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Overweight, obesity, and health risk.

More than half of adult Americans are overweight or obese, and public health recommendations call for weight loss in those who are overweight with associated medical conditions or who are obese. However, some controversy exists in the lay press and in the medical literature about the health risks of obesity. We review briefly the large body of evidence indicating that higher levels of body weight and body fat are associated with an increased risk for the development of numerous adverse health consequences. Efforts to prevent further weight gain in adults at risk for overweight and obesity are essential. For those whose present or future health is at risk because of their obesity and who are motivated to make lifestyle changes, a recommendation for weight loss is appropriate.

Adipose Tissue↗

Overweight and obese patients in a primary care population report less sleep than patients with a normal body mass index.

BACKGROUND: Insufficient sleep and obesity are common in the United States. Restricted sleep causes important neurocognitive changes, including excessive daytime sleepiness and altered mood. This may result in work-related injuries and automotive crashes. Evidence links sleep loss to hormonal changes that could result in obesity. This article examines the association between restricted sleep and obesity in a heterogeneous adult primary care population. METHODS: A total of 1001 patients from 4 primary care practices participated in this prospective study. Patients completed a questionnaire administered by a nurse or study coordinator concerning demographics, medical problems, sleep habits, and sleep disorders. Professional staff measured height and weight in the office. The relationship between body mass index (BMI) and reported total sleep time per 24 hours was analyzed after categorizing patients according to their BMI (calculated as weight in kilograms divided by the square of height in meters) as being of normal weight (<25), overweight (25-29.9), obese (30-39.9), or extremely obese (> or =40). RESULTS: Analyzable forms from 924 patients aged between 18 and 91 years indicated that (1) the mean BMI was 30; (2) women slept more than men; (3) overweight and obese patients slept less than patients with a normal BMI (patients reported less sleep in a nearly linear relationship from the normal through the obese group); and (4) this trend of decreasing sleep time was reversed in the extremely obese patients. CONCLUSIONS: This study found that reduced amounts of sleep are associated with overweight and obese status. Interventions manipulating total sleep time could elucidate a cause-and-effect relationship between insufficient sleep and obesity.

Adolescent↗

Improvement of fitness, body composition, and insulin sensitivity in overweight children in a school-based exercise program: a randomized, controlled study.

BACKGROUND: Obesity and poor physical fitness constitute a health problem affecting an increasing number of children. Causes include a pervasive "toxic" environment that facilitates increased caloric intake and reduced physical activity. An effective strategy for prevention and treatment of childhood obesity likely includes a collaborative effort in the school setting. OBJECTIVE: To determine whether a school-based fitness program can improve body composition, cardiovascular fitness level, and insulin sensitivity in overweight children. DESIGN: Fifty overweight middle school children with a body mass index (BMI) above the 95th percentile for age were randomized to lifestyle-focused, fitness-oriented gym classes (treatment group) or standard gym classes (control group) for 9 months. Children underwent evaluation of fasting insulin and glucose levels, body composition by means of dual energy absorptiometry, and maximum oxygen consumption (V0(2)max) treadmill testing at baseline (before the school year) and at end of the school year. SETTINGS: Rural middle school and an academic children's hospital. MAIN OUTCOME MEASURES: Baseline test results for cardiovascular fitness, body composition, and fasting insulin and glucose levels. RESULTS: At baseline, there were no differences between groups before intervention (values for age, 12 +/- 0.5 years [all results, mean +/- SD]; BMI [calculated as weight in kilograms divided by the square of height in meters], 31.0 +/- 3.7; percentage of body fat, 36.5% +/- 4.6%; lean body mass, 41.4 +/- 8.6 kg; and V0(2)max, 31.5 +/- 5.1 mL/kg per minute). Compared with the control group, the treatment group demonstrated a significantly greater loss of body fat (loss, -4.1% +/- 3.4% vs -1.9% +/- 2.3%; P = .04), greater increase in cardiovascular fitness (V0(2)max, 2.7 +/- 2.6 vs 0.4 +/- 3.3 mL/kg per minute; P<.001), and greater improvement in fasting insulin level (insulin level, -5.1 +/- 5.2 vs 3.0 +/- 14.3 microIU/mL [-35.4 +/- 36.1 vs 20.8 +/- 99.3 pmol/L]; P = .02). CONCLUSIONS: Children enrolled in fitness-oriented gym classes showed greater loss of body fat, increase in cardiovascular fitness, and improvement in fasting insulin levels than control subjects. The modification to the school physical education curriculum demonstrates that small but consistent changes in the amount of physical activity has beneficial effects on body composition, fitness, and insulin levels in children. Partnering with school districts should be a part of a public health approach to improving the health of overweight children.

Body Composition↗

A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder.

BACKGROUND: Cognitive-behavioral therapy (CBT) has documented efficacy for the treatment of binge eating disorder (BED). Interpersonal psychotherapy (IPT) has been shown to reduce binge eating but its long-term impact and time course on other BED-related symptoms remain largely unknown. This study compares the effects of group CBT and group IPT across BED-related symptoms among overweight individuals with BED. METHODS: One hundred sixty-two overweight patients meeting DSM-IV criteria for BED were randomly assigned to 20 weekly sessions of either group CBT or group IPT. Assessments of binge eating and associated eating disorder psychopathology, general psychological functioning, and weight occurred before treatment, at posttreatment, and at 4-month intervals up to 12 months following treatment. RESULTS: Binge-eating recovery rates were equivalent for CBT and IPT at posttreatment (64 [79%] of 81 vs 59 [73%] of 81) and at 1-year follow-up (48 [59%] of 81 vs 50 [62%] of 81). Binge eating increased slightly through follow-up but remained significantly below pretreatment levels. Across treatments, patients had similar significant reductions in associated eating disorders and psychiatric symptoms and maintenance of gains through follow-up. Dietary restraint decreased more quickly in CBT but IPT had equivalent levels by later follow-ups. Patients' relative weight decreased significantly but only slightly, with the greatest reduction among patients sustaining recovery from binge eating from posttreatment to 1-year follow-up. CONCLUSIONS: Group IPT is a viable alternative to group CBT for the treatment of overweight patients with BED. Although lacking a nonspecific control condition limits conclusions about treatment specificity, both treatments showed initial and long-term efficacy for the core and related symptoms of BED.

Adult↗

Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men.

CONTEXT: Recent guidelines for treatment of overweight and obesity include recommendations for risk stratification by disease conditions and cardiovascular disease (CVD) risk factors, but the role of physical inactivity is not prominent in these recommendations. OBJECTIVE: To quantify the influence of low cardiorespiratory fitness, an objective marker of physical inactivity, on CVD and all-cause mortality in normal-weight, overweight, and obese men and compare low fitness with other mortality predictors. DESIGN: Prospective observational data from the Aerobics Center Longitudinal Study. SETTING: Preventive medicine clinic in Dallas, Tex. PARTICIPANTS: A total of 25714 adult men (average age, 43.8 years [SD, 10.1 years]) who received a medical examination during 1970 to 1993, with mortality follow-up to December 31, 1994. MAIN OUTCOME MEASURES: Cardiovascular disease and all-cause mortality based on mortality predictors (baseline CVD, type 2 diabetes mellitus, high serum cholesterol level, hypertension, current cigarette smoking, and low cardiorespiratory fitness) stratified by body mass index. RESULTS: During the study period, there were 1025 deaths (439 due to CVD) during 258781 man-years of follow-up. Overweight and obese men with baseline CVD or CVD risk factors were at higher risk for all-cause and CVD mortality compared with normal-weight men without these predictors. Using normal-weight men without CVD as the referent, the strongest predictor of CVD death in obese men was baseline CVD (age- and examination year-adjusted relative risk [RR], 14.0; 95% confidence interval [CI], 9.4-20.8); RRs for obese men with diabetes mellitus, high cholesterol, hypertension, smoking, and low fitness were similar and ranged from 4.4 (95% CI, 2.7-7.1) for smoking to 5.0 (95% CI, 3.6-7.0) for low fitness. Relative risks for all-cause mortality in obese men ranged from 2.3 (95% CI, 1.7-2.9) for men with hypertension to 4.7 (95% CI, 3.6-6.1) for those with CVD at baseline. Relative risk for all-cause mortality in obese men with low fitness was 3.1 (95% CI, 2.5-3.8) and in obese men with diabetes mellitus 3.1 (95% CI, 2.3-4.2) and as slightly higher than the RRs for obese men who smoked or had high cholesterol levels. Low fitness was an independent predictor of mortality in all body mass index groups after adjustment for other mortality predictors. Approximately 50% (n = 1674) of obese men had low fitness, which led to a population-attributable risk of 39% for CVD mortality and 44% for all-cause mortality. Baseline CVD had population attributable risks of 51% and 27% for CVD and all-cause mortality, respectively. CONCLUSIONS: In this analysis, low cardiorespiratory fitness was a strong and independent predictor of CVD and all-cause mortality and of comparable importance with that of diabetes mellitus and other CVD risk factors.

Adult↗

Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: a randomized trial.

CONTEXT: Enhancing participation in long-term exercise may translate into improved long-term weight loss in overweight adults. OBJECTIVES: To compare the effects of intermittent with traditional continuous exercise on weight loss, adherence, and fitness, and to examine the effect of combining intermittent exercise with that using home exercise equipment. DESIGN: Randomized trial from September 1996 through September 1998. SETTING AND PARTICIPANTS: A total of 148 sedentary, overweight (mean [SD] body mass index, 32.8 [4.0] kg/m2) women (mean [SD] age, 36.7 [5.6] years) in a university-based weight control program. INTERVENTIONS: Eighteen-month behavioral weight control program with 3 groups: long-bout exercise (LB), multiple short-bout exercise (SB), or multiple short-bout exercise with home exercise equipment (SBEQ) using a treadmill. MAIN OUTCOME MEASURES: Body weight, body composition, cardiorespiratory fitness, and exercise adherence. RESULTS: Of 148 subjects, 115 (78%) completed the 18-month program. At 18 months, mean (SD) weight loss was significantly greater in subjects in the SBEQ group compared with subjects in the SB group (-7.4 [7.8] kg vs -3.7 [6.6] kg; P<.05). Mean (SD) weight loss for subjects in the LB group (-5.8 [7.1] kg) was not significantly different than for subjects in the SB or SBEQ groups. Subjects in the SBEQ group maintained a higher level of exercise than subjects in both the SB and LB groups (P<.05) at 13 to 18 months of treatment. All groups showed an increase in cardiorespiratory fitness from baseline to 18 months, with no difference between groups. Mean (SD) weight loss at 18 months was significantly greater in individuals exercising more than 200 min/wk throughout the intervention (-13.1 [8.0] kg) compared with individuals exercising 150 to 200 min/wk (-8.5 [5.8] kg) or less than 150 min/wk (-3.5 [6.5] kg) (P<.05). CONCLUSIONS: Compared with the LB group, subjects in the SB group did not experience improved long-term weight loss, exercise participation, or cardiorespiratory fitness. Access to home exercise equipment facilitated the maintenance of SB, which may improve long-term weight loss. A dose-response relationship exists between amount of exercise and long-term weight loss in overweight adult women.

Adult↗

Elevated C-reactive protein levels in overweight and obese adults.

CONTEXT: Human adipose tissue expresses and releases the proinflammatory cytokine interleukin 6, potentially inducing low-grade systemic inflammation in persons with excess body fat. OBJECTIVE: To test whether overweight and obesity are associated with low-grade systemic inflammation as measured by serum C-reactive protein (CRP) level. DESIGN AND SETTING: The Third National Health and Nutrition Examination Survey, representative of the US population from 1988 to 1994. PARTICIPANTS: A total of 16616 men and nonpregnant women aged 17 years or older. MAIN OUTCOME MEASURES: Elevated CRP level of 0.22 mg/dL or more and a more stringent clinically raised CRP level of more than 1.00 mg/dL. RESULTS: Elevated CRP levels and clinically raised CRP levels were present in 27.6% and 6.7% of the population, respectively. Both overweight (body mass index [BMI], 25-29.9 kg/m2) and obese (BMI, > or =30 kg/m2) persons were more likely to have elevated CRP levels than their normal-weight counterparts (BMI, <25 kg/m2). After adjustment for potential confounders, including smoking and health status, the odds ratio (OR) for elevated CRP was 2.13 (95% confidence interval [CI], 1.56-2.91) for obese men and 6.21 (95% CI, 4.94-7.81) for obese women. In addition, BMI was associated with clinically raised CRP levels in women, with an OR of 4.76 (95% CI, 3.42-6.61) for obese women. Waist-to-hip ratio was positively associated with both elevated and clinically raised CRP levels, independent of BMI. Restricting the analyses to young adults (aged 17-39 years) and excluding smokers, persons with inflammatory disease, cardiovascular disease, or diabetes mellitus and estrogen users did not change the main findings. CONCLUSION: Higher BMI is associated with higher CRP concentrations, even among young adults aged 17 to 39 years. These findings suggest a state of low-grade systemic inflammation in overweight and obese persons.

Adult↗

Overweight as an avoidable cause of cancer in Europe.

There is growing evidence that excess body weight increases the risk of cancer at several sites, including kidney, endometrium, colon, prostate, gallbladder and breast in post-menopausal women. The proportion of all cancers attributable to overweight has, however, never been systematically estimated. We reviewed the epidemiological literature and quantitatively summarised, by meta-analysis, the relationship between excess weight and the risk of developing cancer at the 6 sites listed above. Estimates were then combined with sex-specific estimates of the prevalence of overweight [body mass index (BMI) 25-29 kg/m(2)] and obesity (BMI > or = 30 kg/m(2)) in each country in the European Union to obtain the proportion of cancers attributable to excess weight. Overall, excess body mass accounts for 5% of all cancers in the European Union, 3% in men and 6% in women, corresponding to 27,000 male and 45,000 female cancer cases yearly. The attributable proportion varied, in men, between 2.1% for Greece and 4.9% for Germany and, in women, between 3.9% for Denmark and 8.8% for Spain. The highest attributable proportions were obtained for cancers of the endometrium (39%), kidney (25% in both sexes) and gallbladder (25% in men and 24% in women). The largest number of attributable cases was for colon cancer (21,500 annual cases), followed by endometrium (14,000 cases) and breast (12,800 cases). Some 36,000 cases could be avoided by halving the prevalence of overweight and obese people in Europe.

Body Weight↗

Emotions and attitudes related to being overweight.

A questionnaire was constructed to examine the relationship between eating habits and emotional attitudes toward food. This was administered to 60 individuals who varied widely in body weight relative to the statistically determined optimum for their age and sex. Correlations between item scores and weight discrepancy values from optimum revealed a number of significant correlations. The more the degree of overweight, the greater the tendency to have problems in three areas: depression, anxiety and impulsivity. In addition, the number of overweight relatives in one's immediate family also is related to an individual's degree of overweight. Some implications for the therapy of obesity were suggested.

Adult↗

Chitosan for overweight or obesity.

BACKGROUND: Chitosan, a deacetylated chitin, is a dietary supplement reported to decrease body weight. It is widely available over the counter worldwide and although evaluated in a number of trials its efficacy remains in dispute. OBJECTIVES: To assess the effects of chitosan as a treatment for overweight and obesity. SEARCH STRATEGY: We searched electronic databases (MEDLINE, EMBASE, BIOSIS, CINAHL, The Cochrane Library), specialised web sites (Controlled Trials, IBIDS, SIGLE, Reuter's Health Service, Natural Alternatives International, Pharmanutrients), bibliographies of relevant journal articles, and contacted relevant authors and manufacturers. Last searches were completed in March 2004. SELECTION CRITERIA: Trials were included in the review if they were randomised controlled trials of chitosan a minimum of four weeks duration in adults who were overweight or obese. Authors of included studies were contacted for additional information where appropriate. DATA COLLECTION AND ANALYSIS: Details from eligible trials were extracted independently by two reviewers using a standardised data extraction form. Differences in data extraction were resolved by consensus. Continuous data were expressed as weighted mean differences and standard deviations. The pooled effect size was computed by using the inverse variance weighted method. MAIN RESULTS: Fourteen trials including a total of 1131 participants met the inclusion criteria. No trial to date has measured the effect of chitosan on mortality or morbidity. Analyses including all trials indicated that chitosan preparations result in a significantly greater weight loss (weighted mean difference -1.7 kg; 95% confidence interval (CI) -2.1 to -1.3 kg; P < 0.00001), decrease in total cholesterol (-0.2 mmol/L; 95% CI -0.3 to -0.1; P < 0.00001), decrease in systolic (-5.9 mmHg; 95% CI -7.3 to -4.6; P < 0.0001) and diastolic (-3.4 mmHg; 95% CI -4.4 to -2.4; P < 0.00001) blood pressure compared with placebo. There were no clear differences between intervention and control groups in terms of frequency of adverse events or in faecal fat excretion. However, the quality of many studies was sub-optimal and analyses restricted to studies that met allocation concealment criteria, were larger, or of longer duration showed that such trials produced substantially smaller decreases in weight and total cholesterol. AUTHORS' CONCLUSIONS: There is some evidence that chitosan is more effective than placebo in the short-term treatment of overweight and obesity. However, many trials to date have been of poor quality and results have been variable. Results obtained from high quality trials indicate that the effect of chitosan on body weight is minimal and unlikely to be of clinical significance.

Adult↗

Body mass index, overweight and obesity in married and never married men and women in Poland.

The study examined the relationship between marital status and the body mass index (BMI) and the prevalence of overweight and obesity in the Polish population. The sample included 2,266 men and 4,122 women, 25-60 years of age, who were occupationally active inhabitants of Wroclaw, in southwestern Poland. Marital status was defined by two categories: never married and presently married, and two groups in each category were established on the basis of educational level: well-educated (12 or more years in school) and poorly educated (less than 12 years in school). The subjects were also divided into four age groups: 25-30, 31-40, 41-50, and 51-60 years. Height and weight were measured and the BMI was calculated. Three categories of the BMI were established: normal, BMI < 25.0 kg/m(2), overweight, BMI > or = 25 < 30 kg/m(2), and obese, BMI > or = 30 kg/m(2). In each age and educational group, married individuals had a higher BMI than those who were never married. With the exception of well-educated males 51-60 years, differences in the BMI between married and never married individuals increased with age. In general, married men and women were more likely to be overweight and obese than never married individuals. The results indicated a significant association (P < 0.001) between marital status and the BMI in both sexes. After age, marital status was the most important predictor of overweight/obesity among men (P < 0.001), whereas educational level did not have a significant role. Among women, age, marital status, and education were significantly (P < 0.001) related to the BMI.

Adult↗

Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial.

OBJECTIVE: The Arthritis, Diet, and Activity Promotion Trial (ADAPT) was a randomized, single-blind clinical trial lasting 18 months that was designed to determine whether long-term exercise and dietary weight loss are more effective, either separately or in combination, than usual care in improving physical function, pain, and mobility in older overweight and obese adults with knee osteoarthritis (OA). METHODS: Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older, with a body mass index of > or =28 kg/m(2), knee pain, radiographic evidence of knee OA, and self-reported physical disability, were randomized into healthy lifestyle (control), diet only, exercise only, and diet plus exercise groups. The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included weight loss, 6-minute walk distance, stair-climb time, WOMAC pain and stiffness scores, and joint space width. RESULTS: Of the 316 randomized participants, 252 (80%) completed the study. Adherence was as follows: for healthy lifestyle, 73%; for diet only, 72%; for exercise only, 60%; and for diet plus exercise, 64%. In the diet plus exercise group, significant improvements in self-reported physical function (P < 0.05), 6-minute walk distance (P < 0.05), stair-climb time (P < 0.05), and knee pain (P < 0.05) relative to the healthy lifestyle group were observed. In the exercise group, a significant improvement in the 6-minute walk distance (P < 0.05) was observed. The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures. The weight-loss groups lost significantly (P < 0.05) more body weight (for diet, 4.9%; for diet plus exercise, 5.7%) than did the healthy lifestyle group (1.2%). Finally, changes in joint space width were not different between the groups. CONCLUSION: The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone.

Aged↗

Different contributions of insulin resistance and beta-cell dysfunction in overweight Israeli Arabs with IFG and IGT.

BACKGROUND: Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are both intermediate stages that exist between normal glucose tolerance and overt type 2 diabetes. Epidemiological studies demonstrated that the two categories define distinct populations. In this study, we examined the contributions of insulin resistance and beta-cell dysfunction to both states in overweight subjects of Arab origin. METHODS: Twelve subjects with isolated IFG, 10 with isolated IGT, and 20 with IFG and IGT (combined glucose in tolerance-CGT) were compared with 30 subjects with normal glucose tolerance (NGT) subjects; all were of Arab origin and were overweight or obese. Different indices for insulin resistance and beta-cell function were calculated from oral glucose tolerance (OGTT) values. RESULTS: Subjects with isolated IFG and CGT were more obese and had significantly higher values of insulin resistance than subjects with isolated IGT and NFG. There was no significant difference between the insulin resistance in subjects with isolated IGT and that in subjects with NGT. Indices of beta cell function were severely reduced among subjects with isolated IGT and CGT when compared with those with both isolated IFG and NGT, while subjects with isolated IFG had similar beta-cell indices to subjects with NGT. CONCLUSION: These data demonstrate that beta-cell dysfunction and insulin resistance contribute differently to the pathogenesis of IFG and IGT among overweight Arab subjects.

Adult↗

Loss of control over eating, adiposity, and psychopathology in overweight children.

OBJECTIVE: To investigate the relationship between loss of control over eating, adiposity, and psychological distress in a nontreatment sample of overweight children. METHOD: Based on self-reports of eating episodes, 112 overweight children, 6-10 years old, were categorized using the Questionnaire of Eating and Weight Patterns-Adolescent Version into those describing episodes of loss of control over eating (LC), and those with no loss of control (NoLC). Groups were compared on measures of adiposity, dieting, and eating behavior, and associated psychological distress. RESULTS: LC children (33.1%) were heavier and had greater amounts of body fat than NoLC children. They also had higher anxiety, more depressive symptoms, and more body dissatisfaction. 5.3% met questionnaire criteria for BED. Episodes of loss of control occurred infrequently, were often contextual, and involved usual meal foods. DISCUSSION: As in adults, overweight children reporting loss of control over eating have greater severity of obesity and more psychological distress than those with no such symptoms. It remains unknown whether children who endorse loss of control over eating before adolescence will be those who develop the greatest difficulties with binge eating or obesity in adulthood.

Analysis of Variance↗

Overeating among seriously overweight children seeking treatment: results of the children's eating disorder examination.

OBJECTIVE: We sought to examine rates of eating disorder symptoms among seriously overweight children seeking treatment using the Eating Disorder Examination for Children (ChEDE) and to provide initial data about their association with treatment outcome. METHOD: Overweight children (N = 27) 8-13 years old were interviewed using the ChEDE before participating in a family-based behavioral treatment program. Height and weight were measured pretreatment, posttreatment, and approximately 8 months posttreatment. RESULTS: Fifteen percent of children reported subjective bulimic episodes (SBE). Weight loss did not differ for children with and without SBEs, but concerns about body shape were related to larger weight losses during treatment. CONCLUSION: A considerable minority of treatment-seeking overweight children report an episodic sense of loss of control over eating. Loss of control is related to other disordered eating attitudes and behaviors, but does not appear to affect treatment outcome. Future studies are needed to replicate these initial findings.

Adolescent↗

The effect of intensity controlled aerobic dance exercise on aerobic capacity of middle-aged, overweight women.

The purpose of this study was to determine the effect of intensity controlled exercise on the aerobic capacity of overweight, middle-aged women. Thirty-eight moderately overweight women, ages 35-57, participated in a 16-week dance-exercise program. Random assignment was made to an experimental group (n = 20) in which intensity of exercise was controlled and prescribed, and a control group (n = 18) in which exercise was of an intensity typical to commercial aerobic classes. Prior to the onset of training, and at the completion of 16 weeks, the following fitness tests were administered: Aerobic capacity expressed as VO2 max, body composition analysis, blood chemistry, blood pressure, resting heart rate, muscular endurance, and flexibility. T-tests, ANCOVA, and gain-score analyses were utilized to evaluate data. Both groups showed small changes in weight, percent fat, resting systolic and diastolic blood pressure, resting heart rate, high density lipoprotein-cholesterol (HDL-C), muscular endurance, and flexibility, but these changes were statistically nonsignificant. The VO2 max for the experimental group increased 41%, while the VO2 max for the control group increased 22% (p less than 0.05). The results suggest that the cardiovascular fitness changes for overweight, middle-aged women are greater when exercise intensity and progression are tailored to their age and fitness level.

Adult↗

Perception of daily stress and oral coping behaviors in normal, overweight, and recovering alcoholic women.

One method of coping with perceived stress is the use of oral behaviors (e.g., eating, drinking, smoking). This study addressed the influence of perceived daily stress level (day rated as pleasant, neutral, or unpleasant) on oral behaviors in three groups of women, aged 25 to 45. Subjects included 37 female normal alcohol users of normal weight, 23 recovering alcoholics of normal weight, and 37 normal alcohol users who were 25% to 100% overweight. The normals responded to daily stress levels by changing their oral behaviors in predictable and consistent ways. On unpleasant days, the normals and the recovering alcoholic women ate more sweet, starchy, and salty/spicy foods. The overweight women ate more food, especially salty/spicy and sweet foods regardless of the type of day. The alcoholic women desired alcohol and smoked more than the other two groups all the time. Hence, the alcoholics and overweight women desired to or engaged in their habituated oral behaviors regardless of fluctuating daily stress levels.

Adaptation, Psychological↗

Early family mealtime experiences and eating attitudes in normal weight, underweight and overweight females.

The aim of this study was to examine young women's recollections of family mealtimes in order to determine whether these memories may serve to differentiate those of normal weight from those who were underweight or overweight. A sample of 340 women selected on the basis of their enrollment in a college course completed the Childhood Family Mealtimes Questionnaire and the short form of the Eating Attitudes Test (EAT). The women were divided into under, normal and overweight groups on the basis of their body mass index (BMI). Two factors (appearance-weight control and emphasis on mother's weight) were significantly higher among the overweight than the underweight women, and mealtime communication-based stress was highest among the underweight women. The use of family mealtimes as a window for understanding the development of eating disorders (ED) is discussed.

Adult↗