Biomedical subjects

R R Wing

Publications and source records attributed to R R Wing.

At least 91 records · Page 5Linked to original sources

PubMed1996

Coronary artery disease in IDDM. Gender differences in risk factors but not risk.

Insulin-dependent diabetes mellitus (IDDM) increases the risk of developing coronary artery disease (CAD) compared with that seen in the general population, while the sex differential in rates of CAD is considerably reduced in IDDM populations. To further our understanding of these observations, the effects of gender on baseline risk factors for CAD incidence were examined. Participants in the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study were recruited from the Children's Hospital of Pittsburgh IDDM registry and had been diagnosed between 1950 and 1980. Subjects completed a series of questionnaires and were given a full clinical examination at baseline (1986 through 1988) and every subsequent 2 years. This report is based on the first 4 years of follow-up. Similar incidence rates of new CAD events were observed in men and women. In neither sex was glycemic control a predictor of later CAD. Sex-specific Cox proportional hazards models showed that for men, duration of IDDM, HDL cholesterol, fibrinogen, hypertension, and smoking were all significantly associated with the onset of CAD. Hypertension, fibrinogen, and smoking were all replaced by nephropathy when this latter variable was added to the model. For women, duration, hypertension, waist-hip ratio, physical activity, and depressive symptomatology were all significant independent predictors of CAD. Nephropathy status did not enter the model for women. While 4-year incidence of CAD in IDDM varies little by sex in this population, the predictive risk factors vary considerably. In particular, the effect of renal disease was stronger in men, while the cluster of physical activity, waist-to-hip ratio, and depressive symptomatology were more important in women. These results may help explain the relatively greater impact IDDM has on CAD risk for women and suggest new potential preventive approaches.

Adolescent↗

PubMed1996

Effect of the number of high-fat and low-fat cues on food choice.

This study examined the effects on food choice of increasing the number of healthy items available (fruit) and decreasing the number of unhealthy items available (candy bars). A similar choice, involving nonfood items, was also examined. Two hundred eighty-nine men and women were randomly assigned to 1 of 4 experimental groups: (a) control group, (b) increased number of fruits, (c) decreased number of candy bars, and (d) combination. Between 30% and 40% of participants chose fruit regardless of the amount of fruit and candy presented: there was no effect of increasing fruit or decreasing candy bars. However, restrained participants and current dieters were more likely to choose fruit. In contrast, both stimulus control techniques were effective in increasing the percentage of participants choosing a nonfood item. These results suggest that stimulus control may not be sufficient to modify food choice: other powerful factors affect eating behavior, and these must be considered.

Journal Article↗

PubMed1996

Effectiveness of a behavioral weight control program for blacks and whites with NIDDM.

OBJECTIVE: To compare the weight losses of black and white patients with NIDDM treated in a year-long behavioral weight loss program. RESEARCH DESIGN AND METHODS: Subjects were randomly assigned to a behavioral program that either used a low-calorie diet throughout or included two 12-week periods of a very-low calorie diet (VLCD). Weight, dietary intake, and exercise were measured at 0, 6, and 12 months of treatment, and attendance and self-monitoring records were assessed weekly throughout the year. RESULTS: Blacks had smaller weight losses than whites regardless of treatment condition. Overall weight losses (baseline to 1 year) were 7.1 kg in blacks vs 13.9 kg in whites. The differences in overall outcome resulted primarily from greater weight regain in blacks during months 6-12 than in whites. There was a trend for blacks to have poorer attendance than whites during the latter half of the program and for blacks to report smaller changes in calorie intake from baseline to 6 months. CONCLUSIONS: The results confirm prior studies with nondiabetic patients showing smaller weight losses in blacks than in whites and suggest that these differences may result primarily from faster weight regain in blacks. Further research is needed to more carefully examine the variables that may explain this difference and to develop more effective programs for blacks with NIDDM.

Adult↗

PubMed1996

Food provision vs structured meal plans in the behavioral treatment of obesity.

OBJECTIVE: Providing overweight patients with the food they should eat has been shown to significantly improve weight loss in a behavioral treatment program. The objective of this study was to examine the contribution of three components of food provision to these positive effects: the specific meal plans indicating what foods should be eaten at each meal; the food itself; and the fact that the food was provided free. SUBJECTS: 163 overweight women. DESIGN: Randomized, controlled study with subjects assigned to one of four conditions: (1) a standard behavioral treatment program (SBT) with weekly meetings for six months; (2) SBT plus structured meal plans and grocery lists; (3) SBT plus meal plans plus food provision, with subjects sharing the cost; or (4) SBT plus meal plans plus free food provision. RESULTS: Subjects in Group 1 lost significantly less weight than subjects in Groups 2-4 at the end of the six month program (-8.0 kg vs -12.0, -11.7 and -11.4 kg respectively) and at follow-up one year later (-3.3 kg vs -6.9, -7.5 and -6.6 kg respectively). No significant differences were seen in weight loss between Groups 2-4, suggesting that the component of food provision that is responsible for its success is the provision of highly structured meal plans and grocery lists. Subjects receiving meal plans were more likely to exhibit an eating pattern of three meals/day, had more definite plans regarding what to eat and reported more favorable changes in foods stored in their homes and in perceived barriers to weight loss. CONCLUSIONS: Providing structured meal plans and grocery lists improves outcome in a behavioral weight control program; no further benefit is seen by actually giving food to patients.

Adult↗

PubMed1995

A prospective study of effects of weight cycling on cardiovascular risk factors.

BACKGROUND: The possible adverse health effects of weight cycling (weight loss followed by weight regain) have been the subject of recent concern. To determine whether such weight cycling negatively influences cardiovascular risk factors, 153 overweight individuals were followed up prospectively through a 30-month weight loss and maintenance program. METHODS: Subjects were divided into seven groups according to their weight-change patterns during this 30-month study (steady weight loss of different magnitudes, weight gain, no change in weight, and different weight-cycling patterns). These weight-change groups were compared with regard to lipid levels, blood pressure measurements, waist-to-hip ratio, and percent body fat at 0, 6, 12, 18, and 30 months. RESULTS: No adverse effects of weight cycling on any of the cardiovascular risk factors were observed. Subjects who initially lost 9.0 kg or more and then regained it did not differ from those who had no change in weight with regard to any cardiovascular risk factor at month 30. Subjects who gained weight during the 30-month interval increased their risk factors, those who lost weight decreased their risk factors in proportion to the magnitude of weight loss, and, in general, cardiovascular risk factors at month 30 were related to the net weight loss achieved and not the route taken to achieve the weight loss. CONCLUSIONS: This study showed no negative effects of weight cycling on cardiovascular risk factors and confirmed previous findings of positive effects of weight loss on risk factors. Therefore, overweight individuals should be encouraged to lose weight and then maintain their weight loss.

Adult↗

PubMed1995

Diagnosis of binge eating disorder: discrepancies between a questionnaire and clinical interview.

Binge eating is a common problem among obese individuals, and a simple, accurate way to identify obese binge eaters is needed. This study measured the concordance of the Binge Eating Scale (BES) and the Eating Disorder Examination (EDE). Women seeking obesity treatment (N = 126) were identified as binge eaters or nonbinge eaters using the BES, and then interviewed by clinicians blind to BES score using the EDE, a semistructured interview considered to be the "gold standard" for eating disorder diagnosis. The BES accurately identified nonbinge eaters; 39 of 42 (92.9%) BES-identified nonbinge eaters were confirmed by the EDE. However, the BES did not accurately identify binge eaters; only 43 of the 83 (51.8%) BES-identified binge eaters were confirmed by the EDE. Reasons for the discrepancy between the BES and the EDE in the identification of binge eaters were explored, and modifications to the BES that might improve its accuracy were considered.

Adult↗

PubMed1995

Nocturnal eating in binge eating disorder and matched-weight controls.

OBJECTIVE: To examine the association of nocturnal eating (getting up out of bed to eat) with overweight, binge eating, and negative mood or anxiety. METHOD: Forty overweight women diagnosed with binge eating disorder (BED) and 39 overweight controls monitored their nocturnal eating for an average of eight nights. RESULTS: Seven instances of nocturnal eating were recorded by 6 patients, all of whom were binge eaters. Foods consumed nocturnally tended to be selected from those favored for binge episodes, and reported control over nocturnal eating was low. Patients reported tiredness, but not poor mood or anxiety, at the nocturnal eating episodes. DISCUSSION: In this sample, nocturnal eating was associated more with eating disorder than overweight. This report should provide the basis of future work to determine whether nocturnal eating should be evaluated and treated among eating disordered or overweight groups of patients.

Adult↗

PubMed1995

Comparison of obese NIDDM and nondiabetic women: short- and long-term weight loss.

Previous research suggests that overweight patients with diabetes lose less weight than nondiabetics. We compared the response of obese women with NIDDM to nondiabetic controls, matched for age and weight, to a behavior weight loss program. Forty-three overweight women (20 NIDDM, 23 nondiabetic) participated in the study. NIDDM and nondiabetic subjects were treated together and received the same 16-week behavioral weight loss program. Dependent measures included weight, 3-day food records, physical activity, fasting plasma glucose, and questionnaires assessing eating behavior and depressive symptomatology. Weight loss of NIDDM and nondiabetic subjects at posttreatment was comparable (-7.4 +/- 5.3 kg vs. -6.4 +/- 3.8 kg, respectively). Changes in caloric intake, eating behavior, exercise and depressive symptomatology were also similar between the two groups. However, during the 1-year follow-up period, NIDDM subjects regained 5.4 +/- 6.1 kg compared to 1.0 +/- 6.7 kg for nondiabetics (p = .058). These data indicate that NIDDM subjects can lose as much weight as their nondiabetic peers during active treatment. Once treatment terminated, however, NIDDM subjects demonstrated poor weight loss maintenance. Thus the added motivation that comes from having diabetes and seeing improvements in glycemic control with weight loss were not sufficient to improve long term weight loss in diabetic subjects. A continuous care model of weight control may be particularly necessary for overweight patients with type II diabetes.

Analysis of Variance↗

PubMed1995

Changing diet and exercise behaviors in individuals at risk for weight gain.

To date, there have been very few studies on the primary prevention of obesity and/or weight gain. This paper identifies three times periods that might be appropriate for such efforts at weight gain prevention--the 25 to 35 year age window, the perimenopausal period, and the year following successful weight loss. Research is encouraged that compares these three time periods and various intervention strategies. Several different approaches to primary prevention are identified, including group treatment programs with weekly meetings vs. less intensive, community-based interventions; focusing on those who are currently at ideal body weight vs. including those who are overweight as well; and targeting weight gain prevention per se vs. attempting to produce modest weight losses and/or modify cardiovascular risk factors. This paper suggests that primary prevention efforts should include exercise, changes in quality and quantity of food consumed, behavior modification, and some degree of therapist contact, but the manner in which these changes should be implemented to produce long-term habit change remains unclear.

Adult↗

PubMed1995

Prevention of cardiovascular risk factor elevations in healthy premenopausal women.

BACKGROUND: A number of factors contribute to increased risk of coronary heart disease (CHD) among postmenopausal women, including atherogenic changes in serum cholesterol profiles, weight gain, and decreases in physical activity during the menopause. To date, no study has attempted to prevent elevations in primary CHD risk factors as women experience menopause. METHODS: A sample of 535 healthy premenopausal women, ages 44-50, were recruited for an ongoing 5-year randomized prevention trial testing whether increases in low-density lipoprotein cholesterol (LDL-C) and body weight can be prevented during the menopause with a dietary and behavioral intervention. The aim was to reduce total dietary and saturated fat and cholesterol, prevent weight gain, and increase physical activity levels. Changes in CHD risk factors after the first 6 months of treatment were analyzed comparing 253 intervention and 267 assessment-only control participants. RESULTS: The intervention group showed significant reductions in total cholesterol (-0.34 mmol/liter), LDL-C (-0.28 mmol/liter), triglycerides (-0.04 mmol/liter), weight (-4.8 kg), waist-hip ratio (-0.008), systolic blood pressure (-3.5 mm Hg), diastolic blood pressure (-2.2 mm Hg), serum glucose levels (-0.06 mmol/liter), and HDL-C (-0.06 mmol/liter) and significant increases in physical activity (+383 kcal). No significant changes were observed in the control group. CONCLUSION: Six-month results suggested that participants were receptive to the preventive approach to CHD risk reduction and were successful in making initial positive lifestyle changes. Follow-up data will evaluate long-term adherence to the intervention and the interaction between adherence and physiological changes during menopause.

Analysis of Variance↗

PubMed1995

Use of very-low-calorie diets in the treatment of obese persons with non-insulin-dependent diabetes mellitus.

This article discusses the use of very-low-calorie diets (VLCDs) in the treatment of obese persons with non-insulin-dependent diabetes mellitus (NIDDM). Research using VLCDs with overweight participants with and without diabetes is reviewed. In both groups of participants, it has been shown that VLCDs used in combination with behavior therapy increase initial weight loss. However, to date, it has not been possible to develop treatment programs that maintain this weight loss long term. Neither intensive maintenance sessions nor intermittent VLCDs have been successful in maintaining the benefits of VLCDs long term. Thus, from the perspective of producing long-term weight loss, balanced low-calorie diets appear to be as effective as VLCDs. However, VLCDs may be useful in treating obese persons with NIDDM, because caloric restriction independent of notable weight loss has marked effects on glycemic control. Several studies have shown that just 7 days of caloric restriction can produce dramatic improvements in glycemic control; moreover, VLCDs produce greater improvements in glycemic control than more moderate diets, even if weight losses are the same. Research is needed to explore new ways to use VLCDs and other approaches to caloric restriction in the treatment of obese persons with NIDDM.

Blood Glucose↗

PubMed1995

Long-term effects of interventions for weight loss using food provision and monetary incentives.

One hundred seventy-seven men and women who had participated in an 18-month trial of behavioral interventions involving food provision and financial incentives were examined 12 months later. Food provision, but not financial incentives, led to better weight loss than standard behavioral treatment during the 18-month trial, but over 12 additional months of no-treatment follow-up, all treated groups gained weight, maintained only slightly better weight losses than a no-treatment control group, and did not differ from each other. Weight loss success during both active treatment and maintenance was associated with increase in exercise, decrease in percentage of energy from fat, increase in nutrition knowledge, and decrease in perceived barriers to adherence. Obesity treatment research should focus on developing better ways to maintain changes in the diet and exercise behaviors needed for sustained weight loss.

Adult↗

PubMed1995

Responses to hypothetical high risk situations: do they predict weight loss in a behavioral treatment program or the context of dietary lapses?

Before starting a behavioral weight control program and after 6 months of treatment, 93 participants were asked to listen to 4 scenarios describing typical high risk situations for dieters (family celebration, watching TV, tension at work, argument). The number of coping responses generated, latency of responses, and perceived risk of lapsing were assessed; participants also identified which situation would be most difficult for them. Telephone interviews were conducted during the weight loss program to assess situations surrounding actual dietary lapses. Participants who rated the negative affect situations as most difficult were more likely to lapse in situations involving negative affect; 87% of these participants lapsed in association with negative affect. Moreover, participants who generated coping responses to more of the situations subsequently lost more weight. Thus, baseline performance on a hypothetical high risk task predicts subsequent performances in a behavioral weight loss program.

Adult↗

PubMed1995

Effects of surgical menopause on psychological characteristics and lipid levels: the Healthy Women Study.

The authors examined the effects of surgical menopause, with or without hormone replacement therapy (HRT), on psychosocial functioning and lipid levels in a population-based study of initially premenopausal women. Within 5 years of study entry, 28 women underwent hysterectomy, with 9 retaining their ovaries and 19 having bilateral salpingo oophorectomy (BSO), and with 173 premenopausal women as a comparison group. Women undergoing hysterectomy reported fewer stress symptoms and a more optimistic attitude at follow-up, whereas BSO cases without HRT had lower mean total high-density lipoprotein (HDL) and HDL2, relative to premenopausal women. Subject to limited power, the authors' findings suggest that surgical menopause among middle-aged women does not lead to negative psychological outcomes but that BSO in the absence of hormone use has significant adverse effects on the HDL and HDL2.

Adaptation, Psychological↗

PubMed1995

Effects of a behavioral weight loss program stressing calorie restriction versus calorie plus fat restriction in obese individuals with NIDDM or a family history of diabetes.

OBJECTIVE: The aim of this randomized trial was to compare the effects of a behavioral intervention focusing on either calorie restriction alone or calorie plus fat restriction on weight loss and changes in lipids and glycemic control in individuals with non-insulin-dependent diabetes mellitus (NIDDM) or a family history of diabetes. RESEARCH DESIGN AND METHODS: We recruited 44 obese women with NIDDM and 46 obese women with a family history of NIDDM and randomly assigned these subjects to calorie restriction (CAL) or to calorie plus fat restriction (CAL + FAT). All subjects participated in a 16-week behavioral weight loss program, with training in diet, exercise, and behavior modification. Subjects assigned to the CAL condition were given a 1,000-1,500 kcal/day goal and self-monitored calories consumed. Subjects assigned to the CAL+FAT condition had the same calorie goal, but were also given a fat goal (grams of fat/day), to produce a diet with < 20% of calories from fat; this group monitored both calories and fat grams. RESULTS: Among NIDDM subjects, weight loss of the subjects in the CAL+FAT condition was significantly greater than subjects in the CAL condition (7.7 vs. 4.6 kg) and the CAL+FAT condition group also maintained their weight loss better at the 1-year follow-up (5.2 vs. 1.0 kg). Significant decreases in glucose, high-density lipoprotein (HDL) cholesterol, and total cholesterol were seen after 16 weeks of treatment among NIDDM subjects; these changes were similar in CAL and CAL+FAT groups, but a greater proportion of subjects in CAL condition required oral hypoglycemic medication. At the 1-year follow-up, all parameters had returned to baseline. No significant differences in weight loss or physiological changes were seen between CAL and CAL+FAT conditions in subjects with a family history of diabetes. CONCLUSIONS: These results suggest that using the combination of calorie and fat restriction may help promote weight loss in obese NIDDM patients. No other long-term benefits of this regimen were observed.

Behavior Therapy↗

PubMed1995

Effect of modest weight loss on changes in cardiovascular risk factors: are there differences between men and women or between weight loss and maintenance?

The aim of this work was to determine whether the effects of weight loss on coronary heart disease (CHD) risk factors are comparable in men and women and whether the long term impact of modest weight loss is as great as the initial response. Changes in CHD risk factors were examined at 6 month intervals in 159 moderately overweight subjects who were participating in an 18 month behavioral weight loss program. Men experienced greater decreases in blood pressure, triglycerides, and waist-to-hip ratio (WHR) and greater increases in HDL-cholesterol with weight loss than women. Most of these gender differences were removed by adjusting for baseline values and changes in BMI. After these adjustments, improvements in WHR at 18 months were shown to be greater in women than in men. Participants (n = 39) who lost 4.5 kg or more from baseline to 6 months (mean weight loss of 11.8 kg or 13% of initial body weight) and maintained this weight loss within +/- 2.3 kg had significant long term improvements (through 18 months) in triglycerides, HDL and LDL-cholesterol, WHR, systolic and diastolic blood pressure, and fasting and 2 h insulin. Changes in HDL-cholesterol, the HDL:Total cholesterol ratio, and WHR actually increased between 6 and 18 months and improvements in all other parameters were maintained over time. Men have greater improvements in CHD risk factors with weight loss than women, but this gender difference appears to derive from differences in CHD risk factors at baseline and differences in weight loss.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Cognitive effects of ketogenic weight-reducing diets.

OBJECTIVE: To determine whether ketogenic weight reducing diets have adverse effects on cognitive performance. SUBJECTS: 21 overweight women (mean BMI = 41 kg/m2). DESIGN: Randomized double-blinded study. METHOD: Subjects were randomized to ketogenic or nonketogenic liquid formula very low energy diets, that were comparable in energy and in protein content. Subjects remained on the diet for 28 days and were reevaluated periodically with brief measures of cognitive performance assessing attention and mental flexibility. RESULTS: Weight losses were comparable on the two diets (Mean = 8.1 kg). Performance on attention tasks did not differ as a function of the diet. However, performance on the trail making task, a neuropsychological test that requires higher order mental processing and flexibility, was adversely affected by the ketogenic diet. The worsening in performance was observed primarily between baseline and week one of the ketogenic diet. CONCLUSIONS: Further research is needed to confirm this finding and to determine whether ketogenic diets negatively affect other complex mental tasks, such as problem solving.

Adult↗

PubMed1995

Prescribing exercise in multiple short bouts versus one continuous bout: effects on adherence, cardiorespiratory fitness, and weight loss in overweight women.

OBJECTIVE: To investigate whether prescribing exercise in several short-bouts versus one long-bout per day would enhance exercise adherence, cardiorespiratory fitness, and weight loss in overweight adult females in a behavioral weight control program. DESIGN: Randomized controlled trial with subjects randomized to either a short-bout exercise group (SB, n = 28, age = 40.4 +/- 5.9 yrs) or a long-bout exercise group (LB, n = 28, age = 40.9 +/- 7.3 yrs), with subjects followed for a period of 20 weeks. Both groups were instructed to exercise 5 days per week with exercise duration progressing from 20 to 40 min per day. The LB group performed one exercise bout per day, whereas the SB group performed multiple 10 min bouts of exercise per day. The recommended caloric intake for all subjects was 5022-6277 kJ/day (1200-1500 kcal/day), with fat reduced to 20% of caloric intake. SUBJECTS: Fifty-six obese, sedentary females (BMI = 33.9 +/- 4.1 kg/m2). MEASUREMENTS: Exercise participation was assessed from self-reported diaries and Tri-Trac Accelerometers. Cardiorespiratory fitness was assessed using a submaximal cycle ergometer test. RESULTS: Exercising in multiple short-bouts per day improved adherence to exercise: the SB group reported exercising on a greater number of days (mean +/- s.d. = 87.3 +/- 29.5 days vs 69.1 +/- 28.9 days; P < 0.05) and for a greater total duration (223.8 +/- 69.5 min/week vs 188.2 +/- 58.4 min/week; P = 0.08) than the LB group. Predicted VO2Peak increased by 5.6% and 5.0% for the LB and SB groups, respectively (P < 0.05). There was a trend for the weight loss to be greater in the SB group (-8.9 +/- 5.3 kg) compared to the LB group (-6.4 +/- 4.5 kg; P < 0.07). CONCLUSION: These results suggest that short-bouts of exercise may enhance exercise adherence. Short-bouts of exercise may also enhance weight loss and produce similar changes in cardiorespiratory fitness when compared to long-bouts of exercise. Thus, short-bouts of exercise may be preferred when prescribing exercise to obese adults.

Adult↗