Improving adherence to fluid restrictions in male hemodialysis patients: A comparison of cognitive and behavioral approaches.

Compared a cognitive intervention and a behavioral intervention to determine their relative effectiveness in reducing interdialytic weight gain (IWG) among 8 adult male hemodialysis patients. The behavioral model consisted of positive reinforcement, shaping, and self-monitoring. The cognitive model consisted of a counseling intervention designed to modify health beliefs. In 3 studies, both interventions produced immediate reductions in IWG. However, the behavioral intervention was superior to the cognitive intervention in producing maintenance of reduced weight gain. Combining the interventions resulted in no improvement over the behavioral intervention alone. Continuation of self-monitoring procedures produced maintenance of improvements up to 2 mo posttreatment. With the exception of the barriers dimension, health beliefs did not change along with adherence behavior changes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues in the assessment and treatment of obesity.

This article summarizes recent developments in the assessment and treatment of obesity. Limitations of the current height and weight tables frequently used to assess obesity are discussed. New research studies on genetics and weight cycling are reviewed. These studies give us a broader perspective about the heterogeneous etiology of obesity and may help to explain why some individuals have great difficulty losing weight or maintaining significant amounts of weight loss. Changes in the behavioral treatments of obesity since the 1970s are described. These newer programs are longer and more comprehensive, placing greater emphasis on the development of exercise behaviors, nutrition education, social support, and cognitive-behavioral interventions. Results suggest that behavioral interventions are most useful with mildly obese individuals. For individuals who are moderately and severely obese, the aggressive use of very low calorie diets appears promising, although research support for the maintenance of losses is lacking and caution is suggested. Continued collaboration among disciplines is expected to increase our understanding of this complex, refractory disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of weight control and weight control plus body image therapy for obese men and women.

Participants were 65 obese men and women who were randomly assigned to either weight control or weight control plus cognitive–behavioral body image therapy. Both conditions showed clinically significant improvements in body image at posttreatment and 1-year follow-up. Adding body image therapy to weight control did not result in greater psychological improvements and did not result in better maintenance of body image change when participants regained weight after treatment. Weight loss and maintenance were equivalent between groups. Adding body image therapy did not improve or detract from weight loss. Although body image therapy has been shown to be effective in obese persons, it appears that a well-rounded cognitive–behavioral weight control program is effective as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relapse prevention training and problem-solving therapy in the long-term management of obesity.

This study compared 2 extended therapy programs for weight management with standard behavioral treatment (BT) without additional therapy contacts. Participants were 80 obese women who completed 20 weekly group sessions of BT and achieved a mean initial weight loss of 8.74 kg. Participants were randomly assigned to a no-further-contact condition (BT only) or to one of two extended interventions consisting of relapse prevention training (RPT) or problem-solving therapy (PST). No significant overall weight-change differences were observed between RPT and BT or between RPT and PST. However, participants who completed the PST intervention had significantly greater long-term weight reductions than BT participants, and a significantly larger percentage of PST participants achieved clinically significant losses of 10% or more in body weight than did BT participants (35% vs 6%). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obesity in older persons

The prevalence of obesity among older persons is growing. This trend has adverse medical, functional, psychosocial, and health care resource consequences. Many obese older persons were obese middle-aged adults. A sedentary lifestyle may be the dominant contributing factor. Intervention should focus on moderate weight reduction through the modification of diet, exercise, and behavior. Improvements in health and quality of life can be achieved with moderate weight reduction. Strategies tailored to the older population will facilitate successful interventions. Dietitians must be key participants in the effort to raise awareness of obesity as a serious health concern for older persons. The focus must be on achieving a more healthful weight.     

Stage distributions for five health behaviors in the United States and Australia

BACKGROUND: A key variable for the design of individual and public health interventions is the Stage of Change. The five stages of readiness to change are Precontemplation, Contemplation, Preparation, Action, and Maintenance. The distribution of individuals across the stages of change can provide a valuable tool for designing health interventions. METHODS: The pattern of distribution across the stages of change for five behavioral risk factors is presented from five independent surveys, two from the United States and three from Australia. The five risk factors are smoking, low fat diet, regular exercise, reducing stress, and losing weight. Identical single-item questionnaire items for staging health behaviors were used in all surveys. RESULTS: The stage distributions for the five risk factors were similar across the five independent samples. In general, the pattern of stage distributions was stable across health risk factors, gender, country, and sample. CONCLUSIONS: Single-item survey measures of stage of change that are readily applicable to population studies appear to provide important information about the population characteristics of readiness to change behavioral risk factors. The stability of these distributions suggests that interventions matched by stage may have broad applicability.     

Dissonance and healthy weight eating disorder prevention programs: A randomized efficacy trial.

In this trial, adolescent girls with body dissatisfaction (N = 481, M age = 17 years) were randomized to an eating disorder prevention program involving dissonance-inducing activities that reduce thin-ideal internalization, a prevention program promoting healthy weight management, an expressive writing control condition, or an assessment-only control condition. Dissonance participants showed significantly greater reductions in eating disorder risk factors and bulimic symptoms than healthy weight, expressive writing, and assessment-only participants, and healthy weight participants showed significantly greater reductions in risk factors and symptoms than expressive writing and assessment-only participants from pretest to posttest. Although these effects faded over 6-month and 12-month follow-ups, dissonance and healthy weight participants showed significantly lower binge eating and obesity onset and reduced service utilization through 12-month follow-up, suggesting that both interventions have public health potential. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of group- versus home-based exercise in the treatment of obesity.

This study examined the effects of 2 aerobic exercise regimens on exercise participation, fitness, eating patterns, treatment adherence, and weight changes in 49 obese women undergoing a year-long behavioral weight loss program. Participants were assigned randomly to weight loss treatment plus either group- or home-based exercise. All participants were instructed to complete a moderate-intensity walking program (30 min/day, 5 days/week). Group exercise participants were provided with 3 supervised group exercise sessions per week for the 1st 26 weeks and with 2 sessions per week thereafter. Home exercise participants were instructed to complete all exercise in their home environment. After 6 months, both conditions displayed significant improvements in exercise participation, fitness, eating patterns, and weight loss. At 12 months, the home-based program showed superior performance to the group condition in exercise participation and treatment adherence; at 15 months, participants in the home program demonstrated significantly greater weight losses than those in the group program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Continuous assay for acid phosphatase using 1-naphthyl phosphate as a substrate

The sequential effects of an American Heart Association (AHA) Step 1 diet and subsequent weight loss on lipoprotein lipids in obese [body mass index (in kg/m2) > 27], postmenopausal women (n = 48) were determined. Subjects followed a euenergetic AHA Step 1 diet for 2 mo, followed by a weight-loss diet (deficit of 1.0-1.5 MJ/d) for 6 mo. The AHA diet lowered concentrations of total (7%), low-density-lipoprotein (LDL) (6%), and high-density-lipoprotein (HDL) (14%) cholesterol (P < 0.01). Weight loss (-5.6 +/- 0.7 kg; P < 0.01) increased plasma triacylglycerol concentrations (9%; P < 0.01) and increased HDL-cholesterol concentrations (8%; P < 0.01) compared with changes after the AHA diet, but there were no changes in total or LDL cholesterol. The combined AHA diet and weight-loss interventions lowered triacylglycerol (10%) and total (6%), LDL (6%), and HDL (7%) cholesterol. These changes correlated indirectly with the baseline concentration for each lipid. When the women were divided on the basis of initial LDL-cholesterol concentration, the AHA diet and weight-loss interventions reduced (P < 0.01) triacylglycerol (19%), total cholesterol (13%), and LDL cholesterol (14%) in the women with hypercholesterolemia but not in normocholesterolemic or midly hypercholesterolemic women. Thus, an AHA Step 1 diet and subsequent weight loss improve lipoprotein lipid profiles of obese, postmenopausal women with hypercholesterolemia. However, because it lowers HDL cholesterol, a low-fat diet without substantial weight loss may not be beneficial for improving lipoprotein lipid risk factors for coronary artery disease in obese, postmenopausal women with normal lipid profiles.     

Polyamines and paraquat toxicity in Arabidopsis thaliana

The morbidly obese have a disproportionately greater risk of hypertension, diabetes, and coronary artery disease than their lean or less seriously obese counterparts. Roux-en-Y gastric bypass surgery has been found to be highly effective in inducing, and sustaining, weight loss in individuals with morbid obesity. The purpose of the present study was to examine the effects of weight loss with Roux-en-Y gastric bypass surgery (GBP) on blood pressure, fasting blood glucose, and the lipid/lipoprotein status of 61 morbidly obese women and 21 men. Anthropometric and blood pressure assessments and blood samples for glucose and lipid/lipoprotein analyses were obtained before surgery and at 6 to 12 months postoperatively. By this time, morbidly obese (MO) males and females had lost 33% and 30% of their initial body weight, respectively, along with significant reductions in fasting blood glucose (p < 0.01) and systemic blood pressure (p < 0.05). Weight loss with GBP was also associated with significant reductions in the apoprotein B-containing lipoproteins and the triglyceride and cholesterol composition of these particles. There was a trend (p < 0.10) toward increased serum levels of high density lipoprotein (HDL)-cholesterol following GBP, and significant (p < 0.05) improvement in HDL subfraction distribution and composition. These findings demonstrate the effectiveness of GBP in inducing metabolic changes in the MO population, which may reduce the risk of coronary artery disease, diabetes, and hypertension.     

Effectiveness of interventions to improve patient compliance: a meta-analysis

OBJECTIVES: This article summarizes the results of 153 studies published between 1977 and 1994 that evaluated the effectiveness of interventions to improve patient compliance with medical regimens. METHODS: The compliance interventions were classified by theoretical focus into educational, behavioral, and affective categories within which specific intervention strategies were further distinguished. The compliance indicators broadly represent five classes of compliance-related assessments: (1) health outcomes (eg, blood pressure and hospitalization), (2) direct indicators (eg, urine and blood tracers and weight change), (3) indirect indicators (eg, pill count and refill records), (4) subjective report (eg, patients' or others' reports), and (5) utilization (appointment making and keeping and use of preventive services). An effect size (ES) r, defined as Fisher's Z transformation of the Pearson correlation coefficient, representing the association between each intervention (intervention versus control) and compliance measure was calculated. Both an unweighted and weighted r were calculated because of large sample size variation, and a combined probability across studies was calculated. RESULTS: The interventions produced significant effects for all the compliance indicators (combined Z values more than 5 and less than 32), with the magnitude of effects ranging from small to large. The largest effects (unweighted) were evident for refill records and pill counts and in blood/urine and weight change studies. Although smaller in magnitude, compliance effects were evident for improved health outcomes and utilization. Chronic disease patients, including those with diabetes and hypertension, as well as cancer patients and those with mental health problems especially benefited from interventions. CONCLUSIONS: No single strategy or programmatic focus showed any clear advantage compared with another. Comprehensive interventions combining cognitive, behavioral, and affective components were more effective than single-focus interventions.     

Counting the stitches that count: preventive intervention promises and public health

Continued public support for the design, implementation, and dissemination of preventive interventions depends on achievement of four major criteria: (a) Reductions in the incidence or prevalence rates of diagnosable emotional and behavioral disorders, (b) reductions in the need for mental health services through effective primary and secondary interventions, (c) enhancement of the effectiveness of obtained services as screening and early detection efforts are implemented, and (d) reductions in the nation's health care costs associated with emotional and behavioral dysfunctions. Strategies including risk reduction, risk avoidance, health promotion, empowerment, and resource development are preventive insofar as they contribute to achievement of the aforementioned outcomes.     

A multidimensional wellness group therapy program for veterans with comorbid psychiatric and medical conditions.

Development of a healthy lifestyle is an important aspect of mental health that is infrequently targeted in outpatient mental health settings. Although the interrelationship of psychological and physical factors has often been noted, interventions frequently focus on just one aspect of functioning. This project demonstrated the feasibility of a multidimensional weekly wellness group program focused on the overall health behaviors of patients in a Veterans Affairs mental health clinic. The modal participant was a male in his mid-50s, living alone, not employed, depressed, obese, and with many chronic medical problems. Eighty-three patients participated in a 15-week program promoting changes in such areas as stress management (abdominal breathing, muscle relaxation, visualization, and mindfulness), physical health care (exercise, nutrition, sleep routine, and substance use), and behavioral activation (activity scheduling, social affiliation, and use of community resources). Substantial improvement was found for most patients, in both psychosocial and physical functioning domains, and was maintained over time. The melding of psychoeducational and skills training into a positive psychology orientation appears to have been beneficial. In addition, the group process was quite effective in encouraging change in these highly comorbid, chronically ill veterans. The feasibility and importance of integrating psychosocial and physical interventions is underscored by this study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Olfactory mucosa of the South American armadillo Chaetophractus villosus: an ultrastructural study

OBJECTIVE: Morbidly obese individuals are unlikely to reach and maintain normative weights. Thus, interventions aimed at alleviating corollary problems, independent of attempts at weight loss, are appropriate. A cognitive group treatment program (CT) was developed which incorporated a nondieting approach, regular exercise, and use of alternative coping skills. Weight loss per se was not a focus of the intervention. The purpose of the current work was to evaluate this program in a controlled, comparative treatment outcome study. METHOD: Sixty-two obese women with a history of treatment failures were randomly assigned to the CT program, a behavior therapy weight loss program (BT), or a wait-list control group. RESULTS: For CT participants, depression, anxiety, and eating-related psychopathology decreased significantly over the course of treatment while perceptions of self-control increased; BT and control subjects showed no significant changes in these variables. Women in both active treatment groups lost significant amounts of weight, while members of the control group showed a nonsignificant increase in weight. At 6-month follow-up, treatment benefits were maintained. DISCUSSION: Findings suggest that interventions not directly aimed at weight loss can enhance psychological well-being and thus may be appropriate for some obese women.     

The effects of long-term, moderate intensity, intermittent exercise on aerobic capacity, body composition, blood lipids, insulin and glucose in overweight females

OBJECTIVE: To test the hypotheses that the accumulation of 30 min of moderate intensity, intermittent exercise, 5d/week-1, for 32 weeks, will increase aerobic capacity, alter body composition and improve blood lipids, insulin and glucose. Secondly, to identify individuals who may respond to moderate intensity, intermittent exercise. SUBJECTS: Thirteen sedentary, moderately obese females, aged 43 +/- 11 (y), body mass index (BMI) 32.7 +/- 7.7 (kg/M2), body fat 40.6 +/- 8.8 (%), VO2max 24.0 +/- 4.6 (ml/kg-1/min-1). MEASUREMENTS: Aerobic capacity, body composition, blood lipids, fasting insulin and glucose, energy intake. RESULTS: Group data showed no significant changes for aerobic capacity, body composition, blood lipids, insulin or glucose. However, 7 of the 13 subjects increased aerobic capacity, lost fat weight and improved insulin. Adherence to the exercise regimen was excellent with 82.6 +/- 10.0% of the exercise completed. CONCLUSIONS: Moderate intensity, intermittent exercise for a total of 30 min, 5d/week,-1 for 32 weeks duration, was not a sufficient stimulus to significantly increase aerobic capacity, and alter weight, body composition or improve blood lipids, insulin or glucose for the entire group. However, those subjects who increased aerobic capacity and decreased fat weight were significantly older, had lower maximal aerobic capacity and greater body fat at baseline compared to the six subjects who did not increase aerobic capacity and decrease fat weight. For both groups, moderate intensity, intermittent exercise showed excellent adherence and this may be a useful model for future research studies.     

Plasma lipid changes in the normal population following behavioral treatment.

Compared the effectiveness of 3 intervention programs, diet booklet only, nutrition education, and behavioral intervention with nutrition education, for reducing plasma cholesterol and triglyceride in individuals living in the community whose lipid levels fell within the average range for the American population. Results with 183 Ss (volunteers over 18 yrs of age solicited through newspaper articles and food demonstration workshops) show that Ss who received the behavioral intervention with nutrition education had a significantly greater reduction in cholesterol than those in the other 2 conditions at 6 mo. Both nutrition education and behavioral intervention groups had small but statistically significant cholesterol reduction at 12 mo. Triglyceride decreases were also small but statistically significant for both the nutrition education and behavioral intervention groups at 12 mo. Although Ss could lower their lipid levels for 6 mo, they did not maintain their decreases. Implications for the role of behavior modification in public health programs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of interventions for weight loss using food provision and monetary incentives.

One hundred seventy-seven men and women who had participated in an 18-month trial of behavioral interventions involving food provision and financial incentives were examined 12 months later. Food provision, but not financial incentives, led to better weight loss than standard behavioral treatment during the 18-month trial, but over 12 additional months of no-treatment follow-up, all treated groups gained weight, maintained only slightly better weight losses than a no-treatment control group, and did not differ from each other. Weight loss success during both active treatment and maintenance was associated with increase in exercise, decrease in percentage of energy from fat, increase in nutrition knowledge, and decrease in perceived barriers to adherence. Obesity treatment research should focus on developing better ways to maintain changes in the diet and exercise behaviors needed for sustained weight loss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lipid reactivity to stress: II. Biological and behavioral influences.

This study examined behavioral and physiological influences on lipid concentrations during acute and chronic stressors. One hundred men (n?=?92) and women (n?=?8) were tested during a chronic stressor and during 2 acute stressors. During chronic stress, diet, physical activity, exercise, and sleep were examined. During the acute stressors, catecholamines, cortisol, plasma volume, and cardiovascular responses were examined. None of the behavioral influences could explain the lipid response to chronic stress. Responses of the atherogenic lipids to acute stressors were not solely reflecting hemoconcentration of the plasma but were moderately correlated with cardiovascular, epinephrine, and cortisol reactivity. Diastolic blood pressure reactors to the acute stressors had larger lipid responses to the chronic stressor than did nonreactors. Elevations in blood lipids during stress are not artifacts and may be clinically significant. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivations for weight loss and behavior change strategies associated with natural recovery from obesity.

Untreated adults (n?=?21) with lengthy weight problem histories who had maintained stable weight loss for a mean of 4.5 years were interviewed and completed questionnaires about their motivations for and behavioral strategies used during weight loss. Currently obese, untreated adults (n?=?20) served as controls. Successful natural recovery was associated with behavior changes like those emphasized in behavioral weight management programs (e.g., healthier food choices, eating more slowly, regular exercise). Motivations for weight loss were largely negative and reflected appearance and psychosocial concerns. Demographic, weight history, and health variables generally did not distinguish the groups. Obesity treatment was widely available but was viewed negatively. These findings reveal natural processes involved in sustained weight loss, highlight the potential importance of separating influences on behavior change from influences on help-seeking, and suggest ways that obesity treatments could be improved to increase their appeal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)