Application of Protein-Rich Oriental Diet in a Community-Based Obesity Control Program

PURPOSE: To evaluate the efficacy, safety and availability of a 12-week, community-based obesity control program called the Protein-Rich Oriental Diet (PRO Diet) and to compare it to a conventional diet. MATERIALS AND METHODS: A total of 515 overweight people (55 men and 460 women; mean age 41.9 +/- 9.8 years; body mass index (BMI) 28.1 +/- 3.6 kg/m2) participated in the program at two public health centers. PRO Diet was offered as the main diet recommendation for 12 weeks. As a control group, we selected a population who had followed a conventional diet program conducted at a public health center in 2006. RESULTS: 177 subjects (34.3%) completed the 12-week PRO Diet program. In a per protocol (PP) analysis, the mean changes in anthropometry were (conventional program vs. PRO Diet; weight, - 2.3 kg vs. - 4.7 kg, p < 0.001; BMI, - 1.1 kg/m2 vs. - 1.9 kg/m2, p < 0.001; waist circumference, - 3.3 cm vs. - 6.8 cm, p < 0.001; fat mass, - 2.0 kg vs. - 4.2 kg, p < 0.001; fat % mass, - 1.8% vs. - 3.9%, p < 0.001). The triglyceride reduction was significantly greater (- 30.16 mg/dL, p < 0.001) in the PRO Diet group after intervention compared to the conventional group. CONCLUSION: The PRO Diet was an effective tool for weight loss in a community-based weight control program and well-tolerated.

Difference of Body Compositional Changes According to the Presence of Weight Cycling in a Community-based Weight Control Program

Many obese people who try to control body weight experience weight cycling (WC). The present study evaluated the importance of WC in a community-based obesity intervention program. We analyzed the data of 109 Korean participants (86% women) among 177 subjects who had completed a 12-week intervention program at two public health centers in Korea from April to December, 2007. Completion of a self-administrated questionnaire at baseline was used to obtain anthropometric measurements, and laboratory testing was done before and after the program. Differences in body composition change and obesity-related life style between the two groups were compared with respect to WC and non-weight cycling (NWC). After 12 weeks, both groups showed reductions in weight, waist circumference, and body mass index. The group differences were not significant. However, significant differences were evident for the WC group compared to the NWC group in fat percent mass (WC vs. NWC, -3.49+/-2.31% vs. -4.65+/-2.59%, P=0.01), fat free mass (WC vs. NWC, -0.95+/-1.37 kg vs. -0.38+/-1.05 kg, P=0.01), and total cholesterol (WC vs. NWC, -3.32+/-14.63 vs. -16.54+/-32.39, P=0.005). In conducting a community-based weight control program that predominantly targets women, changes of body composition and total cholesterol may be less effective in weight cyclers than in non-weight cyclers.

Patterns of Complementary and Alternative Medicine Therapies in Patients with Chronic Fatigue or Pain / 가정의학회지

BACKGROUND: It is well-known that patients with chronic fatigue or frequent pain seek complementary and alternative medicine therapies (CAT) in Western countries. We conducted this study to determine the pattern of CAT use and the factors related to CAT use in patients with chronic fatigue or pain in Korea. METHODS: This was a cross-sectional study. The participants (n = 143) with chronic fatigue or pain completed a self-reported questionnaire including demographic characteristics and lifestyle as well as disease-related and CAT-related items. RESULTS: The frequency of CAT use was 51.0& and 39.2& over the past 10 years and 1 year, respectively. The most common type of CAT used was herbal medicine. The therapeutic effects of the CAT were similar to physicians' prescriptions. CAT were most often used in combination with conventional medicine rather than alone. More than 70.0& of subjects did not consult their physicians for the use of CAT. The duration of illness, severity of fatigue and pain was signifi cantly related to the use of CAT. CONCLUSION: Many patients with chronic fatigue or pain use CAT. Most of these patients do not consult their physicians regarding CAT use.

Insulin Resistance is Associated with Gallstones Even in Non-obese, Non-diabetic Korean Men

It remains unclear as to whether insulin resistance alone or in the presence of wellknown risk factors, such as diabetes or obesity, is associated with gallstones in men. The aim of this study was to determine whether insulin resistance is associated independently with gallstone disease in non-diabetic men, regardless of obesity. Study subjects were 19,503 Korean men, aged 30-69 yr, with fasting blood glucose level 75 percentile) in subjects with gallstones was significantly higher than in those without, and this association remained even after the obesity stratification was applied. In multiple logistic regression analyses, only age and HOMA proved to be independent predictors of gallstones. Insulin resistance was positively associated with gallstones in non-diabetic Korean men, and this occurred regardless of obesity. Gallstones appear to be a marker for insulin resistance, even in non-diabetic, nonobese men.

The Relation of Physical Activity to Helath Related Quality of Life

BACKGROUND: Numerous studies have identified that physical activity influences decrements of both mortality and morbidity. Besides these objective indices, positive influences of physical activity on individuals' lives are being studied upon various populations. The purpose of this study was to evaluate the association of physical activity on health-related quality of life (HRQOL) in relatively healthy adults of Korea. METHODS: Questionnaires were sent by mail to one thousand examinees who were scheduled for health check-up. We analyzed data from 214 men and 195 women. The physical activities were measured using the International Physical Activity Questionnaraire (IPAQ)-short form and the HRQOL was assessed by the CMCHS ver 1.0. The subjects were separated by gender and into either a recommended level of physical activity group or a lower physical activity group according to the physical activity scale. RESULTS: The group with physical activity beyond the recommended level had better HRQOL measures than those who did not. After revising the factors that affected the HRQOL, cognition of present heath status, satisfaction for health status, bodily pain, physical function, emotional function, social function and general health measure scores were significantly higher in the female group with physical activity beyond recommended quantity than those who did not. However, there were no statical significance in the male group. CONCLUSION: Physical activity was associated with health related quality of life in middle aged women.

Colorectal Cancer Screening Recommendations by Primary Care Physicians' in Seoul

BACKGROUND: Regular colorectal cancer (CRC) screening is known to reduce the CRC incidence and mortality. Health care providers can play a key role in recommending screening to healthy people. However, data on providers' CRC screening knowledge, attitude, and practice are sparse in Korea. We investigated primary care physicians' perception and performance of practice guidelines for CRC screening recommendations, and their view of barriers to physicians' adherence to guidelines. METHODS: A questionnaire was administered to 760 primary care physicians of internal medicine, general surgery, and family medicine in Seoul, Korea. The data were collected from March 2 to April 30, 2004, and those of 106 respondents (response rate 14%) were analyzed. RESULTS: Forty seven percent of respondents reported they recommended CRC screening. The most common screening test equipment in primary care settings was the fecal occults blood test (22.6%) followed by sigmoidoscopy (16.0%), colonoscopy (16.0%), and double contrast barium enema (10.4%). However, colonoscopy was recommended the most as a CRC screening method (54%) and only 43% of respondents complied with the interval indicated on the guidelines. Awareness (64.8%) and agreement (93.2%) to CRC screening recommendation by primary care physicians in Seoul, Korea was high, but the screening delivery was suboptimal. Many primary care physicians regarded patient-related factors were more important barriers of CRC screening than environment-related factors. CONCLUSION: There were many barriers to physicians' guideline adherence. It may be useful to develop and improve guidelines in considerationt these barriers to establish appropriate cancer screening.

Factors Related to Increase of Blood Pressure in Obese Children and Adolescents

Background: As obese population is increasing nowadays, research on blood pressure of obese children is being performed more frequently. However, there are only few research related to factors about blood pressure among obese children in Korea. The purpose of this study was to analyze the factors affecting blood pressure of obese children and adolescents. Methods: The subjects were elementary and middle school students diagnosed with obesity (n=1716). Height, weight, waist circumstance, body fat percent, blood pressure were measured. Family history and sexual maturity were investigated through the questionnaire. The relationship between the factors and the increase of blood pressure was analyzed. Results: Body weight was the most powerful factor among to factors related to increase of blood pressure (male r=0.45, P<0.05, female r=0.37, P<0.05). Also, height, percentage weight for height (PWH), body mass index (BMI) and waist circumference was correlated with the blood pressure. In multiple regression analysis, family history of hypertension and the sexual maturity were significant determinants of blood pressure in males after adjusting for weight. However, body fat percent was a significant determinant in females. Conclusion: Body weight was the most important factor which increased the blood pressure in obese children and adolescents in both sexes. But males and females had different factors related to the increase of blood pressure with the exception of body weight.

The Relationship between Health Risk Appraisal and Health-related Quality of Life among Middle-aged Men

BACKGROUND: Recently, several health risk appraisal programs have been developed to suit Korean character which is currently implemented. This study was conducted to find out the correlation with health age and health-related quality of life through health risk appraisal. METHODS: From March 1, 2004 to July 30, 2004, 107 male patients aged 30 to 59 who visited the family medicine clinic in a university hospital and had agreed to participate in the study have been assessed to determine the correlation between health age and health-related quality of life by measuring tools of health risk appraisal, CMCHS V1.0 questionnaire and Yangseng measurement questionnaire. RESULTS: Among the total 107 subjects, 3 were excluded because of incomplete questionnaire. There were 28 people aged in their thirties, 36 in forties, and 40 in fifties. The health age and health-related quality of life showed a negative correlation. The correlation in men in their fift showed the strongest. Indexes between the health age and health perception, changes in health, vitality, morality Yangseng, diet Yangseng, sleep Yangseng and active and rest Yangseng have shown a strong negative correlation (P<0.05). CONCLUSION: The lower the health age is, the better health-related quality of life in several domains of CMCHS V1.0 and Yangseng in middle aged Korean men.

Fatigue Related Factors in Chronic Fatigue Patients with Chronic Widespread Pain after Treatment

BACKGROUND: The mechanism of fatigue in patients with fibromyalgia (FM) and CFS (CFS) has not been clarified, but recently there are opinions that chronic pain is a major factor causing chronic fatigue. We performed this study to identify major factors related to chronic fatigue. METHODS: The subjects were 37 patients aged over 18 who visited the primary care institute of a university hospital, whose major symptoms were chronic widespread pain and chronic fatigue and who were given the diagnosis of FM or CFS. The research was carried out through four weeks of symptomatic treatment. The correlation of fatigue severity with the intensity of pain, depression level and anxiety level was analyzed, and regression analysis was conducted to examine the relation between improvement of fatigue after the four weeks' treatment and changes in the intensity of pain, depression level and anxiety level. RESULTS: After the four week treatment, only the intensity of pain was significantly correlatied with fatigue severity. In addition, only change in the intensity of pain was statistically significantly correlatied with the improvement of fatigue. CONCLUSION: In patients who complained of chronic fatigue and chronic widespread pain, the improvement of fatigue after treatment was related to the reduction of pain but not emotional factors such as depression and anxiety.

Influence of Obesity on Left ventricular filling patterns in Hypertensives / 대한내과학회지

BACKGROUND: Left ventricular (LV) diastolic dysfunction has often been described in arterial hypertension in either the presence or the absence of LV hypertrophy. Impairment of LV relaxation have been recently described in obese normotensive individuals, and the prevalence of overweight to frank obesity in hypertensive populations is very high, obesity might well be an important confounder for the evaluation of LV diastolic dysfunction in the patients with hypertension. Accordingly, we designed this study to assess the effect of obesity on LV relaxation and filling in arterial hypertension. METHODS: We assessed the relations of left ventricular filling to load and geometry by Doppler echocardiography in 73 normotensive subjects (40 normal-weight [50 +/- 11 years, 22 women] and 33 obese [57 +/- 11 years, 27 women]) and 81 hypertensive subjects without silent coronary heart disease (23 normal-weight [59 +/- 7 years, 13 women] and 58 obese [54 +/- 13 years, 30 women]). RESULTS: Isovolumic relaxation time (IVRT) was prolonged in hypertensive subjects and normotensive obese subjects compared with normotensive normal-weight subjects (all p<0.01). After controlling for age, height, blood pressure, LV mass index, body mass index, between-group differences in IVRT, peak early transmitral flow velocity, the deceleration time (DT) of early filling velocity, and the ratio of early to late left ventricular filling were disappeared. CONCLUSION: Isovolumic relaxation time (IVRT) is prolonged in both arterial hypertension and obesity, and the presence of obesity does not significantly increase isovolumic relaxation time in hypertension, and abnormalities of left ventricular filling in arterial hypertension are offset after controlling for left ventricular mass.

Primary Care Physicians Attitudes Toward Medically Unexplained Symptoms

BACKGROUND: The medically unexplained symptoms present one of the most common problems in medical practice and the role of primary care physicians is becoming greater to manage them. Our goal was to investigate how the primary care physicians conceive and deal with patients complaining of medically unexplained symptoms (MUS). METHODS: A group of 840 primary care physicians, 524 internist and 316 family physicians in Seoul were surveyed. The questionnaire regarding the perception and the way of consultation about MUS was posted by mail. RESULTS: A total of 180 questionnaires were collected via mail and fax. Ten of them were uncompleted, and the response rate was 22%. Over half of the respondents felt that the consultation of MUS was difficult and they were concerned about the possibility of overlooking some of organic problems (57.6%). Average consultation rate of MUS in daily practice was 14%. The anxiety toward failure of treatment was the most common concern during the MUS consultation. Seventeen percent answered they knew the efficient method to deal with MUS patients. Respondents complained of the deficiency of contents and experiences to deal with MUS during the period of training (80%). More family physicians compared to internists perceived patients with MUS to have personality problems and they often tended to prescribe psychotropic drugs. Family physicians also answered that the training courses provided proper knowledge and contents regarding MUS consultation more than the internists. CONCLUSION: MUS consultation imposes a burden on primary care physicians. Therefore, continuing education not only for residency but for post graduates should be considered for effective management for MUS.

Prevalence of Metabolic Syndrome and Waist Circumference Estimation in Some Korean Adults / 예방의학회지

OBJECTIVE: The purpose of this study was to estimate the prevalence of metabolic syndrome, as defined by the ATP III report, in some Korean adults and use the Asian-Pacific proposed waist circumference to investigate waist circumference in some Korean adults using ROC curves. METHODS: Study subjects were seventy-five thousands and ninety one persons (47, 979 men and 27, 111 women) who were selected among the patients who visited hospital for health evaluation from January 2000 to December 2001. All subjects were measured by height, weight, waist and hip circumferences, blood pressure and blood chemistry (lipid profile). RESULTS: The mean age was 41.6+/-8.5 years in men, 41.1+/-10.4 years in women (p< 0.05). Body mass index was in the normal range in 35.3% of men, and 55.9% of women. In both men and women, blood pressure, blood sugar, total cholesterol and triglyceride were positively correlated with BMI. waist circumference, and Broca's index (p< 0.01). However HDL. choloesterol was correlated negatively (p< 0.01). Using ROC curve, the calculated waist circumferences were 84 cm in men (sensitivity 61.4% and specificity 64.1%) and 74 cm in women (sensitivity 65.0% and specificity 73.2%). The age adjusted prevalences of the metabolic syndrome as defined by NCEP ATP III were different for men (6.4%) and women (14.6%). The prevalence increased from 1.2% among participants aged 20 through 29years to 15.0% among participants aged over 60years in men (p< 0.05) and from 1.6% to 27.4% respectively, in women. The age adjusted prevalences, as defined by using the waist circumference that was recommended by WHO's regional office for the western Pacific, were 10.6% in men and 18.5% in women. The age adjusted prevalences, as defined by using the waist circumference that was calculated by the ROC curves, were 17.1% in men and 22.4% in women. And All prevalences were increased following increased BMI and Broca's index. CONCLUSIONS: The prevalence of metabolic syndrome in some Korean adults was lower than that in western adults. Nevertheless because waist circumference was differed among race and region, application of the same criteria was not proper. Morcover, a higher awareness was required in women, because the prevalence of metabolic syndrome was rapidly increased with increment of age.

Desired Weight of Obesity Patients

BACKGROUND: Although expert panels and guidelines recommend that 5~10% weight reductions of initial body weight have beneficial effects for decreasing obesity-related complications, obese persons tend to desire greater weight losses. Little is known about the patients' expectations and the disparity of goal weight between physicians and patients. The aim of this study was to evaluate the patients' weight loss expectation, and the association between the degree of desired weight losses and treatment outcomes. METHODS: A total of 283 obese subjects (84 men, 199 women), aged > or =20 years with body mass index (BMI) over 25 kg/m2 from 19 obesity clinics were included. Patients' desired weight as evaluated using modified GRWQ (Goals and Relative Weight Questionnaire) which included goal weight, ideal weight, satisfactory weight, acceptable weight, and disappointed weight. After 12 weeks, subsequent weight changes and treatment adherence were investigated. RESULTS: Mean BMI of men and women were 30.9+/-4.2 kg/m2 and 29.1+/- 3.8 kg/m2, respectively. Men expected 13.2 kg (14.0%) mean weight reductions and women expected 10.8 kg (15.7%) mean reductions during the 3 months. The heavier the patient's weight, the greater the reduction amount was desired in both men and women. During the 3 months, the dropout rates of men and women were 40.1% and 46.2%, respectively. In women, the amount of desired weight reduction as significantly higher in the dropout group compared to the non-dropout group. Those who attained pre-determined goal weight after 3 months were 6% for men and 4% for women. After 3 months, 81% of male subjects and 80% of female subjects had not achieved even their predefined disappointed weight. CONCLUSION: Obese patients seeking treatment expected average of 15% weight reduction, greater than 'medically reasonable or successful' weight reductions. The disparities between patients' expectations and physicians' recommendations could influence treatment adherence.

Evidence-Based Prescriptions of Functional Foods for Weight Control

No abstract available.

Clinical Guidelines of Treatment of Obesity in Adults

Obesity increases the risk of serious medical conditions such as type 2 diabetes and coronary heart disease. The risks associated with comorbidities can be reduced with a modest weight loss. Obesity should be recognized and treated as a chronic, progressive, and relapsing disease. The management of obesity requires a long-term approach that is tailored to an individual's lifestyle and needs. Initial treatment should focus on lifestyle changes, i.e., reduced calorie intake and increased physical activity, with behavior modification strategies. Medications may be used adjunctively. Most of FDA-approved anti-obesity drugs should be prescribed for short-term weight loss. Recently, sibutramine and orlistat were approved for long-term weight loss and maintenance. In addition to weight reduction, sibutramine and orlistat provided beneficial effects on cardiovascular risk factors in clinical trials. Several drugs, such as fluoxetine, bupropion and topiramate, approved for other uses, have shown weight loss in some clinical trials. Surgical treatment should be reserved for severely obese patients with significant medical comorbidities or physical conditions.

Obesity : the Present State and Issues

No abstract available.

Effect of weight loss on health related quality of life in obese patients

BACKGROUND: Weight loss in obese patients has been shown to decrease plasma lipid level and high blood pressure, to improved glycemic control in diabetic patients and to decrease cardiovascular risk in obese patients. But, study for association of weight loss and Health related Quality of Life is not well known yet worldwide. This study was to determine whether weight loss would associate with improvements on Health Related Quality of Life. METHODS: Participants was recruited in 48 obese patient visiting obesity clinic of Family Medicine of Sungkyunkwan University Hospital. 27 patients who answered mailed questionnaire was analyzed. Health Related quality of life was measured by Catholic Medical Center Health Survey(CMCHS) V 1.0. Questionnaire included not only Health Related Quality of Life but also alcohol habit, excercise, smoking, marital status, economic status, education. RESULTS: In multiple regression analysis, weight loss is statistically significant differences on satisfaction, vitality, physical function, social function, role limitation general health dimensions of CMCHS. CONCLUSION: The Results of this study demonstrate that weight loss on obese patients may be associated with an improvement in Health Related Quality of Life.

The comparision of the quality of life between the well controlled hypertension group and the uncontrolled hypertension group

BACKGROUND: Hypertension is an important as well as common disease in primary practice, so family physicians should concern about it. It is well known that if hypertension were well controlled, it could lower cardiovascular complications. However, there are few studies on the impact of hypertension affecting the quality of life. Therefore, we carried out this study to compare the quality of life in the hypertensive patients by whether it is well controlled or not. METHODS: The authors surveyed the quality of life using the questionnaire named as CMC Health Survey Version 1.0 for the hypertensive patients. The subjects had no complications and no other diseases, and aged 40 or more, and visited doctors at the Department of Family Medicine, Kyung Hee University Hospital or the Department of Internal Medicine, Sungmin Hospital from May 1 to Aug 31, 1998. We categorized the subjects into the two groups of the well controlled group(SBP or = 140 mmHg or DBP> or = 90 mmHg) and compared the quality of life and lifestyle. RESULTS: The total number of subjects was 119, that of well controlled group was 69, and that of the uncontrolled group was 50. Mean systolic and diastolic blood pressure was 133.1+/-7.5 mmHg and 85.3+/-5.2 mmHg in the well controlled group, 159.2+/-7.4 mmHg and 100.2+/-5.5 mmHg in the uncontrolled group. The comparison of the distribution of age, sex, education, occupation, and monthly income between the two groups showed no difference. The comparision of the lifestyle between two groups by Alameda 7 questionnaire showed no difference ,too. As for the comparison of quality of life between two groups, the well controlled group had significantly higher scores in the domain of physical function, social function, general health, vitality(above P<0.01), emotional function, role limitation, and health perception(above P<0.05) than uncontrolled group. However, the scores of the domain of change in health, satisfaction, bodily pain were not significantly different between two groups. After covariated by obesity, the comparion of quality of life between two groups showed similar results. CONCLUSION: We confirmed that the well controlled group had better quality of life than the uncontrolled group. So family physicians should consider the quality of life when they consult the patients with hypertension.

Health-related quality of life in people with overweigh and large waist circumference

BACKGROUND: The relationship between abnormal body fat distribution and increased risks of morbidity and mortality is well established. Less is known about the impact on functional health status and subjective well-being. This study quantified the association between body fatness and health-related quality of life. METHODS: Health-related quality of life was measured by Catholic Medical Center Health Survey(CMCHS) V1.0. Tertiles of body mass index(BMI) and waist circumference in 484 adult persons visiting a university hospital-based Health Screening Center were compared. To estimate the relative risks of poor health in those with high BMI and large waist circumference, odds ratio and 95% confidence interval(CI) were determined by logistic regression analysis. RESULTS: Compared with the reference group (subjects with waist circumference in the lowest tertile), the odds ratios for men with waist circumference in tertile 3 were 2.24 (95% CI:1.15-4.36) for social function, and 2.5(95% CI:1.02-6.11) for change in health. Women in tertile 3 had odds ratio of 3.23(95% CI:1.05-9.97) for bodily pain. Statistical significance was not shown in other domains. The odds ratios of subjects with the largest BMI, compared with those in the lowest tertile, were not statistically significant in 10 domains. CONCLUSION: Large waist circumferences affects quality of life in the domains of social function and change in health for men, and bodily pain for women.

Validity of beck depression inventory(BDI): detection of depressio in primary care

No Abstract Available.