The Regenstrief Institute Inc. hosted nearly 100 of the nation's top scientists in an interdisciplinary conference to discuss research on relationship-centered care. The findings of the conference are reported in a special supplement to the January issue of the Journal of General Internal Medicine.

Thomas Inui, M.D., president of the Regenstrief Institute, Inc. and associate dean for health services research at the Indiana University School of Medicine, and Professor of Medicine Richard Frankel, Ph.D., a research scientist at the Regenstrief Institute and at the Center for Implementing Evidence Based Practice at the Roudebush VA Medical Center, chaired the Ninth Biannual Regenstrief Conference entitled "Re-Forming Relationships in Health Care: Creating a National Research Agenda for Relationship Centered Care."

Presentations by experts representing a wide range of specialties included discussions of the influence of information technology on patient-physician relationships, training of future physicians, and expression of emotion during medical visits. An editorial in the supplement by F. Daniel Duffy, a senior vice president at the American Board of Internal Medicine, notes that it has taken a decade for relationship-centered care to secure attention and that it will take another decade for it to be effectively studied.

"What we have found repeatedly is that medical care succeeds when there are stable and enduring relationships," says Dr. Frankel.

"Successful outcomes lie not simply in the mechanics of medical care, but in the social and emotional context of the doctor patient relationship. For example, a medical test might reveal that a patient has a condition requiring a significant change in diet. The doctor must develop a working relationship with the patient if the treatment is to succeed. Simply telling someone to control his dietary intake, without knowing the individual, doesn't work."

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The researchers found that the mice lacking VMH leptin receptors showed the same degree of body weight gain as those engineered to lack leptin receptors in the ARC. What's more, the researchers found that knocking out both types of neurons showed an additive effect on weight gain in the animals. Their measurements in the mice revealed that such weight gain was due to an increase in fat stores.

Importantly, when the researchers fed the mice deficient in VMH leptin receptors a high-fat, high-sugar diet, they found that the animals rapidly gained weight throughout the feeding period. In contrast, normal mice gained some weight, but leveled off during the feeding period. The knockout mice continued to gain weight, found the researchers, because they did not suppress their food intake, as did normal mice.

The researchers noted that the combined effects on obesity of the deficiency of VMH leptin receptors and high-fat feeding "were greater than expected from the individual components added together.

"This synergistic interaction strongly suggests that leptin action on [the VMH neurons] plays a particularly important role in resisting high-fat-diet-induced obesity."

Lowell and his colleagues concluded that "In total, these findings suggest that the ability of leptin to restrain body weight is distributed to a number of different sites in the brain."

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