Obesity Reviews

Andersen, T.

doi: 10.1046/j.1467-789X.2003.00097.xpmid: 12760440

Hill, J. O.; Astrup, A.

doi: 10.1046/j.1467-789X.2003.00103.xpmid: 12760441

Kinnell, H. G.

doi: 10.1046/j.1467-789X.2003.00096.xpmid: 12760442

The temporary delicensing of the centrally acting appetite suppressants (first in April 2000, then in May 2001) by the European Commission's Committee on Proprietary Medical Products was premature and possibly unjustified. While their ultimate fate is awaited, the European Drugs Evaluation Agency declined to release the information on which its withdrawal advice was based.

Pirozzo, S.; Summerbell, C.; Cameron, C.; Glasziou, P.

doi: 10.1046/j.1467-789X.2003.00099.xpmid: 12760443

Dietary fat intake has been blamed for the increase in adiposity and has led to a worldwide effort to decrease the amount of fat in the diet. However, the comparative efficacy of this approach is debatable. Whilst short‐term dietary intervention studies show that low‐fat diets lead to weight loss in both healthy and overweight individuals, it is less clear if a reduction in fat intake is more efficacious than other dietary restrictions in the long term. The purpose of this systematic review was to determine the effectiveness of low‐fat diets in achieving sustained weight loss when used for the express purpose of weight loss in obese or overweight people. A comprehensive search identified six studies that fulfilled our criteria for inclusion (randomized controlled trial, participants either overweight or obese, comparison of a low‐fat diet with another type of weight‐reducing diet, follow‐up period that was at least 6 months in duration and inclusion of participants 18 years or older without serious disease). There were a total of 594 participants in the six trials. The duration of the intervention varied from 3 to 18 months with follow‐up from 6 to 18 months. There were no significant differences between low‐fat diets and other weight‐reducing diets in terms of sustained weight loss. Furthermore, the overall weight loss at the 12–18‐month follow‐up in all studies was very small (2–4 kg). In overweight or obese individuals who are dieting for the purpose of weight reduction, low‐fat diets are as efficacious as other weight‐reducing diets for achieving sustained weight loss, but not more so.

Vermunt, S. H. F.; Pasman, W. J.; Schaafsma, G.; Kardinaal, A. F. M.

doi: 10.1046/j.1467-789X.2003.00102.xpmid: 12760444

Weight reduction programmes are mainly focused on reducing intake of fat and sugar. In this review we have evaluated whether the replacement of dietary (added) sugar by low‐energy sweeteners or complex carbohydrates contributes to weight reduction. In two experimental studies, no short‐term differences in weight loss were observed after use of aspartame as compared to sugar in obese subjects following a controlled energy‐restricted diet. However, consumption of aspartame was associated with improved weight maintenance after a year. In two short‐term studies in which energy intake was not restricted, substitution of sucrose by artificial sweeteners, investigated mostly in beverages, resulted in lower energy intake and lower body weight. Similarly, two short‐term studies, comparing the effect of sucrose and starch on weight loss in obese subjects did not find differences when the total energy intake was equal and reduced. An ad libitum diet with complex carbohydrates resulted in lower energy intake compared to high‐sugar diets. In two out of three studies, this was reflected in lower body weight in subjects consuming the complex carbohydrate diet. In conclusion, a limited number of relatively short‐term studies suggest that replacing (added) sugar by low‐energy sweeteners or by complex carbohydrates in an ad libitum diet might result in lower energy intake and reduced body weight. In the long term, this might be beneficial for weight maintenance. However, the number of studies is small and overall conclusions, in particular for the long term, cannot be drawn.

Saris, W. H. M.; Blair, S. N.; Van Baak, M. A.; Eaton, S. B.; Davies, P. S. W.; Di Pietro, L.; Fogelholm, M.; Rissanen, A.; Schoeller, D.; Swinburn, B.; Tremblay, A.; Westerterp, K. R.; Wyatt, H.

Egger, G.; Swinburn, B.; Rossner, S.

doi: 10.1046/j.1467-789X.2003.00100.xpmid: 12760446

The search for effective ways of dealing with obesity has centred on biological research and clinical management. However, obesity needs to be conceptualized more broadly if the modern pandemic is to be arrested. The epidemiological triad (hosts, agent/vectors and environments) has served us well in dealing with epidemics in the past, and may be worth re‐evaluating to this end. Education, behaviour change and clinical practices deal predominantly with the host, although multidisciplinary practices such as shared‐care might also be expected to impact on other corners of the triad. Technology deals best with the agent of obesity (energy imbalance) and it's vectors (excessive energy intake and/or inadequate energy expenditure), and policy and social change are needed to cope with the environment. The value of a broad model like this, rather than specific isolated approaches, is that the key players such as legislators, health professionals, governments and industry can see their roles in attenuating and eventually reversing the epidemic. It also highlights the need to intervene at all levels in obesity control and reduces the relevance of arguments about nature vs. nurture.

Myslobodsky, M.

doi: 10.1046/j.1467-789X.2003.00098.xpmid: 12760447

Obesity is an embodiment of a multifactorial problem with several intermediates in its casual pathway. Virtually all who have written on obesity have responded to four inter‐related factors: genetic, perinatal, environmental, and consumption‐expenditure energy imbalance. The message to take home is that while a molecular description of each participant of the obesity machinery seems achievable in principle, a complex model describing all of them is currently beyond our grasp. That is why the eradication of the obesity epidemic is seen in a more precise neuropsychological description of what is wrong with each subset of patients. This review proposes that the neuropsychiatric experience might be the most fundamental for it could help to refocus the view of obesity from ‘traditional’ environmental factors and lifestyle changes to those dominated by a more ‘individual‐centred’ perspective in which different modes of causal attribution are appropriate. This review advocates the idea of environmental dependency as a determinant of obesity, which has been an important idea in neurosciences for more than 30 years with roots in three important areas: psychological, neuropsychiatric, and experimental. The neuropsychology of obesity is yet to become part of today's agenda of obesity research.