Response of obese binge eaters to treatment by behavior therapy combined with very low calorie diet.

Examined attrition and weight loss in 235 female obese binge eaters, episodic overeaters, and nonbingers treated by a 26-wk program of behavior modification and very low calorie diet. No significant differences were observed among conditions in the number of Ss who completed treatment. Episodic overeaters, however, were more likely than Ss in the other 2 conditions to drop out during the last 7 wks of treatment, when Ss resumed consumption of a conventional diet. End-of-treatment weight losses for the 3 conditions, which did not differ significantly, averaged 21.5, 19.4, and 21.7 kg, respectively. No significant differences were observed among conditions in weight regain (which averaged 8.8 kg) in the year following treatment, although small sample sizes prevented an adequate evaluation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior change, weight loss, and physiological improvements in Type II diabetic patients.

53 obese 30–70 yr olds with Type 2 diabetes treated by diet only or oral medication were assigned to a behavior-modification, nutrition-education, or standard-care treatment condition to investigate whether behavior modification would improve short- and long-term results of weight control programs for Ss. The behavior-modification and nutrition-education groups met weekly for 16 wks and were given the same information on nutrition, exercise, and diabetes; however, strategies to change eating behavior were used in the behavior-modification condition. The standard-care condition was identical to the nutrition-education condition except that Ss met only 4 times over the 16-wk treatment period. Results indicate that behavior-modification Ss lost more weight than either the nutrition-education or standard-care Ss during the 16-wk treatment period. However, at 16-mo follow-up, differences in weight loss across treatment conditions were not significant. Physiological parameters and mood improved with initial weight loss, but these changes were not maintained. Physiological changes appeared more directly related to weight loss than to treatment condition. Changes in weight were related to improved eating and exercise habits, and modest weight losses of 4.6–23.6 kg produced significant improvements in blood-sugar control. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight loss and maintenance and changes in diet and exercise for behavioral counseling and nutrition education.

100 out of 112 women who initially were at least 20 lb overweight, but did not weigh over 220 lb completed a 16-wk program of either behavioral counseling or nutrition education. Initial weight losses were similar for both groups, but behavioral Ss (BEs) consumed significantly fewer calories and changed more on 2 of 4 exercise measures than did nutrition education Ss (NEs). Reviews of daily eating records indicated that BEs more often used diets that were nutritionally unsound. The exercise changes in both conditions were modest and highly variable. Seven-month follow-up indicated that BEs maintained significantly more weight loss than did NEs. Interviews with 92 Ss indicated that regular monitoring of eating, an exercise routine, and problem solving were associated with maintenance. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of increasing initial weight loss with the Scarsdale Diet on subsequent weight loss in a behavioral treatment program.

20 overweight Ss (aged 20–65 yrs) who participated in a behavioral weight control program that included 2 wks on the Scarsdale diet lost more weight during that period than did 19 Ss in a behavioral group without the diet. The experimental manipulation of initial weight loss did not significantly affect subsequent or overall weight loss. At 1 yr, the average weight losses of the Scarsdale and behavioral conditions were not significantly different. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peer-led program for the treatment and prevention of obesity in the schools.

Studied 89 overweight children in Grades 2–5 from 2 schools to assess the maintenance of weight loss achieved through school-based programs for obese children. 48 Ss in a Catholic elementary school participated in a 12-wk weight-reduction program conducted primarily by older children trained as peer counselors, while 41 additional Ss from another Catholic school served as control Ss. No program was conducted in the control school, and controls' contact was limited to 3 weigh-ins. Results show that experimental Ss lost 0.15 kg and reduced their percentage overweight by 5.3%, whereas controls gained 1.3 kg and increased their percentage overweight by 0.3%. Experimental Ss also showed positive changes in self-concept, as compared with controls, and displayed improvements in food selection. Changes in weight, self-concept, and food selection were only partially maintained at 18-wk follow-up, however, pointing to the need for an ongoing program of weight loss maintenance. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Additive effects of the mutations in the beta3-adrenergic receptor and uncoupling protein-1 genes on weight loss and weight maintenance in Finnish women

This study examined whether the Trp64Arg mutation in the beta3-adrenergic receptor (beta3AR) and the A-->G mutation in the uncoupling protein-1 (UCP-1) genes have associations with weight loss and subsequent weight maintenance. Seventy-seven obese (body mass index range, 29-46 kg/m2), clinically healthy, premenopausal women were studied. A 12-wk weight reduction by very low calorie diet (VLCD) was followed by a 40-wk weight maintenance phase. The subjects were divided into four groups according to their beta3AR and UCP-1 genotype: no mutation (control; n=37), only Trp64Arg mutation in the beta3AR gene (n=12), only A-->G mutation in the UCP-1 gene (n=23), and both mutations (n=5). Subjects with both mutations had a lower weight reduction during VLCD than the controls [-10.5+/-0.6 (+/-SEM) vs. -14.0+/-0.5 kg; P=0.051, by ANOVA]. During the maintenance phase, weight in subjects with both mutations increased by 5.8+/-1.5 kg, but remained unchanged in the controls (-0.5+/-0.8 kg; P=0.041). The changes in weight in subjects with only one of the mutation were close to the results in the controls. Resting energy expenditure, adjusted for fat mass, fat-free mass, and maximal aerobic power, did not change differently between the groups throughout the study. The results suggest that a combination of the Trp64Arg mutation in the beta3AR and the A-->G mutation in the UCP-1 genes may be associated with faster weight gain after a VLCD.     

Treatment of obesity by behavior therapy and very low calorie diet: A pilot investigation.

Treated 17 obese females (mean age 37.5 yrs) who averaged 87% overweight for 6 mo on a program of diet and behavior modification designed for weight loss maintenance. Ss, who were paid to participate, received a balanced diet of 1,000–2,200 kilocalories/day for Month 1, a low calorie protein liquid (400–500 kilocalories/day) for Month 2, low calorie protein (fish, fowl) for Month 3, and a balanced diet for Months 4–6. Results show that Ss lost an average 20.5 kg during treatment and showed significant reductions in anxiety and depression even while consuming the low calorie diet. At 1-yr follow-up, Ss had regained an average of 2.1 kg. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nondieting versus dieting treatment for overweight binge-eating women.

This study evaluated the effectiveness of nondieting versus dieting treatments for overweight, binge-eating women. Participants (N?=?219) were randomly assigned to 1 of 3 groups: diet treatment (DT), nondiet treatment (NDT), or wait-list control (WLC). DT received a balanced-deficit diet reinforced with behavioral strategies. NDT received therapy designed to help participants break out of their dieting cycles. Treatment in both conditions was administered in weekly groups for 6 months, followed by 26 biweekly maintenance meetings, for a total of 18 months of contact. At 6 months posttreatment, DT lost 0.6 kg while NDT gained 1.3 kg. Both treatment groups reduced their Binge Eating Scale scores significantly more than WLC. At 18-month follow-up, both treatment groups experienced weight gain but maintained similar reductions in binge eating. Results indicate that neither intervention was successful in producing short- or long-term weight loss. Therapist biases, which may have affected treatment integrity, and other methodological issues are discussed in relation to the small weight losses achieved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Controlled trial of very low calorie diet, behavior therapy, and their combination in the treatment of obesity.

Assessed the effectiveness of a combined program of low calorie diet (400–500 kcal) and behavior therapy in treating obesity. 50 women (average age 43.9 yrs) and 9 men (average age 44.7 yrs), averaging 89% overweight, were randomly assigned to 1 of 3 conditions: (a) low calorie diet alone, (b) behavior therapy alone, or (c) low calorie diet plus behavior therapy (combined treatment). Mean weight losses for the 3 conditions at the end of treatment were 14.1, 14.3, and 19.3 kg, respectively; losses for combined treatment were significantly greater than those for the other 2 conditions. At 1-yr follow-up, mean weight losses for the diet alone, behavior therapy alone, and combined-treatment conditions were 4.6, 9.5, and 12.9 kg, respectively; and losses for combined treatment were significantly greater than for the diet alone condition. 29% of the combined-treatment and 44% of the behavior therapy alone Ss maintained weight losses within 2 kg of their end-of-treatment weight; none of the diet-alone Ss met this criterion. Ss in all 3 conditions achieved significant reductions in blood pressure at posttreatment, but only those receiving behavior therapy alone and combined treatment showed significant decreases in depression. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sequencing of behavior therapy and pharmacotherapy for obesity.

Investigated 2 sequences of combining behavior therapy and pharmacotherapy to determine if anorexic medication could be used effectively to facilitate initial weight loss without compromising the long-term effects of behavior therapy. 91 18–30 yr old women, averaging 31% overweight, participated in a 16-wk treatment program with follow-up assessments scheduled 4 mo and 1 yr later. Anorexic medication, fenfluramine HCl, enhanced weight loss whenever it was introduced, but it was more effective when introduced 8 wks into the behavior therapy program rather than initially. Ss in this sequence (later medication) had lost the most weight (9.3 kg) by the end of treatment, significantly more than those receiving either medication or behavior therapy only. These Ss, however, regained weight once treatment was terminated so that by the 1-yr follow-up, the conditions were not significantly different. Ss in the other sequence (initial medication) maintained their weight loss after medication was terminated as long as they continued to receive behavior therapy; however, they too regained weight once all treatment was terminated. Thus, anorexic medication demonstrated a surprisingly strong effect when introduced midway through a behavior therapy program, when the rate of loss typically slows, but this initially beneficial effect was not maintained during the follow-up period. A post hoc exploration of the data indicates that medication was particularly helpful to Ss who did not initially respond well to behavior therapy. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relative efficacy of self-reward, self-punishment, and self-monitoring techniques for weight loss.

Randomly assigned 48 female and 5 male obese adults to 5 groups: (a) self-reward, (b) self-punishment, (c) self-reward and self-punishment, (d) self-monitoring, and (e) information control. All Ss were given information on effective stimulus control techniques for weight loss. Self-monitoring Ss were asked to weigh in twice per week for 4 wks and to record their daily weight and eating habits. Self-reward and self-punishment Ss, in addition to receiving self-monitoring instructions, were asked to award or fine themselves a portion of their deposit contingent on changes in their weight and eating habits. After 4 wks of treatment, self-reward Ss lost significantly more weight than either self-monitoring or control Ss. At a 4-mo follow-up, Ss who had received self-reward instructions continued to show greater improvement than either the self-punishment or control Ss. Findings provide a preliminary indication that self-reward strategies are superior to self-punitive and self-recording strategies in the modification of at least some habit patterns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of successful response to a behavioral weight control clinic.

Attempted to identify what types of persons successfully respond to a behavioral weight control clinic. The 40 participants of the study were physically healthy, 25–45 yrs old, and weighed 150–200 lbs. Measures of psychological functioning during preclinic testing indicated that participants experienced no extreme distress. The treatment was conducted over 4 mo by professional behavioral counselors and resulted in an average weight loss of 12.1 lbs. A prediction model based on problem severity and a model using behavior change both accounted for 25% of the variance in weight loss. Initial weight-loss success was correlated with 2 of the 3 severity variables; Ss reporting frequent binge eating and histories of previous dieting weight loss tended to lose the most weight. Successful weight loss also correlated with decreases in problem eating habits and high-calorie snacking but not with increased activity level. Interviews at the end of 7-mo follow-up were used to compare the 8 Ss who successfully maintained losses with the 13 Ss who showed signs of relapse. Ss who were successful at maintenance used frequent exercise, whereas those who relapsed reported high levels of stress during the follow-up. Implications of these correlates for obesity treatment and the importance of viewing unsuccessful weight control as evidence of negative change are discussed in terms of preventing relapse during follow-up. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pseudomemory effects over time in the hypnotic setting.

Highly (n?=?36), moderately (n?=?26), and low (n?=?48) susceptible Ss were administered either hypnosis or waking instruction to examine the hypothesis that pseudomemory will occur for hypnotic Ss as long as 2 wks after suggestions are given for accepting false events. Accuracy and confidence of memory were measured for all Ss, and memory was examined for free recall, structured recall, and recognition. Results indicated persistence of pseudomemory for the 2-wk period for both highly and moderately susceptible Ss. Data highlighted the multifaceted operation of skill, contextual, and state instruction factors, and a hypothesis that ambiguity of communication when suggestion is delivered plays a part in the maintenance of pseudomemory over time is offered for further testing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mood and weight loss in a behavioral treatment program.

76 obese patients (average age 40 yrs) participating in 2 consecutive behavioral treatment programs completed either the Symptom Check List (SCL-90) and a mood scale (Program A) or the SCL-90, a mood scale, the Beck Depression Inventory and the State-Trait Anxiety Inventory (Program B). Weight losses averaged 12.2 lbs (5.55 kg) during the 10-wk program. Positive changes in mood were reported during this interval, and these changes appeared to be related to changes in weight. There was no evidence that Ss with juvenile-onset obesity had more negative reactions to dieting than Ss with adult-onset obesity or that dropping out was a response to increased depression. Pretreatment mood measures were not linearly related to success in the program, but evidence of a nonlinear relationship was observed. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group cognitive-behavioral treatment for the nonpurging bulimic: An initial evaluation.

This study tested the initial effects of cognitive-behavioral therapy for binge eating in Ss who do not purge. Forty-four female binge eaters were randomized to either cognitive-behavioral treatment (CB) or a waiting-list (WL) control. Treatment was administered in small groups that met for 10 weekly sessions. At posttreatment a significant difference was found, with 79% of CB Ss reporting abstinence from binge eating and a 94% decrease in binge eating compared with a nonsignificant reduction (9%) in binge eating and zero abstinence rate in WL Ss. Following the posttest assessment, WL Ss were treated and evidenced an 85% reduction in binge episodes and a 73% abstinence rate. Binge eating significantly increased at 10-week follow-up for initially treated Ss; however, the frequency remained significantly improved compared with baseline levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group psychotherapy with mastectomy patients.

Compared 20 women who participated in 10 weekly sessions of group psychotherapy with 20 women placed on a waiting list after they had mastectomies. Ss were matched on age (33–65 yrs old), marital status, time since surgery, prognosis, and SES. A structured, scaled interview was used to assess maladjustment, and 2 inventories were used to assess therapy outcome; all Ss were administered all measures before the treatment program began, when it finished 10 wks later, and 4 wks after the end of treatment. Results show that over the course of the therapy period, both groups showed changes in a positive direction; however, Ss in the treatment group showed significantly greater improvement. In the 4-wk follow-up period Ss in the treatment group continued to show significant positive change. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What predicts weight regain in a group of successful weight losers?

This study identified predictors of weight gain versus continued maintenance among individuals already successful at long-term weight loss. Weight, behavior, and psychological information was collected on entry into the study and 1 year later. Thirty-five percent gained weight over the year of follow-up, and 59% maintained their weight losses. Risk factors for weight regain included more recent weight losses (less than 2 years vs. 2 years or more), larger weight losses (greater than 30% of maximum weight vs. less than 30%), and higher levels of depression, dietary disinhibition, and binge eating levels at entry into the registry. Over the year of follow-up, gainers reported greater decreases in energy expenditure and greater increases in percentage of calories from fat. Gainers also reported greater decreases in restraint and increases in hunger, dietary disinhibition, and binge eating. This study suggests that several years of successful weight maintenance increase the probability of future weight maintenance and that weight regain is due at least in part to failure to maintain behavior changes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of the therapist in the self-control of obesity.

The role of the therapist was varied in a weight reduction program with 24 male and 24 female graduate students. When meetings with the therapist were "faded out" over the duration of the 10-wk treatment period, Ss lost significantly more weight compared to Ss who met with the therapist on a regular basis. A follow-up conducted 6 mo after therapy showed that Ss who had regularly met with the therapist during the treatment period had gained back all the weight they had lost during treatment; they no longer differed from controls. Ss who had had the therapist faded out, however, maintained their losses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of hysterectomy on sexual receptivity, food intake, running wheel activity, and hypothalamic estrogen and progestin receptors in rats.

Ovariectomized-hysterectomized (OH) CD rats given sequential treatments with 2 μg of estradiol benzoate (EB) and .5 mg of progesterone (P) showed significantly higher lordosis quotients than ovariectomized (OV) Ss in 2 tests, 1 and 2 wks after surgery. To test whether the effects of hysterectomy persist, 3 groups of OV and OH Ss received weekly injections of EB, EB?+?P, or sesame oil for 4 wks, were given 2 μg of EB followed 24 hrs later by .5 mg of P, and tested for receptivity. Only the OH Ss that had received hormones for 4 wks showed a significantly higher lordosis score than OV Ss. The effects of hysterectomy on food intake, weight gain, and running wheel activity were also tested. After 1 wk of 2 μg/day EB, OH Ss lost significantly more weight and consumed less food than OV Ss, but by 2 wks the effects of hysterectomy were no longer evident. Treatment with .5 μg/day EB resulted in a significant loss in weight and food intake in OH Ss throughout the experiment. OH Ss implanted with Silastic capsules containing EB were significantly more active in running wheels than OV Ss over the 1st 9 days, but by Day 23 the activity of both groups was similar. 24 hrs following a single injection of EB, hypothalamic-preoptic area cell nuclear estrogen receptors and cytoplasmic progestin receptors were significantly higher in OH than in OV Ss. Possible mechanisms by which hysterectomy might act to enhance hormone-dependent behaviors are discussed. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior modification for obesity: The evaluation of exercise, contingency management, and program adherence.

Investigated crucial aspects of behavioral programs for obesity including (a) the assumption that Ss actually engage in requested behaviors and that these behaviors mediate weight loss, (b) the effect of exercise on weight loss, and (c) the problem of long-term maintenance and generalization to the clinically obese. Exercise and self-managed contingency components were compared in a 2?×?2 factorial design on 44 obese Ss and were evaluated after 10 wks of treatment and 3-mo and 1-yr follow-ups. Significant weight loss was observed for all groups at program termination and the 3-mo follow-up, with only those exposed to exercise and/or contingency management maintaining weight loss after 1 yr. There were no main effects or interactions at program termination or at the 3-mo follow-up. However, the influence of exercise at the 1-yr follow-up was noticeable. Assessment of program adherence indicated that Ss engaged in program behaviors, yet only 1 of 10 such behaviors was related to weight loss. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)