Health-related quality of life following a clinical weight loss intervention among overweight and obese adults: intervention and 24 month follow-up effects Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life. A randomized trial of a lifestyle intervention in obese endometrial cancer survivors: quality of life outcomes and mediators of behavior change Dietary weight loss and exercise interventions effects on quality of life in overweight/obese postmenopausal women: a randomized controlled trial Impact of weight loss on Health-Related Quality of Life Diabetes-specific Quality of Life After a Low-carbohydrate and Low-fat Dietary Intervention A pilot church-based weight loss program for African-American adults using church members as health educators: a comparison of individual and group intervention. Translating lifestyle intervention to practice in obese patients with type 2 diabetes: Improving Control with Activity and Nutrition (ICAN) study. The contributions of weight loss and increased physical fitness to improvements in health-related quality of life. Weight loss with self-help compared with a structured commercial program: a randomized trial. Impact of a weight management program on health-related quality of life in overweight adults with type 2 diabetes. Diabetes prevention and control in the workplace: a pilot project for county employees. A randomized controlled trial of a commercial internet weight loss program. Improved psychological well-being, quality of life, and health practices in moderately overweight women participating in a 12-week structured weight loss program. Methodological index for non‐randomized studies (MINORS): development and validation of a new instrument Effect of weight loss and exercise on frailty in obese older adults. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Changes in multiple health outcomes at 12 and 24 weeks resulting from 12 weeks of exercise counseling with or without dietary counseling in obese adults. The impact of high-calorie-expenditure exercise on quality of life in older adults with coronary heart disease. Reduced Body Weight and Adiposity With a High-Protein Diet Improves Functional Status, Lipid Profiles, Glycemic Control, and Quality of Life in Patients With Heart Failure: A Feasibility Study Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. The Lifestyle Challenge Program: A Multidisciplinary Approach to Weight Management Using focus groups to determine what constitutes quality of life in clients receiving medical nutrition therapy: first steps in the development of a nutrition quality-of-life survey. Quality of life as a predictor of weight loss in obese, early-stage breast cancer survivors.
Background Despite a growing literature on the efficacy of behavioral weight loss interventions , we still know relatively little about the long terms effects they have on HRQL . Therefore , we conducted a study to investigate the immediate post-intervention ( 6 months ) and long-term ( 12 and 24 months ) effects of clinical ly based weight management programs on HRQL . Methods We conducted a r and omized clinical trial in which all participants completed a 6 month clinical weight loss program  and were r and omized into two 6-month extended care groups . Participants then returned at 12 and 24 months for follow-up assessment s. A total of 144 individuals ( 78 % women , M age = 50.2 ( 9.2 ) yrs , M BMI = 32.5 ( 3.8 ) kg/m2 ) completed the 6 month intervention and 104 returned at 24 months . Primary outcomes of weight and HRQL using the SF-36 were analyzed using multivariate repeated measures analyses . Results There was complete data on 91 participants through the 24 months of the study . At baseline the participants scored lower than U.S. age-specific population norms for bodily pain , vitality , and mental health . At the completion of the 6 month clinical intervention there were increases in the physical and mental composite measures as well as physical functioning , general health , vitality , and mental health subscales of the SF-36 . Despite some weight regain , the improvements in the mental composite scale as well as the physical functioning , vitality , and mental health subscales were maintained at 24 months . There were no significant main effects or interactions by extended care treatment group or weight loss group ( whether or not they maintained 5 % loss at 24 months ) . Conclusion A clinical weight management program focused on behavior change was successful in improving several factors of HRQL at the completion of the program and many of those improvements were maintained at 24 months . Maintaining a significant weight loss ( > 5 % ) was not necessary to have and maintain improvements in HRQL This study examined the effects of dietary weight loss and exercise on the health-related quality of life ( HRQL ) of overweight and obese , older adults with knee osteoarthritis . A total of 316 older men and women with documented evidence of knee osteoarthritis were r and omly assigned to 1 of 4 18-month interventions : dietary weight loss , exercise , dietary weight loss and exercise , or healthy lifestyle control . Measures included the SF-36 Health Survey and satisfaction with body function and appearance . Results revealed that the combined diet and exercise intervention had the most consistent , positive effect on HRQL compared with the control group ; however , findings were restricted to measures of physical health or psychological outcomes that are related to the physical self Background To examine the effects of a 6 month lifestyle intervention on quality of life , depression , self-efficacy and eating behavior changes in overweight and obese endometrial cancer survivors . Methods Early stage endometrial cancer survivors were r and omized to intervention ( n = 23 ) or usual care ( n = 22 ) groups . Chi-square , Student 's t-test and repeated measures analysis of variance were used in intent-to-treat analyses . Outcomes were also examined according to weight loss . Results Morbidly obese patients had significantly lower self-efficacy , specifically when feeling physical discomfort . There was a significant improvement for self-efficacy related to social pressure ( p = .03 ) and restraint ( p = .02 ) in the LI group . There was a significant difference for emotional well-being quality of life ( p = .02 ) , self-efficacy related to negative emotions ( p < .01 ) , food availability ( p = .03 ) , and physical discomfort ( p = .01 ) in women who lost weight as compared to women who gained weight . Improvement in restraint was also reported in women who lost weight ( p < .01 ) . Conclusion This pilot lifestyle intervention had no effect on quality of life or depression but did improve self-efficacy and some eating behaviors . Trial Registration http://www . clinical trials.gov ; Background Although lifestyle interventions targeting multiple lifestyle behaviors are more effective in preventing unhealthy weight gain and chronic diseases than intervening on a single behavior , few studies have compared individual and combined effects of diet and /or exercise interventions on health-related quality of life ( HRQOL ) . In addition , the mechanisms of how these lifestyle interventions affect HRQOL are unknown . The primary aim of this study was to examine the individual and combined effects of dietary weight loss and /or exercise interventions on HRQOL and psychosocial factors ( depression , anxiety , stress , social support ) . The secondary aim was to investigate predictors of changes in HRQOL . Methods This study was a r and omized controlled trial . Overweight/obese postmenopausal women were r and omly assigned to 12 months of dietary weight loss ( n = 118 ) , moderate-to-vigorous aerobic exercise ( 225 minutes/week , n = 117 ) , combined diet and exercise ( n = 117 ) , or control ( n = 87 ) . Demographic , health and anthropometric information , aerobic fitness , HRQOL ( SF-36 ) , stress ( Perceived Stress Scale ) , depression [ Brief Symptom Inventory (BSI)-18 ] , anxiety ( BSI-18 ) and social support ( Medical Outcome Study Social Support Survey ) were assessed at baseline and 12 months . The 12-month changes in HRQOL and psychosocial factors were compared using analysis of covariance , adjusting for baseline scores . Multiple regression was used to assess predictors of changes in HRQOL . Results Twelve-month changes in HRQOL and psychosocial factors differed by intervention group . The combined diet + exercise group improved 4 aspects of HRQOL ( physical functioning , role-physical , vitality , and mental health ) , and stress ( p ≤ 0.01 vs. controls ) . The diet group increased vitality score ( p < 0.01 vs. control ) , while HRQOL did not change differently in the exercise group compared with controls . However , regardless of intervention group , weight loss predicted increased physical functioning , role-physical , vitality , and mental health , while increased aerobic fitness predicted improved physical functioning . Positive changes in depression , stress , and social support were independently associated with increased HRQOL , after adjusting for changes in weight and aerobic fitness . Conclusions A combined diet and exercise intervention has positive effects on HRQOL and psychological health , which may be greater than that from exercise or diet alone . Improvements in weight , aerobic fitness and psychosocial factors may mediate intervention effects on HRQOL.Trial Registration Clinical Trials , Clinical Trials.gov register , To examine the effect of treatment-induced weight loss on Health-Related Quality of Life ( HRQL )  , 38 mildly-to-moderately overweight persons recruited to participate in a study to examine the efficacy of a lifestyle modification treatment program  completed a sociodemographic question naire , the Beck Depression Inventory ( BDI ) , the Medical Outcomes Study Short-Form Health Survey ( SF-36 , as an assessment of HRQL ) , and underwent a series of clinical evaluations prior to treatment . After baseline evaluations , participants were r and omly assigned to either a program of lifestyle physical activity or a program of traditional aerobic activity . Participants again completed the SF-36 and BDI after the 13-week treatment program had ended . Weight loss averaged 8.6 ± 2.8 kg over the 13-week study . We found that weight loss was associated with significantly higher scores ( enhanced HRQL ) , relative to baseline , on the physical functioning , role-physical , general health , vitality and mental health domains of the SF-36 . The largest improvements were with respect to the vitality , general health perception and role-physical domains . There were no significant differences between the lifestyle and aerobic activity groups on any of the study measures . These data indicate that , at least in the short-term , weight loss appears to profoundly enhance HRQL Purpose The purpose of the study was to examine the impact of a 12-month weight loss intervention with either a low-carbohydrate or a low-fat diet on quality of life ( QOL ) among obese patients with type 2 diabetes . Methods Participants were enrolled in a r and omized trial comparing a low-carbohydrate to a low-fat diet in type 2 diabetes . QOL was assessed with the Diabetes-39 question naire , which measures QOL within 5 distinct scales : anxiety and worry , diabetes control , energy and mobility , social burden , and sexual functioning . Repeated measures ANOVA compared change in QOL scales at baseline and 6 and 12 months . Results Forty-six participants completed all measures . Following 12 months , there was a significant reduction in the scores related to sexual function and energy and mobility , suggesting improvement in QOL related to these domains . These changes were not significantly different between dietary arms . Changes in weight , A1C , and dietary composition were not significantly correlated with changes in QOL . Conclusions Participants with diabetes have various options for weight loss . Dietary interventions with either low-carbohydrate or low-fat diets may lead to some improvements in QOL in patients with type 2 diabetes OBJECTIVE The purpose of this study was to examine a church-based intervention employing a 6-month pilot weight loss program as a strategy to improve health of African-American adults . DESIGN A r and omized trial design was used without a control group . Eligible church members were r and omized into two groups : an intervention delivered in the group setting and an intervention delivered in the individual setting . SETTING The study was conducted at an African-American church in Baton Rouge , Louisiana . PARTICIPANTS Forty church members were enrolled in the study . Two trained church members without specialization in obesity treatment conducted the study . MAIN OUTCOME MEASURES The primary outcome measure was weight loss . RESULTS The program retention rate was 90 % . After six months , a modest but significant mean weight loss was seen in all participants of 3.3 kg . The mean weight losses in the individual and group interventions were 3.4 kg and 3.1 kg , respectively . The mean body fat loss was 2.1 kg and 1.9 kg , respectively . The difference in weight loss and fat loss between the individual and group interventions was not statistically significant . An improvement in the quality of life and an increase in physical activity were reported by the program participants . CONCLUSIONS A church setting may provide an effective delivery mechanism for a health and nutrition program . Church members may be trained to conduct a weight control program . Both interventions ( individual and group ) were effective in inducing weight loss OBJECTIVE To assess the efficacy of a lifestyle intervention program that can be readily translated into clinical practice for obese patients with type 2 diabetes . RESEARCH DESIGN AND METHODS The study consisted of a 12-month r and omized controlled trial of 147 health plan members with type 2 diabetes and obesity ( BMI > or=27 kg/m(2 ) ) . Participants were r and omized to lifestyle case management or usual care . Case management entailed individual and group education , support , and referral by registered dietitians ; intervention cost was US dollars 350 per person . Individuals treated with usual care received educational material . Both groups received ongoing primary care . Outcomes were difference between groups for change in weight ( kilograms ) , waist circumference ( centimeters ) , HbA(1c ) , fasting lipid levels , use of prescription medications , and health-related quality of life . RESULTS Case management result ed in greater weight loss ( P < 0.001 ) , reduced waist circumference ( P < 0.001 ) , reduced HbA(1c ) level ( P = 0.02 ) , less use of prescription medications ( P = 0.03 ) , and improved health-related quality of life ( P < 0.001 ) compared with usual care . The 12-month group difference in weight loss and waist circumference was 3.0 kg ( 95 % CI -5.4 to -0.6 ) and -4.2 cm ( -6.8 to -1.6 ) . HbA(1c ) differences were greatest at 4 months ( -0.59 % , P = 0.006 ) but not significant by 12 months ( -0.19 % , P = 0.45 ) . Participants in the case management group lowered their use of medications , primarily diabetes medications , by 0.8 medications per day more than participants treated with usual care ( P = 0.03 ) . In seven of nine quality -of-life domains , the case management group improved compared with usual care ( P < 0.05 ) . CONCLUSIONS Moderate-cost dietitian-led lifestyle case management may improve diverse health indicators among obese patients with type 2 diabetes The relative contribution of obesity versus poor fitness to adverse health outcomes and diminished quality of life remains an area of controversy . Indeed , some research ers contend that poor cardiorespiratory fitness represents a greater threat to health and health-related quality of life than excess body weight . We addressed this issue by providing 298 obese 50 - 75 year-old women with a six-month lifestyle intervention that incorporated a low-calorie eating pattern coupled with an aerobic exercise program consisting of 30 min/day of brisk walking . The results showed that weight loss exhibited a significant individual contribution to improvements in seven of the nine domains of quality of life assessed by the Medical Outcomes Study Short Form ( SF-36 ) . With the exception of physical functioning , however , physical fitness did not significantly contribute to improvements beyond the effects weight loss . Moreover , weight loss functioned as a full mediator of the association between increases in physical fitness and improvements in general health , vitality , and change in health relative to the previous year . Collectively , these findings suggest that for treatment-seeking obese individuals , weight loss rather than increased fitness contributes significantly to improvements in health-related quality of life CONTEXT Although commercial weight loss programs provide treatment to millions of clients , their efficacy has not been evaluated in rigorous long-term trials . OBJECTIVE To compare weight loss and health benefits achieved and maintained through self-help weight loss vs with a structured commercial program . DESIGN AND SETTING A 2-year , multicenter r and omized clinical trial with clinic visits at 12 , 26 , 52 , 78 , and 104 weeks conducted at 6 academic research centers in the United States between January 1998 and January 2001 . PARTICIPANTS Overweight and obese men ( n = 65 ) and women ( n = 358 ) ( body mass index , 27 - 40 ) aged 18 to 65 years . INTERVENTION R and om assignment to either a self-help program ( n = 212 ) consisting of two 20-minute counseling sessions with a nutritionist and provision of self-help re sources or to a commercial weight loss program ( n = 211 ) consisting of a food plan , an activity plan , and a cognitive restructuring behavior modification plan , delivered at weekly meetings . MAIN OUTCOME MEASURES Weight change was the primary outcome measure . Secondary outcomes included waist circumference , body mass index , blood pressure , serum lipids , glucose , and insulin levels . RESULTS At 2 years , 150 participants ( 71 % ) in the commercial group and 159 ( 75 % ) in the self-help group completed the study . In the intent-to-treat analysis , mean ( SD ) weight loss of participants in the commercial group was greater than in the self-help group at 1 year ( -4.3 [ 6.1 ] kg vs -1.3 [ 6.1 ] kg , respectively ; P<.001 ) and at 2 years ( -2.9 [ 6.5 ] kg vs -0.2 [ 6.5 ] kg , respectively ; P<.001 ) . Waist circumference ( P = .003 ) and body mass index ( P<.001 ) decreased more in the commercial group . Changes in blood pressure , lipids , glucose , and insulin levels were related to changes in weight in both groups , but between-group differences in biological parameters were mainly nonsignificant by year 2 . CONCLUSION The structured commercial weight loss program provided modest weight loss but more than self-help over a 2-year period BACKGROUND Inconsistent findings have been reported regarding improved health-related quality of life ( HRQOL ) after weight loss . We tested the efficacy of a weight management program for improving HRQOL in overweight or obese adults diagnosed as having type 2 diabetes mellitus . METHODS We conducted a r and omized multisite clinical trial at 16 outpatient research centers with 2 treatment arms and blinded measurements at baseline and the end of year 1 . A total of 5145 participants ( mean [ SD ] age , 58.7 [ 6.9 ] years ; mean [ SD ] body mass index [ calculated as weight in kilograms divided by height in meters squared ] , 36.0 [ 5.9 ] ; 59.5 % women ; 63.1 % white ) were r and omized to an intensive lifestyle intervention ( ILI ) or to diabetes support and education ( DSE ) . Main outcome measures included the 36-Item Short-Form Health Survey physical component summary ( PCS ) and mental health component summary ( MCS ) scores and Beck Depression Inventory II ( BDI-II ) scores . Baseline mean ( SD ) scores were 47.9 ( 7.9 ) for PCS , 54.0 ( 8.1 ) for MCS , and 5.7 ( 5.0 ) for BDI-II . RESULTS Improved HRQOL was demonstrated by the PCS and BDI-II scores ( P < .001 ) in the ILI arm compared with the DSE arm . The largest effect was observed for the PCS score ( difference , -2.91 ; 99 % confidence interval , -3.44 to -2.37 ) . The greatest HRQOL improvement occurred in participants with the lowest baseline HRQOL levels . Mean ( SD ) changes in weight ( ILI , -8.77 [ 8.2 ] kg and DSE , -0.86 [ 5.0 ] kg ) , improved fitness , and improved physical symptoms mediated treatment effects associated with the BDI-II and PCS . CONCLUSIONS Overweight adults diagnosed as having type 2 diabetes experienced significant improvement in HRQOL by enrolling in a weight management program that yielded significant weight loss , improved physical fitness , and reduced physical symptoms . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00017953 OBJECTIVES To improve nutrition and physical activity of county employees and promote weight loss . DESIGN R and om assignment to begin the program when first offered or after 3 months ( " wait control " group ) . SETTING Worksite . PARTICIPANTS Onondaga County employees ( n = 45 ) at risk for diabetes ( n = 35 ) or with diabetes ( n = 10 ) . Mean ( ±SD ) age = 51.2 ( ± 8.0 ) years and body mass index ( BMI ) = 37.3 ± ( 6.8 kg/m ) . INTERVENTION Twelve weekly healthy lifestyle sessions based on the Diabetes Prevention Program curriculum , followed by monthly sessions for up to 12 months . OUTCOMES Medical : Weight , BMI , waist circumference , blood pressure , fasting glucose , lipid , and hemoglobin A1c levels . Psychosocial/behavioral : Health-related quality of life Short Form-12 , Impact of Weight on Quality of Life Scale ) , physical activity ( International Physical Activity Question naire ) , eating behavior ( 3-Factor Eating Question naire , National Cancer Institute Fat Screener ) , job satisfaction . RESULTS The intervention group lost significant weight compared to the wait control group over the first 3 months ( mean [ 95 % CI ] , -2.23 kg [ -3.5 to 0.97 ] ) vs [ + 0.73 kg ( + 0.17 to + 1.28 ) ] , with a decrease in BMI ( P < .001 ) and waist circumference ( P = .004 ) , an increase in physical activity ( International Physical Activity Question naire , P = .011 ) and lower dietary fat intake ( P = .018 ) . Over 12 months , 22.5 % ( 9/40 ) lost more than 5 % body weight and 12.5 % ( 5/40 ) lost more than 7 % body weight . After the first 3 months , there was gradual partial weight regain but reduction in waist circumference was maintained . The intervention group demonstrated significant improvement in Impact of Weight on Quality of Life Scale ( P < .001 ) , 3-Factor Eating ( cognitive restraint P < .001 , uncontrolled eating P = .003 , and emotional eating P = .001 ) , International Physical Activity Question naire ( P = .011 ) , and Short Form-12 Physical Component Summary ( P = .048 ) . No improvements were observed in blood pressure , lipid , hemoglobin A1c , or glucose levels . Job satisfaction was inversely related to BMI at baseline ( P = .001 ) with a trend for improvement with the modest weight loss . CONCLUSIONS A worksite intervention program can help government employees adopt healthier lifestyles and achieve modest weight loss OBJECTIVE To assess , in a 1-year r and omized controlled trial , the efficacy of eDiets.com ( a commercial Internet weight loss program ) in improving weight , cardiovascular health , and quality of life . RESEARCH METHODS AND PROCEDURES Participants were 47 women with a mean age of 43.7 + /- 10.2 ( SD ) years and a mean BMI of 33.5 + /- 3.1 kg/m2 . They were r and omly assigned to either : 1 ) eDiets.com , a commercial Internet-based program available to the public ; or 2 ) a weight loss manual ( i.e. , LEARN Program for Weight Control 2000 ) . At baseline , participants in both groups met briefly with a psychologist who instructed them to follow the components of their program as closely as possible . Additional brief visits were provided at weeks 8 , 16 , 26 , and 52 to review their progress . Change in weight was the main outcome measure . RESULTS At week 16 , participants in eDiets.com lost 0.9 + /- 3.2 % of initial weight compared with 3.6 + /- 4.0 % for women assigned to the weight loss manual . At week 52 , losses increased to 1.1 + /- 4.0 % and 4.0 + /- 5.1 % , respectively . Results of a last-observation-carried-forward analysis found that women in the manual group lost significantly ( p < 0.05 ) more weight ( at both times ) than those treated by eDiets.com . ( Results , however , of baseline-carried-forward and completers analyses did not reach statistical significance . ) There were no significant differences between groups in changes in cardiovascular risk factors or quality of life . DISCUSSION This study provides consumers with important information about the probable benefits they can expect from participating in a popular Internet-based weight loss program OBJECTIVE To study the effects of a 12-week weight loss strategy involving increased physical activity , self-selected hypocaloric diet , and group support on psychological well-being , quality of life , and health practice s in moderately obese women . METHODS Eighty women aged 20 - 49 years weighing between 20 - 50 % above 1983 Metropolitan Life Insurance Tables were r and omly assigned to a weight loss intervention ( 6279 kJ/week of physical activity , 33,258 - 41,462 kJ/week diet and weekly meetings ) or served as controls . Subjects were tested pre and post 12-weeks . RESULTS The intervention group lost significant ( p<0.001 ) body weight ( kg ) and body fat ( % ) compared to controls ( -6.07+/-4.01 kg vs. 1.31+/-1.28 kg ; 36.8%-32.5 % vs. 36.2%-36.0 % ) . Intervention subjects vs. controls achieved significant improvements ( p<0.001 ) in body cathexis ( X Change 18.6+/-16.7 vs. 0.7+/-8.6 ) and estimation of ability to achieve physical fitness ( X Change 8.1+/-7.1 vs. 0.9+/-5.9 ) . Various quality of life indices also improved ( p<0.01 ) in the intervention group compared to controls ( physical function : X Change 13.5.2+/-16.7 vs. 1.4+/-9.5 ; vitality : X change 21.7+/-17.9 vs. 2.9+/-20.8 ; mental health : X change 10.4+/-16.0 vs. 2.3+/-10.1 ) . Similarly , physical activity levels also improved significantly ( p<0.0001 ) in the intervention group ( 4.4+/-2.3 vs. 0.6+/-1.3 ; on NASA 0 - 7 scale ) . CONCLUSIONS Practical weight loss practice s such as increased activity , self-selected hypocaloric diet , and group support are effective for weight loss and yield significant health and psychological benefits in moderately obese females Background : Because of specific method ological difficulties in conducting r and omized trials , surgical research remains dependent predominantly on observational or non‐r and omized studies . Few vali date d instruments are available to determine the method ological quality of such studies either from the reader 's perspective or for the purpose of meta‐ analysis . The aim of the present study was to develop and vali date such an instrument BACKGROUND Obesity exacerbates the age-related decline in physical function and causes frailty in older persons . However , appropriate treatment for obese older persons is unknown . We evaluated the effects of weight loss and exercise therapy on physical function and body composition in obese older persons . METHODS We screened 40 obese older volunteers and eventually r and omized 27 frail obese older volunteers to treatment or control groups . Treatment consisted of 6 months of weekly behavioral therapy for weight loss in conjunction with exercise training 3 times per week . Physical function was evaluated with measurements of frailty ( Physical Performance Test , peak oxygen consumption , and Functional Status Question naire ) ; strength , gait , and balance tests ; body composition with dual-energy x-ray absorptiometry ; and quality of life using the Medical Outcomes Survey 36-Item Short-Form Health Survey . Results are reported as mean + /- SD . RESULTS Two subjects in the treatment group did not comply with the intervention , and 1 subject in the control group withdrew . Analyses included all 27 subjects originally r and omized to the treatment and control groups . The treatment group lost 8.4 % + /- 5.6 % of body weight , whereas weight did not change in the control group ( + 0.5 % + /- 2.8 % ; P<.001 ) . Compared with the control group , fat mass decreased ( -6.6 + /- 3.4 vs + 1.7 + /- 4.1 kg ; P<.001 ) , without a change in fat-free mass ( -1.2 + /- 2.1 vs -1.0 + /- 3.5 kg ; P = .75 ) in the treatment group . The Physical Performance Test score ( 2.6 + /- 2.5 vs 0.1 + /- 1.0 ; P = .001 ) , peak oxygen consumption ( 1.7 + /- 1.6 vs 0.3 + /- 1.1 mL/min per kilogram ; P = .02 ) , and Functional Status Question naire score ( 2.9 + /- 3.7 vs -0.2 + /- 3.9 ; P = .02 ) improved in treated subjects compared with control subjects . Treatment also improved strength , walking speed , obstacle course , 1-leg limb stance time , and health survey physical subscale scores ( all P<.05 ) . CONCLUSION These findings suggest that weight loss and exercise can ameliorate frailty in obese older adults . Trial Registration clinical trials.gov Identifier : NCT00146133 BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin OBJECTIVE We compared health outcomes in obese adults who underwent 12 wk of exercise counseling with or without dietary counseling , followed by 12 wk of observational monitoring . METHODS Ninety adults ( 77 women and 13 men ; 42.6 + /- 6.0 y ; body mass index , 31.5 + /- 2.8 kg/m(2 ) ) were r and omly assigned to exercise-only ( EX ) or diet-plus-exercise ( DEX ) groups and counseled weekly by exercise physiologists on a 12-wk walking program . DEX subjects were also counseled by dietitians on a hypocaloric diet ( -500 kcal/d ) . From weeks 12 to 24 , subjects were monitored but not counseled . At weeks 0 , 12 , and 24 , data collection included body composition ( air displacement plethysmography ) , fitness ( maximum oxygen consumption , 3-min step-test , and timed mile ) , plasma lipids , weight loss efficacy ( Weight Efficacy Life-Style Question naire ) , quality of life ( Medical Outcomes Study Health Survey-Short Form 36 ) , and mood ( Profile of Mood States ) . RESULTS At 12 and 24 wk , weight and body mass index decreased in DEX subjects ( both P < 0.05 ) but not in EX subjects . However , lean body mass increased significantly in EX ( 24 wk , P < 0.05 ) but not in DEX subjects . In both groups , fat mass decreased ( P < 0.05 for EX subjects at 24 wk ; P < 0.05 for DEX subjects at 12 and 24 wk ) and waist circumference decreased ( P < 0.05 for EX subjects at 12 and 24 wk ; P < 0.05 for DEX subjects at 12 and 24 wk ) . At 12 and 24 wk , DEX subjects showed decreased levels of total plasma cholesterol and triacylglycerols ( both P < 0.05 ) and improvements with regard to the Weight Efficacy Life-Style Question naire ( P < 0.05 ) , three domains of the Medical Outcomes Study Health Survey-Short Form 36 ( all P < 0.05 ) , and three domains of the Profile of Mood States ( all P < 0.05 ) that were not seen in EX subjects . CONCLUSIONS Exercise counseling for 12 wk in obese adults improves some body composition indices that can be sustained over 12 wk of monitoring . The addition of dietary counseling increases improvements in body composition , lipid profiles , and several psychological parameters The acceptability of a high-calorie-expenditure ( HCE ) exercise program in older coronary heart disease patients participating in a behavioral weight-control program was evaluated . Seventy-four overweight patients ( median age 63 yr ) were r and omly assigned to a 5-mo intervention of HCE exercise ( 3,000 - 3,500 kcal/wk daily walking ) or st and ard cardiac-rehabilitation ( CR ) exercise ( 700 - 800 kcal/wk ) . Both groups received counseling to achieve a dietary caloric deficit of 3,500 kcal/ wk . Assessment s at baseline and 5 mo included self-reported measures of quality of life and psychosocial variables . The HCE group experienced significantly greater weight loss ( 8.2 ± 4 vs. 3.7 ± 5 kg , p < .001 ) . Changes from baseline to 5 mo on scores of physical , emotional , and social functioning were greater for the HCE than CR group ( p < .05 ) . HCE exercise also result ed in greater positive change in exercise enjoyment ( p = .05 ) , which was mediated by weight change . Even high-risk older adults can be successful in an HCE exercise program and experience no adverse physical or emotional changes Background : The effectiveness of high-protein ( HP ) diets in reducing body weight and adiposity and potentially improving clinical outcomes in heart failure ( HF ) is not known . Objective : This feasibility study was conducted to evaluate the impact of 3 dietary interventions on body weight and adiposity , functional status , lipid profiles , glycemic control , and quality of life ( QOL ) in overweight and obese patients with HF and type 2 diabetes mellitus . Design : Fourteen patients with HF with a body mass index greater than 27 kg/m2 were r and omized to an HP diet , a st and ard protein diet , or a conventional diet . Data were obtained at baseline and 12 weeks . Results : There were no significant differences in age ( 59 ± 10 years ) , sex ( 78 % male ) , New York Heart Association class ( 43 % class II , 57 % class III ) , and HF etiology or left ventricular ejection fraction ( 26 ± 7 ) between the groups at baseline . Patients on the HP diet demonstrated significantly greater reductions in weight ( P = .005 ) , percent body fat ( P = .036 ) , total cholesterol ( P = .016 ) , triglyceride concentrations ( P = .034 ) , and low-density lipoprotein cholesterol ( P = .041 ) and greater improvements in functional status ( 6-minute walk [ P = .010 ] and VO2 peak [ P = .003 ] ) , high-density lipoprotein cholesterol ( P = .006 ) , and physical QOL scores ( P = .022 ) compared with those on st and ard protein and conventional diets . Conclusion : A 12-week HP diet result ed in moderate weight loss and reduced adiposity in a small sample of overweight and obese patients with HF that were associated with improvements in functional status , lipid profiles , glycemic control , and QOL . However , these preliminary findings must be confirmed in studies with more participants and long-term follow-up CONTEXT Weight loss , sodium reduction , increased physical activity , and limited alcohol intake are established recommendations that reduce blood pressure ( BP ) . The Dietary Approaches to Stop Hypertension ( DASH ) diet also lowers BP . To date , no trial has evaluated the effects of simultaneously implementing these lifestyle recommendations . OBJECTIVE To determine the effect on BP of 2 multicomponent , behavioral interventions . DESIGN , SETTING , AND PARTICIPANTS R and omized trial with enrollment at 4 clinical centers ( January 2000-June 2001 ) among 810 adults ( mean [ SD ] age , 50 [ 8.9 ] years ; 62 % women ; 34 % African American ) with above-optimal BP , including stage 1 hypertension ( 120 - 159 mm Hg systolic and 80 - 95 mm Hg diastolic ) , and who were not taking antihypertensive medications . INTERVENTION Participants were r and omized to one of 3 intervention groups : ( 1 ) " established , " a behavioral intervention that implemented established recommendations ( n = 268 ) ; ( 2 ) " established plus DASH,"which also implemented the DASH diet ( n = 269 ) ; and ( 3 ) an " advice only " comparison group ( n = 273 ) . MAIN OUTCOME MEASURES Blood pressure measurement and hypertension status at 6 months . RESULTS Both behavioral interventions significantly reduced weight , improved fitness , and lowered sodium intake . The established plus DASH intervention also increased fruit , vegetable , and dairy intake . Across the groups , gradients in BP and hypertensive status were evident . After subtracting change in advice only , the mean net reduction in systolic BP was 3.7 mm Hg ( P<.001 ) in the established group and 4.3 mm Hg ( P<.001 ) in the established plus DASH group ; the systolic BP difference between the established and established plus DASH groups was 0.6 mm Hg ( P = .43 ) . Compared with the baseline hypertension prevalence of 38 % , the prevalence at 6 months was 26 % in the advice only group , 17 % in the established group ( P = .01 compared with the advice only group ) , and 12 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .12 compared with the established group ) . The prevalence of optimal BP ( < 120 mm Hg systolic and < 80 mm Hg diastolic ) was 19 % in the advice only group , 30 % in the established group ( P = .005 compared with the advice only group ) , and 35 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .24 compared with the established group ) . CONCLUSION Individuals with above-optimal BP , including stage 1 hypertension , can make multiple lifestyle changes that lower BP and reduce their cardiovascular disease risk BACKGROUND The increasing prevalence of overweight and obesity in the US has received widespread attention and is highlighted in recent government-issued health priorities . While there are many weight loss programs in different setting s , few include pharmacist involvement in spite of pharmacists ’ recognized easy accessibility to the public . OBJECTIVE To provide insight into a successful , collaborative , multidisciplinary approach to weight management and to encourage pharmacists and other healthcare professionals to adopt a similar approach to patient management . METHODS Adult patients > 18 years of age were recruited from an outpatient university-based setting to participate in a weight management program . The principles of the program included diet , exercise , and behavior modification . The program was conducted through weekly one-hour group sessions held over a 20-week period . Faculty involved in the program included an attending physician specializing in nutrition , a pharmacist , and a behavioral psychologist . All data are expressed as mean ± SD unless otherwise specified . RESULTS Ninety participants ( 74 female , mean age 48 ± 10 y ) entered the program between April 2001 and April 2004 . Participants had multiple obesity-related comorbid diseases . The weight of completers ( n = 59 ) decreased from 100.9 ± 20 kg at baseline to 97.3 ± 19.5 kg at 10 weeks and 95.9 ± 20 kg at 20 weeks . Thirty-nine patients completed both baseline and final assessment s , which showed improvement in health-related quality of life , binge-eating behavior , and depressive symptoms ( p < 0.05 ) . CONCLUSIONS This program is a successful multidisciplinary model for the management of overweight and obese patients in an outpatient-based hospital setting OBJECTIVE As the first part of a multiphase process to develop a Nutrition Quality of Life ( NQOL ) survey , our objective was to identify items that later will be psychometrically evaluated for inclusion into the NQOL survey , a survey that can be used in routine practice to monitor the impact of medical nutrition therapy ( MNT ) . DESIGN We used a prospect i ve , six-step iterative process involving focus groups , surveys , and consensus processes to build a conceptual framework to describe health-related quality of life in individuals receiving MNT , to identify items for inclusion in an NQOL survey , and to refine these items and the survey format . Subjects/ Setting and Methods Items were generated from 65 patients in five geographically diverse locations participating in 10 focus groups and 46 dietitians in the same geographic locations participating in seven focus groups . Patients represented a variety of ages , ethnicities , and clinical and economic conditions . Dietitians were primarily from outpatient locations with both general and speciality practice s. Sixty-one percent of the participants provided feedback via mailed surveys . Additional input was received from audience attendees at sessions at two national nutrition meetings . RESULTS Based on comments generated in client and dietitian focus groups , we identified 50 items in six clusters : 9 items in food impact ; 6 , self-image ; 10 , psychological factors ; 7 , social/interpersonal ; 9 , physical ; and 9 , self-efficacy . Whenever possible , we developed items using the clients ' own words . Clients , responding to the mailed survey , indicated that they took approximately 10 minutes to complete the NQOL survey . Applications/ Conclusions At this time , dietitians may use the 50 questions to probe the impact of MNT on their clients ' NQOL . However , psychometric and clinical testing will be necessary to further refine these items before the NQOL survey can be scored and used to measure the NQOL of patients at baseline , to monitor the impact of MNT over time , and to manage future MNT interventions by using an NQOL survey in a quality improvement program PURPOSE / OBJECTIVES To investigate whether quality of life ( QOL ) assessed before weight loss intervention predicts weight loss and , in turn , what the effect of weight loss is on QOL measures after 12 months in early-stage breast cancer survivors . DESIGN A clinical trial of a weight loss intervention in breast cancer survivors . SETTING Community-wide recruitment in Detroit , MI . SAMPLE 39 breast cancer survivors ( body mass index = 30 - 44 kg/m2 ) , within three years of initial diagnosis and at least three months after chemotherapy or radiation therapy .  METHODS Participants were r and omized to one of three weight loss methods  or a control group . The Functional Assessment of Cancer Therapy-Anemia ( FACT-An ) QOL question naire was administered at baseline and after the intervention . MAIN RESEARCH VARIABLES Six subscales of the FACT-An and weight change . FINDINGS Modest but statistically significant associations were found for the physical and functional subscales of the FACT-An with  weight loss for 39 subjects who completed 12 months of the study . Those reporting relatively impaired physical or functional QOL at baseline lost more weight , which accounted for 8%-9 % of the weight loss variance beyond that result ing from the diet arm assignment . At 12 months , greater weight loss was associated with significant improvements in overall FACT-An score and in the physical , functional , fatigue , and anemia subscales ( p < 0.05 ) . CONCLUSIONS Relatively low physical function at baseline was not a barrier to weight loss ; indeed , it may have been a motivating factor in adherence to the weight loss intervention . Weight loss was associated with improvement in several QOL subscale measures in breast cancer survivors , but the emotional and social subscales were not affected . IMPLICATION S FOR NURSING Counseling for weight loss that includes recommendations for exercise should not be withheld for patients with relatively low physical functioning
OBJECTIVE To systematic ally review the literature to examine whether there has been adequate assessment of the effects of dietary intervention on quality of life ( QOL ) independent of weight loss , assess which instruments are being used to measure nutrition-related QOL , identify gaps in the literature , and suggest future directions .