The American journal of clinical nutrition
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A major concern with the use of starvation or semistarvation diets for weight reduction in severely obese people has been the reports of sudden death due to ventricular arrhythmias. Obesity per se is associated with cardiovascular changes, including left ventricular hypertrophy and prolongation of the QT interval. ⋯ Copper, potassium, and magnesium deficiencies may play important roles in promoting an electrically unstable heart. Stress, by eliciting autonomic imbalance, may act upon an electrically unstable heart to provoke acute arrhythmias in a subset of the obese population with QT interval prolongation.
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To determine the effect of dietary modification on energy utilization during severely restrictive hypocaloric feeding, we measured body composition, energy deficit, and nitrogen metabolism in 13 obese women housed in a metabolic ward consuming a 2.1-MJ diet for 21 d with the three-carbon compounds dihydroxyacetone and pyruvate (DHAP), partially, isocalorically substituted for glucose. Body composition and amino acid (leucine) oxidation and turnover were determined before and after weight loss. ⋯ Nitrogen balance (urine and stool) and leucine metabolism were similar in both groups. We conclude that partial substitution of DHAP for six-carbon compounds of a 2.1-MJ diet will increase weight and fat loss.
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Review Randomized Controlled Trial Clinical Trial
Clinical studies with fluoxetine in obesity.
Fluoxetine is a highly specific serotonin reuptake inhibitor. In studies that used a dose of 60 mg once daily, fluoxetine-treated patients consistently had greater weight loss than placebo-treated patients. In six double-blind, placebo-controlled studies of 6-8 wk duration, mean weight changes on fluoxetine were approximately 0.5 kg/wk. ⋯ Safety analysis has been performed on data from 3491 obese patients in controlled clinical trials of up to 52 wk duration. Adverse events with an incidence of greater than 5%, which were reported significantly more frequently by fluoxetine-treated patients, were headache, asthenia, nausea, diarrhea, somnolence, insomnia, nervousness, sweating, and tremor. Fluoxetine is effective, well tolerated, and safe in the treatment of obesity and obese diabetics.
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We examined the determinants of resting energy expenditure (REE) in 127 observations in 56 burned children. Predicted basal energy expenditure (PBEE), body surface area (BSA), and body weight correlated significantly with REE (r2 = 0.76). Days postburn and burn size (% BSA burned) only accounted for 21%, and 24% of the variation in the elevation in REE above PBEE. ⋯ When our recently described activity factor of 1.2 for burn patients is used, the data predict that the average energy requirement to maintain energy balance is 1.55 x PBEE, which is significantly lower than commonly used recommendations, especially for larger burns. The energy required to ensure that 95% of patients achieve energy balance was (1.55 x PBEE) + (2.39 xoff+PBEE0.75), approximately equal to 2 x PBEE. Because the equations presented are derived from measurements of energy expenditure, they represent the most valid approach to estimating energy requirements.
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The health risks of obesity increase with its severity and reach significance at a weight greater than 20% above optimal, by using life insurance tables, or at a body mass index greater than 27. Risks include hypertension, insulin resistance and diabetes mellitus, cardiovascular disease, hypertriglyceridemia, low high-density-lipoprotein cholesterol, and, in some studies, high total-and low-density-lipoprotein cholesterol. ⋯ The distribution of body fat is directly related to these health risks. Abdominal obesity is more dangerous than gluteal-femoral obesity because the amount of intraabdominal fat seems to determine much of the increased peril; therefore, risks of cardiovascular disease, stroke, hypertension, and diabetes increase with abdominal obesity, even independently of total fat mass.