Obesity: Donnelly JE

Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK, Anonymous00019. · No affiliation provided · Med Sci Sports Exerc. · Pubmed #19127177 No free full text.

Abstract: Overweight and obesity affects more than 66% of the adult population and is associated with a variety of chronic diseases. Weight reduction reduces health risks associated with chronic diseases and is therefore encouraged by major health agencies. Guidelines of the National Heart, Lung, and Blood Institute (NHLBI) encourage a 10% reduction in weight, although considerable literature indicates reduction in health risk with 3% to 5% reduction in weight. Physical activity (PA) is recommended as a component of weight management for prevention of weight gain, for weight loss, and for prevention of weight regain after weight loss. In 2001, the American College of Sports Medicine (ACSM) published a Position Stand that recommended a minimum of 150 min wk(-1) of moderate-intensity PA for overweight and obese adults to improve health; however, 200-300 min wk(-1) was recommended for long-term weight loss. More recent evidence has supported this recommendation and has indicated more PA may be necessary to prevent weight regain after weight loss. To this end, we have reexamined the evidence from 1999 to determine whether there is a level at which PA is effective for prevention of weight gain, for weight loss, and prevention of weight regain. Evidence supports moderate-intensity PA between 150 and 250 min wk(-1) to be effective to prevent weight gain. Moderate-intensity PA between 150 and 250 min wk(-1) will provide only modest weight loss. Greater amounts of PA (>250 min wk(-1)) have been associated with clinically significant weight loss. Moderate-intensity PA between 150 and 250 min wk(-1) will improve weight loss in studies that use moderate diet restriction but not severe diet restriction. Cross-sectional and prospective studies indicate that after weight loss, weight maintenance is improved with PA >250 min wk(-1). However, no evidence from well-designed randomized controlled trials exists to judge the effectiveness of PA for prevention of weight regain after weight loss. Resistance training does not enhance weight loss but may increase fat-free mass and increase loss of fat mass and is associated with reductions in health risk. Existing evidence indicates that endurance PA or resistance training without weight loss improves health risk. There is inadequate evidence to determine whether PA prevents or attenuates detrimental changes in chronic disease risk during weight gain.

Donnelly JE, Smith B, Jacobsen DJ, Kirk E, Dubose K, Hyder M, Bailey B, Washburn R. · The Center for Physical Activity and Weight Management, The Schiefelbusch Institute for Lifespan Studies, The University of Kansas, 1301 Sunnyside Ave, Robinson Center Rm 100, Lawrence, KS 66045, USA. · Best Pract Res Clin Gastroenterol. · Pubmed #15561636 No free full text.

Abstract: Exercise provides a means of increasing energy expenditure and may help adjust energy balance for weight loss and maintenance. At least 30 minutes a day of moderate intensity aerobic exercise per day is recommended for weight loss and maintenance but greater amounts appear to increase the magnitude of weight loss and maintenance. Resistance training has recently been shown to have positive effects on body composition but does not typically show significant decreases in weight. Regardless of weight loss, both aerobic exercise and resistance training have been shown to diminish risk factors for cardiovascular disease and diabetes. Since exercise is only effective if sustained, behavioural strategies such as self-monitoring, goal setting, social support, etc. are used to help individuals start and maintain exercise programs and show improved results compared to exercise programs without behavioural strategies. The available evidence indicates that exercise is an important component of weight loss and perhaps the best predictor of weight maintenance.

Jakicic JM, Clark K, Coleman E, Donnelly JE, Foreyt J, Melanson E, Volek J, Volpe SL, Anonymous00056. · American College of Sports Medicine. · Med Sci Sports Exerc. · Pubmed #11740312 No free full text.

Abstract: In excess of 55% of adults in the United States are classified as either overweight (body mass index = 25-29.9 kg.m(-2)) or obese (body mass index > or = 30 kg.m(-2)). To address this significant public health problem, the American College of Sports Medicine recommends that the combination of reductions in energy intake and increases in energy expenditure, through structured exercise and other forms of physical activity, be a component of weight loss intervention programs. An energy deficit of 500-1000 kcal.d-1 achieved through reductions in total energy intake is recommended. Moreover, it appears that reducing dietary fat intake to <30% of total energy intake may facilitate weight loss by reducing total energy intake. Although there may be advantages to modifying protein and carbohydrate intake, the optimal doses of these macronutritents for weight loss have not been determined. Significant health benefits can be recognized with participation in a minimum of 150 min (2.5 h) of moderate intensity exercise per week, and overweight and obese adults should progressively increase to this initial exercise goal. However, there may be advantages to progressively increasing exercise to 200-300 min (3.3-5 h) of exercise per week, as recent scientific evidence indicates that this level of exercise facilitates the long-term maintenance of weight loss. The addition of resistance exercise to a weight loss intervention will increase strength and function but may not attenuate the loss of fat-free mass typically observed with reductions in total energy intake and loss of body weight. When medically indicated, pharmacotherapy may be used for weight loss, but pharmacotherapy appears to be most effective when used in combination with modifications of both eating and exercise behaviors. The American College of Sports Medicine recommends that the strategies outlined in this position paper be incorporated into interventions targeting weight loss and the prevention of weight regain for adults.

Honas JJ, Washburn RA, Smith BK, Greene JL, Cook-Wiens G, Donnelly JE. · Center for Physical Activity and Weight Management, University of Kansas, KS 66045, USA. · Pediatr Exerc Sci. · Pubmed #19168920 No free full text.

Abstract: The aim of this investigation was to develop an equation to estimate physical activity energy expenditure (PAEE) during a 10-min physically active academic lesson using The System for Observing Fitness Instruction Time (SOFIT) and demographic information. PAEE (portable indirect calorimeter) and physical activity (SOFIT) were simultaneously assessed in 38, 2nd through 5th grade children. PAEE and SOFIT were 3.04 +/- 1.1 (kcal/min) and 3.8 +/- 0.4 (score), respectively. PAEE was predicted from SOFIT score and body weight [PAEE (kcal/min) = (1.384*SOFIT + 0.084*weight (kg)--5.126), R = .81, SEE = 1.23 kcal/min]. PAEE measured by indirect calorimeter and predicted from SOFIT and body weight were 3.04 +/- 1.1 (kcal/min) and 3.04 +/- 0.9 kcal/min) respectively. SOFIT and body weight may provide a useful measure of PAEE associated with classroom based physical activity.

LeCheminant JD, Jacobsen DJ, Bailey BW, Mayo MS, Hill JO, Smith BK, Donnelly JE. · Department of Kinesiology and Health Education, Southern Illinois University Edwardsville, Edwardsville, Illinois 66026, United States. · Int J Sports Med. · Pubmed #17879880 No free full text.

Abstract: This study sought to determine the influence of 16 months of progressive aerobic exercise on excess postexercise oxygen consumption (EPOC) and the extent EPOC contributed to weight management. Twenty-five overweight/obese women and 16 overweight/obese men participated in a 16-month exercise program (moderate-intensity treadmill walking) that progressed across the first 26 weeks to 5 days.wk(-1), 45 min.session(-1), and 75% HRR. Three-hour EPOC was measured at baseline, 9 months, and 16 months by indirect calorimetry in response to an exercise session (treadmill walking), in which energy expenditure (EE) was estimated from the participant's previous 10 exercise sessions. For women, EPOC was 7.5 +/- 4.9, 9.6 +/- 7.6, and 6.5 +/- 6.5 L at baseline, 9 months, and 16 months, respectively (p > 0.05). For men, EPOC increased from baseline (11.8 +/- 6.8 L) to 9 months (13.5 +/- 8.6 L) (p < 0.05) with no further increase at 16 months (13.5 +/- 11.0 L). Change in EPOC was correlated with change in EE at 9 months (r = 0.65; p < 0.05) and 16 months (r = 0.58; p < 0.05) for men but not women. Progressive long-term exercise significantly influenced EPOC in overweight/obese men but not women. Change in volume of exercise likely explained the increase in energy expenditure during EPOC in men. EPOC contributed modestly to EE compared to the exercise itself.

Donnelly JE, Kirk EP, Jacobsen DJ, Hill JO, Sullivan DK, Johnson SL. · Center for Physical Activity and Weight Management, Energy Balance Laboratory, The Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, 66045, USA. · Am J Clin Nutr. · Pubmed #14594781 links to  free full text

Abstract: BACKGROUND: It is commonly believed that moderate aerobic exercise leads to changes in diet composition, specifically, an increase in carbohydrate intake at the expense of fat intake. OBJECTIVE: The goal was to determine the effects of a supervised, long-term program of exercise on the macronutrient intake of previously sedentary, overweight and moderately obese men and women. DESIGN: Participants (n = 74) were recruited from the university and surrounding communities and were randomly assigned to the exercise or control group. Exercise of moderate intensity was performed for 45 min/d, 5 d/wk, under supervision. Diet intake was ad libitum and was measured for energy and macronutrient composition at baseline and at 5 other occasions across the 16-mo study by use of weighing and measuring techniques. Each measurement consisted of a 2-wk period of direct measurement in the university cafeteria. Food consumption outside the cafeteria during the 2-wk periods (ie, snacks) was measured by multiple-pass 24-h dietary recall procedures. RESULTS: There were no significant differences for men or women between the exercise and control groups from baseline to 16 mo in fat, carbohydrate, or protein intake expressed as grams or as percentages of total energy intake. CONCLUSION: Sixteen months of exercise of moderate intensity does not measurably alter the macronutrient intake of young adults.

Potteiger JA, Jacobsen DJ, Donnelly JE, Hill JO, Anonymous00395. · Health and Human Performance Laboratory, Virginia Commonwealth University, Richmond, VA, USA. · Metabolism. · Pubmed #14506624 No free full text.

Abstract: The current study examined the insulin and glucose response during an oral glucose tolerance test (OGTT) in overweight young adults prior to and following exercise training in the Midwest Exercise Trial (MET). Subjects (N = 66) were randomly assigned to non-exercise control (CON; 16 females, 13 males) or exercise (EX; 22 females, 15 males) groups. EX performed supervised and verified exercise on 3 to 5 days per week in 20- to 45-minute sessions at 60% to 75% of heart rate reserve. OGTTs and assessments for body mass, body composition, and maximal oxygen consumption (Vo(2) max) were performed at baseline, and after 9 and 16 months of training. Blood was collected during a 75-g OGTT and analyzed for glucose and insulin concentrations with the total area under the glucose and insulin curves used in the analysis. The EX males had significant decreases from baseline to 9 months in body mass (94.8 +/- 12.5 to 89.2 +/- 9.8 kg) and percent fat (28.3 +/- 4.8 to 24.2 +/- 3.9) with no further changes at 16 months. CON females had significant increases in body mass (78.2 +/- 6.4 to 81.1 +/- 8.1 kg) and percent fat (36.6 +/- 4.2 to 37.8 +/- 4.7) from baseline to 16 months. Vo(2) max increased significantly from baseline to 9 months in the EX males (3.67 +/- 0.62 to 4.36 +/- 0.55 L/min) and EX females (2.53 +/- 0.32 to 2.99 +/- 0.42 L/min). For glucose area under the curve, there were no significant differences between EX or CON across the 16 months of the study. For insulin area under the curve, there was a significant decrease for male EX from baseline to 9 months (12,535 +/- 6,114 to 8,390 +/- 4,231 microU/L/180 min). We conclude that regular exercise in healthy, previously sedentary overweight adult males leads to improvements in Vo(2) max and weight loss and a reduction in the insulin concentration required to dispose of a set glucose load. In females, improvement in Vo(2) max without weight loss does not lead to improvement in insulin sensitivity.

Jacobsen DJ, Donnelly JE, Snyder-Heelan K, Livingston K. · Energy Balance Laboratory, Robinson Center, University of Kansas, Lawrence 66045, USA. · Int J Sports Med. · Pubmed #12905096 No free full text.

Abstract: Few people are active to the levels recommended by Healthy People 2010. Intermittent exercise has been promoted as an exercise prescription which may enable more people to meet recommended guidelines. However, few data are available on intermittent exercise over the long-term. The purpose of the current study was to compare the effects of long-term (72 weeks) continuous (CON) and intermittent (INT) exercise on attrition and adherence in previously sedentary, moderately obese females. Participants were randomized to continuous walking at 60 to 75% of maximum aerobic capacity, 3 days per week, 30 minutes per session, or intermittent exercise for two 15-minute sessions, 5 days per week. Adherence was calculated as the number of sessions completed compared to the number of sessions prescribed. At 12-week intervals, attrition was calculated as the number of participants in the study compared to the total number of participants originally enrolled. For the participants who completed the study, body weight decreased for CON from 80.17 +/- 5.75 kg at baseline to 79.70 +/- 5.40 at 16 months (p < 0.05). For INT, body weight did not change from baseline (85.85 +/- 13.13 kg) to 16 months (85.05 +/- 12.90 kg). By design, INT walked significantly (p < 0.05) further (819 +/- 128 km) compared to CON (527 +/- 46 km). Attrition was 58% for both groups baseline to 72 weeks. However, attrition was greater for CON (38 %) compared to INT (16%) in the first 24 weeks. Adherence was excellent for both groups (> 83%) throughout the study. These results suggest that intermittent and continuous exercise both have considerable attrition rates within 72 weeks of exercise initiation; however, the pattern of attrition differs considerably. That is, it appears that intermittent exercise may reduce attrition in the first 24 weeks of an exercise program; however, attrition does not appear to be different than continuous exercise at 72 weeks.

Kirk EP, Jacobsen DJ, Gibson C, Hill JO, Donnelly JE. · Energy Balance Laboratory, Schiefelbusch Institute for Life Span Studies, The University of Kansas, Lawrence, KS 66045, USA. · Int J Obes Relat Metab Disord. · Pubmed #12861232 No free full text.

Abstract: OBJECTIVE: To determine the time course for changes in aerobic capacity, body weight (BW), and composition in overweight adults in response to a supervised exercise trial with a targeted energy expenditure of 2000 kcal week(-1). DESIGN: The Midwest Exercise Trial (MET) was a randomized, controlled, 16-month verified, supervised exercise trial. Aerobic exercise progressed to 45 min day(-1), 5 days week(-1) over 6-months and was then maintained for 10 months. Controls maintained their normal physical activity and all participants maintained ad libitum diets. SUBJECTS: A total of 131 participants were randomized to exercise or control groups and 74 completed the intervention and all laboratory testing. MEASUREMENTS: At baseline and months 4, 9, 12, and 16, aerobic capacity (VO(2max) ) was measured by indirect calorimetry, BW by digital scale, and fat weight and fat-free weight by hydrostatic weighing. RESULTS: Aerobic capacity (ml kg(-1) min(-1)) increased (P<0.05) from baseline (39.2+/-5.2, mean+/-s.d.) to 9 months (48.8+/-4.3) in exercising men as well as women (32.8+/-4.2-39.6+/-5.5) with no significant changes occurring at 12 or 16 months. From baseline to 9 months BW (94.0+/-12.6-88.7+/-9.7 kg) and fat weight (26.8+/-6.8-21.8+/-4.5 kg) significantly decreased in exercising men with no changes occurring at 12 or 16 months. There were no changes in fat-free weight across the 16 months for exercising men or for BW or composition in exercising women. Further, there were no significant changes for the control men for aerobic capacity, BW, or body composition across 16 months. Women in the control group showed significant increases in weight of 2.9+/-5.5 kg and fat weight of 2.1+/-4.8 kg at 16 months only. CONCLUSIONS: We recommend that investigations that use exercise without diet as the stimulus for weight loss have at least a 9-month duration to provide sufficient time for the full effects to be realized, should such effects be present.

Donnelly JE, Hill JO, Jacobsen DJ, Potteiger J, Sullivan DK, Johnson SL, Heelan K, Hise M, Fennessey PV, Sonko B, Sharp T, Jakicic JM, Blair SN, Tran ZV, Mayo M, Gibson C, Washburn RA. · Energy Balance Laboratory, Schiefelbusch Life Span Institute, University of Kansas, Lawrence 66045, USA. · Arch Intern Med. · Pubmed #12796071 links to  free full text

Abstract: BACKGROUND: In light of the current obesity epidemic, treatment models are needed that can prevent weight gain or provide weight loss. We examined the long-term effects of a supervised program of moderate-intensity exercise on body weight and composition in previously sedentary, overweight and moderately obese men and women. We hypothesized that a 16-month program of verified exercise would prevent weight gain or provide weight loss in the exercise group compared with controls. METHODS: This was a randomized controlled efficacy trial. Participants were recruited from 2 midwestern universities and their surrounding communities. One hundred thirty-one participants were randomized to exercise or control groups, and 74 completed the intervention and all laboratory testing. Exercise was supervised, and the level of energy expenditure of exercise was measured. Controls remained sedentary. All participants maintained ad libitum diets. RESULTS: Exercise prevented weight gain in women and produced weight loss in men. Men in the exercise group had significant mean +/- SD decreases in weight (5.2 +/- 4.7 kg), body mass index (calculated as weight in kilograms divided by the square of height in meters) (1.6 +/- 1.4), and fat mass (4.9 +/- 4.4 kg) compared with controls. Women in the exercise group maintained baseline weight, body mass index, and fat mass, and controls showed significant mean +/- SD increases in body mass index (1.1 +/- 2.0), weight (2.9 +/- 5.5 kg), and fat mass (2.1 +/- 4.8 kg) at 16 months. No significant changes occurred in fat-free mass in either men or women; however, both had significantly reduced visceral fat. CONCLUSIONS: Moderate-intensity exercise sustained for 16 months is effective for weight management in young adults.

Potteiger JA, Jacobsen DJ, Donnelly JE. · Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas 66045, USA. · Int J Obes Relat Metab Disord. · Pubmed #11791151 links to  free full text

Abstract: OBJECTIVE: We examined three methods for calculating the area under the curve (AUC) following an oral glucose tolerance test (OGTT) in overweight adults prior to and after 9 months of exercise. METHOD: Subjects (n=27) were randomly assigned to a control (CON, n=9) or intervention (INT, n=18) group. INT performed supervised exercise 5 days per week, 45 min per session, at 65% of heart rate reserve. OGTTs were administered pre- and post-training. Blood was collected during a 75 g OGTT and analyzed for glucose (GLU) and insulin (INS) concentrations. AUCs were calculated using the incremental, positive incremental, and total AUC methods and the difference scores for pre- and post-training were determined. RESULTS: No differences were observed among the methods for glucose AUC for either group. Significant differences were observed for INT insulin AUC with total AUC (1525+/-3291 microU/1/180 min) significantly greater than incremental AUC (1112+/-3229 microU/1/180 min) or positive incremental AUC (1085+/-3195 microU/I/180 min). Total insulin AUC was significantly reduced following training for INT, while incremental and positive incremental insulin AUCs showed no change. CONCLUSION: These data suggest that the method of used to calculate AUC may affect the interpretation of whether or not an intervention was effective.

Donnelly JE, Jacobsen DJ, Heelan KS, Seip R, Smith S. · Department of Health, Sport and Exercise Sciences, 104 Robinson Center, University of Kansas, Lawrence, KS 66045, USA. · Int J Obes Relat Metab Disord. · Pubmed #10849577 No free full text.

Abstract: OBJECTIVES: To compare the effects of 18 months of continuous vs intermittent exercise on aerobic capacity, body weight and composition, and metabolic fitness in previously sedentary, moderately obese females. DESIGN: Randomized, prospective, long-term cohort study. Subjects performed continuous exercise at 60-75% of maximum aerobic capacity, 3 days per week, 30 min per session, or exercised intermittently using brisk walking for two, 15 min sessions, 5 days per week. MEASURES: Aerobic capacity, body weight, body composition, and metabolic fitness (blood pressure, lipids, glucose and insulin). RESULTS: Significant improvements for aerobic capacity of 8% and 6% were shown for the continuous and intermittent exercise groups, respectively. Weight loss for the continuous exercise group was significant at 2.1% from baseline weight and the intermittent group was essentially unchanged. The continuous group showed a significant decrease in percentage of body fat and fat weight while the intermittent group did not. HDL cholesterol and insulin were significantly improved for both groups. CONCLUSIONS: In previously sedentary, moderately obese females, continuous or intermittent exercise performed long-term may be effective for preventing weight gain and for improving some measures of metabolic fitness.

Kirk EP, Donnelly JE, Smith BK, Honas J, Lecheminant JD, Bailey BW, Jacobsen DJ, Washburn RA. · Department of Kinesiology & Health Education, Southern Illinois University, Edwardsville, IL 62026, USA. · Med Sci Sports Exerc. · Pubmed #19346974 No free full text.

Abstract: Long-term resistance training (RT) may result in a chronic increase in 24-h energy expenditure (EE) and fat oxidation to a level sufficient to assist in maintaining energy balance and preventing weight gain. However, the impact of a minimal RT program on these parameters in an overweight college-aged population, a group at high risk for developing obesity, is unknown. PURPOSE: We aimed to evaluate the effect of 6 months of supervised minimal RT in previously sedentary, overweight (mean +/- SEM, BMI = 27.7 +/- 0.5 kg x m(-2)) young adults (21.0 +/- 0.5 yr) on 24-h EE, resting metabolic rate (RMR), sleep metabolic rate (SMR), and substrate oxidation using whole-room indirect calorimetry 72 h after the last RT session. METHODS: Participants were randomized to RT (one set, 3 d x wk(-1), three to six repetition maximums, nine exercises; N = 22) or control (C, N = 17) groups and completed all assessments at baseline and at 6 months. RESULTS: There was a significant (P < 0.05) increase in 24-h EE in the RT (527 +/- 220 kJ x d(-1)) and C (270 +/- 168 kJ x d(-1)) groups; however, the difference between groups was not significant (P = 0.30). Twenty-four hours of fat oxidation (g x d(-1)) was not altered after RT; however, reductions in RT assessed during both rest (P < 0.05) and sleep (P < 0.05) suggested increased fat oxidation in RT compared with C during these periods. SMR (8.4 +/- 8.6%) and RMR (7.4 +/- 8.7%) increased significantly in RT (P < 0.001) but not in C, resulting in significant (P < 0.001) between-group differences for SMR with a trend for significant (P = 0.07) between-group differences for RMR. CONCLUSION: A minimal RT program that required little time to complete (11min per session) resulted in a chronic increase in energy expenditure. This adaptation in energy expenditure may have a favorable impact on energy balance and fat oxidation sufficient to assist with the prevention of obesity in sedentary, overweight young adults, a group at high risk for developing obesity.

Wacker MJ, Godard MP, McCabe EH, Donnelly JE, Kelly JK. · Department of Basic Medical Science, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA. · Med Sci Monit. · Pubmed #18591916 links to  free full text

Abstract: BACKGROUND: Angiotensin converting enzyme (ACE) catayzes the formation of angiotensin I to angiotensin II. A polymorphism has been identified in intron 16 in which a 287 base-pair alu sequence was found to be present (insertion or I) or absent (deletion or D) in the population. ACE and the components of the renin-angiotensin system are expressed in adipose tissue and therefore the I/D polymorphism within ACE may be associated with obesity. MATERIAL/METHODS: This study involved genotyping two groups with differing body mass indexes (BMI <or=25 and BMI >or=30) that were composed primarily of middle-age Caucasian subjects (n=421). RESULTS: The male groups differed significantly in allele frequency at the ACE locus with the I allele more frequent in the BMI >or=30 group (p<0.05). While the female BMI >or=30 group also had a higher I allele frequency than the BMI <or=25 group, the difference is not significant. CONCLUSIONS: Our results demonstrate a sex difference in the association of the I/D polymorphism and BMI. Our findings differ from some other previous studies using various population groups which indicate that the ACE I/D polymorphism may be differentially associated with obesity depending on multiple factors.

Donnelly JE, Sullivan DK, Smith BK, Jacobsen DJ, Washburn RA, Johnson SL, Hill JO, Mayo MS, Spaeth KR, Gibson C. · Energy Balance Laboratory and Center for Physical Activity, Nutrition, and Weight Management, Schiefelbusch Institute for Lifespan Studies, University of Kansas, Lawrence, Kansas, USA. · Obesity (Silver Spring). · Pubmed #18223621 No free full text.

Abstract: OBJECTIVE: To examine the effects of ad libitum diets with three distinct levels of fat intake for the prevention of weight gain in sedentary, normal-weight and overweight men and women. METHODS AND PROCEDURES: Three hundred and five participants were randomized to one of three diets. The diets targeted <25% of energy from fat (low fat (LF)), between 28 and 32% of energy from fat (moderate fat (MF)), or >35% of energy from fat (high fat (HF)). Participants consumed two meals per day on weekdays and one meal per day on weekends in a university cafeteria over a 12-week period. Energy and nutrient content of cafeteria foods were measured by digital photography. All meals and snacks consumed outside the cafeteria were measured by dietary recall. All analysis of energy and nutrient content was completed using Nutrition Data System for Research (NDS-R) version 2005. RESULTS: Two hundred and sixty participants completed the study. LF gained 0.1 +/- 3.1 kg, MF gained 0.8 +/- 2.5 kg, and HF gained 1.0 +/- 2.2 kg and there was no gender or age effect. Longitudinal mixed modeling indicated a significant difference among the groups in weight over time (P = 0.0366). When adjusting for total energy intake, which was a significant predictor of weight over time, the global effect for the group was eliminated. Thus, increasing weight was a function of increasing energy but not increasing percentage of fat intake. DISCUSSION: Energy intake, but not percentage of energy from fat, appears responsible for the observed weight gain. LF diets may contribute to weight maintenance and HF diets may promote weight gain due to the influence of fat intake on total energy intake.

Befort CA, Stewart EE, Smith BK, Gibson CA, Sullivan DK, Donnelly JE. · Department of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA. · Int J Obes (Lond). · Pubmed #18059404 No free full text.

Abstract: OBJECTIVE: To examine weight loss maintenance among previous participants of a university-based behavioral weight management program and to compare behavioral strategies and perceived barriers between successful and unsuccessful maintainers. METHOD: Previous program participants (n=179) completed mailed surveys assessing current weight, weight control behaviors and perceived barriers to weight loss maintenance. RESULTS: At 14.1+/-10.8 months following completion of treatment, survey respondents were on average 12.6+/-12.6 kg, or 11.3+/-10.7%, below baseline weight; 76.5% of respondents had successfully maintained weight, defined as maintaining a weight loss of at least 5% below baseline. Compared to unsuccessful maintainers, successful maintainers reported practicing four dietary and three physical activity weight control strategies more often and experiencing five barriers to healthy eating and exercise less often. After accounting for time since treatment and maximum weight loss while in treatment, the strongest correlates of successful weight loss maintenance were frequent exercise and perceived difficulty of weight management. CONCLUSIONS: Clinically meaningful weight loss maintenance was achieved by the majority of participants. Findings support the literature indicating that physical activity is one of the strongest predictors of successful weight loss maintenance. Findings also suggest that strategies to reduce the level of perceived effort required for long-term weight control may improve maintenance outcomes.

Lecheminant JD, Gibson CA, Sullivan DK, Hall S, Washburn R, Vernon MC, Curry C, Stewart E, Westman EC, Donnelly JE. · Department of Kinesiology and Health Education, Southern Illinois University Edwardsville, Edwardsville, USA. · Nutr J. · Pubmed #17976244 links to  free full text

Abstract: BACKGROUND: Recent evidence suggests that a low carbohydrate (LC) diet may be equally or more effective for short-term weight loss than a traditional low fat (LF) diet; however, less is known about how they compare for weight maintenance. The purpose of this study was to compare body weight (BW) for participants in a clinical weight management program, consuming a LC or LF weight maintenance diet for 6 months following weight loss. METHODS: Fifty-five (29 low carbohydrate diet; 26 low fat diet) overweight/obese middle-aged adults completed a 9 month weight management program that included instruction for behavior, physical activity (PA), and nutrition. For 3 months all participants consumed an identical liquid diet (2177 kJ/day) followed by 1 month of re-feeding with solid foods either low in carbohydrate or low in fat. For the remaining 5 months, participants were prescribed a meal plan low in dietary carbohydrate (~20%) or fat (~30%). BW and carbohydrate or fat grams were collected at each group meeting. Energy and macronutrient intake were assessed at baseline, 3, 6, and 9 months. RESULTS: The LC group increased BW from 89.2 +/- 14.4 kg at 3 months to 89.3 +/- 16.1 kg at 9 months (P = 0.84). The LF group decreased BW from 86.3 +/- 12.0 kg at 3 months to 86.0 +/- 14.0 kg at 9 months (P = 0.96). BW was not different between groups during weight maintenance (P = 0.87). Fifty-five percent (16/29) and 50% (13/26) of participants for the LC and LF groups, respectively, continued to decrease their body weight during weight maintenance. CONCLUSION: Following a 3 month liquid diet, the LC and LF diet groups were equally effective for BW maintenance over 6 months; however, there was significant variation in weight change within each group.

DuBose KD, Eisenmann JC, Donnelly JE. · Department of Exercise and Sport Science, 153 Minges Coliseum, East Carolina University, Greenville, NC 27858, USA. · Pediatrics. · Pubmed #17974719 links to  free full text

Abstract: OBJECTIVE: The purpose of this study was to examine the combined influence of aerobic fitness and BMI on the metabolic syndrome score in children. METHODS: A total of 375 children (193 girls and 182 boys) aged 7 to 9 years were categorized as being normal weight, at risk for overweight, and overweight on the basis of BMI and aerobic fitness (high or low based on median split) via a submaximal physical working capacity test. Participants were cross-tabulated into 6 BMI fitness categories. High-density lipoprotein cholesterol and triglyceride levels, homeostasis assessment model of insulin resistance, mean arterial pressure, and waist circumference were used to create a continuous metabolic syndrome score. RESULTS: Both BMI and fitness were associated with the metabolic syndrome score. In general, the metabolic syndrome score increased across the cross-tabulated groups with the normal-weight, high-fit group possessing the lowest metabolic syndrome score and the overweight, unfit group possessing the highest metabolic syndrome score. Children who were at risk for overweight and had high fitness had a lower metabolic syndrome score compared with those at-risk-for-overweight, less-fit children, and the score was similar to that of the less-fit, normal-weight children. Furthermore, a high fitness level resulted in a lower metabolic syndrome score in overweight children compared with overweight children with low fitness. CONCLUSIONS: High fitness levels modified the impact that BMI had on the metabolic syndrome score in children. Increasing a child's fitness level could be one method for reducing the risk of obesity-related comorbidities.

Bailey BW, Sullivan DK, Kirk EP, Hall S, Donnelly JE. · Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard Boston, MA 02125-3393, USA. · J Am Coll Nutr. · Pubmed #17906187 No free full text.

Abstract: BACKGROUND: There is some evidence that calcium consumption improves weight loss during energy restriction but the effects of calcium consumption in conjunction with chronic exercise are unknown. OBJECTIVE: The purpose of the study was to determine the degree to which calcium consumption influences weight and fat weight change as a result of 9 months of verified supervised exercise in the absence of energy restriction. METHODS: Participants were 50 previously sedentary, overweight and moderately obese men (n=20) and women (n=30). Exercise of moderate intensity was performed for 45 min/d, 5 d/wk, under supervision. Diet intake was ad libitum and was measured for energy, macronutrient and micronutrient composition at baseline, 4 and 9 months by use of observer recorded weighed plate waste and multiple-pass 24-h dietary recall procedures. RESULTS: Average calcium consumption was 987 +/- 389 mg/day for men and 786 +/- 276 mg/day for women. Weight change over the 9 months was -4.6 +/- 4.6 kg for men and 0.2 +/- 3.3 kg for women. Calcium consumption was associated with weight change (r =-0.47, p<0.05) in men. The calcium to protein ratio was associated with weight change (r=0.56) and fat weight change (r=-0.53) in men. There was no observed association between calcium and weight or fat weight change in women. CONCLUSION: Weight and fat weight loss as a result of nine months of moderate intensity exercise may be improved by increased calcium consumption in men but was not observed in women.

Rowe DA, Dubose KD, Donnelly JE, Mahar MT. · Faculty of Health, Sport and Science, University of Glamorgan, Pontypridd, Wales CF37 1DL, UK. · Int J Pediatr Obes. · Pubmed #17899635 No free full text.

Abstract: PURPOSE: The purpose of the study was to determine the agreement of percent body fat estimates and obesity classification derived via whole-body bioelectrical impedance analysis (% BF-BIA) with percent body fat estimates and obesity classification from skinfolds (% BF-SF) in children and adolescents. METHODS: BIA and SF data were collected on 609 boys and 645 girls aged 7 to 14 years. RESULTS: Although moderate correlations were observed between the measures, Bland-Altman analyses revealed fixed and proportional bias, and 95% limits of agreement covered a range of over 20% BF. Agreement of obesity classification was moderately high in boys (Kq = 0.77) and girls (Kq = 0.81), but fewer children were classified as obese via % BF-BIA (14.5%) than via % BF-SF (19.8%). CONCLUSIONS: The results indicate that whole-body BIA provides % BF estimates that are systematically different from % BF estimates from skinfolds in children and adolescents.

DuBose KD, Mayo MS, Gibson CA, Green JL, Hill JO, Jacobsen DJ, Smith BK, Sullivan DK, Washburn RA, Donnelly JE. · East Carolina University, USA. · Contemp Clin Trials. · Pubmed #17611168 No free full text.

Abstract: BACKGROUND: Over the years schools have reduced physical education and recess time in favor of more academic instruction. Due to the drastic rise in obesity levels among children, some states have begun to mandate minimum amounts of physical activity (PA) that school children receive, causing schools to find alternative methods for increasing PA levels. Physical Activity Across the Curriculum (PAAC) is a 3-year randomized clinical trial incorporating moderate-intensity PA in elementary schools to reduce childhood obesity. This paper describes the rational, design, and methods of the PAAC intervention study. METHODS: Twenty-two elementary schools were randomized to either a control or intervention condition. In schools randomized to the intervention condition (PAAC), regular classroom teachers were taught how to incorporate PA into standard academic lessons. Teachers were asked to accumulate 90-100 min/week of PAAC each week through out the 3-year study period. Schools randomized to the control group did not alter their teaching methods. Direct observation of PA levels in the classroom was collected weekly. Height and weight was measured twice a year to calculate BMI. RESULTS: Two years of the intervention have been completed and only one school has left the study. The remaining 21 schools are participating in the final intervention year. CONCLUSIONS: The results from the PAAC intervention may provide schools with an alternative method to increase PA levels in children and reduce childhood obesity.

Lecheminant JD, Kirk EP, Hall MA, Bailey BW, Jacobsen DJ, Stewart E, Donnelly JE. · Department of Kinesiology and Health Education, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA. · Dis Manag. · Pubmed #17444793 No free full text.

Abstract: This study sought to determine the impact of different levels of weight loss on blood pressure in overweight/obese women. One hundred fifty-nine overweight/obese women (age 48.7 +/- 9.7, weight 101.3 +/- 18.7 kg, BMI 37.3 +/- 6.6 kg/m(2)) completed a six-month clinical weight loss program that included weekly nutrition, behavior, and exercise instruction. Participants consumed a very-low-energy diet (VLED) for 12 weeks. VLED was followed by four weeks of gradual reintroduction to solid foods. At week 16, participants received a diet to maintain weight or slightly reduce weight (<0.5 lb/week) which they followed for the duration of the study. All lab and blood pressure assessments were performed at baseline and six months. Three groups were formed according to the proportion of weight loss after six months; Group 1 had < 10% (n = 19), Group 2 had 10%-20% (n = 64), and Group 3 had >20% (n = 76) weight loss. Differences in systolic blood pressure (mm Hg) were found in dose response fashion for weight loss at six months with 125 +/- 17 (<10%), 119 +/- 13 (10%-20%), and 117 +/- 15 (>20%; p = 0.005). Differences in diastolic blood pressure (mm Hg) were also found in dose response fashion with 81 +/- 9 (<10%), 77 +/- 9 (10%-20%), and 75 +/- 9 (20%; p = 0.003). These data indicate that increasing weight loss beyond 10% of initial body weight may provide added improvements in blood pressure compared to less than 10% weight loss in overweight or obese women.

Donnelly JE, Smith BK, Dunn L, Mayo MM, Jacobsen DJ, Stewart EE, Gibson C, Sullivan DK. · Energy Balance Lab and Center for Physical Activity, Nutrition, and Weight Management, Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS 66045, USA. · Int J Obes (Lond). · Pubmed #17325684 No free full text.

Abstract: OBJECTIVE: To compare the efficacy of a phone vs a traditional face-to-face clinic approach to achieve 10% weight loss and weight maintenance. DESIGN: Twenty-six week, randomized, controlled trial. SUBJECTS: Twenty-four men and 72 women, ages 25-68 years, with a body mass index (BMI) of 33.2+/-3.8. MEASUREMENTS: Weight loss at 12 weeks and weight maintenance at 26 weeks were the primary outcomes. Attendance, meal replacements (MRs), fruits/vegetables (F/V), and physical activity (PA) were measured weekly for process evaluation. RESULTS: Median weight loss (range) from baseline at 12 weeks was significantly different for phone at 10.6 kg (16.6) or 10.4% and clinic at 12.7 kg (19.9) or 13.7%, and both were significantly different when compared with the control group with a weight loss of 0.25 kg (5.6) or 0.24%. Median weight loss at 26 weeks was 12.8 kg (23.4) or 13.0% from baseline for the phone group and 12.5 kg (35.2) or 12.6% from baseline for the clinic group (P>0.05). CONCLUSION: The median weight loss for both phone and clinic groups at 12 and 26 weeks exceeded the NHLBI guideline of 10% weight loss from baseline. The phone approach may be a viable option to the traditional weight management clinic for both service providers and participants.

Butler MG, Theodoro MF, Bittel DC, Donnelly JE. · Section of Medical Genetics and Molecular Medicine, Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri 64108, USA. · Am J Med Genet A. · Pubmed #17103434 No free full text.

Abstract: Prader-Willi syndrome (PWS) is a complex neurodevelopmental disorder characterized by hypotonia, suck and feeding difficulties, hypogonadism, small hands and feet, developmental delay, hyperphagia and early childhood obesity and a particular facial appearance. The obesity associated with PWS is the result of a chronic imbalance between energy intake and energy expenditure (EE) due to hyperphagia, decreased physical activity, reduced metabolic rate and an inability to vomit. EE is affected by body composition as well as exercise. Individuals with PWS have a lower lean body mass (LBM) compared with controls which may contribute to reduced basal level EE. To determine the relationship among body composition, activity levels and metabolic rates, dual energy X-ray absorptiometry (DEXA) and a whole-room respiration chamber were used to measure body composition, total EE (TEE), resting EE (REE), physical activity, and mechanical work (MW) during an 8 hr monitoring period. The chamber consisted of a live-in whole-room indirect calorimeter equipped with a force platform floor to allow simultaneous measurement of EE, physical activity, and work efficiency during spontaneous activities and standardized exercise. Participants with PWS (27 with 15q11-q13 deletion and 21 with maternal disomy 15 with an average age of 23 years) had significantly decreased TEE by 20% and reduced LBM compared to 24 obese subjects. Similarly, REE was significantly reduced by 16% in the individuals with PWS relative to the comparison subjects. Total MW performed during the 8 hr monitoring period was significantly reduced by 35% in the PWS group. The energy cost of physical activity is related to the duration, intensity and type of activity and the metabolic efficiency of the individual. After adjusting group differences in LBM by analysis of variance, TEE and REE were no longer different between the two groups. Our data indicate that there is a significant reduction of EE in individuals with PWS resulting from reduced activity but also from lower energy utilization due to reduced LBM which consists primarily of muscle.

DuBose KD, Stewart EE, Charbonneau SR, Mayo MS, Donnelly JE. · Schiefelbusch Institute for Life Span Studies, Center for Physical Activity and Weight Management, University of Kansas, Lawrence, KS, USA. · Acta Paediatr. · Pubmed #16882578 No free full text.

Abstract: AIM: To determine the prevalence of the metabolic syndrome (MS) and its related components in elementary-aged school children. METHODS: Three hundred and seventy-five 7-9-y-old boys (n=182) and girls (n=193) in the eastern Kansas area served as participants. Criteria for the MS were the presence of three or more of the following components: 1) central obesity (waist circumference>or=90th percentile in males and females); 2) elevated triglyceride concentrations (>or=1.13 mmol/l); 3) low HDL-C concentrations (<or=1.04 mmol/l in males and females); 4) elevated blood pressure (systolic and/or diastolic>or=90th percentile, age and gender specific); or 5) elevated fasting glucose levels (>or=6.10 mmol/l). RESULTS: The prevalence of the MS in this sample was 5%, and was similar across gender and race. Fifty percent of the children had no components and 15% had at least two components, with elevated blood pressure the most common component (37%). CONCLUSION: The MS is prevalent even in young children at rates similarly reported in adolescents.