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English educational policy for pupils displaying disturbed emotions and behaviour has been characterised by inconsistencies, oscillating between discourses of inclusion and exclusion. While the social inclusion agenda presents an opportunity to improve the educational experience of this traditionally underserved population, it appears that inconsistencies remain a feature of current policy. This small case study describes the contradictions faced by a cross-section of education and children's services professionals involved in practice or policy implementation in the secondary phase. Within this English Local Authority district, professionals highlighted confused and contradictory messages for the treatment of and priority afforded to young people with behaviour, emotional and social difficulties (BESD) within the education system. The findings heighten a concern that the pressure on Local Authorities and school leaders to effect academic achievement at the highest grades may overshadow attempts to address the educational and other developmental needs of disadvantaged pupils, including those with BESD.

Objective: Higher self‐reported disability (high Health Assessment Questionnaire [HAQ] score) has been associated with hospitalizations and mortality in established rheumatoid arthritis (RA), but associations in early RA are unknown. Methods: Patients with early RA (symptom duration <1 year) enrolled in the Canadian Early Arthritis Cohort who initiated disease‐modifying antirheumatic drugs and had completed HAQ data at baseline and 1 year were included in the study. Discrete‐time proportional hazards models were used to estimate crude and multi‐adjusted associations of baseline HAQ and HAQ at 1 year with all‐cause mortality in each year of follow‐up. Results: A total of 1,724 patients with early RA were included. The mean age was 55 years, and 72% were women. Over 10 years, 62 deaths (3.6%) were recorded. Deceased patients had higher HAQ scores at baseline (mean ± SD 1.2 ± 0.7) and at 1 year (0.9 ± 0.7) than living patients (1.0 ± 0.7 and 0.5 ± 0.6, respectively; P < 0.001). Disease Activity Score in 28 joints (DAS28) was higher in deceased versus living patients at baseline (mean ± SD 5.4 ± 1.3 versus 4.9 ± 1.4) and at 1 year (mean ± SD 3.6 ± 1.4 versus 2.8 ± 1.4) (P < 0.001). Older age, male sex, lower education level, smoking, more comorbidities, higher baseline DAS28, and glucocorticoid use were associated with mortality. Contrary to HAQ score at baseline, the association between all‐cause mortality and HAQ score at 1 year remained significant even after adjustment for confounders. For baseline HAQ score, the unadjusted hazard ratio (HR) was 1.46 (95% confidence interval [95% CI] 1.02–2.09), and the adjusted HR was 1.25 (95% CI 0.81–1.94). For HAQ score at 1 year, the unadjusted HR was 2.58 (95% CI 1.78–3.72), and the adjusted HR was 1.75 (95% CI 1.10–2.77). Conclusion: Our findings indicate that higher HAQ score and DAS28 at 1 year are significantly associated with all‐cause mortality in a large early RA cohort. [ABSTRACT FROM AUTHOR]

The article discusses the predictive capacity in estimating the risk of all-cause mortality among patients with Rheumatoid Arthritis (RA). Topics include HAQ disability index score, with the results showing similar levels of association with mortality but without improvement in the fit of the model; and Rheumatic Disease Comorbidity Index and could increase the rate of all-cause mortality.

Background Patient-reported outcomes (pros) are essential to capture the patient's perspective and to influence care. Although pros and pro measures are known to have many important benefits, they are not consistently being used and there is there no Canadian pros oversight. The Position Statement presented here is the first step toward supporting the implementation of pros in the Canadian health care setting. Methods The Canadian pros National Steering Committee drafted position statements, which were submitted for stakeholder feedback before, during, and after the first National Canadian Patient Reported Outcomes (canpros) scientific conference, 14-15 November 2019 in Calgary, Alberta. In addition to the stakeholder feedback cycle, a patient advocate group submitted a section to capture the patient voice. Results The canpros Position Statement is an outcome of the 2019 canpros scientific conference, with an oncology focus. The Position Statement is categorized into 6 sections covering 4 theme areas: Patient and Families, Health Policy, Clinical Implementation, and Research. The patient voice perfectly mirrors the recommendations that the experts reached by consensus and provides an overriding impetus for the use of pros in health care. Conclusions Although our vision of pros transforming the health care system to be more patient-centred is still aspirational, the Position Statement presented here takes a first step toward providing recommendations in key areas to align Canadian efforts. The Position Statement is directed toward a health policy audience; future iterations will target other audiences, including researchers, clinicians, and patients. Our intent is that future versions will broaden the focus to include chronic diseases beyond cancer. [ABSTRACT FROM AUTHOR]

The effects of heat transfer by ventilation in snow are investigated theoretically. We draw together standard analytical results for fluid flow in porous media and apply them to the case of steady flows induced by periodic roughness elements. These solutions are used to estimate the relative magnitude of ventilation heat transfer in snow. We conclude that topography-driven ventilation is unlikely to have a significant impact on the larger scale energy balance of snow-covered regions since the airflow is confined to a shallow penetration depth or just the roughness elements themselves, rather than the bulk snowpack. In particular, for the limiting case of very warm and moisture saturated air flowing over a melting snow cover, we show that latent and sensible heat due to ventilation have about equal contributions and that this contribution is small compared to the overall surface flux as predicted by the Monin-Obukhov theory. [ABSTRACT FROM AUTHOR]

Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimise disease management. As with other chronic diseases, poor adherence is common and results in increased rates of morbidity, healthcare expenditures, hospitalisations and possibly mortality, as well as unnecessary escalation of therapy and reduced quality of life. Examples include overuse, underuse, and alteration of schedule and doses of medication, continued smoking and lack of exercise. Adherence is affected by patients' perception of their disease, type of treatment or medication, the quality of patient provider communication and the social environment. Patients are more likely to adhere to treatment when they believe it will improve disease management or control, or anticipate serious consequences related to non-adherence. Providers play a critical role in helping patients understand the nature of the disease, potential benefits of treatment, addressing concerns regarding potential adverse effects and events, and encouraging patients to develop self-management skills. For clinicians, it is important to explore patients' beliefs and concerns about the safety and benefits of the treatment, as many patients harbour unspoken fears. Complex regimens and polytherapy also contribute to suboptimal adherence. This review addresses adherence related issues in COPD, assesses current efforts to improve adherence and highlights opportunities to improve adherence for both providers and patients. [ABSTRACT FROM AUTHOR]

Context: Physical inactivity contributes to weight gain, but only 22% of Americans are regularly active.Objective: To examine short- and long-term changes in weight, body composition, and cardiovascular risk profiles produced by diet combined with either structured aerobic exercise or moderate-intensity lifestyle activity.Design: Sixteen-week randomized controlled trial with 1-year follow-up, conducted from August 1995 to December 1996.Participants and Setting: Forty obese women (mean body mass index [weight in kilograms divided by the square of height in meters], 32.9 kg/m2; mean weight, 89.2 kg) with a mean age of 42.9 years (range, 21-60 years) seen in a university-based weight management program.Interventions: Structured aerobic exercise or moderate lifestyle activity; low-fat diet of about 1200 kcal/d.Main Outcome Measures: Changes in body weight, body composition, cardiovascular risk profiles, and physical fitness at 16 weeks and at 1 year.Results: Mean (SD) weight losses during the 16-week treatment program were 8.3 (3.8) kg for the aerobic group and 7.9 (4.2) kg for the lifestyle group (within groups, P<.001; between groups, P = .08). The aerobic group lost significantly less fat-free mass (0.5 [1.3] kg) than the lifestyle group (1.4 [1.3] kg; P = .03). During the 1-year follow-up, the aerobic group regained 1.6 [5.5] kg, while the lifestyle group regained 0.08 (4.6) kg. At week 16, serum triglyceride levels and total cholesterol levels were reduced significantly (P<.001) from baseline (16.3% and 10.1% reductions, respectively) but did not differ significantly between groups and were not different from baseline or between groups at week 68.Conclusions: A program of diet plus lifestyle activity may offer similar health benefits and be a suitable alternative to diet plus structured aerobic activity for obese women. [ABSTRACT FROM AUTHOR]

Context: Physical inactivity contributes to weight gain in adults, but whether this relationship is true for children of different ethnic groups is not well established.Objective: To assess participation in vigorous activity and television watching habits and their relationship to body weight and fatness in US children.Design: Nationally representative cross-sectional survey with an in-person interview and medical examination.Setting and Participants: Between 1988 and 1994, 4063 children aged 8 through 16 years were examined as part of the National Health and Nutrition Examination Survey III. Mexican Americans and non-Hispanic blacks were oversampled to produce reliable estimates for these groups.Main Outcome Measures: Episodes of weekly vigorous activity and daily hours of television watched, and their relationship to body mass index and body fatness.Results: Eighty percent of US children reported performing 3 or more bouts of vigorous activity each week. This rate was lower in non-Hispanic black and Mexican American girls (69% and 73%, respectively). Twenty percent of US children participated in 2 or fewer bouts of vigorous activity perweek, and the rate was higher in girls (26%) than in boys (17%). Overall, 26% of US children watched 4 or more hours of television per day and 67% watched at least 2 hours per day. Non-Hispanic black children had the highest rates of watching 4 or more hours of television per day (42%). Boys and girls who watch 4 or more hours of television each day had greater body fat (P<.001) and had a greater body mass index (P<.001) than those who watched less than 2 hours per day.Conclusions: Many US children watch a great deal of television and are inadequately vigorously active. Vigorous activity levels are lowest among girls, non-Hispanic blacks, and Mexican Americans. Intervention strategies to promote lifelong physical activity among US children are needed to stem the adverse health consequences of inactivity. [ABSTRACT FROM AUTHOR]

To examine the effect of treatment-induced weight loss on Health-Related Quality of Life (HRQL), 38 mildly-to-moderately overweight persons recruited to participate in a study to examine the efficacy of a lifestyle modification treatment program completed a sociodemographic questionnaire, the Beck Depression Inventory (BDI), the Medical Outcomes Study Short-Form Health Survey (SF-36, as an assessment of HRQL), and underwent a series of clinical evaluations prior to treatment. After baseline evaluations, participants were randomly assigned to either a program of lifestyle physical activity or a program of traditional aerobic activity. Participants again completed the SF-36 and BDI after the 13-week treatment program had ended. Weight loss averaged 8.6 +/- 2.8 kg over the 13-week study. We found that weight loss was associated with significantly higher scores (enhanced HRQL), relative to baseline, on the physical functioning, role-physical, general health, vitality and mental health domains of the SF-36. The largest improvements were with respect to the vitality, general health perception and role-physical domains. There were no significant differences between the lifestyle and aerobic activity groups on any of the study measures. These data indicate that, at least in the short-term, weight loss appears to profoundly enhance HRQL. [ABSTRACT FROM AUTHOR]

This work explores the stability and hysteresis effects that occur when a small sink of momentum is introduced into a heat-driven, two-dimensional convective flow. As per standard fluid mechanical intuition, the system minimizes work generation and dissipation when one component of momentum is extracted. However, when the sink absorbs all incoming momentum, the system configures itself such that one of the convection plumes aligns directly with the sink. This state is the most hydrodynamically stable, but it maximizes, rather than minimizes extracted mechanical work. Furthermore, in the case of only vertical momentum extraction, there are two attractors, with different stabilities. Numerical experiments involving slow variations of the horizontal momentum extraction show a clear history dependence. This hysteresis preserves information about the system's past states, and hence represents a primitive memory. The momentum sink can also be used to manipulate the horizontal position of the flow field, with potential applications in microfluidics and laminar convection systems. This simple system exhibits the phenomena of autocatalysis (during the initial growth of the convection plumes), negative feedback (the attractors are either fully or quasistable), memory, and elementary computation. [ABSTRACT FROM AUTHOR]

Purpose: To explore barriers, facilitators, and motivators to adopting and maintaining regular physical activity among women with obesity who have undergone bariatric surgery.Approach: Individual interviews with women 3 to 24 months post-bariatric surgery.Setting: Participants were recruited from a bariatric clinic in Montreal, Canada.Participants: Twelve women were recruited (mean age = 47 ± 9 years) using poster advertisements and word of mouth. Participants were on average 15 months postsurgery.Method: Each woman was interviewed once using a semistructured interview protocol. Recruitment was conducted until data saturation (i.e., no new information emerged). The interviews were transcribed, coded, and analyzed using inductive thematic analysis.Results: Three interrelated themes emerged: the physical body, appraisal of the physical and social self, and the exercise environment. Barriers included weight-restricted mobility, side effects of surgery, body dissatisfaction, compromised psychological health, competing responsibilities, a lack of exercise self-efficacy and social support, reduced access to accommodating facilities, lack of exercise knowledge, and northern climate. Participants reported postsurgical weight loss, weight and health maintenance, enjoyment, body image, and supportive active relationships, as well as access to accommodating facilities and exercise knowledge, as facilitators and motivators.Conclusion: Suggested physical activity programming strategies for health care professionals working with this unique population are discussed. Physical activity and health promotion initiatives can also benefit from a cultural paradigm shift away from weight-based representations of health. [ABSTRACT FROM AUTHOR]

Objective: Metabolic syndrome (MetS) prevalence in early rheumatoid arthritis (ERA) is conflicting. The impact of sex, including menopause, has not been described. We estimated the prevalence and factors associated with MetS in men and women with ERA., Methods: A cross-sectional study of the Canadian Early Arthritis Cohort (CATCH) was performed. Participants with baseline data to estimate key MetS components were included. Sex-stratified logistic regression identified baseline variables associated with MetS., Results: The sample included 1543 participants; 71% were female and the mean age was 54 (SD 15) years. MetS prevalence was higher in men 188 (42%) than women 288 (26%, P < 0.0001) and increased with age. Frequent MetS components in men were hypertension (62%), impaired glucose tolerance (IGT, 40%), obesity (36%), and low high-density lipoprotein cholesterol (36%). Postmenopausal women had greater frequency of hypertension (65%), IGT (32%), and high triglycerides (21%) compared with premenopausal women ( P < 0.001). In multivariate analysis, MetS was negatively associated with seropositivity and pulmonary disease in men. Increasing age was associated with MetS in women. In postmenopausal women, corticosteroid use was associated with MetS. Psychiatric comorbidity was associated with MetS in premenopausal women. MetS status was not explained by disease activity or core RA measures., Conclusion: The characteristics and associations of MetS differed in men and women with ERA. Sex differences, including postmenopausal status, should be considered in comorbidity screening. With this knowledge, the interplay of MetS, sex, and RA therapeutic response on cardiovascular outcomes should be investigated., (© 2019 The Authors. ACR Open Rheumatology published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.)

Background and Objectives: Vitamin D is a steroid hormone with important skeletal and non-skeletal biologic functions. Vitamin D deficiency is common and manifests with musculoskeletal symptoms. In rheumatoid arthritis (RA), vitamin D deficiency may be associated with increased disease activity and disability. We aimed to estimate the relationship between Vitamin D level and disease activity, pain, and disability in RA., Methods: Data were drawn from 62 RA patients seen in an academic arthritis clinic. 25(OH)D levels were evaluated along with markers of RA disease activity, physician and patient global assessments, pain (VAS) and HAQ. DAS-28 was calculated. Vitamin D deficiency was defined as 25(OH)D levels<30ng/ml., Results: Sixty-one percent of RA patients were classified as vitamin D deficient. In patients with active RA (DAS 28 score≥2.6), 25(OH)D was moderately and inversely associated with DAS 28 (-0.38), pain (-0.49) and HAQ (-0.54) (p<0.01). However, no significant associations were found between 25(OH)D and these variables in patients in remission (DAS 28<2.6). Vitamin D deficient patients with active RA had six times the odds (OR=6.0, 95% CI 1.2-31.2) of being moderately or severely disabled (HAQ≥1.25)., Conclusions: Vitamin D deficiency was common in this RA group. In patients with moderate to high disease activity, vitamin D deficiency was associated with higher DAS scores, pain and disability. Clinicians in northern climates may wish to monitor vitamin D status in their RA patients.

Context: Inner-city minority children with asthma use emergency departments (ED) frequently., Objective: To examine whether maternal depressive symptoms are associated with ED use., Design, Setting, and Patients: Baseline and 6-month surveys were administered to mothers of children with asthma in inner-city Baltimore, Md, and Washington, DC., Main Outcome Measures: Use of the ED at 6-month follow-up was examined. Independent variables included asthma morbidity, age, depressive symptoms, and other psychosocial data., Results: Among mothers, nearly half reported significant levels of depressive symptoms. There were no demographic or asthma-related differences between the children of mothers with high and low depressive symptoms. However, in bivariate analyses, mothers with high depressive symptoms were 40% (prevalence ratio [PR], 1.4; 95% confidence interval [CI], 1.0-3.6; P =.04) more likely to report taking their child to the ED. Mothers aged 30 to 35 years were more than twice as likely (PR, 2.2; 95% CI, 1.9-9.3; P =.001) to report ED use, as were children with high morbidity (PR, 1.9; 95% CI, 1.4-7.1; P =.006). Child age and family income were not predictive of ED use. After controlling for asthma symptoms and mother's age, mothers with depressive symptoms were still 30% more likely to report ED use., Conclusions: Depression is common among inner-city mothers of children with asthma. Beyond asthma morbidity, maternal age and depressive symptoms are strong predictors of reports of ED visits. Identifying and addressing poor psychological adjustment in mothers may reduce unnecessary ED visits and optimize asthma management among inner-city children.

Objectives: To examine the relationship between television watching, energy intake, physical activity, and obesity status in US boys and girls, aged 8 to 16 years., Methods: We used a nationally representative cross-sectional survey with an in-person interview and a medical examination, which included measurements of height and weight, daily hours of television watching, weekly participation in physical activity, and a dietary interview. Between 1988 and 1994, the Third National Health and Nutrition Examination Survey collected data on 4069 children. Mexican Americans and non-Hispanic blacks were oversampled to produce reliable estimates for these groups., Results: The prevalence of obesity is lowest among children watching 1 or fewer hours of television a day, and highest among those watching 4 or more hours of television a day. Girls engaged in less physical activity and consumed fewer joules per day than boys. A higher percentage of non-Hispanic white boys reported participating in physical activity 5 or more times per week than any other race/ethnic and sex group. Television watching was positively associated with obesity among girls, even after controlling for age, race/ethnicity, family income, weekly physical activity, and energy intake., Conclusions: As the prevalence of overweight increases, the need to reduce sedentary behaviors and to promote a more active lifestyle becomes essential. Clinicians and public health interventionists should encourage active lifestyles to balance the energy intake of children.

The prevalence of obesity and severe obesity is growing rapidly, along with obesity-related comorbidities and mortality. Given the increased health risks associated with obesity, it is vital that obese persons have adequate access to, and make consistent use of, medical care services. Assuming obese persons have access to medical care that is comparable to non-obese persons, one would expect to observe greater use of medical services among obese persons. In this article we briefly review empirical evidence of the access to and use of medical care among obese persons. Although certain subgroups that tend to have disproportionately high prevalences of obesity (i.e., low socioeconomic status, minority groups) have reduced access to care, no studies have specifically examined whether or not obese persons have the same access to health care as do their lean counterparts. With respect to use of health care services, however, obesity has been consistently linked with greater rates of utilization and increased health care expenditures. Both the increased use and cost appear to be largely a function of treating obesity-associated comorbidities such as diabetes and hypertension. We conclude that, although it is clear that obesity is associated with both greater use and cost of medical care, the relationship between obesity and access to medical care has not been determined.

Objective: To compare sociodemographic characteristics and health-related quality of life (HRQL) between groups of obese persons who sought and did not seek university-based treatment for overweight., Method: Three-hundred twelve consecutive obese persons sought outpatient university-based weight management treatment. The sample of obese persons (N = 89) who indicated that they were not currently trying to lose weight was derived from a larger convenience sample (N = 232) of persons surveyed in a hospital setting. Both groups completed sociodemographic and brief medical history questionnaires and the HRQL as measured by the Medical Outcomes Study Short-Form-36 Health Survey (SF-36)., Results: Obese persons who had sought treatment tended to be heavier, older, Caucasian, married, in white collar employment, and reported a higher prevalence of diabetes, hypertension, and pain. In multivariate analyses, both adjusted and unadjusted for these differences, obese persons who had sought treatment were significantly more impaired on the bodily pain, general health, and vitality HRQL domains than those who were not trying to lose weight., Discussion: Although differences on sociodemographic and medical variables between the two groups may attenuate the obesity-HRQL relationship somewhat, obesity appears to have a pronounced impact on important dimensions of HRQL independent of whether or not the person is attempting to lose weight, (Copyright 2000 by John Wiley & Sons, Inc.)

Objective: To assess the prevalence of persistent knee pain among older adults in the US., Design: A nationally representative cross-sectional survey with an in-person interview and medical examination, Setting and Participants: Between 1988 and 1994, 6596 adults aged 60 to 90+ years were examined as part of the National Health and Nutrition Examination Survey III. Mexican Americans and non-Hispanic blacks were over-sampled to produce reliable estimates for these groups., Main Outcome Measurements: Participants were asked to report whether they had experienced knee pain on most days for the 6 weeks preceding their medical exam., Results: Overall, 18.1% of US men and 23.5% of US women aged 60 years and older reported knee pain. Sixty- to ninety-year-old men reported knee pain less frequently than their age-matched female counterparts. There was a trend for reports of knee pain to increase steadily as these adults aged from 60 to 85 years. The highest prevalence of knee pain was reported among 85- to 90-year-old men (23.7%) and women (30.0%). Among non-Hispanic white adults older than age 60, 18.4% of men and 22.0% of women reported knee pain. Reports of knee pain among non-Hispanic black men and Mexican American men were similar to those of their non-Hispanic white counterparts. In contrast, 26.4% of Mexican American women and 32.8% of non-Hispanic black women reported knee pain. We also found that difficulty in performing physical functioning activities was associated with a higher prevalence of knee pain., Conclusions: Many US adults older than age 60 years report knee pain, and the prevalence is higher in older adults. Reports of knee pain are highest among non-Hispanic black women and the oldest Americans. Intervention strategies are needed to prevent and better manage knee pain among older US adults to stem the adverse health consequences and diminished quality of life associated with this common problem.

Objective: The prevalence of successful weight loss remains unclear. In 1982, Schachter concluded that in the general population, the rate of "self-cured" obesity approached 63%-much higher than the rate from clinical trials. Several subsequent studies have addressed this issue., Research Methods and Procedures: Our initial goal was to meta-analyze these studies to evaluate the validity of the original hypotheses and the extent to which additional investigations supported the findings. We began by restating Schachter's hypotheses in precise, testable terms., Results: A systematic review of these studies found many methodological limitations and much heterogeneity among the samples studied, hypotheses addressed, and operational definitions. Some of these limitations appear to stem from the lack of clear, precise statements of the exact hypotheses tested. Differences among studies are delineated, and we outline why meta-analytic pooling of these data appears inappropriate., Conclusions: The current data are inadequate to draw any definite conclusions regarding the cure rate of obesity. Criteria for the adequate study of success rates with "self-cure" in the general population are proposed.

Background: The U.S. Surgeon General advocates the accumulation of moderate-intensity activity throughout the day to improve health., Objectives: To test the effectiveness of signs to encourage use of stairs instead of escalators., Design: Community intervention., Setting: Shopping center., Participants: 17901 shoppers., Intervention: Signs promoting the health and weight-control benefits of stair use were placed beside escalators with adjacent stairs., Measurements: The sex, age, race, weight classification, and use of stairs were observed., Results: Overall, stair use increased from 4.8% to 6.9% and 7.2% with the health and weight-control signs, respectively. Younger persons increase their stair use from 4.6% to 6.0% with the health sign and 6.1% with the weight-control sign. Older persons almost doubled their stair use from 5.1% to 8.1% with the health sign and increased use to 8.7% with the weight-control sign. Differential use of stairs was observed between ethnic groups. Among white persons, stair use increased from 5.1% to 7.5 and 7.8% with the health sign and weight-control signs. Among black persons, stair use decreased from 4.1% to 3.4% with the health sign and increased to 5.0% with the weight-control sign. At baseline, lean persons used the stairs more often than overweight persons (5.4% and 3.8%, respectively). The health sign increased stair use to 7.2% among normal-weight persons and 6.3% among overweight persons; the weight-control sign prompted stair use to increase to 6.9% among persons of normal weight and to 7.6% among overweight persons., Conclusions: Simple, inexpensive interventions can increase physical activity. Research is needed to identify effective motivators to promote activity among black persons.

This study investigated the relationship between binge eating and the outcome of weight loss treatment. Participants in a 48-week trial of a structured diet combined with exercise and behavior therapy were classified into one of four groups: no overeating; episodic overeating; subthreshold binge-eating disorder(BED); and BED. Binge eating status was not associated with either dropout or adherence to the diet, but did affect weight loss and mood. The BED group lost significantly more weight at the end of treatment than all other groups, even when adjusting for initial weight. At 1-year follow-up, there were no differences among groups in weight loss or weight regain. The BED group began treatment with significantly higher BDI scores, but improvement in mood occurred by week 5. On the basis of these findings, and a review of the recent literature, we conclude that obese binge eaters respond as favorably to standard dietary and behavioral treatments as do obese nonbingers.

This study investigated changes in body composition, resting energy expenditure (REE), appetite, and mood in 128 obese women who were randomly assigned to 1 of 4 treatment conditions: diet alone, diet plus aerobic training, diet plus strength training, or diet combined with aerobic and strength training (i.e., combined training). All women received the same 48-week group behavioral program and were prescribed the same diet. Exercising participants were provided 3 supervised exercise sessions per week for the first 28 weeks and 2 sessions weekly thereafter. Participants across the 4 conditions achieved a mean weight loss of 16.5 +/- 6.8 kg at Week 24, which decreased to 15.1 +/- 8.4 kg at Week 48. There were no significant differences among conditions at any time in changes in weight or body composition. Women who received aerobic training displayed significantly smaller reductions in REE at Week 24 than did those who received strength training. There were no other significant differences among conditions at any time on this variable or in changes in appetite and mood.

Participants were 130 obese women with a mean age of 41.1 +/- 8.4 years and a mean weight of 97.9 +/- 13.5 kg, who reported having undertaken a mean lifetime total of 4.7 +/- 1.2 major diets on which they had lost a mean total of 45.9 +/- 21.4 kg. Participants with a severe history of weight cycling had a significantly younger age of onset of their obesity than did mild cyclers and reported initiating dieting at a significantly younger age and lower weight. No evidence, however, was found that weight cycling was associated with greater reports of depression or other psychopathology; nor was it associated with a significantly greater frequency of binge eating disorder. The results are discussed in terms of the need to use additional measures of psychological functioning.

This study examined the combination of sertraline, a selective serotonin reuptake inhibitor, and relapse prevention training in the maintenance of weight loss following treatment by a very-low-calorie diet. A total of 53 women who had lost a mean (+/- SD) of 22.9 +/- 7.1 kg from a pretreatment weight of 103.1 +/- 17.8 kg were randomly assigned to a 54-week weight maintenance program that was combined with either: 1) 200 mg/d of sertraline; or 2) placebo. During the first 6 weeks, sertraline subjects lost significantly more weight and reported significantly greater reductions in hunger and preoccupation with food than did subjects on placebo. After this time, however, women in both conditions regained weight steadily. The 13 sertraline subjects who completed the 54-week study regained 17.7 +/- 10.6 kg of their original 26.3 +/- 7.6 kg loss, equal to a regain of 70.9 +/- 41.7%. The 17 placebo completers regained 11.8 +/- 9.0 kg of their 23.4 +/- 7.8 kg loss, equal to a 46.5 +/- 34.6% regain. End-of-treatment differences between groups in weight change were not statistically significant. Nor were there significant differences between the two conditions at any time in changes in fat-free mass, resting metabolic rate or dysphoria, all of which tended to increase with weight regain. The results are discussed in relation to findings from other long-term studies that combined diet and medication.

Several reports have suggested that modest weight losses, as little as 10% of initial weight, are sufficient to control many of the health complications of obesity. This study examined the relation between changes in weight and those in serum lipids and lipoproteins in obese women who participated in a 48-wk weight-reduction study. Subjects were 66 obese women who were prescribed a 3870-kJ (925-kcal)/d diet for the first 16 wk and a balanced-deficit diet of 5029-6279 kJ (1200-1500 kcal)/d thereafter. Anthropometric measures were assessed at baseline and weeks 8, 24, and 48, as were serum triacylglycerols (triglycerides), total cholesterol, and low-density-lipoprotein- and high-density-lipoprotein-cholesterol concentrations. Weight decreased 11.1% during the first 8 wk, during which time triacylglycerols and total cholesterol fell 22.7% and 15.7%, respectively. Subjects lost an additional 4.7 kg (equal to a total reduction of 16.4%) between weeks 8 and 24 but triacylglycerols and total and low-density-lipoprotein cholesterol increased by 5.2%, 4.2%, and 4.5%, respectively during this time. Multiple-regression analyses showed that at no time did weight loss account for > 6% of the variance in the reductions in triacylglycerol and cholesterol concentrations. These findings indicate that modest weight losses are associated with significant improvements in serum lipids, but that factors including the energy and macronutrient content of the diet prescribed contribute significantly to the improvements observed.

This study assessed the incidence of gallstone formation in 47 obese women who consumed a low-calorie diet (LCD) for the first 16 weeks of a 26-week weight loss program. The LCD consisted of four daily servings of a liquid diet combined with an evening meal of a pre-packaged dinner entrée and provided approximately 925 kcal/d. Six of the 47 patients (12.8%) displayed gallstones at week 17, as determined by sonography. Five patients were asymptomatic when followed for up to 48 weeks. The sixth, however, reported severe abdominal pain 30 weeks after beginning treatment and required a cholecystectomy. Patients who developed gallstones, as compared with those who did not, had significantly higher baseline triglyceride and total cholesterol levels and had a significantly greater rate of weight loss. Results of this study indicate that an increased risk of gallstones is not limited to very-low-calorie diets and that the incidence of this complication should be assessed in persons who consume popular over-the-counter meal replacement plans.

To determine the optimal energy intake of very-low-calorie diets (VLCDs), 76 obese women were randomly assigned, in a double-blind fashion, to one of three liquid-formula diets: 1758 kJ/d (420 kcal/d), 2763 kJ/d (660 kcal/d), or 3349 kJ/d (800 kcal/d). Weight, body composition, symptoms, mood, and acceptability of the diet were assessed throughout the 6-mo study. There were no significant differences in weight losses or changes in body composition among the three dietary conditions at the end of treatment, nor were there significant differences among conditions in acceptability of the diet, symptoms, or mood. These results suggest that there is no clinical advantage to using VLCDs that provide less than 3349 kJ/d (800 kcal/d).