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Biomedical subjects

M D Marcus

Publications and source records attributed to M D Marcus.

At least 37 records · Page 2Linked to original sources
PubMed1993

Binge eating disorder should be included in DSM-IV: a reply to Fairburn et al.'s "the classification of recurrent overeating: the binge eating disorder proposal".

Extensive recent research supports a proposal that a new eating disorder, binge eating disorder (BED), be included in DSM-IV. BED criteria define a relatively pure group of individuals who are distressed by recurrent binge eating who do not exhibit the compensatory features of bulimia nervosa. This large number of patients currently can only be diagnosed as eating disorder not otherwise specified (EDNOS). Recognizing this new disorder will help stimulate research and clinical programs for these patients. Fairburn et al.'s critique of BED fails to acknowledge the large body of knowledge that indicates that BED represents a distinct and definable subgroup of eating disordered patients and that the diagnosis provides useful information about psychopathology, prognosis, and outcome (Fairburn, Welch, & Hay [in press]. The classification of recurrent overeating: The "binge eating disorder" proposal. International Journal of Eating Disorders.) Against any reasonable standard for adding a new diagnosis to DSM-IV, BED meets the test.

Anorexia Nervosa↗
PubMed1992

Lifetime prevalence of major depression and its effect on treatment outcome in obese type II diabetic patients.

OBJECTIVE: To assess the lifetime prevalence of major depression (MD) and its relation to glycemic control among a group of non-insulin-dependent (type II) diabetic subjects seeking obesity treatment and to determine whether a history of MD affected response to treatment. RESEARCH DESIGN AND METHODS: Sixty-six obese subjects with type II diabetes (22 men, 44 women) completed the Inventory to Diagnose Depression-Lifetime Version before a 52-wk behavioral weight-control program. Weight, glycosylated hemoglobin, fasting blood glucose, and mood were assessed at pre- and posttreatment. RESULTS: Thirty-two percent of the subjects reported a history of MD. Neither a history of MD nor current depressive symptoms were associated with pretreatment glycemic control. However, a history of MD was related to treatment attrition (52.4 vs. 22.2%, P = 0.03). Subjects with and without a history of MD showed comparable improvements in weight, glycemic control, and mood. CONCLUSIONS: A history of MD among type II diabetic patients seeking obesity treatment was not related to pretreatment glycemic control but was associated with higher rates of attrition from treatment. Individuals with a history of MD who completed the program did not differ from those with no history of MD in response to treatment.

Adult↗
PubMed1991

A "family-based" approach to the treatment of obese type II diabetic patients.

Forty-nine obese diabetic patients with obese spouses (diabetic or nondiabetic) were randomly assigned to an alone or together condition. Patients in the alone group participated by themselves in a 20-week behavioral weight control program; their spouses attended assessment sessions only. Patients in the together group attended the program with their spouses; both were targeted for weight loss and taught social support strategies. Weight losses of patients treated alone and together did not differ significantly at posttreatment (19.9 vs. 19.1 lb) or 1-year follow-up (11.6 vs. 7.0 lb). However, there was a significant interaction of treatment and gender; women did better when treated with their spouses, whereas men did better when treated alone. A "family-based" approach was not effective for these obese Type II diabetic patients as a whole but may be helpful for women.

Adult↗
PubMed1991

Psychological responses of obese type II diabetic subjects to very-low-calorie diet.

OBJECTIVE: Very-low-calorie diets have been shown to produce dramatic improvements in glycemic control in obese subjects with non-insulin-dependent (type II) diabetes. There have been no studies of the psychological responses of diabetic subjects to these diets. RESEARCH DESIGN AND METHODS: This study examined changes in hunger, depression, and anxiety in 33 obese type II diabetic subjects who were randomly assigned to behavior modification programs that used either a balanced diet of 4185-6277 J/day (1000-1500 cal/day) throughout or included an 8-wk period of a very-low-calorie diet (1674 J/day or 400 cal/day of lean meat, fish, or fowl). Subjects completed the Beck Depression Inventory, the Spielberger State Anxiety Questionnaire, and self-report measures of hunger frequently throughout the 20-wk program. RESULTS: Both groups experienced significant improvements in depressive symptomatology, anxiety, and lessening of hunger during the course of the program, with no significant differences observed between the balanced diet and the very-low-calorie diet groups. CONCLUSIONS: Very-low-calorie diets, used in the context of a behavioral weight-control program, result in reductions in hunger and improvements in mood state comparable to those observed on more moderate weight-loss regimens.

Adult↗
PubMed1991

Effects of a very-low-calorie diet on long-term glycemic control in obese type 2 diabetic subjects.

We tested the hypothesis that the use of a very-low-calorie diet (VLCD) in combination with behavior modification would promote long-term glycemic control in obese type 2 diabetic subjects. Thirty-six diabetic subjects were randomly assigned to a standard behavior therapy program or to a behavior therapy program that included an 8-week period of VLCD. The behavior therapy group consumed a balanced diet of 4200 to 6300 J/d throughout the 20-week program. The VLCD group consumed a balanced diet of 4200 to 6300 J for weeks 1 to 4, followed by a VLCD (1680 J/d of lean meat, fish, and fowl) for weeks 5 to 12. The VLCD group then gradually reintroduced other foods during weeks 13 to 16 and consumed a balanced diet of 4200 to 6300 J/d for weeks 17 to 20. Thirty-three of the 36 subjects completed the 20-week program and the 1-year follow-up. Use of the VLCD produced greater decreases in fasting glucose at the end of the 20-week program and at 1-year follow-up and greater long-term reductions in HbA1. The VLCD group also had greater weight losses at week 20, but weight losses from pretreatment to 1-year follow-up were similar in the two treatment groups. The improved glycemic control with the VLCD appeared to be due to increased insulin secretion, but further research is needed to confirm this.

Adult↗
PubMed1990

Long-term followup of patients treated with 1 or 2, 6-week courses of intravesical bacillus Calmette-Guerin: analysis of possible predictors of response free of tumor.

We report our long-term experience with 104 patients treated for recurrent superficial bladder tumors followed for a mean of 48 +/- 2 months (range 6 to 83 months). Patients received 6 weekly intravesical bacillus Calmette-Guerin instillations, and were followed for response with urinary cytology, cystoscopy and bladder biopsy. Patients were considered treatment failures if either urinary cytology or biopsy results were positive for tumor. Of 69 patients who failed the initial treatment course 60 were given an additional 6-week course of therapy. A 6-week course of bacillus Calmette-Guerin was successful in 19 of 55 patients (35%) treated for prophylaxis, 10 of 32 (31%) treated for carcinoma in situ and 6 of 17 (35%) treated for residual tumor. The response rate for the total patient population treated with 1, 6-week course was 34% (35 of 104). Another 6-week course was successful in 32 of 60 patients (53%). The over-all response rate free of tumor for patients treated with either 6 or 12 weeks of therapy was 64%. The mean interval free of tumor was 48 months. We evaluated tumor type, stage and grade in conjunction with muscle invasion to assess potential indicators of response to a second course of bacillus Calmette-Guerin. Of 13 patients with carcinoma in situ and 45 with papillary disease 5 (38%) and 26 (58%), respectively, responded to a second course of bacillus Calmette-Guerin (not significantly different). In contrast, 5 of 8 carcinoma in situ failures (63%) had muscle invasive disease, compared to only 3 of 19 papillary nonresponders (16%) (p less than 0.02). These results suggest that intravesical bacillus Calmette-Guerin for the treatment of superficial bladder tumors is an effective long-term therapy. One 6-week course may be ineffective for some patients and another 6-week course provides long-term survival free of tumor for many course 1 failures. Patients who present with carcinoma in situ after a single 6-week course of intravesical bacillus Calmette-Guerin have a significantly higher risk for muscle invasive disease than those with recurrent papillary tumors.

Administration, Intravesical↗
PubMed1990

A double-blind, placebo-controlled trial of fluoxetine plus behavior modification in the treatment of obese binge-eaters and non-binge-eaters.

To determine whether fluoxetine is effective in the long-term treatment of obesity and whether it is particularly useful in the treatment of obese binge-eaters, the authors randomly assigned 45 obese subjects (22 with binge-eating problems and 23 without binge-eating) to fluoxetine (60 mg/day) or placebo in a 52-week double-blind trial. The 21 subjects who completed the trial made 13 clinic visits and were taught basic behavior modification strategies. Patients treated with fluoxetine plus behavior modification lost significantly more weight than those treated with placebo plus behavior modification. However, the drug did not appear to have a differential benefit for binge-eaters.

Adolescent↗
PubMed1990

Depressive symptomatology in obese adults with type II diabetes.

This study compared depressive symptomatology in 32 obese subjects with type II (non-insulin-dependent) diabetes (16 men, 16 women) and their obese nondiabetic spouses. All subjects completed the Beck Depression Inventory (BDI) before participation in a behavioral weight-loss program. Diabetic subjects reported significantly more depressive symptomatology than their overweight nondiabetic spouses (10.6 +/- 6.4 vs. 7.5 +/- 6.2, P less than 0.04). Diabetic subjects scored higher than their spouses on 15 of 20 BDI items, with significant differences in feelings of being punished, perceived appearance, and interest in sex. Mean BDI score in the diabetic spouses was similar to that observed in the first 123 diabetic subjects to enter the weight-loss program (BDI 11.2 +/- 6.9). Further studies are needed to determine whether diabetic subjects differ from age-, sex-, and weight-matched nondiabetic individuals in clinical depression and depressive symptomatology.

Depression↗
PubMed1990

Variables associated with weight loss and improvements in glycemic control in type II diabetic patients in behavioral weight control programs.

Because weight loss is difficult to achieve, it would be helpful to determine whether there are subgroups of obese type II diabetic patients who benefit most from participation in a behavioral weight loss program. We studied 178 obese patients with type II diabetes, who participated in a 12-20 week behavioral weight loss program and were followed for 1 year after the program to determine whether age, gender, percent overweight, medication, duration of diabetes or fasting glucose were related to weight loss and/or to the magnitude of improvement in glycemic control experienced with weight loss. Gender was the only variable related to weight loss; males lost more weight and had greater decreases in percent overweight than females. The variable most strongly related to improvement in glycemic control was pretreatment fasting glucose level; patients with higher initial glucose levels experienced the greatest improvements in control. There was no evidence to support the belief that patients on insulin have poorer weight losses or that patients with long-duration diabetes benefit less from weight reduction than those with recent-onset diabetes.

Behavior Therapy↗
PubMed1986

Giant cell lichenoid dermatitis.

A case of drug-induced lichenoid dermatitis with an unusual epidermotropic multinucleated giant cell inflammatory response is reported. The patient is a 52-year-old white woman who is steroid-dependent because of long-standing systemic lupus erythematosus. At the time of presentation of her generalized papulosquamous pruritic eruption, she was taking oral antihypertensive medications (methyldopa and chlorothiazide). After discontinuation of these medications and local treatment with topical corticosteroids, the skin eruption dramatically improved. Microscopically, the skin lesions had a lichenoid inflammatory pattern, with multiple cytoid bodies, multinucleated giant cells, and a mixed chronic inflammatory infiltrate that included lymphocytes, histiocytes, and eosinophils.

Chlorothiazide↗
PubMed1985

Binge eating and dietary restraint in obese patients.

The present study was conducted to determine the prevalence and severity of binge eating among 432 women seeking behavioral treatment for obesity and to assess the relationship between binge eating and dietary restraint. Subjects completed standardized self-report questionnaires which assessed the severity of binge eating and habitual dietary restraint. Binge eating was extremely prevalent, with 46% of subjects reporting serious problems. Serious binge eating was more common in younger and heavier subjects. Further, binge eating severity was significantly related to overall dietary restraint. The current findings indicate that the treatments of binge eating may need to be considered in planning behavioral programs for the obese.

Adolescent↗
PubMed1984

Mood changes in behavioral weight loss programs.

Ten studies investigating the relationship between mood change and weight loss in behavioral weight loss programs were reviewed. Significant positive changes in mood were observed in 6 of the 10 studies. There was no evidence to indicate that untoward reactions to dieting were frequent, that patients with juvenile-onset obesity experienced more negative mood changes than those with adult-onset obesity, or that dropping out of treatment was a response to increasing depression. The positive changes in mood were related to active participation in a treatment program, and occurred in behavioral and nonbehavioral treatment programs. Differences between the studies reviewed and the earlier research on mood and weight loss are discussed and suggestions made for subsequent studies of mood changes during weight reduction.

Anxiety↗
PubMed1981

Use of a fractional factorial design to evaluate interactions of environmental factors affecting biodegradation rates.

For investigation of main and interactive effects of six experimentally controlled environmental factors on phenol biodegradation in a shake-flask system, a largely neglected statistical procedure was applied. A major benefit resulting from the application of the orthogonal, fractional factorial design is that the number of experiments necessary to evaluate multifactor interactions is limited. In our investigation, the required number of experiments was reduced to 81 from the 324 necessary with conventional factorial designs; information was sacrificed for only 3 of 15 possible two-factor interactions. Six experimentally controlled factors were investigated at two or three treatment levels each; the six factors were (1) amount of phenol substrate, (2) amount of bacterial inoculum, (3) filtration of inoculum, (4) type of basal salts medium, (5) initial pH of basal salts medium, and (6) flask closure. Significant main effects were found for factors 1, 2, and 4; whereas significant interactive effects were found only for factor 2 with factor 3 and for factor 2 with factor 5. Our results suggest that the application of these statistical designs will greatly reduce the number of experiments necessary to evaluate multifactor effects on degradation rates during optimization of both hazard screening systems and waste treatment systems.

Journal Article↗