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Promoting weight control at the worksite: a pilot program of self-motivation using payroll-based incentives.

Thirty-six individuals participated in a worksite weight-loss program in which the central component was a self-motivation program of biweekly payroll deductions refunded contingent on meeting self-selected weight-loss goals. Half were assigned to early treatment and the remainder to a delayed treatment control group. Nine additional individuals also enrolled at the time of delayed treatment and were included in descriptive analyses of factors associated with weight loss. Results showed low program attrition over 6 months (6%) and mean weight losses (12.3 lb) that are competitive with those obtained in clinical settings. Although not different at baseline, participants in the delayed treatment group lost more than twice as much weight as those in the early treatment condition. This difference was interpreted as either a strong seasonal effect or a critical mass effect related to the proportion of employees at the worksite participating in the program. We conclude that self-motivation programs for health behavior change using the payroll system as an organization framework offer a promising new methodology for promoting healthful behaviors in work settings.

Adult↗

Accumulating aerobic exercise for effective weight control.

PURPOSE: To compare the effects of different patterns of regular treadmill walking and cycle ergometry on body weight, body composition, waist and hip circumferences in overweight adult Singaporean females. METHODS: Thirty overweight (BMI > 23 kg/m2) Singaporean females, aged 42.2 +/- 5.4 yr (mean +/- SD), all spasmodically physically active, were randomly assigned to two different eight-week programmes of aerobic exercise. One programme involved walking and cycling on indoor exercise machines at a moderate, comfortable intensity until 400 kcals had been expended, five times a week, thus giving a total weekly energy expenditure of 2,000 kcal. The other programme involved the same type of exercise but expending 1,000 kcal per session on two days a week, thereby giving the same weekly energy expenditure. Body weight, body mass index, body composition, waist and hip circumferences were measured before and after each programme. Prior to commencement of the study all subjects attended a one hour seminar on nutrition, health and fitness where the project structure was explained. They were asked not to change their eating habits during the intervention period and food diaries were kept and monitored weekly. RESULTS: All subjects completed the eight-week programmes of exercise. Both programmes significantly reduced body weight, body mass index, percentage body fat and waist circumference (all p < 0.05). These reductions were identical in both the short-bout and long-bout programmes. No changes were observed in either group for hip circumference or lean body mass. CONCLUSION: These findings demonstrated the effectiveness of moderate aerobic exercise in reducing body weight, body fat percentage and waist circumference whilst maintaining lean body mass in moderately overweight Singaporean females. The study also demonstrated that whether the exercise is performed in a series of short bouts five times a week or in longer bouts twice a week, the results are identical, providing that the total weekly energy expenditure remains the same.

Adult↗

Community-based exercise and weight control: diabetes risk reduction and glycemic control in Zuni Indians.

Cardiovascular disease is a significant health problem for the Zuni Indians of southwest New Mexico, in part because of high rates of non-insulin-dependent diabetes mellitus (NIDDM). The Zuni Diabetes Project was initiated in July 1983 to reduce rates of obesity and provide primary and secondary prevention of NIDDM. Two studies of the project's activities have been carried out to date. After 2 y of follow-up, diabetic participants in an exercise program compared with diabetic nonparticipants experienced weight loss, a drop in fasting blood glucose values, and reductions in the use of hypoglycemic medications. In a weight-loss competition, 45% (122/271) of the enrollees finished and lost greater than or equal to 2.3 kg. The results of these two studies demonstrate that 1) participation in a community-based exercise program can produce significant weight loss and improvement in glycemic control in Zuni Indians with NIDDM and 2) weight-loss competitions appear to be an important public health model for health-behavior change in communities similar to that of Zuni, NM.

Adult↗

Weight control in wrestling: eating disorders or disordered eating?

PURPOSE: Several recent studies have pointed out that the weight loss techniques used by wrestlers to make weight are similar to the behavior of bulimics. The purpose of this study was to determine whether an increased risk of bulimia nervosa existed for a group of junior high and high school wrestlers. METHODS: Wrestlers (N = 85) completed the Eating Disorder Inventory (EDI) once during the season, and once during the off-season. A comparison group of nonwrestlers (N = 75) also completed the questionnaire. RESULTS: No significant differences were found between the number of in-season wrestlers and nonwrestlers classified as "at risk" for bulimia nervosa. Significant differences were revealed, however, between in-season wrestlers and nonwrestlers, and between in-season wrestlers and off-season wrestlers, on the Drive for Thinness subscale. In both cases, significantly more in-season wrestlers scored above the "at risk" cutoff on the subscale. CONCLUSIONS: These results indicate that although in-season wrestlers are more weight conscious than nonwrestlers, these feelings and attitudes are transient. All subjects classified as "at risk" also participated in an interview which followed the format of the Eating Disorder Examination. Interviews with in-season wrestlers revealed that their concerns with weight were due entirely to the demands of wrestling, and did not meet the severity level required for a diagnosis of bulimia nervosa.

Adolescent↗

Body dissatisfaction and unhealthy weight-control practices among adolescents with and without chronic illness: a population-based study.

OBJECTIVE: To compare body dissatisfaction and unhealthy weight-loss practices among adolescents with and without chronic illness. DESIGN: Survey. PARTICIPANTS: The sample consisted of 2149 adolescent boys and girls with diabetes, asthma, attention deficit disorder, physical disabilities, or seizure disorders; and a comparison group of 1381 adolescents without chronic illness. MAIN OUTCOME MEASURES: Body concerns, binge eating, frequent dieting, vomiting, and laxative or diuretic use among adolescents. RESULTS: Adolescents with chronic illness reported higher body dissatisfaction and engaged in more high-risk weight-loss practices than adolescents without chronic illness. This trend was consistent across the different conditions and was not limited to those with a nutrition-related condition such as diabetes. The trend remained after conducting logistic regression and controlling for age, race, socioeconomic status, and body mass index. CONCLUSIONS: Adolescents with chronic illness are at high risk for engaging in unhealthy weight-loss practices and should be screened and targeted for prevention and treatment.

Adolescent↗

Attitudes and behaviors related to weight control in two diverse populations.

BACKGROUND: Researchers have found that African-American women have concerns about their weight, but are less successful in their weight loss efforts compared to Caucasian women. Reasons for this disparity have not been explored in great detail. Identifying specific attitudes and behaviors that contribute to obesity in these subpopulations will help inform the design of interventions. METHODS: This report compares specific attitudes and behaviors related to diet and exercise in two groups who are trying to lose weight: African-American women in Indianapolis (n = 80) and Caucasian women from the rural Midwest (n = 45). Data are from surveys that shared many common measures, but were otherwise not related to one another. The choice of measures was guided by a conceptual framework of self-management processes. RESULTS: Compared to women in the urban study, women in the rural study report greater social support for behavior change, greater self-efficacy, and outcome expectations, and greater use of every strategy measured. CONCLUSIONS: While there is room for improvement in both groups, these results contribute to our understanding of subgroup differences and similarities in the complex behavioral issues surrounding successful weight management. Larger studies with more representative samples are needed to confirm these findings and inform future interventions.

Black or African American↗

A review of psychosocial pre-treatment predictors of weight control.

Prompted by the large heterogeneity of individual results in obesity treatment, many studies have attempted to predict weight outcomes from information collected from participants before they start the programme. Identifying significant predictors of weight loss outcomes is central to improving treatments for obesity, as it could help professionals focus efforts on those most likely to benefit, suggest supplementary or alternative treatments for those less likely to succeed, and help in matching individuals to different treatments. To date, however, research efforts have resulted in weak predictive models with limited practical usefulness. The two primary goals of this article are to review the best individual-level psychosocial pre-treatment predictors of short- and long-term (1 year or more) weight loss and to identify research needs and propose directions for further work in this area. Results from original studies published since 1995 show that few previous weight loss attempts and an autonomous, self-motivated cognitive style are the best prospective predictors of successful weight management. In the more obese samples, higher initial body mass index (BMI) may also be correlated with larger absolute weight losses. Several variables, including binge eating, eating disinhibition and restraint, and depression/mood clearly do not predict treatment outcomes, when assessed before treatment. Importantly, for a considerable number of psychosocial constructs (e.g. eating self-efficacy, body image, self-esteem, outcome expectancies, weight-specific quality of life and several variables related to exercise), evidence is suggestive but inconsistent or too scant for an informed conclusion to be drawn. Results are discussed in the context of past and present conceptual and methodological limitations, and several future research directions are described.

Body Image↗

Effect of weight control on hepatic abnormalities in obese patients with fatty liver.

This study was aimed at finding out whether weight reduction alone can improve liver function in obese patients with fatty liver. We did a longitudinal, clinical intervention study on weight reduction by behavior modification, diet and exercise. The study subjects were 25 patients referred to an obesity clinic in whom obesity is the sole factor causing abnormal liver function and fatty liver. Patients were weighed about one year later. We compared the degree of improvement in hepatic function between Group I that showed weight reduction and Group II that showed no-weight reduction. Group I (13) showed dramatic improvement in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, nearly all down to within normal levels. AST showed statistically significant improvement from 74 +/- 36 IU/l to 25 +/- 7 IU/l. ALT also showed statistically significant improvement from 109 +/- 67 IU/l to 30 +/- 14 IU/l. Group II (12) showed higher AST and ALT levels on follow-up visit than initial visit. AST showed statistically significant elevation from 43 +/- 11 IU/l to 59 +/- 23 IU/l. ALT also showed statistically significant elevation from 64 +/- 21 IU/l to 97 +/- 33 IU/l. If we can rule the other causes of hepatic abnormalities in obese patients with fatty liver, we suggest these patients would benefit by weight reduction.

Adolescent↗