This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. It has been clearly shown that obesity is associated with common medical illnesses and that it shortens life. The health care costs and lost wages of people suffering from obesity-related conditions amount to 68 billion dollars per year. Weight loss of as little as 5-10 percent of initial weight and weight loss maintenance can dramatically decrease or reverse these associated medical illnesses and improve health. While weight loss can be achieved by a variety of methods, most people regain the weight they have lost. We propose that while weight loss can be achieved with a calorie-restricted diet, the outcomes depend on the treatment strategies added to the diet. We propose to compare in men and women with abdominal obesity the following strategies for achieving a 10 percent weight loss: 1) A reduced calorie diet; 2) A reduced calorie diet with exercise; 3) A reduced calorie diet and Ephedrine/caffeine (E/C) (components of non-prescription herbal supplements, used for the treatment of obesity), and 4) A reduced calorie diet with exercise and E/C. We will then compare the combinations of diet, endurance training and E/C in preventing weight regain over a period of 12 months. Stress may contribute to weight gain and regain of weight after weight loss. We therefore plan to evaluate the emotional background of subjects participating in the study and the responses of the stress hormones cortisol and ACTH to stress challenges. Eighty non-diabetic women and men will be recruited. Included will be men and non-pregnant women ages 18-55 of all racial and ethnic groups with a Body Mass Index (BMI= weight/height2) of 29-40 (normal less than 24) and abdominal obesity (a waist circumference of >45 in). They will not be clinically diabetic and will be able to exercise. Following screening and acceptance into the study, the following will be measured: Body weight, fat distribution and body composition; an oral Glucose Tolerance Test to evaluate for diabetes; blood lipid levels and oxygen consumption in order to calculate physical fitness. Subjects will then be randomly assigned to one of the four treatment protocols. Studies will be repeated after a 10 percent weight loss and 12 months thereafter.
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