Endoscopic sleeve gastroplasty (ESG) for morbid obesity: how effective is it?

INTRODUCTION: ESG is an effective treatment for classes I and II obesity. However, the benefit of ESG in patients with morbid obesity (BMI ≥ 40 kg/m2) who decline surgery is not known. The study aims to compare the effectiveness and safety of ESG in all three obesity classes at 1 year. METHODS: We reviewed 484 patient records and identified 435 patients (class I: 105, class II: 169, class III: 161) who underwent ESG at our unit between May 2013 and March 2020. We compared their total body weight loss (%TBWL) and safety over 1 year. We used a linear mixed model (LMM) to analyse repeated measures of weight loss outcomes at 3, 6, 9, and 12 months for comparison between the three BMI groups. RESULTS: Among the 435 patients, 396 patients (class I: 99, class II: 151, class III: 146) completed 6 months, and 211 patients reached 1 year (class I: 50, class II: 77, class III: 84). There was no difference in age between the groups. In LMM analysis, adjusting for age and sex, we found ESG had a significantly higher TBWL, %TBWL, and BMI decline in class III compared to classes I and -II obesity at all time points (p < 0.001). The adjusted mean %TBWL at 1 year with classes I, -II, and -III obesity was 16.5%, 18.2%, and 20.5%, respectively. The overall complication rate and the hospital stay was identical in the three groups. CONCLUSION: ESG induced significant weight loss in all classes of obesity. In class III obesity, the weight loss achieved was significantly higher at 1 year. In patients declining or unsuitable for surgery, ESG could be considered as an alternative treatment option.

ENDOSCOPIC SLEEVE GASTROPLASTY FOR OBESITY TREATMENT: TWO YEARS OF EXPERIENCE.

Background: Bariatric endoscopic techniques are minimally invasive and induce gastric volume reduction to treat obesity. Aim : To evaluate endoscopic sleeve gastroplasty (Apollo method) using a suturing method directed at the greater curvature, as well as the perioperative care, two year safety and weight loss. Method: Prospective single-center study over 154 patients (108 females) using the endoscopic sleeve gastroplasty procedure under general anesthesia with overnight inpatient observation. Of the154 initial patients, 143 were available for 1-month of follow-up, 133 for 6-month, 64 for 12-month and 28 completed the 24 month assessment. Follow-up was carried out by a multidisciplinary team (nutritionist and psychologist). Outcomes evaluated were: change in BMI; change in body weight (TBWL); % of loss of initial body weight (%TBWL); % of excess body weight loss (%EWL) (segregated in > or <25% and adverse effects. Voluntary oral contrasted radiological examinations were scheduled to assess the gastroplasty at different times post-procedure. Results: Mean age was 44.9 (23-69) years. At 24 months after the procedure baseline mean BMI change from 38.3 to 30.8 kg/m2. TBWL, %TBWL and %EWL were of 21.3 kg, 19.5% and 60.4% respectively. 85.7% of patients achieve the goal of >25% %EWL. There were no mayor adverse events intraprocedure or during the 24 months of follow-up . Conclusion: Endoscopic sleeve gastroplasty with regular monitoring by a multidisciplinary team can be considered an effective, safe and well tolerated procedure for obesity treatment, at least for two years of follow-up.

Racional: As técnicas de endoscopia bariátrica são minimamente invasivas e induzem à redução do volume gástrico para tratar a obesidade. Objetivo: Avaliar a gastroplastia sleeve endoscópica (método Apollo) usando um método de sutura direcionado para a grande curvatura, bem como os cuidados perioperatórios, segurança em dois anos e perda de peso. Método: Estudo prospectivo em um único centro com 154 pacientes (108 mulheres) usando o procedimento endoscópico de gastroplastia sleeve sob anestesia geral com observação do paciente internado durante a noite. Dos 154 pacientes iniciais, 143 estiveram disponíveis para acompanhamento de um mês, 133 durante seis meses, 64 durante 12 meses e 28 completaram a avaliação de 24 meses. O acompanhamento foi realizado por equipe multidisciplinar (nutricionista e psicólogo). Foram avaliados nos resultados as mudanças no IMC, no peso corporal (TWBL), no % de perda do peso corporal inicial (% TBWL) no % de excesso de perda de peso corporal (%EWL) segregado em > ou < 25% e efeitos adversos. Estudos radiológicos contratados orais voluntários foram programados para avaliar a gastroplastia em diferentes tempos após o procedimento. Resultados: A idade média foi de 44,9 anos (23-69). Aos 24 meses após o procedimento a linha de base média do IMC mudou de 38,3 para 30,8 kg/m2. O TBWL, %TBWL e %EWL foram de 21,3 kg, 19,5% e 60,4%, respectivamente, e 85,7% dos pacientes alcançaram o objetivo de >25% EWL. Não houve eventos adversos graves peroperatórios ou durante os 24 meses de acompanhamento. Conclusão: A gastroplastia sleeve endoscópica com monitoramento regular por equipe multidisciplinar pode ser considerado procedimento eficaz, seguro e bem tolerado para o tratamento de pacientes com obesidade, pelo menos nos dois anos de acompanhamento.

Endoscopic sleeve gastroplasty for obesity treatment: two years of experience / Gastroplastia sleeve endoscópica para tratamento da obesidade: dois anos de experiência

ABSTRACT Background: Bariatric endoscopic techniques are minimally invasive and induce gastric volume reduction to treat obesity. Aim: To evaluate endoscopic sleeve gastroplasty (Apollo method) using a suturing method directed at the greater curvature, as well as the perioperative care, two year safety and weight loss. Method: Prospective single-center study over 154 patients (108 females) using the endoscopic sleeve gastroplasty procedure under general anesthesia with overnight inpatient observation. Of the154 initial patients, 143 were available for 1-month of follow-up, 133 for 6-month, 64 for 12-month and 28 completed the 24 month assessment. Follow-up was carried out by a multidisciplinary team (nutritionist and psychologist). Outcomes evaluated were: change in BMI; change in body weight (TBWL); % of loss of initial body weight (%TBWL); % of excess body weight loss (%EWL) (segregated in > or <25% and adverse effects. Voluntary oral contrasted radiological examinations were scheduled to assess the gastroplasty at different times post-procedure. Results: Mean age was 44.9 (23-69) years. At 24 months after the procedure baseline mean BMI change from 38.3 to 30.8 kg/m2. TBWL, %TBWL and %EWL were of 21.3 kg, 19.5% and 60.4% respectively. 85.7% of patients achieve the goal of >25% %EWL. There were no mayor adverse events intraprocedure or during the 24 months of follow-up . Conclusion: Endoscopic sleeve gastroplasty with regular monitoring by a multidisciplinary team can be considered an effective, safe and well tolerated procedure for obesity treatment, at least for two years of follow-up.

RESUMO Racional: As técnicas de endoscopia bariátrica são minimamente invasivas e induzem à redução do volume gástrico para tratar a obesidade. Objetivo: Avaliar a gastroplastia sleeve endoscópica (método Apollo) usando um método de sutura direcionado para a grande curvatura, bem como os cuidados perioperatórios, segurança em dois anos e perda de peso. Método: Estudo prospectivo em um único centro com 154 pacientes (108 mulheres) usando o procedimento endoscópico de gastroplastia sleeve sob anestesia geral com observação do paciente internado durante a noite. Dos 154 pacientes iniciais, 143 estiveram disponíveis para acompanhamento de um mês, 133 durante seis meses, 64 durante 12 meses e 28 completaram a avaliação de 24 meses. O acompanhamento foi realizado por equipe multidisciplinar (nutricionista e psicólogo). Foram avaliados nos resultados as mudanças no IMC, no peso corporal (TWBL), no % de perda do peso corporal inicial (% TBWL) no % de excesso de perda de peso corporal (%EWL) segregado em > ou < 25% e efeitos adversos. Estudos radiológicos contratados orais voluntários foram programados para avaliar a gastroplastia em diferentes tempos após o procedimento. Resultados: A idade média foi de 44,9 anos (23-69). Aos 24 meses após o procedimento a linha de base média do IMC mudou de 38,3 para 30,8 kg/m2. O TBWL, %TBWL e %EWL foram de 21,3 kg, 19,5% e 60,4%, respectivamente, e 85,7% dos pacientes alcançaram o objetivo de >25% EWL. Não houve eventos adversos graves peroperatórios ou durante os 24 meses de acompanhamento. Conclusão: A gastroplastia sleeve endoscópica com monitoramento regular por equipe multidisciplinar pode ser considerado procedimento eficaz, seguro e bem tolerado para o tratamento de pacientes com obesidade, pelo menos nos dois anos de acompanhamento.

Endoscopic sleeve gastroplasty with 1-year follow-up: factors predictive of success.

BACKGROUND AND STUDY AIMS: Bariatric endoscopy has emerged as an aid in the nonsurgical treatment of obesity. The objective of this study is to critically provide the results and follow-up of endoscopic sleeve gastroplasty 1 year after the procedure. PATIENTS AND METHODS: Prospective single-center follow-up study of 25 patients (5 men, 20 women) who underwent flexible endoscopic suturing for endoluminal gastric volume reduction. A multidisciplinary team provided post-procedure care. Patient outcomes were recorded at 1 year after the procedure. Linear regression analysis was done to evaluate the variables associated with best results at 1 year of follow-up. RESULTS: Mean body mass index (BMI) was 38.5 ±â€Š4.6 kg/m(2) (range 30 - 47) and mean age 44.5 ±â€Š8.2 years (range 29 - 60). At 1 year, 22 patients continued with the follow-up (2 dropped out at 6 months and 1 at 3 months). There were no major intra-procedural, early, or delayed adverse events. Mean BMI loss was 7.3 ±â€Š4.2 kg/m(2), and mean percentage of total body weight loss was 18.7 ±â€Š10.7 at 1 year. In the linear regression analysis, adjusted by initial BMI, variables associated with %TBWL involved the frequency of nutritional (ß = 0.563, P = 0.014) and psychological contacts (ß = 0.727, P = 0.025). The number of nutritional and psychological contacts were predictive of good weight loss results. CONCLUSIONS: Endoscopic sleeve gastroplasty is a feasible, reproducible, and effective procedure to treat obesity. Nutritional and psychological interaction are predictive of success.

Dual Intragastric Balloon: Single Ambulatory Center Spanish Experience with 60 Patients in Endoscopic Weight Loss Management.

BACKGROUND: Many obese patients fail conventional medical management and decline bariatric surgery. Less invasive weight loss options such as intragastric balloons may provide an opportunity to reach this large number of untreated patients. The aim of this study was to investigate the safety and effectiveness of the Dual Intragastric Balloon (DIGB) in the treatment of obese patients, as well as the impact of degree of obesity, age, and gender. METHODS: The study was conducted at the Bariatric Endoscopy Unit of the Madrid Sanchinarro University Hospital. Sixty patients (11 men, 49 women) underwent endoscopic placement of a DIGB filled with a total of 900 cc of saline (450 cc in each balloon) for at least 6 months, along with regular counseling from a multidisciplinary team. Study outcomes included: change in body weight (TBWL), % of loss of initial body weight (%TBWL), % of excess body weight loss (%EWL), and adverse events. RESULTS: Initial BMI 38.8 kg/m(2) decreased 6.1 units, with mean TBWL, %TBWL, and %EWL of 16.6 kg, 15.4 %, and 47.1 %, respectively. We found no difference in %TBWL between grade of obesity, age or sex, but morbidly obese patients demonstrated greater TBWL, and women and less obese subjects obtained higher %EWL. The DIGB was generally well tolerated, with one early removal for patient intolerance, one early deflation without migration, and one gastric perforation. Fourteen patients had small, clinically insignificant ulcers or erosions noted at the time of removal. CONCLUSIONS: The present study shows that the DIGB was easy to use, resulted in significant weight loss, safe, and well tolerated.

Endoscopic Sleeve Gastroplasty: How I Do It?

BACKGROUND: Primary endoscopic weight loss therapies are of interest for access, simplicity, and economy. The objective of this manuscript is to describe the endoscopic sleeve gastroplasty used in 50 patients. METHODS: The goal of this procedure is to reduce the gastric lumen into a tubular configuration, with the greater curvature modified by a line of sutured plications. General anesthesia with endotracheal intubation is needed. An endoscopic suturing system requiring a specific double-channel endoscope delivers full-thickness sets of running sutures from the antrum to the fundus. Patients are admitted and observed, with discharge planned within 24 h. Post-procedure outpatient care includes diet instruction with intensive follow-up by a multidisciplinary team. Voluntary oral contrast and endoscopy studies are scheduled to assess the gastroplasty at 3, 6, and 12 months. RESULTS: The technique was applied in 50 patients (13 men) with an average body mass index (BMI) of 37.7 kg/m(2) (range 30-47) with 13 having reached 1 year. Procedure duration averaged 66 min during which six to eight sutures on average were placed. All patients were discharged in less than 24 h. There were no major intra-procedural, early, or delayed adverse events. Weight loss parameters were satisfactory, mean BMI changes from 37.7 ± 4.6 to 30.9 ± 5.1 kg/m(2) at 1 year, and mean %TBWL was 19.0 ± 10.8. Oral contrast studies and endoscopy revealed sleeve gastroplasty configuration at least until 1 year of follow-up. CONCLUSION: Endoscopic sleeve gastroplasty is a safe, effective, and reproducible primary weight loss technique.

Changes in bread consumption and 4-year changes in adiposity in Spanish subjects at high cardiovascular risk.

The effects of bread consumption change over time on anthropometric measures have been scarcely studied. We analysed 2213 participants at high risk for CVD from the PREvención con DIeta MEDiterránea (PREDIMED) trial to assess the association between changes in the consumption of bread and weight and waist circumference gain over time. Dietary habits were assessed with validated FFQ at baseline and repeatedly every year during 4 years of follow-up. Using multivariate models to adjust for covariates, long-term weight and waist circumference changes according to quartiles of change in energy-adjusted white and whole-grain bread consumption were calculated. The present results showed that over 4 years, participants in the highest quartile of change in white bread intake gained 0·76 kg more than those in the lowest quartile (P for trend = 0·003) and 1·28 cm more than those in the lowest quartile (P for trend < 0·001). No significant dose-response relationships were observed for change in whole-bread consumption and anthropometric measures. Gaining weight (>2 kg) and gaining waist circumference (>2 cm) during follow-up was not associated with increase in bread consumption, but participants in the highest quartile of changes in white bread intake had a reduction of 33 % in the odds of losing weight (>2 kg) and a reduction of 36 % in the odds of losing waist circumference (>2 cm). The present results suggest that reducing white bread, but not whole-grain bread consumption, within a Mediterranean-style food pattern setting is associated with lower gains in weight and abdominal fat.

Preferences of owners of overweight dogs when buying commercial pet food.

Most pet dogs in developed countries are fed commercial diets. The aim of this study was to evaluate the preferences of owners of overweight dogs when buying commercial pet food. The study was a descriptive observational multi-centre study on a group of 198 owners of urban household dogs. Personal interviews were conducted to examine the owners' opinions with questions rating the importance of certain qualities of prepared dog food. Bivariate analyses for comparisons of absolute means between groups of owners of dogs with excess weight (n = 137) and owners of normal weight dogs (n = 61) were made using the Mann-Whitney U-test. A low price (p < 0.001) and special offers (p = 0.008) of commercial dog food were more important for owners of dogs with excess weight than for owners of normal weight dogs. The quality of ingredients (p = 0.007) and the nutritional composition (p < 0.001) were more important for owners of normal weight dogs than for owners of dogs with excess weight. The veterinarian was the most important source of information on dog nutrition for both groups (83.6% for owners of normal weight dogs and 83.2% for owners of dogs with excess weight) (p = 0.88). The owners of dogs with excess weight had less interest in corrected dog nutrition than owners of normal weight dogs (p < 0.001).

Estudio de prevalencia de automedicación en una población turística realizado desde una farmacia comunitaria / Prevalence study of self-medication in a touristic population done by a community pharmacy

Objetivos: Analizar la práctica de automedicación en una localidad turística situada en el sur de Gran Canaria. Método: Estudio de prevalencia de automedicación en una farmacia comunitaria de San Bartolomé de Tirajana. Durante los meses de febrero a diciembre de 2008 se obtuvieron un total de 300 encuestas entre las personas que acudían a la farmacia. Se recogió información sobre sus características sociodemográficas (edad, sexo, situación laboral...), características de la automedicación (tipo de medicamento, síntomas tratados, motivo para no acudir al médico...) y conocimientos generales sobre los medicamentos utilizados (efectos adversos, lectura de los prospectos, posibles o potenciales efectos adversos con la medicación crónica). Resultados: Se registró un 69,3% de casos de automedicación. Los individuos menores de 45 años y los extranjeros son los grupos que más realizan este tipo de práctica. Los principales síntomas tratados fueron el dolor (58,2%), la fiebre (16%) y la tos (13%). Por grupos de medicamentos, los analgésicos y los antiinflamatorios no esteroideos (AINE) representaron el 62% del autoconsumo. La solicitud directa fue la forma más habitual de adquirir el medicamento, sin ningún tipo de información recibida por parte de la farmacia en un 72% de los casos. El 54,3% no consideraba necesario acudir al médico, al 39,4% le recomendó el medicamento algún familiar o amigo, y en un 26,9% de los casos los pacientes recordaban prescripciones hechas por el médico en ocasiones anteriores. El 54,8% de los encuestados obtuvo la información del medicamento a través de los prospectos y el 51,4% decía conocer las contraindicaciones. El 37% de las personas que se automedicaban padecía algún problema de salud crónico, entre los cuales la hipertensión y la diabetes eran los más frecuentes. Del 37% de los casos que presentaban algún problema de salud, el 76,6% desconocía la posibilidad de que se produjesen interacciones entre ambas medicaciones. Conclusiones: La automedicación es una práctica muy importante entre la población de estudio, sobre todo entre los extranjeros y las personas menores de 45 años. El dolor es el síntoma más automedicado; los analgésicos y los AINE son los fármacos más utilizados. La solicitud directa en las farmacias es muy habitual y el prospecto de los medicamentos constituye una fuente importante de información (AU)

Objectives: Analyzing the practice of self-medication in a tourist town in the South of Gran Canaria. Methods: Prevalence study of self-medication in a community pharmacy in San Bartolome de Tirajana. The total during the months from February to December 2008 was 300 surveys of the persons who went to the pharmacy. Features sociodemographic information was collected (age, employment status), features self-medication (type of medication, treated symptoms, reason not going to the doctor, etc.) and general knowledge about used medications (possible adverse effects, reading the prospectuses, knowledge or potential effects with chronic medication). Results: Saw a 69.3% self-medication. The individuals less than 45 years of age and foreigners are the one of the most engaged in this type of practice. The primary symptoms treated were pain (58.2%), fever (16%) and cough (13%). For the group of analgesic drugs and NSAIDs accounted for 62% of consumption. The request was the most common way to acquire the medicine, not receiving any information on a 72% of cases by the pharmacy. The 54.3% is not necessary to see a doctor and 39.4% recommended medication and a family member or friend in a 26.9% of cases prescriptions made out by the doctor in the past. The 54.8% of respondents obtained information from the medicine through the prospectuses and 51.4% said to know the side effects. The 37% of those suffering from self chronic health problems, basically hypertension and diabetes were the most abundant. 37% of the cases suffering from health problems, 76.6% were unaware of the potential interactions between medications. Conclusions: Self-medication is a common practice among the population, especially among foreigners and persons under 45 years of age. The common symptom of self-medication is pain and NSAIDs are the common medicines most used. The direct application in pharmacies is very common and the listing of medicines, constitutes an important source of information. The most persons considered good or very good practice (AU)

Aspectos epidemiológicos del sobrepeso y obesidad infantil en España / Epidemiological features of overweightness and childhood obesity in Spain

La obesidad infantil es un diagnóstico cada vez más frecuente en las sociedades occidentales difícil en muchos casos de cuantificar, debido a la ausencia de datos representativos procedentes de los diferentes países, y de la variación de los criterios empleados para su definición. En España existen diferentes estudios nacionales o regionales, que analizan la prevalencia de la obesidad infantojuvenil, su evolución a lo largo del tiempo y los diferentes factores implicados en su desarrollo. Dentro de ellos destaca el estudio en Kid por ser el único estudio epidemiológico observacional de diseño transversal reciente, realizado sobre una muestra poblacional representativa de la población española de 2 a 24 años. El objetivo de este trabajo ha sido el análisis de la tendencia y situación actual de la prevalencia de sobrepeso y obesidad en España a través de los principales estudios epidemiológicos realizados en las últimas décadas. A partir de los resultados del estudio enKid, en España se estima la prevalencia de obesidad en el 13,9% y la de sólo sobrepeso del 12,4%. La prevalencia de obesidad es superior en varones y en edades más jóvenes (de 6 a 13 años). Se comprueba la elevada tendencia al incremento en las últimas décadas que varía en función de los grupos de edad y sexo y nivel socioeconómico (AU)

The diagnosis of childhood obesity has become increasingly frequent in western societies, yet in many cases has been difficult to quantify due to the lack of representative data from different countries and the varying criteria used in its definition. In Spain, various national or regional studies have been conducted that analyse the prevalence of childhood and adolescent obesity, its evolution over time and the different factors implicated in its development. Among these, the enKid study stands out as it is the only recent observational epidemiological study of a cross-sectional design that was carried out in a representative sample of the Spanish population aged 2 to 24. The objective of this paper was to evaluate the current state and trends in the prevalence of overweight and obesity in Spain analyzing key epidemiological studies conducted in the last few decades. Based on the results of the enKid study, the prevalence in Spain was estimated to be 13,9% for obesity and 12,4% for overweight. Obesity prevalence was greater in males at younger ages (from 6 to 13 years). The trend of increasing prevalence over the last few decades was confirmed, which varied according to age group, sex and socioeconomic status (AU)

[Nutritional evaluation of health shift workers from the Canary Islands]. / Valoración nutricional de trabajadores sanitarios expuestos a turnicidad en Canarias.

OBJECTIVE: Shift workers are known to have increased morbidity associated to wrong habits. In this study we have evaluated the nutritional status, food habits and physical activity in health shift workers. SUBJECTS: 207 permanent morning-shift workers and 210 shift workers (3-shift system) were randomized selected from the 2,100 workers of the North Area of the Canary Island Sanitary Health System. METHODS: Dietary intake was assessed by a self-registered food frequency questionnaire. We also assessed Body Mass Index, blood lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides), physical activity, age and sex. RESULTS: Shift workers shown higher intake of red meat, eggs, fruit juices and pasta. No differences were observed in lipid levels, weight status and physical activity in relation to the shift working status. 62% of men and 37.2% of women were overweight or obese. 46% of the subjects were sedentary. CONCLUSIONS: Shift work system seems to have little influence on the food habits of health workers.

Valoración nutricional de trabajadores sanitarios expuestos a turnicidad en Canarias / Nutritional evaluation of health shift workers from the Canary islands

Objetivo: El trabajo a turnos induce hábitos de vida anómalos, lo cual se asocia al aumento de la morbilidad en los trabajadores. En este estudio se valoró el estado nutricional, los hábitos alimentarios y la actividad física de trabajadores hospitalarios sometidos a turnos. Ámbito: La población de estudio estuvo compuesta por 207 trabajadores con turno fijo de mañana y 210 con turno rotatorio (mañana, tarde y noche) seleccionados aleatoriamente entre 2.100 trabajadores. Intervenciones: La ingesta dietética se determinó mediante cuestionario de frecuencia de consumo de alimentos autoadministrado. También se determinaron índice de masa corporal, parámetros lipídicos (colesterol total, colesterol HDL, colesterol LDL y triglicéridos), actividad física, edad y sexo. Resultados: Los trabajadores sometidos a turnicidad mostraron un mayor consumo de ternera, huevos, zumos y pastas. No se encontraron diferencias significativas en cuanto a niveles lipídicos, estado ponderal ni de actividad física entre los trabajos sometidos y no a turnicidad y no. El 62% de los hombres y el 37,2% de las mujeres mostraron sobrecarga ponderal (obesidad y sobrepeso).El 46% de los individuos de la muestra presentaron sedentarismo. Conclusiones: La turnicidad en los trabajadores hospitalarios influye sólo parcialmente en los hábitos alimentarios de dicho colectivo (AU)

Objective: Shift workers are known to have increased morbidity associated to wrong habits. In this study we have evaluated the nutritional status, food habits and physical activity in health shift workers. Subjects: 207 permanent morning-shift workers and 210 shift workers (3-shift system) were randomized selected from the 2,100 workers of the North Area of the Canary Island Sanitary Health System. Methods: Dietary intake was assessed by a self-registered food frequency questionnaire. We also assessed Body Mass Index, blood lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides),physical activity, age and sex. Results: Shift workers shown higher intake of red meat, eggs, fruit juices and pasta. No differences were observed in lipid levels, weight status and physical activity in relation to the shift working status. 62% of men and 37.2% of women were overweight or obese. 46% of the subjects were sedentary. Conclusions: Shift work system seems to have little influence on the food habits of health workers (AU)

Variables predictive of adherence to diet and physical activity recommendations in the treatment of obesity and overweight, in a group of Spanish subjects.

OBJECTIVE: To assess the factors that could predict a successful completion of a weight loss program. STUDY DESIGN: A single-centered, cross-sectional, prospective study conducted over 4 y. SUBJECTS: Data were obtained on 1018 overweight subjects (788 women, 230 men) aged 14.8-76.3 y (mean 38.4) and body mass index (BMI) of 31.7 (range 25.03-57.1) seeking help to lose weight at a specialist obesity clinic. MATERIALS AND METHODS: A program involving a hypocaloric, Mediterranean diet was prescribed plus recommendations for free-time exercise and day-to-day activity. Follow-up was weekly until the desired weight loss was achieved ('successful completion') or the patient dropped-out of the program ('failure'). Cox's regression analysis was used to evaluate success and the variables included were compliance with the program, age, gender, initial BMI, physical activity, alcohol consumption, smoking habit, hypertension, diabetes, hypercholesterolemia, cardiovascular disease, previous dietary programs, cause of obesity, age at which excessive weight was first noted and parental obesity. RESULTS: Factors predictive of completion were: gender (males responded better), previous dietary programs (predictive of dropout), initial BMI (higher index, lower completion), and age (younger age, poorer outcome). There was an interaction between parental obesity and offspring childhood obesity. Absence of parental obesity and adult-onset obesity had a higher probability of program completion. CONCLUSIONS: In a standard weight reduction program the recommendations of dietary restriction and moderate exercise seems less effective for women, persons with high BMI, younger age groups and those who have had other attempts at weight loss. Poorest outcomes applied to those subjects with childhood obesity and who had obese parents.