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Objective: Obesity is a major risk factor for the development of type 2 diabetes. Tumor necrosis factor (TNF)-alpha is a candidate gene for the development of both obesity and insulin resistance. We investigated whether a common polymorphism in the promoter region (-308 G/A) of the TNF-alpha gene was associated with increased risk for the development of insulin resistance and cardiovascular disease in an obese Australian population., Research Methods and Procedures: Obese, non-diabetic subjects (146 women and 34 men) were genotyped with polymerase chain reaction-restriction fragment length polymorphism techniques, and anthropometric and biochemical measurements were analyzed. A homeostasis model assessment (HOMA) score was used to gauge the level of insulin resistance., Results: The frequencies of the G allele and the A allele were 0.759 and 0.241, respectively. Subjects homozygous for the A allele had higher fasting insulin levels (226 vs. 131 pM; p < 0.001), higher HOMA scores (10.2 vs. 5.3; p < 0.001), higher systolic blood pressure (143 vs. 129 mm Hg; p = 0.02), and lower high-density lipoprotein (HDL) cholesterol (1.13 vs. 1.25 mM; p = 0.04) than did subjects homozygous for the G allele. Whereas an association between insulin resistance and body mass index or waist circumference was seen in all subjects, a highly significant negative correlation of HDL cholesterol to HOMA scores (r = -0.710; p < 0.001) occurred in subjects with the A allele only., Discussion: The -308 G/A TNF-alpha gene variant conveys an increased risk for the development of insulin resistance in obese subjects. The presence of low HDL cholesterol levels further increases the risks associated with insulin resistance in carriers of the A allele.

Objective: To assess the effect of a 3 month behaviour modification weight management programme on self-efficacy and anthropometric variables among obese women seeking treatment at an obesity management clinic and to compare self-efficacy among these obese women to non-obese women., Design: Cross sectional., Subjects: A total of 161 non-obese (BMI 22.6+/-2.9 kg/m(2)) and 138 obese (BMI 37.7+/-5.8 kg/m(2)) women of similar age., Measurements: Self-efficacy in relation to eating was assessed by the Weight Efficacy Lifestyle (WEL) questionnaire. Demographic information was obtained by interview and questionnaire in the obese and by questionnaire in the non-obese. Anthropometric measurements were obtained by direct measure in the obese and BMI was calculated from self-reported weight and height in the non-obese., Results: At entry to the programme obese women scored significantly less (P<0.0001) than non-obese women on the WEL (99.4+/-34.1 vs 139.0+/-24.9). Women who completed the programme (n=65) demonstrated a decrease in waist circumference of 3.9+/-5.3 cm, a 10.0+/-11.5% loss of excess weight and a significant improvement in total WEL score from 106.0+/-30.3 to 126.5+/-28.4., Conclusion: Improvements in some dimensions of self-efficacy among obese women were of sufficient magnitude to attain scores similar to women of a normal weight. The WEL questionnaire may provide an additional measure of success as well as provide positive feedback and encouragement to the client.

Koreans are a recent but relatively small ethnic minority group in Australia. This descriptive cross-sectional, comparative intercountry study examines the effect of Australian acculturation among elderly Koreans on cardiovascular disease (CVD) risk factors, compared with their counterparts in Korea. Fifty-one (72.4 ± 8.7 years) Australian Koreans (AK) and 48 (75.7 ± 6.9 years) Koreans (K) living in Seoul participated in the study. Diabetes was reported by 10.2% of AK and 17.4% of K and hypertension by 38.8 and 29.8% of AK and K, respectively. Significantly, more AK (85.7%) than K (53.2%) reported undertaking physical activity (P = 0.0005) and fewer AK were current smokers (6% vs 26.1%; P = 0.0077). After controlling for age, body mass index and waist-to-hip ratio no differences were found in lipid profiles between AK and K men or women. The effect of acculturation may be reflected among Australian Koreans by increased physical activity and reduced smoking levels and increased levels of abdominal obesity.

Objective: To describe the process of establishing a Shared Care obesity management programme between general practitioners and a hospital based specialist obesity service and to compare outcomes of the Shared Care programme (SC) to an established hospital based programme (MOS)., Design: A comparative study of two obesity management programmes. Patients were matched on gender, age and BMI (kg/m2)., Subjects: 29 female and eight male (age: 47.0 +/- 2 years, BMI 35.9 +/- 0.8 kg/m2) patients enrolled in the Shared Care programme (SC) were matched to 81 female and 20 male (age: 45.8 +/- 1.1 years, BMI 35.7 +/- 0.4 kg/m2) patients enrolled in a hospital based programme (MOS)., Main Outcome Measures: Relative and absolute weight loss and retention rate were compared between the programmes at 10 and 26 weeks. Food habits were assessed at enrolment and week 10 of the programme in the SC group by a Food Habits Questionnaire and cognitive restraint, disinhibition and hunger were assessed by the Eating Inventory Questionnaire., Results: Shared Care patients (n = 28) lost significantly more weight than the MOS patients (n = 60) (SC 4.8 +/- 0.6 kg and MOS 2.6 +/- 0.4 kg; p = 0.0016) over the 10 weeks of the programme. At 26 weeks both groups demonstrated a 5 kg weight loss. There was a significant improvement in food habits, and cognitive restraint, disinhibition and hunger over the 10 weeks of the programme in the SC group. Patient satisfaction was reflected in a better retention rate at 26 weeks by the Shared Care group., Conclusion: The study demonstrated that the obese patient managed in a shared care setting achieved better weight loss in the short term and attrition was lower in the longer term than a similar patient attending a specialist service based in a hospital.

Objective: As successful weight management demands a long term approach, a better understanding of weight changes during and for significant periods after cessation of dexfenfluramine therapy is essential to the evaluation of the drug's effectiveness in clinical practice. This study aimed to investigate additional benefits to weight loss during 6 months treatment with dexfenfluramine in 60 patients enrolled in a weight loss programme., Design: Sixty obese subjects (21 males; 39 females) were randomised to dexfenfluramine (15 mg twice daily) or placebo for six months. Fifty one (27 dexfenfluramine; 24 placebo) subjects completed the double blind, randomised, placebo controlled clinical trial., Results: After a one month 'run in' phase and six months treatment, weight loss in the dexfenfluramine group was significantly greater than placebo, 9.7 +/- 1.1 kg vs 4.9 +/- 0.9 kg (mean +/- s.e.m.); P = 0.002. Reduction in body fat, 5.0 +/- 0.7 kg vs 1.0 +/- 0.9 kg; P = 0.002 and waist circumference, 10.5 +/- 1.9 cm vs 5.7 +/- 1.1 cm; P = 0.04 was also greater in the dexfenfluramine group. Despite significant weight loss, waist to hip ratio (WHR) did not change in either group. The dexfenfluramine group reported a significantly greater incidence of nausea, dry mouth and dizziness which tended to decrease as treatment progressed. No subjects withdrew due to drug induced side effects. Reduction in serum triglyceride levels and an increase in HDL cholesterol (in female subjects) in conjunction with a reduction in fasting insulin, collectively support an improved cardiovascular risk profile in the dexfenfluramine group. Despite significant weight loss, these risk factor measurements worsened in the placebo group. After cessation of dexfenfluramine therapy, there was a significantly greater weight regain indicating a loss of treatment effect. By 5 months after cessation of dexfenfluramine, the treatment effect was negated with weight loss in the dexfenfluramine (6.0 +/- 1.6 kg) and placebo (6.2 +/- 1.3 kg) group, similar., Conclusion: The results of this study support the longer term use of dexfenfluramine therapy for patients with chronic obesity.

Obstructive sleep apnoea (OSA) has been estimated to affect between 1 and 4% of the total population. OSA may be more frequent among women than studies based on subjects presenting for treatment would indicate. The aim of this study was to determine the prevalence of OSA in an obese female population (BMI > 30 kg/m2, age > 18 years) who presented to a hospital-based obesity clinic. The women were screened by an overnight ambulatory sleep study (MESAM) to detect OSA. Subjective sleep quality and sleep disturbance were assessed by a 19-item questionnaire, the Pittsburg sleep quality index (PSQI). From a population of 108 women, 29 were screened by MESAM. OSA was determined on the basis of respiratory disturbance index (RDI). The prevalence of OSA, defined as five or more respiratory disturbances per hour, was 37.9%. The mean age of the women was 43.6 +/- 2.57 years (mean +/- s.e.m.) and they had a mean BMI of 40.7 +/- 1.40 kg/m2. There was a significant positive correlation for RDI and BMI (r = 0.71; P < 0.001). Our findings indicate that over one third of women had OSA, yet they did not complain of symptoms even though the PSQI questionnaire indicated that they were poor sleepers. Non-specific symptomatology of OSA may be important diagnostically, particularly in women, and obese women should be considered at risk of OSA.

Objectives: To determine the efficacy of two dietary therapies in both the short term (hospitalisation) and the longer term treatment of severe obesity., Design: A descriptive study of two patient groups with obesity defined by a body mass index of greater than 30 kg/m2., Setting: A multidisciplinary weight control program in a tertiary care hospital., Patients: All admissions to hospital of patients on the weight control program for initiation of weight loss during a period of 48 months., Intervention: A standard kilojoule reduction regimen or the use of complete, followed by partial, long term meal substitution with a very low energy liquid diet (VLED), coupled with an exercise and a behavioural modification program., Outcome Measures: Weight loss during and after hospitalisation was measured in both dietary regimen groups., Results: Both diets induced weight loss in hospital. Men prescribed VLED lost significantly more weight, 8.3 +/- 0.8 kg (mean +/- SEM) than women prescribed this diet (5.5 +/- 0.5 kg) or standard kilojoule restriction (5.1 +/- 0.8 kg)., Conclusions: VLED and standard kilojoule restriction are both effective for the treatment of severe obesity, particularly in a controlled environment (hospitalisation). In the longer term, VLED is an effective method of maintaining weight loss. Lack of continuing weight loss may reflect the patients who were initially placed on this regimen--small eaters with a presumed high metabolic efficiency.