Obesity is a major health problem facing the developed and developing world. Efforts by individuals, health professionals, educators, and policy makers to combat the escalating trend of growing obesity prevalence have been multifaceted and mixed in outcome. Various dietary supplements have been marketed to reduce obesity. These products have been suggested to accomplish this by decreasing energy intake and energy absorption, and/or increasing metabolic rate. Ephedra, one such supplement, was banned from sale in the US market because of concerns about adverse events. Another substance, Citrus aurantium, which contains several compounds including synephrine alkaloids, has been suggested as a safe alternative. This review examines the evidence for safety and efficacy of C. aurantium and synephrine alkaloids as examined in animal studies, clinical weight loss trials, acute physiologic studies and case reports. Although at least three reviews of C. aurantium have been published, our review expands upon these by: (i) distinguishing and evaluating the efficacy of C. aurantium and related compounds; (ii) including results from previously unreviewed research; (iii) incorporating recent case reports that serve to highlight, in an anecdotal way, potential adverse events related to the use of C. aurantium and related compounds; and (iv) offering recommendations to guide the design of future trials to evaluate the safety and efficacy of C. aurantium. While some evidence is promising, we conclude that larger and more rigorous clinical trials are necessary to draw adequate conclusions regarding the safety and efficacy of C. aurantium and synephrine alkaloids for promoting weight loss.

A traditional lifestyle intervention using meal replacements can be effective for weight control and reduction in risk of chronic disease in the physician's office setting as well as in the dietitian-led group setting.

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Unlike previous individual study findings, this meta-analysis did not find any differential effects for 4 of the 5 program characteristics. In addition, the significant effect noted was contrary to expectation, exemplifying the complexity of identifying effective program strategies. This study adds to the current literature by assessing the program characteristics of RCT studies in an effort to determine what factors may affect school-based violence prevention program success.

30 to 50 years old) were randomized into three interventions: group A, a dietitian-led intervention; group B, a dietitian-led intervention incorporating MRs; and group C, a clinical office-based intervention incorporating MRs. In year 1, groups A and B attended 26 group sessions, whereas group C received the same educational materials during 26 10-minute office visits with a physician-nurse team. In year 2, participants attended monthly group seminars and drop-in visits with a dietitian. Results: For the 74 subjects completing year 1, weight loss in the office-based group C was as effective as the traditional dietitian-led group A (4.3 Ϯ 6.5% vs. 4.1 Ϯ 6.4%), while group B maintained a significantly greater weight loss (9.1 Ϯ 8.9%; p Ͻ 0.02; mean Ϯ SD). For the 43 subjects completing year 2, group B showed significant differences in the percentage of weight loss (Ϫ8.5 Ϯ 7.0%) compared with group A (Ϫ1.5 Ϯ 5.0%) and group C (Ϫ3.0 Ϯ 7.0%; p Ͻ 0.001). Discussion: Study results showed that a traditional weight loss intervention incorporating MRs was effective as a weight loss tool in the medical office practice and in the dietitian-led group setting.