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The female weight-control smoker: a profile.

Hypothesizing the existence of a subgroup of female smokers for whom nicotine masks, and abstinence unmasks, a tendency toward hyperphagia and perhaps even subthreshold disordered eating, we compared female "weight-control smokers" (WC; n = 46) and "non-weight-control smokers" (NWC; n = 52) on smoking- and eating-related variables. We also examined the relationship between weight-control smoking and withdrawal symptomatology during 48-hours of nicotine abstinence (n = 23). Although WC were not more depressed, anxious, or nicotine-dependent than NWC, they were significantly more likely to report weight gain and increased hunger during abstinence; they also scored higher on Cognitive Restraint and Disinhibition (Three-Factor Eating Questionnaire). The expected correlation of cotinine with weight emerged for NWC but not for WC. Weight-control smoking correlated with increased eating during abstinence. Our findings suggest that WC use dietary restraint as well as smoking to manage weight, and that abstinence may precipitate episodes of disinhibited or binge eating. If WC overinclude women vulnerable to excess or unpredictable eating and consequently to substantial weight gain that can be managed by nicotine, highly focused treatment strategies may be helpful.

Adult↗

Predictors of weight control advice in primary care practices: patient health and psychosocial characteristics.

BACKGROUND: Past research has surveyed primary care physicians (PCP) about their attitudes and practices towards obese patients, yet less is known about the patients receiving advice. METHODS: The Primary Care Weight Control Project (PCWC) enrolled 18 PCPs in a randomized clinical trial and asked 255 of their patients who were either overweight or obese at baseline about past weight control advice. RESULTS: At baseline, 66.4% of patients reported that their physician previously told them they were overweight. Body mass index (BMI) was a strong predictor of being identified as obese. While 65.1% received information on the health benefits of weight loss, only 36.6% of patients were ever given specific weight control advice, and 28.2% were advised to increase their physical activity. A history of type 2 diabetes, high cholesterol, or hypertension was associated with physician-delivered weight control advice. Stages of change and number of prior visits with the PCP were also associated with physician advice. CONCLUSIONS: Patients were more likely to receive education about weight loss than specific behavioral advice on how to lose weight. Physicians were more likely to provide weight control advice to their patients who had obesity-related comorbidities than to patients who were overweight or obese and without risk factors.

Adult↗

Behavior therapy for weight control: long-term results of two programs with nutritionists as therapists.

Two studies examined the effectiveness of behavior modification techniques utilizing nutritionists as therapists. In study 1, therapist training on the use of behavioral techniques was done by self-study. Fifty-seven females at least 10% overweight (X = 20%, SD = +/- 14.0) were placed in one of three 10-week treatment conditions; 1) a multiple technique behavioral program, 2) food exchange treatment, and 3) delay treatment control. End of treatment weight losses averaged 3.0, 2.2, and 0.1 kg, respectively. When treated, the delay group lost 2.7 kg. One year post-treatment the behavior therapy subjects were maintaining approximately 70% of the weight lost during treatment; the other two groups maintained less than half of their achieved loss. In study 2, 54 female subjects 15 to 60% overweight (X = 39%, SD = +/- 12.3) underwent one of two 14-week behavioral weight control treatments. One was the same behavioral treatment used in study 1; the other was built around the concept of stimulus control. Both treatments included nutrition information. The therapists were trained by a behavioral psychologist. Weight loss at the end of treatment was 8.4 and 7.3 kg for the stimulus control and multiple technique conditions, respectively. There was a significant difference in favor of the stimulus control treatment at 3 and 6 months posttreatment. At the 18-month follow-up the stimulus control subjects were maintaining 80% of achieved weight loss; the other group only 50%.

Adolescent↗

Adolescents' attitudes about and consumption of low-fat foods: associations with sex and weight-control behaviors.

The objective of the study was to examine adolescents' attitudes about and consumption of low-fat foods by sex and weight-control behaviors. Ninth- to 12th-grade students (n=1,083) in 20 Minnesota high schools completed mail surveys (response rate=74%) as part of baseline measurements (Fall 2001) in a randomized controlled trial (TACOS: Trying Alternative Cafeteria Options in Schools). Linear models examined attitudes and consumption of low-fat foods by sex and weight-control behaviors. Girls were more likely than boys to report positive attitudes and consumption of low-fat foods (all P<.01). Weight-control practices were associated with more positive attitudes about and higher consumption of low-fat foods. Promoting low-fat snacks to adolescents who are interested in weight control may be an effective component of nutrition intervention programs because these students have more positive attitudes about low-fat foods. Dietitians' efforts to educate adolescents about the benefits and healthfulness of low-fat foods would aid intervention programs.

Adolescent↗

A high exercise load is linked to pathological weight control behavior and eating disorders in female fitness instructors.

Demographic data, exercise habits, weight control behavior, attitudes towards body shape, eating disorder (ED) experience, and menstrual regularity among female fitness instructors were descriptively assessed. A 60-item questionnaire was sent to 295 female fitness instructors at eight fitness centers. Responders (57%) reported a mean weekly exercise load of 5.5 h week(-1) (SD 2.6), which indicates frequent training, however, less than that of athletes. Overall, 35% reported ED experience (DSM-IV criteria), with an onset at 15-17 years of age. The problems had lasted 5-7 years, and 20% of the entire group reported recovery, however, 11% still had EDs. For the entire group, it was found that a high weekly exercise load was linked to a pathological weight control behavior. Fitness instructors with an active ED exercised more than instructors who never had an ED or who had a past ED. Menstrual irregularity was more common among instructors who did not use contraceptives (14%), compared to those who did (5%). As ED experience and pathological weight control behavior were common in the studied group, the importance of guidelines regarding communication from female fitness instructors about healthy training habits to regular exercisers is discussed in the article.

Adolescent↗

Weight perceptions and weight control practices in American Indian and Alaska Native adolescents. A national survey.

OBJECTIVE: To assess weight perceptions and weight control practices among American Indian-Alaska Native adolescents. DESIGN: Survey. SETTING: Nonurban schools from eight Indian Health Service areas. PARTICIPANTS: A total of 13,454 seventh- through 12th-grade American Indian-Alaska Native youths. MAIN OUTCOME MEASURES: A revised version of the Adolescent Health Survey, a comprehensive, anonymous self-report questionnaire with eating- and body image-related questions. RESULTS: Forty-one percent of the adolescent girls reported feeling overweight, 50% were dissatisfied with their weight, and 44% worried about being overweight. Almost half (48%) had been on a weight-loss diet in the past year, with 27% reporting that they had self-induced vomiting at some time to try to lose weight. Eleven percent reported using diet pills. Girls who reported feeling overweight were more likely to engage in unhealthy weight control practices than were those who felt they were of normal weight or underweight. A larger proportion of boys were satisfied with their weight (68%), with 22% worrying about being overweight. However, compared with rural Minnesota youth, both American Indian girls and boys had greater dissatisfaction with body weight. CONCLUSIONS: Our study shows that American Indian youth, particularly girls, are dissatisfied with their weight and are worried about being overweight, and that unhealthy weight control practices are common. More attention needs to be placed on developing culturally appropriate weight management programs for Indian youths.

Adolescent↗

Reproductive failure in women who practice weight control.

Forty-seven women (29 with unexplained infertility and 18 with menstrual dysfunction) practiced weight control by caloric restriction in order to maintain a fashionable body habitus. All of these women were below ideal body weight (IBW) when compared with Metropolitan Life Insurance Company tables for height and weight. When 36 of these women followed a dietary regimen designed to increase their weight to predicted IBW, 19 of 26 infertile women (73%) conceived spontaneously; 9 of 10 women (90%) with secondary amenorrhea resumed menstruation. Eleven women (23%) would not accept their practice of weight control as the cause of reproductive failure and did not participate in the study. Differences in the serum gonadotropin luteinizing hormone:follicle-stimulating hormone (LH:FSH) ratio were found to be significantly related to differences in the percentage of IBW. The practice of weight control may be a cause of unexplained infertility and menstrual disorders in otherwise healthy women.

Adolescent↗

Holistic Self-Care Model for permanent weight control.

Nearly one fourth of adult women in the United States are currently overweight, despite numerous approaches to weight control. Nurses are confused about appropriate interventions for overweight women who weight cycle--that is, experience repeated periods of weight loss followed by weight regain. Women continue to suffer the negative physical, psychological, and financial consequences of weight cycling, which is related to increased adiposity, an additional important health risk. Moderately successful, long-term weight control treatments are programs that have a combined intervention prescribing both controlled amounts of health food intake and aerobic exercise. Although such a physical program can promote weight loss, the psychological components often are not considered and are the reasons why so many diet/exercise programs fail. The Holistic Self-Care Model combines the successful physical, cognitive, and psychological essentials of healthy approaches for weight reduction as a means of stopping weight cycling and promoting weight control.

Adult↗

Weight control in adolescent girls: a comparison of the effectiveness of three approaches to follow-up.

The purpose of the project was to compare the effectiveness of three different types of follow-up of a weight control program in assisting adolescent girls to achieve and maintain ideal body weight. During the initial phase of the weight control program, subjects attended two sessions of approximately one hour each for eight weeks. One session each week included theory and practice of physical exercise. The other session was devoted to behavioral control of eating and diet therapy. After eight weeks, 18 subjects were divided randomly into three groups for follow-up: Group 1--monthly measurements and reinforcement of behavioral, diet, and exercise components of the weight control program; Group 2--monthly measurements; and Group 3--annual measurements. Fifteen subjects completed the 12-month follow-up program. Mean weight loss during follow-up of Group 1 was 3.65 kg, Group 2 was 1.90 kg, while Group 3 had a mean weight gain of 3.44 kg. The results suggest that regular follow-up may be a critical element in successful weight control programs for adolescent girls.

Adolescent↗

Risky weight control among university students.

OBJECTIVE: The objectives of the current study were to investigate risky weight control measures (vomiting or pills) among university students in Lebanon and to assess their relation to demographic, scholastic, and health risk behavioral characteristics. METHOD: The study used a cross-sectional design. A proportionate random sample of 2,013 students was selected from public and private universities in Greater Beirut. Each participant completed a self-administered anonymous questionnaire. RESULTS: Among participating students, 123 (6.1%) reported practicing risky weight control measures. Multivariate analysis indicated that younger females, cigarette smokers, engaged/married students, and those with a higher body mass index (BMI) were at increased odds of performing risky weight control measures. CONCLUSION: Health awareness measures need to be proposed and, if possible, implemented to better define the motives and methods of weight reduction among Lebanese youth.

Body Weight↗

Weight control practices and disordered eating behaviors among adolescent females and males with type 1 diabetes: associations with sociodemographics, weight concerns, familial factors, and metabolic outcomes.

OBJECTIVE: This study examines the prevalence of specific weight control practices/disordered eating behaviors and associations with sociodemographic characteristics, BMI and weight perceptions, family functioning, and metabolic control among adolescent females and males with type 1 diabetes. RESEARCH DESIGN AND METHODS: The study population included 70 adolescent females and 73 adolescent males with type 1 diabetes who completed the AHEAD (Assessing Health and Eating among Adolescents with Diabetes) survey. Data on BMI and glycosylated hemoglobin (HbA(1c)) were drawn from medical records. RESULTS: Unhealthy weight control practices were reported by 37.9% of the females and by 15.9% of the males. Among the females, 10.3% reported skipping insulin and 7.4% reported taking less insulin to control their weight. Only one male reported doing either of these behaviors. Weight control/disordered eating behaviors were not associated with age, parental level of education, family structure, or race/ethnicity. Higher levels of weight dissatisfaction tended to be associated with unhealthy weight control/disordered eating; associations with BMI were inconsistent. Family cohesion was negatively associated with disordered eating among females (r = -0.52; P < 0.001) and males (r = -0.41; P < 0.001), but correlations with other measures of family environment (control, independence, and responsibility for diabetes management) were not significant. Correlations between disordered eating and HbA(1c) levels were significant among females (r = 0.33; P < 0.01) and males (r = 0.26; P < 0.05). CONCLUSIONS: Special attention is needed for youth with weight concerns and those from less cohesive families to assist in the development of healthy diabetes management behaviors.

Adolescent↗

Agreement between survey and interview measures of weight control practices in adolescents.

OBJECTIVE: The present study examined agreement between survey and interview measures of weight control practices in a nonclinical sample of adolescents. METHOD: Surveys were administered in three school health classes. Clinical interviews were conducted in a student subsample (N = 43). RESULTS: Survey-based prevalences for eating behaviors in the past month were: trying to lose weight, 44%; binge eating, 41%; vomiting, 4.7%; laxative use, 0%; and fasting, 14%. Interview-based prevalences were 30%, 11.6%, 0%, 0% and 0%, respectively. Sensitivity was high for all behaviors assessed. However, positive predictive values were low. DISCUSSION: Surveys may be useful as preliminary screening tools for prevention programs, but may yield inflated estimates of unhealthy weight control practices in nonclinical adolescent populations. Research is needed to examine whether adolescents overreport weight control practices on surveys or whether they are less willing to disclose such practices in a private interview.

Adolescent↗

Behavioral weight control for overweight adolescents initiated in primary care.

OBJECTIVE: This study evaluates the post-treatment and short-term follow-up efficacy of, as well as participant satisfaction for, a 4-month behavioral weight control program for overweight adolescents initiated in a primary care setting and extended through telephone and mail contact. RESEARCH METHODS AND PROCEDURES: 44 overweight adolescents were randomly assigned to either a multiple component behavioral weight control intervention (Healthy Habits [HH]; n = 23) or a single session of physician weight counseling (typical care [TC]; n = 21). Weight, height, dietary intake, physical activity, sedentary behavior, and problematic weight-related and eating behaviors and beliefs were assessed before treatment, after the 4-month treatment, and at 3-month follow-up. Participant satisfaction and behavioral skills use were measured. RESULTS: HH adolescents evidenced better change in body mass index z scores to post-treatment than TC adolescents. Body mass index z scores changed similarly in the conditions from post-treatment through follow-up. Behavioral skills use was higher among HH than TC adolescents, and higher behavioral skills use was related to better weight outcome. Energy intake, percentage of calories from fat, physical activity, sedentary behavior, and problematic weight-related or eating behaviors/beliefs did not differ by condition or significantly change over time independent of condition. The behavioral intervention evidenced good feasibility and participant satisfaction. DISCUSSION: A telephone- and mail-based behavioral intervention initiated in primary care resulted in better weight control efficacy relative to care typically provided to overweight adolescents. Innovative and efficacious weight control intervention delivery approaches could decrease provider and participant burden and improve dissemination to the increasing population of overweight youth.

Adolescent↗

Weight control practices of lightweight football players.

The objective of this research was to investigate the weight control practices of lightweight football players. In addition, the importance of several variables was examined for their clinical importance and ability to identify individuals at high risk for pathogenic eating behaviors. Male college lightweight football players (N = 131) were administered a 45-item version of the Diagnostic Survey For Eating Disorders (9). Results revealed that 74% had experienced binge eating, and 17% had experienced self-induced vomiting. During the month preceding questionnaire administration, 66% had fasted, nearly 4% had used laxatives, while less than 2.5% had used diet pills, diuretics, or enemas for the purpose of weight control. Furthermore, the "teacher/coach" seemed to be the individual who motivated dieting behavior, and more than 20% of the sample reported that their weight control practices interfered with their thoughts and extracurricular activities "often" or "always." Most importantly, 42% of the sample evidenced a pattern of dysfunctional eating, while 9.9% of the sample engaged in binge-purge behavior to the degree that it might represent an eating disorder. Finally, discriminant the degree that it might represent an eating disorder. Finally, discriminant analysis yielded several variables that might be useful in identifying individuals at risk for pathogenic eating behaviors.

Adolescent↗

Examination of the use of smoking for weight control in restrained and unrestrained eaters.

Recent research has examined the perceived benefits of smoking and suggests that continued smoking may be related to contemporary concerns for weight and shape. The present study examined the role of restrained eating in predicting smoking for reasons of weight control, reports of weight gain following cessation, and reasons for relapse and intentions to quit. Eighty-four restrained eaters and 83 unrestrained eaters completed a questionnaire examining their smoking behavior. The results suggest that the restrained eaters gave significantly greater endorsement than the unrestrained eaters to statements relating to smoking initiation and smoking maintenance for weight control, the role of weight gain in previous experiences of smoking relapse, intentions to quit following weight loss, and intentions to quit in 5 years. No differences were found between the restrained and unrestrained eaters in terms of experiences of post cessation weight gain, the number of attempts to quit, and intentions to quit in 6 months. The results are discussed in terms of developing a model of the relationship between smoking and weight concerns.

Adolescent↗

Psychosocial factors influencing weight control behavior of African American women.

The purpose of this descriptive study was to seek directly from college-educated African American women factors which they perceived influenced their individual weight control behavior, and those that influenced African American women collectively. Face-to-face, in-depth interviews were conducted, primarily in their homes, with 36 African American women. Thirteen major categories were identified. Six factors that influenced the women's individual weight control behavior were emotions/feelings, beliefs, life events, self-control, discipline, and commitment. Perceived benefits of the behavior and perceived barriers to the behavior were influential in determining the attractiveness, the type, and the extent of the weight control behavior. Five factors related to the African American culture were identified and described by the women. Recognition of psychosocial determinants of weight control behavior may enable health professionals to design unique interventions relevant to African American women.

Adult↗

Factors associated with weight change among clients of a residential weight control program indicating binge and nonbinge traits.

The long-term effects of a 12- and 26-day residential weight control program on weight change were determined in 187 men and women, 1 to 5 years after treatment. Subjects completed a paper/pencil questionnaire assessing current diet, weight control techniques, exercise behaviors, behavior modification techniques, binge eating, and dieting behavior. General linear modeling was used to investigate the association between behaviors maintained posttreatment and current weight among subjects who demonstrated behaviors indicative of binge traits (BT) and nonbinge traits (NBT). Results indicate that dissimilar variables are predictive of weight change in the BT and NBT groups. Engaging in exercise behaviors and reduced attempts at dieting lead to greater weight loss in NBT individuals. The use of preplaning techniques was found to be indicative of greater weight loss in BT individuals. These findings suggest the importance of identifying individuals who indulge in binge-eating behaviors prior to intervention in order to deliver the appropriate treatment methods.

Adult↗

Use of extreme weight control behaviors with and without binge eating in a community sample: implications for the classification of bulimic-type eating disorders.

OBJECTIVE AND METHOD: To inform the classification of bulimic-type eating disorders not meeting formal diagnostic criteria for bulimia nervosa (BN), levels of eating disorder psychopathology and functional impairment associated with subjective and objective bulimic episodes (SBEs and OBEs) and purging and nonpurging methods of weight control were examined in a large community-based sample of women (n = 5,232). RESULTS: Participants who reported recurrent bulimic episodes had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not and this was the case whether the episodes were objective or subjective. Similarly, participants who reported the use of extreme weight control behaviors had higher levels of eating disorder psychopathology and functional impairment than those who did not, and this was the case whether purging or nonpurging behaviors were employed. The combination of bulimic episodes and extreme weight control behaviors was associated with particularly high levels of eating disorder psychopathology and functional impairment. CONCLUSION: The combination of bulimic episodes, objective or subjective, and extreme weight control behaviors, purging or nonpurging, is significant in terms of impairment in psychosocial functioning among individuals affected by eating disorders not meeting formal diagnostic criteria for BN. The combination of SBEs and extreme weight control behaviors, in particular, warrants further investigation.

Adolescent↗