针灸结合行为疗法治疗老年单纯性肥胖病的临床研究

目的观察以针灸结合行为疗法对老年单纯性肥胖者肥胖相关指标、心血管危险因素、生活质量的影响，探讨行为疗法在老年肥胖者针灸减肥中的作用。方法将205例军队老年肥胖者随机分为单纯针灸组（A组）、单纯行为疗法组（B组）和针灸结合行为治疗组（C组）。治疗前后测定三组体重、腰臀围比、体成分等肥胖指标，测定血胰岛素、血脂、血糖等心血管危险因素指标，采用生存质量评定量表简表（WHOQOL—BREF）中文版对肥胖患者生活质量进行评定。结果三组患者减重后的腰围、臀围、腰臀围比、体脂含量及百分比等指标以及生活质量评分较减重前有明显改善，血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、胰岛素等较减重前亦明显下降，治疗前后均有显著性差异（P〈0．05），且针灸结合行为治疗组显著优于单纯针灸组和单纯行为疗法组（P〈0．05）。结论针灸结合行为疗法的综合减肥方案能更有效地改善老年肥胖者的肥胖指标、心血管危险因素和生活质量。两者合用具有协同作用。     

4周有氧运动对肥胖儿童青少年身体形态、血脂和血胰岛素的影响

目的:观察4周有氧运动对肥胖儿童青少年身体形态、血脂和血胰岛素的影响,探讨运动减肥对肥胖儿童青少年健康的促进作用。方法:以2007～2009年参加上海巅峰运动减肥夏令营的126名(男64名,女62名)8~17岁,体脂率>30%的肥胖儿童青少年为研究对象,入营时测试身高、体重、体脂率、BMI、脂肪体重、腰围、臀围、大腿围、空腹血胰岛素(FIN)、空腹血脂(TC、TG、HDL-C、LDL-C)、空腹血糖(FBG),经运动负荷试验和体格检查,排除心血管机能障碍等危险因素后确定个体运动减肥方案。以心率为运动强度监控指标,目标心率=安静心率+心率储备×(20%～40%)。选择强度容易控制、能持续长时间的运动方式,如游泳、快走、慢跑、健美操、羽毛球、篮球等。运动过程中遥测心率实时监控运动强度。根据研究对象的年龄、体重和基础代谢率计算其每天热能生理需要量,由专业营养师配餐。4周后测定相同指标并与入营时比较。结果:4周后,肥胖儿童青少年体重、体脂率、BMI、脂肪体重、腰围、臀围、大腿围、腰围身高比、臀围身高比和大腿围身高比与入营时比较均显著下降(P<0.01),体脂率下降明显大于体重和BMI。入营时,肥胖儿童青少年普遍存在血脂异常,空腹血胰岛素明显升高。4周运动减肥后,肥胖儿童青少年空腹血胰岛素、血脂和血糖水平与入营时相比均有明显改善。结论:肥胖儿童青少年已经存在脂类代谢紊乱倾向和胰岛素抵抗倾向。4周有氧运动结合适量饮食控制可以有效改善肥胖儿童青少年的身体形态,改善脂代谢紊乱和胰岛素抵抗,预防代谢综合征。与体重、BMI相比,体脂率是评价肥胖程度和减肥效果的首选指标。     

正常人血清脂联素水平分析

目的　探讨正常人血清脂联素水平及其与体重指数、血压、血脂代谢及胰岛素抵抗指数间的相关 性。方法　收集北京地区87例健康体检者的血清标本,采用放射免疫法测定血清脂联素水平。结果　正常 人血清空腹脂联素水平为(8.34±4.72)μg/ml,女性显著高于男性。血清空腹脂联素水平与体重、体重指数、 腰围、臀围、腰臀比、收缩压、低密度脂蛋白 胆固醇、空腹胰岛素水平以及稳态模型评估的胰岛素抵抗指数呈 负相关,与高密度脂蛋白 胆固醇呈显著正相关,与年龄无关。其中腰臀比和空腹胰岛素水平是影响血清脂联 素水平最显著的因素。结论　脂联素在正常人血循环中丰富存在,与肥胖程度、血脂水平及胰岛素抵抗指数 间存在相关性。     

减体重对女子举重运动员运动能力的影响及营养干预的效果

目的探讨在运动训练中的慢速减体重、赛前快速降体重和赛前体能恢复期间实施营养学干预对运动员减重后运动能力的影响.方法12名女子举重运动员随机分成实验组和对照组,每组6人.实验组和对照组运动员进行统一的运动训练并采用等同能量的饮食.实验组减重期间服用减重棒、维生素和电解质等运动营养食品,在减重后的恢复期服用快速能量补充制剂和维生素电解质强化运动营养补充;对照组服用相应的安慰剂.分别在减重前后对两组对象进行有氧能力和无氧能力测试.运动员在减重实验前与实验期间填写饥饿度自评表.结果实验组运动员体重从实验前的67.4±14.2 kg下降到快速减重后的64.6±14.1 kg,对照组从67.4±15.5 kg下降到64.3±15.4 kg.实验组在快速减重后的恢复阶段,6分钟乳酸稳态实验后即刻血乳酸浓度、心率以及主观疲劳评分显著低于对照组.两组在慢减期后、快减期后和恢复阶段,30秒Wingate测试单位体重的最大功率、平均功率和最小功率均无显著性差异,但实验组在快速恢复第1天和第3天单位体重的最大功率显著高于实验前.结论科学地减少饮食热量摄入能够按照既定的目标减轻体重;快速能量补充制剂和维生素、电解质的复合补充制剂能够明显促进运动员减体重后身体快速恢复,保持无氧能力和有氧能力;以魔芋为主要成分的减重棒能明显减轻减体重期间的饥饿感.     

86例高血压患者血胰岛素水平与血脂、血糖的关系分析

目的:研究高血压病患者血胰岛素、血糖和血脂水平的变化以及相关的影响因素。方法:对86例原发性高血压患者进行口服葡萄糖耐量试验(OGTT)和胰岛素释放试验(IRT),同时测定血中胰岛素、血糖和血胆固醇、甘油三酯的水平。结果:高血压患者血胰岛素、血糖、血胆固醇及甘油三酯水平升高。结论:高血压患者存在胰岛素抵抗(ISR),而且与血压、年龄和体重指数密切相关。     

运动员减体重期对维生素代谢的改变及其补充

对34名摔跤运动员减体重期维生素代谢的研究表明,运动员减体重期摄入的VA、VB1、VB2、PP、Vc都明显低于运动员供给量标准。血中VA浓度减重前后基本一致,暗适应时间稍延长,24h尿中VB1、VB2、Vc排出量减体重后明显低于减体重前。尿中PP排出量减体重前后基本一样,任意克肌酐尿中VB1、VB2、PP、Vc排出量与24h尿中这几种维生素排出量结果基本一致,进一步说明了结果的可靠性。服用减重营养饼干后,血中VA含量减体重后高于减前,适应时间减体重前后基本一致,但短于普通饼干组。尿中VB1、VB2、PP、Vc排出量减体重后高于减重前,且均高于吃普通饼干对照组。说明减体重营养饼干补充了运动员减体重造成的各种维生素的不足和丢失,满足了运动员减体重对维生素的需要。     

罗格列酮治疗多囊卵巢综合征胰岛素抵抗临床研究

目的研究罗格列酮对多囊卵巢综合征（PCOS）患者高胰岛素血症的疗效,观察患者治疗前后生殖激素的变化以及有排卵月经的恢复情况。方法选择诊断为多囊卵巢综合征及空腹血胰岛素≥15.6uIU/ml的患者30例,每天早餐前口服罗格列酮4mg,共12周,比较治疗前后体重指数、腰臀围比、胰岛素水平、血糖、胰岛素抵抗指数、生殖激素水平和排卵率的变化。结果治疗12周后,基础胰岛素、空腹血糖、餐后2小时血糖、胰岛素抵抗指数、睾酮、黄体生成素、黄体生成素/卵泡刺激素比值显著降低,性激素结合球蛋白显著增高。结论罗格列酮可增强胰岛素敏感性,纠正糖代谢异常和高雄激素血症等内分泌紊乱,促进有排卵月经的恢复。     

营养干预和远程随访减肥效果观察

 目的 观察营养替餐干预和远程随访对肥胖者减重的效果。方法 选取我院体检中心体检的肥胖者150人, 应用替餐营养棒进行体重管理, 通过电话、互联网对其进行长达1年的健康生活方式教育及营养指导, 收集其替餐前、替餐后30、90、180、360 d体重、腰围、臀围等数据并进行比较。结果 经营养干预和远程随访, 肥胖者平均减重(7.09±6.57) kg, 且多在干预后90 d达到目标体重, 其中8人提前终止干预, 5人失访, 12人出现体重反弹。结论 营养干预和远程随访可有效地帮助肥胖者改变不健康行为, 减轻体重。     

有氧运动对不同肥胖亚型儿童心血管危险因素的干预效果

目的：分析代谢正常型肥胖（MHO）和代谢异常型肥胖（MUO）儿童心血管危险因素的差异,观察有氧运动对不同肥胖亚型儿童心血管危险因素的影响。方法：选取全封闭减肥夏令营肥胖儿童75名,平均年龄12.79±1.74岁,平均体重73.32±17.94 kg。实验前测试受试者的身体形态学指标、安静血压、安静心率、空腹血糖、胰岛素及血脂四项的基础值,分为MHO组（n=43）和MUO组（n=32）。对两组受试者进行为期4周的有氧运动干预,以心率作为运动强度的监控指标,目标心率为安静心率加储备心率的20%～40%,运动方式选择游泳、慢跑、快走等。干预结束后再测试上述指标,比较干预前后组间的差异和组内指标的变化。结果：（1）干预前,MUO组儿童的身体质量指数（BMI）、腰围（WC）、收缩压（SBP）、舒张压（DBP）、甘油三酯（TG）、动脉粥样硬化指数（AI）、非高密度脂蛋白胆固醇（nonHDL-C）高于MHO组（P<0.01）,腰围身高比（WHtR）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）高于MHO组（P<0.05）;胰...     

运动员减体重期维生素代谢的改变及其补充

对３４名摔跤运动员减体重期维生素代谢的研究表明,运动员减体重期摄入的ＶＡ、ＶＢ１、ＶＢ２、ＰＰ、ＶＣ都明显低于运动员供给量标准。血中ＶＡ浓度减重前后基本一致,暗适应时间稍延长,２４ｈ尿中ＶＢ１;、ＶＢ２、ＶＣ排出量减体重后明显低于减体重前。尿中ＰＰ排出量减体重前后基本一样,任意克肌酐尿中ＶＢ１、ＶＢ２、ＰＰ、ＶＣ排出量与２４ｈ尿中这几种维生素排出量结果基本一致,进一步说明了结果的可靠性。服用减重营养饼干后,血中ＶＡ含量减体重后高于减前,适应时间减体重前后基本一致,但短于普通饼干组。尿中ＶＢ１、ＶＢ２、ＰＰ、ＶＣ排出量减体重后高于减重前,且均高于吃普通饼干对照组。说明减体重营养饼干补充了运动员减体重造成的各种维生素的不足和丢失,满足了运动员减体重对维生素的需要。     

Plasma levels of insulin and leptin in patients with morbid obesity and anorexia nervosa after weight loss or gain, respectively

The present study was conducted in order to analyze the relationship existing between leptin and insulin levels in massive weight loss and weight recovery. Thirteen patients with severe obesity, 14 patients with anorexia nervosa and 13 healthy control subjects were studied. The patients with severe obesity underwent a vertical banded gastroplasty followed by an 800 kcal/day diet for 12 weeks. They were evaluated prior to (body mass index [BMI] 51.2 +/- 8.8 Kg/m2) and after drastic weight loss (BMI 40.6 +/- 6.7 Kg/m2). Patients with anorexia nervosa were treated exclusively with nutritional therapy during 12 weeks, and they were evaluated at their lowest weight status (BMI 16.2 +/- 2.2 Kg/m2) and after weight recovery (BMI 17.9 +/- 2.3 Kg/m2). The BMI of the normal subjects was in the normal range of 20 to 27 Kg/m2 (average 22.8 +/- 2.6 Kg/m2). BMI, percentage of body fat, waist circumference, and serum levels of leptin, insulin, and C-peptide were determined in each patient and normal subject. In severely obese patients, serum leptin and insulin decreased significantly after drastic weight reduction (leptin: from 51.8 +/- 22.3 to 23.7 +/- 10.2 ng/ml; insulin: from 27.1 +/- 13.3 to 17.2 +/- 7.2 mU/ml). In patients with anorexia nervosa, the mean serum leptin levels were significantly higher after weight recovery (5.5 +/- 3.2 vs 7.6 +/- 6 ng/ml). Serum leptin in the severe obesity group correlated positively with BMI, percentage body fat and waist circumference before and after weight loss. In those patients suffering from anorexia nervosa, serum leptin correlated positively with the BMI, percentage of body fat, and waist circumference in the low weight state and after weight recovery. In addition, their serum insulin correlated with BMI and waist circumference after weight recovery. These data reveal that serum leptin concentration correlates significantly with the BMI and body fat content 1) in subjects with a range of weight and caloric intake, 2) in obese patients after drastic weight loss; 3) in anorexic patients after weight gain; and that hyper- or normoinsulinemia do not seem to have any influence on the leptin changes caused by weight loss or gain.     

4周有氧运动对不同肥胖程度、肥胖类型儿童少年血清胰岛素水平的影响

目的:探讨4周有氧运动对不同肥胖程度、肥胖类型儿童少年血清胰岛素水平的影响。方法:以参加2011年上海巅峰运动减肥夏令营的82名肥胖儿童少年为研究对象,进行4周有氧运动为主结合适当饮食控制的减肥运动训练,实验前后测定身高、体重、体脂率、腰围等身体形态指标及空腹血清胰岛素水平。分别依据体脂率、腰围身高比,对受试对象进行肥胖程度及肥胖类型分组。结果:实验前,肥胖儿童少年血清胰岛素水平由高到低依次为:极重度肥胖组>重度肥胖组>中度肥胖组>轻度肥胖组>超重组,腹型肥胖组胰岛素水平显著高于周围型肥胖组(P<0.01)。实验后,受试对象腰围身高比、体脂率、胰岛素均显著下降(P<0.01),胰岛素下降幅度由高到底依次为:极重度肥胖组>重度肥胖组>中度肥胖组>轻度肥胖组>超重组。腹型肥胖组各指标下降幅度均大于周围型肥胖组(P<0.01)。结论:儿童少年血清胰岛素水平随肥胖程度加重而升高,腹型肥胖者胰岛素水平较周围型显著升高,有氧运动减肥是降低肥胖儿童少年尤其腹型肥胖者肥胖程度和血清胰岛素水平的有效途径。     

PC-1 genotype and IRS response to exercise training

The purpose of this study was to investigate whether the efficacy of exercise training as a means of insulin resistance syndrome (IRS) treatment is dependent on the PC-1 gene K121Q variants. A population of 84 abdominally obese Korean women was analyzed prospectively. Before and after a 12-week exercise (walking) training program, indices of body fatness including body mass index, percent body fat, and waist circumference, and cardiorespiratory fitness were measured. Total cholesterol (TC), triacylglycerol, high-density lipoprotein cholesterol (HDLC), glucose, and insulin were measured in fasting venous blood. At baseline, KK individuals had significantly lower waist circumference (p = 0.019) and TC (p = 0.001) than KQ/QQ individuals did. In particular, compared with KQ/QQ individuals, KK individuals had significantly greater reductions in body weight (p = 0.002), BMI (p = 0.032), and fasting insulin (p = 0.042), and a greater increase in HDLC (p = <0.001), following the 12-week walking exercise program. This study suggests that the PC-1 gene K121Q polymorphism may modulate responses of IRS to exercise training, at least in this population.     

Exercise-induced weight loss preferentially reduces abdominal fat

PURPOSE: To investigate whether abdominal fat is reduced in response to substantial weight loss induced by exercise in young obese men. METHODS: Thirty obese men (mean age 19.8 +/- 0.6 yr) were evaluated before (pretraining) and after (posttraining) 4 months of regimented training in the Singapore Armed Forces. There were 30 obese male subjects (mean age 19.2 +/- 1.3 yr) without training who were monitored as control subjects. Fat free mass (FFM), fat mass, and percent body fat were determined from skinfold measurements. Differences between pre- and posttraining responses were analyzed with a paired -test. RESULTS: Subjects lost 12.0 +/- 3.6 kg (P < 0.001) from pre- to posttraining, which was attributable to a reduction in fat mass (P < 0.001), as FFM was unchanged. Both waist circumference (WC) and hip circumference (HC) decreased (P < 0.01), the reduction in WC (13.7%) being greater than the reduction in HC (7.7%) as reflected by the decrease in waist-to-hip ratio (WHR; P < 0.001). These data reveal that large exercise-induced weight losses are associated with maintenance of FFM. The significant reduction in WHR indicates a greater mobilization of abdominal fat and a preferential loss of fat from this region. CONCLUSIONS: Large exercise-induced weight loss is associated with a preferential reduction in abdominal fat and a corresponding maintenance of FFM. Such an effect on body composition should reduce disease risk and the eventual weight regain that typically follows diet-induced weight losses with obese subjects.     

Pedometer-determined walking and body composition variables in African-American women

PURPOSE: This study evaluated the relationship between pedometer-determined physical activity and body composition variables in middle-aged, African-American women. METHODS: Height, weight, waist circumference, hip circumference, and percent body fat were measured in 69 African-American females (mean age 51.4 +/- 5.4 yr). Subjects wore a pedometer for seven consecutive days, and average steps per day (i.e, walking volume) were compared with each anthropometric variable. Caloric intake was assessed by a 3-d diet record. The subjects were categorized into three different groups based on their physical activity level: <5000, 5000-7499, and > or =7500 steps per day. A one-way analysis of variance (ANOVA) was performed to examine the body composition variables among the three groups. Partial correlation coefficients controlling for age and caloric intake were calculated for walking volume and body composition variables (BMI, percent body fat, waist and hip circumferences, and WHR). Significance was set at P < 0.05 for all tests. RESULTS: There were significant differences between the least active and most active group for age (P = 0.013), BMI (P = 0.005), percent body fat (P < 0.001), waist circumference (P = 0.004), and hip circumference (P = 0.043). When a partial correlation controlling for age and caloric intake was used to compare steps per day with body composition variables, significant negative correlations still existed for each variable except WHR. These correlations were significant for BMI (P < 0.001), percent body fat (P < 0.001), waist circumference (P = 0.002), and hip circumference (P = 0.017). CONCLUSIONS: Middle-aged, African-American women who accumulate more ambulatory activity have significantly lower body fat percentages, BMI values, waist circumferences, and hip circumferences.     

不同类型肥胖儿童代谢紊乱的特点

目的探讨不同类型肥胖儿童代谢紊乱的特点。方法纳入2006年7月-2009年3月重庆医科大学附属儿童医院门诊确诊的单纯性肥胖儿童145例,同期80例体检正常儿童作为对照组。测量所有儿童的身高、体重、腰围、臀围、血压、体重指数(BMI),并检测血脂、血糖、胰岛素水平,计算胰岛素抵抗指数(HOMA-IR)。根据BMI和腰围再将肥胖儿童分为腹型肥胖组及非腹型肥胖组,比较各组间血压、血脂、血糖、胰岛素水平的差异。结果145例肥胖儿童中,腹型肥胖组127例(87.6%),非腹型肥胖组18例(12.4%)。腹型肥胖组空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)和血压均高于非腹型肥胖组和对照组(P<0.05);非腹型肥胖组FPG、TC、LDL、高密度脂蛋白(HDL)、血压与对照组比较差异无统计学意义(P>0.05),但TG高于正常儿童(P<0.05)。腹型肥胖组检出胰岛素抵抗77例,空腹血糖受损14例,糖耐量受损7例,高TG血症24例,高TC血症13例,高LDL血症10例,血压升高者15例。非腹型肥胖组中仅检出胰岛素抵抗2例。结论儿童肥胖以腹型肥胖为主,腹型肥胖儿童比非腹型肥胖儿童更易出现代...     

4周运动减肥对肥胖青少年血浆致动脉粥样硬化指数和脂酰辅酶A胆固醇酰基转移酶2的影响

目的:观察运动减肥对肥胖青少年血浆致动脉粥样硬化指数和脂酰辅酶A胆固醇酰基转移酶等动脉粥样硬化致病相关因子的影响。方法:以参加2011年上海巅峰运动减肥夏令营的30名肥胖青少年为对象,进行4周中小强度有氧运动为主结合适当饮食控制的减肥运动训练。分别于入营第一天和出营前一天进行身体形态及血液指标测试。结果:经过夏令营4周有氧运动训练,肥胖青少年体重、体脂率、BMI与运动前相比显著下降,空腹血清胰岛素、血脂水平与运动前相比均明显改善,血浆致动脉粥样硬化指数、脂酰辅酶A胆固醇酰基转移酶2水平显著降低。结论:4周有氧运动明显降低了肥胖青少年的肥胖程度和胰岛素水平,改善血脂代谢,在一定程度上降低了动脉粥样硬化发病的风险。     

中低强度有氧运动结合饮食控制对肥胖青少年血脂和肝脏功能的影响

目的:探讨4周中低强度有氧运动结合饮食控制对肥胖青少年减肥效果以及血脂和肝脏功能的影响。方法:以参加2007年上海巅峰运动减肥中心运动减肥夏令营的56名9～19岁肥胖青少年(男26名,女30名)为对象,测定其身体形态、安静状态心电图、空腹血糖、胰岛素、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、谷氨酸氨基转移酶(ALT)、丙氨酸氨基转移酶(AST)、-谷氨酰转肽酶(GGT),进行肝脏B超检查。根据运动负荷试验结果确定个体运动强度,范围在心率储备的20～40%。选择容易控制强度和长时间持续的运动方式,如游泳、快走、慢跑、健美操、娱乐性球类等。根据年龄、体重和基础代谢率计算个体每日热能需要量,遵循足量蛋白质和低脂的原则,由专业营养师配餐,保证生理需要量营养素供给。4周实验后测定相同指标并进行前后比较。结果:与实验前比较,4周后,(1)实验对象体重、BMI、体脂率明显下降;(2)空腹血脂、血糖和胰岛素均明显下降;(3)肝脏B超检查显示脂肪肝程度减轻,ALT、AST和GGT异常例数明显减少。结论:中低强度长时间运动结合足量蛋白质、低脂饮食是肥胖青少年减肥的有效途径,不仅明显改善体内脂类代谢,降低空腹胰岛素水平,提高组织细胞对胰岛素的敏感性,还可明显减轻肥胖青少年脂肪肝的程度,改善肝功能。     

Do skinfolds accurately assess changes in body fat in obese children and adolescents?

PURPOSE: Obesity is epidemic in Western societies, with rapid rates of increase in the young. Various methods exist for the assessment of body composition, but these have not been compared in obese children and adolescents. This study compared methods of body composition assessment in obese young people to determine whether changes in various measures of body composition as a result of exercise training were correlated. METHODS: Multiple anthropometric measures (weight, height, body mass index (BMI), skinfolds, waist and hip girths) and dual-energy x-ray absorptiometry (DEXA) were undertaken in 38 obese children and adolescents (12.7 +/- 2.1 yr) at baseline and following 8 wk of exercise training. RESULTS: At baseline, there were strong relationships (all P < 0.01) between DEXA total fat and weight (r = 0.83), BMI (r = 0.86), waist girth (r = 0.81), hip girth (r = 0.88), sum of six skinfolds (sum6, r = 0.79), and percent body fat (percent body fat) calculated using a four-skinfold equation (EQ4; r = 0.69). Similar relationships (all P < 0.001) existed between DEXA abdominal fat and weight (r = 0.79), waist girth (r = 0.83), hip girth (r = 0.69), and height (r = 0.71). Neither skinfold sums, nor percent body fat calculated from skinfold equations, were selected as independent predictors of DEXA total or abdominal fat by stepwise hierarchical linear regression. The reductions in DEXA total and abdominal fat following exercise were not predicted by changes in skinfolds or percent body fat calculated from skinfolds. CONCLUSION: These data suggest that body fat derived from skinfold measures is poorly predictive of abdominal and total fat derived from DEXA in obese children and adolescents. This finding highlights the limitations of skinfolds in obese subjects and questions the validity of their use to assess changes in body composition with interventions such as exercise training.     

A carbohydrate-restricted diet during resistance training promotes more favorable changes in body composition and markers of health in obese women with and without insulin resistance

Objective: To determine whether sedentary obese women with elevated levels of homeostatic model assessment (HOMA) insulin resistance (ie, > 3.5) experience greater benefits from an exercise + higher-carbohydrate (HC) or carbohydrate-restricted weight loss program than women with lower HOMA levels. Methods: 221 women (age, 46.5 ± 12 years; body weight, 90.3 ± 16 kg; body mass index, 33.8 ± 5 kg/m(2)) participated in a 10-week supervised exercise and weight loss program. The fitness program involved 30 minutes of circuit-style resistance training 3 days per week. Subjects were prescribed low-fat (30%) isoenergetic diets that consisted of 1200 kcals per day for 1 week (phase 1) and 1600 kcals per day for 9 weeks (phase 2) with HC or higher protein (HP). Fasting blood samples, body composition, anthropometry, resting energy expenditure, and fitness measurements were obtained at 0 and 10 weeks. Subjects were retrospectively stratified into lower (LH) or higher (HH) than 3.5 HOMA groups. Data were analyzed by multivariate analysis of variance with repeated measures and are presented as mean ± standard deviation changes from baseline. Results: Baseline HOMA levels in the LH group were significantly lower than those in the HH group (LH, 0.6 ± 0.7; HH, 6.3 ± 3.4; P = 0.001). Diet and training significantly decreased body weight (-3.5 ± 3 kg), fat mass (-2.7 ± 3 kg), blood glucose (-3%), total cholesterol (-4.5%), low-density lipoproteins (-5%), triglycerides (-5.9%), systolic blood pressure (-2.6%), and waist circumference (-3.7%), while increasing peak aerobic capacity (7.3%). Subjects in the HP group experienced greater weight loss (-4.4 ± 3.6 kg vs -2.6 ± 2.9 kg), fat loss (-3.4 ± 2.7 kg vs -1.7 ± 2.0 kg), reductions in serum glucose (3% vs 2%), and decreases in serum leptin levels (-30.8% vs -10.8%) than those in the HC group. Participants in the HH (-14.1%) and HP-HH (-21.6%) groups observed the greatest reduction in serum blood glucose. Conclusion: A carbohydrate-restricted diet promoted more favorable changes in weight loss, fat loss, and markers of health in obese women who initiated an exercise program compared with a diet higher in carbohydrate. Additionally, obese women who initiated training and dieting with higher HOMA levels experienced greater reductions in blood glucose following an HP diet.