Lifestyle changes for obese patients linked to modest weight loss

Posted on March 12, 2012 by weightcontrol

A program that helps obese patients improve healthy behaviors is associated with modest weight loss and improved blood pressure control in a high-risk, low-income group, according to researchers at Washington University School of Medicine in St. Louis, Duke University, Harvard University and other institutions.

The research is published March 12 in Archives of Internal Medicine.

Obesity treatments are not widely available in the U.S. primary care setting, particularly for low-income patients who seek care at community health centers, according to the study’s authors.

“We undertook this study in federally qualified health centers, requiring minimal primary care time, so that we might develop a strategy that could be easily implemented through the broad range of health centers that receive support from the federal government,” says epidemiologist Graham A. Colditz, MD, DrPH, the Niess-Gain Professor of Surgery at Washington University School of Medicine in St. Louis and associate director of prevention and control at the Siteman Cancer Center. “The great recession added to the strains under which our inner city, low-income participants were living. Despite this, we managed to retain 86 percent of the patients through the entire study.”

The two-year study included 365 obese patients receiving treatment for high blood pressure. More than 70 percent were African-American, 68 percent were female, and 33 percent had less than a high school education. The average participant was 54 years old.

The patients were randomly assigned to receive either usual care or to participate in a program that promoted weight loss by setting goals to change behavior, self-monitoring online or with an automated phone system, counseling sessions by telephone and optional group support sessions. The patients were all seen at three community health centers in Boston.

Compared to those receiving usual care, the lifestyle intervention slowed increases in weight and blood pressure in this population of high-risk patients. Although six-month weight losses were modest — a little more than two pounds — the patients did not gain back any weight over the two-year study. The lifestyle intervention was associated with improvements in blood pressure that were clinically significant.

During the study, the average systolic blood pressure (the top number in a blood pressure reading) was lower in the intervention group compared with the usual care group but not significantly different. However, increases in systolic blood pressure were significantly lower in the intervention group. And at two years, patients in the intervention group were more likely to have controlled blood pressure than patients in the usual care group.

The researchers note this study’s modest results may apply better to real-world health center settings than results from highly controlled trials that show larger effects from treatment.

Because low-income patients are underrepresented in clinical trials but bear the greatest risk and disease burden of obesity, Colditz and his colleagues call for more work to find the best ways to address their needs.

###

Bennett GG, Warner ET, Glasgow RE, Askew S, Goldman J, Ritzwoller DP, Emmons KM, Rosner BA, Colditz GA. Obesity treatment for socioeconomically disadvantaged patients in primary care practice. Archives of Internal Medicine. Online March 12, 2012.

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10 Tips for Foodies Who Need to Lower Sodium Intake

Posted on March 7, 2012 by weightcontrol

Newswise — For people who need to cut back on their daily intake of sodium to control blood pressure and lower the risk of stroke, the key may be in home cooking.

Most sodium in the diet comes from prepackaged foods and restaurants. Home-cooked meals can be fast, easy, delicious and, above all, better for your health than most restaurant and prepared meals from supermarkets. That’s the message that culinary dietitian Gavin Pritchard, RD, from Greenwich Hospital’s Weight Loss & Diabetes Center, drives home in his ‘In the Kitchen” series of cooking classes.

“As dietitians we often tell people to take things away from their diet. I like to tell people they don’t have to eliminate things they like, but back off on the amount you use. I prefer to emphasize adding things, in this case – herbs and spices.”

Here are 10 Tips from Gavin Pritchard to encourage you to put down the saltshaker and add spices to enhance flavor and improve your health:

1. Treat yourself to fresh herbs, readily available in supermarkets, on occasion, and keep a good assortment of dried spices on hand for convenience.

2. Replace your dried herbs and spices every six months for most robust flavor. Mark spice bottles with the purchase date so you know when to replace them.

3. Be generous with herbs. It’s hard to add too many fresh herbs like parsley, dill, tarragon, basil or rosemary. However, it’s easy to overpower a dish with too many fresh spices like cloves or nutmeg.

4. Let your taste buds be your guide. When adding herbs and spices, add gradually and taste as you go. You’ll know when it’s to your liking. This prevents you from overdoing it.

5. If you’re using dried herbs, add them early in the cooking process so they reconstitute. If using fresh herbs, add a little in the beginning, and then add a big bunch toward the end of cooking to get a boost of both flavor and color.

6. Use different types of wine (including rice wine) and vinegars (including flavored vinegars.)A reduction of vinegar, wine or a combination makes a powerfully tasty sauce without the need to add salt or fat.

7. Shop for garlic powder rather than garlic salt, onion powder rather than onion salt, and read the ingredients when you buy dried spices to make sure there is no added salt in the product.

8. Make your own blends of seasoned salt, using the flavors you like the most. Add salt if you like, but not enough to dominate the ingredient list. Crush dried herbs between your palms before adding to spice mixes. This will release the oils to produce more flavor.

9. For more intense flavor, toast whole spices over high heat in a dry, heavy skillet before grinding them into a powder. This helps to release more flavor. Heat, while stirring, until you can smell the spice. Let cool before grinding.

10. If possible, buy whole spices and grind as you need them for more potent flavor. Purchase an inexpensive coffee grinder to use strictly for grinding spices, making sure to clean the grinder well after each use.

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Researchers find majority of women with bulimia reach highest-ever weight after developing the disorder

Posted on March 7, 2012 by weightcontrol

Researchers at Drexel University have found that a majority of women with bulimia nervosa reach their highest-ever body weight after developing their eating disorder, despite the fact that the development of the illness is characterized by significant weight loss. Their new study, published online last month in the International Journal of Eating Disorders, adds to a body of recent work that casts new light on the importance of weight history in understanding and treating bulimia.

“Most patients lose a lot of weight as part of developing this disorder, and all dedicate significant effort, including the use of extreme behaviors, to prevent weight gain,” said Jena Shaw, a clinical psychology doctoral student in Drexel’s College of Arts and Sciences who was lead author of the new study. “In spite of this, we found that most women also regain a lot of weight while they have bulimia. We want to find out why that is.”

Working with Dr. Michael Lowe, a professor of psychology at Drexel, and other collaborators, Shaw examined data from two study populations of women with bulimia, including a group of 78 women who were patients at the Renfrew Center in Philadelphia studied over two years, and a group of 110 women from a Harvard study who were interviewed at six-month intervals for eight years.

“Most of the women we studied reached their highest weight ever after developing bulimia and before remission,” Shaw said. A total of 59 percent of women in the two-year study population, and 71.6 percent of women in the eight-year study population, showed this weight history pattern. These weights were even higher than their weights before developing bulimia, despite the fact that their pre-bulimia weights were overall already higher than average.

The researchers also explored group differences between women who reached their highest weight after onset of bulimia, and those whose highest weight preceded the eating disorder. The women who reached a new highest weight during bulimia had generally developed the disorder at an earlier age, and struggled with it for a longer period of time.

These findings add to a body of work led by Lowe that emphasizes the importance of weight and weight history in the outcomes and treatment of bulimia. Lowe’s research has quantified relationships between personal weight history and the symptoms and outcomes of eating disorders.

“Bulimia nervosa was first medically described in 1979 among patients whose body weight generally appeared ‘normal,’ but who, in most cases, had weighed substantially more in the past,” said Lowe. “Yet relatively few studies have considered weight history or the fear of becoming overweight again as a possible perpetuating factor for the disorder.”

In his eating disorder studies, Lowe has examined a variable called “weight suppression,” which is the difference between a person’s past highest weight and her current weight. Most people with bulimia have higher weight suppression values than their peers without bulimia. His studies have shown correlations between higher weight suppression in bulimic women and undesired outcomes including greater likelihood of dropping out of treatment, less likelihood of abstaining from binge/purge behaviors, greater weight gain and longer time to remission. Recently, other researchers have found a relationship between weight suppression and metabolism in healthy women, suggesting that people with higher weight suppression must eat fewer calories to maintain their weight than women of similar weight who have always been close to their current weight.

By clarifying the connections between women’s weight history and the course of their eating disorder, researchers may identify ways to use productive discussion of weight and weight history to improve treatments, Lowe said.

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Study: Most weight loss supplements are not effective

Posted on March 7, 2012 by weightcontrol

CORVALLIS, Ore. – An Oregon State University researcher has reviewed the body of evidence around weight loss supplements and has bad news for those trying to find a magic pill to lose weight and keep it off – it doesn’t exist.

Melinda Manore reviewed the evidence surrounding hundreds of weight loss supplements, a $2.4 billion industry in the United States, and said no research evidence exists that any single product results in significant weight loss – and many have detrimental health benefits.

The study is online in the International Journal of Sport Nutrition and Exercise Metabolism.

A few products, including green tea, fiber and low-fat dairy supplements, can have a modest weight loss benefit of 3-4 pounds (2 kilos), but it is important to know that most of these supplements were tested as part of a reduced calorie diet.

“For most people, unless you alter your diet and get daily exercise, no supplement is going to have a big impact,” Manore said.

Manore looked at supplements that fell into four categories: products such as chitosan that block absorption of fat or carbohydrates, stimulants such as caffeine or ephedra that increase metabolism, products such as conjugated linoleic acid that claim to change the body composition by decreasing fat, and appetite suppressants such as soluble fibers.

She found that many products had no randomized clinical trials examining their effectiveness, and most of the research studies did not include exercise. Most of the products showed less than a two-pound weight loss benefit compared to the placebo groups.

“I don’t know how you eliminate exercise from the equation,” Manore said. “The data is very strong that exercise is crucial to not only losing weight and preserving muscle mass, but keeping the weight off.”

Manore, professor of nutrition and exercise sciences at OSU, is on the Science Board for the President’s Council on Fitness, Sports and Nutrition. Her research is focused on the interaction of nutrition and exercise on health and performance.

“What people want is to lose weight and maintain or increase lean tissue mass,” Manore said. “There is no evidence that any one supplement does this. And some have side effects ranging from the unpleasant, such as bloating and gas, to very serious issues such as strokes and heart problems.”

As a dietician and researcher, Manore said the key to weight loss is to eat whole grains, fruits, vegetables and lean meats, reduce calorie intake of high-fat foods, and to keep moving. Depending on the individual, increasing protein may be beneficial (especially for those trying to not lose lean tissue), but the only way to lose weight is to make a lifestyle change.

“Adding fiber, calcium, protein and drinking green tea can help,” Manore said. “But none of these will have much effect unless you exercise and eat fruits and vegetables.”

Manore’s general guidelines for a healthy lifestyle include:

  • Do not leave the house in the morning without having a plan for dinner. Spontaneous eating often results in poorer food choices.
  • If you do eat out, start your meal with a large salad with low-calorie dressing or a broth-based soup. You will feel much fuller and are less likely to eat your entire entrée. Better yet: split your entrée with a dining companion or just order an appetizer in addition to your soup or salad.
  • Find ways to keep moving, especially if you have a sedentary job. Manore said she tries to put calls on speaker phone so she can walk around while talking. During long meetings, ask if you can stand or pace for periods so you don’t remain seated the entire time.
  • Put vegetables into every meal possible. Shred vegetables into your pasta sauce, add them into meat or just buy lots of bags of fruits/vegetables for on-the-go eating.
  • Increase your fiber. Most Americans don’t get nearly enough fiber. When possible, eat “wet” sources of fiber rather than dry – cooked oatmeal makes you feel fuller than a fiber cracker.
  • Make sure to eat whole fruits and vegetables instead of drinking your calories. Eat an apple rather than drink apple juice. Look at items that seem similar and eat the one that physically takes up more space. For example, eating 100 calories of grapes rather than 100 calories of raisins will make you feel fuller.
  • Eliminate processed foods. Manore said research increasingly shows that foods that are harder to digest (such as high fiber foods) have a greater “thermic effect” – or the way to boost your metabolism.

 

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Weight Control Stude: Additive feeding inhibitory and aversive effects of naltrexone and exendin-4 combinations : Author Interview

Posted on February 28, 2012 by weightcontrol

Additive feeding inhibitory and aversive effects of naltrexone and exendin-4 combinations

Author Interview: Dr N-C Liang,

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Building, Room 621, Baltimore, MD 21205, USA.

What are the main findings of the study?
The main findings include:

1. Combination of opioid receptor antagoinst Naltrexone and GLP-1 agoinst Exendin-4 have additive effects on reducing food intake.

2. The additive effects on food intake reduction is strongly related to aversive effects e.g. malaise caused by this combination as stronger conditioned food avoidance are produced by such combination. 

Were any of the findings unexpected?

When use independently, both Naltrexone and Exendin-4 have been reported to produce side effects such as nausea. Initially we predict that lower doses of the two drugs combined can produce sufficient food intake suppression, and at the same time little adverse effects would occur because of the individual low dose used.

However, we found that the combination not only enhance food intake suppression but also the aversive effects of the drugs. 

 
What should clinicians and patients take away from this study?
We emphasized that pharmaceutical approach to treat obesity have the benefit of treating larger obese populations as compared to surgical methods e.g. gastric bypass surgery.

Recent pharmaceutical approach has focused on developing combinational drugs that could act on multiple mechanisms to control food intake and body weight. Combinational drugs have the potential benefit to enhance the desired effects and minimize the adverse effects because lower dose of each individual drug is used. This is the approach we have taken in the study because Naltrexone is considered a drug to reduce food palatability and Exendin-4 is a drug to enhance satiety.

This particular example, however, did not show the benefit of minimizing the adverse effects. Thus, as large funding and resources are used to develop drug combinations for obesity treatment, one must carefully examine possible enhancement of adverse effects at early stage of drug development. 

What recommendations do you have for future research as a result of your study?

From pharmaceutical drug development aspect, it is important to develop compounds that minimize malaise while retaining effects on food intake suppression.

From basic science aspect, I am interested in studying neural mechanisms of anorexia. The idea is that obese and anorexia nervosa are two extremes of the body weight scale.

Food hedonic is similar, goes from highly palatable to aversive. Different degrees of food intake reduction results in either weight loss or severe anorexia. Drugs that produce both food intake suppression and malaise can be a model to tease apart underlying mechanisms for reducing food intake and aversion that could support anorexia.  

Reference:

Additive feeding inhibitory and aversive effects of naltrexone and exendin-4 combinations.

Liang NC, Bello NT, Moran TH.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Int J Obes (Lond). 2012 Feb 7. doi: 10.1038/ijo.2012.16. [Epub ahead of print]

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Study says overweight Americans may risk kidney damage when attempting weight loss

Posted on February 22, 2012 by weightcontrol

Analysis adds to concerns about weight-loss methods and dietary protein intake

Tuesday, February 21, 2012, Cleveland: With 1 in 5 overweight Americans suffering from chronic kidney disease, Cleveland Clinic researchers analyzed the nutritional and lifestyle habits of overweight adults, finding that their methods included diets and diet pills that may cause further kidney damage.

The study findings, published online this month in the International Journal of Obesity, came from an analysis of food choices and lifestyle habits of 10,971 overweight adults taken from the National Health and Nutrition Examination Survey (NHANES), a federally-administered assessment of the overall health and nutritional status of Americans.

Of the overweight and obese patients with kidney disease included in the survey, 50 percent reported that they had attempted to lose weight in the past year. The survey showed that, on average, obese Americans with kidney disease consume protein in amounts that are above the recommended levels prescribed by the National Kidney Foundation for chronic kidney disease patients.

The typical American diet each day includes approximately 1.2g of protein per kilogram of body weight. Patients with CKD are advised to consume 0.6g to 0.75g protein per kilogram of body weight each day and popular high-protein diets may call for up to 1.9g per kilogram of body weight.

“People who are overweight or obese are at higher risk for chronic kidney disease and there is a great need to define what the appropriate lifestyle changes and weight loss modalities are for protecting kidney function,” said Sankar Navaneethan, M.D., a nephrologist in the Glickman Urological and Kidney Institute at Cleveland Clinic and lead author of the study. “Rather than using fad diets or diet pills, overweight and obese people with kidney disease may adopt a weight loss plan that incorporates a low-protein, low-calorie diet, regular physical activity and close follow-up by their physicians.”

The survey asked patients whether they participated in regimens that included diet or exercise or both, but the specific program, such as a high-protein diet or low-protein diet, was not named. The survey also found that eight percent of weight loss seekers with CKD used medications as part of their weight loss regimen. Certain weight loss methods, especially high-protein diets and weight loss medications are not recommended in people with kidney disease as they may lead to further kidney damage.

The authors recommend further studies designed to identify safe treatment strategies for weight loss with regards to protecting kidney function.

According to the Centers for Disease Control and Prevention, more than 10 percent of adults aged 20 or older in the U.S., or more than 20 million people, have chronic kidney disease (CKD), a condition that describes the progressive worsening of kidney function. It is often found in patients who have diabetes or hypertension, and can exist without symptoms until it progresses to severe levels. When CKD progresses to end-stage renal disease, patients typically require treatment through dialysis or transplantation. The prevalence of the disease is rapidly growing as is the cost burden. Medicare costs in the U.S. for the care of patients with end-stage renal disease has risen from $12.2 billion in 2000 to $20.8 billion in 2007.

Source: Eurekalert

More on Weight Control from WeightControl.com

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Dietary fat intake and polymorphisms at the PPARG locus modulate BMI & type 2 diabetes risk in the D.E.S.I.R. prospective study: Dr. Fumeron

Posted on February 18, 2012 by weightcontrol

Dear Dr. Fumeron,
Dietary fat intake and polymorphisms at the PPARG locus modulate BMI and type 2 diabetes risk in the D.E.S.I.R. prospective study

Author Interview: Frédéric Fumeron, PhD

UFR de Médecine Université Paris Diderot – Paris

What are the main findings of the study?

The Peroxysome proliferator activity receptor gamma (PPARg) is involved in adipose tissue and lipid metabolisms. There is a common genetic variation modifying the protein, Pro12Ala.

In a large cohort study, with a 9-year follow-up, DESIR, a high fat consumption (the highest tertile in percentage of energy intake) is associated with an increase in type 2 diabetes risk in people carrying the common genotype ProPro only, but not in those carrying Ala.

However those carrying the Ala Ala genotype had a higher Body Mass Index when consuming a high fat diet.

Were any of the findings unexpected?

The main results of our study might seem paradoxical. A high fat intake increases BMI in AlaAla individuals but increases T2D risk in ProPro homozygotes.

This may be in line with the effects of the PPARg agonists, the glitazones which are drugs for treatment of diabetes that increase body weight.

Also another genetic variant highly linked to Pro12Ala has paradoxically an opposite effect on BMI, for unknown reason.

What should clinicians and patients take away from this study?

1) the effects of dietary intake might be different among individuals, depending on the genetic background. But it is too early to make prescriptions according to the genotype yet.

2) in some people, a high fat diet may increase the BMI without increasing their type 2 diabetes risk.

What recommendations do you have for future research as a result of your study?

Future research is needed for understanding the mechanisms of these interactions. The emphasis should be put on the specific fatty acid composition of the diet too.

Reference:

Dietary fat intake and polymorphisms at the PPARG locus modulate BMI and type 2 diabetes risk in the D.E.S.I.R. prospective study.

Lamri A, Abi Khalil C, Jaziri R, Velho G, Lantieri O, Vol S, Froguel P, Balkau B, Marre M, Fumeron F.
Int J Obes (Lond). 2012 Feb;36(2):218-24. doi: 10.1038/ijo.2011.91. Epub 2011 May 3.

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FOUR NOVEL /UCP3/ GENE VARIANTS ASSOCIATED WITH CHILDHOOD OBESITY: Dr. Buono

Posted on February 18, 2012 by weightcontrol

FOUR NOVEL /UCP3/ GENE VARIANTS ASSOCIATED WITH CHILDHOOD OBESITY:
EFFECT ON FATTY ACID OXIDATION AND ON PREVENTION OF TRIGLYCERIDE STORAGE

Author Interview: Professor P Buono
Dipartimento di Studi delle Istituzioni e dei Sistemi Territoriali
Università degli Studi di Napoli ‘Parthenope’, Via Medina 40
Naples 80133, Italy

What are the main findings of the study?

Recently, UCP3 gene as been  proposed as a candidate gene for the human obesity.

We found four novel mutation in UCP3 gene associated to severe obesity
in a cohort of 200 children.

Our data support the notion that protein UCP3 is
involved in long-chain fatty acid metabolism in mitochondria and in
the prevention of cytosolic triglyceride storage. We also provide
evidence that telmisartan positively affected HbA1c, total and
low-density lipoprotein cholesterol and hypertension in type 2
diabetes patients, improves palmitate oxidation in cells expressing
wt or mutant UCP3 proteins.

Were any of the findings unexpected?

The findings were not unexpected, but our study provide for the first time a functional analyses of wt and mutant UCP3 proteins in in-vitro.

Furthermore, we provides evidences that telmisartan improves palmitate oxidation also in cells expressing the dominant-negative UCP3 mutant proteins.

What should clinicians and patients take away from this study?

Our in-vitro data suggests that telmisartan may be useful in subjects in
whom fatty acid metabolism is severely impaired.

What recommendations do you have for future research as a result of
your study?

Our future aim is to enlarge our cohort study and to
investigate if the activity of mutant-negative UCP3 proteins is
correlated with dietary fat intake and/or with the degree of daily
physical activity.

Reference:

Four novel UCP3 gene variants associated with childhood obesity: effect on fatty acid oxidation and on prevention of triglyceride storage.

Musa CV, Mancini A, Alfieri A, Labruna G, Valerio G, Franzese A, Pasanisi F, Licenziati MR, Sacchetti L, Buono P.
Int J Obes (Lond). 2012 Feb;36(2):207-17. doi: 10.1038/ijo.2011.81. Epub 2011 Apr 19.

 

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Novel genes and cellular pathways related to infection with adenovirus-36 as an obesity agent in human mesenchymal stem cells: Dr. Nam

Posted on February 18, 2012 by weightcontrol

Novel genes and cellular pathways related to infection with adenovirus-36 as an obesity agent in human mesenchymal stem cells

Professor J-H Nam,
Department of Biotechnology
The Catholic University of Korea
43-1 Yeokgok-dong, Wonmi-gu
Bucheon, 420-743, Korea

What are the main findings of the study?

We found that Adenovirus 36 (Ad36) which can induce human obesity was associated with some novel pathways, including the PPAR gamma, inflammation, and mitochondria, raising the possibility that these pathways may be key regulators of Ad36 induced adipogenesis.
Moreover, human mesenchymal stem cells (hMSCs) could be good model system to research Ad36.

Were any of the findings unexpected?

It is surprising for us that mitochondria pathway may be activated in Ad36 induced obesity.
The induction of mitochondria function may be related with the improvement of hyperglycemia.

What should clinicians and patients take away from this study?

Ad36 is considered as obesity agent for human. However, Ad36 infection seems to be a double-edged sword because Ad36 infection can trigger the obesity, whereas it can improve the glycemic control due to several reasons including induction of mitochondria activity.

What recommendations do you have for future research as a result of your study?

We will focus on the role of mitochondria in Ad36 infection for further study.

Reference:

Novel genes and cellular pathways related to infection with adenovirus-36 as an obesity agent in human mesenchymal stem cells.

Na HN, Kim H, Nam JH.

Department of Biotechnology, The Catholic University of Korea, Bucheon, Korea.
Int J Obes (Lond). 2012 Feb;36(2):195-200. doi: 10.1038/ijo.2011.89. Epub 2011 May 3.

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Effectiveness of interventions for reducing diabetes and cardiovascular disease risk in people with metabolic syndrome: Dr. Gray

Posted on February 15, 2012 by weightcontrol

Effectiveness of interventions for reducing diabetes and cardiovascular disease risk in people with metabolic syndrome: systematic review and mixed treatment comparison meta-analysis 

Author Interview  Dr. Laura Gray, BSc (Hons), MSc, PhD.

Lecturer of Population and Public Health Sciences
University of Leicester

What are the main findings of the study?

All three anti-obesity drugs gave modest weight and BMI reductions, with rimonabant and sibutramine (which are both now unlicensed in the UK) giving the greatest reductions.

Lifestyle advice also reduced weight at 6 and 12 months compared to placebo but not to the same extent as the pharmacological interventions.

Were any of the findings unexpected?

These finding were not unexpected, but this is the first time all the evidence for the 3 anti-obesity drugs have been synthesized in a single analysis.

What should clinicians and patients take away from this study?

Orlistat is the only drug currently approved worldwide for the long-term treatment of obesity. In clinical practice, Orlistat should be considered to aid weight reduction with lifestyle interventions in those individuals who have not been successful in reducing their weight with lifestyle alone.

What recommendations do you have for future research as a result of your study?

The effectiveness of the withdrawn interventions – sibutramine and rimonabant – suggests that more effective drugs may be available in the future if the side effect risk can be alleviated.

Reference:

Effectiveness of interventions foe reducing diabetes and cardiovascular disease risk in people with metabolic syndrome: systematic review and mixed treatment comparison meta-analysis.

Dunkley AJ, Charles K, Gray LJ, Camosso-Stefinovic J, Davies MJ, Khunti K.
Diabetes Obes Metab. 2012 Jan 27. doi: 10.1111/j.1463-1326.2012.01571.x.

Posted in Author Interviews, Diet - Obesity Medications, Orlistat - Alli / Xenical | Tagged , , , | Leave a comment