title: Effects of an intensive behavioral weight loss intervention consisting of caloric restriction with or without physical activity on common carotid artery remodeling in severely obese adults.
abstract: OBJECTIVE
  Obesity increases cardiovascular disease risk and adversely affects vascular structure and function. Few studies have evaluated the vascular effects of non-surgical weight reduction in the severely obese. We hypothesized that weight loss and improvements in cardiometabolic factors would reduce common carotid artery intima-media thickness (CIMT) and inter-adventitial diameter (AD) in severely obese adults.
  
  
  METHODS
  We performed carotid ultrasound and measured cardiometabolic factors in 90 severely obese participants (body mass index (BMI)≥35 kg/m(2), age 30-55) at baseline and 6 months in a randomized clinical trial of dietary intervention with (n=45) or without (n=45) physical activity.
  
  
  RESULTS
  The achieved weight loss (mean=8%) did not differ significantly by intervention group (P=0.10) and resulted in a 0.07 mm mean decrease in AD (P=0.001). AD change was positively correlated with changes in BMI, waist circumference, abdominal visceral and subcutaneous fat, and body fat mass, and AD decreased more in men (P<0.05 for all). After multivariable adjustment, changes in BMI (P=0.03) and abdominal subcutaneous fat (P=0.04) were significant determinants of AD change. Although CIMT did not decrease significantly overall (-0.008 mm, P=0.16), individuals who lost at least 5% of their body weight experienced a significant mean reduction in CIMT of 0.02 mm (P=0.002). CIMT change was positively correlated with changes in BMI, waist circumference, fat-free mass, leptin, and insulin (P<0.05 for all). After multivariable adjustment, insulin reduction remained a significant determinant of CIMT decrease (P=0.03).
  
  
  CONCLUSIONS
  A 6 month intensive behavioral intervention can significantly reverse metabolic and vascular abnormalities in severely obese adults.
authors.affiliation: Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261, USA. jnn9@pitt.edu
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Cooper
authors.forename: Mindy L
authors.initials: ML
authors.lastname: Columbus
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Shields
authors.forename: Julius
authors.initials: J
authors.lastname: Asubonteng
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Meyer
authors.forename: Kim
authors.initials: K
authors.lastname: Sutton-Tyrrell
authors.forename: Bret H
authors.initials: BH
authors.lastname: Goodpaster
authors.forename: James P
authors.initials: JP
authors.lastname: DeLany
authors.forename: John M
authors.initials: JM
authors.lastname: Jakicic
authors.forename: Emma
authors.initials: E
authors.lastname: Barinas-Mitchell
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D015992:Body Mass Index; D031204:Caloric Restriction; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000473:pathology / Q000628:therapy*; D014463:Ultrasonography; D015431:Weight Loss