Obesity: Kushner RF

Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J, Guven S, Anonymous00032, Anonymous00033, Anonymous00034. · No affiliation provided · Obesity (Silver Spring). · Pubmed #19319140 No free full text.

Abstract: American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist health-care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.

Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. · No affiliation provided · Surg Obes Relat Dis. · Pubmed #18848315 No free full text.

Abstract: American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist healthcare professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.

Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. · No affiliation provided · Endocr Pract. · Pubmed #18723418 No free full text.

This publication has no abstract.

Villareal DT, Apovian CM, Kushner RF, Klein S, Anonymous00076, Anonymous00077. · Division of Geriatrics and Nutritional Sciences, Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO 63110, USA. · Obes Res. · Pubmed #16339115 No free full text.

Abstract: Obesity causes serious medical complications and impairs quality of life. Moreover, in older persons, obesity can exacerbate the age-related decline in physical function and lead to frailty. However, appropriate treatment for obesity in older persons is controversial because of the reduction in relative health risks associated with increasing body mass index and the concern that weight loss could have potential harmful effects in the older population. This joint position statement from the American Society for Nutrition and NAASO, The Obesity Society reviews the clinical issues related to obesity in older persons and provides health professionals with appropriate weight-management guidelines for obese older patients. The current data show that weight-loss therapy improves physical function, quality of life, and the medical complications associated with obesity in older persons. Therefore, weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss.

Villareal DT, Apovian CM, Kushner RF, Klein S, Anonymous00250, Anonymous00251. · Division of Geriatrics and Nutritional Sciences and Center for Human Nutrition, Washington University School of Medicine, St Louis, MO 63110, USA. · Am J Clin Nutr. · Pubmed #16280421 links to  free full text

Abstract: Obesity causes serious medical complications and impairs quality of life. Moreover, in older persons, obesity can exacerbate the age-related decline in physical function and lead to frailty. However, appropriate treatment for obesity in older persons is controversial because of the reduction in relative health risks associated with increasing body mass index and the concern that weight loss could have potential harmful effects in the older population. This joint position statement from the American Society for Nutrition and the NAASO, The Obesity Society reviews the clinical issues related to obesity in older persons and provides health professionals with appropriate weight-management guidelines for obese older patients. The current data show that weight-loss therapy improves physical function, quality of life, and the medical complications associated with obesity in older persons. Therefore, weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss.

Kushner RF. · Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, Rubloff 9-976, Chicago, IL 60611, USA. · Expert Opin Pharmacother. · Pubmed #18473708 No free full text.

Abstract: BACKGROUND: Recent discoveries about the metabolic and genetic control systems that govern regulation of body weight and energy expenditure have afforded the opportunity to develop pharmacological agents that can be used as adjunctive treatments for patients with obesity. However, the scarcity of medications available or those that have made it to Phase III trials reflects the difficult challenge of manipulating the biology of appetite regulation. OBJECTIVE: The aim of this study was to inform health professionals about new anti-obesity medications that target neuronal systems within the central nervous system and peripheral humoral proteins that send signals to the central nervous system. METHODS: A critical review was conducted of information available from the medical literature. RESULTS/CONCLUSIONS: An emerging theme is to use combination therapies that are directed towards several targets or leverage existing gastrointestinal satiety hormonal signals. By using combination therapies, it is anticipated that greater weight loss will be achieved compared to monotherapy.

Kushner RF. · Department of Medicine, Northwestern University Feinberg School of Medicine, Wellness Institute, 150 East Huron Street, Suite 1100, Chicago, IL 60611, USA. · Gastroenterol Clin North Am. · Pubmed #17472882 No free full text.

Abstract: Because obesity is associated with an increased risk of multiple health problems, it is important for gastroenterologists and all health care providers routinely to identify, evaluate, and treat patients for obesity in the course of daily practice. Therapy for obesity always begins with lifestyle management and may include pharmacotherapy or surgery. Setting an initial weight loss goal of 10% over 6 months is a realistic target, followed by long-term management.

Kushner RF, Noble CA. · Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. · Mayo Clin Proc. · Pubmed #17036578 No free full text.

Abstract: With the increasing number of bariatric surgical procedures being performed, outcome assessment is of even greater importance. Few randomized, controlled prospective trials have compared bariatric surgery to nonsurgical weight-loss treatments, and the quality of current outcome data is suboptimal. However, the available evidence suggests that bariatric surgery, and particularly gastric bypass, is the most effective weight-loss treatment for people with extreme (class III) obesity. In addition to reduced energy intake and to a lesser extent malabsorption, numerous other potential mechanisms related to bariatric surgery may play a role in promoting weight loss and improving comorbidities. After bariatric surgery, clinical improvement or resolution has been reported in 64% to 100% of patients with diabetes mellitus, 62% to 69% of patients with hypertension, 85% of patients with obstructive sleep apnea, 60% to 100% of patients with dyslipidemia, and up to 90% of patients with nonalcoholic fatty liver disease. A wide range of other weight-related conditions also appear to improve, and limited data suggest that overall mortality may decrease in patients undergoing bariatric surgery. Although not conclusive, evidence from available studies indicates that bariatric surgery is cost-effective. Further research with improved methodology is needed to define the mechanisms of action of bariatric surgery; to document its effect on long-term weight loss, comorbid conditions, and overall mortality; and to determine its cost-effectiveness.

Noble CA, Kushner RF. · Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. · Curr Opin Gastroenterol. · Pubmed #16462172 No free full text.

Abstract: PURPOSE OF REVIEW: The use of low-carbohydrate diets in weight loss is an area of great controversy. In recent years, a significant amount of research has been conducted to evaluate the efficacy of these diets. This review aims to discuss mechanisms of action for weight loss; to assess impact on metabolic parameters including insulin sensitivity and cardiovascular risk parameters and to evaluate the data regarding safety and effectiveness for weight loss. RECENT FINDINGS: Most studies demonstrate that subjects following low carbohydrate diets lose more weight over the first 3-6 months than subjects consuming control diets. This weight loss is not sustained, however, at 1 year. Carbohydrate controlled diets may be associated with increased insulin sensitivity and improved glycemic control. High carbohydrate, low fat diets appear to have a more favorable impact on total and LDL cholesterol, whereas low carbohydrate diets have been shown to significantly decrease triglyceride and increase HDL cholesterol levels in short-term studies. SUMMARY: Low carbohydrate diets may be effective in helping people to lose weight. More long-term studies need to be performed, however, to better evaluate efficacy, safety, and impact on metabolic profile.

Kushner RF. · Northwestern University Feinberg School of Medicine, Wellness Institute, Northwestern Memorial Hospital, Chicago, Illinois, USA. · Nutr Clin Pract. · Pubmed #16207642 No free full text.

Abstract: Low-carbohydrate diets are based on an alternative theory of obesity where dietary carbohydrate, particularly unprocessed sugars, causes hyperinsulinemia, leading to insulin resistance, obesity, and cardiovascular disease. In this model, carbohydrate is viewed as a "metabolic poison" and therefore is limited in the diet. This article systematically reviews and refutes the 6 major physiologic claims made by proponents of low-carbohydrate diets. Any benefits or advantages resulting from these diets must therefore be derived from factors other than those stated by the alternative theory.

Roth JL, Kushner RF, Bateman E. · Northwestern University Feinberg School of Medicine, 150 East Huron Street, Suite 1100, Chicago, IL 60611, USA. · Curr Gastroenterol Rep. · Pubmed #16042919 No free full text.

Abstract: Overweight and obesity is the most common chronic disease in the United States and is associated with an increased risk for morbidity and mortality. For the hospitalized patient, the mechanical, metabolic, and inflammatory physiologic changes induced by obesity necessitate additional considerations for care. Calculation of nutritional requirements is problematic and challenging due to difficulty in measuring body composition and energy expenditure. Provision of selective hypocaloric feeding in this population may be particularly beneficial in reducing complications of hyperglycemia, fluid overload, and reduction in fat mass. Clinical care should incorporate a team approach that addresses the special nutritional and metabolic needs of this population.

Kushner RF, Blatner DJ. · Northwestern University Feinberg School of Medicine, Chicago, IL, USA. · J Am Diet Assoc. · Pubmed #15867897 No free full text.

Abstract: Risk assessment of the overweight and obese patient is an important and necessary first step in the treatment process. Risk classification begins with determination of body mass index (BMI), waist circumference for those with a BMI of 35 or less, and presence of comorbid conditions. With the exception of measuring a fasting blood glucose and lipid panel on all patients, other diagnostic laboratory tests are selected based on the patient's risk factor status. Understanding the reasons leading to and sustaining the patient's overweight and obesity is the next major step and is paramount to designing individualized and targeted treatment. This information is ascertained by having the patient graph his or her weight pattern with associated life events and by assessing detailed dietary and physical activity histories. Calculating estimated energy balance has both benefits and limitations in clinical practice. Pediatric and geriatric patients represent special populations that require additional focus. Improvement in the assessment process will likely be achieved by using a team approach along with future developments in practical measurement of body composition and energy expenditure.

Kushner RF, Roth JL. · Northwestern University Feinberg School of Medicine, Galter Pavilion, Suite 3-150, 251 East Huron Street, Chicago, IL 60611, USA. · Psychiatr Clin North Am. · Pubmed #15733613 No free full text.

This publication has no abstract.

Kushner RF, Roth JL. · Northwestern University, Feinberg School of Medicine, Wellness Institute, Northwestern Memorial Hospital, 150 East Huron, Suite 1100, Chicago, IL 60611, USA. · Endocrinol Metab Clin North Am. · Pubmed #14711068 No free full text.

Abstract: Obesity may be the most significant medical problem that health care providers will face over the coming decades. Physicians must aggressively address this chronic disease, providing both preventive and therapeutic care. Because this topic traditionally has not been taught in medical schools, physicians need to acquire the knowledge, skills, and attitudes necessary to be effective obesity care providers. Performing a detailed initial assessment, including an obesity-focused history, physical examination, and selected laboratory and diagnostic tests, is fundamental to the process of care.

Kushner RF. · Northwestern University, Feinberg School of Medicine, Wellness Institute, Northwestern Memorial Hospital, 150 East Huron, Suite 1100, Chicago, IL 60611, USA. · Prim Care. · Pubmed #14567151 No free full text.

Abstract: Effective obesity care will not be accomplished without the implementation of a well-planned, office-based organizational system designed to address the assessment, evaluation, and treatment of the overweight and obese patient. Completing an office audit, as shown in Table 1, should be useful for triggering quality improvement opportunities regarding obesity care. Similarly, the chart audit in Table 4 can be used to assess current and future practice behavior. This article has reviewed the key office-based components for the delivery of obesity care. The strategies and techniques used for treatment are addressed in the remaining articles in this issue.

Kushner RF. · Department of Medicine, Northwestern University Medical School, Chicago, IL 60611, USA. · Semin Gastrointest Dis. · Pubmed #12230315 No free full text.

Abstract: Obesity is the most prevalent and serious nutritional disease among western countries and is rapidly replacing undernutrition as the most common form of malnutrition in the world. Approximately 300,000 deaths a year are currently associated with overweight and obesity, second only to cigarette smoking as a leading cause of preventable death in the United States. Obesity effects 9 organ systems and is a risk factor for gastroesophageal reflux disease, nonalcoholic fatty liver disease, cholelithiasis, and colon cancer. Evidence-based guidelines on the identification, evaluation, and treatment of overweight and obesity have recently been developed by the National Institutes of Health to help practitioners effectively manage their patients. The body mass index is used to classify weight status and risk of disease. Treatment for obesity includes lifestyle management, consisting of diet therapy, physical activity, and behavioral modification, and may include pharmacotherapy or surgery based on level of risk. Currently only 2 medications, sibutramine and orlistat, are approved for long-term use. An initial weight loss of 10% of body weight achieved over 6 months is a recommended target. This article reviews the evaluation and management of the adult obese patient.

Kushner RF, Foster GD. · Department of Medicine, Northwestern University, Chicago, Illinois 60611, USA. · Nutrition. · Pubmed #11054600 No free full text.

Abstract: The focus of this review is the impact of obesity and weight loss on quality of life. A focus on quality of life broadens the scope of treatment efficacy beyond weight loss and provides a patient-centered perspective. The concept of quality of life is defined, and both general and obesity-specific measures are reviewed. It is clear that obesity confers negative consequences on both the physical and psychosocial aspects of quality of life, especially among the severely obese. The effects of weight loss appear to be favorable, although few studies have examined non-surgical interventions. Future studies would be enhanced by assessing a variety of approaches to weight loss by using both general and obesity-specific measures of quality of life and conducting follow-up studies to assess the effects of weight regain on quality of life.

Kushner RF, Weinsier RL. · Department of Medicine, Northwestern University School of Medicine, Chicago, Illinois, USA. · Med Clin North Am. · Pubmed #10793648 No free full text.

Abstract: The evaluation process for obesity uses the same framework of a history, physical examination and interpretation of selected laboratory and diagnostic tests that are used for other chronic care patient encounters. What makes this evaluation process different is knowing how to take an obesity focused history, what to examine, and which tests to order. An assessment of risk status is then determined based on the National Heart, Lung, and Blood Institute Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Other important aspects of the evaluation process include determining the patient's goals, expectations, and motivation for weight loss along with support systems and/or barriers to behavior change.

Early JL, Apovian CM, Aronne LJ, Fernstrom MH, Frank A, Greenway FL, Heber D, Kushner RF, Cwik KM, Walch JK, Hewkin AC, Blakesley V. · Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, 1010 N. Kansas Rd., Wichita, KS 67214-3199, USA. · Obesity (Silver Spring). · Pubmed #17557984 No free full text.

Abstract: OBJECTIVE: Our objective was to assess the efficacy and safety of sibutramine with a low-calorie diet (LCD) and commercial meal-replacement product in achieving weight loss and weight-loss maintenance in obese patients. RESEARCH METHODS AND PROCEDURES: Eight U.S. centers recruited 148 obese patients for a 3-month comprehensive weight-loss therapy (Phase I) comprising daily sibutramine 10 mg + LCD (two Slim-Fast meal-replacement shakes, one low-calorie meal; total kcal/d = 1200-1500). Patients (N = 113) who lost > or =5% of initial body weight during Phase I were randomized for a 9-month period (Phase II) to daily sibutramine 15 mg + LCD (one meal-replacement shake; two low-calorie meals: total kcal/d approximately 1200-1500) or daily placebo + three low-calorie meals (total kcal/d approximately 1200-1500). Both phases included behavior modification. Efficacy was assessed by body weight change during each phase and by the number of patients at endpoint maintaining > or =80% of the weight they had lost by the end of Phase I. Other outcomes included changes in cardiovascular and metabolic risk factors, adverse events, and vital signs. RESULTS: Mean body weight change during Phase I was -8.3 kg (p < 0.001). Patients randomized to sibutramine in Phase II had an additional -2.5 kg mean weight loss vs. a 2.8-kg increase in the placebo group (p < 0.001). More sibutramine patients maintained > or =80% of their Phase I weight loss at the end of Phase II (85.5% vs. placebo 36.7%, p < 0.001). Most adverse events were mild or moderate in severity, and all serious adverse events were unrelated to sibutramine. DISCUSSION: Sibutramine plus LCD with meal replacements and behavior modification is a safe and effective strategy for achieving and sustaining weight loss in obese patients.

Sharma AM, Kushner RF. · Division of Endocrinology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. · Int J Obes (Lond). · Pubmed #19188927 No free full text.

Abstract: Current classifications of obesity based on body mass index, waist circumference and other anthropometric measures, although useful for population studies, have important limitations when applied to individuals in clinical practice. Thus, these measures do not provide information on presence or extent of comorbidities or functional limitations that would guide decision making in individuals. In this paper we review historical and current classification systems for obesity and propose a new simple clinical and functional staging system that allows clinicians to describe the morbidity and functional limitations associated with excess weight. It is anticipated that this system, when used together with the present anthropometric classification, will provide a simple framework to aid decision making in clinical practice.

Barak N, Greenway FL, Fujioka K, Aronne LJ, Kushner RF. · Obecure Ltd., Ramat-Gan, Israel. · Int J Obes (Lond). · Pubmed #18698316 No free full text.

Abstract: OBJECTIVE: To determine the magnitude and determinants of weight loss in humans exposed to betahistine, a centrally acting histamine-1 (H-1) agonist and partial histamine-3 (H-3) antagonist. DESIGN: A multicenter randomized, placebo-controlled dose-ranging weight loss trial with a 12-week treatment period. SUBJECTS: Two hundred and eighty-one obese but otherwise healthy participants. MEASUREMENTS: Weight and obesity-related comorbidities at baseline and at the end of the intervention. RESULTS: Betahistine, at the doses tested, did not induce significant weight loss. With the exception of headache, no difference in adverse effect profile was noted between placebo and treatment groups. Subgroup analysis revealed that age below 50 years, ethnicity (non-Hispanics) and gender (women) were the strongest predictors of weight loss in this population. When these three factors were combined together, the betahistine 48 mg group (n=23) lost -4.24+/-3.87 kg, whereas the placebo group (n=25) lost -1.65+/-2.96 kg during this time period (P=0.005). CONCLUSION: Betahistine, at the doses tested, induced significant weight loss with minimal adverse events only in women below 50 years.

Kushner RF, Blatner DJ, Jewell DE, Rudloff K. · Wellness Institute, Northwestern Memorial Hospital, 150 East Huron, Suite 1100, Chicago, IL 60611, USA. · Obesity (Silver Spring). · Pubmed #17062806 No free full text.

Abstract: OBJECTIVE: Obesity is a significant public health problem that is affecting people and their pets. The human-companion animal bond and the role of pets in providing social support provides a rationale framework for studying the effectiveness of a combined people and pets (PP) exercising together (PPET) weight loss program. RESEARCH METHODS AND PROCEDURES: Thirty-six pairs of overweight or obese people with an obese pet (PP) and 56 overweight or obese people only (PO) participated in a 1-year prospective controlled weight loss study. In a group format, people received dietary and physical activity counseling, and dogs were fed a calorie-controlled prescription diet. Physical activity was recorded using the physical activity recall questionnaire. RESULTS: Completion rates at 1 year were 61% for the PP group and 58% for the PO group. Mean weight losses at 12 months using last observation carried forward were 4.7% (PP) and 5.2% (PO). Mean weight loss among the dogs was 15%. Time spent in physical activity increased in both groups to 3.9 (PP) and 3.5 (PO) h/wk. Two-thirds of total physical activity in the PP group was spent with the dogs. DISCUSSION: The PPET study is the first program to demonstrate the effectiveness of a combined PP weight loss program. This fresh approach to the dual obesity epidemic builds on the human-companion animal bond. Consideration of social support for weight loss of family members, friends, and coworkers should be extended to include pets.

Kushner RF, Manzano H. · Division of General Internal Medicine, Northwestern University Medical School, Chicago, Illinois 60611, USA. · Curr Opin Gastroenterol. · Pubmed #17033290 No free full text.

Abstract: Over the past several years, the pharmacologic treatment of obesity has undergone changes in safety, efficacy, and therapeutic targeting. The prevalence of cardiac valvulopathy associated with treatment with phentermine, fenfluramine, and dexfenfluramine is now becoming clarified with the publication of longer-term studies. Phenylpropanolamine, a well-known over-the-counter appetite suppressant, was recently removed from the market in the United States because of an increased risk of hemorrhagic stroke in women. In contrast, two currently approved medications, sibutramine and orlistat, have been shown to be safe and moderately effective for weight loss with documented beneficial effects on cardiovascular risk factors. Three other drugs, bupropion, topiramate, and ciliary neurotrophic factor, are undergoing clinical trials for obesity based on empirical observations. Most promising are the advances in genetics and molecular biology that are beginning to elucidate new targets for controlling appetite and energy utilization. These therapeutic agents will likely herald a second generation of anti-obesity medications over the next decade.

Kushner RF, Shanta Retelny V. · Northwestern University Feinberg School of Medicine, Wellness Institute, Northwestern Memorial Hospital, Chicago, IL 60611, USA. · Obes Surg. · Pubmed #16354533 No free full text.

Abstract: Pica, the compulsive ingestion of non-food substances, is a common, yet less well known symptom of iron deficiency anemia (IDA). Ice eating or pagophagia is one of the most common forms of pica associated with iron deficiency and IDA, and has only recently been identified among patients who had undergone Roux-en-Y gastric bypass (RYGBP). This article presents additional cases of pagophagia in women which emerged after RYGBP and resolved with iron treatment. These cases, added to the literature, lead to further discussion of how healthcare providers can subtly probe patients for the presence of pica.

Kushner RF, Gleason B, Shanta-Retelny V. · Northwestern University Feinberg School of Medicine, Wellness Institute, Northwestern Memorial Hospital, 150 East Huron, Chicago, IL 60611, USA. · J Am Diet Assoc. · Pubmed #15354156 No free full text.

Abstract: Abstract Pica, the compulsive ingestion of nonnutritive substances, has been a fascinating and poorly understood phenomenon for centuries. Pagophagia, or ice eating, is one of the most common forms of pica and is closely associated with the development of iron-deficiency anemia. Although this condition has been well described among pregnant women and malnourished children, particularly in developing countries, it has not been previously reported to occur following gastric bypass surgery for treatment of severe obesity. This article presents two cases of women who experienced a recurrence of pagophagia following gastric bypass surgery, along with an updated review of the literature.