Objective: In this study we tried to find out which would be the most important attitude-related factors that make the weight loss management difficult. Methods:We discussed problems of weight loss attempts with 68 persons having tried to lose weight. 32 had been successful having managed to lose at least 5 kg of their weight permanently; they formed "the successful group". 36 had not been successful at all, forming "the non-successful group". We compared the amount of harmful attitudes between these groups.Results: During these discussions emerged 15 attitude-related factors that seemed to disturb successful weight loss and maintenance. These attituderelated factors were found significantly more often in the non-successful group as opposed to the successful group. The factors that seemed to disturb the attempts to lose weight were inertia ("laziness")(IN), culinary attitude (CU), Depressive mood (DE), restlessness (RE), superiority attitude (SB), criticism (CR), bitterness (BI), food dependency (FD), experiencing general difficulties in weight loss (DI), impaired physical condition (IC), hunger (HG), incapacity (ICA), peer pressure (PP), lack of the time (LT) and unrealistic activity (UN). Statistically the most significant factors in this study were depressive mood (p=0.0018), food dependency (p=0.006), restlessness (p=0.035), bitterness (p=0.035) and inertia (p=0.23). Also one combination of three factors (criticism, experiencing general difficulties in weight loss and impaired physical condition) was statistically more abundant in the non-successful group (p=0.0299). Conclusion:During a 30 minute discussion there were found attitudes that are not beneficial to the weight loss management. The most disturbing attitudes in our study were depressive mood, food dependency, restlessness, bitterness and inertia. The existence of factors that alone were not statistically significantbetween the two studied groups became statistically significantas a combination.

Objective:The objective of the study was to evaluate the effect of an eight week period of very low calorie diet (VLCD) on heart function and amount of epicardial adipose tissue in obese people without heart disease.Methods: Fifty-two obese patients (38 women, 14 men, mean age 47.6±12.3years, mean BMI 46.2±7.0kg/m 2 ) were assigned to a VLCD enriched with vegetables for eight weeks. Transthoracic echocardiography was performed before and after the diet period. Left ventricular size, ejection fraction, diastolic function, left and right ventricular myocardial performance index (MPI) and thickness of epicardial adipose tissue were measured. Heart rate, blood pressure and plasma glucose and triglyceride concentration were also analysed. Results:During the diet period the BMI decreased from 46.2±7.0kg/m 2 to 41.8±6.1kg/m 2 (p<0.0001). The left ventricular MPI decreased from 0.42±0.07 to 0.37±0.07 (p<0.0001) and right ventricular MPI decreased from 0.30±0.09 to 0.27±0.09 (p=0.0256) showing significant systolic and diastolic improvement in the performance of both ventricles. The thickness of epicardial fat decreased from 4.4±1.5mm to 3.4±1.4mm (p<0.0001). The heart rate decreased from 75.8±9.7beats/min to 67.0±10.3 beats/min (p<0.0001) and the systolic blood pressure decreased from 140±14.3mmHg to 135.2±10.6mmHg (p=0.0087). The plasma glucose concentration decreased from 6.71±1.96mmol/l to 6.02±1.59mmol/l (p<0.0001). The plasma triglyceride concentration decreased from 1.77±0.89mmol/l to 1.36±0.68mmol/l (p=0.0002). Conclusion:VLCD caused during only eight weeks period significant reduction in BMI as well as in the amount of epicardial fat and significant improvement in the systolic and diastolic function of both ventricles in obese persons.

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In our previous study we showed an improvement of cardiac systolic and diastolic function after an eight week period of Very Low Calorie Diet. This article is under evaluation for publishing in this same journal. The reason for this improvement of cardiac function is not known. In the previous study we also showed a decrease in fat around the heart. In this extension study with the same study group we tried to analyze further the fat around the heart and its possible effect on the improvement of the cardiac function. Methods Fifty-seven obese persons without any heart diseases (41 women, 16 men, mean age 48.0+12.3years, mean body mass index 46.1±7.2kg/ m 2) were assigned to a very low calorie diet for eight weeks. The diet consisted of commercially available VLCD-products (Nutrifast, Allevo) enriched with vegetables. The estimated total amount of calories was 700-900kcal/day. The demographics of the patients are seen in Table 1.

Objective: We tried to evaluate the importance of self-monitoring of caloric content of the diet in weight loss. It has been suggested that self-monitoring is an essential part of weight loss attempts and it has been suggested to be essential also in maintenance.Methods: As a study group we had 77 persons who were or had been as hospital outpatients for the treatment of obesity. The history of all their weight loss efforts was analysed and the amount of weight lost in all their weight loss efforts was counted. The amount of the weight lost was divided in two parts: the amount lost by the means including self-monitoring of caloric content of the food eaten and amount lost by methods not including self-monitoring. The methods that did not include selfmonitoring were attempts to change the life style (a general intention to eat less and better and exercise more to lose weight). Results:The amount of weight lost by methods including self-monitoring were 5 fold bigger compared to methods not including self -monitoring (2064,4kg/397,5kg). As self-monitoring was discontinued the weight came back. This difference was considered to be statistically extremely statistically significant (p<0.0001 in Fisher's exact test). Conclusion:Self-monitoring of the caloric content of the food consumed should be a permanent habit in the weight loss management even in the maintenance phase.