Fast versus slow weight loss: development process and rationale behind the dietary interventions for the TEMPO Diet Trial.

OBJECTIVE AND METHODS: Finding effective solutions to curb the obesity epidemic is a great global public health challenge. The need for long-term follow-up necessitates weight loss trials conducted in real-world settings, outside the confines of tightly controlled laboratory or clinic conditions. Given the complexity of eating behaviour and the food supply, this makes the process of designing a practical dietary intervention that stands up to scientific rigor difficult. Detailed information about the dietary intervention itself, as well as the process of developing the final intervention and its underlying rationale, is rarely reported in scientific weight management publications but is valuable and essential for translating research into practice. Thus, this paper describes the design process and underlying rationale behind the dietary interventions in an exemplar weight loss trial - the TEMPO Diet Trial (Type of Energy Manipulation for Promoting optimal metabolic health and body composition in Obesity). This trial assesses the long-term effects of fast versus slow weight loss on adiposity, fat free mass, muscle strength and bone density in women with obesity (body mass index 30-40 kg m-2) that are 45-65 years of age, postmenopausal and sedentary. RESULTS AND CONCLUSIONS: This paper is intended as a resource for researchers and/or clinicians to illustrate how theoretical values based on a hypothesis can be translated into a dietary weight loss intervention to be used in free-living women of varying sizes.

The use of motivational enhancement strategies for the maintenance of weight loss among obese individuals: a preliminary investigation.

AIM: To investigate the efficacy of motivational enhancement strategies integrated within a standard lifestyle modification program for the maintenance of weight loss and improved psychosocial functioning of obese adults. METHODS: Twenty-two obese adults completed 20 sessions of a motivationally informed cognitive behavioural treatment for weight loss and maintenance. Treatment outcome measures included anthropometrics, obesity-specific quality of life, impulsive eating tendencies, body dissatisfaction, mood disturbance and maladaptive cognitions. RESULTS: At post-treatment, there was a significant decrease in body weight (123.04 +/- 22.06 vs. 116.84 +/- 23.53, p < 0.001) with no significant change by the 12-month follow-up. Patients also reported significant improvements in obesity-related quality of life, impulsive eating tendencies, body dissatisfaction and maladaptive cognitions at post-treatment that were maintained at the 1-year follow-up. CONCLUSIONS: The implementation of motivational enhancement strategies within a cognitive behavioural program results in sustained weight loss that compares favourably to previous lifestyle modification programs.

The use of magnesium sulphate infusions in the management of very severe tetanus.

The use of magnesium sulphate infusions as an adjunct to the management of patients with very severe tetanus was studied in 10 subjects with persistent autonomic dysfunction despite heavy sedation. Satisfactory cardiovascular control was established in nine of these cases, and there were two deaths in the series, neither directly attributable to the tetanus itself. Haemodynamic measurements performed in six patients, showed that cardiac output was well preserved during magnesium infusions. There was a significant reduction in pulse rate (p less than 0.05) and systemic vascular resistance (p less than 0.01), with an increase in stroke volume (p less than 0.05). It is suggested that magnesium may be a useful adjunct to standard forms of management of such cases.

Nitrous oxide analgesia and altitude.

The analgesic effectiveness of 50% nitrous oxide and oxygen or oxygen-enriched air, measured by variations in pain threshold, was studied at an altitude of 1460 m and simulated altitudes of sea level and 3300 m. At sea level pressures, 50% nitrous oxide exerted a similar analgesic effect to that found for morphine, raising the pain thresholds by a mean of 71.5%. At 1460 m, the increase in pain threshold produced was 40% and at 3300 m the increase in pain threshold was only 19%. The difference between the analgesic effects of nitrous oxide at each altitude was statistically significant. It is concluded that moderate altitudes significantly reduce the effectiveness of nitrous oxide in a manner directly related to the partial pressure of nitrous oxide at each altitude.