In Western countries, 10% to 20% of men and women have a body mass index above 30 kg/M2, and these prevalences have been increasing.1-3 Since overweight and central fat distribution are associated with increased risks of chronic diseases such as diabetes,4 cardiovascular diseases,5'6 cancer,7 8 and premature death,9"0 it is surprising that the quality of life in overweight subjects is less well documented than these diseases.An early study indicated that overweight subjects are more likely to have poorer physical functioning status," a measure of quality of life, but detailed quantification in the present-day population is unavailable. With advancing age, overweight persons are more likely to develop serious limitations in performing basic daily activities.'2 These persons impose an enormous burden on health care resources. 13"4 Poor physical function and quality of life attributable to overweight are important in terms of public health, and they should be addressed by preventive measures and promotion of healthy living. To our knowledge, the quality of life for subjects with adverse fat distribution (i.e., large waists and high waist-to-hip ratios) has not been reported in the literature. The present study quantified the impairment of the quality of life in overweight subjects and in those with large waist circumferences.of subjects in the present study represent those who attended their local health centers for measurements, which included anthropometry. Those who did not attend the health centers or were of non-Dutch nationality were excluded from the analyses. AnthropometryAll anthropometric measurements were made by trained paramedic personnel in accordance with World Health Organization16 recommendations. Subjects wore light clothes during measurements; body weight was measured to the nearest 100 g with calibrated scales, height in bare feet to the nearest millimeter, waist circumference at the level between the lowest rib margin and iliac crest, and hip circumference at the widest trochanters to the nearest millimeter. Circumferences were measured twice and average values were used in analysis. The waist-to-hip circumferential ratio was computed, and body mass index was calculated as weight (in kilograms) divided by height (in meters) squared. Quality ofLife

Intermittent energy restriction may be an effective strategy for the treatment of overweight and obesity. Intermittent energy restriction was comparable to continuous energy restriction for short term weight loss in overweight and obese adults. Intermittent energy restriction was shown to be more effective than no treatment, however, this should be interpreted cautiously due to the small number of studies and future research is warranted to confirm the findings of this review.

Medical records were reviewed of all 263 Type 2 diabetic patients from the Aberdeen diabetic clinic who were known to have died in 1985 or 1986. Mean age was 65 years (interquartile range 57-75 years) at diagnosis and 72 (66-80) years for men, 75 (72-83) years for women, at death. Life expectancy at age 65 was 35% less than published figures for the general population. Analysis of survival in 233 patients who lived more than 1 year (189 overweight) using stepwise multiple regression indicated as significant (p less than 0.05) adverse independent variables: age at diagnosis, presence of clinical ischaemic heart disease at diagnosis, plasma glucose at diagnosis; and as significant favourable variables: oral hypoglycaemic drug therapy, weight loss in the first year, and an interaction between weight loss and BMI for patients with BMI greater than 25 kg m-2. Changes in fashions over the years are likely to have biased these results towards including oral hypoglycaemic therapy and excluding the expected adverse effect of smoking. Mean weight loss at 1 year was 2.6 kg for those with BMI 25-30 kg m-2, 6.8 kg with BMI greater than 30 kg m-2, following standard dietetic advice. For the average patient each 1 kg weight loss was associated with 3-4 months prolonged survival.

BackgroundBehavioural counselling with intensive follow-up for obesity is effective, but in resource-constrained primary care settings briefer approaches are needed.ObjectivesTo estimate the clinical effectiveness and cost-effectiveness of an internet-based behavioural intervention with regular face-to-face or remote support in primary care, compared with brief advice.DesignIndividually randomised three-arm parallel trial with health economic evaluation and nested qualitative interviews.SettingPrimary care general practices in the UK.ParticipantsPatients with a body mass index of ≥ 30 kg/m2(or ≥ 28 kg/m2with risk factors) identified from general practice records, recruited by postal invitation.InterventionsPositive Online Weight Reduction (POWeR+) is a 24-session, web-based weight management intervention completed over 6 months. Following online registration, the website randomly allocated participants using computer-generated random numbers to (1) the control intervention (n = 279), which had previously been demonstrated to be clinically effective (brief web-based information that minimised pressure to cut down foods, instead encouraging swaps to healthier choices and increasing fruit and vegetables, plus 6-monthly nurse weighing); (2) POWeR+F (n = 269), POWeR+ supplemented by face-to-face nurse support (up to seven contacts); or (3) POWeR+R (n = 270), POWeR+ supplemented by remote nurse support (up to five e-mails or brief telephone calls).Main outcome measuresThe primary outcome was a modelled estimate of average weight reduction over 12 months, assessed blind to group where possible, using multiple imputation for missing data. The secondary outcome was the number of participants maintaining a 5% weight reduction at 12 months.ResultsA total of 818 eligible individuals were randomised using computer-generated random numbers. Weight change, averaged over 12 months, was documented in 666 out of 818 participants (81%; control,n = 227; POWeR+F,n = 221; POWeR+R,n = 218). The control group maintained nearly 3 kg of weight loss per person (mean weight per person: baseline, 104.4 kg; 6 months, 101.9 kg; 12 months, 101.7 kg). Compared with the control group, the estimated additional weight reduction with POWeR+F was 1.5 kg [95% confidence interval (CI) 0.6 to 2.4 kg;p = 0.001] and with POWeR+R was 1.3 kg (95% CI 0.34 to 2.2 kg;p = 0.007). By 12 months the mean weight loss was not statistically significantly different between groups, but 20.8% of control participants, 29.2% of POWeR+F participants (risk ratio 1.56, 95% CI 0.96 to 2.51;p = 0.070) and 32.4% of POWeR+R participants (risk ratio 1.82, 95% CI 1.31 to 2.74;p = 0.004) maintained a clinically significant 5% weight reduction. The POWeR+R group had fewer individuals who reported doing another activity to help lose weight [control, 47.1% (64/136); POWeR+F, 37.2% (51/137); POWeR+R, 26.7% (40/150)]. The incremental cost to the health service per kilogram weight lost, compared with the control group, was £18 (95% CI –£129 to £195) for POWeR+F and –£25 (95% CI –£268 to £157) for POWeR+R. The probability of being cost-effective at a threshold of £100 per kilogram was 88% and 98% for POWeR+F and POWeR+R, respectively. POWeR+R was dominant compared with the control group. No harms were reported and participants using POWeR+ felt more enabled in managing their weight. The qualitative studies documented that POWeR+ was viewed positively by patients and that health-care professionals generally enjoyed supporting patients using POWeR+.Study limitationsMaintenance of weight loss after 1 year is unknown.Future workIdentifying strategies for longer-term engagement, impact in community settings and increasing physical activity.ConclusionClinically valuable weight loss (> 5%) is maintained in 20% of individuals using novel written materials with brief follow-up. A web-based behavioural programme and brief support results in greater mean weight loss and 10% more participants maintain valuable weight loss; it achieves greater enablement and fewer participants undertaking other weight-loss activities; and it is likely to be cost-effective.Trial registrationCurrent Controlled Trials ISRCTN21244703.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 4. See the NIHR Journals Library website for further project information.