|Diet; Obesity; Weight loss; Bio-impedance; Weekly
|Obesity is considered an endemic disease, as widespread in a
population geographically limited. Specifically, obesity is typical
prerogative, even if not exclusively, in Western countries, where about
one third of the population is overweight. The United States had so
far the country “negative guidance”, with approximately 69% of the
population overweight or obese, followed by Australia and Great Britain.
In Europe this condition is nearly 50%, but the problem continues to
worsen rapidly. The WHO has defined this condition a pandemic [1,2].
|The high prevalence of very high Waist circumference in our
study population, especially among women, may be explained by
their seven-fold greater risk of developing central obesity. A study by
Pischon et al.  showed that each 5 cm above WC reference values
increases cardiovascular risk by 13% in women and 17% in men.
However, Sánchez et al.  found that in general women have more
subcutaneous fat in the abdominal region, while men tend to have more
visceral adipose tissue, which may explain their higher risk for chronic
diseases since visceral fat has greater pro-inflammatory characteristics
than subcutaneous fat . According to ISTAT data, in 1999 the Italian
overweight were approximately 33.6% of the population, while the obese
were “only” 9.1%. Since then, the obesity epidemic has not mentioned
slowdowns, so that has now reached the threshold of 10% (9.8%). Also
a growing number of Italian overweight increased from 33.6% in 1999
to the current 34.2%. Obesity is a disease condition characterized by
an excess of fat mass compared to lean body mass, according to the
limits considered normal for age, sex and height. In general when it
comes to obesity: the body weight exceeds the ideal weight of a quantity
equal to at least 20%; or when the body mass index (BMI) is above 30
kg/m [2,6]. Furthermore, studies using doubly labeled water indicated
that individuals with higher than recommended body mass index
(BMI) >25 have a high absolute total energy expenditure as compared to individuals with lower BMI [7-9]. Although the prevalence of
extreme obesity, as defined by BMI ≥ 40, is about 5% in population
of the industrialized world, representing an important increase over
the last 40 years, few studies have investigated the modification of the
obesity status following the subjects with close regular control and
the usual protocol concerns a monthly check of effectiveness of diet
therapy . The aim of this work was to measure the weight loss in
severely obese adults and their respective bodily changes after every
week for six months of monitoring, compared with patients with
monthly monitoring since there are no works that have investigated
such correlation in terms of loss of body weight, and bio-impedance
examination compared with a loss of the same parameters in monthly
check patients with a state of obesity BMI >30.
|Materials and Methods
|All treatments follow the guideline of our Comitato Etico
dell’Azienda Ospedaliera Universitaria of the Second University of
Naples. The study was performed in accordance with the ethical
standards stated in the 1964 Declaration of Helsinki and approved
by the local clinical research ethics committee; informed consent was
obtained from all subjects before examination.
|Male and female subjects (n=80) were enrolled between the subjects
of the Department of Clinical Dietetics at the Second University of the
Studies Naples, Italy, with a height ranging from 1.60 to 1.75 m, so that
the population of all subjects was homogeneous in terms of height.
Subjects aged between 30-40 years avoiding women in menopause
status. The patients do not have diabetes, hypertension, metabolic
syndrome and any thyroid illness. All patients follow a low-calorie diet
therapy. The low-calorie diet of each patient was made keeping in mind
their bioelectrical impedance (BIA), their energy expenditure related to
daily physical activity level (PAL) or Integrated Energy efficiency index
(IEI), as reported by Human energy requirements-Report of a joint
FAO/WHO/UNU expert Consultation, 2001.The diet was divided into
5 meals, and according to the diagram of the Food Pyramid (extensive
use of fresh vegetables , foods containing fiber), satisfying a calculation
that would lead to a reduced calorie diet divided into about 50%
carbohydrates, about 20% protein, about 30% lipids. Lipids are in turn
subdivided according to the habits of the Mediterranean diet: 1\4 lipids
containing saturated fatty acids, approximately 1\2 of lipids containing
monounsaturated fatty acids, 1\4 lipids containing polyunsaturated
fatty acids (with a ratio between omega-3/omega6 of 5:1).
|Forty patients with First Instance obesity were treated with lowcalorie
diet therapy for 6 months with weekly checks, while other 40
patients were treated with same diet therapy but with the monthly
check. For measurement of weight and height, the two outpatient
clinics followed the methods recommended by anthropometric
standardization reference manual Lohman et al.  using platform
scales (capacity 150 kg in 100 g divisions) with stadiometer (in 1-mm
divisions). Weight and height were then used to calculate BMI, using
the classification recommended by the WHO. WC was measured with
a non-stretch tape measure according to the standards and cut-offs
recommended by the WHO. The subjects were divided into two groups:
the first group with a BMI ranging from 30 to 34.9 kg/m2, and the
second group with BMI >40 kg/m2. Each group was divided into two
subgroups related to sex (n=20 for each subgroup) The subjects used in this study were healthy (do not have diabetes, hypertension, metabolic
syndrome and any thyroid illness) and stable in weight for a period of
three months preceding the study. Each subject had a normal physical
examination. The weight was measured without shoes or clothing to the
nearest 0.1 kg. The participants were fasted overnight for at least 12 h.
|The measurements BIA (bioelectrical impedance) was conducted
between 8:00 to 10:00 am and before the beginning of the measurements
the subjects had rested quietly for 30 min. Body composition was
calculated by bioelectric impedance using an analyzer (Akern BIA-
101/S, Italy). For reasons of brevity, only the percentage of FFM
(calculated as kg of FFM/kg of total body weight × 100) was reported in
this article. The values are presented as means ± SE. Statistical analysis
was performed using the analysis of variance. All texts for comparison
between groups with and those without weekly control were performed
using the non-parametric U test of Mann-Whitney test.
|Taking advantage of the BIA (bio-impedance examination) suitable
for the assessment and body composition analysis we were able to
follow the trend of the weekly Total Body Water (%), Extracellular
Water (%), Intracellular Water (%), Mass lean (%), Fat Mass (%), Basal
|The weight loss of the group with weekly control was 63% higher
(p<0.000) with respect to monthly monitoring regardless of age or sex
of the patients (Figures 1 and 2).
|In both women and men (Figures 3 and 4) the weekly check
produces significant differences by increasing the effects of diet therapy
treatment. Reaching statistical significance not only for the decrease in
body weight but also for the majority of BIA parameters considered
in our analysis. Hence, the exchangeable Na/K increases significantly
(p<0.001 in man and p<0.008 women) in weekly control with respect
to the monthly ones. In both sexes the fat mass weight (p<0.000 in
women and man), BMI (p<0.000 in women and man) and body weight (p<0.000 in women and man) significantly decrease in weekly
control groups with respect to the monthly checked groups. Also the
lean mass weight significantly increases in both sexes (p<0.000) in
weekly controlled groups. As far as it concerns the extracellular and
intracellular water, our results show significative differences only in women checked weekly with respect to the monthly control (p<0.010
and p<0.013 respectively).
|An exception is the basal metabolic rate which increases in men
with weekly check (p<0.000) while in women even decreases.
|Despite the varying definitions it is clear that the incidence of the
obesity is increasing among men and women of all ages and ethnicities
 depending on the wellness of population. The prevalence of obesity
is also increasing worldwide, with the condition predicted to affect
more than one billion people by the year 2020 . The increasing
global prevalence of obesity in children and adults, and its medical and
socio-economic consequences represent a major public health concern.
|Complex gene-environment interactions are certainly contributing
to the current diabesity epidemic. Nutrition and physical activity are
key environmental factors, which potentially interact with genetic
predisposition, to promote the progression and pathogenesis of these
combined environmental and polygenic, diet-related diseases. More
than half of adults in Europe and the US are overweight or obese .
There is no doubt that a genetic component can also impact on the risk
of insulin resistance, the sensitivity to which may be further amplified
by poor diet. At a public health level, more attention must be given to
modification of lifestyles of the general public to reduce risk of obesity.
At a clinical level, individual patients with increased metabolic risk
need to be identified so that their multiple risk factors can be reduced.
Implementation of healthy lifestyle changes in nutritional behavior and
exercise or pharmacotherapy, may be important in reducing disease
|From the nutritional/dietary advice perspective, this paper has
explored the usefulness of close follow in subjects with first type obesity
with respect to the usual monthly or longer monitoring. In our study,
the controls were carried out for a period of six months. With the same
low-calorie diet, diet therapy have placed better to the subjects who
were weekly monitored than those who were monthly monitored. From our data emerges as important result, that obese patients subjected to
continuous monitoring and close in time have the ability to reduce
body parameters more intensely and in a shorter time. It seems obvious
that these results are not attributable only to the type of low-calorie
diet suggested because the same type of diet is also recommended
to those who are monthly checked. This suggests that most likely
the psychological component in patients receiving weekly check
will encourage them to keep the feeding behavior suggested by the
medical specialist in dietetics. Thus, a part the genetic component, the
environmental factors and social conditions, there is also a psychological
component in determining the state of obesity. This suggests that to
achieve the best results from a diet therapy is necessary an ongoing
relationship of trust with the medical specialist in dietetics, to create an
empathy between them in order to get better results. Lastly we suggest
a new approach to obese patients that provides a new protocol in which
the steady-state controls by dietician and the patient’s body parameters
should be performed weekly for faster, longer and more stable results.
|TE, BV, and MM designed research; TE, AN, SA, conducted research; BV
analyzed data; TE, BV, and MM wrote the paper. TE had primary responsibility for
final content. All authors read and approved the final manuscript.
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