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ClinicalClinicalDDiiggeesstt 3?
Obesity
diabetes care Slim Fast with reductil and Slim Fast
o pivotal is obesity treatment with sibutramine accompanied
in the development by an intermittent low calorie diet involving
Sof type 2 diabetes, lim ast meal replacement products. The
Effect of a and such is the glycaemic latter is a novel strategy to make intensive
combination weight Jonathan Pinkney, improvement that results from caloric restriction less unpleasant and to
Senior Lecturer/ maor weight loss, that weight reduce relapse. The main findings were
loss programme Honorary Consultant
Physician, Univer loss is a maor therapeutic benefits in the combination therapy group,
Readability 333 sity of Liverpool /
?? University Hospital goal. owever, this goal suggesting that this might be a useful weight
Applicability to practice 3 3 3 intree
WOW! factor 333 currently eludes most patients. loss strategy. Obvious weaknesses, however,
Although very low calorie diets hile the effects of orlistat and sibutramine, are the minimal impact of the comparator
1are known to produce substantial the two currently licensed antiobesity drugs, ‘lifestyle’ intervention and, seriously, the
weight loss, it is unclear whether on weight loss and glycaemic control are lack of placebo drug treatment. The study
this weight loss will be maintained modest in type 2 diabetes, around two that would perhaps now be most helpful
long-term. thirds of the weight loss elicited in trials would compare an intermittent low calorie
Other approaches to of these drugs is achieved in the placebo diet meal replacements, with sibutramine
2weight loss, such as meal arms, suggesting that other features of the or placebo, and a third group with standard
replacements, have not been weight reduction programmes are more vital dietary intervention and sibutramine. The
adequately tested in individuals with
type 2 diabetes. determinants of outcomes. n other words, treatment of obesity always has to be
The aim of this study was to we still do not fully know how best to use individualised, and so the main importance of
3assess whether a combination of antiobesity drugs. this interesting preliminary work is probably
weight loss therapies might improve edmon and colleagues report a the suggestion that short-duration cycles of
weight loss. randomised trial comparing a standard meal replacements could be an alternative
A total of patients were ‘lifestyle’ weight loss intervention with weight loss strategy for some obese patients
4randomised to combination or combination therapy – comprising continuous with type 2 diabetes.
standard therapy for weight loss. oth
groups underwent a standard weight
loss programme. ather’s social class at participant’s
The combination therapy group journal of epidemiology 3age years was inversely associated
5received –mg sibutramine and community health
with all measures of obesity in men and
daily, low calorie diets using meal women at age years.
replacement products for week every This difference remained after
2 months, and between low-calorie Effect of social 4adustment for participant’s own
diet weeks, once daily use of meal class on obesity social class in young adulthood and
replacement product and snack bars to middle age.
replace one usual meal and snack. Readability 333
oth adult social classes were
There was a significantly greater Applicability to practice 3 3
WOW! factor 333 5inversely related to obesity among
6weight loss and reduction in bA
c ower childhood and adult social women after adustment for childhood
at year on combination therapy 1class have both been associated circumstances. This effect was not seen
compared with standard therapy. , with higher levels of adult obesity. in men.
fat mass and lean body mass were owever, the cumulative influence of These gender differences and the
also more reduced in the combination lifetime socioeconomic circumstances 6detection of time sensitive points
therapy group than the standard is less clear. for the development of social class
therapy group. differences in adult obesity is important
eight loss programmes that This prospective cohort study of
7achieve and maintain weight loss for 22 men and women born to plan timely and gender-specific public
in investigated the influence health interventions.
at least year may be useful clinically. of social class in childhood, young
angenberg , ardy , uh , runner , adsworth
edmon , aat
, eck et al 2 adulthood and middle age, and 2 entral and total obesity in middle aged
One-year outcome of a combination of weight intergenerational mobility, on adult men and women in relation to lifetime socioeconomic
loss therapies for subects with type 2 diabetes status evidence from a national birth cohort. Journal
iabetes are 26(9) 2– central and total obesity. of Epidemiology and Community Health 57 –22
Diabetes Digest Volume 3 Number 1 2004 27
Obesity ClinicalDigest
Weight, waist international journal of obesity owever, the efficacy of such a diet to The observed weight reduction was
‘ correct the atherogenic lipid profile has 4associated with favourable changes
circumference,
insulin, HbA not yet been evaluated. in plasma cholesterol, cholesterol,
1c Effect of rapid weight and fasting triglyceride.
and fasting bld n this study, patients with type
glucse all fell loss on lipid profile 22 diabetes were given weeks of hort-term use of a low calorie diet
significantl after Readability 333 meal-replacement diet eight sachets 5is very effective to improve glycaemic
the lw calrie Applicability to practice 3 3 3 of a nutrition powder. ipid profile was control in overweight patients with type
WOW! factor 333 assessed by spectroscopy. 2 diabetes.
diet eight loss as a result of following
’ a low calorie diet has been shown to eight, waist circumference, insulin, arder , inesen , Astrup A 2 The effect of a
1
improve glycaemic control in overweight 3 bA and fasting blood glucose all rapid weight loss on lipid profile and glycaemic control
c in obese type 2 diabetic patients. nternational Journal
individuals with type 2 diabetes. fell significantly after the low calorie diet. of esity epub No 2
diabetic medicine in this article, using the technical reviews vidence is discussed about the
effectiveness of advice provided by
of the uropean Association for the tudy 3
of iabetes and other sources. dietitians.
Epansion of dietetic The recommendations differ The subcommittee conclude
from those published previously 4that dietetic services need to be
serices needed 2 e¡panded to implement the for
Readability 333 as they include more fle¡ibility in the iabetes and to prevent type 2 diabetes
Applicability to practice 3 3 3 3 3 proportions of energy derived from in the increasingly obese population.
WOW! factor 333 carbohydrates and monounsaturated
onsensus-based recommendations fats, more active promotion of foods utrition ubcommittee of the iabetes are
for the practical implementation of with a low ¢ and more emphasis on Advisory ommittee of iabetes 2 The
1 implementation of nutritional advice for people
nutritional advice in the are provided advice about lifestyle changes. with diabetes. iaetic edicine 2 –
Obesity ClinicalDigest
european journal of diabetes have received little attention. ach -year increase in age and A reductin in
clinical nutrition A total of patients were 5each increase in dietary energy ‘
were associated with £ and 2£ dietar saturated
2interviewed about their level of decreases in , respectively. fat and ecess
ifestyle and physical activity over the past weeks. A reduction in dietary saturated fat and bdweight ma
ach five-unit increase in energy 6e¡cess bodyweight may be helpful in be helful in the
glycaemic control 3from dietary saturated fat and the improvement of glycaemic control in imrement f
Readability 3333 five-unit increase in were associated older patients with diabetes. An increase in glcaemic cntrl
Applicability to practice 3 3 3 3 3 with £ and £ increases in bA ,
c physical activity and a reduction in energy in lder atients
WOW! factor 333 respectively. from dietary sucrose, particularly in women, with diabetes
Older people with diabetes have There was a £ reduction in may assist weight control. ’
1special needs in terms of diabetes 4in females with moderate compared ¢rylls , cen
ie , owarth , ann 2
management. The effects of lifestyle with low overall activity. n males, the ifestyle factors associated with glycaemic control
and body mass inde¡ in older adults with diabetes.
intervention in older patients with type 2 reduction in was only £. European Journal of Clinical utrition 57 –
journal of the american This paper reviews the impact of coronary heart disease by si¡-fold.
college of nutrition 2obesity and weight gain on risk for A weight loss of £ of original
diabetes and coronary heart disease. 5bodyweight substantially improves
eight management n this systematic review of controlled glycaemic control.
in type 2 diabetes 3clinical trials, a meta-analysis of the eight management may be the
effects of weight loss for obese individuals 6most important therapeutic task for
Readability 3333 with diabetes was done. obese individuals with type 2 diabetes.
Applicability to practice 3 3 3 3 3 Obesity or weight gain can increase
WOW! factor 333 Anderson , endall , enkins A 2
An estimated –£ of type 2 4the risk of developing diabetes by mportance of weight management in type 2 diabetes
greater than ninety-fold and the risk for review with meta-analysis of clinical studies. Journal
diabetes is related to obesity. of the merican College of utrition 22(5) –
1
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