2002;10:401-407. Objective: Obesity is a major risk factor for the development of type 2 diabetes. Tumor necrosis factor (TNF)-␣ is a candidate gene for the development of both obesity and insulin resistance. We investigated whether a common polymorphism in the promoter region (Ϫ308 G/A) of the TNF-␣ 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 Ͻ 0.001), higher HOMA scores (10.2 vs. 5.3; p Ͻ 0.001), higher systolic blood pressure (143 vs. 129 mm Hg; p ϭ 0.02), and lower high-density lipoprotein (HDL) cholesterol (1.13 vs. 1.25 mM; p ϭ 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 ϭ Ϫ0.710; p Ͻ 0.001) occurred in subjects with the A allele only. Discussion: The Ϫ308 G/A TNF-␣ 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 modi®cation weight management programme on self-ef®cacy and anthropometric variables among obese women seeking treatment at an obesity management clinic and to compare self-ef®cacy among these obese women to non-obese women. DESIGN: Cross sectional. SUBJECTS: A total of 161 non-obese (BMI 22.6 AE 2.9 kgam 2 ) and 138 obese (BMI 37.7 AE 5.8 kgam 2 ) women of similar age. MEASUREMENTS: Self-ef®cacy in relation to eating was assessed by the Weight Ef®cacy 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 signi®cantly less (P`0.0001) than non-obese women on the WEL (99.4 AE 34.1 vs 139.0 AE 24.9). Women who completed the programme (n 65) demonstrated a decrease in waist circumference of 3.9 AE 5.3 cm, a 10.0 AE 11.5% loss of excess weight and a signi®cant improvement in total WEL score from 106.0 AE 30.3 to 126.5 AE 28.4. CONCLUSION: Improvements in some dimensions of self-ef®cacy among obese women were of suf®cient 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. International Journal of Obesity (2001) 25, 907 ± 913

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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.