KOLOTKIN, RONETTE L., ROSS D. CROSBY, G. RHYS WILLIAMS, GUILFORD G. HARTLEY, AND SUSAN NICOL. The relationship between health-related quality of life and weight loss. Obes Res. 2001;9:564 -571. Objective: This is a report of health-related quality of life (HRQOL) changes in obese patients completing at least 1 year of outpatient treatment in a weight reduction program combining phentermine-fenfluramine and dietary counseling. Research Methods and Procedures: Participants were 141 women (87.6%) and 20 men (12.4%) who had an average body mass index at intake of 41.1 kg/m 2 (SD ϭ 7.0, range ϭ 29.5 to 67.0 kg/m 2 ) and an average age of 44.9 years (SD ϭ 9.3, range ϭ 23 to 65 years). HRQOL was assessed at intake and at 1-year follow-up using the Impact of Weight on Quality of Life (IWQOL)-Lite questionnaire. The relationship between HRQOL changes and weight loss was examined using Pearson correlations. Clinically meaningful change in HRQOL was defined as a 1.96 SEM reduction in IWQOL-Lite total score. Results: On average, participants lost 20.2 kg or 17.6% of their weight over the 1-year period. Of the participants, 15.5% lost Ͻ10% of their weight, 24.2% lost 10% to 14.9%, 23.6% lost 15% to 19.9%, and 36.6% lost 20% or more. All five IWQOL-Lite scales and total score showed statistically significant improvement over the 1-year period. Changes in IWQOL-Lite scores from intake to 1 year showed statistically significant correlations with percentage of weight loss for all subscales and total score. Subscale correlations with weight loss ranged from 0.166 (Public Distress) to 0.396 (Physical Function) and was 0.370 for the total score. Fortyfour percent of participants losing Ͻ10% met the criterion of clinically meaningful change, compared with 51.3% losing 10% to 14.9%, 55.3% losing 15% to 19.95%, and 76.3% losing Ͼ20%. For total score and for three of the five IWQOL-Lite scales (Physical Function, Self-Esteem, and Sexual Life), the relationship between weight loss and clinically meaningful change was linear and was significant at p Ͻ 0.05. Physical Function and Self-Esteem were most strongly affected by weight loss. Discussion: HRQOL changes, as measured by an obesityspecific instrument (IWQOL-Lite), are strongly related to weight reduction.Key words: quality of life, health-related quality of life, Impact of Weight on Quality of Life-Lite questionnaire, weight loss, clinically meaningful change

Obese patients who took fenfluramine and phentermine, dexfenfluramine alone, or dexfenfluramine and phentermine had a significantly higher prevalence of cardiac valvular insufficiency than a matched group of control subjects.

. Impact of weight loss and regain on quality of life: mirror image or differential effect? Obes Res. 2003;11:1207-1213. Objective: To compare the impact of weight regain and weight loss on health-related quality of life. Research Methods and Procedures: Subjects were 122 (106 women, 16 men) overweight and obese participants in a weight reduction program (phentermine-fenfluramine and dietary counseling) who had initially lost at least 5% of their total body weight and then regained at least 5% of their weight during the follow-up period. Follow-up periods ranged from 10 to 41 months (mean, 28 months). Participants completed the Impact of Weight on Quality of LifeLite, an obesity-specific health-related quality of life (HRQOL) measure, at 3-month intervals. Results: Mean BMI at baseline was 40.9 Ϯ 6.6 kg/m 2 (range, 29.2 to 63.7 kg/m 2 ). Average weight loss from entry was 18.8 Ϯ 6.7% (range, 6.0% to 43.7%), and average regain was 10.1 Ϯ4.4% of baseline weight (range, 5.0% to 30.6%). The effects of weight regain on HRQOL mirrored the effects of weight loss-rates of HRQOL change were similar in magnitude but different in direction for comparable weight loss and regain. Those with more severe initial impairments in HRQOL experienced greater improvements in HRQOL during weight loss as well as greater deterioration during weight regain than those with less severe impairments. Discussion: Weight loss and regain produced mirror image changes in HRQOL. The initial severity of HRQOL impairment had a greater impact on the magnitude of HRQOL change than the direction of weight change. Findings underscore the importance of maintaining weight loss for the purposes of retaining obesity-specific HRQOL benefits.Key words: weight gain, weight regain, health-related quality of life, obesity-specific health-related quality of life, Impact of Weight on Quality of Life

Bariatric surgery performed at US academic centers is safe and associated with low mortality.

Background: Further investigations are warranted to better characterize variables that may confound the clinical interpretation of plasma natriuretic peptide measurements, which are increasingly recognized to have diagnostic and predictive importance. Methods: Blood samples (EDTA plasma) from patients (n ‫؍‬ 206) attending clinics for the medical treatment and follow-up of obesity were analyzed for B-type natriuretic peptide (BNP; Bayer assay) and the N-terminal segment of its prohormone (NT-proBNP; Roche assay). Natriuretic peptide concentration ranges were evaluated in those without diagnosis of congestive heart failure (CHF) or chronic kidney disease (CKD). Results: BNP and NT-proBNP were directly correlated (r ‫؍‬ 0.87; P ‫؍‬ 0.01), with NT-proBNP concentrations higher relative to BNP. Of obese patients without CHF or CKD, 21.6% (40 of 185) had NT-proBNP concentrations greater than the published assay upper reference limit. Concentrations of both natriuretic peptides were higher in patients currently exposed to beta blockers, patients with the diagnosis of hypertension or type 2 diabetes, and patients with a history of gastric bypass surgery. An inverse relationship between body mass index (BMI) and both BNP and NT-proBNP was evident. According to the National Institutes of Health, National Heart, Lung, and Blood Institute classification,

VESSEY. Diabetes disease stage predicts weight loss outcomes with long-term appetite suppressants. Obes Res. 2000:8:43-48. Objectives: Characterize degree of weight loss with stage of diabetes and describe its effect on cardiovascular disease risk factors in obese patients with and without diabetes. Research Methods and Procedures: Retrospective cohort analysis from patients participating in a long-term weight management protocol using diet, exercise, behavioral modification, and appetite-suppressant therapy. Patient groups, with (n ϭ 19) and without diabetes (n ϭ 19) were matched for age, gender, and weight before weight loss therapy. The effect of 12 months of therapy on weight, blood pressure, glycemic control, lipid profile, and medication requirements were tested. Additionally, patients were grouped or staged based upon therapy required for control of diabetes at the beginning of weight loss intervention. Analysis of covariance described relationships between diabetes disease stage and weight loss at 12 months. Results: Nondiabetic patients had greater mean reduction in BMI than the diabetic group (7.98 kg/m 2 vs. 4.77 kg/m 2 , p Ͻ 0.01). A significant linear trend (p Ͻ 0.001) for decreasing weight loss with stage of diabetes was observed. Blood pressure, lipid profile, and glycemia improved significantly. The average daily glyburide-equivalent dose decreased from 9.4 to 3.0 mg (p Ͻ 0.01). Discussion: Patients with diabetes lost less weight than similarly obese patients without diabetes. Regardless of differential weight loss between groups, cardiovascular disease risk factors improved. Hypoglycemic medication requirements decreased with weight loss therapy. A predictive relationship may exist between diabetes disease stage before weight loss therapy and future weight loss potential.

We evaluated changes in sexual quality of life as they relate to weight loss over a 2-year period in individuals undergoing weight loss treatment. Six dimensions of sexual quality of life were measured using items from the Impact of Weight on Quality of Life questionnaire (feeling sexually unattractive, lacking sexual desire, reluctance to be seen undressed, difficulty with sexual performance, avoidance of sexual encounters and lack of enjoyment of sexual activity). At baseline women were more likely than men to report lack of sexual enjoyment and reluctance to be seen undressed in spite of lower body mass index (BMI). Weight loss averaged 13.1% and was significantly associated with improvements in all sexual quality of life dimensions. A 3-4% regain did not appear to negatively affect sexual quality of life. The greatest improvements for women had occurred by 3 months and were observed in all dimensions, whereas for men only 'not feeling sexually attractive' showed marked improvement in this short time frame.

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