T5:P5a-001EFFECTIVENESS OF A COMMERCIAL WEIGHT-LOSS PROGRAMME COMPARED WITH USUAL CARE IN PRIMARY CAREClaire Appleton1, Carolyn Summerbell1, Paul Finn1, Anita Plummer2, Anne Helmn21University of Teesside, UK; 2Dr Chaudhry & partner, Middlesbrough, UK

Aim: To compare the weight loss at three, six and 12 months in over-weight (BMI >27) adult patients, identi ed within primary care, and randomly allocated to one of two weight-loss programmes, a commer-cial weight-loss programme (The Cambridge Health Plan Programme, CHP) provided free of charge OR usual care (UC).Methods: Two Primary Care practices in two different areas of the UK were recruited to the study. In total, 35 patients were randomised to CHP and 31 were randomised to UC. Patients measurements were recorded at three months and will be recorded at six, and 12 months. Results: 12/35 patients in the CHP group and 9/31 in the UC group dropped out at three months. Data in the table relate to completers.

GROUP n Mean Weight (kg)baseline (SD)

Mean (kg)3 months (SD)

Bristol (CHP) 16 100.9 (21.5) -10.8 (6.1)Bristol (UC) 12 93.6 (7.7) -3.1 (0.9)Teesside (CHP) 19 94.2 (14.7) -6.7 (4.3)Teesside (UC) 19 93.9 (14.8) -3.2 (3.1)

Conclusion: At three months, patients randomised to CHP achieved a greater weight loss than those randomised to UC (p 30kg/m2) subjects (OBS).Methods: An investigation was performed upon 1000 OWS and OBS, aged 18-70 years, from a sample survey by phone.Results: 75,8% of the total subjects (TS) are OWS and 24,2 % are OBS. 76 % of the OWS (Male (M) 68,9%; Female (F) 81,2 %) and 85 % of the OBS (M 77 % ; F 90 %) have already felt the need to lose weight. 66 % of the OWS and 83 % of the OBS have already tried to reduce their weight intentionally. During these attempts, 79 % of the subjects have begun a restrictive diet and 65 % have practised physical activity (less often if the BMI is higher, and males more often than females), from their own initiative. Among those who have already tried to lose weight intentionally, 49 % have taken medical (general practioner > specialist) or dietetician advice (more often if the BMI is higher, and females more often than males). 63 % of the TS (OWS 58,9 %, OBS 76 %) have followed at least one restrictive diet during their life. Among them, 57 % have dif culties to follow it, 47 % have a tendency to stop it prematurely, 26 % consider that dieting do not work for them (more often if BMI is higher, and if they have already asked for medical advice, for each item). 37 % know that drug treatment for weight loss exists and only 12 % of the total subjects would consider using such medications.Conclusions: Attempts for weight loss concern a lot of OWS and OBS. Most of the subjects have already followed a restrictive diet, but they often meet dif culties. Only few would consider to use a drug treatment. Means which are used seem to be in discrepancy with the frequent need to lose weight in OWS and OBS.

T5:P5a-004DIFFERENCES IN PHYSICAL, EMOTIONAL AND SOCIAL FACTORS WITH WEIGHT CHANGE IN ADULTS SEEKING TREAMENT FOR THEIR OBESITYBrown Jenny1, Wimpenny Pete2, West Bernice2, Broom John11NHS Grampian, Aberdeen, 2The Robert Gordon University, Aber-deen, UK

Aims: To ascertain any differences between perceived physical, emo-tional and social factors with weight change.Methods: A total of 48 subjects (15 male and 33 female), aged >18years with a BMI> and seeking treatment for obesity, completed a6-month longitudinal study at a Scottish Specialist Centre. Data werecollected by self-report questionnaire. ANOVA analysis identi edthe differences between the following 3 groups: weight gain, 0-5%weight loss and >5% weight loss, and paired t-tests were applied toexamine the extent of the difference.Results: Weight gain was associated with lower levels of activity andperceived support, decreased functional ability, increased levels ofsymptom severity, negative emotions, anxiety and depression. Theconverse was seen in weight loss especially if greater weight losswas achieved.Conclusions: It is important to consider the patients perception ofphysical, emotional and social factors in weight management. If, asthe results suggest, there is a link between weight change and suchperceived factors then approaches to weight management that incor-porate all of these is essential and in line with holistic approaches tocare.

Abstracts

S133

International Journal of Obesity

T5:P5a-005ANTIOXIDANT STATUS DURING WEIGHT LOSS IN OBESE PATIENTSCelakovsky Jan1, Mullerova Dana1, Zloch Zdenek1, Matejkova Dagmar2, Racek Jaroslav31Charles University, Medical Faculty in Pilsen, Institute of Hygiene; 21st Internal Clinic of Faculty Hospital; 3Clinic of Biochemistry of Faculty Hospital, Pilsen, Czech Republic

Aim: To follow changes in oxidant/antioxidant status in obese persons during their weight loss determined by low-calorie diet. Method: The plasma total antioxidant status (TAS), glutathione peroxi-dase (GSHPx), and thiobarbituric acid-reacting substances (TBARS) were measured using RANDOX kits in 12 obese people (mean initial BMI = 36.5 kg/m2) twice, at the beginning and during 5 MJ diet (1.7 kJ from fruit and vegetables) when the patients reduced minimal 4 % of their initial body weight. The mean weight loss was 10.3 - 6.3 % of ini-tial body weight. The increase in physical activity was recommended, although not checked. The paired T-test for statistical evaluation was used.Results: The TAS was signifi cantly increased during weight reduction (p < 0.05). The TBARS, marker of lipid peroxidation, was also in-creased (p < 0.05); however, the activity of GSHPx did not signifi cantly change.Conclusions: Weight loss at low-calorie diet with a high content of fruit and vegetables was associated with signifi cant improvement of plasma total antioxidative status; however, there was simultaneously increased plasma lipid peroxidation marker, probably due to higher lipolysis. Surprisingly, the activity of GSHPx was not changed during calorie restriction and increased fruit and vegetable intake period.

T5:P5a-006THE EFFECT OF INCREASED RED MEAT INTAKE ON WEIGHT LOSS, BODY COMPOSITION, INSULIN SENSITIVITY AND CARDIOVASCULAR RISK FACTORS IN AUSTRALIAN ADULT WOMENClifton Peter M, Noakes Manny, Keogh Jennifer, Foster PaulCSIRO Health Sciences and Nutrition, Adelaide, Australia

Aims: To determine the ef cacy of a dietary pattern higher proteinfrom red meat on maintenance of weight loss after 12 months.Methods: In all, seventy eight women completed a 12-month weight-loss program comparing an allocation to a higher protein, high-meatdiet (HM) with a low-meat, high-carbohydrate diet (HC).Results: The overall weight loss in the two groups was not differentat 4.7 and 4.4 kg on HM and HC, respectively. However, when theactual protein intake, calculated from dietary records at 12 months,was used as a criterion, the weight loss was greater in the group whichconsumed more than 88g/day of protein: 6.5 kg (n=27) versus 3.1kg (n=45, p=0.03). However, this weight difference did not translateinto a difference in central fat loss between the two groups. Lipids,glucose, insulin, C-reactive protein (CRP) and homocysteine were allimproved by weight loss with no differences between groups. HDLcholesterol rose by 20%. A higher serum B12 was seen in the higherprotein group and folate levels were not different between groups.Conclusions: A higher protein intake appears to confer some weightloss bene t at 12 months.

T5:P5a-007DEPRIVATION AND EARLY DROP-OUT FROM A COUNTERWEIGHT WEIGHT-MANAGEMENT MODELCounterweight Project TeamLuton and Dunstable Hospital, UK

Aim: To ascertain if deprivation in uenced patient drop-out from a UK primary care weight-management intervention programme. Methods: Eighty primary care practices from 7 areas of the UK were re-cruited into the Counterweight programme. The primary care practices come from areas with a wide range of socio-economic backgrounds. Each practice was allocated the Carstairs deprivation score according to their postcode. The scores were categorised as 1=low deprivation, 2=moderate deprivation, 3=high deprivation. The number of patients attending less than 2 appointments was calculated for each practice and compared to the deprivation category.Results: There was an early drop-out rate of approximately one-quarter across all deprivation categories. In categories 1, 2 and 3, the drop-out rates were 22.5% (116/515), 25.2% (124/493) and 27.4% (167/610), respectively (Chi-squared test for trend, p = 0.06).Conclusions: The Counterweight weight-management intervention model is equally acceptable to af uent and deprived areas (as far as early drop-out is concerned).

T5:P5a-008OBESITY MANAGEMENT USING RESPIRATORY INTEGRATION WITH ALPHA AND BETA PINENES PEROXIDESDe Cristofaro Paolo1, Dragani Beatrice1, Malatesta Guido1, Battistini Nino Carlo2, Pietrobelli Angelo31Centro Regionale di Fisiopatologia della Nutrizione, ASL Teramo; 2Cattedra di Nutrizone Umana, Universita di Modena; 3Clinica Pediatrica Universita di Verona, Italy

Introduction: Reduction in ventilation function is one of the consequenc-es of obesity, and hypoxia could contribute to insulin resistance. Fastinghigh level of Respiratory Quotient (QR) could contribute to weight gain,due to low level or lipid/carbohydrate oxidation ratio. According to these ndings, a reduction of this oxygenation de cit in obese subjects couldimprove treatment results.Methods: After the previous observation of a reduced QR in 40 womenusing respiratory integration with therpenic compounds alpha and betaand peroxidate by technological procedure (Holiste, France) in compari-son with 40 controls, we tested 16 subjects (14 F e 2 M), age 45.1 + 7.7years, BMI 36.6 + 10.3 kg/m2 and QR 0.97 + 0.09 on balanced diet (de citof approximately 500 kcal). Subjects performed 9 min. per day of respi-ratory integration (3 5 times/week) for two months and we evaluatedmetabolic (indirect calorimeter) and body composition (anthropometrics)changes. Results: Subjects after the treatment period showed 4.1 kg weight reduc-tion on average; highly signi cant reduction of QR (p=.0001) and VCO

2(p=.01); an increase of arm circumference (p=.0001), and VO

2 (p=.007)

and a signi cant positive correlation between increasing of arm circum-ferences and VO

2 (r=0.69, p=.003).

Conclusions: Respiratory integration using the device designed by RnJacquier improved oxygen biodisponibility at the tissue level and pro-moted lipid oxidation. These ndings could introduce with success anadditional new tool in obesity managing, improving other treatments.

Abstracts

S134

International Journal of Obesity

T5:P5a-009WEIGHING IT UP - THE ACCURACY OF RECORDING WEIGHT WITHIN A UK GENERAL HOSPITALDenman Karen1, Morris Penelope J1, Finer Nick21Centre for Obesity Research, Luton, UK; 2Wellcome Trust Clinical Research Facility, Cambridge, UK

Aims: To determine the accuracy of weighing procedures within a UK general hospital. Methods: A total of 53 patients (30M, 23F) attending 10 specialist outpatient clinics (Gastroenterology, Respiratory, Lipid, Cardiology, Rheumatology, Diabetes and General Surgery) underwent a measure of body mass, using speci c calibrated scales by a trained nurse following WHO guidelines (RBM). This measure was then compared to body mass, if recorded by outpatient clinic staff (CBM). Hospital policy states that all out-patient attendees should be weighed.Results: Of the 53 patients approached, only 6 had a clinic height re-corded; 20 had no CBM recorded (none attending Cardiology or Gen-eral Surgery clinics). RBM of these patients was 30 (22.4, 42.1 kg/m2) (median (range)). Of the remaining 33 patients, BMI < 24.9kg/m2:12, 25-29.9 kg/m2 :9, BMI > 30 kg/m2:12. CBM differed from RBM by 0.3 (-0.2, +3.2 kg).Conclusions: Body weight assessment and treatment of overweight or obesity is integral to medical care; yet, even in this specialist care set-ting, less than two-thirds of patients had a body mass measured. Due to the infrequency of height measurements, BMI could only be calculated in 11% of patients. When weight was measured, it was done so with accuracy (error compared to RBM

T5:P5a-013EFFECT OF ORLISTAT ON THE BODY FAT MASS AND LEAN BODY MASS IN THE TREATMENT OF OBESITYHandjiev Svetoslav1, Handjieva Teodora2, Darlenski Razvigor21Transport Medical Institute, So a; 2Medical University, So a, Bulgaria

Aim: To determine the effect of Orlistat in Body Fat Mass ( BFM) and Lean Body Mass (LBM) in the treatment of obesity.Methods: BFM and LBM/BFM relation were examined with imped-ance-measuring apparatus Omron before and after the treatment of obesity in 90 patients. The subjects were divided into 2 groups:Group 1: 52 patients, treated with Orlistat and diet (36 women, 16 men, mean parameters- age 39,4 , body mass-102 kg, BMI - 36,2, BFM- 40,8%, LBM/ BFM- 1,45).Group 2 (control group): 38 subjects, treated only with diet (23 women and 15 men, mean parameters- age 42,1, body mass- 96,8 kg, BMI- 34,3, BFM- 38,7%, LBM/BFM- 1,58).The values of serum lipids and blood sugar were also measured. Results: After a period of 3 months treatment, favourable change in the observed parameters was established in all patients. In those treated with Orlistat, the positive effect is statistically signi cant higher than in the control group.The improvement of BFM, respectively LBM/BFM, in group 1 is 17,8%, and in group 2 - 10,9% after a period of 3 months.Conclusion: The treatment of obesity with Orlistat has a favourable effect not only for BM, BMI, seum lipids, and glycaemia, but also in BFM and LBM.

T5:P5a-014NUTRITION KNOWLEDGE IN THE OVERWEIGHT AND OBESE DOES NOT PREDICT INCLINATION TO ATTEMPT WEIGHT LOSSHankey Catherine1, Lee Annie1, Leslie Wilma1, Lean Michael1, McCombie Louise21University of Glasgow; 2Counterweight Project, Glasgow, UK

Introduction: Anecdotal evidence suggests that improving nutritionknowledge is often the main focus for weight management in clinicalpractice. However, treatment effectiveness may depend more on indi-vidual readiness to attempt weight loss than understanding of nutrition.Aims: To investigate whether nutritional knowledge is related to readinessto implement weight loss in overweight or obese patients.Methods: A postal questionnaire to assess the (1) nutrition knowledge1

and (2) stage of change (SOC) 2 was sent to a random sample of 100 pa-tients, documented as being overweight/obese, registered with a generalpractice in South Glasgow. All responses were anonymous.Results: The response rate was 47%. Mean nutrition knowledge score was60 SD 13, range 34 90 %. Eleven patients were in the pre-contemplativeSOC (BMI 26.1 SD 2.0 kg/m2), 3 in contemplation (BMI 30.2 SD 3.8kg/m2), 31 in action (BMI 30.4 SD 4.3 kg/m2) and 2 in maintenance (BMI29.2 SD 0.6 kg/m2). Although no relationship was found between nutri-tion knowledge and SOC, obese patients were signi cantly more likely tobe contemplating or attempting weight loss (p=0.006). Conclusions: The stage of change and BMI appear linked, but differencesin nutritional knowledge do not explain the variations in readiness toimplement weight loss.References:1. Parmenter K, Wardle J 1999 Health Education Research 53 (4) 298-308.2. Prochaska and DiClemente 1982 Psychotherapy 19 (3) 276-287.

T5:P5a-015EFFECTS OF GROUP COUNSELLING INTENSITY ON WALKING BEHAVIOUR AND WEIGHT LOSS IN SEVERELY OBESE ADULTS Hemmingsson Erik1, Page Angie2, Rssner Stephan11Obesity Unit, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden; 2Dept of Exercise & Health Sciences, University of Bristol, UK

Aims: To study the impact of group-counselling intensity on walking behaviour and weight loss in severely obese adults.Methods: Two-armed, prospective, randomised clinical trials, with 66 obese adult outpatients (13m, 53w; BMI M sd: 41.7 5.7; age: 42.7 12.0). Additional group counselling (20 weeks) was added to a conventional obesity-SBT programme during the second semester. The between-arms difference was group-counselling intensity: meeting volume (10 vs 5 meetings), frequency (2 vs 4 week interval), duration (120 vs 60 min), and size (8 vs 16 participants) - a resource ratio of 4:1. Stepsday-1 were reported in ten 7-day activity diaries every other week during the second semester. Intention-to-treat analysis was used. Results: Drop-out was 25.2% at the end of the second semester (11 in the high-intensity group and 6 in the low-intensity group, p=0.087). During the 20 weeks, the high-intensity group on average walked 9001 stepsday-1 (95% CI: 7896-10106). The corresponding fi gure for the low-intensity group was 6606 stepsday-1 (5569-7644) (F 10.8, p29.Method: A total of 2218 obese females were either self or GP referred.All had a medical examination before starting the Programme. Age range 18 to 69.Start weight between 68.5kg and 224 Kg.Mean start weight 100.7 Kg.Results: Of the 2218 starters, 71.9% (1594) completed 10 weeks. The meanweight loss of these was 1.318 Kgs per week (13.18 Kgs in 10 weeks).57% (893) of those clients went on to complete Phase 1 (100 days). Meanweight loss of Phase 1 completers was 1.342 Kgs per week. Mean weightloss of Phase 1 completers at the end of 14 wks was 18.8 Kgs.Conclusions: Training enables people to work with VLCDs and CBT is aneffective method of weight loss in the community.

Abstracts

S136

International Journal of Obesity

T5:P5a-017FOUR-COMPARTMENT CELLULAR LEVEL BODY COMPOSITION MODEL: COMPARISON OF TWO METHODS DIFFERING IN COST AND COMPLEXITY.Heyms eld Steven B1, St-Onge Marie-Pierre1, Wang Jack1, Pietrobelli Angelo2, Wang ZiMian11St. Lukes Roosevelt Hospital, Columbia University, NY, USA; 2Ped. Unit, Verona University Medical School, Verona, Italy

Introduction: Dual-energy X-ray absorptiometry (DXA) permits measure-ment of bone mineral (Mo), lean soft tissue (LST), and fat. Although widely used as a measure of metabolically active tissue, LST includes non-energy-producing extracellular uid (ECF) and extracellular solids protein (ECS) in addition to energy-producing body cell mass (BCM). Aim: To compare 2 approaches for developing a DXA-based 4-compart-ment (BCM + ECF + ECS + fat) cellular level model that differs in cost and complexity [model 1: BCM from total body potassium (TBK) by whole-body counting; ECF = LST-BCM; ECS and fat from DXA; model 2: ECF and BCM from D

2O dilution (i.e., total body water, TBW) and Br; ECS and

fat from DXA]. Results: We compared BCM and ECF estimates using the two models in 105 healthy men and women. There was a good correlation between ECF estimates by the two models (r2=0.58, p

T5:P5a-021COMPARISION OF TREATMENT OF ADIPOSITY BY DIFFERENT METHODS.Ivanova Lioudmila A.Kuban Medical Academy, Krasnodar, Russia

Aims: To compare the effi ciency of treatment with a diet, physical activity; with a diet, physical activity, Orlistat; with a diet, physical activity, Orlistat, Metformin.Methods: A total of 62 patients, 34-56 years, with adiposity have been divided into 3 groups: I - 20 persons were treated with a diet, physical activity; II - 21 persons - a diet, physical activity, Orlistat (3 months); III - 21 persons - a diet, physical activity, Orlistat, Metformin (3 months) with subsequent transition to a diet, physical activity (I, II) and Metformin (III). All patients received high-protein, hypolipidemic diet. A weight, body mass index (BMI), waist circumference (WC), appetite, a carbohydrate and lipid metabolism, blood pressure (BP), HOMA-IR, and oral glucose tolerance test (OGTT) were measured initially and at 3 and 12 months.Results: At 3 months, more expressed positive dynamics was marked in groups II, III in comparison with I, with a valid difference of weight, BMI, WC, of cholesterol, triglyceride levels, number of food intakes without a valid difference between group II and III. The valid decrease in BP was found in all the 3 groups. In group III, HOMA-IR decreased (p25 lost most weight, butthey used the program less often than the more normal weight group.Conclusions: An IW seems to be an effi cient alternative to those whocannot get help from other support systems. With an IW, it is possibleto treat numerous subjects extremely cost-effectively. The databasewill provide a unique opportunity to evaluate factors of importance formaintained weight loss.

T5:P5a-023INFLUENCE OF SIBUTRAMINE ON BLOOD PRESSURE: EVIDENCE FROM TWO PLACEBO-CONTROLLED TRIALS WITH HYPERTENSIVE OBESE PATIENTS IN GERMANYJordan Jens1, Scholze Jrgen2, Matiba Bernd3, Wirth Alfred4, Hauner Hans5, Sharma Arya M.61Franz-Volhard Clinical Research Center, Charit, Berlin; 2Outpa-tient Department, Charit, Berlin; 3Abbott GmbH, Ludwigshafen; 4Teutoburger-Wald-Klink, Bad Rothenfelde; 5Else-Krner-Fresenius-Zentrum fr Ernhrungsmedizin, Mnchen, Germany; 6McMaster University, Hamilton, Canada

Aims: To determine the effect of sibutramine treatment on blood pressure in obese subjects with different degrees of hypertension (normotension, grade 1 and 2 hypertension, isolated systolic hypertension (ISH)). Methods: Meta-analysis of two clinical trials with 1336 pat.Results: Sibutramine reduced body weight regardless of basal blood pressure. In the complete set of patients, systolic blood pressure did not change with either intervention over a 48-week period (-0.115.5 mmHg with sibutramine, -0.215.2 mmHg with placebo, p=0.9). The change in diastolic blood pressure was 0.39.5 mmHg with sibutramine and 0.89.2 with placebo (p=0.049). The blood pressure response was not exacerbated in patients with grade 1 or grade 2 hypertension or in patients with ISH. Blood pressure changed to -2.815/-4.5 9.8 mmHg with sibutramine and -1.414/-5.79 mmHg with placebo, -7.715/-4.29.2 mmHg and -1122/-6.612 mmHg, -8.113/1.98.7 and -515/0.56.9 mmHg in patients with grade 1 and 2 hypertension and with ISH, respectively.Conclusions: Sibutramine treatment is unlikely to elicit a major increase in blood pressure even in hypertensive patients. However, blood pressure and heart rate should be monitored closely.

T5:P5a-024ASSOCIATION OF CHANGES IN MACRONUTRIENT AND CALCIUM INTAKES WITH BODY WEIGHT CHANGE IN OBESE SUBJECTSKabrnova K., Braunerova R., Aldhoon B., Hlavaty P., Wagenknecht M., Kunesova M., Parizkova J., Hainer V.Obesity Management Ctr., Endocrine Institute, Prague, Czech Republic

Aims: To evaluate the association between body weight change andchange in the consumption of macronutrients, calcium and phosphorus inresponse to the weight-reduction regime.Methods: Two hundred and eight obese subjects (BMI: 40.0+7.6, bodyweight: 112.8+25.6, age: 46.7+12.3) were followed during the weightmanagement lasting 3-6 months. Patients were prescribed a diet with a500 kcal daily de cit related to calculated total energy expenditure, halfan hour daily walking and regular dietary records and monthly check-upsby dietician. Energy and nutrient intake was evaluated from a one-weekfood record utilizing the PC programme. Nutrition intake was both at thebeginning and at the end of weight-reduction regime. Partial correlationsbetween the change in body weight and change in nutrient intake werecalculated.Results: Change in body weight was positively related to the change infat intake (r = 0.220, p = 0.002) and phosphorus intake (r = 0.195, p =0.006) and negatively related to the change in protein intake (r = -0.289, p= 0.000) and calcium intake (r = -0.210, p = 0.003). On the other hand, nosigni cant association with the change in carbohydrate intake and changein body weight was observed.Conclusion: In contrast to the change in fat intake, changes in proteinand calcium consumption are inversely related to body weight change inresponse to the negative energy balance.Supported by grant of the Czech Ministry of Agriculture QF3166 andgrant COST B17-40.

Abstracts

S138

International Journal of Obesity

T5:P5a-025WEIGHT LOSS AND SLEEP APNEA SYMPTOMSKaukua Jarmo1, Pekkarinen Tuula1, Sane Timo2, Mustajoki Pertti11Peijas Hospital, Helsinki, 2Meilahti Hospital, Helsinki, Finland

Aims: To assess sleep apnea symptoms and health-related quality of life during and after weight loss in patients with sleep apnea using patients without sleep apnea as a control group.Methods: The sample included 11 patients with (S group) and 53 with-out (N group) sleep apnea. The mean BMI was 43 in S and 42 in N. The weight-loss program included 4 months of weekly group visits with ini-tial 10 weeks on VLED. Daytime sleepiness was measured by Epworth Sleepiness Scale (ESS), quality of life by Obesity-related Psychosocial problems scale (OP). Weight, ESS, and OP were measured at baseline, 4 months, and at 1 and 2 y after the end of weight-loss program.Results: At 4 months, the mean+/-sem weight change was 9.9(1.7)% in S and 13.2(0.8) in N, and at 2 years 5.1(2.3) in S and 2.0(1.1) in N (p=0.05). There were no between-groups differences in weight-loss success (proportion of those with 5% or more maintained weight loss). The mean+-sd ESS score at baseline was 11.7(2.7) in S and 4.1(2.7) in N. In sleep apnea group at 4 months, the score decreased to 7.8(4.0), and at 2 years the score was still at a reduced level 6.2(3.6). The score did not change in N (p

T5:P5a-029THE EFFECT OF A LOW-CARBOHYDRATE DIET ON WEIGHT LOSS AND INSULIN SENSITIVITY IN MILDLY OBESE ADULTS

Komorowski Joanna1, MacLaren Robin2, Murrin Jane3, Schuller Graham31Concordia University, Montreal; 2McGill University, Montreal; 3Uni-versity of Ottawa, Canada

Aims: The aim of the study was to investigate the effect of a low-carbohy-drate (CHO), ad libitum diet on body weight and insulin sensitivity indica-tors in mildly obese adults. Methods: Eleven males and 13 females, age 240.7, body fat 291.4%, were tested before and after 14 days on a low CHO diet. Food diaries (3-d) and fasting blood samples for insulin sensitivity index (HOMA) and nega-tively associated with insulin sensitivity plasma NEFA, phospholipid (PL) FA (SFA, MUFA and PUFA) and triglycerols (TG) were collected before and after the diet. Results: Daily caloric intake on the diet was reduced by 37%. CHO intake decreased from 48% to 7% and protein increased from 16% to 34% total kcal/day. The dietary contribution of fat increased from 36% to 59% total kcal/day; however, absolute fat intake did not differ (10614 vs. 99.67.7 g/day) and % contribution of MUFA, PUFA and SFA remained unchanged on the diet. A signifi cant (p

T5:P5a-033LIPID-LOWERING EFFECT OF ORLISTAT IN FILIPINO PATIENTS: AN RCT STUDYLitonjua Augusto1, Sy Rody21Makati Medical Center, Makati City; 2Cardinal Santos Medical Center, San Juan, Metro Manila, Philippines

Aims: Is there signifi cant lowering of total cholesterol and/or LDL-cho-lesterol in hypercholesterolemic overweight/obese patients who received orlistat+diet compared to placebo+diet? What is the tolerability of orlistat to these subjects? Methods: Randomized, double-blind, placebo-controlled, parallel,multi-center study,with 586 patients, M/F,18-65 years old; BMI > 25;with choles-terol 6.21 mmol/L and/ or LDL 3.36 mmol/L. Patients were randomized to orlistat (n=286) or placebo (n=300) tid po for 3 months, and advised AHA step I diet, keep a food diary, 30-minute daily walking, and clinic visits at 4-week intervals. Intent-to-treat analysis was performed. Results: Demographics, clinical data, weight, BMI, cholesterol and lipid profi le, compliance to clinic visits, drug intake, exercise, and submission of diet diaries were comparable in both groups. Orlistat subjects had signifi cantly greater reduction of body weight (p=0.001) and cholesterol/ LDL blood levels (p

T5:P5a-037EFFECT OF A WEIGHT-MANAGEMENT PROGRAM ASCRIBING TO A HEALTH-CENTERED PARADIGMMongeau Lyne1, Gauvin Lise2, Rivard Michele21Institut national de sant publique du Qubec, Montral, Canada; 2Groupe de recherche interdisciplinaire en sant & Department of Social and Preventive Medicine

Aims: The purpose of this research was to evaluate the effects of About losing weight?, a program ascribing to the Health at Any Size Paradigm (H@AS) on eating behaviors, body image, self-esteem, self-ef cacy, physical activity involvement and body mass index. The role of decision-making was also examined.Methods: The study used a quasi-experimental design. The interven-tion was offered to middle-aged, obese women who were chronic dieters (n = 286). The program, which was offered at local community health centers, consisted of four months of weekly health education and group discussions focused on a nondieting approach to weight loss. Results: The program resulted in signi cant and sustained improve-ments in body image, as well as less stable improvements in emotional eating and self-esteem. At 12 months, improvements in dieting, self-ef cacy, and depression were also observed. There were no signi cant reductions in body mass index although a greater proportion of persons in the control group increased their weight. Decisional status acted as a moderator in that women in the experimental group who, by the end of the intervention, had made an informed decision about weight loss experienced greater improvements in psychosocial outcomes. Conclusions: In the context of a healthy weight-management interven-tion, women who participate in the program and make an informed decision about weight loss had greater improvements in body image, emotional eating, and bulimic tendencies.

T5:P5a-038EFFECT OF PEANUT OIL ON METABOLISM AND THERMOGENESIS IN OVERWEIGHT SUBJECTSMonteiro Jose na Bressan Resende1, Coelho Sandra Bragana1, Salles Regiane Lopes1, Paiva Aline Cardoso de1, Costa Neuza Maria Brunoro1, Mattes Richard21Universidade Federal de Viosa, Viosa, Brazil; 2Purdue University, West Lafayette, USA

Aims: The purpose of this study was to evaluate the effects of mono-unsaturated fatty acids (MUFA) on energy expenditure.Methods: A total of 24 subjects (12 men and 12 women) with a BMIof 28.153.26, age 34.21 7.47 years, ingested a load correspondingto 30% of their BMR as peanut oil in milk shake for 8 weeks. Basalmetabolic rate (BMR) and diet-induced thermogenesis (DIT) weremeasured using indirect calorimetry, at the beginning and at the endof the study, and these were related to lipid pro le.Results: A weight gain was observed; however, this was only 39.16%of the expected weight gain. HDL-C of the volunteers was statisti-cally higher after 8 weeks of the study; however, there was registeredan increase (7.50 mg/dL) in the rst 4 weeks, followed by a decrease(5.50 mg/dL) up to the 8th week. BMR was also signi cantly higherafter the study, even after correction by weight. No signi cant differ-ences were observed for DIT, diet composition and physical activityduring the study.Conclusions: Monounsaturated fatty acids increase BMR but not al-ter DIT. Further studies are necessary to evaluate the effects of peanutoil-containing MUFA not in addition to the diet, but as a substitute ofsaturated fatty acids.Supported by: USAID-LAG-G-00-96-90013-00.

T5:P5a-039DIETARY ADVICE FOR PREVENTION OF TYPE 2 DIABETES MELLITUS IN ADULTSMoore Helen1, Summerbell Carolyn1, Hooper Lee2, Johnstone Paul3, Ashton Vicki1, Kopelman Peter41University of Teesside, UK; 2University of Manchester, UK; 3Depart-ment of Health, UK; 4University of London, UK

Aims: To assess the effect of type and frequency of different types of dietary advice to all adults on morbidity, weight, quality of life, total mortality and measures of diabetic control. Methods: We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, bibliographies and contacted relevant experts. All randomised controlled trials, of six months or longer, where dietary advice was the main intervention in adults with type 2 diabetes mel-litus, were included. Results: Fourteen articles reporting nine trials were included. The di-etary approaches looked at included low-fat, low-cholesterol dietary advice and reduced energy diets. Two trials compared the usual dietary habits with a low-fat diet. Six studies compared dietary advice with di-etary advice plus exercise and one other study looked at dietary advice versus dietary advice plus a behavioural approach. All the studies mea-sured weight and glycaemic control, although not all studies reported these. Four studies reported the number of participants who developed diabetes and only two studies reported mortality. Other outcomes measured in these studies included blood pressure, serum cholesterol (including LDL and HDL cholesterol), serum triglycerides, maximal exercise capacity and compliance. Conclusions: Adoption of regular exercise is a good way to promote better glycaemic control in adults. There is a need for well-designed studies that examine a range of interventions.

T5:P5a-040DIETARY ADVICE FOR TREATMENT OF TYPE 2 DIABETES MELLITUS IN ADULTSMoore Helen1, Summerbell Carolyn1, Hooper Lee2, Cruickshank Kennedy2, Vyas Avni2, Johnstone Paul3, Ashton Vicki1, Kopelman Peter41University of Teesside, UK; 2University of Manchester, UK; 3De-partment of Health, UK; 4University of London, UK

Aims: To assess the effect of type and frequency of different types ofdietary advice to all adults with type 2 diabetes on morbidity, weight,quality of life, total mortality and measures of diabetic control.Methods: We searched The Cochrane Library, MEDLINE, EM-BASE, CINAHL, AMED, bibliographies and contacted experts. Allrandomised controlled trials, of six months or longer, where dietaryadvice was the main intervention in adults with type 2 diabetes mel-litus, were included. Results: Thirty-six articles reporting eighteen trials were included.Various dietary approaches were looked at. Nine studies looked at di-etary advice versus another diet. Six studies compared dietary advicewith dietary advice plus exercise and three other studies looked atdietary advice versus dietary advice plus behavioural approaches. Allthe studies all measured weight and glycaemic control although notall studies reported these. Other outcomes measured in these studiesincluded mortality, blood pressure, serum cholesterol (including LDLand HDL cholesterol), serum triglycerides, maximal exercise capac-ity and compliance. Conclusions: Adoption of regular exercise is a good way to promotebetter glycaemic control in type 2 diabetic patients. There is a needfor well-designed studies that examine a range of interventions,although there is one promising study currently underway.

Abstracts

S142

International Journal of Obesity

T5:P5a-041HAS THE ANALYSIS OF 24-HOUR DIETARY RECALL (DR) PRIOR THE BEGINNING OF THE DIET THERAPY ANY PREDICTIVE VALUE FOR FRUITFULNESS OF WEIGHT LOSS? Mullerova Dana1, Matejkova Dagmar1, Muller Ludek1, Celakovsky Jan21Charles University, Medical Faculty in Pilsen, 1st Internal Clinic of Fac-ulty Hospital in Pilsen; 2Institute of Hygiene, Czech Republic

Aims: To evaluate the predictive value for fruitfulness of weight loss, and future compliance to the low-calorie diet (LCD) from the results of DR from the previous day before starting the low-calorie diet therapy and to compare results of DR of obese (DRo) with the results of DR of non-obese (DRc).Methods: 81 randomly selected obese females were during their 1st visit in the obesity treatment centre asked for their DR from the previous day (DRo), as well as their BMI was set. They were recommended to keep LCD (1200 kcal, 20% calories from fat) and were examined (BMI) after 3 months. The control sample was created from age-matched healthy non-obese 250 females. Energy and nutritional content from all DRs were analysed using NutriDAN software. Dependence of BMI reduction upon nutritional results from DRo was investigated using a linear regression model. T-test of DRo between drop-out patients and ongoing patients after 3 months, as well as comparison of DRo with DRc were performed.Results: There was found only a weak negative correlation between total energy intake and reduction of BMI (cor. coef: 0.004, t-stat: 1.93; P-value 0.059). There was no con rmation of difference in the DR of drop-out patients and ongoing patients. The mean values of energy, protein, fat, carbohydrates and other nutrients reached only 72-77% of the mean values of DRc. Conclusions: We found no evidence that analysis of DR has a signi cant predictive function for weight loss, probably because of low validity of DR reported by obese persons.

T5:P5a-042OPPOSING EFFECTS OF CALCIUM AND CALORIC INTAKE ON WEIGHT REGAIN AFTER DIETOchner Christopher N., Lowe Michael R.Drexel University, Philadelphia, Pennsylvania, USA

Aims: The purpose of these analyses was to determine the relation-ship between calcium and caloric intake (as predictors) and weightregain following a weight-loss diet.Methods: In all, 103 women lost weight (M = 9.6 kg) on a mealreplacement-supplemented diet over a 6-month period. Caloric in-take and calcium intake were both assessed using the Block FoodFrequency Questionnaire at 6 months (post-treatment) and at an18-month follow up. All treatment ended at 6 months. Using changescores from 6 to 18 months, a regression analysis examined the re-lationship between changes in calcium and caloric intake and weightchange (the outcome variable).Results: When tested individually, neither change in calcium intakenor change in caloric intake was associated with change in weight.However, when entered simultaneously, increases in caloric intakepredicted increased weight regain and increases in calcium intakepredicted decreased weight regain after the diet. Thus, each variablewas predictive in the expected direction only when controlling for theother variable (a dual suppressor effect).Conclusions: Increases in caloric intake produce both greater weightgain and higher calcium intake. However, greater calcium may op-pose weight gain, canceling out the effect of higher caloric intake.Therefore, when entered singly, neither variable predicts weightchange. However, when holding the other variable constant, a posi-tive relationship between caloric intake and weight gain, as well asa negative relationship between calcium intake and weight gain, isrevealed.

T5:P5a-043COST EFFECTIVENESS OF MEAL REPLACEMENT PRODUCTS IN WEIGHT CONTROLOReilly Jacqueline , Carr Louise, West PeterYork Health Economics Consortium, University of York, UK

Aims: In a recent trial, GPs patients did not achieve weight loss through diet and lifestyle modi cations alone, which suggests that additional weight management tools are necessary (Moore et al., BMJ 2003;327). This paper conducts an economic evaluation of partial meal replacements (PMRs), compared to the anti-obesity pharmaceuti-cal agent, orlistat. Methods: The study examined the cost and ef cacy of PMRs com-pared to orlistat using cost utility and cost effectiveness models. The perspective of the study was that of the UK National Health Service (NHS). Data from published sources were used to populate a Markov model, estimating the costs and bene ts of the two treatments for 1,000 patients over 1 year. Two scenarios were examined. The rst assumed that NHS resource utilisation for a PMR regime was similar to that of a traditional reduced-calorie diet. The second scenario involved mini-mal medical input for PMR one initial GP visit prior to commencing treatment. Results: PMRs yielded slightly better results than orlistat in weight loss (74% of PMR subjects lost 5% of initial body weight compared to 53% of orlistat), improvements in quality-adjusted life years (0.0066) and the impact of weight on quality of life score (0.8). Of more signi -cance was the cost difference: PMR was less costly than orlistat in both scenarios (resulting in savings of over 500 per patient over 1 year). Conclusions: Under the assumptions and data in this study, PMRs were found to be cost-effective relative to orlistat for weight loss, making them a potentially worthwhile programme for consideration by GPs.

T5:P5a-044THE ROLE OF ENERGY EXPENDITURE PREDICTION EQUATIONS IN A WEIGHT MANAGEMENT CLINICORiordan Christina, Metcalf Brad, Alba Sandra, Noble Louise, Perkins Jenny, Wilkin TerencePeninsula Medical School, Plymouth, UK

Aims: The national obesity forum recommends a 500kcal de cit of en-ergy requirements to achieve appropriate weight loss in the overweightand the obese. We compared four energy expenditure prediction equationswith measured resting energy expenditure (REE) by indirect calorimetry(IC) across a range of BMI, in order to evaluate their predictive value forindividuals attending a weight management clinic.Methods: IC was used to measure REE in 196 adults (28 male, 168 fe-male, mean age 28.9 6.4.yrs) with a BMI ranging from 19 to 67kg/m2.REE was calculated using the Scho eld (S, 1985), Harris & Benedict (H&B, 1919), James and Lean (J&L, 1986) and WHO (1985) energy expen-diture prediction equations.Results: The mean REE by IC, S, H&B, J&L and WHO were 1934, 1983,1933, 2001 and 1966 kcals/day, respectively. Paired t-tests between meth-ods demonstrated signi cant differences between IC and S (p=0.034) andIC and J&L (p=0.003). An increasing BMI had only a slight effect on thedifference between IC and S (+65kcals/10 units BMI, p=0.02). However,the variance was large and the estimated REE in an individual with a BMIof 35 could lie anywhere from 661kcals above the IC measure to 618kcalsbelow it. Individual precision was not better for the other equations: J&L67 634 kcals, H&B 1 584kcals, WHO 32 614kcals.Conclusion: Prediction equations offer a quick assessment of energyrequirements needed for hypocaloric diets. In reality, however, they runthe risk of randomly offering excessive restriction or weight-gainingprogrammes. Dietetics is a science and its successful practice demandsreliable tools.

Abstracts

S143

International Journal of Obesity

T5:P5a-045EFFECTS OF ENCAPSULATED GREEN TEA EXTRACT AND CAFFEINE ON 24H ENERGY EXPENDITURE AND FAT OXIDATION IN MENPelletier Catherine, Brub-Parent Sonia, Tremblay AngeloDivision of Kinesiology, Laval University, Qubec, Canada

Aims: It has been reported that green tea has a thermogenic effect, due to its caffeine content, and probably also to the catechin epigallocatechin-3-gallate (EGCG). The main aim of this study was to compare the effect of green tea extract containing a xed dose of caffeine and variable doses of EGCG on 24h energy expenditure and fat oxidation. Methods: Fourteen subjects took part in this randomized, placebo-con-trolled, double-blind, crossover study. Each subject was tested 5 times in a metabolic chamber to measure 24h energy expenditure, substrate oxidation and blood pressure. During each stay, the subjects ingested a placebo or capsules containing 200 mg of caffeine and a variable dose of EGCG (90, 200, 300 or 400 mg) 3 times/day, 30 minutes before controlled meals. All subjects received the 5 doses and treatment order was randomized. Results: The 24h energy expenditure increased signi cantly by about 750 kJ with any dose of EGCG compared to placebo. No effect of the green tea extract was observed for lipid oxidation. Systolic and diastolic blood pressure increased by 6-9 and 4-6 mmHg, respectively, with EGCG compared to placebo. This increase was signi cant only for 24h diastolic blood pressure. Conclusions: The main nding of this study was the increase in 24h energy expenditure with the green tea extract. However, this increase was similar with all doses of EGCG.This research was supported by MuscleTech Research & Development, Inc.

T5:P5a-046A COMBINED APPROACH FOR THE TREATMENT OF OBESITY WITHIN PRIMARY CARE SETTINGPlumis Nikolaos1, Tzortzis Emmanuel1, Sakka Irene1, Philalithis Anastasios21Hersonissos Medical Center, Hersonissos; 2Dept of Social Medicine, Medical School, University of Crete, Heraklion, Greece

Aims: The incidence of obesity is increasing in modern society. Most physicianstreat the consequences of obesity (i.e. diabetes, hypertension), but may fail to ad-dress obesity for many reasons. The aim of this study is to assess the possibility ofa combined approach for the treatment of obesity and healthy-weight maintainancewithin the primary care setting.Methods: Obese patients (Body Mass Index (BMI) >30) visiting the public MedicalOf ce of Hersonissos were recruited after consenting to participate in the project.All patients gave a detailed medical history, received complete physical examinationand blood tests including cholesterol and thyroid function tests. Orlistat with speci cdietary instructions were administered to the patients. Patients had weekly coursesof group therapy, which included measurement of their weight, and were encouragedto continue their efforts.Results: Thirty ve obese patients (all women) were recruited, their mean ageranged from 17 to 60 years (mean 42 years). Baseline weight of subjects averaged85 15 kg. BMI at baseline was 333 kg/m2. The comorbid conditions at baselineincluded low back pain (8/35), hypercholesterolemia (7/35), hypertension (5/35),type II diabetes (3/35). Thirty patients completing 3 months in this program lostan average of 4.5 Kg. For 27 patients who completed 6 months, the weight losscontinued, with an average loss of 8.5 Kg from baseline weight. For 23 patients whocompleted 9 months, the weight loss was 11.3 kg. The above patients reported a highdegree of satisfaction and agreed that the group therapy sessions were very helpful.No major side effects from the use of orlistat were observed.Conclusion: Primary health care physicians are in a unique position to reach allsegments of a population, and therefore can provide a stable of ce-based approachfor weight management and disease prevention. Effective weight managementincludes pharmacological treatment combined with group therapy techniques.The latter permits a more frequent examination of patient weight, and provides aphysician-aided support system for the obese people.

T5:P5a-047THE ESTIMATION OF EFFECTIVENESS OF DIET FOR PATIENTS SUFFERING FROM OBESITYPogozheva Alla V., Denissova Natalia N., Baturin Alexander K.The Institute of Nutrition, Moscow, Russia

Aims: To con rm the effectiveness of dietary treatment for patients with cardiovascular diseas`es under the condition of obesity, for further development of an adequate individual diet. Methods: We have examined 140 patients with obesity aged from 32 to 70 years. Within the framework of the comprehensive clinical exami-nation of the patients, we have made the estimation of anthropometric data and body composition by bioimpedansmetry. To x the individual energy expenditures, we used an accelorometre Caltrac. Food fre-quency was used for dietary assessment. Results: Before treatment, the average diet energy value was 2409142,2 kcal for men, calorie burned - 2217141,8 kcal, including 519 48,3 kcal- owing to motions; for women, it was 2209132,2 kcal, energy spent - 2016114,1 kcal, including 48936,3 kcal- owing to motions. The fat content was 45,6% of energy.In clinical conditions, the patients consumed a diet of about 1700 kcal (fat - 30 % of energy). The calorie burned was 2100 kcal per day. Si-multaneously, patients were trained to principles of a healthy nutrition. In 30 days, the body weight has decreased by 4.6 kg, including 2.3 kg of fat mass.Conclusion: The effectiveness of dietary treatment for patients with obesity must be many-sided and include anthropometric data and the estimation of physical conditions, data physical activity and data on an actual consumption of the patients.

T5:P5a-048FACTORS ASSOCIATED WITH SUCCESSFUL WEIGHT LOSS AND ATTENDANCE AT A COMMERCIAL SLIMMING GROUPPowell Charlie1, Lavin Jacquie2, Russell Jean1, Barker Margo11Human Nutrition Unit and CICS, University of Shef eld, Shef led, UK; 2Slimming World, Alfreton, Derbyshire, UK

Aims: The aim of this study was to examine factors associated with suc-cessful weight loss in new members attending a commercial slimminggroup, Slimming World (SW).Methods: 240 new Slimming World members completed two self-admin-istered questionnaires, one at baseline and one 12 weeks later. These col-lected personal details and information relating to previous weight loss,dieting experience, eating behaviour, motivation, self-effi cacy, and life-style. Weight loss and group attendance was obtained from SW records.Results: The average age of participants was 40yr and BMI = 31.5kg/m2.95% were female. Mean weight loss over the 12 weeks was 4.8kg (6%weight loss). 54% achieved > 5% weight loss, with 15% achieving >10%loss. The mean attendance was 9.7 weeks. 63% were still attending at 12weeks; of these, the average attendance was 11 weeks and weight loss6.2kg (7.3%). Weight loss was positively associated with duration of at-tendance, smoking, ease of adherence to the dietary plan, early weightloss and self-effi cacy. Members who were economically inactive andthose receiving family support were likely to stay in the programme forlonger. Other demographic and lifestyle factors were not predictive ofsuccess. Conclusions: Targets for 5-10% weight loss for health improvement canbe achieved in commercial slimming groups. Compliance to the slimmingplan coupled with early weight-loss success and family support seem tobe the key elements in achieving success in a commercial setting.

Abstracts

S144

International Journal of Obesity

T5:P5a-049COMBINATION WEIGHT-LOSS THERAPIES FOR TYPE 2 DIABETES MELLITUSRaatz Susan K., Redmon J. Bruce, Reck Kristell P., Swanson Joyce E., Kwong Christine A., Thomas William, Bantle John P.University of Minnesota, Minneapolis, MN, USA

Aims: To evaluate the effects over 2 years of a combination weight-loss program on weight loss, diabetes control and cardiovascular risk factors in overweight or obese subjects with type 2 diabetes. We hypothesized that long-term effi cacy of weight-loss therapies would be increased if several weight-loss approaches are combined.Methods: A total of 59 subjects treated with diet or oral medica-tion were randomly assigned to either combination therapy (CT) for 2 years or a standard therapy (ST) for 1 year, followed by a CT in the second year (S/C). All participants received diet, exercise and behavioral instruction as ST. CT consisted of ST plus daily sibutramine; low-calorie diets (LCD) using meal replacements 1 week every 2 months; and, between LCD weeks, once daily use of meal replacements. The outcome measures were body weight, gly-cemic control, plasma lipids, blood pressure, and body composition.Results: In all, 48 participants (23 CT and 25 S/C) completed 2 years. Both groups had signifi cant weight loss from baseline (4.6 1.2 kg CT and 8.1 1.6 kg S/C, P = 0.08). At 2 years, the change in hgb A1c from baseline was 0.5 0.3% CT and 0.3 0.2% S/C (P = 0.61). However, the average reduction in hgb A1c over 2 years was signifi cantly greater for the CT (0.8 0.1% vs 0.2 0.1% CTand S/C, respectively; P = 0.009). At 2 years, CT had signifi cant reductions from baseline in weight, BMI, fat mass, lean body mass and SBP. Conclusions: Use of a combination of weight loss therapies resulted in signifi cant weight loss and improved diabetes control over a 2-year period in subjects with type 2 diabetes.

T5:P5a-050OBESITY & MAINTENANCE-AN INTEGRAL INTENSIVE FOCUS & ITS RESULTS IN A 5 Yr PERIODRavenna Mximo, Olkies Abel, Meaglia DanielTherapeutic Center Mximo Ravenna, Buenos Aires, Argentina

Aims: Obesity has increased in the world rapidly with epidemic ten-dency. We present the need for alternative, integral & more effectivemethods.Method: A group of 190 patients between 25 and 60 years old of bothsexes, which initially presented an obesity BMI of 30 to 55.76 withabdominal visceral obesity and nally reached BMI under 25, wasstudied. All were included in a therapeutic, ambulatory, integrated andintensive program. The task is to reach the ideal weight 5 kg (ad-equate weight). Immediate weight loss based on a nutritional schemeVLCD-SMR (Structured Meal Replacement) between 600 and 800cal., alternating with a period of LCD and therapeutic groups (cog-nitive behavioural therapy) were applied to approach the DependantAddictive Link concept. It emphasizes the importance of the smallservings, adequate distance between each ingestion and the permanentidea of the quick cut in the loss of control. Adapted Physical Activ-ity and telephone follow-up were used to strengthen the MaintenanceProtection Network.Results: After 5 years in the program, there are no data on 20 patients,25 re-gained 20% of the weight lost, 35 re-gained the weight and main-tained contact with the clinic. The 120 remaining kept continuity inprograms with NLP (Neuro Linguistic Programming), adapting the dif-ferent resources to their needs resulting in a long-term maintenance.Conclusion: A WLPII (Weight Loss Plan of Initial High Impact), sup-ported with an integral therapeutic system, results in positive long-termmaintenance.

T5:P5a-051INSULIN SENSITIVITY IN OBESE CHILDREN AND ADOLESCENTS ACCORDING TO DEGREE OF WEIGHT LOSSReinehr Thomas, Andler WernerVestische Kinder- und Jugendklinik Datteln, University of Witten/Herdecke, Germany

Aims: To examine the amount of weight loss required to improve insulin sensitivity in obese children.Methods: We studied changes in insulin sensitivity indices of glucose me-tabolism (ISI-HOMA, ISI-QUICKI) and fat metabolism (ISI-FFA) over a 1-year period in 57 obese children aged 6 to 14 years, who attended an obe-sity intervention program. The children were divided into 4 groups accord-ing to their changes in standard deviation scores of BMI (SDS- BMI): group I: decrease in SDS-BMI >0.5; group II: decrease in SDS-BMI >0.25 -

T5:P5a-053METABOLIC ASSESSEMENT OF TWO HYPOCALORIC DIETS WITH DIFFERENT CONTENT ON FRUCTOSERodrguez M Cristina, Martnez de Morentin Blanca E, Marques-Lpes Iva, Parra M Dolores, Prez Salome, Martnez J AlfredoDepartment of Physiology and Nutrition, University of Navarra, Pamplona, Spain

Aim: A high dietary fructose intake could adversely modulate the me-tabolism. The aim of this study was to investigate the effects of differ-ent fructose content on weight-loss diets.Methods: Twenty healthy women (22-40 years) participated: Five (BMI: 21.81 0.89 kg/m2) constituted the control group and fteen (BMI: 34.94 2.95 kg/m2) were assigned to follow a high-fructose (15% content) or a low-fructose (5% content) hypocaloric diet for 8 weeks. The source of fructose was fruits and vegetables. Before and af-ter dieting, fructose oxidation was measured by (1-13C)fructose breath test, using isotope ratio mass spectrometry. The tracer (1.1 mmol) was administered in fruit juice. Breath samples were obtained before and at 15 minutes intervals during 4 hours after ingestion. Results: The intervention decreased body fat mass (high: -2.31.7% p = 0.020; low: -2.71.9% p=0.007), but no statistically signi cant differences were found between diets (p=0.660). At baseline, lean (25.53.9%) and obese (24.55.4%) women oxidized a similar (p= 0.715) percentage of (1-3C)fructose, and this oxidation did not change after high (before diet: 24.53.9% after diet: 22.83.8% p = 0.405) or low (before diet: 23.76.7% after diet: 22.06.9%p = 0.150) fructose hypocaloric diets.Conclusions: Fructose intake did not affect weight reduction and fruc-tose oxidation in obese women fed hypocaloric diets.

T5:P5a-054RELATIONSHIP BETWEEN WEIGHT REDUCTION, CONTROL OF HYPERTENSION AND REGRESSION OF LEFT VENTRICULAR HYPERTROPHYRosu Doina, Ivan Viviana, Turcan Marius, Bordea MariaAcademic Hospital Timisoara, Romania

The aim of the study was to assess the relationship between weight re-duction, good control of hypertension and regression of left ventricularhypertrophy (LVH) in hypertensive and obese patients (P), knowing theinvolvement of the two characteristics in the pathogenesis of LVH.In all, 34 hypertensive P in II-III stage (20 male), mean age 55.98with severe obesity (BMI = 35.75.6 kg/m2) and LVH (left ventricularmass index LVMI=164g/m2; Penn convention) have been treated withantihypertensive drugs and hypocaloric diet (20 P- group I). The rest 14P (group II) received Xenical (orlistat).Echocardiography (2D, Doppler), EKG, ambulatory blood pressuremonitoring (ABPM) and laboratory tests were performed at the begin-ning of the study and every three months. The follow-up period wasone year.Results: Systolic and diastolic blood pressure values were reducedfrom 16836 to 13811 mmHg, respectively, 10227 to 8511 mmHg,p

T5:P5a-057EARLY CARBOHYDRATE DISTURBANCES IN PATIENTS WITH METABOLIC SYNDROMEShamansurova Zulaykho, Shamansurova ZulaykhoEndocrinology, Tashkent, Uzbekistan

Background and aim: Metabolic Syndrome (MS) viewed as an early stage of Diabetes Mellitus (DM). Early-detection MS may be useful in prevention of becoming the following stage DM. There are many diagnostic tests that were suggested for detection of MS and optimal test, which are not yet found even today.Material and methods: Anthropometric parameters (BMI), Standard oral glucose tolerance test (GTT), HbA1c, and erythrocyte glucose uptake (EGU) were observed in 12 patients with obesity (O), 16 pa-tients with polycystic ovary syndromes (PCOS), 26 patients with type 2 diabetes mellitus (DM) and 10 healthy subjects (HS). Results: BMI was increased in all group patients other than HS. GTT shows an elevated postprandial level (after 2 hour) of blood glucose of 11.2% (P>0.05) in patients with PCOS, 17.1% (P

T5:P5a-061ILEAL BRAKE EFFECTS ON SATIETY AND MEAL INTAKE IN HUMANS AFTER A MEAL REPLACERSymerski Tomas1, Kee Babette1, Haddeman Edward2, Peters Harry2, Masclee ad11Dept of Gastroenterology, Leiden Univ Medical Center, Leiden, The Netherlands; 2Unilever Health Institute, Vlaardingen, The Netherlands

Aims: Lipids delivered to the ileum activate the ileal brake, resulting in delayed gastric emptying (GE) and small bowel transit (SBT). Effects on satiety are largely unknown, especially at low lipid doses. Hence, we studied the effect of ileal vs. oral delivery of low-dose oil emulsions on satiety and energy intake after ingestion of a liquid meal replacement (MR).Methods: In all, 16 healthy, normal weight volunteers (9 F; mean age 25.8 yr) were intubated with a naso-ileal tube and randomly assigned to 3 days. On one day, subjects drank the MR containing 3 g fat (0.92 MJ; trt A). At t=105 min, the ileum was perfused with a fat-free solution for 45 min. On the other two days, volunteers drank a fat-free version MR (0.82 MJ) and the ileum was perfused at t=105 min with an emulsion containing 3 g (trt B) or 10 g (trt C) saf ower oil. This was repeated during the afternoon (at t=240 the meal, at t=345 the ileal oil infusion). Satiety (using line scales) was measured at regular intervals. Meal intake was assessed at t=490 min. GE (breath 13C-acetate) and SBT (H2 breath after lactulose infusion) were assessed during the afternoon only.Results: Ileal oil perfusion increased satiety both in B and C vs A (p

T5:P5a-065SLEEP, ALERTNESS AND WEIGHT-MANAGEMENT PREDEFINING WORK ABILITYTerttunen Jukka1, Taimela Simo2, Partinen Markku31Finnair Health Services, Vantaa; 2Evalua International Ltd; 3Rinnekoti Research Foundation, Finland

Aim: Airline personnel work irregular working hours. Alertness plays a signi cant role in achieving high-quality customer service and air safety. A questionnaire concerning self-perceived work ability during the next two years is a strong predictor of future absenteeism from work and early retirement. The aim was to assess the determinants of self-perceived work ability. Methods: Previously validated questionnaires inquiring items on lifestyle (body mass index, alcohol consumption, smoking, exercise habits), sleep disturbances (sleep apnea, sleep disorder, daytime sleepi-ness, insuf cient sleep), work-related stress, depression and self-ex-perienced disability due to musculoskeletal problems were used. The subjects included 230 individuals in various airline professions. Discri-minant analysis was used to assess the differences between those who considered themselves able to work and those who were concerned about their ability to continue working. Results: 8,9 % of the study sample reported uncertainty concerning work ability.Conclusions: Those who report uncertainty concerning self-perceived work ability suffer from multiple problems including weight management, sleep, alertness, musculoskeletal and psychological elements.

T5:P5a-066THE EFFECT OF HYPOENERGETIC DIETS WITH A FAT ENERGY PERCENT OF 20-25 OR 40-45 ON BODY WEIGHT, BLOOD LIPIDS, INSULIN AND GLUCOSE IN COMPILANT OBESE SUBThe NUGENOB Consortium Represented by Martin Petersen and Moira A Taylor

Aims: To study the effect of low- and moderate-fat diets on weight loss,blood lipids, insulin and glucose in compliant obese subjects. Methods: Obese subjects (n=771) were randomised to a 10-week dietaryintervention comparing two hypoenergetic diets with a fat E% of 20-25or 40-45, only data from compliant subjects are reported here, n=154 andn=136 resp. Results: The energy intake was 1519 333 kcal/d (mean SD) in thelow- versus 1613 319 kcal/d in the moderate-fat group, p=0.05. Weightloss was 7.2 3.1 kg in the low versus 6.8 3.3 kg in the moderate-fatgroup (ns). Fasting plasma total, LDL, and HDL-cholesterol decreased inboth groups, for HDL more so in the low-fat group, 0.11 0.18 versus0.04 0.18 mmol/l (p=0.002). Plasma triacylglycerol was lowered by0.23 0.63 mmol/l in the moderate-fat group, but was unchanged in thelow-fat group (p

T5:P5a-069THE USE OF METFORMIN AFTER ONE-YEAR SIBUTRAMINE TREATMENT PREVENTS WEIGHT GAIN AND IMPROVES GLUCOSE AND LIPID METABOLISM IN OBESE PATIENTSUcar Edip, Sabuncu Tev k, Yasar Ozgur, Kilic FeryalUniversity of Harran, Department of Endocrinology and Metabolism, Sanliurfa, Turkey

Aims: To evaluate the effect of one-year sibutramine, and subsequently one-year metformin treatment, comparing with only hypocaloric diet, on body weight, glucose and lipid metabolism in obese subjects.Methods: Thirty eight nondiabetic obese subjects, with a body mass index >30 kg/m2, underwent one-year sibutramine treatment; thereafter the patients were randomized in order to take metformin (n:21) or diet treatment alone (n:17) for one year.Results: Sibutramine achieved signi cant improvements in body weight, waist circumference, insulin sensitivity index, AUC-glucose and insulin, total-, LDL- and HDL-cholesterol, triglycerides and uric acid. Subsequent metformin treatment was accompanied by signi cant improvements in body weight, insulin sensitivity index, AUC-glucose and insulin, total- and LDL-cholesterol, and uric acid levels, when compared with the diet group. Conclusions: These results suggest that the use of metformin after one-year sibutramine treatment prevents the weight gain and achieves additional improvements in glucose and lipid metabolism in obese patients.

T5:P5a-070EFFECTS OF WEIGHT REDUCTION ON PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS)Uddn Joanna1, Nerfeldt Pia2, Nilsson Bengt Y3, Rssner Stephan1, Friberg Danielle21Obesity Unit, Karolinska University Hospital, Karolinska Institutet; 2Department of Otology, Karolinska Institutet, Karolinska Universi-ty Hospital; 3Department of Neurophysiology, Karolinska Institutet, Karolinska Univ. Hospital, Stockholm, Sweden

Aims: To evaluate the effects of weight reduction on daytime sleepi-ness, nocturnal respiratory disturbances and metabolic factors in agroup of obese OSAS patients.Methods: A total of 21 obese outpatients (6 w, 15 m) with OSAS(Oxygen Desaturation Index (ODI) >6, median BMI 38.6 (range34.2-47.8), were recruited. Home polysomnography (measuringApnea Hypopnea Index (AHI) and ODI), metabolic factors andEpworth Sleepiness Scale (ESS) were assessed before seven weekslow-calorie diet (LCD), when entering day-care (only ESS) and after3 months behavioural therapy in a day-care setting (AHI and ODI). Results: All 21 patients completed the LCD-period with a medianweight loss of 18 kg (p

T5:P5a-073A COMPLEX OBESITY GROUP TREATMENT PROGRAM AND CHANGES OF BODY COMPOSITION, RESTING ENERGY EXPENDITURE (RRE) AND RQ INDEXZahorska - Markiewicz Barbara, Olszanecka - Glinianowicz Magdalena, ak - Gob Agnieszka, Koceak Piotr, liwa MarekDepartment of Pathophysiology, Medical University of Silesia, Katowice, Poland

Aims: The aim of this study was to assess the infl uence of the complex obesity group treatment program with regular physical activity on changes in body com-position, resting energy expenditure (REE) and RQ.Methods: A total of 27 obese patients (4 male and 23 female), age 48.112.0, were performed a 3-month program consisting of a 2 hour meeting with a physi-cian, psychologist, dietician and physiotherapist every two weeks. All the subjects were prescribed a diet of 1000 1200 kcal/day (fat