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MARTIN, CORBY K., PATRICK M. O’NEIL, AND LAURA PAWLOW. Changes in food cravings during lowcalorie and very-low-calorie diets. Obesity. 2006;14: 115–121. Objective: This study examined food cravings during a primarily food-based low-calorie diet (LCD) and a supplement-based very-LCD (VLCD). Research Methods and Procedures: The Food Craving Inventory (FCI) was used to measure general cravings and cravings for specific types of foods (sweets, high fats, carbohydrates/starches, and fast food fats). The FCI was completed by participants in the LCD and VLCD programs at baseline and after 11 weeks of dieting. The VLCD group also completed the FCI at Week 6 and after 5 weeks of a refeeding phase, when their diet consisted primarily of solid food. Results: From baseline to Week 12, craving decreases were greater for the VLCD group than for the LCD group on all measures. All craving measures decreased significantly for the VLCD group. The LCD group experienced a marginally significant decrease in sweet cravings. Within the VLCD group, all craving measures decreased significantly by Week 6 and did not change thereafter, including after resumption of solid food intake, and craving scores during all dieting points were lower than baseline. Changes in cravings were not related to weight loss. Discussion: Cravings did not increase during either diet; all changes represented decreases. Compared with a primarily food-based diet (LCD), a more restrictive supplement-based diet (VLCD) resulted in significantly larger decreases in food cravings that occurred by the end of the 5th week of supplement use and did not rebound with resumption of solid food intake. The results of this study suggest that food cravings diminish with calorie restriction.

Background Among severely obese persons seeking surgical treatment, lifetime prevalence rates of Axis 1 psychiatric disorders range up to 50%; 27% to 42% have a diagnosable psychiatric disorder at the time of evaluation. Despite recommendations by the National Institutes of Health Consensus Development Panel that evaluation for surgery include a mental health component, little data are available on the outcomes of such evaluations. Similarly, there are also few data on the frequency and type of psychotropic medication use by these patients. The primary objective of this study was to describe the recommendations resulting from psychological evaluations of bariatric surgery applicants; a secondary purpose was to describe the point and lifetime prevalences of psychotropic medication use. Methods We examined the psychological evaluation recommendations of successive gastric bypass applicants at the Medical University of South Carolina. Results Results indicated that the overwhelming majority (81.5%) of gastric bypass applicants had no psychological contraindication to surgery. A smaller percentage (15.8%) required psychological treatment before surgery, and only 2.7% of all applicants were considered psychologically inappropriate for surgery. Results also indicate that 47.7% were using at least 1 psychotropic medication at the time of the evaluation, and that 9.2% were using more than 1. The overwhelming majority of medications used were antidepressants, followed by antianxiety medications and mood stabilizers. Conclusions These results indicate that the vast majority of patients will not be denied surgery as the result of a psychological assessment, yet approximately 20% of patients may be considered, based on psychological evaluation, psychologically inappropriate for immediate surgery, at least without initial treatment. These data also suggest that pharmacologic treatment of psychiatric disorders is quite common among gastric bypass applicants.

To examine the characteristics and outcomes of physician-referred weight management patients relative to self-referred patients.Review of clinic records of all individuals contacting a weight control program during a 2-year period with follow-up throughout consecutive levels of treatment (i.e., enrollment, completion, and outcome).Medical school weight management center.A consecutive sample (N = 1,392) of overweight and obese callers was categorized as physician-initiated (n = 345), media (n = 653), or personal (n = 394) referrals. Attendees at initial consultation (n = 571) were age 41.7 +/- 12.8 years, weight 113.9 +/- 36.1 kilograms, and body mass index (BMI) 40.3 +/- 11.3 kg/m(2) (data expressed as mean +/- standard deviation).Low-calorie-diet and very-low-calorie-diet programs.Gender comparisons, attendance at initial consultation, body mass index, motivation, comorbidities, enrollment and completion rates, and weight loss.Compared to callers from other referral sources, physician referrals included a larger minority of males (25.2%) and were more likely to attend an initial consultation (63.5%; P.001). Among consultation attendees, physician referrals were heavier (mean BMI = 44.8), reported more comorbidities, were less likely to join programs (16.9%), and scored as less motivated than other referrals (P.007). Completion rates for physician referrals were higher than for self-referrals in the very-low-calorie-diet program (85.7%; P.04) but not in the low-calorie-diet program (P.05). Among completers, physician referrals did not differ on weight loss in either program (P.05).Compared to self-referrals, physician-referred individuals are in greater need of weight loss, less motivated, less likely to enter treatment, but equally likely to profit from it. Therefore, physician referral for weight loss is beneficial for at least some patients and should be encouraged.

Obesity, a primary health concern worldwide, results in increased rates of chronic disease and mortality. Despite an urgent need for creative solutions to the obesity epidemic, human factors and ergonomics professionals have yet to apply their skill sets to solving this global problem. The present study evaluates the “Bite Counter”, a wrist-worn device that can detect when an individual takes a bite of food. The usability and acceptability of the bite counter will be examined during a weight loss trial. Understanding user difficulties that lead to decreased user compliance will result in guidelines for improving future iterations of the device and future weight loss trials with the Bite Counter.

Objective: Studies of age of first binge have been conducted in clinical samples of patients with bulimia nervosa (BN) and binge eating disorder (BED), but few studies have examined age of first binge using nationally representative samples. Method: We examined age of first binge and its clinical correlates using data generated from the National Women’s Study (n 53,006). Participants who endorsed ever binge eating (n 5707) were divided into two groups: (1) child-adolescent onset (CO)—age of fi rst binge

Objective: Clinical experience has indicated that dieting usually precedes the onset of binge eating in the development of bulimia nervosa (BN). However, data confirming this in nonclinical, representative samples are lacking. Method: Using results obtained from the National Women's Study (NWS), we were able to determine the chronological relationship between age of onset of significant dieting (attempting to lose 15 Ibs) and onset of bingeing in 85 respondents who met DSM-III-R criteria for BN. These respondents were a subset of over 3,000 female adult U.S. women who completed a random telephone interview (averaging 40 min and including screenings for rape, sexual molestation, aggravated assault, posttraumatic stress disorder [PTSD], and BN). Results: We found that the age of first serious attempt to diet preceded the age of first binge in 46% of cases. There were no significant differences in histories of victimization experiences among the groups. First binge preceded first serious diet in 37% of cases, and these behaviors occurred during the same age in 17% of cases. Discussion: These data confirm that dieting is more likely to precede binge eating, although binge eating precedes significant dieting in a substantial proportion of bulimic respondents.

Background: Long-term maintenance of weight loss remains a therapeutic challenge in obesity treatment. Objective: This multicenter, double-blind, placebo-controlled study was designed to test the hypothesis that orlistat, a gastrointestinal lipase inhibitor, is significantly more effective than a placebo in preventing weight regain. Design: Obese subjects who lost ≥8% of their initial body weight during a 6-mo lead-in of a prescribed hypoenergetic diet (4180-kJ/d deficit) with no adjunctive pharmacotherapy were randomly assigned to receive placebo, 30 mg orlistat, 60 mg orlistat, or 120 mg orlistat 3 times daily for I y in combination with a maintenance diet to help prevent weight regain. Of 1313 recruited subjects [body mass index (in kg/m 2 ): 28-43], 729 subjects lost ≥8% of their initial body weight during the 6-mo weight-loss lead-in period and were enrolled in the double-blind phase. Results: After 1 y, subjects treated with 120 mg orlistat 3 times daily regained less weight than did placebo-treated subjects (32.8 ± 4.5% compared with 58.7 ± 5.8% regain of lost weight; P < 0.001). Moreover, more subjects in the 120-mg orlistat group than in the placebo group regained ≤25% of lost weight (47.5% of subjects compared with 29.9%). In addition, orlistat treatment (120 mg 3 times daily) was associated with significantly greater reductions in total and LDL-cholesterol concentrations than was placebo (P < 0.001). Conclusion: The use of orlistat during periods of attempted weight maintenance minimizes weight readjustment and facilitates long-term improvement in obesity-related disease risk factors.

To identify three groups of obese people entering weight loss treatment, who have distinctly different cognitive appraisals of dietary transgressions and to compare these groups on self-report inventories of eating patterns, dieting, and depression, as well as on treatment completion rates and weight loss.Retrospective review of clinical records. Using a measure which evaluates eating-related cognitive appraisals, participants were categorized into one of three cognitive groups (All-or-None, Rationalization, Matter-of-Degree).289 treatment-seeking obese women (age: 40.9 y, body mass index (BMI): 34.7 kg/m2).Self-reported eating and dieting behavior (Three-Factor Eating Questionnaire and Eating Behavior Inventory); depression (Beck Depression Inventory); attendance information and body weight obtained during treatment.The cognitive group representing objective thinkers (Matter-of-Degree) reported significantly fewer problems with overeating and more personal control over eating than did the rigid, dichotomous thinkers (All-or-None). In addition, the Matter-of-Degree (MAT) group endorsed significantly less subjective hunger and fewer depressive symptoms than the other two cognitive groups. The Rationalization group was more likely to complete a treatment program than was the All-or-None group, with the MAT group not differing from either. Despite these findings, there were no significant differences among cognitive groups on total weight loss.Cognitive appraisals of weight-control lapses appear to be associated with self-reported eating behavior, depressive symptoms and treatment completion rates, but not with treatment-induced weight loss. The relationship between long-term weight loss and cognitive appraisals of dieting lapses is yet to be determined. It appears necessary to assess empirically the validity of assumptions regarding factors associated with treatment outcome.

This study examined the relations between stable moods (i.e., non clinical levels of anxiety and depression) and average daily intake of certain macro- and micronutrients, among a sample of obese women. Subjects were 38 women assessed at entry to a long-term weight-loss medication trial. Subjects' levels of anxiety and depression were assessed by self-report measures and by a psychiatrist's ratings. Average daily intakes of energy, macronutrients, certain micronutrients, and caffeine were computer analyzed (Nutritionist III) from subjects' eating diaries. Results were analyzed via Pearson correlation coefficients and multiple regression analyses. Higher carbohydrate (CHO) intake, particularly simple CHO intake, was consistently related to lower levels of both anxiety and depression. Some relations of mood to caffeine and micronutrients were also observed on correlational analyses. Discussion examines possible explanations for findings, particularly the surprisingly strong association between higher intakes of simple CHO and lower levels of depression and anxiety.

Introduction Obesity is a major health problem (1) and treatment approaches are changing rapidly (2). Although many clinical trials of obesity agents have been reported, interpretation of their results is hampered by the short-term duration of most studies and by the lack of standardized outcome measurements. As future clinical trials are conducted, it seems important to standardize protocols and define meaningful endpoints. To address the need for state-of-the-art clinical research, a 2-day conference "Clinical Trials for Obesity Agents" was held on May 12-13, 1997 in New Orleans, LA. The purposes of this conference were to: (a) have experienced investigators review specific areas and make recommendations about conduct of clinical trials for obesity agents; and (b) have experienced clinical trial investigators in the obesity area review current guidelines and make specific recommendations about design and conduct of clinical trials with obesity agents. This conference was co-chaired by James W. Anderson, MD, and F. Xavier Pi-Sunyer, MD. The following presentations were made: "General Considerations for Trial Designs by Myrlene Staten, MD; "FDA Guidance" by Eric Coleman, MD; "Diet Considerations" by Jolene Held, MS, RD; "Exercise Recommendations and Monitoring" by Michael Perri, Ph.D.; "Behavioral Considerations" by John Foreyt, Ph.D.; and "Long-Term Maintenance Considerations" by Thomas Wadden, Ph.D. These co-morbidities were discussed: "Diabetes" by Charles Lucas, MD; "Hy

Objective In recent years there has been increased interest regarding the role of crime victimization in the development and/or maintenance of eating disorders, particularly bulimia nervosa. Method: To examine the relationship among assault, bulimia nervosa, and binge eating disorder, a national, representative sample of 3,006 women completed structured telephone interviews. Results: Lifetime prevalence of completed, forcible rape for respondents with bulimia nervosa was 26.6%, as compared with 11.5% for respondents with binge eating disorder and 13.3% for respondents without bulimia nervosa or binge eating disorder. Compared to respondents without bulimia nervosa or binge eating disorder, aggravated assault history was significantly more prevalent in women with bulimia nervosa (26.8%), as was a lifetime history of posttraumatic stress disorder (36.9%). Characteristics of sexual assault experiences were not associated with dysfunctional eating patterns. Specific types of disordered eating such as compensatory behaviors in bulimia nervosa were associated with higher rates of victimization. Conclusions: In sum, the significantly higher rates of both sexual and aggravated assault among women with bulimia nervosa compared with women without such a diagnosis support the hypothesis that victimization may contribute to the development and/or maintenance of bulimia nervosa. © 1997 by John Wiley & Sons, Inc. Int J Eat Disord 21: 213–228, 1997.

Greater self-regulatory behavior usage is associated with greater weight loss within behavioral weight loss treatments. Hedonic hunger (i.e., susceptibility to environmental food cues) may impede successful behavior change and weight loss. Adult men and women ( N = 111, body mass index M ± SD = 35.89 ± 6.97 kg/m2) were assessed before and after a 15-week lifestyle change weight loss program with a partial meal-replacement diet. From pre- to post-treatment, reported weight control behavior usage improved and hedonic hunger decreased, and these changes were inversely related. Individuals with higher hedonic hunger scores at baseline showed the greatest weight loss. Similarly, participants with lower baseline use of weight control behaviors lost more weight, and increased weight control behavior usage was associated with greater weight loss—particularly among individuals with low baseline hedonic hunger. Further study is warranted regarding the significance of hedonic hunger in weight loss treatments.

Objective. Dietary fiber can reduce hunger and enhance satiety, but fiber intake during hypocaloric weight loss diets typically falls short of recommended levels. We examined the nutritional effects and acceptability of two high-fiber hypocaloric diets differing in sources of fiber: (a) beans or (b) fruits, vegetables, and whole grains. Methods. Subjects were 2 men, 18 women, mean age = 46.9, and mean BMI = 30.6. Subjects completed 3-day food diaries in each of the two baseline weeks. Subjects were then randomized to four weeks on one of two 1400-calorie diets including 25–35 g fiber primarily from 1.5 cups beans/day or from fruits, vegetables, and whole grains. Recommended fiber-rich foods were provided. Subjects kept weekly 3-day food diaries and were assessed weekly. Results. Diet conditions did not differ on outcome measures. Both diets increased fiber intake from 16.6 g/day (SD = 7.1) at baseline to (treatment average) 28.4 g/day (SD = 6.5) (). Fiber intake was consistent over treatment. Caloric intake dropped from 1623.1 kcal/day (SD = 466.9) (baseline) to 1322.2 kcal/day (SD = 275.8) (). Mean weight loss was 1.4 kg (SD = 1.5; ). Energy density and self-reported hunger decreased (’s < 0.01) while self-reported fullness increased (). Both diets were rated as potentially acceptable as long as six months. Conclusions. Both diets significantly increased fiber intake by 75%, increased satiation, and reduced hunger. Results support increasing fiber in weight loss diets with a variety of fiber sources.

Neurocognitive abilities were measured in 14 morbidly obese children, five of whom had obstructive sleep apnea as determined by polysomnography. As in adults, children with obstructive sleep apnea had deficits in learning, memory, and vocabulary. Moreover, apneic/hypopneic events were inversely related to memory and learning performance among the entire sample.

AIM: Research suggests that exercise absence is frequently associated with greater guilt and negative affect, particularly when obligatory exercise beliefs and eating disordered psychopathology are considered. Two separate studies used ecological momentary assessment (EMA) to examine differences in mood on exercise and non-exercise days and the moderating impact of obligatory exercise beliefs and eating disordered beliefs and behaviors. METHOD: Both studies recruited female university students who endorsed frequent exercise behavior and study two also recruited based on level of eating disordered psychopathology. Participants completed the Obligatory Exercise Questionnaire at baseline and EMA measures of affect and exercise behavior for approximately one week. Study two participants also completed measures of body dissatisfaction and cognitions. RESULTS: Results of study one suggest that obligation to exercise appears to have a greater impact on general level of affect than does exercise absence or the interaction of these two. In addition, in study two, eating disorder symptomatology was significantly associated with affect and cognition while exercise absence and obligatory exercise beliefs were not. CONCLUSIONS: The present studies suggest that the absence of exercise is not associated with significant changes in affect or cognitions. However, obligation to exercise and eating disorder symptomatology do impact affect and cognitions.

Objective This study assessed changes in cardiovascular disease risk factors among participants in a 12-week behavioral weight loss intervention featuring a commercial format. Method 132 participants were enrolled in a randomized controlled trial of a 12-week group-based lifestyle intervention that involved two structured food plan conditions. Of them, 112 (100 women and 12 men, mean BMI = 31.44 ± 2.18 kg/m2) completed the program with post-treatment assessments. Weight and changes in risk factors (cholesterol, triglycerides, fasting blood glucose, and blood pressure) were assessed at pre- and posttreatment. Additionally, changes for each risk factor were examined among participants with baseline values of risk factors beyond recommended cut points. Results With no weight loss differences between conditions, analyses used the combined sample. Participants lost 3.74 ± 3.16 kg (4.37 ± 3.71% of baseline weight), and exhibited significant decreases in triglyceride, total cholesterol and LDL-cholesterol levels. There were trends toward reductions in fasting glucose, systolic blood pressure, and HDL cholesterol. Among participants with elevated baseline values, significant reductions were seen on all risk factors, with the exception of HDL cholesterol. Discussion Modest weight loss achieved via a relatively brief, non-intensive intervention using a commercial format can yield significant improvements in cardiovascular disease risk factors, particularly among individuals with initially higher-risk values.

The BLOOM-DM (Behavioral Modification and Lorcaserin for Obesity and Overweight Management in Diabetes Mellitus) study evaluated efficacy and safety of lorcaserin for weight loss in patients with type 2 diabetes. Secondary objectives included evaluations of glycemic control, lipids, blood pressure, and quality of life. This 1-year, randomized, placebo-controlled trial enrolled 604 patients 1:1:1 to placebo, lorcaserin 10 mg once daily (QD) or lorcaserin 10 mg twice daily (BID). Patients were treated with metformin, a sulfonylurea (SFU) or both; had glycated hemoglobin (HbA(1c)) 7-10%; were 18-65 years old; and had BMI 27-45 kg/m(2). Patients received diet and exercise counseling. Safety monitoring included serial echocardiograms. Mean (± SD) age was 52.7 ± 8.7; 54.2% were women; 60.5% were white, 20.9% were African American, and 13.8% were Hispanic. Mean (± SD) weight was 103.6 ± 17.8 kg; BMI was 36.0 ± 4.5 kg/m(2). Most patients (91.7%) took metformin; 50.2% took a SFU. More patients lost ≥5% body weight with lorcaserin BID (37.5%; P < 0.001) or lorcaserin QD (44.7%; P < 0.001) vs. placebo (16.1%; modified intent to treat (MITT)/last observation carried forward (LOCF)). Least square mean (± SEM) weight change was -4.5 ± 0.35% with lorcaserin BID and -5.0 ± 0.5% with lorcaserin QD vs. -1.5 ± 0.36% with placebo (P < 0.001 for each). HbA(1c) decreased 0.9 ± 0.06 with lorcaserin BID, 1.0 ± 0.09 with lorcaserin QD, and 0.4 ± 0.06 with placebo (P < 0.001 for each); fasting glucose decreased 27.4 ± 2.5 mg/dl, -28.4 ± 3.8 mg/dl, and 11.9 ± 2.5 mg/dl, respectively (P < 0.001 for each). Symptomatic hypoglycemia occurred in 7.4% of patients on lorcaserin BID, 10.5% on lorcaserin QD, and 6.3% on placebo. Common adverse events were headache, back pain, nasopharyngitis, and nausea. Lorcaserin was associated with significant weight loss and improvement in glycemic control in patients with type 2 diabetes.

Food cravings have been understudied in bariatric surgery patients and the Food Craving Questionnaire-Trait has not been validated in this population. Reliability and validity of the FCQ-T were examined and a regression analysis was run to determine whether or not preoperative scores on individual subscales of the instrument could predict weight loss at 6 months. The FCQ-T demonstrated excellent internal consistency in bariatric surgery-seeking patients, and individual subscales measuring emotion and mood were correlated with other measures of depression and anxiety. Endorsement of binge eating or emotional eating behaviors during a clinical interview was correlated with similar subscales on the FCQ-T. Higher scores on the subscale 'cues that may trigger food cravings' were associated with greater weight loss at 6 months post-surgery and higher scores on the subscale 'guilt from cravings and/or giving into them' was associated with less weight loss. Management of external cues may predict successful outcomes while emotional impact of cravings may indicate the need for further intervention to help manage specific food craving traits.

This study examined whether a single session of repetitive transcranial magnetic stimulation (rTMS) of the left prefrontal cortex would inhibit food cravings in healthy women who endorsed frequent food cravings. Ten participants viewed images of food and completed ratings for food cravings before and after receiving either real or sham rTMS over the left prefrontal cortex (10Hz, 100% rMT, 10 seconds-on, 20 seconds-off for 15 minutes; 3000 pulses). Sham TMS was matched with real TMS with respect to perceived painfulness of the stimulation. Each participant received both real and sham rTMS in random order and were blind to the condition in a within-subject cross-over design. With an improved sham control condition, prefrontal rTMS inhibited food cravings no better than sham rTMS. The mild pain from the real and sham rTMS may distract or inhibit food craving, and the decreased craving may not be caused by the effect of rTMS itself. Further studies are needed to elucidate whether rTMS has any true effects on food craving and whether painful stimuli inhibit food or other cravings. A sham condition which matches the painfulness is important to understand the true effects of TMS on behaviors and diseases.

This study examined whether a 20-min session of prefrontal transcranial direct current stimulation (tDCS) (anode over the right prefrontal cortex and cathode over the left prefrontal cortex) would reduce food cravings and increase the self-reported ability to resist foods in 19 healthy individuals who reported frequent food cravings. Participants viewed computerized images of food and used computerized visual analogue scales to rate food cravings and inability to resist foods before, during, and after receiving either real or sham tDCS. This study employed a randomized within-subject crossover design; participants received both real and sham tDCS and were blind to the condition. Food cravings ratings were reduced in both conditions, however, the percent change in cravings ratings from pre- to post-stimulation was significantly greater for real stimulation than for sham. The percent change in inability to resist food from pre- to post-stimulation also showed a greater decrease in the real condition than for sham. Post hoc analyses suggest that active prefrontal tDCS acutely and significantly decreased food cravings ratings for sweet foods and carbohydrates more so than sham tDCS. No significant differences were seen in the amount of food ingested between real and sham tDCS. These findings in healthy subjects indicate that tDCS is able to temporarily reduce food cravings and improve the self-reported ability to resist foods.

Normal-weight bulimic patients have disturbed appetite, mood, and neuroendocrine function and often respond to antidepressants. Since these findings suggest abnormalities in brain monoaminergic pathways, the authors measured CSF monoamine concentrations in 27 normal-weight bulimic patients and 14 volunteers. Bulimic patients had a significantly lower mean CSF norepinephrine concentration. Levels of CSF 5-HIAA, the major serotonin metabolite, and CSF HVA, the major dopamine metabolite, were normal, although more frequent binge-eating in bulimic subjects was associated with a significantly lower CSF HVA level. Whether trait- or state-related, monoaminergic disturbances are part of this disorder's neurobiological syndrome. The lower CSF norepinephrine concentration suggests bulimia is not simply a variant of affective disorders.

We address the assertion that weighing obese patients in weight loss programs can be a source of distress and can lead to unfavorable outcomes. Examination of the relevant literature suggests that there is no evidence that weighing by weight loss participants is a cause of negative mood or of body dissatisfaction. Further, there is little evidence that negative mood states or body dissatisfaction lead to a poor outcome in weight loss programs. To the contrary, a number of studies consistently show that more frequent weighing is associated with better weight loss and maintenance. We offer suggestions for dealing with this issue in clinical practice.

The Eating Behavior Inventory (EBI) is a questionnaire designed to assess behaviours associated with weight loss and weight management. In the 25 years since it was first published, the EBI has been used to examine weight management behaviours of adults and children in more than 20 weight loss investigations. This paper systematically reviews the use of the EBI in these studies. Results indicate that baseline EBI scores have remained quite consistent over time and are generally not influenced by patient variables. The EBI has also been shown to be consistently sensitive to behavioural weight management interventions, but it appears that the amount of change in EBI scores has decreased slightly over time. Finally, the amount of change in EBI score with treatment typically correlates positively with the amount of weight subjects lose. Overall, the research that has used the EBI has provided solid and consistent evidence of the utility of the EBI as a valid tool for assessing weight management behaviours.

The purpose of the study was to examine differences in current, former, and never smokers' weight loss in three comprehensive weight loss programs. Archival data from 389 overweight participants enrolled in three comprehensive weight loss programs were analyzed. The programs differed in length and by type of diet (food-based low calorie diet, partial meal replacement low calorie diet, and supplement-based very low calorie diet). Significant differences in weight loss were found among former, current, and never smokers in one weight loss program (partial meal replacement low calorie diet). Post hoc analyses showed that former smokers lost significantly more weight than current smokers. Results suggest that current smokers are not more successful at behavioral weight loss than former smokers, and if anything, are less successful. Former smokers do not appear to have difficulty losing weight compared to current and never smokers.

This chapter describes the qualifications and functions of each of the members of a multidisciplinary team, suggests ways to organize the functioning of such a team, and discusses ways to capture many of the strengths of the multidisciplinary team in settings where such an on-site team is not feasible (Table 1). Examples of specific situations are provided to demonstrate how the complexities of obesity therapy can require a broad range of expertise. A treatment team comprising representatives of different disciplines can provide such a scope of knowledge and skills.

Objective: Research investigating obesity-related quality of life (QOL) has shown that at increasing levels of overweight, individuals report more impaired QOL. Further, some research has indicated that white women suffer more impairment than men and African Americans. The current study sought to expand the existing literature by investigating an extreme subsample of the obese population. It was expected that participants in the current study would report more impaired obesity-related QOL than in previous research conducted with less obese individuals. It was also hypothesized that race and gender groups would differ in obesity-related QOL and that the relationship between degree of overweight and QOL would not be consistent across race and gender groups. Research Methods and Procedures: Impact of Weight on Quality of Life Questionnaire-Lite Version data were collected from 512 individuals seeking gastric bypass surgery (mean BMI = 53.3) Results: Results confirmed the study hypotheses. In general, white women reported the most QOL impairment, despite having significantly lower BMI than other race/gender groups. Compared with previous studies, the observed relationships between BMI and QOL were somewhat attenuated. Discussion: Various domains of QOL may be differentially affected by degree of obesity; these relationships are not homogeneous throughout the obese population.

BACKGROUND: Night eating syndrome (NES) is characterized by a lack of appetite in the morning, consumption of 50% or more of daily food intake after 6:00 p.m., and difficulty falling and/or staying asleep. It has been associated with stress and with poor results at attempts to lose weight. OBJECTIVE: The purpose of this study was to determine whether a relaxation intervention (Abbreviated Progressive Muscle Relaxation Therapy, APRT) that has been shown to significantly reduce stress levels in normal, healthy adults would also benefit an NES sample. RESEARCH METHODS AND PROCEDURES: A total of 20 adults with NES were randomly assigned to either a relaxation training (APRT) or a Control (quietly sitting for the same amount of time) group, and all subjects attended two laboratory sessions 1 week apart. Pre- and postsession indices of stress, anxiety, relaxation, and salivary cortisol were obtained, as well as Day 1 and Day 8 indices of mood. Food diaries and hunger ratings were also obtained. RESULTS: The results indicated that 20 min of a muscle relaxation exercise significantly reduced stress, anxiety, and salivary cortisol immediately postsession. After practicing these exercises daily for a week, subjects exhibited lowered stress, anxiety, fatigue, anger, and depression on Day 8. APRT was also associated with significantly higher a.m. and lower p.m. ratings of hunger, and a trend of both more breakfast and less night-time eating. DISCUSSION: These data support the role of stress and anxiety in NES and suggest that practicing relaxation may be an important component of treatment for this condition.

The present study attempted to predict weight loss in, and completion of, low-calorie diet (LCD, n=167) and very low-calorie diet (VLCD, n=96) weight loss programs. Program completion and weight loss were examined in association with three groups of variables: demographic (e.g., age), medical/physical (e.g., body mass index [BMI]), and motivational/behavioral (e.g., exercise, ratings for motivation and commitment for the program). In the LCD group, age was positively associated with program completion, and commitment to the program was negatively associated with both program completion and weight loss. In the VLCD group, no variables predicted program completion, and only male gender predicted weight loss. Our results offer little to contradict previous findings that preexisting participant characteristics are of limited utility in predicting weight loss treatment outcome. In the LCD group, the negative associations of commitment with program completion and weight loss were surprising. If replicated, they might suggest the need to clarify patients' expectations about the level of commitment required for successful treatment.

OBJECTIVE: To examine the perceived relative worth of reaching and maintaining a self-selected goal weight, for obese and non-obese individuals. DESIGN: Cross-sectional study. SUBJECTS: Twenty-five obese treatment-seekers (age 41.0 y, BMI 42.5) and a community sample of 31 obese (age 40.8 y, BMI 32.2) and 64 non-obese participants (age 32.4 y, BMI 23.4). MEASUREMENT: An 18-item forced-choice questionnaire evaluating what participants would hypothetically sacrifice to reach and maintain their goal weight. RESULTS: Most obese treatment-seekers would hypothetically endure much to achieve their desired weight. For example, 88% or more would forego a job promotion, retiring with full-pay, eliminating the national debt, or winning their dream house or car or an all-expense-paid vacation, and smaller majorities would suffer loss of half their income or a job demotion. Many non-treatment-seeking obese would forfeit future rewards to reach goal weight, but fewer would incur negative events. About a third of non-obese participants would forgo certain positive events, but few would suffer an adverse event to achieve goal weight. Within the combined obese sample, females viewed attaining goal weight as more important than did males, but there were no significant racial differences. An index of overall worth of weight goal was related positively to current weight and BMI and negatively to goal weight as percentage of current weight (P

It is commonly asserted that the average American gains 5 lb (2.3 kg) or more over the holiday period between Thanksgiving and New Year's Day, yet few data support this statement.To estimate actual holiday-related weight variation, we measured body weight in a convenience sample of 195 adults. The subjects were weighed four times at intervals of six to eight weeks, so that weight change was determined for three periods: preholiday (from late September or early October to mid-November), holiday (from mid-November to early or mid-January), and postholiday (from early or mid-January to late February or early March). A final measurement of body weight was obtained in 165 subjects the following September or October. Data on other vital signs and self-reported health measures were obtained from the patients in order to mask the main outcome of interest.The mean (+/-SD) weight increased significantly during the holiday period (gain, 0.37+/-1.52 kg; P0.001), but not during the preholiday period (gain, 0.18+/-1.49 kg; P=0.09) or the postholiday period (loss, 0.07+/-1.14 kg; P=0.36). As compared with their weight in late September or early October, the study subjects had an average net weight gain of 0.48+/-2.22 kg in late February or March (P=0.003). Between February or March and the next September or early October, there was no significant additional change in weight (gain, 0.21 kg+/-2.3 kg; P=0.13) for the 165 participants who returned for follow-up.The average holiday weight gain is less than commonly asserted. Since this gain is not reversed during the spring or summer months, the net 0.48-kg weight gain in the fall and winter probably contributes to the increase in body weight that frequently occurs during adulthood.

Objective: To examine the association of body mass index to all-cause and cardiovascular disease (CVD) mortality in white and African American women. Research methods and procedures: Women who were members of the American Cancer Society Prevention Study I were examined in 1959 to 1960 and then followed 12 years for vital status. Data for this analysis were from 8,142 black and 100,000 white women. Body mass index (BMI) was calculated from reported height and weight. Associations were examined using Cox proportional hazards modeling with some analyses stratified by smoking (current or never) and educational status (less than complete high school or high school graduate). Results: There was a significant interaction between ethnicity and BMI for both all-cause (p

Body fat distribution is a reliable predictor of the health risks of obesity. Abdominal obesity (AO) has been associated with various health complications whereas gluteal-femoral obesity (GFO) appears to be less hazardous. Body size overestimation, a type of body image disturbance, is found in a subset of obese persons. OBJECTIVE: The current study examined body size estimation accuracy as a function of body fat distribution. DESIGN: Cross-sectional, retrospective review of clinical records. SUBJECTS: 101 obese women (Mean age=39.4) joining a weight loss program. MEASUREMENTS: Subjects provided body size estimates using a live video distortion procedure and were grouped into tertiles (AO; Mixed type obesity (MTO); GFO) on the basis of their waist-to-hip ratios. RESULTS: GFO women had significantly lower body size estimates and felt thinner than did AO or MTO women. In addition, more AO women (20.6% vs GFO: 8.8%) overestimated their body size by more than 15% whereas more GFO women (29.4% vs AO: 5.9%) underestimated their body size by more than 15%. CONCLUSION: Body fat distribution appears to be a mediator in body size estimation accuracy. These findings are discussed in terms of possible differences in perceptual and societal experiences among the groups.

This paper selectively reviews available evidence concerning psychological characteristics associated with obesity, psychological changes accompanying very-low-calorie diets (VLCDs), and the influence of certain psychological factors on response to VLCD treatment. The obese population as a whole does not show an elevated incidence of psychopathology. Treatment-seeking obese do show more psychiatric disturbance, at a level comparable to other medical/surgical patients. There appear to be no global personality traits or profiles that are associated with obesity. However, obese people differ from non-obese groups on psychological and behavioral variables related to weight and eating and more frequently display perceptual and emotional body image anomalies. Binge eating appears rather common among obese groups. VLCDs have generally neutral to positive effects on hunger, depression, and anxiety. New data on body image suggest that VLCDs are associated with post-treatment underestimation of body size. Finally, recent data on possible psychological and behavioral correlates of VLCDs outcome are presented.

Third year medical students on core psychiatry clinical rotations received expanded alcoholism training via inclusion of a programmed text on alcoholism, the Alcohol Learning Program (ALP), as required reading. Effects of use of the ALP on alcoholism-related knowledge and attitudes were assessed within a pretest-posttest control group design. Students on alternate rotations received the ALP and constituted the experimental group (n = 60). The control group (n = 66) comprised students on the remaining rotations who received the less extensive alcoholism exposure usually provided. Assessment instruments, completed on the first and last days of rotations, included two alcoholism knowledge tests and a semantic differential completed under six sets of instructions to assess attitudes toward groups differing in use and/or abuse of beverage alcohol. Students receiving the ALP displayed a significantly higher level of knowledge than did controls. Although attitude change associated with use of the ALP was minimal, attitudes toward the different categories of persons rated varied considerably; for example, students viewed alcoholics least favorably and recovered alcoholics most favorably. Discussion focuses on potential advantages of programmed self-instructional training about alcoholism and on implications of attitude findings for design of alcoholism educational efforts for medical students.

Results of three studies are presented which explore the relation of experienced control to participation in treatment for obesity. Subjects in all studies were adult females participating in an outpatient, behaviorally-oriented obesity program. Experienced control was measured using the Experienced Control Scale (Tiffany, 1967). Study 1 was a naturally occurring experiment which compared two groups ( ns = 7 and 8) that differed in extent of self-directed efforts to begin treatment. Study 2 compared 32 persons who completed the program and 18 persons who did not complete it. High levels of experienced control over internal forces were associated with increased efforts to initiate treatment and with completion of treatment. Study 3 assessed the temporal stability of the Experienced Control Scale with obese females tested at the beginning and end of the 12-wk. treatment program. Test-retest reliability coefficients were .64 ( p < .01) for the internal control subscale and .29 ( P < .10) for the external control subscale.

Male alcoholic veterans (N=194) were divided into four groups on the basis of their scores on the MacAndrew scale (MAC) of the Minnesota Multiphasic Personality Inventory (MMPI) and compared on psychological and sociodemographic measures and self-reported alcohol, drug, and legal histories. Nineteen subjects scored in the “nonalcoholic” (NA) range of the MAC (i.e., false negatives, MAC≤23). Remaining subjects, scoring in the “alcoholic” range of the MAC, were divided into thirds by MAC scores (lowest third, L-MAC=24–28,n=53; middle third, M-MAC=29–31,n=63; highest third, H-MAC>31,n=59). Groups did not differ on age, any important sociodemographic variables, or scores on the Profile of Mood States, State-Trait Anxiety Inventory, Symptom Checklist-90, or Rod and Frame Test. Significant group differences were obtained on several MMPI scales. Lower MAC scores were associated with higher scores onL, K, D, andR, and lower scores onMa. There was also a tendency for subjects with lower MAC scores to score higher onSi. NA subjects began drinking and heavy drinking later than other subjects, although groups did not differ on duration, quantity, or frequency of drinking. Subjects with higher MAC scores more often reported drinking in bars, drinking liquor straight, alcohol-related job disruptions, and previous use of marijuana, hallucinogens, and barbiturates. Subjects with higher MAC scores had more often been arrested, convicted, fined, and jailed for alcohol-related offenses but not for other offenses. Results are examined with respect to MacAndrew's distinction between primary and secondary alcoholics and with respect to the possible relations of MAC to important person variables such as sensation seeking.