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PubMed1997

Motivational interviewing to improve adherence to a behavioral weight-control program for older obese women with NIDDM. A pilot study.

OBJECTIVE: The aim of this randomized pilot study was to examine whether the addition of motivational interviewing strategies to a behavioral obesity intervention enhances adherence and glucose control in older obese women with NIDDM. RESEARCH DESIGN AND METHODS: Twenty-two older obese women (41% black) with NIDDM were randomly assigned to 1) a standard 16-week group behavioral weight-control program that provided instruction in diet, exercise, and behavioral modification or 2) the same group behavioral program with three individualized motivational interviewing sessions added. RESULTS: The motivational group attended significantly more group meetings (13.3 vs. 8.9), completed significantly more food diaries (15.2 vs. 10.1), and recorded blood glucose significantly more often (46.0 vs. 32.2 days) than the standard group. Further, participants in the motivational group had significantly better glucose control post-treatment (9.8 vs. 10.8%). Although both groups demonstrated significant weight loss, no differences were apparent between groups. CONCLUSIONS: These results suggest that augmenting a standard behavioral treatment program for obese women with NIDDM with a motivational interviewing component may significantly enhance adherence to program recommendations and glycemic control. Preliminary data warrant further investigation with larger samples and a longer follow-up.

Behavior Therapy↗
PubMed2002

Active insulin infusion using optimal and derivative-weighted control.

Close control of blood glucose levels significantly reduces vascular complications in Type I diabetes. A control method for the automation of insulin infusion that utilizes emerging technologies in blood glucose biosensors is presented. The controller developed provides tighter, more optimal control of blood glucose levels, while accounting for variation in patient response, insulin employed and sensor bandwidth. Particular emphasis is placed on controller simplicity and robustness necessary for medical devices and implants.A PD controller with heavy emphasis on the derivative term is found to outperform the typically used proportional-weighted controllers in glucose tolerance and multi-meal tests. Simulation results show reductions of over 50% in the magnitude and duration of blood glucose excursions from basal levels. A closed-form steady state optimal solution is also developed as a benchmark, and results in a flat glucose response. The impact and trade-offs associated with sensor bandwidth, sensor lag and proportional versus derivative-based control methods are illustrated. Overall, emerging blood glucose sensor technologies that enable frequent measurement are shown to enable more effective, automated control of blood glucose levels within a tight, acceptable range for Type I and II diabetic individuals.

Blood Glucose↗
PubMed1994

Factors associated with weight control in older adults.

Dieting behaviors in a sample of 183 overweight older adults were studied to assess how they were influenced by six cognitive, behavioral, emotional, and social variables. Membership in a weight control program was also evaluated to assess whether it affected these relationships. Responses indicated that reports of high quality dieting behaviors were associated with higher levels of depression and less effective coping skills. Dieting behaviors among subjects who were participants in weight loss programs were not as strongly associated with less effective coping skills, but were associated with external health locus-of-control. The degree of social support had a limited impact on dieting behaviors, while measures of optimism and health status were unrelated to dieting behaviors. We concluded that older adults, especially those who diet independently, are likely to experience significant stress associated with weight loss efforts. Weight loss programs for older adults might produce better outcomes if they focus on reducing depression and stress associated with dieting.

Adaptation, Psychological↗
PubMed2005

Adherence across behavioral domains in treatment promoting smoking cessation plus weight control.

The authors tested whether adherence to simultaneous health behavior changes was unitary or domain specific among 76 women who modified smoking, eating, and physical activity to accomplish smoking cessation plus weight control. Random-effects regression analyses showed that adherence to both smoking and diet plans declined linearly and covaried positively; their association tended to grow stronger over time. In contrast, physical activity plan adherence did not change over time and was unrelated to other domains. At the end of treatment, 65%, 30.5%, and 25% adhered well or excellently to smoking, diet, and activity treatments, respectively. Findings support both unitary and domain-specific aspects of adherence and suggest that among smokers, smoking and eating behaviors may have similarities unshared by physical activity.

Adult↗
PubMed1998

Weight control during the holidays: highly consistent self-monitoring as a potentially useful coping mechanism.

The study examined the extent to which trait self-monitoring (the systematic observation and recording of target behaviors) was related to weight control during the high-risk holiday season. The participants (32 women, 6 men) averaged 223.1 lbs (101.41 kg), 57.2% overweight, 50.2 weeks of participation, and 21.3 lbs (9.68 kg) lost at the beginning of the study. Consistency of self-monitoring and weight changes were assessed for 3 holiday versus 7 nonholiday weeks. Analyses of variance (Consistency of Self-Monitoring Groups x Holiday/Nonholiday Weeks) revealed that participants gained 500% more weight per week during holiday compared with nonholiday weeks. Only participants in the most consistent self-monitoring quartile averaged any weight loss over the 10 weeks of the study and during the holiday weeks.

Adaptation, Psychological↗
PubMed2004

Efficacy of lifestyle modification for long-term weight control.

A comprehensive program of lifestyle modification induces loss of approximately 10% of initial weight in 16 to 26 weeks, as revealed by a review of recent randomized controlled trials, including the Diabetes Prevention Program. Long-term weight control is facilitated by continued patient-therapist contact, whether provided in person or by telephone, mail, or e-mail. High levels of physical activity and the consumption of low-calorie, portion-controlled meals, including liquid meal replacements, can also help maintain weight loss. Additional studies are needed of the effects of macronutrient content (e.g., low-fat vs. low-carbohydrate diets) on long-term changes in weight and health. Research also is needed on effective methods of providing comprehensive weight loss control to the millions of Americans who need it.

Behavior Therapy↗
PubMed1992

Long-term weight control study. I (weeks 0 to 34). The enhancement of behavior modification, caloric restriction, and exercise by fenfluramine plus phentermine versus placebo.

To investigate the value of anorexiant medications as an adjunct to other forms of weight control therapy, we studied 121 people in a 34-week, double-blind clinical trial of 60 mg extended-release fenfluramine plus 15 mg phentermine resin versus placebo added to behavior modification, caloric restriction, and exercise. Participants weighed 130% to 180% (154% +/- 1.2%, mean +/- SEM) of ideal body weight (1983 Metropolitan Life tables) and were in good health. By week 34, participants receiving active medication lost an average of 14.2 +/- 0.9 kg, or 15.9% +/- 0.9% of initial weight (n = 58), versus a loss of 4.6 +/- 0.8 kg or 4.9% +/- 0.9% of initial weight by subjects taking placebo (n = 54; p less than 0.001). On visual analog scales, participants rated fenfluramine plus phentermine as more helpful than placebo (50.3 +/- 0.5 versus 20.3 +/- 0.3) and not bothersome (fenfluramine plus phentermine, 17.4 +/- 0.3 versus 13.5 +/- 0.2). Blood pressure decreased and pulse remained unchanged in both groups. Dry mouth was the most common adverse effect in subjects receiving fenfluramine plus phentermine; all adverse effects decreased after 4 weeks. Only nine participants left the study in the first 34 weeks. Two subjects from each group left the study as a result of adverse effects. Overall, fenfluramine plus phentermine used in conjunction with behavior modification, caloric restriction, and exercise aided weight loss and continued to be efficacious for 34 weeks.

Adult↗
PubMed1982

Focus on health. Part 2: holistic weight control.

The success of the holistic self-care approach rests with the nurse's and client's commitments to tailoring a new lifestyle which includes permanent weight control. One year of counseling is only a beginning; but the wealth of new-found information that the client can discover about self can be the motivation to continue one day at a time. The only "never" that the client is encouraged to say is, "I'll never go on a diet again." Going on a diet means that one will eventually go off of it. Instead the client is assisted in changing lifestyle by developing different behaviors that will include healthier responses. Nursing implications (integrated throughout this article) include multiple skills, a solid knowledge base, and expert communication skills. Until the nurse experiences or at least simulates the experiences of the yo-yo dieter, he/she cannot be an effective counselor. Unless the nurse practices a self-care approach in his/her life, hypocritical "nursing care" is being practiced. And finally, the nurse must be willing to make a longitudinal commitment to his/her client if the holistic, self-care approach is used. If you as a nurse have these qualifications and choose to adopt the approach, you, as well as the client, will receive rewards and insights about yourself both as nurse and human being.

Behavior Therapy↗
PubMed1987

Disordered eating and weight control behaviors among male and female university students.

The purposes of this study were to develop an instrument capable of assessing factors potentially related to disordered eating and weight control behaviors among university students and then to compare male and female students on these factors. A 90 item instrument was developed. Sixty-four items were written by these authors, such that eight items would assess each of eight identified factors related to disordered eating. Additionally, all 26 items from the Eating Attitudes Test (EAT-26) were included and interspersed within the instrument. The instrument was administered to 502 female university students and their responses were factor analyzed. Ten factors were identified. The instrument was then administered to 94 female and 76 male university students. Results indicate that compared to males, females report a greater desire to be thin, less tolerance for cold, more frequent use of laxatives, and a greater occurrence of eating in response to internal and external cues. There were no other sex differences. The students in this study appeared to be engaging in appropriate health practices.

Adult↗
PubMed1983

Time-calorie displacement diet for weight control: a prospective evaluation of its adequacy for maintaining normal nutritional status.

An unsupplemented 1000 kcal (4186 kJ) diet emphasizing large quantities of unrefined complex carbohydrates was evaluated for nutritional adequacy in a 20-week weight-control program for obese adults. Assessment of nutritional status, routinely obtained upon admission, was repeated at approximately 10-week intervals on 26 patients who were losing weight while adhering to the dietary guidelines. At least one repeat assessment was obtained on all 26 patients: 13 had follow-up assessment at 10 weeks, three at 20 weeks, and ten at both 10 and 20 weeks. Weight loss averaged 0.7 kg/wk over an average of 15 weeks with a mean energy intake of 1020 kcal (4270 kJ), 55 percent of baseline. At each follow-up assessment mean skinfold thickness fell significantly whereas muscle mass was maintained according to arm muscle circumference and creatinine-height index. Mean blood levels of retinol, beta-carotene, folate, vitamin B12, ascorbic acid, thiamin, riboflavin, pyridoxine, iron, transferrin saturation and calcium excretion remained within normal limits throughout treatment. Ascorbic acid levels rose significantly. The results indicate that the experimental diet, without supplementation, can fulfil nutritional requirements while restricting energy intake for weight reduction.

Adult↗
PubMed1999

Intense sweeteners and energy density of foods: implications for weight control.

Energy density of foods, as opposed to their sugar or fat content, is said to be a key determinant of energy intakes. Recent laboratory studies have shown that, under ad lib conditions, subjects consume a constant weight or volume of food, so that their energy intakes depend on the energy density of the diet. Because low energy-density foods provide fewer calories per eating bout, they should-in theory-lead to reduced energy intakes and therefore weight loss. However, there is some question whether energy-dilute foods are as palatable as the more energy-dense foods. Generally high energy density equals high palatability and vice versa. Intense sweeteners represent an exception to the rule, since they maintain sweetness while reducing energy density. While many studies have explored the effects of intense sweeteners on short-term regulation of food intake, fewer studies have addressed the effectiveness of intense sweeteners in reducing energy density for weight control. Issues of energy density, palatability, and satiety, as applied to intense sweeteners are the topic of this review.

Body Weight↗
PubMed1985

What is behavior therapy? A very short description of behavioral weight control.

Behavior therapy of obesity is very widely used and is the subject of numerous reports in the medical literature. The background of this therapy is described and a table lists the 49 most commonly used elements of behavioral weight control as abstracted from five of the most widely read publications on the topic.

Behavior Therapy↗
PubMed2006

V.I.K. (Very Important Kids): a school-based program designed to reduce teasing and unhealthy weight-control behaviors.

The purpose of this study was to evaluate the feasibility and effectiveness of V.I.K. (Very Important Kids), a school-based, multi-component intervention designed to prevent teasing and unhealthy weight-control behaviors among fourth through sixth grade students. The effectiveness of the V.I.K. intervention was evaluated using a pre-post quasi-experimental design with one school assigned to each condition: intervention and assessment-only control. Data were collected at baseline and at 8-month post-test among 63 students at the intervention school and 57 students at the control school. The V.I.K. intervention included an after-school program, a theater program, school environment components and a family component. Process data suggest that the V.I.K. program can feasibly be implemented within a school setting and can effectively engage students, school staff and parents. Analysis of impact data revealed that the percentage of students reporting being teased decreased significantly in the intervention school relative to the control school, after controlling for baseline levels of teasing, body mass index z score and demographic factors (odds ratio = 0.22; 95% confidence interval = 0.06, 0.88; P = 0.03). These findings provide promising evidence that multi-component, school-based interventions may effectively reduce teasing in elementary schools. Future research of interventions aimed at preventing teasing using a larger sample of schools is warranted.

Aggression↗
PubMed1999

Eating problems and related weight control behaviour in adult Japanese women.

BACKGROUND: Fewer studies concerning eating problems have been conducted in adult than in adolescent female populations. The aims of this study are to ascertain the proportion of eating problems and clarify weight control behaviour in adult Japanese women. METHODS: This study employed a questionnaire survey with a cross-sectional design. Subjects were adult females aged 20-39 years, working in a computer factory. Four hundred and six women agreed to participate in the study. The questionnaire elicited self-reported age, body height, body weight and various histories of dieting, fasting and purging behaviour. The Eating Attitudes Test 26-item version (EAT-26) was also administered. Subjects showing an EAT-26 score equal to or greater than 20 were identified as having eating problems. RESULTS: Among the subjects, 172 women (42.4%) had some history of dieting behaviour and 24 (5.9%) had some history of fasting behaviour. Regarding misuse of laxatives, diet pills and diuretics for the purpose of weight loss, 50 (14.3%) were past or current users of diet pills, followed by 42 (10.3%) laxative abusers and 15 (3.7%) diuretic abusers. Six (1.5%) subjects had an EAT-26 score of 20 or greater, 5 (1.9%) in their 20s, and 1 (0.8%) in her 30s, the difference not being statistically significant. CONCLUSIONS: Although dieting behaviour is common in adult Japanese working women, the proportion of eating problems is low in comparison with Western adult populations.

Adult↗
PubMed2004

Short-term hunger intensity changes following ingestion of a meal replacement bar for weight control.

Meal replacement products for weight loss are popular and safe for most unsupervised consumers desiring to lose weight. Previously we reported that the thickness of meal replacement diet shakes had a direct and significant effect on hunger intensity during the first 2 h and that hunger intensity scores for liquid meal replacements were significantly below baseline for 3 h following consumption (Mattes & Rothacker, 2001) This study uses the same protocol to investigate meal replacement bars designed for overweight consumers. Subjects were prescreened to include only those that normally ate breakfast and liked chocolate. The bar used in this study contained 250 calories (about 30 more than most liquid diet shakes), 4 g dietary fiber, 14 g protein and 8 g fat. Subjects were instructed to consume the entire bar with a glass of water following an overnight fast when they would normally consume their first meal of the day and to assess their hunger on a 1 (not hungry at all) to 9 (as hungry as I have ever felt) scale before consumption, immediately after and hourly for 6 h (only on typical weekdays). Similar assessments were made for the perception of stomach fullness (1=empty, 9=extremely full), strength of the desire to eat (1=no desire, 9=extremely strong) and thirst (1=not at all thirsty, 9=extremely thirsty). One-hundred and eight subjects (23 male and 85 female) completed the study. No gender satiety differences were found. Hunger ratings and desire to eat remained significantly below baseline for 5 h following consumption. Stomach fullness scores were significantly above baseline for 5 h. Thirst scores were significantly below baseline for 3 h. In conclusion, although the meal replacement diet bars contained only 30 additional calories than liquids, they provided an additional 2 h of hunger suppression from baseline that may have an impact on overall weightloss success. These results support superior short-term hunger control with solid meal replacements.

Adult↗
PubMed1989

The effect of weight control on lipid changes in obese children.

The effects of weight change on serum lipid changes were assessed in a sample of 56 obese children randomly assigned to family-based behavioral obesity treatment vs controls given no treatment. Fasting serum lipid levels, height, weight, and fitness were measured at program entry and after 6 months of treatment. Children assigned to treatment showed significantly greater relative weight and weight changes than children in the control group, and the weight changes were significantly related to reductions in fasting serum triglyceride and total serum cholesterol levels and increases in high-density lipoprotein serum cholesterol. Results after 5 years of follow-up available for a small sample of treated children showed that a change in relative weight and fitness from 6 months to 5 years was also associated with changes in the high-density lipoprotein level. These results suggest that weight control in obese preadolescent children may be associated with improvement in lipoprotein profiles.

Child↗
PubMed1988

The Dieter's Inventory of Eating Temptations: a measure of weight control competence.

This research reports the development and initial investigation of the reliability and validity of the Dieter's Inventory of Eating Temptations (DIET), a self-report inventory designed to assess behavioral competence in six types of situations related to weight control: (a) overeating, (b) negative emotions, (c) exercise, (d) resisting temptation, (e) positive social, and (f) food choice. The scales were shown to have adequate test-retest reliability and internal consistency. A comparison of 193 normal weight and 168 overweight subjects showed that overweights rated themselves as less competent in the overeating, negative emotions, and exercise situations. As a further validation, DIET scores were compared with measures of eating style derived from self-monitoring records. All of the DIET scales were significantly associated with specific parameters of eating behavior. In order to identify subtypes of overweight and normal weight individuals, cluster analyses were performed. Normal weight and overweight subjects could be grouped into interpretable clusters based on their profile of DIET scores. These data suggest that there is a relationship between eating patterns and body weight, and that there may be several types of problem behavior patterns. Treatment programs should combined assessment of behavioral competency in energy balance situations with intensive skill training in areas where situation specific competency deficits are found.

Adult↗