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At least 685 records · Page 38Linked to original sources
PubMed2006

Plasma interleukin 6 levels are elevated in polycystic ovary syndrome independently of obesity or sleep apnea.

Premenopausal women with polycystic ovary syndrome (PCOS) are at a much higher risk for excessive daytime sleepiness, fatigue, and insulin resistance than control women. Elevated levels of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) are presumably part of the pathogenesis of these clinical manifestations. Forty-two obese women with PCOS, 17 body mass index-comparable obese controls, and 15 normal-weight controls free from apnea participated in the study that included one 8-hour nighttime polysomnography, single morning cytokine plasma concentrations, and insulin resistance indices. Women with PCOS exhibited higher plasma concentrations of IL-6 than obese controls, who had intermediate values, or normal-weight controls, who had the lowest values (4.75 +/- 0.5 vs 3.65 +/- 0.4 vs 1.84 +/- 0.3 pg/mL, P < .01). Tumor necrosis factor alpha values were higher in PCOS and obese controls compared with normal-weight controls, but the difference was not statistically significant (4.05 +/- 0.3 vs 3.79 +/- 0.2 vs 3.14 +/- 0.2 pg/mL, P = .103). Based on backward regression analysis, IL-6 levels had a stronger association with the PCOS group than with the obese group, and the sleep or hypoxia variables did not make a significant contribution to either IL-6 or TNF-alpha. Both IL-6 and TNF-alpha correlated positively with body mass index (P < .01) in obese controls but not in women with PCOS. Furthermore, within the PCOS group, IL-6 and TNF-alpha correlated more strongly with indices of insulin resistance than obesity. We conclude that IL-6 levels are elevated in obese women with PCOS independently of obesity or sleep apnea and may represent a pathophysiologic link to insulin resistance.

Adult↗
PubMed2003

Relation between dieting and weight change among preadolescents and adolescents.

OBJECTIVE: To assess whether dieting to control weight was associated with weight change among children and adolescents. METHODS: A prospective study was conducted of 8203 girls and 6769 boys who were 9 to 14 years of age in 1996, were in an ongoing cohort study, and completed at least 2 annual questionnaires between 1996 and 1999. Dieting to control weight, binge eating, and dietary intake were assessed annually from 1996 through 1998 with instruments designed specifically for children and adolescents. The outcome measure was age- and sex-specific z score of body mass index (BMI). RESULTS: In 1996, 25.0% of the girls and 13.8% of the boys were infrequent dieters and 4.5% of the girls and 2.2% of the boys were frequent dieters. Among the girls, the percentage of dieters increased over the following 2 years. Binge eating was more common among the girls, but in both sexes, it was associated with dieting to control weight (girls: infrequent dieters, odds ratio [OR]: 5.10; frequent dieters, OR: 12.4; boys: infrequent dieters, OR: 3.49; frequent dieters, OR: 7.30). During 3 years of follow-up, dieters gained more weight than nondieters. Among the girls, frequency of dieting was positively associated with increases in age- and sex-specific z scores of BMI (beta = 0.05 and beta = 0.04 for frequent and infrequent dieters vs nondieters). Among the boys, both frequent and infrequent dieters gained 0.07 z scores of BMI more than nondieters. In addition, boys who engaged in binge eating gained significantly more weight than nondieters. CONCLUSIONS: Although medically supervised weight control may be beneficial for overweight youths, our data suggest that for many adolescents, dieting to control weight is not only ineffective, it may actually promote weight gain.

Adolescent↗
PubMed2000

Psychometric development of a multidimensional measure of weight-related attitudes and behaviors.

Most weight control programs facilitate weight loss by encouraging participants to adopt healthy eating patterns and increase physical activity. There is a need for a relatively brief measure of eating habits and physical activity that could be used to evaluate changes in behavior during weight loss treatment. The purpose of this series of four studies was to develop and validate such a measure, which was subsequently named the Weight Loss Behavior Scale (WLBS). Study 1 (n = 533) included item and scale development and examination of the WLBS's factor structure and internal consistency. Study 2 (n = 226) evaluated the test-retest reliability and convergent validity of its subscales. Study 3 examined their reliability and internal consistency scales in a predominantly overweight sample (n = 36). Study 4 evaluated the WLBS as a treatment outcome measure in a weight loss intervention (n = 50). Study 1 found that the WLBS contained five internally consistent and stable factors: 1) Concern with Dieting and Weight, 2) Exercise, 3) Overeating, 4) Avoidance of Fattening Foods and Sweets, and 5) Emotional Eating. Study 2 found convergent validity for the WLBS by assessing the correlation of its factors/scales with established inventories of comparable constructs, e.g., dietary restraint, disinhibited eating, and physical activity. Test-retest reliability of the five scales was also supported in this second study. In Study 3, support for the internal consistency and test-retest reliability of the WLBS among overweight individuals was found. Study 4 found that all scales significantly changed in the expected directions after a 5-month behavioral weight loss treatment. The findings from this series of studies suggest that the WLBS is a reliable and valid self-report inventory of cognitive and behavioral scales associated with weight control that can be utilized as an outcome measure for weight loss interventions.

Adult↗
PubMed2005

The relationship between parent and child self-reported adherence and weight loss.

OBJECTIVE: Better adherence to treatment strategies in family-based behavioral weight control programs may lead to greater weight reduction and improved weight maintenance in youth. This study assessed the influence of child and parent self-reported adherence to behavioral strategies on changes in 2-year child and parent percentage overweight. RESEARCH METHODS AND PROCEDURES: Participants included 8- to 12-year-old children in >or= 85th BMI percentile and their parents from 110 families taking part in two family-based randomized controlled weight control studies. This study examined whether self-reported adherence to behavioral strategies measured at 24 months increased prediction of child and parent percentage overweight change through 24-month follow-up after accounting for other factors that may influence weight change. RESULTS: Child adherence to weighing and to preplanning for celebrations where high-fat foods are served and parent adherence to praising the child and modeling healthy eating habits predicted 24-month child percentage overweight change (p<0.001). Child adherence to recording food and calories and parent adherence to modeling healthy eating habits predicted 24-month parent percentage overweight change (p<0.001). In hierarchical regression models, child weighing and preplanning and parent modeling were significant (p<0.01) incremental predictors (r2 of 24.8%) of 24-month child percentage overweight. Child recording and parent modeling were significant (p<0.01) incremental predictors (r2 of 14%) of parent 24-month percentage overweight change. DISCUSSION: Child and parent adherence to specific components of family-based behavioral weight control treatment are independent predictors of long-term child and parent percentage overweight change.

Adult↗
PubMed2002

Ethnic/racial differences in weight-related concerns and behaviors among adolescent girls and boys: findings from Project EAT.

OBJECTIVE: To compare weight-related concerns and behaviors across ethnicity/race among a population-based sample of adolescent boys and girls. METHODS: The study population included 4746 adolescents from urban public schools in the state of Minnesota who completed surveys and anthropometric measurements as part of Project EAT (Eating Among Teens), a population-based study focusing on eating patterns and weight concerns among teenagers. Main outcome measures included measured body mass index (BMI), weight-related concerns (perceived weight status, weight disparity, body satisfaction and attitudes about weight control) and weight-related behaviors (general/specific weight control behaviors and binge eating). RESULTS: In comparison to White girls, African American girls tended to report fewer weight-related concerns/behaviors, while Hispanic, Asian American and Native American girls tended to report similar or more concerns/behaviors. Among boys, weight-related concerns/behaviors were equally or more prevalent among all non-Whites than among Whites. In particular, African American and Asian American boys were at greater risk for potentially harmful weight-related concerns/behaviors than White boys. CONCLUSIONS: Weight-related concerns and behaviors are prevalent among adolescents, regardless of their ethnic/racial background, indicating a need for prevention and treatment efforts that reach adolescents of different ethnic backgrounds. However, ethnic differences demonstrate a need for ensuring that the specific needs of different groups are addressed in the development of such interventions.

Adolescent↗
PubMed1998

Can inexpensive signs encourage the use of stairs? Results from a community intervention.

BACKGROUND: The U.S. Surgeon General advocates the accumulation of moderate-intensity activity throughout the day to improve health. OBJECTIVES: To test the effectiveness of signs to encourage use of stairs instead of escalators. DESIGN: Community intervention. SETTING: Shopping center. PARTICIPANTS: 17901 shoppers. INTERVENTION: Signs promoting the health and weight-control benefits of stair use were placed beside escalators with adjacent stairs. MEASUREMENTS: The sex, age, race, weight classification, and use of stairs were observed. RESULTS: Overall, stair use increased from 4.8% to 6.9% and 7.2% with the health and weight-control signs, respectively. Younger persons increase their stair use from 4.6% to 6.0% with the health sign and 6.1% with the weight-control sign. Older persons almost doubled their stair use from 5.1% to 8.1% with the health sign and increased use to 8.7% with the weight-control sign. Differential use of stairs was observed between ethnic groups. Among white persons, stair use increased from 5.1% to 7.5 and 7.8% with the health sign and weight-control signs. Among black persons, stair use decreased from 4.1% to 3.4% with the health sign and increased to 5.0% with the weight-control sign. At baseline, lean persons used the stairs more often than overweight persons (5.4% and 3.8%, respectively). The health sign increased stair use to 7.2% among normal-weight persons and 6.3% among overweight persons; the weight-control sign prompted stair use to increase to 6.9% among persons of normal weight and to 7.6% among overweight persons. CONCLUSIONS: Simple, inexpensive interventions can increase physical activity. Research is needed to identify effective motivators to promote activity among black persons.

Adult↗
PubMed1999

Effect of weight loss and regional fat distribution on plasma leptin concentration in obese women.

OBJECTIVES: To investigate how circulating leptin concentrations are related to regional fat distribution and whether moderate weight loss alters these relationships. DESIGN: A 6 month, clinical weight reduction trial with measurements before and after weight loss. SUBJECTS: 38 healthy, obese women (age: 44.3+/-9.9 y, BMI: 34.0+/-4.0 kg/m2). MEASUREMENTS: The following measurements were made. 1. indices of obesity and fat distribution: weight, body mass index (BMI), hip circumference (peripheral fat), waist circumference, total body fat (bioelectrical impedance), abdominal fat distribution: visceral fat and abdominal subcutaneous fat (ultrasonography); and 2. Biochemical measurements: plasma leptin and serum insulin. RESULTS: Baseline plasma leptin concentrations were three-fold higher in obese women than in normal weight controls. After weight loss averaging 8.4 kg (9.0%), plasma leptin decreased by a mean of 22.3% (P < 0.001), corresponding to body fat decrease of 16.6% (P < 0.001), abdominal subcutaneous fat decrease of 17.4% (P < 0.001) and visceral fat decrease of 18.7% (P < 0.001). The total amount of body fat correlated with plasma (serum) leptin before (r = 0.64, P < 0.001) and after (r = 0.75, P < 0.001) weight loss. Plasma leptin concentrations expressed per kg of body fat did not change significantly during weight loss. After controlling for body fat, baseline leptin concentrations were significantly associated with hip circumference (r = 0.57, P < 0.001) but not with any indices of abdominal fat distribution. After weight loss the associations became significant for hip and waist circumference as well as for visceral and abdominal subcutaneous fat. Changes in leptin correlated with changes in all indices of obesity except visceral fat. CONCLUSIONS: Plasma leptin concentrations reflect not only total fat mass but also adipose tissue distribution, especially peripheral fat. Plasma leptin values per kilogram of fat mass do not change significantly with modest weight loss.

Abdomen↗
PubMed1995

Prevalence of binge eating disorder in different populations of French women.

OBJECTIVE: The aim of this study was to evaluate the prevalence of binge eating disorder (BED) in nonpatient women in the community and in weight control groups in France and to compare the characteristics of weight history of subjects with and without BED. METHODS: Eating patterns over the past six months were studied by questionnaires in self-report format. The prevalence of binge eating, BED, and bulimia was studied in 447 nonpatient women and in subjects seeking help for weight control either in private practice (PP, n = 292) or in a hospital department of nutrition (H, n = 85). RESULTS: BED was common (PP = 9%; H = 15%) among patients attending weight control clinics but very rare in the community (0.7%). The disorder was associated with a history of weight fluctuations. Many subjects with BED referred to regular use of diet pills (29%) or vomiting (39%) but the prevalence of these strategies of weight control fell short for the requirement for the diagnosis of bulimia. DISCUSSION: BED was common in subjects seeking help for weight control and extremely rare in the community nonpatients.

Adolescent↗
PubMed1995

Extremely low birth weight and control infants at 2 years corrected age: a comparison of intellectual abilities, motor performance, growth and health.

A 2-year cohort of 63 surviving extremely low birth weight (ELBW) infants was prospectively studied and 60 of these infants, together with 44 normal birth weight control infants, were assessed at 2 years of age for intellectual abilities, motor skills, growth and health. The total ELBW group differed significantly from controls on overall Griffiths developmental quotient (99.3 vs. 103.8 P = 0.02) and in the personal/social subscale (100.7 vs. 106.7 P = 0.01). A subset of 43 of the ELBW infants was identified as low risk at discharge. No statistically significant differences were present between the low risk ELBW subset and controls in intellectual abilities though both the total ELBW group and the low risk ELBW subset differed from controls in fine and gross motor abilities, and in weight at 2 years. The total ELBW group also experienced more frequent ill health and hospital readmission.

Child, Preschool↗
PubMed2003

The management of the obese diabetic patient.

The prevalence of obesity and diabetes is increasing in the United States and worldwide. These diseases are predicted to explode to epidemic proportions, unless appropriate counteractive measures are taken. Several large studies (DCCT, UKPDS, Kumamoto) clearly showed that intensive glycemic control in the diabetic patient reduced microvascular complications and improved mortality. Despite this, the NHANES III showed that only 50% of diabetics have been able to achieve a HgbAic level that is less than 7%; this suggests the need for a re-evaluation of our approach to these patients. The management of the obese diabetic patient involves glycemic control and weight reduction. These goals are particularly difficult to achieve in the obese diabetic patient because progressive beta-cell dysfunction and increasing insulin resistance necessitates the administration of increasingly higher dosages of insulin, which, in turn, promotes weight gain. A vicious cycle may ensue. Lifestyle modifications with diet and exercise are an essential part of the management of the obese diabetic patient. These measures alone are often insufficient and concomitant pharmacologic therapy is usually required to achieve glycemic and weight control. Oral agents that improve glycemia, decrease insulin resistance, and limit weight gain are desirable. Because of the progressive nature of diabetes, glycemic control with monotherapy often deteriorates over time, which necessitates the addition of other pharmacologic agents, including insulin. When insulin therapy is required in the treatment of the obese diabetic patient, combinations with oral agents that have been shown to minimize the amount of exogenous insulin that is required, may minimize weight gain. In addition, the obese diabetic patient who is poorly controlled with maximum oral hypoglycemic therapy may benefit from weight-reducing agents, such as sibutramine or orlistat. The introduction of these agents at other points in the management of the obese diabetic patients have been successful. Finally, for the severely obese diabetic patient, bariatric surgery may be the only effective treatment. Gastric bypass has been unequivocally shown to produce significant weight loss and improve glycemic control on a long-term basis in the obese diabetic patient. It is recommended that physicians avail themselves of all of these strategies in the management of the obese patient who has type 2 diabetes.

Anti-Obesity Agents↗
PubMedDate not supplied

[Unfounded dieting among adolescent girls and socio-economic status of their families].

UNLABELLED: AIM OF THE STUDY was to examine: the prevalence of dieting and other weight control behaviour among adolescent girls without body mass excess (BMI 90 percentile or less); relationship between weight control practices and the socio-economic status of the girls' families by age and place of residence. MATERIAL AND METHODS: Data from HBSC (Health Behaviour in School-aged Children: A WHO Collaborative Cross-national Study) surveys, carried out in Poland in 2002 in representative sample of girls aged 11.7; 13.7 and 15.7 (N= 2774) was used. An international standard questionnaire (anonymous) has been chosen as an instrument for data collection. Two indicators of socio-economic status (SES) were developed by researchers in the HBSC study: FAS (Family Affluence Scale) and PFW (Perceived Family Wealth). RESULTS: 18.8% of adolescent girls were engaged in dieting and other weight control behaviour, 25.1% were in the risk group (girls who think that they should loose some weight). The prevalence of these behaviours increase with age, is higher among girls living in cities than in villages. The prevalence of weight control behaviour is higher among girls from families with higher SES. The risk of unfounded weight control behaviour is higher among 15-year old, girls living in town in families with higher SES. CONCLUSIONS: Unfounded dieting and other weight control practices among adolescent girls should be recognized as a new risk behaviour; future studies are necessary for assessment of causes and range of these behaviours as the basis for development of preventive programmes.

Adolescent↗
PubMed1999

Using weighted global control for stabilizing patterned states.

A general method to control a desired patterned state in reaction-diffusion processes is presented. Weighted global control is aimed to keep weighted spatially averaged properties of state variable at preset values. It is shown that weighted global control creates a stable direction in the global space of system states and affects system dynamics globally. We apply it for a specific two-component reaction-diffusion system and show that the desired pattern is attainable for a wide range of the control parameters. (c) 1999 American Institute of Physics.

Journal Article↗
PubMed2006

Synthesis of copolymers containing an active ester of methacrylic acid by RAFT: controlled molecular weight scaffolds for biofunctionalization.

We report the controlled radical copolymerization of N-(2-hydroxypropyl)methacrylamide (HPMA) with a monomer containing an active ester, N-methacryloyloxysuccinimide (NMS), by reversible addition fragmentation chain transfer (RAFT). The large difference in the reactivity ratios of HPMA and NMS resulted in significant variations in copolymer composition with increasing conversion during batch copolymerization. The use of a semi-batch copolymerization method, involving the gradual addition of the more reactive NMS, allowed uniformity of copolymer composition to be maintained during the polymerization. We synthesized polymers in a wide range of molecular weights (M(n) = 3000-50,000 Da) with low polydispersities (1.1-1.3). The effect of the ratio of monomer to chain transfer agent (CTA) on the molecular weight of the polymer was investigated. Given the numerous applications of poly(HPMA)-based conjugates in designing polymeric therapeutics, these controlled molecular weight activated polymers represent attractive scaffolds for biofunctionalization. As a demonstration, we attached a peptide to the activated polymer backbone to synthesize a potent controlled molecular weight polyvalent inhibitor of anthrax toxin.

Biopolymers↗
PubMed1995

Community programs for obesity prevention: the Minnesota Heart Health Program.

Community intervention strategies for obesity that were developed and evaluated in the Minnesota Heart Health Program (MHHP) are described. The MHHP was a 13-year research and demonstration project involving 6 communities that was designed to evaluate whether a sustained multicomponent education campaign could reduce population-wide risk factors for cardiovascular disease. MHHP weight control activities included adult education classes for weight control, exercise, and cholesterol reduction, a worksite weight control program, a home correspondence course for weight loss and a weight gain prevention program. In separate component evaluation studies each of the programs was shown to facilitate favorable changes in weight among individuals choosing to participate in them. Compared to more intensive interventions, weight changes produced by these methods were modest in magnitude, but the number of individuals participating in some of them was quite large. The overall effects of the MHHP program on population levels of obesity were disappointing. Over 7 years of intervention there was a strong upward trend in weight in all communities, independent of age, demographics, smoking habits, or other potential confounding variables. This trend was not different in communities receiving education than in comparison communities. Possible reasons for these results are discussed.

Adult↗
PubMed1999

Relation of peer and media influences to the development of purging behaviors among preadolescent and adolescent girls.

OBJECTIVE: To assess prospectively the relation of peer and media influences on the risk of development of purging behaviors. DESIGN: Prospective cohort study. SETTING: One year follow-up of 6982 girls aged 9 to 14 years in 1996 who completed questionnaires in 1996 and 1997 and reported in 1996 that they did not use vomiting or laxatives to control weight. MAIN OUTCOME MEASURE: Self-report of using vomiting or laxatives at least monthly to control weight. RESULTS: During 1 year of follow-up, 74 girls began using vomiting or laxatives at least monthly to control weight. Tanner stage of pubic hair development was predictive of beginning to purge (odds ratio [OR] = 1.8; 95% confidence interval [CI], 1.3-2.4). Independent of age and Tanner stage of pubic hair development, importance of thinness to peers (OR = 2.3; 95% CI, 1.8-3.0) and trying to look like females on television, in movies, or in magazines (OR= 1.9; 95% CI, 1.6-2.3) were predictive of beginning to purge at least monthly. Regardless of the covariates included in the logistic regression model, the risk of beginning to purge increased approximately 30% to 40% per 1-category increase in frequency of trying to look like females on television, in movies, or in magazines. CONCLUSIONS: Both peers and popular culture, independent of each other, exert influence on girls' weight control beliefs and behaviors. Therefore, to make eating disorder prevention programs more effective, efforts should be made to persuade the television, movie, and magazine industries to employ more models and actresses whose weight could be described as healthy, not underweight.

Adolescent↗
PubMed1987

Rumination and vomiting in Prader-Willi syndrome.

Inability to vomit has been cited as characteristic of Prader-Willi syndrome (PWS). Although post-prandial vomiting after gastric by-pass surgery has been reported, neither vomiting under "typical" circumstances or rumination have been described. Prompted by the discovery of several cases of vomiting and rumination, a questionnaire was sent to members of the PWS Association. Approximately 36% (113/313) of affected individuals reportedly experienced at least one episode of vomiting. Induced vomiting was unsuccessful in 9 of 14 cases in whom results were known. However, no complications of Ipecac were reported. We suggest that there is an alteration in the physiologic set-point at which vomiting occurs, leading to a decreased propensity to vomit. Liberal and strict definitions of rumination yielded 15.7% and 10.2% positive responses, respectively. Rumination was associated with a history of vomiting. Enamel deterioration consistent with rumination has been observed, and such changes should be looked for in all PWS children. In several instances, rumination was found to decrease when very strict weight control was lessened. Certain individuals may ruminate under too strict a weight control program, and weight control goals should be evaluated to achieve a reasonable compromise between ideal weight and obesity. Vomiting and rumination do not rule out the diagnosis of PWS.

Adolescent↗
PubMed1984

Effect of chronic ingestion of ethanol on in vitro uptake of lipids and glucose in the rabbit jejunum.

This study was undertaken to determine the effect of chronic feeding of ethanol on the in vitro jejunal uptake of lipids and glucose. The first group of rabbits was fed ad libitum (CAL); the food intake of a second control group [weight control (WC)] was restricted to match their gain in body weight with that of a chronically ethanol-fed group (ETH); and the food intake of a third control group [food control (FC)] was restricted to match the food intake with that of ETH. There was a marked decline in cholesterol uptake in WC and FC compared with CAL, and cholesterol uptake in ETH was intermediate between the higher value in CAL and the lower value in WC and FC. The uptake of fatty acids 4:0-12:0 was similar in the CAL, FC, WC, and ETH groups, both when the bulk phase was stirred and unstirred; the uptake of fatty acids 16:0 and 18:0 was lower in WC and FC than in CAL; and the uptake of fatty acids 14:0, 16:0, and 18:0 was even lower in ETH. The uptake of a homologous series of fatty alcohols was greater in WC and ETH than in CAL at five different rates of stirring of the bulk phase. When the uptake of fatty acids 6:0-12:0 was corrected for unstirred layer resistance, a linear relation was noted between fatty acid chain length and the natural logarithm of rate of uptake/aqueous diffusion coefficient, and the steeper slope in WC and ETH than in CAL represented a higher incremental change in free energy. Glucose uptake was similar in CAL, WC, and FC but was greater in ETH from 5 to 40 mM glucose. These studies demonstrate that 1) weight restriction, food restriction, and chronic ethanol feeding are associated with a change in the effective resistance of the unstirred layer and in the passive permeability properties of the rabbit jejunum, and 2) ethanol has a differential effect on passive permeation of short-, medium-, and long-chain fatty acids and cholesterol.

Alcoholism↗
PubMed1994

First step in managing bulimia nervosa: controlled trial of therapeutic manual.

OBJECTIVE: To test the short term efficacy of a self directed treatment manual for bulimia nervosa. DESIGN: Randomised controlled trial of the manual against cognitive behavioural therapy and a waiting list. SETTING: Tertiary referral centre. SUBJECTS: 81 consecutive referrals presenting with bulimia nervosa or atypical bulimia nervosa. MAIN OUTCOME MEASURES: Frequency of binge eating, vomiting, and other behaviours to control weight as well as abstinence from these behaviours. RESULTS: Cognitive behavioural treatment produced a significant reduction in the frequency of binge eating, vomiting, and other behaviours to control weight. The manual significantly reduced frequency of binge eating and weight control behaviours other than vomiting, and there was no change in the group on the waiting list. Full remission was achieved in five (24%) of the group assigned to cognitive behavioural treatment, nine (22%) of the group who used the manual, and two (11%) of the group on the waiting list. CONCLUSIONS: A self directed treatment manual may be a useful first intervention in the treatment of bulimia nervosa.

Adult↗