<i  >Objective</i>. To assess the efficacy and tolerability of the association sibutramine (10&#x2013;20&#x2009;mg/day) and orlistat (120&#x2009;mg 2-3 times a day) in the treatment of obesity in a six-month open trial. <i  >Methods</i>. 446 overweight and obese patients who sought treatment for obesity in a private clinic were assessed every 2 weeks during a period of 3 and 6 months. <i  >Results</i>. After 3 months, the mean weight loss was 10.5&#x2009;kg (<svg style="vertical-align:-0.0pt;width:10.825px;" id="M1" height="4.5999999" version="1.1" viewBox="0 0 10.825 4.5999999" width="10.825"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,4.6)">
		<g transform="translate(72,-68.32)">
			<text transform="matrix(1,0,0,-1,-71.95,68.37)">
				<tspan style="font-size: 12.50px; " x="0" y="0">−</tspan>
			</text>

		</g>
	</g>
</svg>9.8&#x25; of the initial weight, <svg style="vertical-align:-0.17555pt;width:50.724998px;" id="M2" height="11.0375" version="1.1" viewBox="0 0 50.724998 11.0375" width="50.724998"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,11.0375)">
		<g transform="translate(72,-63.17)">
			<text transform="matrix(1,0,0,-1,-71.95,63.4)">
				<tspan style="font-size: 12.50px; " x="0" y="0">𝑛</tspan>
				<tspan style="font-size: 12.50px; " x="9.6773224" y="0">=</tspan>
				<tspan style="font-size: 12.50px; " x="21.71771" y="0">2</tspan>
				<tspan style="font-size: 12.50px; " x="27.969212" y="0">6</tspan>
				<tspan style="font-size: 12.50px; " x="34.220711" y="0">3</tspan>
			</text>

		</g>
	</g>
</svg>), and after 6 months, the mean weight loss was 13.9&#x2009;kg (<svg style="vertical-align:-0.0pt;width:10.825px;" id="M3" height="4.5999999" version="1.1" viewBox="0 0 10.825 4.5999999" width="10.825"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,4.6)">
		<g transform="translate(72,-68.32)">
			<text transform="matrix(1,0,0,-1,-71.95,68.37)">
				<tspan style="font-size: 12.50px; " x="0" y="0">−</tspan>
			</text>

		</g>
	</g>
</svg>12.8&#x25; of the initial weight, <svg style="vertical-align:-0.27588pt;width:42.912498px;" id="M4" height="11.0375" version="1.1" viewBox="0 0 42.912498 11.0375" width="42.912498"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,11.0375)">
		<g transform="translate(72,-63.17)">
			<text transform="matrix(1,0,0,-1,-71.95,63.5)">
				<tspan style="font-size: 12.50px; " x="0" y="0">𝑛</tspan>
				<tspan style="font-size: 12.50px; " x="9.6773224" y="0">=</tspan>
				<tspan style="font-size: 12.50px; " x="21.71771" y="0">9</tspan>
				<tspan style="font-size: 12.50px; " x="27.969212" y="0">7</tspan>
			</text>

		</g>
	</g>
</svg>). The tolerability of such association was quite acceptable and coherent with the action mechanism of each component. <i  >Conclusions</i>. The association of orlistat and sibutramine is quite efficient and it seems to promote a higher rate of weight loss than that reported in clinical studies performed with each drug separately.

Alfredo Halpern

Renata B. Pepe

Ana Paola Monegaglia

Mônica Beyruti

Maria Edna de Melo

Marcio C. Mancini

Efficacy and Tolerability of the Association of Sibutramine and
Orlistat for Six Months in Overweight and Obese Patients

Metformin is a widely used insulin-sensitizing drug, though its mechanisms are not fully understood. Metformin has been shown to activate AMPK in skeletal muscle; however, its effects on the inhibitor of <svg     style="vertical-align:-0.1638pt;width:8.7375002px;" id="M2" height="7.9499998" version="1.1" viewBox="0 0 8.7375002 7.9499998" width="8.7375002"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,7.675)"><path id="x1D705" d="M484 406q0 -21 -22 -38q-10 -7 -18 -1q-15 11 -30 11q-30 0 -77.5 -37t-74.5 -67l79 -168q11 -23 19.5 -34.5t13 -14t10.5 -2.5q9 0 30 17.5t40 42.5l17 -23q-31 -45 -57.5 -69.5t-40.5 -29.5t-31 -5q-18 0 -32 13.5t-35 55.5q-34 71 -69 160q-36 -32 -59 -56&#xA;q-12 -27 -36 -158q-44 -7 -77 -15l-5 7l82 349q6 25 -2 25q-16 0 -72 -41l-14 22q44 41 89 69.5t66 28.5q19 0 19 -32q0 -16 -6 -43l-35 -160l146 143q94 92 136 92q20 0 33 -12t13 -30z" /></g>

		
	
</svg>B kinase<svg     style="vertical-align:-3.56265pt;width:10px;" id="M3" height="16.6625" version="1.1" viewBox="0 0 10 16.6625" width="10"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,12.162)"><use xlink:href="#x1D6FD"/></g>

		
	
</svg> (IKK<svg     style="vertical-align:-3.56265pt;width:10px;" id="M4" height="16.6625" version="1.1" viewBox="0 0 10 16.6625" width="10"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,12.162)"><use xlink:href="#x1D6FD"/></g>

		
	
</svg>) in this same tissue are unknown. The aim of this study was to (1) determine the ability of metformin to attenuate IKK<svg     style="vertical-align:-3.56265pt;width:10px;" id="M5" height="16.6625" version="1.1" viewBox="0 0 10 16.6625" width="10"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,12.162)"><use xlink:href="#x1D6FD"/></g>

		
	
</svg> action, (2) determine whether changes in AMPK activity are associated with changes in IKK<svg     style="vertical-align:-3.56265pt;width:10px;" id="M6" height="16.6625" version="1.1" viewBox="0 0 10 16.6625" width="10"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,12.162)"><use xlink:href="#x1D6FD"/></g>

		
	
</svg> action in skeletal muscle, and (3) examine whether changes in AMPK and IKK<svg     style="vertical-align:-3.56265pt;width:10px;" id="M7" height="16.6625" version="1.1" viewBox="0 0 10 16.6625" width="10"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,12.162)"><use xlink:href="#x1D6FD"/></g>

		
	
</svg> function are consistent with improved insulin signaling. Lean and obese male Zuckers received either vehicle or metformin by oral gavage daily for four weeks (four groups of eight). Proteins were measured in white gastrocnemius (WG), red gastrocnemius (RG), and soleus. AMPK phosphorylation increased (<svg     style="vertical-align:-0.1638pt;width:50.549999px;" id="M8" height="11.375" version="1.1" viewBox="0 0 50.549999 11.375" width="50.549999"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><path id="x1D443" d="M619 482q0 -69 -40.5 -119t-96 -72.5t-118.5 -26.5h-44l-70 20l-31 -151q-14 -67 0.5 -83t89.5 -22l-5 -28h-287l8 28q65 7 81.5 22t29.5 83l79 398q12 56 0.5 70.5t-78.5 20.5l7 28h255q108 0 164 -43t56 -125zM524 478q0 141 -146 141q-25 0 -47 -8q-16 -6 -20.5 -13.5&#xA;t-10.5 -39.5l-43 -241q37 -13 83 -13q67 0 125.5 45t58.5 129z" /></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><path id="x3C" d="M512 -3l-437 233v51l437 233v-58l-378 -200v-2l378 -199v-58z" /></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><path id="x2E" d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z" /></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><path id="x30" d="M241 635q53 0 94 -28.5t63.5 -76t33.5 -102.5t11 -116q0 -58 -11 -112.5t-34 -103.5t-63.5 -78.5t-94.5 -29.5t-95 28t-64.5 75t-34.5 102.5t-11 118.5q0 58 11.5 112.5t34.5 103t64.5 78t95.5 29.5zM238 602q-32 0 -55.5 -25t-35.5 -68t-17.5 -91t-5.5 -105&#xA;q0 -76 10 -138.5t37 -107.5t69 -45q32 0 55.5 25t35.5 68.5t17.5 91.5t5.5 105t-5.5 105.5t-18 92t-36 68t-56.5 24.5z" /></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><path id="x35" d="M153 550l-26 -186q79 31 111 31q90 0 141.5 -51t51.5 -119q0 -93 -89 -166q-85 -69 -173 -71q-32 0 -61.5 11.5t-41.5 23.5q-18 17 -17 34q2 16 22 33q14 9 26 -1q61 -50 124 -50q60 0 93 43.5t33 104.5q0 69 -41.5 110t-121.5 41q-53 0 -102 -20l38 305h286l6 -8&#xA;l-26 -65h-233z" /></g>

		
	
</svg>) in WG in both lean (57&#x25;) and obese (106&#x25;), and this was supported by an increase in phospho-ACC in WG. Further, metformin increased I<svg     style="vertical-align:-0.1638pt;width:8.7375002px;" id="M9" height="7.9499998" version="1.1" viewBox="0 0 8.7375002 7.9499998" width="8.7375002"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,7.675)"><use xlink:href="#x1D705"/></g>

		
	
</svg>B<svg     style="vertical-align:-0.1638pt;width:9.7749996px;" id="M10" height="7.9499998" version="1.1" viewBox="0 0 9.7749996 7.9499998" width="9.7749996"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,7.675)"><path id="x1D6FC" d="M545 106q-67 -118 -134 -118q-24 0 -40 37.5t-30 129.5h-2q-47 -72 -103 -119.5t-108 -47.5q-47 0 -76 45.5t-29 119.5q0 113 85 204t174 91q47 0 70 -33.5t43 -119.5h3q32 47 80 140l55 13l10 -9q-47 -80 -138 -201q17 -99 27.5 -136t22.5 -37q23 0 69 61zM333 204&#xA;q-14 98 -31 149.5t-50 51.5q-49 0 -94 -70t-45 -164q0 -55 15.5 -86t40.5 -31q70 0 164 150z" /></g>

		
	
</svg> levels in both WG (150&#x25;) and RG (67&#x25;) of obese rats, indicative of reduced IKK<svg     style="vertical-align:-3.56265pt;width:10px;" id="M11" height="16.6625" version="1.1" viewBox="0 0 10 16.6625" width="10"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,12.162)"><use xlink:href="#x1D6FD"/></g>

		
	
</svg> activity (<svg     style="vertical-align:-0.1638pt;width:50.549999px;" id="M12" height="11.375" version="1.1" viewBox="0 0 50.549999 11.375" width="50.549999"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x35"/></g>

		
	
</svg>), and was associated with reduced IRS1-p<svg     style="vertical-align:-0.20473pt;width:39.712502px;" id="M13" height="16.1" version="1.1" viewBox="0 0 39.712502 16.1" width="39.712502"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,15.775)"><path id="x53" d="M409 504l-29 -5q-16 60 -44.5 96t-86.5 36q-54 0 -82.5 -32t-28.5 -77q0 -51 30.5 -82.5t96.5 -65.5l35.5 -18t33 -19.5t33.5 -23.5l27 -25.5t24.5 -32t13.5 -36.5t6 -45q0 -80 -62 -134.5t-160 -54.5q-47 0 -98 15q-22 7 -50 21q-8 23 -27 155l30 7q7 -27 18 -52&#xA;t30 -51.5t49 -42.5t67 -16q56 0 88 32.5t32 87.5q0 51 -31.5 82t-98.5 67q-80 44 -110 73q-55 53 -55 124q0 75 56 126.5t150 51.5q53 0 126 -23z" /></g><g transform="matrix(.017,-0,0,-.017,8.341,15.775)"><path id="x65" d="M380 106l15 -22q-42 -52 -87 -74t-76 -22q-89 0 -142 62t-53 151q0 103 66 175q67 73 146 73h1q61 0 105.5 -46.5t44.5 -105.5q0 -16 -4.5 -22.5t-18.5 -9.5q-54 -10 -262 -17q1 -95 46 -143.5t104 -48.5q61 0 115 50zM225 412q-35 0 -64.5 -32.5t-40.5 -90.5q83 0 170 3&#xA;q14 0 19 4.5t5 15.5q1 41 -23.5 70.5t-65.5 29.5z" /></g><g transform="matrix(.017,-0,0,-.017,15.565,15.775)"><path id="x72" d="M181 342h2q63 107 121 107q24 0 41 -16t17 -34q0 -34 -32 -49q-17 -7 -26 2q-21 20 -43 20q-20 0 -42 -22t-38 -63v-183q0 -50 12.5 -62t69.5 -16v-26h-230v26q47 5 58 17t11 61v207q0 49 -9 60.5t-53 16.5v23q74 12 141 40v-109z" /></g>

			<g transform="matrix(.012,-0,0,-.012,21.887,7.613)"><path id="x33" d="M285 378v-2q65 -13 102 -54.5t37 -97.5q0 -57 -30.5 -104.5t-74 -75t-85.5 -42t-72 -14.5q-31 0 -59.5 11t-40.5 23q-19 18 -16 36q1 16 23 33q13 10 24 0q58 -51 124 -51q55 0 88 40t33 112q0 64 -39 96.5t-88 32.5q-29 0 -64 -11l-6 29q77 25 118 57.5t41 84.5&#xA;q0 45 -26.5 69.5t-68.5 24.5q-67 0 -120 -79l-20 20l43 63q51 56 127 56h1q66 0 107 -37t41 -95q0 -42 -31 -71q-22 -23 -68 -54z" /></g><g transform="matrix(.012,-0,0,-.012,27.599,7.613)"><use xlink:href="#x30"/></g><g transform="matrix(.012,-0,0,-.012,33.31,7.613)"><path id="x37" d="M447 623l8 -12l-283 -613l-74 -10l-7 11q174 283 297 551h-216q-48 0 -62.5 -12t-33.5 -63h-29q10 60 18 148h382z" /></g>

		
	
</svg> (30&#x25;) in the WG of obese rats (<svg     style="vertical-align:-0.1638pt;width:50.549999px;" id="M14" height="11.375" version="1.1" viewBox="0 0 50.549999 11.375" width="50.549999"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><path id="x32" d="M412 140l28 -9q0 -2 -35 -131h-373v23q112 112 161 170q59 70 92 127t33 115q0 63 -31 98t-86 35q-75 0 -137 -93l-22 20l57 81q55 59 135 59q69 0 118.5 -46.5t49.5 -122.5q0 -62 -29.5 -114t-102.5 -130l-141 -149h186q42 0 58.5 10.5t38.5 56.5z" /></g>

		
	
</svg>). From these data we conclude that metformin treatment appears to exert an inhibitory influence on skeletal muscle IKK<svg     style="vertical-align:-3.56265pt;width:10px;" id="M15" height="16.6625" version="1.1" viewBox="0 0 10 16.6625" width="10"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,12.162)"><use xlink:href="#x1D6FD"/></g>

		
	
</svg> activity, as evidenced by elevated I<svg     style="vertical-align:-0.1638pt;width:8.7375002px;" id="M16" height="7.9499998" version="1.1" viewBox="0 0 8.7375002 7.9499998" width="8.7375002"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,7.675)"><use xlink:href="#x1D705"/></g>

		
	
</svg>B<svg     style="vertical-align:-0.1638pt;width:9.7749996px;" id="M17" height="7.9499998" version="1.1" viewBox="0 0 9.7749996 7.9499998" width="9.7749996"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,7.675)"><use xlink:href="#x1D6FC"/></g>

		
	
</svg> levels and reduced IRS1-<svg     style="vertical-align:-0.20473pt;width:39.712502px;" id="M18" height="16.1" version="1.1" viewBox="0 0 39.712502 16.1" width="39.712502"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,15.775)"><use xlink:href="#x53"/></g><g transform="matrix(.017,-0,0,-.017,8.341,15.775)"><use xlink:href="#x65"/></g><g transform="matrix(.017,-0,0,-.017,15.565,15.775)"><use xlink:href="#x72"/></g>

			<g transform="matrix(.012,-0,0,-.012,21.887,7.613)"><use xlink:href="#x33"/></g><g transform="matrix(.012,-0,0,-.012,27.599,7.613)"><use xlink:href="#x30"/></g><g transform="matrix(.012,-0,0,-.012,33.31,7.613)"><use xlink:href="#x37"/></g>

		
	
</svg> phosphorylation in a fiber-type specific manner.

Benjamin T. Bikman

Donghai Zheng

Daniel A. Kane

Ethan J. Anderson

Tracey L. Woodlief

Jesse W. Price

G. Lynis Dohm

P. Darrell Neufer

Ronald N. Cortright

Metformin Improves Insulin Signaling in Obese Rats via Reduced IKK<svg style="vertical-align:-3.56265pt" height="16.6625" version="1.1" viewBox="0 0 10 16.6625" width="10" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg"><g transform="matrix(.017,-0,0,-.017,.062,12.162)"><path id="x1D6FD" d="M558 587q0 -32 -14 -61t-40 -53.5t-48.5 -41t-54.5 -36.5q144 -51 144 -174q0 -55 -43.5 -108t-104.5 -87q-77 -42 -131 -42q-31 0 -54 20t-31 47l11 18q48 -29 108 -29q79 0 119.5 43t40.5 109t-44.5 107.5t-119.5 50.5l22 47q34 1 65 21q96 61 96 157q0 42 -24 67.5&#xA;t-62 25.5q-24 0 -43.5 -9t-35 -29.5t-27 -44t-22.5 -63t-19.5 -75.5t-18.5 -91q-57 -294 -68 -380q-26 -190 -35 -200q-26 -31 -97 -37l-4 26q19 9 48 170l77 413q23 121 52.5 187.5t83.5 114.5q70 62 148 62q51 0 88.5 -34t37.5 -91z" /></g></svg> Action in a Fiber-Type Specific Manner

<i  >Background</i>. Links between dietary quality and abdominal obesity are poorly understood. <i  >Objective</i>. To examine the association between an obesity-specific dietary quality index and abdominal obesity risk in women. 
<i  >Methods</i>. Over 12 years, we followed 288 Framingham Offspring/Spouse Study women, aged 30&#x2013;69 years, without metabolic syndrome risk factors, cardiovascular disease, cancer, or diabetes at baseline. An 11-nutrient obesity-specific dietary quality index was derived using mean ranks of nutrient intakes from 3-day dietary records. Abdominal obesity (waist circumference &#x3E;88&#x2009;cm) was assessed during follow-up. 
<i  >Results</i>. Using multiple logistic regression, women with poorer dietary quality were more likely to develop abdominal obesity compared to those with higher dietary quality (OR 1.87; 95&#x25; CI, 1.01, 3.47; <svg     style="vertical-align:-0.0pt;width:10.9375px;" id="M1" height="11.175" version="1.1" viewBox="0 0 10.9375 11.175" width="10.9375"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.113)"><path id="x1D443" d="M619 482q0 -69 -40.5 -119t-96 -72.5t-118.5 -26.5h-44l-70 20l-31 -151q-14 -67 0.5 -83t89.5 -22l-5 -28h-287l8 28q65 7 81.5 22t29.5 83l79 398q12 56 0.5 70.5t-78.5 20.5l7 28h255q108 0 164 -43t56 -125zM524 478q0 141 -146 141q-25 0 -47 -8q-16 -6 -20.5 -13.5&#xA;t-10.5 -39.5l-43 -241q37 -13 83 -13q67 0 125.5 45t58.5 129z" /></g>

		
	
</svg> for trend <svg     style="vertical-align:-0.1638pt;width:43.174999px;" id="M2" height="11.125" version="1.1" viewBox="0 0 43.174999 11.125" width="43.174999"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.862)"><path id="x3D" d="M535 323h-483v50h483v-50zM535 138h-483v50h483v-50z" /></g><g transform="matrix(.017,-0,0,-.017,14.749,10.862)"><path id="x2E" d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z" /></g><g transform="matrix(.017,-0,0,-.017,18.625,10.862)"><path id="x30" d="M241 635q53 0 94 -28.5t63.5 -76t33.5 -102.5t11 -116q0 -58 -11 -112.5t-34 -103.5t-63.5 -78.5t-94.5 -29.5t-95 28t-64.5 75t-34.5 102.5t-11 118.5q0 58 11.5 112.5t34.5 103t64.5 78t95.5 29.5zM238 602q-32 0 -55.5 -25t-35.5 -68t-17.5 -91t-5.5 -105&#xA;q0 -76 10 -138.5t37 -107.5t69 -45q32 0 55.5 25t35.5 68.5t17.5 91.5t5.5 105t-5.5 105.5t-18 92t-36 68t-56.5 24.5z" /></g><g transform="matrix(.017,-0,0,-.017,26.785,10.862)"><path id="x34" d="M456 178h-96v-72q0 -51 12.5 -62.5t72.5 -16.5v-27h-256v27q65 5 78 17t13 62v72h-260v28q182 271 300 426h40v-407h96v-47zM280 225v295h-2q-107 -148 -196 -295h198z" /></g><g transform="matrix(.017,-0,0,-.017,34.944,10.862)"><path id="x38" d="M249 635q70 0 116 -43t46 -105q0 -46 -28 -80q-22 -25 -80 -64q62 -35 97 -75t35 -99q0 -81 -63 -131t-135 -50q-83 0 -137.5 45.5t-54.5 123.5q0 52 45 95q29 28 89 64q-109 62 -109 155q0 66 50.5 115t128.5 49zM238 603q-42 0 -67.5 -31t-25.5 -72q0 -50 32.5 -79.5&#xA;t98.5 -62.5q61 48 61 124q0 59 -29.5 90t-69.5 31zM248 20q46 0 76.5 33.5t30.5 89.5q0 50 -39 85.5t-110 71.5q-81 -54 -81 -137q0 -67 35.5 -105t87.5 -38z" /></g>

		
	
</svg>) independent of age, physical activity, smoking, and menopausal status. 
<i  >Conclusions</i>. An obesity-specific dietary quality index predicted abdominal obesity in women, suggesting targets for dietary quality assessment, intervention, and treatment to address abdominal adiposity.

Dolores M. Wolongevicz

Lei Zhu

Michael J. Pencina

Ruth W. Kimokoti

P. K. Newby

Ralph B. D'Agostino

Barbara E. Millen

An Obesity Dietary Quality Index Predicts Abdominal Obesity in Women: Potential Opportunity for New Prevention and Treatment Paradigms

<i  >Background</i>. Revision of failed bariatric procedures is a significant challenge for bariatric surgeons, because of the increasing number of recurring morbid obesity or complications, especially in patients with a previous Vertical Banded Gastroplasty (VBG). <i  >Methods</i>. Since November 1998, 109 patients with failed or complicated VBG were followed in a retrospective study. 49 patients underwent re-VBG and, since 2004, 60 underwent Roux-en-Y Gastric Bypass-on-Vertical Banded Gastroplasty (RYGB-on-VBG). <i  >Results</i>. At 3 years follow-up, mean BMI decreased from 37.4 to 31.2&#x2009;<svg style="vertical-align:-2.7337pt;width:41.825001px;" id="M1" height="17.174999" version="1.1" viewBox="0 0 41.825001 17.174999" width="41.825001"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,17.175)">
		<g transform="translate(72,-58.26)">
			<text transform="matrix(1,0,0,-1,-71.95,61.03)">
				<tspan style="font-size: 12.50px; " x="0" y="0">K</tspan>
				<tspan style="font-size: 12.50px; " x="9.0271664" y="0">g</tspan>
				<tspan style="font-size: 12.50px; " x="15.278666" y="0">/</tspan>
				<tspan style="font-size: 12.50px; " x="18.754499" y="0">m</tspan>
			</text>

			<text transform="matrix(1,0,0,-1,-43.47,66.03)">
				<tspan style="font-size: 8.75px; " x="0" y="0">2</tspan>
			</text>

		</g>
	</g>
</svg> in the first group, and from 35.0 to 28.4&#x2009;<svg style="vertical-align:-2.7337pt;width:41.825001px;" id="M2" height="17.174999" version="1.1" viewBox="0 0 41.825001 17.174999" width="41.825001"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,17.175)">
		<g transform="translate(72,-58.26)">
			<text transform="matrix(1,0,0,-1,-71.95,61.03)">
				<tspan style="font-size: 12.50px; " x="0" y="0">K</tspan>
				<tspan style="font-size: 12.50px; " x="9.0271664" y="0">g</tspan>
				<tspan style="font-size: 12.50px; " x="15.278666" y="0">/</tspan>
				<tspan style="font-size: 12.50px; " x="18.754499" y="0">m</tspan>
			</text>

			<text transform="matrix(1,0,0,-1,-43.47,66.03)">
				<tspan style="font-size: 8.75px; " x="0" y="0">2</tspan>
			</text>

		</g>
	</g>
</svg> in the second. Early complications were 7 (14.3&#x25;) in the first group and 4 (6.5&#x25;) in the second; late complications were 33 (59.1&#x25;) and 11 (18.3&#x25;), respectively. <i  >Conclusion</i>. Although both operations seem to be effective as bariatric revision procedures in terms of BMI, the mid-term outcomes of RYGB-on-VBG demonstrate the lowest rate of complications and better quality of life.

Stefano Cariani

Laura Agostinelli

Luca Leuratti

Eleonora Giorgini

Pietro Biondi

Enrico Amenta

Bariatric Revisionary Surgery for Failed or Complicated Vertical Banded Gastroplasty (VBG): Comparison of VBG Reoperation (re-VBG) versus Roux-en-Y Gastric Bypass-on-VBG (RYGB-on-VBG)

<i  >Background</i>. Many institutions mandate preoperative weight loss prior to bariatric surgery. This study examines the correlation between preoperative weight change and postoperative success following laparoscopic Roux-en-Y gastric bypass. <i  >Methods</i>. We retrospectively studied the correlation between change in BMI before surgery and change in BMI postoperatively, using linear regression analyses and one-way ANOVA, in 256 consecutive gastric bypass patients with 1-year followup. <i  >Results</i>. Of 256 patients, 125 lost weight preoperatively (mean <svg style="vertical-align:-0.13794pt;width:30.362499px;" id="M1" height="10.8625" version="1.1" viewBox="0 0 30.362499 10.8625" width="30.362499"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,10.8625)">
		<g transform="translate(72,-63.31)">
			<text transform="matrix(1,0,0,-1,-71.95,63.5)">
				<tspan style="font-size: 12.50px; " x="0" y="0">−</tspan>
				<tspan style="font-size: 12.50px; " x="8.5645552" y="0">1</tspan>
				<tspan style="font-size: 12.50px; " x="14.816055" y="0">.</tspan>
				<tspan style="font-size: 12.50px; " x="17.941805" y="0">7</tspan>
			</text>

		</g>
	</g>
</svg>&#x25; BMI), while 131 maintained or gained weight (mean +1.2&#x25; BMI). Postoperatively, there was no significant difference in percent BMI loss between the two groups (34.6&#x25; and 34.5&#x25;). The percent change in BMI preoperatively did not predict postoperative BMI change after 1 year (<svg style="vertical-align:-0.13792pt;width:50.5px;" id="M2" height="10.5" version="1.1" viewBox="0 0 50.5 10.5" width="50.5"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,10.5)">
		<g transform="translate(72,-63.6)">
			<text transform="matrix(1,0,0,-1,-71.95,63.79)">
				<tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
				<tspan style="font-size: 12.50px; " x="10.890113" y="0">=</tspan>
				<tspan style="font-size: 12.50px; " x="22.930502" y="0">n</tspan>
				<tspan style="font-size: 12.50px; " x="29.182001" y="0">.</tspan>
				<tspan style="font-size: 12.50px; " x="32.307751" y="0">s</tspan>
				<tspan style="font-size: 12.50px; " x="37.171417" y="0">.</tspan>
			</text>

		</g>
	</g>
</svg>). <i  >Conclusions</i>. Our study did not show any correlation between preoperative weight change and postoperative weight loss after Roux-en-Y gastric bypass. Therefore, we do not believe that potential patients should be denied bariatric surgery on the basis of their inability to lose weight preoperatively.

Dan Eisenberg

Andrew J. Duffy

Robert L. Bell

Does Preoperative Weight Change Predict Postoperative Weight Loss after Laparoscopic Roux-en-Y Gastric Bypass in the Short Term?

<i  >Aim and Method</i>. To examine in obese people the potential effectiveness of a six-week, two times weekly aquajogging program on body composition, fitness, health-related quality of life, and exercise beliefs. Fifteen otherwise healthy obese persons participated in a pilot study. <i  >Results</i>. Total fat mass and waist circumference decreased 1.4&#x2009;kg (<svg     style="vertical-align:-0.1638pt;width:50.549999px;" id="M1" height="11.375" version="1.1" viewBox="0 0 50.549999 11.375" width="50.549999"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><path id="x1D443" d="M619 482q0 -69 -40.5 -119t-96 -72.5t-118.5 -26.5h-44l-70 20l-31 -151q-14 -67 0.5 -83t89.5 -22l-5 -28h-287l8 28q65 7 81.5 22t29.5 83l79 398q12 56 0.5 70.5t-78.5 20.5l7 28h255q108 0 164 -43t56 -125zM524 478q0 141 -146 141q-25 0 -47 -8q-16 -6 -20.5 -13.5&#xA;t-10.5 -39.5l-43 -241q37 -13 83 -13q67 0 125.5 45t58.5 129z" /></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><path id="x3D" d="M535 323h-483v50h483v-50zM535 138h-483v50h483v-50z" /></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><path id="x2E" d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z" /></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><path id="x30" d="M241 635q53 0 94 -28.5t63.5 -76t33.5 -102.5t11 -116q0 -58 -11 -112.5t-34 -103.5t-63.5 -78.5t-94.5 -29.5t-95 28t-64.5 75t-34.5 102.5t-11 118.5q0 58 11.5 112.5t34.5 103t64.5 78t95.5 29.5zM238 602q-32 0 -55.5 -25t-35.5 -68t-17.5 -91t-5.5 -105&#xA;q0 -76 10 -138.5t37 -107.5t69 -45q32 0 55.5 25t35.5 68.5t17.5 91.5t5.5 105t-5.5 105.5t-18 92t-36 68t-56.5 24.5z" /></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><path id="x33" d="M285 378v-2q65 -13 102 -54.5t37 -97.5q0 -57 -30.5 -104.5t-74 -75t-85.5 -42t-72 -14.5q-31 0 -59.5 11t-40.5 23q-19 18 -16 36q1 16 23 33q13 10 24 0q58 -51 124 -51q55 0 88 40t33 112q0 64 -39 96.5t-88 32.5q-29 0 -64 -11l-6 29q77 25 118 57.5t41 84.5&#xA;q0 45 -26.5 69.5t-68.5 24.5q-67 0 -120 -79l-20 20l43 63q51 56 127 56h1q66 0 107 -37t41 -95q0 -42 -31 -71q-22 -23 -68 -54z" /></g>

		
	
</svg>) and 3.1&#x2009;cm (<svg     style="vertical-align:-0.1638pt;width:58.712502px;" id="M2" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><path id="x35" d="M153 550l-26 -186q79 31 111 31q90 0 141.5 -51t51.5 -119q0 -93 -89 -166q-85 -69 -173 -71q-32 0 -61.5 11.5t-41.5 23.5q-18 17 -17 34q2 16 22 33q14 9 26 -1q61 -50 124 -50q60 0 93 43.5t33 104.5q0 69 -41.5 110t-121.5 41q-53 0 -102 -20l38 305h286l6 -8&#xA;l-26 -65h-233z" /></g>

		
	
</svg>), respectively. The distance in the Six-Minute Walk Test increased 41 meters (<svg     style="vertical-align:-0.1638pt;width:58.712502px;" id="M3" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><path id="x31" d="M384 0h-275v27q67 5 81.5 18.5t14.5 68.5v385q0 38 -7.5 47.5t-40.5 10.5l-48 2v24q85 15 178 52v-521q0 -55 14.5 -68.5t82.5 -18.5v-27z" /></g>

		
	
</svg>). Three scales of the Impact of Weight on Quality of Life-Lite questionnaire improved: physical function (<svg     style="vertical-align:-0.1638pt;width:58.712502px;" id="M4" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><path id="x38" d="M249 635q70 0 116 -43t46 -105q0 -46 -28 -80q-22 -25 -80 -64q62 -35 97 -75t35 -99q0 -81 -63 -131t-135 -50q-83 0 -137.5 45.5t-54.5 123.5q0 52 45 95q29 28 89 64q-109 62 -109 155q0 66 50.5 115t128.5 49zM238 603q-42 0 -67.5 -31t-25.5 -72q0 -50 32.5 -79.5&#xA;t98.5 -62.5q61 48 61 124q0 59 -29.5 90t-69.5 31zM248 20q46 0 76.5 33.5t30.5 89.5q0 50 -39 85.5t-110 71.5q-81 -54 -81 -137q0 -67 35.5 -105t87.5 -38z" /></g>

		
	
</svg>), self-esteem (<svg     style="vertical-align:-0.1638pt;width:58.712502px;" id="M5" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><path id="x34" d="M456 178h-96v-72q0 -51 12.5 -62.5t72.5 -16.5v-27h-256v27q65 5 78 17t13 62v72h-260v28q182 271 300 426h40v-407h96v-47zM280 225v295h-2q-107 -148 -196 -295h198z" /></g>

		
	
</svg>), and public distress (<svg     style="vertical-align:-0.1638pt;width:50.549999px;" id="M6" height="11.375" version="1.1" viewBox="0 0 50.549999 11.375" width="50.549999"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x34"/></g>

		
	
</svg>). Increased perceived exercise benefits (<svg     style="vertical-align:-0.1638pt;width:50.549999px;" id="M7" height="11.375" version="1.1" viewBox="0 0 50.549999 11.375" width="50.549999"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><path id="x32" d="M412 140l28 -9q0 -2 -35 -131h-373v23q112 112 161 170q59 70 92 127t33 115q0 63 -31 98t-86 35q-75 0 -137 -93l-22 20l57 81q55 59 135 59q69 0 118.5 -46.5t49.5 -122.5q0 -62 -29.5 -114t-102.5 -130l-141 -149h186q42 0 58.5 10.5t38.5 56.5z" /></g>

		
	
</svg>) and decreased embarrassment (<svg     style="vertical-align:-0.1638pt;width:50.549999px;" id="M8" height="11.375" version="1.1" viewBox="0 0 50.549999 11.375" width="50.549999"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x33"/></g>

		
	
</svg>) were observed. <i  >Conclusions</i>. Aquajogging was associated with reduced body fat and waist circumference and improved aerobic fitness and quality of life. These findings suggest the usefulness of conducting a randomized controlled trial with long-term outcome assessments.

Eveline J. M. Wouters

Annemieke M. A. Van Nunen

Rinie Geenen

Ronette L. Kolotkin

Ad J. J. M. Vingerhoets

Effects of Aquajogging in Obese Adults: A Pilot Study

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<p><em>Journal of Obesity</em> focuses on topics such as obesity, lipid metabolism, metabolic syndrome, diabetes, paediatric obesity, genetics, nutrition &amp; eating disorders, exercise &amp; human physiology, weight control and risks associated with obesity.</p>


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Journal of Obesity focuses on topics such as obesity, lipid metabolism, metabolic syndrome, diabetes, paediatric obesity, genetics, nutrition & eating disorders, exercise & human physiology, weight control and risks associated with obesity.

Journal of Obesity