A JAMA THEME ISSUEEdited by Phil B. Fontanarosa, MD
Television watching has been positively associated with obesity and
weight gain in children and adults and with type 2 diabetes in men. In this
analysis of data from women enrolled in the Nurses' Health Study, a prospective
cohort study of female registered nurses aged 30 to 55 years, Hu and colleagues
found that sedentary behaviors, especially television watching, were associated
with significantly elevated risk of obesity and type 2 diabetes during 6 years
of follow-up. Light activities, such as standing or walking around at home,
and brisk walking were associated with a significantly lower risk.
In this 2-year randomized trial, Heshka and colleaguesArticle compared
weight loss and health benefits of a brief counseling and self-help weight
loss program with an ongoing commercial program among overweight and obese
adults. Weight loss was achieved in both the self-help and commercial groups
at 1 year but was significantly greater in the commercial group. During the
second year, weight loss was maintained in the commercial group but weight
returned to baseline in the self-help group. Tate and colleaguesArticle compared
1-year outcomes of an Internet weight loss program alone or with behavioral
counseling via e-mail among individuals at risk for type 2 diabetes. Decreases
in weight, percentage of initial body weight, and waist circumference were
significantly greater in the behavioral e-counseling group.
To examine the effect of weight loss on markers of systemic vascular
inflammation and insulin resistance, Esposito and colleagues conducted a randomized
trial among obese women (BMI ≥30) of lifestyle changes (low-energy Mediterranean-style
diet and increased physical activity) designed to achieve a sustained weight
reduction of 10% or more. After 2 years, reductions in body mass index, circulating
levels of interleukin 6, interleukin 18, and C-reactive protein, and insulin
resistance were significantly greater in the lifestyle intervention group
than in the control group. Levels of adiponectin, an anti-inflammatory adipocytokine,
increased significantly in the intervention group compared with the control
Berkowitz and colleaguesArticle conducted a 6-month
randomized trial to compare a comprehensive behavioral weight control program
plus sibutramine, an anorexiant medication, with behavior therapy alone for
the treatment of obese adolescents. Weight loss and reduction of BMI were
significantly greater in the behavior therapy plus sibutramine group. From
months 7 through 12, when all participants received open-label sibutramine,
adolescents initially treated with sibutramine largely maintained their weight,
whereas those who switched from placebo to sibutramine lost additional weight.
In a cross-sectional study, Schwimmer and colleaguesArticle found
that severely obese children and adolescents reported significantly lower
health-related quality of life than a reference sample of healthy children.
The risk of having impaired health-related quality of life was similar among
severely obese children and a reference sample of children receiving chemotherapy
for cancer. In an editorial, Yanovski and YanovskiArticle discuss
treatment of pediatric obesity.
Low-carbohydrate diets are currently a popular means to achieve rapid
weight loss. Bravata and colleaguesArticle conducted
a systematic review of articles that evaluated low-carbohydrate diets for
treatment of obesity. Evidence was insufficient to make recommendations for
or against the use of low-carbohydrate diets. Weight loss while using low-carbohydrate
diets was principally associated with decreased caloric intake, longer diet
duration, and initial body weight but not with reduced carbohydrate intake.
In an editorial, BrayArticle discusses strategies for
A practical tool for weight loss counseling adapted from the smoking
cessation treatment model.
The growing demand for surgery to treat patients with morbid obesity
is prompting a host of ethical and scientific questions about the practice.
Results of 2 randomized clinical trials provide preliminary evidence
of the effectiveness of novel pharmacotherapies for weight loss—zonisamide,
an antiepileptic drug, and recombinant human variant ciliary neurotrophic
factor, a protein that signals through leptinlike pathways.
For your patients: Information about obesity.
This Week in JAMA . JAMA. 2003;289(14):1739. doi:10.1001/jama.289.14.1739