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Biomedical subjects

T A Wadden

Publications and source records attributed to T A Wadden.

At least 19 recordsLinked to original sources
PubMed2004

The influence of the stigma of obesity on overweight individuals.

OBJECTIVE: To investigate the internalization of anti-fat bias among overweight individuals across a variety of attitudes and stereotypes. DESIGN: Two studies were conducted using the Implicit Association Test (IAT), a performance-based measure of bias, to examine beliefs among overweight individuals about 'fat people' vs 'thin people'. Study two also contained explicit measures of attitudes about obese people. SUBJECTS: Study 1 participants were 68 overweight patients at a treatment research clinic (60 women, 8 men; mean Body Mass Index (BMI) of 37.1+/-3.9 kg/m(2)). Study 2 involved 48 overweight participants (33 women, 15 men) with a BMI of 34.5+/-4.0 kg/m(2). RESULTS: Participants exhibited significant anti-fat bias on the IAT across several attributes and stereotypes. They also endorsed the explicit belief that fat people are lazier than thin people. CONCLUSION: Unlike other minority group members, overweight individuals do not appear to hold more favorable attitudes toward ingroup members. This ingroup devaluation has implications for changing the stigma of obesity and for understanding the psychosocial and even medical impact of obesity on those affected.

Adult↗
PubMed2001

Obese patients' perceptions of treatment outcomes and the factors that influence them.

BACKGROUND: Despite considerable professional consensus that modest weight losses of 5% to 10% are successful for reducing the comorbid conditions associated with obesity, obese patients often desire weight losses 2 to 3 times greater than this. Examining ways to reduce the disparities between treatment expectations and subsequent outcomes, this study evaluated the role of physical characteristics, treatment setting, and mood in patients' evaluations of treatment outcomes. METHODS: This study was conducted in a university outpatient weight loss clinic with a sample of 397 obese individuals seeking weight loss by a variety of modalities. Before treatment, participants' heights and weights were measured, and the Beck Depression Inventory and the Goals and Relative Weight Questionnaire were administered. RESULTS: Outcome evaluations ranged from 64.4 +/- 11.1 kg (mean +/- SD) for dream weight to 90.1 +/- 19.1 kg for disappointed weight. Initial body weight was the strongest predictor of disappointed, acceptable, and happy weights (beta =.90,.76, and.57, respectively). Sex (beta = -.37) and height (beta =.37) were the strongest determinants of dream weight. Heavier participants chose higher absolute weights, but the weight loss required to reach each of the outcomes was greater for heavier than for lighter patients. CONCLUSIONS: These data signal a therapeutic dilemma in which the amount of weight loss produced by the best behavioral and/or pharmacologic treatments is viewed as even less than disappointing. Patients with the highest pretreatment weights are likely to have the most unrealistic expectations for success.

Adult↗
PubMed2001

Benefits of lifestyle modification in the pharmacologic treatment of obesity: a randomized trial.

BACKGROUND: Weight loss medications are recommended as an adjunct to diet and exercise modification but seem to be prescribed as a monotherapy by many physicians. This practice is likely to be associated with suboptimal weight loss. METHODS: This 1-year, randomized trial compared the effects of sibutramine hydrochloride used alone (ie, the drug-alone group) to sibutramine plus group lifestyle modification, prescribed with either a 5021- to 6276-kJ/d diet (1200-1500-kcal/d diet) (ie, the drug-plus-lifestyle group) or, for the first 4 months, a 4184-kJ/d diet (1000-kcal/d diet (ie, drug-plus-lifestyle with a portion-controlled diet [the combined treatment] group). Participants were 53 women with a mean (+/-SD) age of 47.2 +/- 9.8 years and weight of 101.3 +/- 9.7 kg. At baseline, they reported the number of pounds they expected to lose at the end of treatment. RESULTS: At month 12, patients treated with the drug alone lost (mean +/- SD) 4.1% +/- 6.3% of their initial body weight compared with significantly (P<.05) larger losses in the drug-plus-lifestyle group of 10.8% +/- 10.3% and the combined treatment group of 16.5% +/- 8.0%. Women in the 2 lifestyle groups achieved a significantly (P<.05) greater percentage of their expected weight loss than those in the drug-alone group and were significantly more satisfied with the medication and with changes in weight, health, appearance, and self-esteem (P<.05 for all). Significant reductions were observed at 12 months in triglyceride and low-density lipoprotein cholesterol levels but systolic and diastolic blood pressure both increased significantly (P<.05 for all). CONCLUSION: The addition of group lifestyle modification to the pharmacologic management of obesity significantly improved weight loss and patients' satisfaction with treatment outcome.

Adult↗
PubMed2001

Psychosocial aspects of obesity and obesity surgery.

There is a growing consensus that bariatric surgery is the treatment of choice for extremely obese individuals who have failed to reduce their weight satisfactorily using behavioral or pharmacologic interventions. The gastric bypass in particular is associated with excellent long-term weight loss. Although most extremely obese individuals will have essentially normal psychological functioning, a significant minority suffer from depression, binge eating, trauma, or other emotional complications that may require treatment before or after bariatric surgery. A structured behavioral assessment, conducted by a mental-health professional and a registered dietitian, can readily identify those who are most likely to require adjunct counseling.

Adult↗
PubMed2000

Behavioral treatment of obesity.

The behavioral treatment of obesity consists of a set of principles and techniques to help overweight individuals modify inappropriate eating and activity habits. As provided in University and hospital clinics, this approach produces an average loss of 8.5 kg (9% of initial weight) in approximately 20 weeks. The maintenance of weight loss is facilitated by the provision of long-term patient-provider contact as well as by the use of weight-loss medications. The most promising results are likely to be obtained when behavioral and pharmacologic approaches are combined. The article concludes with a discussion of the importance of treating obese individuals with respect and compassion.

Adult↗
PubMed2000

Effects of sibutramine plus orlistat in obese women following 1 year of treatment by sibutramine alone: a placebo-controlled trial.

OBJECTIVE: This study assessed whether adding orlistat to sibutramine would induce further weight loss in patients who previously had lost weight while taking sibutramine alone. RESEARCH METHODS AND PROCEDURES: Patients were 34 women with a mean age of 44.1 +/- 10.4 years, weight of 89.4 +/- 13.8 kg, and body mass index (BMI) of 33.9 +/- 4.9 kg/m2 who had lost an average of 11.6 +/- 9.2% of initial weight during the prior 1 year of treatment by sibutramine combined with lifestyle modification. Patients were randomly assigned, in double-blind fashion, to sibutramine plus orlistat or sibutramine plus placebo. In addition to medication, participants were provided five brief lifestyle modification visits during the 16-week continuation trial. RESULTS: Mean body weight did not change significantly in either treatment condition during the 16 weeks. The addition of orlistat to sibutramine did not induce further weight loss as compared with treatment by sibutramine alone (mean changes = +0.1 +/- 4.1 kg vs. +0.5 +/- 2.1 kg, respectively). DISCUSSION: These results must be interpreted with caution because of the study's small sample size. The findings, however, suggest that the combination of sibutramine and orlistat is unlikely to have additive effects that will yield mean losses > or =15% of initial weight, as desired by many obese individuals.

Adult↗
PubMed1999

Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial.

CONTEXT: Physical inactivity contributes to weight gain, but only 22% of Americans are regularly active. OBJECTIVE: To examine short- and long-term changes in weight, body composition, and cardiovascular risk profiles produced by diet combined with either structured aerobic exercise or moderate-intensity lifestyle activity. DESIGN: Sixteen-week randomized controlled trial with 1-year follow-up, conducted from August 1995 to December 1996. PARTICIPANTS AND SETTING: Forty obese women (mean body mass index [weight in kilograms divided by the square of height in meters], 32.9 kg/m2; mean weight, 89.2 kg) with a mean age of 42.9 years (range, 21-60 years) seen in a university-based weight management program. INTERVENTIONS: Structured aerobic exercise or moderate lifestyle activity; low-fat diet of about 1200 kcal/d. MAIN OUTCOME MEASURES: Changes in body weight, body composition, cardiovascular risk profiles, and physical fitness at 16 weeks and at 1 year. RESULTS: Mean (SD) weight losses during the 16-week treatment program were 8.3 (3.8) kg for the aerobic group and 7.9 (4.2) kg for the lifestyle group (within groups, P<.001; between groups, P = .08). The aerobic group lost significantly less fat-free mass (0.5 [1.3] kg) than the lifestyle group (1.4 [1.3] kg; P = .03). During the 1-year follow-up, the aerobic group regained 1.6 [5.5] kg, while the lifestyle group regained 0.08 (4.6) kg. At week 16, serum triglyceride levels and total cholesterol levels were reduced significantly (P<.001) from baseline (16.3% and 10.1% reductions, respectively) but did not differ significantly between groups and were not different from baseline or between groups at week 68. CONCLUSIONS: A program of diet plus lifestyle activity may offer similar health benefits and be a suitable alternative to diet plus structured aerobic activity for obese women.

Adult↗
PubMed1999

Two-year changes in lipids and lipoproteins associated with the maintenance of a 5% to 10% reduction in initial weight: some findings and some questions.

OBJECTIVE: This study assessed whether a 5% to 10% reduction in initial weight would be associated with as favorable long-term (i.e., 100 weeks) changes in lipids and lipoproteins, as have been observed on a short-term basis (i.e., 8 weeks). RESEARCH METHODS AND PROCEDURES: This was a prospective evaluation of 25 obese women, each of whom had lost > or =5% of initial weight during 48 weeks of treatment and had maintained a weight loss of this magnitude at 1-year follow-up (week 100). Lipids and lipoproteins were obtained at baseline and at weeks 8, 24, 48, and 100. All participants had a baseline total cholesterol > or =5.17 mmol/L (200 mg/dL). RESULTS: At the end of the first 8 weeks, weight fell an average of 11.7+/-2.8%, total cholesterol 20.6+/-7.5%, low-density-lipoprotein (LDL) cholesterol 23.0+/-18.1%, and triglycerides 26.0+/-20.1%. At week 48, weight had fallen to 20.1+/-7.0% below baseline, but total cholesterol and LDL cholesterol were reduced only 11.5+/-10.4% and 12.0+/-14.0% below baseline, respectively. These latter reductions were significantly (p<0.05) smaller than those observed at week 8, despite the larger weight loss at week 48. High-density-lipoprotein cholesterol declined significantly (p<0.05) during the first 8 weeks, but returned to baseline values by week 24. Patients gained 7.4+/-7.4 kg from weeks 48 to 100, during which time total and LDL cholesterol (but not triglycerides) rose significantly (p<0.05). Patients who, at week 100, maintained losses >10% of initial weight had significantly greater reductions in total and LDL cholesterol values than did patients who maintained losses of only 5% to 10% of initial weight. DISCUSSION: Results of this study underscore the importance of assessing long-term changes in weight-related health complications when patients have lost weight but are no longer dieting (and exercising) as aggressively as they did during the initial months of treatment.

Adult↗
PubMed1999

Behavioural treatment of the overweight patient.

The goal of obesity treatment has changed significantly in the past decade. Where once the goal was a reduction to ideal weight, the current objective is the achievement of a healthier weight. For many obese individuals, this means losing as little as 5-15% of their initial weight. This article briefly describes behavioural methods to help obese individuals modify their eating and activity habits in order to achieve these new goals. A review of recent studies shows that patients treated by a comprehensive group behavioural programme lose approximately 9% of their initial weight in 20 weeks and, without further treatment, maintain a loss of 5% 1 year later. Methods of improving the maintenance of weight loss include increasing physical activity, extending the length of behavioural treatment and, with appropriately selected individuals, combining behavioural and pharmacological interventions. The importance of helping obese individuals adopt realistic treatment expectations is also discussed.

Anti-Obesity Agents↗
PubMed1999

The treatment of obesity: what's new, what's recommended.

The prevalence of obesity in the United States has increased, with approximately one third of American men and women considered obese. Obese individuals who seek weight reduction frequently lose weight with the goal of returning to their ideal body weight. For the majority of obese persons, however, reaching their ideal body weight is an unattainable goal, few people are able to maintain even more modest weight losses over the long term. The result is that many obese persons end up feeling frustrated, if not defeated, by their weight loss efforts. Recent weight loss treatment recommendations have focused on helping patients lose 5%-10% of their body weight and maintaining these losses for longer durations. These more modest losses frequently are associated with reductions in obesity-related comorbidities and improvements in psychological status. The practitioner assisting obese individuals with weight reduction is presented with a variety of treatment options, including behavioral programs, pharmacotherapy, and low-calorie diets. Each of these approaches has been shown to be effective in producing the 5%-10% weight losses now recommended. A combination of these approaches, such as the use of pharmacotherapy with a behavioral modification program, ultimately may prove to be the most effective treatment for obese persons. We review the new weight loss recommendations and provide suggestions for assessing patients for weight loss treatment. We also discuss both existing and new treatment options and focus on their application in a primary care setting.

Anti-Obesity Agents↗
PubMed1999

Changes in resting energy expenditure after weight loss in obese African American and white women.

BACKGROUND: Previous studies showed that resting energy expenditure (REE) is lower in obese African American women than in obese white women. It is unknown, however, whether there are racial differences in how REE responds to weight loss and energy restriction. OBJECTIVE: We assessed REE, body composition, and respiratory quotient before and after weight loss in obese black and white women. DESIGN: We measured REE by indirect calorimetry and body composition by densitometry before and after 20-24 wk of treatment with a 3870-4289-kJ/d diet. Subjects were 109 obese females (24 black, 85 white) with a mean (+/-SD) body mass index (in kg/m2) of 36.3+/-5.0, weight of 95.7+/-12.6 kg, and age of 42.3+/-8.1 y. RESULTS: Before treatment, REE, adjusted for body composition, was significantly lower in black than in white subjects (P = 0.001). Black subjects lost significantly less weight during treatment than did white subjects (13.4+/-5.9 kg or 14.2+/-5.7% compared with 16.4+/-5.6 kg or 17.0+/-5.7%, respectively; P = 0.04). Analyses that controlled for initial REE and changes in fat mass and fat-free mass showed that blacks had significantly greater decreases in REE after treatment than did whites (9.9+/-7.3% compared with 6.3+/-7.4%; P = 0.02). CONCLUSION: This study suggests that weight loss results in greater reductions in REE in obese black women than in obese white women. These data underscore the need to consider both biological and behavioral factors when setting expectations and assessing outcomes for obesity treatment in African American women.

Adult↗
PubMed1999

Adult psychological functioning of individuals born with craniofacial anomalies.

This study represents an initial investigation into the adult psychological functioning of individuals born with craniofacial disfigurement. A total of 24 men and women born with a craniofacial anomaly completed paper and pencil measures of body image dissatisfaction, self-esteem, quality of life, and experiences of discrimination. An age- and gender-matched control group of 24 non-facially disfigured adults also completed the measures. As expected, craniofacially disfigured adults reported greater dissatisfaction with their facial appearance than did the control group. Craniofacially disfigured adults also reported significantly lower levels of self-esteem and quality of life. Dissatisfaction with facial appearance, self-esteem, and quality of life were related to self-ratings of physical attractiveness. More than one-third of craniofacially disfigured adults (38 percent) reported experiences of discrimination in employment or social settings. Among disfigured adults, psychological functioning was not related to number of surgeries, although the degree of residual facial deformity was related to increased dissatisfaction with facial appearance and greater experiences of discrimination. Results suggest that adults who were born with craniofacial disfigurement, as compared with non-facially disfigured adults, experience greater dissatisfaction with facial appearance and lower self-esteem and quality of life; however, these experiences do not seem to be universal.

Adult↗
PubMed1998

A comparison of two approaches to the assessment of binge eating in obesity.

OBJECTIVE: To compare two different methods of assessing binge eating in a sample of 128 obese women enrolled in a weight loss protocol. METHOD: Prior to treatment, participants completed the Binge Eating Scale (BES) and the Questionnaire on Eating and Weight Patterns (QEWP), as well as measures of other relevant constructs. They were then classified as bingers and nonbingers by each method and chance-corrected agreement was calculated. RESULTS: The BES and QEWP identified a small and nearly equal number of subjects as having significant binge eating, but there was only modest overlap between the two groups (kappa of .45). Subgroup comparisons revealed fundamental differences between the BES and QEWP in the assessment of the critical and associated features of binge eating. DISCUSSION: The relative merits of these two approaches to classifying binge eaters and implications for the design of new methods are discussed.

Adult↗
PubMed1998

The fen-phen finale: a study of weight loss and valvular heart disease.

OBJECTIVE: To assess weight loss, as well as the prevalence of valvular heart disease, in 21 obese women who completed 2 years of treatment by fenfluramine and phentermine (fen-phen) in June 1997. RESEARCH METHODS AND PROCEDURES: Patients were 21 of 22 women who had completed a 1-year, open-label trial of fen-phen combined with lifestyle modification. This study describes the results of a second year of treatment. The presence of valvular heart disease, defined as aortic regurgitation of mild or greater severity and/or mitral regurgitation of moderate or greater severity, was assessed using two-dimensional, color Doppler and pulsed- and continuous-wave Doppler examinations. RESULTS: At 2 years, the 21 patients had a mean reduction in initial weight of 13.9 + 10.0%, which was significantly (p<0.001) smaller than their 1-year loss of 17.1 +/- 8.7%. Nine of 21 patients reported that they took fen-phen irregularly during the last 4 months of the study because of fears of developing health complications. These nine patients had a 2-year weight loss of 8.7 +/- 7.5%, compared with a significantly (p<0.04) larger loss of 17.6 +/- 10.5% for participants who reported taking medication regularly. Six of 20 (30%) patients met criteria for valvular heart disease. None of the six had signs or symptoms of this condition. DISCUSSION: Fenfluramine was withdrawn from the market on September 15, 1997 because of concerns that it was associated with valvular heart disease. The present findings are discussed in terms of the potentially favorable long-term benefits of combining lifestyle modification with weight loss medications that are both safe and effective.

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