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JAMA. 2003;289:1739.

OBESITY RESEARCH
A JAMA THEME ISSUE
Edited by Phil B. Fontanarosa, MD

Sedentary Behaviors and Risk of Obesity and Diabetes
Television watching has been positively associated with obesity and weight gain in children and adults and with type 2 diabetes in men. In this analysis of data from women enrolled in the Nurses' Health Study, a prospective cohort study of female registered nurses aged 30 to 55 years, Hu and colleagues found that sedentary behaviors, especially television watching, were associated with significantly elevated risk of obesity and type 2 diabetes during 6 years of follow-up. Light activities, such as standing or walking around at home, and brisk walking were associated with a significantly lower risk.

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Longer-term Outcomes of Behavioral Obesity Therapy
In this 2-year randomized trial, Heshka and colleagues (SEE ARTICLE) compared weight loss and health benefits of a brief counseling and self-help weight loss program with an ongoing commercial program among overweight and obese adults. Weight loss was achieved in both the self-help and commercial groups at 1 year but was significantly greater in the commercial group. During the second year, weight loss was maintained in the commercial group but weight returned to baseline in the self-help group. Tate and colleagues (SEE ARTICLE) compared 1-year outcomes of an Internet weight loss program alone or with behavioral counseling via e-mail among individuals at risk for type 2 diabetes. Decreases in weight, percentage of initial body weight, and waist circumference were significantly greater in the behavioral e-counseling group.

Weight Loss and Changes in Markers of Inflammation
To examine the effect of weight loss on markers of systemic vascular inflammation and insulin resistance, Esposito and colleagues conducted a randomized trial among obese women (BMI 30) of lifestyle changes (low-energy Mediterranean-style diet and increased physical activity) designed to achieve a sustained weight reduction of 10% or more. After 2 years, reductions in body mass index, circulating levels of interleukin 6, interleukin 18, and C-reactive protein, and insulin resistance were significantly greater in the lifestyle intervention group than in the control group. Levels of adiponectin, an anti-inflammatory adipocytokine, increased significantly in the intervention group compared with the control group.

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Pediatric Obesity: Treatment and Quality of Life
Berkowitz and colleagues (SEE ARTICLE) conducted a 6-month randomized trial to compare a comprehensive behavioral weight control program plus sibutramine, an anorexiant medication, with behavior therapy alone for the treatment of obese adolescents. Weight loss and reduction of BMI were significantly greater in the behavior therapy plus sibutramine group. From months 7 through 12, when all participants received open-label sibutramine, adolescents initially treated with sibutramine largely maintained their weight, whereas those who switched from placebo to sibutramine lost additional weight. In a cross-sectional study, Schwimmer and colleagues (SEE ARTICLE) found that severely obese children and adolescents reported significantly lower health-related quality of life than a reference sample of healthy children. The risk of having impaired health-related quality of life was similar among severely obese children and a reference sample of children receiving chemotherapy for cancer. In an editorial, Yanovski and Yanovski (SEE ARTICLE) discuss treatment of pediatric obesity.

Efficacy and Safety of Low-Carbohydrate Diets
Low-carbohydrate diets are currently a popular means to achieve rapid weight loss. Bravata and colleagues (SEE ARTICLE) conducted a systematic review of articles that evaluated low-carbohydrate diets for treatment of obesity. Evidence was insufficient to make recommendations for or against the use of low-carbohydrate diets. Weight loss while using low-carbohydrate diets was principally associated with decreased caloric intake, longer diet duration, and initial body weight but not with reduced carbohydrate intake. In an editorial, Bray (SEE ARTICLE) discusses strategies for obesity treatment.

CLINICIAN'S CORNER
Contempo Updates
A practical tool for weight loss counseling adapted from the smoking cessation treatment model.

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Medical News & Perspectives
The growing demand for surgery to treat patients with morbid obesity is prompting a host of ethical and scientific questions about the practice.

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Novel Medications for Weight Loss
Results of 2 randomized clinical trials provide preliminary evidence of the effectiveness of novel pharmacotherapies for weight loss—zonisamide, an antiepileptic drug, and recombinant human variant ciliary neurotrophic factor, a protein that signals through leptinlike pathways.

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JAMA Patient Page
For your patients: Information about obesity.

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