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Reducing weight increases postural stability in obese and morbid obese men Top of pageAbstractObjective: To investigate the effect of weight loss on balance control in obese and morbid obese men.Methods: In a longitudinal and clinical intervention study, postural stability was measured with a force platform before and after weight loss in men. Weight loss was obtained in obese men (mean body mass index (BMI)=33.0 kg/m2) by hypocaloric diet until resistance and in morbid obese men (mean BMI=50.5 kg/m2) by bariatric surgery. Morbid obese men were tested before surgery, and 3 and 12 months after surgery when they had lost 20 and nearly 50% of initial body weight, respectively. Normal weight individuals (mean BMI=22.7 kg/m2) were tested twice within a 6 to 12 month period to serve as control. Body fatness and fat distribution measures, and posturographic parameters of the center of foot pressure (CP) along the antero posterior and medio lateral axes for conditions with and without vision were performed in all subjects.Results: Weight loss averaged 12.3 kg after dieting and 71.3 kg after surgery. Body weight remained unchanged in the control group. A strong linear relationship was observed between weight loss and improvement in balance control measured from CP speed (adjusted R2=0.65, PConclusion: Weight loss improves balance control in obese men and the extent of the improvement is directly related to the amount of weight loss. This should decrease the habitual greater risk of falling observed in obese individuals.Keywords: weight loss, posture, balance control, postural stabilityTop of pageIntroductionOverweight and obesity are significantly associated with an endless list of diseases such as diabetes, high blood pressure, chronic heart diseases, dyslipidemia, endothelial dysfunction, stroke, cancer (endometrial, breast, prostate and colon cancer), osteoarthritis, sleep apnea and respiratory problems.1, 2, 3, 4, 5, 6, 7, 8 Also there are evidences to suggest that an increased body fat mass decreases postural stability and increases the odds of falling, particularly when combined with low muscle mass. Owusu et al.9 reported that hip and wrist fractures among 43 053 men aged 40 years was increased depending on waist circumference and waist to hip ratio. Four studies with obese boys also suggest that obesity imposes added constraints on the postural control system. Petti et al.10 examined the relationship between obesity and traumatic dental injuries in a study population of 938 school children aged 6 years. They reported that more obese children suffer from traumatic accidents to anterior teeth than non obese children. Goulding et al.11 reported that in obese boys aged 10 there was a significant relationship between body weight, body mass index, percentage of fat and total fat mass and a clinical balance score (Bruininks Obese boys also showed greater sway areas and variability in the medial/lateral direction when compared with non obese prepubertal boys.12 Altogether, these studies support the view that overweight can yield poorer balance. More recently, Bernard et al.13 reported similar results in obese teenagers but only when the postural control was stressed by adding a foam surface. Adding a foam surface presumably perturbs the lower limbs somatosensory information and requires a greater reliance on the remaining sensory systems. They suggested that the less stable posture was not only the result of overweight by itself but could be related to sensory integration problems.We have presented a mathematical model of postural stability in obese persons useful to study how an abnormal distribution of body fat in the abdominal area could influence the stabilizing torque needed at the ankle joints when an obese person was submitted to a small and normal forward oscillation.14 Results of the mathematical model suggested that obese persons were at higher risk of falling than lightweight individuals. This was the interpretation given to a nonlinear increase in the torque needed to stabilize the body when the ankle torque response was delayed (onset of the stabilizing torque or slower time to peak torque response). This effect was aggravated by a more pronounced anterior position of the center of mass. A decreased balance control has important functional limitations as balance does not refer only in the upright position but it also subserves most of our daily activities. Moncler Down Jackets Women Button With Hooded Red Any aiming or reaching movement in an upright position requires proper balance control for stability. A decreased stability control with obesity would represent a major constraint to daily functional activities.In the present study, we wanted to examine the impact of obesity on postural stability by measuring the effect of weight loss caused by dieting or surgery in obese men. Our hypothesis was that balance control would benefit from a weight loss. We also wanted to examine if there is a specific relationship between the magnitude of weight loss and the improvement in balance control.Top of pageMaterials and methodsSubjects and protocolThree groups of Caucasian male adults were tested in this study: 16 control subjects (BMI2), 14 obese subjects (302) and 14 morbid obese subjects (BMI>40 kg/m2). They were not involved in any sustained or regular exercise program. Participants in the obese group were evaluated at baseline (before hypocaloric diet) and after the diet program when they were experiencing resistance to weight loss (resistance). They had to follow a hypocaloric diet between the baseline visit and the last visit (see Dietary Intervention section). Resistance to weight loss represented a stable body weight for 4 consecutive weeks. This period occured after a treatment duration ranging from 15 to 47 weeks across obese participants. Subjects in the morbid obese group were evaluated at baseline (3 months before a biliopancreatic surgery) and twice after the biliopancreatic surgery: (1) 3 months post surgery (after loosing about 20% of their initial body; average weight loss of 32.0 kg; 12 weeks post surgery) and (2) 12 months post surgery (after loosing nearly 50% of their initial body; average weight loss of 71.3 kg; 50 weeks post surgery). Body weight was measured with a standard beam scale and abdomen circumference was taken according to Lohman et al.15 Control lean participants were also tested twice (delay varying from 6 to 12 months between their visits). For control participants, there was no other appointment between visits. Descriptives characteristics are presented in Table 1.Dietary interventionThe weight loss program was a hypocaloric non macronutrient specific diet. An energy restriction, which corresponded to a reduction in energy intake of approximately 700 kcal/day, was fixed for all obese subjects. In order to achieve this energy restriction, the baseline resting metabolic rate, measured by indirect calorimetry, was used by extrapolating this value over a 24 h period and then multiplying it by an activity factor of 1.4, which corresponds to a sedentary state. A 3 day dietary record16 was used to assess macronutrient and micronutrient composition of the diet of subjects at the onset of the program. In order to achieve the energy restriction and to maintain macronutrient composition, a nutritionist followed each subject during the diet program. During the study, obese subjects had to come to our laboratory every other week for a control session during which they were asked to fill out a 24 h dietary recall with a nutritionist. This served to assess compliance to the energy restriction.Surgery proceduresThe morbid obese patients underwent a duodenal switch procedure. It consisted of 65% distal gastrectomy, gastroenterostomy at 250 cm from the ileocecal valve, and ileoileostomy 100 cm from the ileocecal valve, creating an alimentary chanel of 250 cm including a common chanel of 100 cm.17, 18 The procedure let food go only into the distal intestine, decreases the surface of food absorption and decreases the role of bile. This is a malabsorptive procedure and not a restrictive procedure.Postural stability proceduresPostural stability was evaluated with the help of a force platform (model 9284, Kistler instruments, AG Winterthur, Switzerland). Subjects stood barefoot on the platform with feet together for 35 s (14 trials). Half of the trials were collected with vision for the 35 s. For the other half of the trials, a computer generated tone was given at 5 s and indicated the participants to close their eyes. For both conditions, only the last 30 s served for the data analyses. An assistant helped throughout each session to ensure that procedures were adequately followed.Data analysesAntero posterior and medio lateral coordinates of the center of pressure (CP) were determined from the ground reaction forces recorded at 200 Hz (12 bit A/D conversion). Before computing the CP displacement, the force data were digitally filtered (Butterworth fourth order, 7 Hz low pass cutoff frequency with dual pass to remove phase shift). To evaluate the ability of participants to control their balance, several dependent variables were extracted from the CP signals. Center of pressure speed, the root mean square of the CP location along x and y axes (RMS x and RMS y), the root mean square of the CP velocity along x and y axes (RMS x velocity and RMS y velocity), and the range of CP displacement along x and y axes (Range x and Range y) were measured. The mean speed of the CP corresponds to the cumulative distance over the sampling period. The range of the CP displacement indicates the average minimal and maximal excursion of the CP from the base of support. Root mean square (both for CP displacement and velocity) are often taken as measure of stability with greater RMS values indicating less stable subjects.19 Center of pressure speed constitutes a good index of activity required to maintain stability20, 21 and has been often considered as a sensitive and discriminant variable of stability.22, 23In addition, structural posturographic parameters were computed using a sway density plot approach.23, 24 This analysis allows to document the possible physiological processes underlying balance control that were modified as a result of weight loss. Barratto et al.23 suggested that the data extracted reflect the capacity of the postural control system to integrate the sensory information and anticipate physiological internal delays in order to keep the vertical alignment of the whole body. The sway density plot is computed by counting the number of consecutive samples during which the postural oscillations remain inside a 2.5 mm radius. The mean value of all peaks and the mean of all distances between one peak and the successive peak are extracted from the sway density curve. The peaks correspond to time instants in which the CP is relatively stable (valleys correspond to time instants in which the CP rapidly shifts from one stable value to another) and a shorter mean distance between peaks indicates a more stable CP. The discriminative power of these two sway density parameters, together with the mean speed, is greater than that of other global parameters (for instance, range of the CP) to distinguish among sensory and pathological conditions in the general framework of postural stabilization.23Statistical analysisStatistica software 7.0. (Statsoft, Inc, Tulsa, OK) was used for all analyses. Analyses of variance were used to compare Groups for age, weight, BMI and waist circumference. The Kolmogorov test was used to verify if all data were normally distributed.To determine if weight loss improved postural stability, the CP data obtained before and after the weight loss intervention for all dependent variables (postural parameters) were submitted to a Group (Obese, Morbid obese, Control) Phase (baseline/post intervention) Vision (vision/no vision) ANOVA with repeated measures on the last two factors. For the Morbid obese group, data at 12 months post surgery were considered for the analyses. At the time of the preparation of the paper, data covering 12 months post surgery were available for 10 subjects.To assess if a relationship exists between the magnitude of weight loss and postural stability, data obtained after weight loss (weight loss of about 10% at resistance to lose weight for the obese group, weight loss of about 20% after 3 months post surgery and weight loss of nearly 50% after 12 months for the morbid group, respectively) were tested using a multiple regression analysis. Center of pressure speed was the dependent variable and weight loss, BMI loss, waist circumference loss, and hip circumference loss were the independent variables.All results were considered to be significant at the 5% critical level (PTop of pageResultsAnthropometric characteristicsThe anthropometric characteristics of the three groups of subjects before and after the weight loss are presented in Table 1. At baseline, body weight, BMI, waist circumference and hip circumference were significantly higher in obese than lean subjects. Values for Moncler Men Down Vest Hooded Zip Green each variable were also significantly greater for morbid obese than obese subjects. After weight loss, body weight, BMI, waist circumference and hip circumference were significantly reduced for obese and morbid obese subjects. Specifically, at resistance to lose weight, obese subjects had lost, on average, 12.3 kg of body weight, 4.1 kg/m2 of BMI, 12.9 cm of waist circumference, and 8.1 cm for hip circumference. At 3 and 12 months post surgery, the mean decrease in anthropometric variables in morbid obese subjects was 32.0 and 71.3 kg for body weight, 10.6 and 23.5 kg/m2 for BMI, 21.3 and 53.1 cm for waist circumference, and 22.4 and 44.8 cm for hip circumference, respectively.Postural stability after weight loss interventionsThe main objective of this study was to determine if balance control would benefit from a weight loss. Figure 1 illustrates the effect of the weight loss intervention on the average speed of the CP displacement (CP speed) for the vision and no vision conditions. Center of pressure speed was measured before the weight loss interventions for the baseline testing session and after the interventions (at resistance for the obese group and after 12 months post surgery for the morbid group). Center of pressure (CP) oscillations as measured by CP speed decreased significantly after the weight loss interventions with vision (a) and without vision (b). Values Moncler Bubble Vest are means and 95% CI.

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