or over diagnosed with type 2 diabetes, which reported weight change and at least one diabetic outcome. A total of 765 articles were identified out of which 12 fulfilled the inclusion criteria. The overall mean weight reduction (3, 6 and 12 months) in the orlistat group was ?4.25 kg (95% CI: ?4.5 to ?3.9 kg). The mean weight difference between treatment and control groups was ?2.10 kg (95% CI: ?2.3 to ?1.8 kg, P < 0.001), the mean HbA1c difference was ?6.12 mmol mol^?1 (95% CI: ?10.3 to ?1.9 mmol mol^?1, P < 0.004) and the mean fasting blood glucose difference was ?1.16 mmol L^?1 (95% CI: ?1.4 to ?0.8 mmol L^?1, P < 0.001). Treatment with orlistat plus lifestyle intervention resulted in significantly greater weight loss and improved glycaemic control in overweight and obese patients with type 2 diabetes compared with lifestyle intervention alone.     

Associations between weight change over 8 years and baseline body mass index in a cohort of continuing and quitting smokers

Aim To examine the association between weight change and baseline body mass index (BMI) over 8 years in a cohort of continuing and quitting smokers. Design Prospective cohort. Setting Oxfordshire general practices nicotine patch/placebo trial with 8‐year follow‐up. Participants Eighty‐five participants were biochemically proven abstinent at 3, 6, 12 months and 8 years (abstainers). A total of 613 smoked throughout the 8 years (smokers), 26 quit for a whole year but were smoking again by 8 years (relapsed); 116 smoked for the first year but were abstinent at 8 years (late abstainers). Measurements Weight and BMI was measured at baseline and at 8 years. Regression models were used to examine weight gain by smoking status and the association of BMI at the time of quitting. Findings Abstainers gained 8.79 kg [standard deviation (SD) 6.36; 95% confidence interval (CI) 7.42, 10.17]. Smokers gained 2.24 kg (SD 6.65; 95% CI 1.7, 2.77). Relapsed smokers gained 3.28 kg (SD 7.16; 95% CI 0.328, 6.24). Late abstainers gained 8.33 kg (SD 8.04; 95% CI 6.85, 9.81). The association between baseline BMI and weight change was modified by smoking status. In smokers there was a negative linear association of BMI, while in abstainers a J‐shaped curve fitted best. These models estimated weight change over 8 years in abstainers of +9.8 kg, +7.8 kg, +10.2 kg, +19.4 kg and in smokers of +3.9 kg, +2.6 kg, 1.0 kg and ?0.8 kg, where BMI was 18, 23, 29 and 36, respectively. Conclusion Obese smokers gain most weight on quitting smoking, while obese continuing smokers are likely to remain stable or lose weight. Obese quitters have the greatest need for interventions to ameliorate weight gain.     

Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis

Diet and exercise are two of the commonest strategies to reduce weight. Whether a diet‐plus‐exercise intervention is more effective for weight loss than a diet‐only intervention in the long‐term has not been conclusively established. The objective of this study was to systemically review the effect of diet‐plus‐exercise interventions vs. diet‐only interventions on both long‐term and short‐term weight loss. Studies were retrieved by searching MEDLINE and Cochrane Library (1966 – June 2008). Studies were included if they were randomized controlled trials comparing the effect of diet‐plus‐exercise interventions vs. diet‐only interventions on weight loss for a minimum of 6 months among obese or overweight adults. Eighteen studies met our inclusion criteria. Data were independently extracted by two investigators using a standardized protocol. We found that the overall standardized mean differences between diet‐plus‐exercise interventions and diet‐only interventions at the end of follow‐up were ?0.25 (95% confidence interval [CI]?0.36 to ?0.14), with a P‐value for heterogeneity of 0.4. Because there were two outcome measurements, weight (kg) and body mass index (kg m^?2), we also stratified the results by weight and body mass index outcome. The pooled weight loss was 1.14 kg (95% CI 0.21 to 2.07) or 0.50 kg m^?2 (95% CI 0.21 to 0.79) greater for the diet‐plus‐exercise group than the diet‐only group. We did not detect significant heterogeneity in either stratum. Even in studies lasting 2 years or longer, diet‐plus‐exercise interventions provided significantly greater weight loss than diet‐only interventions. In summary, a combined diet‐plus‐exercise programme provided greater long‐term weight loss than a diet‐only programme. However, both diet‐only and diet‐plus‐exercise programmes are associated with partial weight regain, and future studies should explore better strategies to limit weight regain and achieve greater long‐term weight loss.     

Assessing obesity and overweight in a high mountain Pakistani population

OBJECTIVES: To estimate the prevalence of obesity and overweight among adults in a high mountain rural population of Pakistan, and to determine the correlates of excess body weight. Design Cross-sectional study. METHODS: A random sample of 4203 adults (aged 18 years and over) was selected by stratified random sampling from 16 villages in north Pakistan. Trained medical students measured height, weight and blood pressure. Trained interviewers obtained information from participants on sociodemographic variables, use of snuff, daily cigarette consumption, hypertension and family history of hypertension. Body mass index (BMI) calculated as kg/m(2) was used to define overweight (BMI > or = 25 kg/m(2)) and obesity (BMI > or = 30 kg/m(2)). RESULTS: Using weight and height data available for 1391 men and 2754 women, mean BMI was 22.4 (95% CI 21.9, 22.9) for men and 22.6 (95% CI 21.9, 23.2) for women. The age-adjusted prevalence of BMI > or = 25 (overweight/obesity) was 13.5% for men and 14.1% for women. Overweight/obesity increased with age and the increase per year was identical for both men and women [adjusted odds ratio (AOR) = 1.01, 95% CI 1.01, 1.03]. Overweight/obese men and women were more likely to be hypertensive (men, AOR = 3.32, 95% CI 2.16, 5.09; women, AOR = 1.70, 95% CI 1.21, 2.39). Overweight/obese women were more likely to work in business or as skilled workers (AOR = 6.24, 95% CI 1.18, 32.83) while overweight/obese men were more likely to work as government employees (AOR = 2.59, 95% CI 1.66, 4.03). Family history of hypertension was a significant correlate of overweight/obesity in men (P value 0.004) and women (P value 0.000). Overweight/obese men and women were less likely to use smokeless tobacco (men, AOR = 0.65, 95% CI 0.43, 0.97; women, AOR = 0.54, 95% CI 0.35, 0.85). CONCLUSION: The prevalence of risk factors for non-communicable diseases (NCDs) in Pakistan is expected to increase as further epidemiologic, nutritional and demographic changes occur. The assessment of excess body weight, and patterns and determinants of other risk factors for NCDs is important to provide useful guidelines in the planning of interventions to counter a growing problem.     

Body Mass Index,Weight Loss,and Cause‐Specific Mortality in Rheumatoid Arthritis

Objective

To examine associations of body mass index (BMI) and weight loss with cause‐specific mortality in rheumatoid arthritis (RA).

Methods

A cohort of US veterans with RA was followed until death or through 2013. BMI was categorized as underweight, normal, overweight, and obese. Weight loss was calculated as the 1) annualized rate of change over the preceding 13 months, and 2) cumulative percent. Vital status and cause of death were obtained from the National Death Index. Multivariable competing‐risks regression models were utilized to assess the time‐varying associations of BMI and weight loss with cause‐specific mortality.

Results

Among 1,600 participants and 5,789 patient‐years of followup, 303 deaths occurred (95 cardiovascular, 74 cancer, and 46 respiratory). The highest weight‐loss rate and weight‐loss percent were associated with a higher risk of cardiovascular mortality (rate: subdistribution hazard ratio [sHR] 2.27 [95% confidence interval (95% CI) 1.61–3.19]; percent: sHR 2.31 [95% CI 1.06–5.01]) and cancer mortality (rate: sHR 2.36 [95% CI 1.11–5.01]; percent: sHR 1.90 [95% CI 1.00–3.62]). Overweight BMI was protective of cardiovascular mortality (sHR 0.59 [95% CI 0.38–0.91]), while underweight BMI was associated with a near 3‐fold increased risk of respiratory mortality (sHR 2.93 [95% CI 1.28–6.67]). Incorporation of time‐varying BMI and weight loss in the same models did not substantially alter individual associations for cardiovascular and cancer mortality, but an association between weight‐loss percentage and respiratory mortality was attenuated after BMI adjustment.

Conclusion

Both BMI and weight loss are predictors of cause‐specific mortality in RA. Weight loss is a strong predictor of cardiovascular and cancer mortality, while underweight BMI is a stronger predictor of respiratory mortality.