or 35 in patients with obesity-related conditions associated with a high cardiovascular disease risk (such as sleep apnea or diabetes mellitus) or induce physical problems that interfere with lifestyle (joint disorders or body size problems interfering with employment, family function, or ambulation), in accordance with criteria commonly used when considering weight-loss sur- gery (20). Between December 2005 and April 2006, 132 patients seeking weight reduction were prospectively examined at their first visit. Patients were excluded if they used multivitamin sup- plements (n 10), refused to comply with study procedures (n 2), were 60 y of age (n 5), were currently being treated for a severe psychiatric disorder (n 2), had an alcohol intake 50 g/d (n 2), or had thyroid abnormalities (n 1, excessive thyroxine substitution). Ten patients undergoing thyroxine sub- stitution who had normal serum concentrations of thyroid- stimulating hormone (TSH) and thyroxine were included. The final study sample consisted of 110 patients.