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Diabetes, Overweight, and Obesity
Published in Michelle Tollefson, Nancy Eriksen, Neha Pathak, Improving Women's Health Across the Lifespan, 2021
Better weight loss occurs with concurrent fat and total caloric restrictions than with either of the two alone and should target weight loss of 2 lbs a week. Very low-calorie diets (VLCD) (<800 kcal/day) show a weight loss of 20 lbs over 12 weeks, but have high weight regain following the reintroduction of foods. Low-calorie diets of 1200–1500 kcal/day with higher amounts for individuals with initial weights >200 lbs produced similar long-term weight losses as VLCD.97 Reducing fat intake is important as most patients with obesity or T2D have higher fat intake at baseline. 98,99 Fat intake should be <20% of daily calories.100,101
High-intensity Therapeutic Lifestyle Change
Published in James M. Rippe, Lifestyle Medicine, 2019
Notice that the prevalence of any remission was ~2% for standard Diabetes support and education, and the maximum was <12% for the Intensive lifestyle intervention. The “so-called” Intensive lifestyle intervention was significantly more effective than the standard Diabetes support and education, but not close to th e very-low-calorie diet in the Counterpoint study.
General Nutritional Considerations for Chronic Hyperglycemia—Type 2 Diabetes
Published in Robert Fried, Richard M. Carlton, Type 2 Diabetes, 2018
Robert Fried, Richard M. Carlton
Two trials compared the ADA exchange diet with a standard reduced fat diet and five studies assessed low-fat diets versus moderate-fat or low-carbohydrate diets. Two studies assessed the effect of a very-low-calorie diet versus a low-calorie diet. Six studies compared dietary advice with dietary advice plus exercise, and three other studies assessed dietary advice versus dietary advice plus behavioral approaches. The studies all measured weight and measures of glycemic control, although not all studies reported these in the articles published.
Current and future strategies for diagnostic and management of obstructive sleep apnea
Published in Expert Review of Molecular Diagnostics, 2021
Sartaj Khurana, Narshone Soda, Muhammad J. A. Shiddiky, Ranu Nayak, Sudeep Bose
Obesity has been regarded as one of the most common and potential risk factors for OSA [128]. Food habits such as increased calorie intake especially high in carbohydrates have been seen to be associated with OSA severity [129]. Several studies have demonstrated that weight loss achieved through very low calorie diet intake has been successful in alleviating the symptoms of OSA by improving the BMI and AHI [130]. Very low calorie diet accompanied with active lifestyle not only results in weight loss and OSA tolerance but also improves other existing comorbidities such as hypertension, cardiovascular diseases, and diabetes by improving a range of cardiovascular variables [131]. Mediterranean diets have been observed to be beneficial for weight loss as they promote satiation and encourage adherence to calorie-restricted diets [132]. Moreover, surgically induced weight loss has also been associated with improvements in OSA severity, associated clinical conditions, and overall quality of life [133]. However, in morbidly obese OSA patients, only weight loss cannot completely cure OSA and additional therapies are required. In addition to diet mediated weight loss, changing of sleeping postures has been advised to alleviate the symptoms of OSA. Supine position increases the likelihood of the tongue falling back into the airway as a result of gravity, thereby blocking the airway. Therefore, positional therapy is advised in OSA patients to reduce the apneic events from occurring.
Important lessons about testosterone therapy- weight loss vs. testosterone therapy for symptom resolution, classical vs. functional hypogonadism, and shortterm vs. lifelong testosterone therapy
Published in The Aging Male, 2020
We applaud Ng Tang Fui et al. [1] for their randomized controlled trial investigating the effects of testosterone therapy or placebo together with caloric restriction and moderate intensity exercise on body composition outcomes. Men aged 18–70 years with low testosterone were randomly allocated to receive 1000 mg testosterone undecanoate injections or placebo injections at weeks 0 and 6, and every 10 weeks thereafter throughout the 56-week study. During weeks 1–8, all subjects followed a very low energy diet (VLED, also known as “very low-calorie diet”) providing 640 calories per day and two cups of low-starch vegetables. During weeks 9–10, subjects weaned their VLED and ordinary foods were gradually reintroduced. After 10 weeks, subjects had completely ceased the VLED and were instructed to follow an energy-restricted diet providing 1350 calories per day, aimed at preventing weight regain, for the remaining 46 study weeks. Subjects were advised to perform at least 30 min of moderate-intensity exercise each day and completed exercise questionnaires and accelerometer testing (at weeks 0, 10, and 56) to reinforce and encourage participation in exercise. The results were reported as mean adjusted differences (MAD), calculated as the difference between groups of mean change in the outcome measures over time. DEXA and computed tomography were used for body composition and visceral fat assessment [1].
Replication and Extension of the Weight Loss For Life Community-Based Treatment Protocol
Published in Behavioral Medicine, 2018
James J. Annesi, Jennifer L. Unruh-Rewkowski, Nicole Mareno
Although the majority of related studies are cross-sectional and descriptive, and describe how characteristics of individuals relate to weight change, there is some research that tested methods intended to enhance maintenance of treatment effects. For example, both monthly phone contacts and Internet-based support with experimenter prompts, focused on “motivation, support, problem solving, and relapse prevention,” failed to affect maintenance of lost weight better than a self-directed, minimal-intervention condition.10 Extending a 17-week treatment consisting of several months of a very-low-calorie diet paired with a manual-supported self-help curriculum to 69 weeks, through the addition of monthly 1.5-hour meetings focused on topic such as controlling eating impulses, body image changes, and cooking/shopping, was judged to be ineffective at supporting weight loss.43 A 5-month follow-up treatment component consisting of accelerometer use, tracking its corresponding data and barriers to exercise, and 4 visits with an interventionist, was promising over 15 months after treatment start.44 Although it supported the present study's emphasis on physical activity and addressing barriers, a brief time frame, weak experimental power, and analysis of only treatment “completers” minimized confidence in its findings. A consideration of incorporating follow-ups within behavioral obesity treatments should include the time burden placed on participants and their (often media-driven) desire/expectation for quick and permanent results—even though their condition is now considered by the medical community to be chronic.45 We are presently undertaking research to better-understand participants' tolerance for follow-up processes so that its architecture might be appropriately informed.