Undereating or eliminating overeating?

Comments on an article titled Medicare's Search for Effective Obesity Treatments: Diets Are Not the Answer, by Mann et al (see record 2007-04834-008). The current authors state that on the basis of their review of studies of long-term outcomes of calorie-restricting diets, Mann et al. concluded that dieting does not lead to lasting weight loss. Although this conclusion is hardly new--see Stunkard's (1975, p. 196) famous verdict: "Of those who do lose weight, most will regain it"--it is still valuable in view of recent more optimistic claims that "the success rate for long-term weight loss is closer to 20%" (Fletcher, 2003, p. 822). Mann et al.'s (2007) indictment of dieting as a treatment for obesity seems warranted, but that indictment ought not to extend to efforts to eliminate overeating. No one denies the benefits of exercise, for which Mann et al. (2007) are strong advocates. An exercise regimen, however, does not address overeating tendencies and therefore may be ineffective or even counterproductive (insofar as exercise may "justify" overeating). Further, we must acknowledge that exercise may improve health without necessarily lowering weight. Muscle weighs more than fat does, so losing fat is not necessarily the same as losing weight. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maelstrom revisited.

Comments on K. D. Brownell and J. Rodin's (see record 1995-03008-001) review of the debate (i.e., maelstrom) over the risks and benefits of weight loss dieting. Discussion includes the lack of evidence for the long term safety of clinical treatments for obesity, the effectiveness of weight loss maintenance programs, and the efficacy and safety of weight loss diets. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obesity: Understanding and treating a serious, prevalent, and refractory disorder.

Examines the psychology and physiology of obesity, its assessment and treatment, the role of exercise in weight reduction, and new directions for the field. The health risks of obesity are discussed, particularly the controversy about weight reduction for persons less than 30% overweight. Several physiological factors are presented, including the set point theory of body weight regulation, the role of fat cell size and number, and dietary influences on body weight. Assessment issues are noted along with results from treatment programs for obese children and adults. The role of exercise is emphasized, not only because of increased energy expenditure, but also because exercise may suppress appetite, offset the decline in basal metabolic rate caused by dieting, minimize loss of lean body mass, and counteract the ill effects of obesity. Two problems in the field are raised: the misinterpretation of the strengths of behavior therapy and the trap of focusing on long-term results. New directions are urged, including aggressive approaches to dieting, treatment combinations, and the use of social support. (5 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Consequences of dieting to lose weight: Effects on physical and mental health.

Concern has been raised that negative physiological and psychological effects of dieting may outweigh aesthetic and health benefits. This review of the literature concludes the following: (1) The measurement of dieting is an important unresolved issue; (2) current dieting, chronic dieting, desire to lose weight, specific weight control behaviors, and weight changes may have different effects on health and need to be distinguished; (3) dieting is usually not associated with nutritional deficiencies, adverse physiologic adaptations, severe psychological reactions, or the development of eating disorders; and (4) recommendations against weight loss efforts involving moderate changes in eating and exercise habits are not warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Naturalistic weight-reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents.

This study examined the prospective relations of naturalistic weight-reduction efforts to growth in relative weight and onset of obesity with data from a community study of female adolescents (N?=?692). Initial self-labeled dieting, appetite suppressant/laxative use, incidental exercise, vomiting for weight-control purposes, and binge eating predicted elevated growth in relative weight over the 4-year period. Dietary restraint, self-labeled dieting, exercise for weight-control purposes, and appetite suppressant/laxative use predicted an increased risk for obesity onset. Data imply that the weight-reduction efforts reported by adolescents are more likely to result in weight gain than in weight loss and suggest the need to educate youth on more effective weight-control strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical issues in the treatment of weight-dissatisfied clients.

A number of ethical issues must be considered in the treatment of clients who are dissatisfied with their weight. Current societal attitudes of opprobrium toward fat affect psychologists as well as the general public, and may have deleterious effects on the ability to provide competent, responsible, and respectful help to large clients, particularly women. Psychologists should be aware that weight status has a large biogenetic component and that dieting is remarkedly ineffective in producing long-term weight loss. Professionals tend to overestimate the harmful effects of obesity and underestimate the negative impact of dieting on physical and psychological functioning. It is proposed that psychologists accept diversity of body size as a manifestation of human differences, promote overall health over thinness, and help clients become self-accepting instead of self-depriving. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why diets fail--expert diet advice as a cause of diet failure.

Comments on an article titled Medicare's Search for Effective Obesity Treatments: Diets Are Not the Answer, by Mann et al (see record 2007-04834-008). The current author states that this article offers the following broad, sweeping conclusion: "The benefits of dieting are simply too small and the potential harms of dieting are too large for it to be recommended as a safe and effective treatment for obesity" (p. 230). This statement is provocative and unproven in the text. According to the laws of thermodynamics, which appear to apply everywhere in the known universe, anytime one consumes fewer Calories than one burns, there will be weight loss (Brooks, Fahey, & Baldwin, 2005, p. 22), despite the claims of some diet gurus and MDs (Cruise, 2005, p. 55; Katz, 2005). Any and every diet must work so long as a person voluntarily sustains a condition of fewer Calories in than out for a sufficient duration. Yet the article's conclusion denies this simple universal truth. This is a failing. Since the laws of thermodynamics are likely to remain operational on this planet for the foreseeable future and all episodes of fewer Calories in than out will always result in weight loss, the better approach to analyzing why diets fail is to look to expert diet advice as the primary cause. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An experimental test of the effect of weight-loss dieting on bulimic pathology: Tipping the scales in a different direction.

Although it is widely accepted that dieting increases the risk for bulimic pathology, this hypothesis has not been tested in a randomized experiment. Accordingly, the authors conducted an experimental test of the dietary restraint model by randomly assigning nonobese women (N=82) to either a 6-week, low-calorie diet or a waitlist control condition. The diet intervention resulted in significant weight loss, confirming that dieting was successfully manipulated. Contrary to the restraint model, dieting resulted in significant decreases in bulimic symptoms relative to the control condition. Results converge with past findings from randomized obesity prevention and treatment trials and provide evidence that dieting does not promote bulimic pathology; rather, effective decreases in caloric intake appear to reduce bulimic symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dieting behaviors and weight change history in female adolescents.

The prevalence of dieting, weight change history, and specific weight loss behaviors was examined in a population-based sample of 1,015 female 9th–12th graders. Healthy weight loss behaviors were reported much more frequently than unhealthy weight loss behaviors (e.g., healthy behaviors: exercise?=?32.4%, decrease fat intake?=?26.0%, reduce snacks?=?25.0%, reduce kilocalorie intake?=?22.4%; unhealthy behaviors: fasting?=?8.1%, diet pills?=?5.4%, vomiting?=?4.4%). Obesity status and restrained eating scores were positively related to greater history of weight loss episodes, pounds lost, and weight fluctuations and to greater use of healthy weight loss methods and weight loss programs. Implications for public health recommendations regarding dieting and its associated behaviors in female adolescents are discussed. (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)     

Obesity, dieting, and the expression of obese characteristics.

86 obese, normal, and underweight college-age males were divided into subgroups of dieters and nondieters. Consumption following a preload was found to vary as a function of dieting, not obesity, with dieters exhibiting the "obese" response (absence of caloric compensation) irrespective of weight classification. Similarly, elevated levels of free fatty acids, normally found in the obese, were associated with dieting rather than obesity per se. Implications of these findings for current theories of obesity are discussed. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of a Weight Maintenance Diet on Bulimic Symptoms in Adolescent Girls: An Experimental Test of the Dietary Restraint Theory.

It is widely accepted that dieting increases the risk for bulimia nervosa, but there have been few experimental tests of this theory. The authors conducted a randomized experiment with adolescent girls (N=188) to examine the effects of a weight maintenance diet on bulimic symptoms. A manipulation check verified that the diet intervention resulted in weight maintenance and significantly reduced the risk for obesity onset and weight gain observed in assessment-only controls. As hypothesized, the diet intervention resulted in significantly greater decreases in bulimic symptoms and negative affect than observed in controls. These experimental findings, which converge with those from a weight loss diet experiment, appear antithetical to dietary restraint theory and suggest instead that dietary restriction curbs bulimic symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of self-image to body size and weight loss attempts in black women: the CARDIA study. Coronary Artery Risk Development in Young Adults

It has been suggested that the prevalence of obesity in black women is high partly because self-image in black women is not strongly dependent on body size. To determine associations between self-image, body size, and dieting behavior among black women, the authors assessed an Appearance Evaluation Subscale (AES) score (range, 1-5), a Body Image Satisfaction (BIS) score (range, 2-11), and reported dieting behavior in a population-based sample of 1,143 black women aged 24-42 years from the fourth follow-up examination (1992-1993) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Lower AES and BIS scores indicate poorer self-image and lower body size satisfaction, respectively. After adjustment for age, education, smoking, and physical activity, women in the lowest, middle, and highest tertiles of body mass index (weight (kg)/height (m)2) had mean AES scores of 3.7, 3.3, and 2.9, respectively (p < 0.001), and mean BIS scores of 7.8, 6.7, and 5.9, respectively (p < 0.001). After additional control for body mass index as a continuous variable, both AES and BIS scores were inversely related to ever dieting, current dieting, and previous weight loss of 10 pounds (4.5 kg) or more in all tertiles of body mass index. These results suggest that among black women, a higher body mass index is associated with poorer self-image and lower body size satisfaction and that these perceptions may be an avenue to promoting weight control.     

Reduction of obesity and improvement in metabolic parameters by inhibition of intestinal lipases: current results with orlistat

Until recently, obesity did not play a major role in considerations of physicians and public health authorities. The impact of health-threatening overweight was so far considered only as a risk factor for various other serious illnesses, such as hypertension, diabetes mellitus, hyperuricemia, elevated blood lipid levels and of vascular diseases of the heart, the brain and the kidneys. Recently however, obesity has been rated by the WHO as an unique disease, resulting in elevated morbidity and mortality. It is of constantly increasing importance because of the raising number of obese individuals in all industrial countries. In Austria an incidence of 8.5% of the adult population is estimated to be obese with a BMI > 30. Though the established concept for treatment of overweight consists of reduction of the caloric intake by diet, there is an obvious need for drugs making dieting easier acceptable to obese patients for prolonged periods. Orlistat is the first representative of a new class of such drugs, inhibiting intestinal acting lipase thus reducing the intestinal absorption of triglycerides; it contributes, therefore, to a reduced calorie intake. Preliminary results of treatment studies with Orlistat are presented, demonstrating its efficacy in inducing weight loss and improving metabolic parameters with tolerable intestinal side effects. After finalization of international studies, demonstrating efficacy and tolerability, orlistat has been registered in Austria in September 1998.     

Traitement de l'obésité: Soutenir l'individu dans l'appropriation de sa démarche.

Obesity is a serious and prevalent health problem that has numerous negative consequences (World Health Organisation, 1998). Body image dissatisfaction has been recognised as an important psychosocial correlate of obesity. Confronted with the thin-ideal model promoted by our society, most overweight or obese women are preoccupied with their body and want to lose excess weight in order to reduce the gap between their actual and desired weight. They also strive to attain this thin-ideal but unreachable model. Although, the underpinnings of obesity are quite clear (i.e., a discrepancy between energy intake and energy expenditure) its treatment is far more complicated. Treatments of obesity, relying essentially on reducing calorie intake while increasing physical activity, seem to be effective in terms of initial weight loss but are often ineffective in terms of long-term maintenance. It is important to identify the potential psychosocial factors that might be involved in the explanation of maintenance failure. This article, discusses obesity and reviews the traditional treatments and their efficacy. The article outlines, based on Self-Determination Theory (SDT), a clinical conceptualisation of maintenance failure. Self-determination has been widely used as a theoretical framework for understanding behavioural change. Recently, empirical findings have supported the relevance of SDT in the comprehension of weight problems. Pelletier and his colleagues (2004) have shown that self-determination is negatively associated with the endorsement of sociocultural pressures to be thin, body dissatisfaction and bulimic symptoms. In addition, they demonstrated that women presenting a self-determined regulation of their alimentation (as compared to women whose regulation is not self-determined) are more preoccupied with the quality of their food than with its quantity, perceive themselves as self-efficient in the regulation their alimentation, engage in more healthful eating behaviours and manifest better psychological functioning. Concurrently, some studies have shown that self-determination is linked to treatment adherence, quantity of weight loss and maintenance. These results clearly indicate the importance of relying not only on the intensity of motivation but also on examining the nature of that motivation in order to understand weight loss and maintenance. Moreover, the distinction between intensity and nature of motivation must be taken into account in our clinical explanation of maintenance failures. Furthermore, although autonomy-support is an essential component of SDT, up until now studies on SDT have been conducted in intensive weight loss programs, programs that are not optimizing autonomy-support. This situation shows an important gap between theory and practice. In reference to a new paradigm of weight management (health at every size approach), our article encourages the development of interventions that will promote autonomy-support and suggests a more extensive participation of psychologists in the development and the empirical validation of such interventions. We conclude with some guidelines to promote autonomy-support in weight management interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Etiology and treatment of obesity: Understanding a serious, prevalent, and refractory disorder.

Obesity remains a leading public health problem because of its complications, prevalence, and resistance to change, despite record rates of dieting. Risk factors exist at both population and individual levels, thus obesity has diverse etiologies and consequences. Dieting is often grounded in the notion that the body can be molded at will and that the rewards justify the effort, creating a drive for unrealistic goals. This article argues for establishing a "reasonable weight," which may differ from health and aesthetic ideals. Intervention is less a matter of finding a "best" treatment but of finding the approach with "best fit" for the individual. Advances in treatment are most likely when research is driven by theory on the etiology of weight gain, the relapse process, and methods for permanent behavior change. This article integrates information on etiology, social beliefs about body weight, theory, and treatment into a comprehensive and compassionate model for intervention. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Relation of successful dietary restriction to change in bulimic symptoms: A prospective study of adolescent girls.

Recent experimental evidence that dietary restriction results in decreased bulimic and depressive symptoms seems inconsistent with findings from prospective studies and etiologic theory. However, because the dieting manipulated in these experiments may be unrepresentative of real-world weight loss dieting, the authors tested whether successful dietary restriction was associated with decreases in these outcomes by using longitudinal data from a school-based study of 496 adolescent girls. Moderately overweight participants who evidenced successful dietary restriction showed significantly greater decreases in bulimic symptoms than weight-matched participants who did not show successful dietary restriction; however, there were no effects for depressive symptoms. In conjunction with past experimental findings, results seem to imply that successful dietary restriction curbs bulimic symptoms, suggesting that current etiologic models may need revision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health dietary practices among European students.

Predictors of 5 healthy dietary habits were examined in data from the European Health and Behaviour Survey (A. Steptoe & J. Wardle, 1996), a study of over 16,000 students from 21 European countries. The level of practice of these healthy dietary habits was low. Significant univariate associations with healthy dietary habits were identified for gender, weight, dieting status, dietary health beliefs, nutrition knowledge, and health locus of control. In multivariate analyses, only gender, dieting status, and dietary health beliefs were significant predictors of healthy dietary habits. The practical implications of these results for dietary health promotion are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributions for dietary failures: Problems reported by participants in the Hypertension Prevention Trial.

Assigned 416 male and 209 female adult participants in the Hypertension Prevention Trial (HPT; HPT Research Group, in press) to 1 of 4 diets for 3 yrs. The diets were weight loss, reduced sodium, weight loss plus reduced sodium, and reduced sodium plus increased potassium. At 6-mo intervals, Ss reported problems they were having adhering to their diets. Problem attributions were coded along the dimensions of internality, stability, and controllability and were categorized as intrapersonal or extrapersonal. Ss assigned to weight-loss groups were significantly more likely than Ss assigned to non-weight-loss groups to blame themselves for their problems with adherence, making characterological as opposed to external or situational attributions. Men perceived problems to be more controllable than women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tetralogy of Fallot with flap valve ventricular septal defect producing suprasystemic right ventricular pressure: echocardiographic observations

The study objectives were to gain insight into how the terms "dieting" and "binge eating" are understood and used by adolescents and to assess whether interpretations of these terms are consistent across age and gender. Twenty-five focus groups were conducted with 203 adolescents (138 girls and 65 boys) in urban public junior and senior high schools. Respondents were asked questions about dieting and binge eating behaviors. In the majority of groups (n=19), healthful eating behaviors, such as eating less fat or more fruits and vegetables, were mentioned in reference to dieting. However, in many of the groups (n=13) unhealthful eating behaviors, such as skipping meals or "starvation," were also described. Dieting was frequently described as an umbrella term for different behaviors aimed at weight control (ie, physical activity) or in nonbehavioral terms (ie, as a desire or plan for weight loss). Although binge eating was described as overeating by many participants, often it was not clear if youth were referring to uncontrolled overeating. In nearly half of the groups, participants indicated unfamiliarity with the term "binge eating." There was some confusion between binge eating and other forms of disordered eating. The findings suggest that prevalence rates of self-reported dieting and binge eating behaviors should be interpreted with caution and it should not be assumed that the majority of adolescents who self-report dieting are engaging in unhealthful behaviors. In providing nutrition counseling to youth, and in assessing dieting and binge eating behaviors in clinical settings and in research studies, specific behaviors should be defined.