Objective: Dietary carbohydrate is the major determinant of postprandial glucose levels, and several clinical studies have shown that low-carbohydrate diets improve glycemic control. In this study, we tested the hypothesis that a diet lower in carbohydrate would lead to greater improvement in glycemic control over a 24-week period in patients with obesity and type 2 diabetes mellitus.Research design and methods: Eighty-four community volunteers with obesity and type 2 diabetes were randomized to either a low-carbohydrate, ketogenic diet (<20 g of carbohydrate daily; LCKD) or a low-glycemic, reduced-calorie diet (500 kcal/day deficit from weight maintenance diet; LGID). Both groups received group meetings, nutritional supplementation, and an exercise recommendation. The main outcome was glycemic control, measured by hemoglobin A 1c .Results: Forty-nine (58.3%) participants completed the study. Both interventions led to improvements in hemoglobin A 1c , fasting glucose, fasting insulin, and weight loss. The LCKD group had greater improvements in hemoglobin A 1c (-1.5% vs. -0.5%, p = 0.03), body weight (-11.1 kg vs. -6.9 kg, p = 0.008), and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p < 0.001) compared to the LGID group. Diabetes medications were reduced or eliminated in 95.2% of LCKD vs. 62% of LGID participants (p < 0.01). Conclusion:Dietary modification led to improvements in glycemic control and medication reduction/elimination in motivated volunteers with type 2 diabetes. The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/ elimination than the low glycemic index diet. Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes.

SMA interventions improve biophysical outcomes among patients with diabetes. There was inadequate literature to determine SMA effects on patient experience, utilization, and costs.

Background The presence of loss of control (LOC) eating in youth predicts excessive weight gain. However, few studies have measured the actual energy intake of children reporting LOC eating. Objective To characterize energy intake and macronutrient composition of “normal” and “binge” laboratory meals in non-overweight and overweight boys and girls with LOC eating. Design 177 youth (8–17y) consumed two lunchtime meals ad libitum from a multi-item food array after being instructed either to binge-eat (binge meal) or to eat normally (normal meal). Prior LOC eating was determined by semi-structured clinical interview. Results Participants consumed more energy at the binge meal than the normal meal (p=0.001). Compared to youth without LOC episodes (n=127), those reporting LOC (n=50) did not consume more energy at either meal. However, at both meals, youth with LOC consumed a greater percentage of calories from carbohydrate and a smaller percentage from protein than those without LOC (ps<0.05). Children with LOC ate more snack and dessert-type foods and less meats and dairy (ps<0.05). LOC participants also reported greater increases in post-meal negative affect at both meals compared to those without LOC (ps≤0.05). Secondary analyses restricted to overweight and obese girls found that those with LOC consumed more energy at the binge meal (p=0.025). Conclusions When presented with an array of foods, youth with LOC consumed more high-calorie snack and dessert-type foods than those without LOC. Further research is required to determine whether habitual consumption of such foods may promote overweight.

OBJECTIVE-To investigate the relationship between loss of control over eating, adiposity, and psychological distress in a non-treatment sample of overweight children.METHOD-Based on self-reports of eating episodes, 112 overweight children, 6-10 y, were categorized using the Questionnaire of Eating and Weight Patterns -Adolescent Version into those describing episodes of loss of control over eating (LC), and those with no loss of control (NoLC). Groups were compared on measures of adiposity, dieting and eating behavior, and associated psychological distress.RESULTS-LC children (33.1%) were heavier and had greater amounts of body fat than NoLC children. They also had higher anxiety, more depressive symptoms, and more body dissatisfaction. 5.3% met questionnaire criteria for BED. Episodes of loss of control occurred infrequently, were often contextual, and involved usual meal foods. DISCUSSION-As in adults, overweight children reporting loss of control over eating have greater severity of obesity and more psychological distress than those with no such symptoms. It remains unknown whether children who endorse loss of control over eating before adolescence will be those who develop the greatest difficulties with binge eating or obesity in adulthood. KeywordsBinge eating; obesity; child; race; psychopathology Binge eating is a frequent behavior in overweight adults ( Loro & Orleans, 1981;Gormally, Black, Daston & Rardin, 1982;Marcus, Wing & Lamparski, 1985;Spitzer et al, 1992;Fairburn & Wilson, 1993;Grisset & Fitzgibbon, 1996;Robertson & Palmer, 1997), and is Author ManuscriptAuthor Manuscript Author ManuscriptAuthor Manuscript defined by the consumption of large amounts of food associated with a feeling of loss of control over eating (Fairburn & Wilson, 1993). A smaller proportion of individuals reporting binge eating meet criteria for binge eating disorder (BED), a research diagnostic category of the DSM IV that is characterized by recurrent binge-eating episodes associated with marked distress, but without inappropriate compensatory behaviors. The prevalence of BED in obese adults seeking weight loss treatment may be as high as 20% to 30% (Spitzer et al., 1992 while rates of BED in community samples have been estimated at somewhat less than 3% (Yanovski, 1999).In adults, binge eating is often associated with obesity (Telch, Agras & Rossiter, 1988;Smith, Marcus, Lewis, Fitzgibbon & Schreiner, 1998) and other disturbed eating behaviors. Besides having less ability to control eating behavior (Grisset & Fitzgibbon, 1996;Wadden, Foster, Letizia & Wilk, 1993;Kuehnel & Wadden, 1994), obese adults reporting binge eating also have greater concerns with body shape and weight (Marcus, Smith, Santilli, Kaye, 1992;Spitzer et al., 1993;Wilson, Nonas & Rosenblum, 1993), report an earlier onset of obesity and dieting, and describe a higher percentage of their lifetimes spent on a diet than non-binge eating obese individuals (Brody, Walsh & Devlin, 1994). Several studies have shown that obese adult binge eaters also report...

OBJECTIVE-Metformin can decrease adiposity and ameliorate obesity-related comorbid conditions, including abnormalities in glucose homeostasis in adolescents, but there are few data evaluating the efficacy of metformin among younger children. Our objective was to determine whether metformin treatment causes weight loss and improves obesity-related comorbidities in obese children, who are insulin-resistant.RESEARCH DESIGN AND METHODS-This study was a randomized double-blind placebo-controlled trial consisting of 100 severely obese (mean BMI 34.6 6 6.6 kg/m 2 ) insulin-resistant children aged 6-12 years, randomized to 1,000 mg metformin (n = 53) or placebo (n = 47) twice daily for 6 months, followed by open-label metformin treatment for 6 months. All children and their parents participated in a monthly dietitian-administered weight-reduction program.RESULTS-Eighty-five percent completed the 6-month randomized phase. Children prescribed metformin had significantly greater decreases in BMI (difference 21.09 kg/m 2 , CI 21.87 to 20.31, P = 0.006), body weight (difference 23.38 kg, CI 25.2 to 2 1.57, P , 0.001), BMI Z score (difference between metformin and placebo groups 20.07, CI 20.12 to 20.01, P = 0.02), and fat mass (difference 21.40 kg, CI 22.74 to 20.06, P = 0.04). Fasting plasma glucose (P = 0.007) and homeostasis model assessment (HOMA) insulin resistance index (P = 0.006) also improved more in metformin-treated children than in placebo-treated children. Gastrointestinal symptoms were significantly more prevalent in metformin-treated children, which limited maximal tolerated dosage in 17%. During the 6-month open-label phase, children treated previously with placebo decreased their BMI Z score; those treated continuously with metformin did not significantly change BMI Z score further.CONCLUSIONS-Metformin had modest but favorable effects on body weight, body composition, and glucose homeostasis in obese insulin-resistant children participating in a low-intensity weight-reduction program. Diabetes 60: [477][478][479][480][481][482][483][484][485] 2011

Background Recent changes to the Food and Drug Administration boxed warning for metformin will increase use in individuals with historical contraindications or precautions. Prescribers must understand clinical outcomes of metformin use in these populations. Purpose To synthesize data addressing outcomes of metformin use in populations with type 2 diabetes and moderate-to-severe chronic kidney disease, congestive heart failure, or chronic liver disease with hepatic impairment. Data Sources MEDLINE (via PubMed) from January 1994 to September 2016; Cochrane Library, EMBASE, and International Pharmaceutical Abstracts from January 1994 to November 2015. Study Selection English-language studies that examined adults with type 2 diabetes and chronic kidney disease with eGFR <60 mL/min/1.73m2, congestive heart failure, or chronic liver disease with hepatic impairment; compared diabetes regimens that included metformin to regimens that did not; and reported all-cause mortality, major adverse cardiovascular events and other outcomes of interest. Data Extraction Two reviewers abstracted data and independently rated study quality and strength of evidence. Data Synthesis Based on quantitative/qualitative syntheses involving 17 observational studies, metformin use is associated with reduced all-cause mortality in patients with chronic kidney disease, congestive heart failure, and chronic liver disease with hepatic impairment, and reduced heart failure readmission in patients with chronic kidney disease and congestive heart failure. Limitations We identified low strength of evidence and sparse data on multiple outcomes of interest. Available studies were observational and had varying follow-up durations. Conclusions Metformin use in patients with moderate chronic kidney disease, congestive heart failure, or chronic liver disease with hepatic impairment is associated with improvements in key clinical outcomes. Our findings support recent changes in metformin labeling. Registration PROSPERO CRD42016027708 Funding Source U.S. Department of Veterans Affairs

According to adolescent and parent reports, overweight is associated with poorer QOL in adolescence, regardless of race; however, compared with overweight white adolescents, blacks report less impairment in QOL. Future research is required to determine whether differences in QOL are predictive of treatment success.

ABSTRACT. Objective. Relatively little is known about how excess body mass affects adolescents' capacity to perform sustained exercise. We hypothesized that most of the difficulty that severely overweight adolescents have with sustained exercise occurs because the metabolic costs of moving excess mass result in use of a high proportion of their total oxygen reserve.Methods. We compared results from a maximal cycle ergometry fitness test in 129 severely overweight adolescents who had BMIs of 41.5 ؎ 9.7 kg/m 2 and ages of 14.5 ؎ 1.8 years (range: 12.1-17.8 years) and 34 nonoverweight adolescents who had BMIs of 20.1 ؎ 2.9 kg/m 2 and ages of 14.5 ؎ 1.5 years (range: 12.0 -18.1 years). Oxygen uptake (V O 2 ) was compared at 3 times: during a 4-minute period of unloaded cycling (ULV O 2 ), at the lactate threshold estimated by gas exchange (LTV O 2 ), and at maximal exertion (V O 2 max). Heart rate was obtained at rest and at V O 2 max. Participants also completed a 12-minute walk/ run performance test to obtain distance traveled (D12) and heart rate. Results. Absolute LTV O 2 and V O 2 max and LTV O 2 as a percentage of V O 2 max were not different in overweight and nonoverweight adolescents during the cycle test.However, absolute ULV O 2 was significantly greater in overweight adolescents: ULV O 2 accounted for 35 ؎ 8% of V O 2 max (and 63 ؎ 15% of LTV O 2 ) in overweight adolescents but only 20 ؎ 5% of V O 2 max (and 39 ؎ 12% of LTV O 2 ) in nonoverweight adolescents. Resting heart rate before initiating the cycle test was significantly greater in overweight than nonoverweight adolescents (94 ؎ 14 vs 82 ؎ 15 beats per minute). However, maximal heart rate during the cycle test was significantly lower in overweight adolescents (186 ؎ 13 vs 196 ؎ 11 beats per minute). During the walk/run test, mean D12 was significantly shorter for overweight than for nonoverweight adolescents (1983 ؎ 323 vs 1159 ؎ 194 m). D12 was negatively related to BMI SDS (r ‫؍‬ ؊0.81) and to ULV O 2 (r ‫؍‬ ؊0.98).Discussion. Overweight and nonoverweight adolescents had similar absolute V O 2 at the lactate threshold and at maximal exertion, suggesting that overweight adolescents are more limited by the increased cardiorespiratory effort required to move their larger body mass through space than by cardiorespiratory deconditioning. ABBREVIATIONS. V o 2 max, maximum oxygen uptake; SDS, SD score; ULV o 2 , unloaded oxygen uptake; LTV o 2 , oxygen uptake at the lactate threshold; V o 2 max, oxygen uptake at maximal exertion; HRR, heart rate reserve; RPE, rating of perceived exertion; bpm, beats per minute; D12, distance achieved at 12 minutes during walk/run test; ANCOVA, analysis of covariance. O verweight during childhood has been identified as a major health problem in the United States. 1-4 Pediatric overweight commonly presages adult obesity 5 and is associated with the development of weight-related comorbid conditions and increased morbidity. [6][7][8] Decreased physical activity and a more sedentary lifestyle have been implicated as importan...