Predictors of programme adherence and weight loss in women in an obesity programme using meal replacements

Objective: To explore predictors of programme adherence and weight loss in patients participating in a weight management programme using meal replacements (MR).Design: One hundred and fifty healthy obese women, age 48.5 years (s.d. = 8.3); weight, 97.6 kg (13.4); body mass index (BMI) 36.5 (3.7), participated in a longitudinal study with a 16-week acute weight loss phase (Phase 1) followed by 1 year of a trial of weight-loss maintenance (Phase 2). Energy intake during Phase 1 totaled 900 kcal (3.7 MJ) a day from a diet including two MR. Energy intake during Phase 2 consisted of either MR or a low-fat diet with a calculated energy deficit of 600 kcal/day (2.5 MJ).Methods: Weight, height and waist circumference were measured and body composition assessed by air plethysmography (Bodpod). Glucose and insulin were measured by standard immunoassays and insulin sensitivity assessed by homeostatic model assessment.Results: At the end of 16 weeks, 114 subjects (76%) completed Phase 1 and achieved a mean weight loss of 8.95 kg (3.38). Adherence to Phase 1 was predicted by weight loss over the first 2 weeks (p < 0.001). Weight loss during Phase 1 was predicted by initial weight and initial systolic blood pressure. Adherence to Phase 2 was not predicted by physiological measures. Weight loss maintenance in Phase 2 (not gaining more than 3% of the weight at start of phase 2) was predicted by cholesterol and triglyceride measured at the start of Phase 2 but otherwise was not predicted by the physiological measures. Initial insulin sensitivity did not predict weight loss in either phase.Conclusion: Participants whose weight loss over the first 2 weeks falls in the bottom third may need additional intervention if they are to continue in this type of programme. A battery of physiological measures at entry to a MR weight loss and maintenance programme explains only a very small proportion of the variation in weight loss

Potential of Best Practice to Reduce Impacts from Oil and Gas Projects in the Amazon

The western Amazon continues to be an active and controversial zone of hydrocarbon exploration and production. We argue for the urgent need to implement best practices to reduce the negative environmental and social impacts associated with the sector. Here, we present a three-part study aimed at resolving the major obstacles impeding the advancement of best practice in the region. Our focus is on Loreto, Peru, one of the largest and most dynamic hydrocarbon zones in the Amazon. First, we develop a set of specific best practice guidelines to address the lack of clarity surrounding the issue. These guidelines incorporate both engineering-based criteria and key ecological and social factors. Second, we provide a detailed analysis of existing and planned hydrocarbon activities and infrastructure, overcoming the lack of information that typically hampers large-scale impact analysis. Third, we evaluate the planned activities and infrastructure with respect to the best practice guidelines. We show that Loreto is an extremely active hydrocarbon front, highlighted by a number of recent oil and gas discoveries and a sustained government push for increased exploration. Our analyses reveal that the use of technical best practice could minimize future impacts by greatly reducing the amount of required infrastructure such as drilling platforms and access roads. We also document a critical need to consider more fully the ecological and social factors, as the vast majority of planned infrastructure overlaps sensitive areas such as protected areas, indigenous territories, and key ecosystems and watersheds. Lastly, our cost analysis indicates that following best practice does not impose substantially greater costs than conventional practice, and may in fact reduce overall costs. Barriers to the widespread implementation of best practice in the Amazon clearly exist, but our findings show that there can be great benefits to its implementation

The impact of a health professional recommendation on weight loss attempts in overweight and obese British adults: a cross-sectional analysis

Objectives: To examine the effect that health professional (HP) advice to lose weight has on overweight and obese adults ’ motivation to lose weight and attempts to lose weight. Design: Cross-sectional survey. Setting: Great Britain. Participants: 810 overweight or obese (body mass index ≥ 25 kg/m 2 ) adults. Main outcome measures: Participants were asked if they had ever received HP advice to lose weight and reported their desire to weigh less (ideal weight ≤ 95% of current weight) and whether they were attempting to lose weight. Results: Only 17% of overweight and 42% of obese respondents recalled ever having received HP advice to lose weight. HP advice was associated with wanting to weigh less (89% vs 61% among those not receiving advice) and attempting to lose weight (68% vs 37%). In multivariable analyses, HP advice to lose weight was associated with increased odds of wanting to weigh less (OR=3.71, 95% CI 2.10 to 6.55) and attempting to lose weight (OR=3.53, 95% CI 2.44 to 5.10) independent of demographic characteristics and weight status. Conclusions: HP advice to lose weight appears to increase motivation to lose weight and weight loss behaviour, but only a minority of overweight or obese adults receive such advice. Better training for HPs in delivering brief weight counselling could offer an opportunity to improve obese patients ’ motivation to lose weight

Rimonabant improves cardiometabolic risk factors in overweight/obese patients with poorly controlled type 2 diabetes (HbA(1c)>= 8%) on monotherapy with metformin or sulfonylureas

peer reviewe

Can we reconcile ‘the obesity paradox’ with recent cardiovascular outcome trials in diabetes?

Several recent cardiovascular outcome trials (CVOT) in patients with type 2 diabetes have shown benefit in terms of both weight loss and cardiovascular benefit. At the same time a number of epidemiological studies have shown that a body mass index above 25 kg/m² may be beneficial - the so-called ‘obesity paradox’. We discuss whether these CVOT support the potential benefits of intentional or therapeutic weight loss, but conclude that such conclusions would be simplistic and will require trials specifically designed for this purpose

Logging Concessions Enable Illegal Logging Crisis in the Peruvian Amazon

The Peruvian Amazon is an important arena in global efforts to promote sustainable logging in the tropics. Despite recent efforts to achieve sustainability, such as provisions in the US–Peru Trade Promotion Agreement, illegal logging continues to plague the region. We present evidence that Peru\u27s legal logging concession system is enabling the widespread illegal logging via the regulatory documents designed to ensure sustainable logging. Analyzing official government data, we found that 68.3% of all concessions supervised by authorities were suspected of major violations. Of the 609 total concessions, nearly 30% have been cancelled for violations and we expect this percentage to increase as investigations continue. Moreover, the nature of the violations indicate that the permits associated with legal concessions are used to harvest trees in unauthorized areas, thus threatening all forested areas. Many of the violations pertain to the illegal extraction of CITES-listed timber species outside authorized areas. These findings highlight the need for additional reforms

Force-Velocity Relations of a Two-State Crossbridge Model for Molecular Motors

We discuss the force-velocity relations obtained in a two-state crossbridge model for molecular motors. They can be calculated analytically in two limiting cases: for a large number and for one pair of motors. The effect of the strain-dependent detachment rate on the motor characteristics is studied. It can lead to linear, myosin-like, kinesin-like and anomalous curves. In particular, we specify the conditions under which oscillatory behavior may be found.Comment: 5 pages, 4 figures, REVTeX; thoroughly revised version; also available at http://www.physik.tu-muenchen.de/~frey

Bronchopulmonary Dysplasia: Executive Summary of a Workshop

Comment in Bronchopulmonary Dysplasia: The Ongoing Search for One Definition to Rule Them All. [J Pediatr. 2018] Midlife crisis? In its 50th year, BPD redefines itself. [J Pediatr. 2018