Biomedical subjects

T A Wadden

Publications and source records attributed to T A Wadden.

At least 37 records · Page 2Linked to original sources

PubMed1998

The psychology of cosmetic surgery: a review and reconceptualization.

This article discusses the psychology of cosmetic surgery. A review of the research on the psychological characteristics of individuals who seek cosmetic surgery yielded contradictory findings. Interview-based investigations revealed high levels of psychopathology in cosmetic surgery patients, whereas studies that used standardized measurements reported far less disturbance. It is difficult to fully resolve the discrepancy between these two sets of findings. We believe that investigating the construct of body image in cosmetic surgery patients will yield more useful findings. Thus, we propose a model of the relationship between body image dissatisfaction and cosmetic surgery and outline a research agenda based upon the model. Such research will generate information that is useful to the medical and mental health communities and, ultimately, the patients themselves.

Body Image↗

PubMed1998

Exercise and the maintenance of weight loss: 1-year follow-up of a controlled clinical trial.

This study reports results 1 year after treatment for 77 obese women who had been treated for 48 weeks by diet combined with supervised (a) aerobic exercise, (b) strength training, (c) aerobic plus strength training combined, or (d) no exercise. Mean (+/- SD) end-of-treatment weight losses for the 4 conditions ranged from 13.5 +/- 9.1 kg to 17.3 +/- 10.3 kg, but there were no statistically significant differences among groups. Participants in all 4 conditions regained approximately 35% to 55% of their weight loss in the year after treatment; again, there were no significant differences among groups. Participants, however, who reported exercising regularly in the 4 months preceding the follow-up assessment regained significantly less weight than did nonexercisers.

Adult↗

PubMed1998

Assessment of body image dissatisfaction in obese women: specificity, severity, and clinical significance.

This study assessed the specificity, severity, and clinical significance of body image dissatisfaction in 79 obese women using the Body Dysmorphic Disorder Examination--Self-Report (J. C. Rosen & J. Reiter, 1996). The vast majority of obese women demonstrated body image dissatisfaction related to their obesity, with almost half reporting the greatest dissatisfaction with their waist or abdomen. On average, they reported significantly more body image dissatisfaction than did 43 nonobese controls. The 2 groups did not differ on self-reported symptoms of depression or self-esteem. Body image dissatisfaction correlated significantly with reports of depressive symptoms and lower self-esteem but was not correlated with body mass index. Results are discussed in terms of the role of body image dissatisfaction in understanding and treating obese individuals.

Adult↗

PubMed1998

The Eating Inventory in obese women: clinical correlates and relationship to weight loss.

OBJECTIVES: Describe the physical and psychological correlates of the Eating Inventory (EI) (also known as the Three-Factor Eating Questionnaire) factors in an obese sample, and determine the relationship between the three EI factors and weight loss. DESIGN: Consecutive series of obese women enrolled between 1987 and 1996 in clinical trials of weight loss treatments. PARTICIPANTS: 223 obese women with a weight of 100.7 +/- 15.5 kg, an age of 41.4 +/- 8.8 y and a body mass index (BMI) of 37.2 +/- 5.6 kg/m2. MEASURES: The EI and a variety of physical (weight, body composition and resting energy expenditure) and psychological (mood and binge eating) measures were assessed before and after 5-6 months of treatment. RESULTS: Before treatment, higher restraint scores were associated with lower body weights (P = 0.02), while higher disinhibition scores were associated with greater binge eating severity (P<0.0001). Weight loss treatment was associated with significant increases in restraint and decreases in disinhibition and hunger (all Ps<0.0001). Greater increases in restraint during treatment were associated with larger weight losses (P<0.0001). CONCLUSIONS: The three factors of the EI showed clinical utility in a sample of women receiving treatment for obesity.

Adult↗

PubMed1998

Stigmatization of obesity in medieval times: Asia and Europe.

OBJECTIVE: To describe the stigmatization of obesity in medieval times in Asia and in Europe. DESIGN: Literature review. RESULTS: Obesity was stigmatized in medieval Japan in part, at least, because it was viewed as the karmic consequence of a moral failing in a Buddhist context. The stigma in Europe was based on the Christian deadly sin of gluttony. CONCLUSION: Stigmatization of obesity is not new. It was foreshadowed centuries ago by attitudes deriving from then extant theories of the origins of obesity.

Asia↗

PubMed1998

Body image concerns of reconstructive surgery patients: an underrecognized problem.

This study assessed the body image concerns of reconstructive plastic surgery patients. Forty-three reconstructive surgery patients completed two measures of body image. Responses were compared with a group of patients seeking cosmetic procedures. The two groups did not differ in the degree of dissatisfaction with their overall appearance or dissatisfaction with the specific feature for which they were seeking surgery. Reconstructive patients did consider themselves less healthy and less invested in their appearance than did cosmetic patients. Seven of the reconstructive surgery patients (all scar revision patients) reported a level of dissatisfaction and preoccupation consistent with the psychiatric diagnostic of body dysmorphic disorder. These results underscore the importance of screening for body image dissatisfaction in persons with an objective deformity. Plastic surgeons are in an optimal position to identify body image concerns in these patients and provide appropriate referrals for psychotherapy.

Adult↗

PubMed1998

Effects of weight loss and exercise training on natural killer cell activity in obese women.

PURPOSE: The purposes of this study were two-fold: (1) to evaluate the effects of an 8-wk weight loss program on natural killer (NK) cell activity in obese women and 2) to determine whether an additional program of combined aerobic and resistance exercise training modified the effects of caloric restriction on immune function. METHODS: Twenty-two healthy obese women with a mean weight of 96.9 +/- 14 kg and age of 38 +/- 7 yr were randomly assigned to diet-alone (D) or diet-plus-exercise training (D + EX) conditions. Subjects consumed 950 kcal.d-1 using prepackaged portion-controlled foods. Subjects in the D + EX group participated 3 times.wk-1 in a supervised program of light-to moderate-intensity aerobic activity and resistance training. Data were analyzed using a repeated measures ANOVA. RESULTS: After 8 wk of treatment, body weight decreased significantly in both groups (10.8% in D vs 11.4% in D + EX), whereas absolute and relative VO2peak increased in only D + EX (12.3% in D vs 57.7% in D + EX). Both groups experienced significant decreases in peripheral blood leukocytes and lymphocytes, although cell numbers remained within clinically normal range at week 8. NK cell (CD56+) proportion was unchanged in both groups after weight loss. The proportion of peripheral mononuclear cells expressing the interleukin-2 receptor-alpha (IL-2R alpha) (CD25+) decreased significantly (25.2%) in D and was unchanged in D + EX, resulting in a significant difference between groups at week 8. NK cell cytotoxicity was suppressed in D and unchanged in D + EX after treatment. Changes in NK cell activity were significantly correlated with proportional changes in (CD25+) (r = 0.584, P = 0.022), but not CD56+. CONCLUSIONS: A combined program of light- to moderate-intensity aerobic and resistance exercise offsets the apparent decrement in NK cell activity associated with weight loss.

Adult↗

PubMed1998

Psychological investigations in cosmetic surgery: a look back and a look ahead.

This article reviews the history of psychological investigations of cosmetic surgery patients. These studies have been designed to address two fundamental questions: (1) Are there "patient types" or forms of psychopathology that serve as contraindications to cosmetic surgery? and (2) What is the likelihood of psychological change following cosmetic surgery? This review suggests that the research has not fully answered these questions. In response, we propose a new direction for psychological investigation, focusing on issues of body image in cosmetic surgery patients. We discuss the relationship between body image and cosmetic surgery and pose several relevant questions for future research.

Body Image↗

PubMed1998

Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients.

This study was the first empirical investigation of body image dissatisfaction and body dysmorphic disorder in cosmetic surgery patients. Of 132 women, 100 women (response rate, 76 percent) completed two body image measures prior to surgery, the Multidimensional Body-Self Relations Questionnaire and the Body Dysmorphic Disorder Examination Self-Report. Cosmetic surgery patients did not demonstrate greater dissatisfaction with their overall appearance compared with the reported normal values of the measures. However, when asked about the specific bodily feature they were considering for cosmetic surgery, they reported significantly greater dissatisfaction than a normative sample. In addition, 7 percent of the sample met diagnostic criteria for body dysmorphic disorder, a potential psychiatric contraindication to cosmetic surgery. Implications of these findings are discussed with respect to the nature of body image dissatisfaction and the prevalence of body dysmorphic disorder in cosmetic surgery populations.

Adult↗

PubMed1998

Bigger is not always better: body image dissatisfaction in breast reduction and breast augmentation patients.

This study investigated body image dissatisfaction in breast reduction and breast augmentation patients. Thirty breast reduction and 30 breast augmentation patients completed two body image measures preoperatively. Breast reduction patients reported greater dissatisfaction with their overall body image as compared with breast augmentation patients, part of which can be understood as a function of their increased body weight. When asked specifically about their breasts, reduction patients displayed increased body image dysphoria and maladaptive behavioral change, including embarrassment about their breasts in public areas and social settings and avoidance of physical activity. Results are discussed in the context of ideal body weight cutoffs by third-party payers for reimbursement for breast reduction. Recommendations for reimbursement criteria that de-emphasize the role of body weight are made.

Adult↗

PubMed1998

Short- and long-term changes in serum leptin dieting obese women: effects of caloric restriction and weight loss.

This study examined the effects of caloric restriction and weight loss on serum leptin concentrations in 49 obese women who participated in a 40-week weight loss program. During the first 12 weeks, half the subjects were provided a 1000 kcal/day low-calorie diet (LCD), compromised of portion-controlled foods, whereas the other half were prescribed a 1200 kcal/day balanced deficit diet (BDD) consisting of self-selected table foods. Thereafter, subjects in both conditions were instructed to consume approximately 1200-1800 kcal/day of self-selected foods, depending on their desired weight change. During the first 6 weeks, weight and serum leptin fell significantly more (P < 0.05) in women in the LCD condition than in the BDD condition. In the former group, the 55% reduction in baseline leptin was 10 times greater than the relative reduction in body weight. Stepwise multiple regression analysis revealed that degree of caloric restriction, but not weight loss, contribution significantly to the variance in the change in leptin at week 6. By contrast, long-term changes in leptin, when subjects had increased their calorie intake, were more strongly related to changes in weight and fat. At week 40, for example, weight loss account for 47% of the variance in the change in leptin. Serum leptin and body fat remained highly correlated after weight loss (r = 0.79, P < 0.001), as before (r = 0.66, P < 0.001). After treatment, however, we observed a greater-than-expected reduction in serum leptin concentrations, as expressed per kilogram of body fat. The significance of this finding remains to be determined.

Adipose Tissue↗

PubMed1997

A multicenter evaluation of a proprietary weight loss program for the treatment of marked obesity: a five-year follow-up.

OBJECTIVE: The traditional goal of obesity therapy has been the reduction of body weight to an ideal standard. Patient difficulties, however, in reaching this goal have led to a reassessment of weight loss criteria. The Institute of Medicine of the National Academy of Sciences recently proposed that successful long-term weight loss be defined as the reduction of initial weight by 5% or more and the maintenance of this loss for at least 1 year. The present study used these criteria to evaluate the long-term efficacy of a proprietary weight loss program. METHODS: Patients were 621 persons who had completed a 26-week weight loss program that included 12 weeks of treatment by a very-low-calorie diet. They were recruited from a total of 1,283 eligible persons who had been treated at 36 clinics nationwide. Clinics were randomly selected to participate. Patients' weights were determined in telephone interviews initially conducted 2 years after treatment and then at yearly intervals through 5 years of follow-up. RESULTS: At the end of treatment, men achieved a mean reduction in initial weight of 25.5 +/- 1% and women 22.6 +/- 1%. Subjects regained substantial amounts of weight by the 2-year follow-up but 77.5% of men and 59.9% of women still maintained losses of 5% or more of body weight. At the 3-year follow-up, 53% of the original sample (of 621 persons) maintained losses of 5% or more and 35% losses of 10% or more. These trends were apparent 4 and 5 years after treatment but the dwindling sample sizes prevented definitive assessments. DISCUSSION: The findings showed that a program of lifestyle modification combined with the brief use of a very-low-calorie diet was associated with successful weight control in a substantial portion of patients several years after treatment. Long-term weight losses of 5% or more of initial weight are likely to be associated with improvements in health complications.

Adult↗

PubMed1997

Resting energy expenditure in obese African American and Caucasian women.

The prevalence of obesity among African American women approaches 50% and greatly exceeds rates for Caucasian women. In addition, black women lose less weight than white during obesity treatment and gain more weight when untreated. This study assessed resting energy expenditure (REE) and body composition in obese white (n = 122) and black (n = 44) women to explore the relationship between biological variables and these observed differences. REE and body composition were assessed by indirect calorimetry and densitometry, respectively, before weight loss. REE was significantly lower in black subjects (1637.6 +/- 236.9 kcal/d) than in white (1731.4 +/- 262.0) (p = 0.04). REE remained significantly lower in blacks than whites after adjusting for body weight (p = 0.02). REE, adjusted for fat-free mass, was also significantly lower in blacks than whites (p < 0.0001), although the overestimation of fat-free mass by densitometry in blacks may have contributed to this finding. There were no differences between the groups in respiratory quotient. These results suggest that a decreased REE may exist in obese black women, and it may be related to the observed differences between black and white women in the prevalence of obesity and in the response to weight loss treatment. These cross-sectional findings await confirmation in longitudinal studies.

Adult↗

PubMed1997

Lifestyle modification in the pharmacologic treatment of obesity: a pilot investigation of a potential primary care approach.

This study examined a new method of providing brief, individual lifestyle modification to obese individuals treated by pharmacotherapy. Twenty-six women with a mean (+/- SD) age of 47.0 +/- 7.2 years, weight of 97.6 +/- 13.0 kg, and body mass index of 36.5 +/- 5.0 kg/m2 were prescribed 60 mg/d of fenfluramine and 15 mg/d of phentermine for one year. In addition, half of the women were randomly assigned to traditional group behavior modification, conducted by a nutritionist, which included 32 75-minute sessions during the year. The other half were provided lifestyle modification by a physician during 10 15-20 minute structured visits. All participants received identical treatment manuals and comparable assignments for behavior change. At the end of one year, patients in the physician group achieved the same highly successful weight losses as those treated by group behavior modification (13.9 +/- 9.6 kg vs. 15.4 +/- 7.9 kg, respectively). Treatment was associated with highly significant improvements in lipids and lipoproteins, as well as in mood and several measures of appetite. Weight loss the first four weeks, as well as patient completion of daily food records during the first 18 weeks, correlated positively with weight loss at weeks 18, 26, and 52. Results of this study await replication using larger samples but strongly suggest that effective lifestyle modification can be provided during brief, structured physician visits. The findings are discussed in terms of their implications for the treatment of obesity in primary care practice.

Adult↗

PubMed1997

Psychological effects of weight cycling in obese persons: a review and research agenda.

This review summarizes studies on the psychological effects of weight cycling (i.e., weight loss and regain) in obese persons and proposes an agenda for future research on this topic. Among general psychological constructs, the current literature suggests that weight cycling is not associated with depression, other psychopathology, or depressogenic cognitive styles. Weight cycling is associated with decreased perceptions of health and well-being, although the clinical significance of this relationship is uncertain. Among weight- and eating-related constructs, weight cycling does not appear to be related to restraint, hunger, or personality traits associated with eating disorders. Weight cycling, however, does appear to be associated with clinically significant reductions in eating self-efficacy and weak but consistent increases in binge eating severity. Definitive conclusions about the presence or absence of the psychological consequences of weight cycling are premature, given the small number of studies, as well as a variety of methodological and interpretive concerns. A new generation of research is necessary to determine the extent and nature of the psychological sequelae of weight cycling.

Eating↗

PubMed1997

Changes in bone mineral content in obese dieting women.

Significant reductions in total-body bone mineral density (BMD) have been reported in obese women who consume very-low-calorie diets. A reduction in bone mass is highly correlated with an increased risk of osteoporosis. The present study investigated whether strength training would prevent such reductions in dieters. Twenty-one healthy obese women weighing (mean +/- SD) 91.1 +/- 9 kg and aged 38 +/- 9 years were randomly assigned to receive either diet alone or diet plus resistance training. Both groups consumed a 925-kcal/d portion-controlled diet for the first 16 of 17 weeks and a 1,000 to 1,500-kcal/d balanced deficit diet thereafter. Bone mineral content (BMC), BMD, fat-free mass (FFM), and fat mass were measured with dual-energy x-ray absorptiometry (DEXA) before and after 24 weeks of dieting. No significant changes in total-body or lumbar spine BMC and BMD were observed in either condition at the end of treatment. However, both groups demonstrated a significant loss of both BMC and BMD in the femoral neck and greater trochanter. Diet plus resistance training was not associated with a significantly better outcome on either of these measures versus diet alone. The results suggest that increasing the energy content of very-low-calorie diets to 925 kcal/d may prevent the loss of total BMD, but not the loss from the femoral neck and greater trochanter. These findings raise a concern in light of the high frequency of dieting in American women.

Adult↗

PubMed1997

What is a reasonable weight loss? Patients' expectations and evaluations of obesity treatment outcomes.

Expert panels and governmental guidelines now recommend that obese persons seek modest (i.e., "reasonable") reductions in body weight rather than striving for "ideal" weights. Little is known, however, about patients' views of what is a "reasonable" weight loss. This study assessed patients' goals, expectations, and evaluations of various outcomes before, during, and after 48 weeks of treatment. Before treatment, 60 obese women (99.1 +/- 12.3 kg; body mass index of 36.3 +/- 4.3 kg/ m2) defined their goal weight and 4 other weights: "dream weight"; "happy weight"; "acceptable weight"; and "disappointed weight." Goal weight averaged a 32% reduction in body weight. A 17-kg weight loss was defined as disappointed; a 25-kg loss, was acceptable. After 48 weeks of treatment and a 16-kg weight loss, 47% of patients did not achieve even a disappointed weight. These data illustrate the dramatic disparity between patients' expectations and professional recommendations and the need to help patients accept more modest weight loss outcomes.

Adult↗

PubMed1997

Exercise in the treatment of obesity: effects of four interventions on body composition, resting energy expenditure, appetite, and mood.

This study investigated changes in body composition, resting energy expenditure (REE), appetite, and mood in 128 obese women who were randomly assigned to 1 of 4 treatment conditions: diet alone, diet plus aerobic training, diet plus strength training, or diet combined with aerobic and strength training (i.e., combined training). All women received the same 48-week group behavioral program and were prescribed the same diet. Exercising participants were provided 3 supervised exercise sessions per week for the first 28 weeks and 2 sessions weekly thereafter. Participants across the 4 conditions achieved a mean weight loss of 16.5 +/- 6.8 kg at Week 24, which decreased to 15.1 +/- 8.4 kg at Week 48. There were no significant differences among conditions at any time in changes in weight or body composition. Women who received aerobic training displayed significantly smaller reductions in REE at Week 24 than did those who received strength training. There were no other significant differences among conditions at any time on this variable or in changes in appetite and mood.

Adult↗