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PubMed2002

Establishing dietary habits during childhood for long-term weight control.

OBJECTIVE: To review psychosocial research with respect to relevance for the development of nutritional education strategies for optimal weight control during childhood and the longer term. RESULTS: Recent decades have witnessed changes in the social context of eating, with a trend away from family meals towards grazing and eating alone. At the same time, the prevalence of overweight and obesity is increasing amongst both children and adults, with even young children deliberately practising weight control measures, ranging from selective food choice to self-induced vomiting. Such behaviour is motivated by unrealistic perceptions of healthy body weight and shape. Successful long-term management of healthy body weight is supported by flexible control of eating behaviour and long-term educational strategies. Children are interested in learning about a wide range of nutrition topics. However, to be effective, nutrition education should be appropriate to the stage of cognitive development according to the age of the child, and be placed in the context of the direct, perceivable and immediate benefits resulting from good nutrition. CONCLUSION: Educational strategies should focus on consumption of a balanced diet, coupled with provision of a variety of foods, including a range of nutrient-dense "healthy" food and encouraging children to taste unfamiliar dishes. They should provide a stable and predictive pattern of social eating occasions to promote the social meaning and importance of eating, and to enable social learning of food preferences. Educational strategies should provide orientation and reassurance regarding the range of healthy and acceptable body weights and shapes. They should also encourage flexible control of eating behaviour to enable children to maintain their weight within this healthy range.

Adolescent↗
PubMed2004

Binge eating disorder, weight control self-efficacy, and depression in overweight men and women.

OBJECTIVE: To examine binge eating, depression, weight self-efficacy, and weight control success among obese individuals seeking treatment in a managed care organization. DESIGN: Gender-stratified analyses of associations between binge eating, depression, weight self-efficacy, and weight change, using data from a randomized clinical trial that compared low-cost telephone-based, mail-based, and usual care interventions for weight loss. SUBJECTS: A total of 1632 overweight individuals (460 men, 1172 women; mean age: 50.7 y; mean body mass index: 34.2 kg/m(2)) were recruited from a large Midwestern US managed care organization. MEASUREMENTS: Height and weight were measured by study personnel at baseline, and self-reported weight was assessed at 6 and 12 months; self-reported depression status, binge eating, and self-efficacy for weight control were assessed at baseline. RESULTS: Lifetime prevalence rates for depression and probable binge eating disorder were high. Weight self-efficacy was inversely related to weight in both men and women. For women, depression was associated with lower weight self-efficacy and higher body weight. Women reporting depression or lower weight self-efficacy at baseline had less weight loss success at 6 and 12 months. Depression, binge eating disorder, and weight self-efficacy were not significantly associated with weight loss success in men. CONCLUSION: Negative emotional states are highly prevalent and predict poor treatment outcomes, particularly for obese women. As obese women with clinical depression typically are excluded from intervention studies, further research on how to address the intersection of obesity intervention and mood management may be warranted.

Adult↗
PubMed1995

The relationship between stress and weight-control behavior in African-American women.

Obesity is a problem for African-American women across all socioeconomic strata. Age-adjusted prevalence of overweight is 48.5% among African-American women compared with 21% among white women. An exploratory field was designed to examine selected psychosocial factors that influence the weight-control behavior of middle-income African-American women. A triangulation methodology was used in which both qualitative and quantitative data were collected. First, semistructured interviews were held with 36 African-American women between the ages of 25 and 75. Second, a Global Stress Scale was administered to measure perceived stress. Statistical analysis of the data revealed a positive correlation between body weight and stress in that women who were more overweight were experiencing more stress. Ethnographic analysis of the data showed that more than 50% of the women thought that stress negatively affected their weight-control behavior. Additionally, occupational stressors related to racism, sexism, and workload were major stressors for this group of women. Recognition of factors that influence weight-control health practices will enable health professionals to assist African-American women to manage their weight.

Adult↗
PubMed2006

What can the National Weight Control Registry teach us?

Given the high obesity rate and its economic burden, it is critical to better understand weight loss and maintenance. The National Weight Control Registry (NWCR) provides useful information about the strategies used by successful weight maintainers long term; recent data suggest that a diet with less food group variety will provide a lower calorie intake and that medical triggers have been associated with better initial weight loss and maintenance. The NWCR data suggest that long-term weight loss maintenance can be achieved and that health care practitioners may need to adjust weight control programs accordingly.

Diet, Reducing↗
PubMed1989

Gastric surgery for morbid obesity. Complications and long-term weight control.

The efficacy of gastric surgery for morbid obesity has often been questioned because of incomplete long-term patient follow-up. Between 1977 and 1984, 537 consecutive patients received either a gastric bypass with a Roux-en-Y gastrojejunostomy, an unbanded gastrogastrostomy, or a vertical banded gastroplasty. The follow-up period was 5 years for all patients who underwent Roux-en-Y gastrojejunostomy and unbanded gastrogastrostomy and 3 years for all patients who underwent vertical banded gastroplasty. Only 5.8% of all patients were unavailable for this late follow-up. The unbanded gastrogastrostomy was not an effective weight-control operation. Both the Roux-en-Y gastrojejunostomy and vertical banded gastroplasty provided effective long-term weight control. Although the Roux-en-Y gastrojejunostomy gave slightly better weight control than the vertical banded gastroplasty, the more simple, safe, and physiological vertical banded gastroplasty is the procedure of choice for most patients with morbid obesity.

Adolescent↗
PubMed1997

Psychosocial concerns and weight control behaviors among overweight and nonoverweight Native American adolescents.

OBJECTIVE: To compare the psychosocial and weight-related concerns and weight control, eating, and exercise behaviors of overweight and nonoverweight Native American adolescents living on or near reservations. STUDY DESIGN: A cross-sectional survey assessed psychosocial, health, and weight-specific concerns; disordered eating; and health-promoting behaviors. STUDY POPULATION: The study population included 11,868 Native American youth in grades 7 through 12. STATISTICAL ANALYSES PERFORMED: Analyses of variance and chi 2 tests were used to examine associations between weight status and psychosocial and weight-related concerns and behaviors. Stratified analyses were done by gender and by gender and age. RESULTS: Self-reported weights and heights indicated that 25% of the study population was overweight. Overweight youth were twice as likely to report health concerns as nonoverweight youth. Although a high percentage of nonoverweight youth expressed body- or weight-related concerns and reported engaging in disordered eating behaviors, prevalence rates for these concerns were significantly higher among overweight youth. Overweight youth were also somewhat less likely to engage in health-promoting behaviors. In contrast, differences in global psychosocial concerns were minimal. APPLICATIONS: Overweight Native American youth were concerned about their weight, but did not appear to have major psychosocial concerns associated with being overweight. Interventions aimed at obesity prevention and overall health promotion are essential, given the high prevalence of obesity and of psychosocial and weight-related concerns and behaviors among the study population as a whole. The challenge is to develop culturally appropriate interventions aimed at the promotion of healthful weight control behaviors that will not lead to negative psychosocial consequences.

Adolescent↗
PubMed1987

Appearance changes associated with participation in a behavioral weight control program.

Relationships among objectively-measured weight changes, perceived changes in weight, and perceived changes in attractiveness of participants in a behavioral weight control program were examined. Participants in the program were weighed and photographed before and after treatment and at a six-month follow-up session. These photographs were then rated on the dimensions of perceived weight and perceived attractiveness by the same participants, who were kept blind to the times at which the photographs were taken. Correlational analyses indicated that there was little correspondence between objectively-measured weight change and perceived weight changes or between objectively-measured weight change and perceived change in attractiveness. Perceptions of weight change and perceptions of attractiveness change were, however, strongly related.

Adult↗
PubMed2001

Determinants of food choice: relationships with obesity and weight control.

The decision to eat, and to eat particular foods, varies for different individuals and situations. Individual differences in food likes and desires develop throughout life because of differing food experiences and attitudes. There are many internal and external cues, not just stimulation from foods or hunger, which can trigger the immediate desire to eat or orient eating toward certain foods. Food desires and intake are an outcome of interactions between these cues and more stable individual physiological and psychological characteristics. Overweight and obese individuals show a tendency toward greater liking and selection of energy-dense foods, which may contribute to development and maintenance of these conditions. However, although liking (pleasure from eating) is an important part of food choice, it may make only a modest contribution to overall variation in food choice and eating behaviors. Indeed, difficulties of weight control may reflect problems with cues and motivations to eat, rather than with heightened pleasure derived from eating. Paradoxically, individuals highly concerned with food intake and weight control may be particularly susceptible to thoughts, emotions, and situational cues that can prompt overeating and undermine their attempts to restrain eating. Repeat dieting, high day-to-day fluctuations in intakes, and attempts to enforce highly rigid control over eating all seem to be counterproductive to weight control efforts and may disrupt more appropriate food choice behaviors. Longer-term weight maintenance solutions and programs that offer a degree of structuring of the personal food environment, while retaining flexibility in choices, therefore, may be particularly beneficial in weight management.

Body Weight↗
PubMed1980

The effect of contract witnessing on motivation and weight loss in a weight control program.

To investigate the impact which commitment has on the achievement of behavioral-change goals in a weight control program, a behavioral contracting process was used. One-hundred six adult volunteers were randomly identified as treatment or control group members and co-participated in a four-week, eight-hour, behavioral self-management weight control program. As part of homework assignments, all participants were provided with three take-home contracts which were to be returned either signed by the participant only (control group with baseline commitment) or by the participant and at least one friend, relative, or peer (treatment group with enhanced commitment). Analyses of comparable treatment and control group members shows the treatment group holding significantly stronger behavioral intentions 10 to 15 weeks after the program ended and losing weight at a significantly faster rate. Implications for program planning, implementation, and evaluation are discussed.

Adult↗
PubMed1990

Nutrient intake of obese children in a family-based behavioral weight control program.

The caloric and nutrient intakes, weight, percent overweight and growth of obese and lean children aged 8-12 were compared at baseline and after the obese children participated in a six month family-based behavioral weight control program. At baseline there were no significant differences in the caloric, fat, calcium, iron, vitamin A, vitamin C, thiamin, and riboflavin intakes, or height percentiles of the obese and lean children. After six months the obese children significantly decreased their calorie, protein, fat, and carbohydrate intake, while the lean children significantly increased their protein intake. The percent overweight of the obese children decreased significantly (-18.3 percent), with no changes in percent overweight of the lean children (-0.1 percent). Both the obese (+4.3 cm) and lean (+3.8 cm) children grew significantly over six months, with no significant changes in height percentiles. At baseline and six months both groups exceeded at least two-thirds of the RDA for all nutrients studied.

Age Factors↗
PubMed1996

Socioeconomic status and weight control practices among 20- to 45-year-old women.

OBJECTIVES: This study examined the relationship between socioeconomic status (SES) and weight control practices in women. METHODS: SES, defined by family income, was examined in an economically diverse sample of 998 women in relation to dieting practices by means of multivariate regression analyses controlling for age, ethnicity, smoking, and body mass index. RESULTS: SES was positively associated with healthy, but not unhealthy, weight control practices; inversely related to energy and fat intake; and positively associated with weight concern and perceived social support for healthy eating and exercise. SES gradients were particularly striking at the low end of the income distribution (i.e., family income < or = $10,000 per year). The SES gradient in body mass index persisted in analyses controlling for attitudes and behaviors. CONCLUSIONS: Economic deprivation may contribute to high rates of obesity among lower SES women. The reasons for this require further research.

Adult↗
PubMed1991

Evaluation of long-term weight changes after a multidisciplinary weight control program.

The American Medical Association Council on Scientific Affairs recently emphasized the importance of nutritionally sound weight reduction diets and changes in life-style to promote long-term weight control. The purpose of this study was to evaluate long-term effectiveness and to identify predictors of success of an intensive multidisciplinary program utilizing the time-calorie displacement diet, a low-fat, high-complex-carbohydrate diet, to promote and maintain reduced body weight. In 213 obese adults consecutively entering the program, including dropouts, weight loss averaged 6.3 kg (0.4 kg/week) and 16% of excess weight over 7 months of treatment. The 78 (37%) completing the recommended 15 visits lost a mean of 10.8 kg and 28% of their excess weight while under treatment. Weight loss was largely predicted by number of visits, which was more important than treatment duration. An increased number of visits was predicted by being married, being female, and reporting a usual diet low in snack foods. Of 147 patients contacted at posttreatment follow-up, 53% maintained their weight loss or continued to lose weight an average of 25 months later and 24% experienced weight rebound but were still below their pretreatment weight; only 23% regained their lost weight. Mean net weight loss from pretreatment to follow-up was 8.0 +/- 1.0 kg (mean +/- standard error of the mean). No factor significantly predicted posttreatment weight rebound. Results suggest that a nutritionally sound diet, prescribed in a multidisciplinary program and emphasizing life-style changes, can result in long-term weight control in a majority of patients treated.

Adult↗
PubMed2002

Weight control and physical activity in cancer prevention: international evaluation of the evidence.

To evaluate the evidence for the role of weight control and physical activity in cancer prevention and to identify priorities for research and for public health action in relation to the primary prevention of cancer, an international working group of experts was convened in Lyon in February 2001 by the International Agency for Research on Cancer of the World Health Organization. The expert group concluded that limiting weight gain during adult life, thereby avoiding overweight and obesity, reduces the risk of postmenopausal breast cancer and cancers of the colon, endometrium, kidney (renal cell) and esophagus (adenocarcinoma). Limiting weight gain possibly reduces risk of cancer of the thyroid. Weight loss among overweight or obese persons possibly reduces risks of these cancers, but no definite conclusion can be drawn because of the paucity of the epidemiological evidence. The working group also concluded that there was sufficient evidence for the role of physical activity in preventing colon and breast cancers, and limited evidence for the cancers of the prostate and endometrium. Some of these effects were independent of that of the weight control. Taken together, the working group considered that excess body weight and physical inactivity account for approximately a quarter to one-third of cancers of the colon, breast, endometrium, kidney (renal cell) and esophagus (adenocarcinoma). Thus adiposity and physical inactivity appear to be the most important avoidable causes of these cancers.

Animals↗
PubMed2001

Weight control in the physician's office.

BACKGROUND: Lifestyle changes involving diet, behavior, and physical activity are the cornerstone of successful weight control. Incorporating meal replacements (1-2 per day) into traditional lifestyle interventions may offer an additional strategy for overweight patients in the primary care setting. METHODS: One hundred thirteen overweight premenopausal women (mean +/- SD age, 40.4 +/- 5.5 years; weight, 82 +/- 10 kg; and body mass index, 30 +/- 3 kg/m(2)) participated in a 1-year weight-reduction study consisting of 26 sessions. The women were randomly assigned to 3 different traditional lifestyle-based groups: (1) dietitian-led group intervention (1 hour per session), (2) dietitian-led group intervention incorporating meal replacements (1 hour per session), or (3) primary care office intervention incorporating meal replacements with individual physician and nurse visits (10-15 minutes per visit). RESULTS: For the 74 subjects (65%) completing 1 year, the primary care office intervention using meal replacements was as effective as the traditional dietitian-led group intervention not using meal replacements (mean +/- SD weight loss, 4.3% +/- 6.5% vs 4.1% +/- 6.4%, respectively). Comparison of the dietitian-led groups showed that women using meal replacements maintained a significantly greater weight loss (9.1% +/- 8.9% vs 4.1% +/- 6.4%) (P =.03). Analysis across groups showed that weight loss of 5% to 10% was associated with significant (P =.01) reduction in percentage of body fat, body mass index, waist circumference, resting energy expenditure, insulin level, total cholesterol level, and low-density lipoprotein cholesterol level. Weight loss of 10% or greater was associated with additional significant (P =.05) improvements in blood pressure and triglyceride level. CONCLUSIONS: A traditional lifestyle intervention using meal replacements can be effective for weight control and reduction in risk of chronic disease in the physician's office setting as well as in the dietitian-led group setting.

Adult↗
PubMed1997

Recommendations from overweight youth regarding school-based weight control programs.

This study aimed to obtain recommendations from overweight youth on the development of school-based weight control programs; to determine their level of interest in participation; and to learn about the outcomes they desired from such a program. Because obesity is prevalent among youth of certain minority groups and low socioeconomic backgrounds, and since few programs address the needs of these youth, the study population was selected from inner city public schools with high percentages of youth from minority groups and low socioeconomic backgrounds. Sixty-one overweight adolescents participated in semi-structured, in-depth individual interviews, which were audiotaped, transcribed, coded, and analyzed. Findings indicated that many overweight adolescents were interested in participating in school-based weight control programs, provided they are conducted in a supportive manner; offer enjoyable activities; are informative; are sensitive to the needs of overweight youth; and do not conflict with other activities. Adolescents stressed the importance of a program leader who understands the difficulties that overweight youth face, and many expressed their preference for a leader who is currently overweight or had been overweight in the past.

Adolescent↗
PubMed1986

Family-based behavioral weight control in obese young children.

The effects of a family-based, behavioral weight control program on weight, linear growth, and nutrient intake among 17 obese children aged 1 to 6 were studied. The 1-year behavioral treatment involved three components: diet, exercise, and child management. Treatment meetings were held weekly for 10 weeks and then monthly for the remainder of the year. Relative body weight decreased significantly from 42.1% at baseline to 24.0% overweight at 1 year and 27.8% overweight at 2 years, while height increased normally over the 2 years of observation, suggesting that the children were obtaining adequate calories to maintain growth. The caloric and nutrient intakes of the children were analyzed from 3-day food records kept by the mothers during baseline and the tenth week of treatment. The mean caloric intake was 1,457 kcal prior to treatment and 1,025 kcal during treatment. Nutrient intake exceeded the Recommended Dietary Allowances at pretreatment for the nutrients investigated and continued to exceed the RDAs for all nutrients except calcium (96% of RDA) and iron (84% of RDA) during treatment. Improvements in nutrient density were shown for all nutrients. The results suggest that obesity can be treated successfully in young children without detrimental effects on growth or nutrient intake.

Behavior Therapy↗
PubMed1984

Recommended therapeutic guidelines for professional weight control programs.

At the present time there are no established guidelines to serve as standards for the operation of weight control programs. This increases the possibility that some programs may be conducted in a fashion that is unethical, jeopardizes patient health, and lacks credibility. As a first step toward developing such standards, a panel was organized by the International Congress on Obesity to describe minimum recommended features of professional weight control programs. The present report served as a supporting document for the summary statement and describes recommended guidelines for the treatment of obesity encompassing diet, physical activity, and behavior modification with psychological support. The role of drugs and surgery is not considered in this report. For the average patient it is suggested that three components of therapy--diet, exercise, and behavioral/psychological support--be prescribed together since they are closely interrelated, interdependent and mutually supportive.

Behavior Therapy↗