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The 26-item Eating Attitudes Test (EAT-26) is used to identify eating disturbances in non-clinical populations. The present study examined the construct validity of a screening version of EAT-26. The EAT-26 was administered to 2104 college students and their data were factor analyzed. The initial Alpha solution was rotated with orthogonal and oblique solutions. The analysis produced 5 factors that accounted for 57.4% of the total variance. The first principle component accounted for 61.3% of the total factor variance. The other 4 factors accounted for the remaining 38.7%. The factor 1 items with orthogonal loadings > 0.6 were retained resulting in a 10-item EAT (EAT-10). The Chronbach alpha reliability estimates of EAT-26 and EAT-10 were 0.897 and 0.952. The correlation between EAT-10 and EAT-26 was 0.92. The EAT-10 was directly correlated with age (i=0.14), BMI (r=0.19), percent body fat (r=0.19), and inversely correlated with VO 2max (r=−0.16). The EAT-10 was re-administered to a new sample of college students (n = 1776). These data, combined with the data from the original sample, were used to establish population norms (n = 3880). These data show the EAT-10 is a highly internal consistent measure of the principal EAT construct and has promise of being a valid eating disorder screening test. Additional calibration research is underway to develop probability models for estimating the risk of the presence of eating disorders in a non-clinical population.

Objective. —To provide an overview of the published scientific information on the safety and efficacy of very low-calorie diets (VLCDs) and to provide rational recommendations for their use. Data Sources and Extraction. —Original reports obtained through a MEDLINE search for 1966 through 1992 on VLCDs or reducing diets plus obesity, supplemented by a manual search of bibliographies and the opinions of experts in the field of nutrition and weight loss therapy for obesity. Only studies of humans were cited. Data Synthesis. —Current VLCDs are usually provided in the context of comprehensive treatment programs, during which usual food intake is completely replaced by specific foods or liquid formulas containing 3350 kJ/d (800 kcal/d) or less. Weight loss on VLCDs averages 1.5 to 2.5 kg/wk; total loss after 12 to 16 weeks averages 20 kg. These results are superior to standard low-calorie diets of 5020 kJ/d (1200 kcal/d), which lead to weight losses of 0.4 to 0.5 kg/wk and an average total loss of only 6 to 8 kg. There is little evidence that intakes of less than 3350 kJ/d (800 kcal/d) result in better weight losses than 3350 kJ. Intake of at least 1 g/kg of ideal body weight per day of protein of high biologic value appears to be important in helping to preserve lean body mass. Serious complications of modern VLCDs are unusual, cholelithiasis being most common. Conclusions. —Current VLCDs are generally safe when used under proper medical supervision in moderately and severely obese patients (body mass index [weight in kilograms divided by height in meters squared] >30) and are usually effective in promoting significant short-term weight loss, with concomitant improvement in obesity-related conditions. Long-term maintenance of weight lost with VLCDs is not very satisfactory and is no better than with other forms of obesity treatment. Incorporation of behavioral therapy and physical activity in VLCD treatment programs seems to improve maintenance. ( JAMA . 1993;270:967-974)

The majority of patients treated for obesity regain lost weight after treatment. We speculate on what might be done to improve long-term success rates by examining the factors associated with success or relapse. An emphasis on exercise and prescribing more gradual changes in diet and exercise appears to be associated with better outcomes. There may be a need to conceptualize obesity as a food dependency disorder not amenable to self-control strategies. External social control through peer support groups may be indicated to help patients through temptations.

We investigated the effect of diet on high-density-lipoprotein (HDL) cholesterol in 59 healthy middle-aged marathon runners, 85 joggers, and 74 inactive men. Marathon runners and joggers reported eating less red meat (P less than 0.0001), bacon (P less than 0.05), and sausage (P less than 0.01) than did the inactive men, although meat consumption was not significantly correlated with HDL. Results suggest that HDL differences (marathon runners, 65 mg per deciliter; joggers, 58 mg per deciliter; inactive men, 43 mg per deciliter) among the three groups were primarily the result of distance run, not dietary factors. Distance run was also the best predictor of the HDL:total cholesterol ratio and of total cholesterol (a negative correlation), and it was second only to weight in predicting triglyceride levels.

To assess the effects of refundable monetary deposits upon attrition in obesity studies, three groups, each comprised of 14 overweight females, received treatment involving both a written weight reduction manual and covert sensitization under conditions involving a $20.00 deposit, a $5.00 deposit and no deposit. Contrary to the suggestion that a monetary deposit (especially a small deposit) might serve to increase attrition by reducing a subject's guilt over a broken commitment to attend, it was found that the requirement of a deposit significantly reduced attrition. In addition, subjects rated the written manual as significantly more useful and more helpful than the covert sensitization treatment.

The effect that age and length of stay in a mental hospital have on the projected economic benefits of securing patients' release was investigated. Securing the early release of younger patients and of patients who have been hospitalized for long periods produces the greater economic benefits. The estimated benefits of patient release by age length of hospitalization are presented.

Abstinence from alcohol consumption for 3 weeks was followed by 3 weeks of wine intake in 18 inactive and 18 physically active premenopausal women (runners). The runners weighed less and had higher plasma high-density lipoprotein (HDL) cholesterol and lower low-density lipoprotein cholesterol levels than the inactive women. There were no differences between groups in plasma total cholesterol, triglyceride and apolipoprotein A-I concentrations. Runners had higher plasma HDL 2 cholesterol concentrations than inactive women (34 ± 17 vs 19 ± 12 mg/dl), but HDL 3 cholesterol concentration did not differ between the groups (41 ± 10 vs 39 ± 9 mg/dl). Addition of 35 g/day of ethanol for 3 weeks did not result in a significant change in either group for any of the variables measured. The amount of exercise appears to be a more important determinant of plasma lipoproteins and apolipoprotein A-I than alcohol intake in premenopausal women.

A benefit-cost analysis of a token economy program with adult psychiatric patients examined the hospital costs foregone by getting and keeping patients out of the hospital, minus the extra costs to the public incurred by the patients once they had been released. Behavior modification techniques work; they change the behaviors of patients and clients in an efficient and effective manner. This fact has been amply demonstrated in hundreds of token economy programs in mental hospitals, institutions for the retarded, day care centers, prisons, and other residential settings (Kazdin & Bootzin, 1972). However, token economy programs have not yet been subjected to benefit-cost analyses. This is a much needed step in the evaluation of these programs because token economies involve more than just custodial type costs. Part of the cost of token economy programs is treatment cost, and it is important to know to what extent this treatment is "worth it" in the economic sense. With public funding

Fifty one letters from formerly long-term severely dependent cigarette smokers were analyzed for factors and procedures they thought to have been effective for termination of smoking. All respondents had stopped smoking without professional help. Most respondents used multiple techniques, but there was no systematic clustering of these methods.

The purpose of this study was to examine the community adjustment of token economy graduates and to compare their adjustment to that of a comparable group of patients released from other programs in the hospital. Community adjustment questionnaires were sent to the 98 graduates of the first 25 months of the token program and to a comparable group released from other parts of the hospital over the same time period. Recidivism over the 25- month period was significantly lower for the released token economy patients. Questionnaire data indicated that the released token economy patients were doing as well as, and possibly better than the released control patients in terms of community adjustment outside the hospital.

Results of a large behavioral weight control program suggest that patients lose modest amounts of weight during treatment and maintain these losses for at least 1 year. One hundred forty-three males lost an average of 6.77 kg during treatment and 7.63 kg at 1-year follow-up; 447 females lost an average of 4.27 kg and 5.24 kg during treatment and follow-up, respectively. By follow-up, 4.7% of these patients had achieved their goal weight. Behavior modification, as it is presently taught, is effective for many mildly to moderately obese patients. It is less effective with heavier patients. Research is needed to develop procedures for helping patients achieve goal body weights.

College women volunteers for a weight reduction program were assigned to one of three treatment conditions. Twelve subjects received olfactory aversion therapy, while another group of 12 received attention-placebo treatment. A third group of 14 served as waiting-list controls. Weight losses over time were statistically significant, but there were no differences among groups. The losses were clinically trivial, and both aversion therapy and placebo treatments were considered to be ineffective in the treatment of obesity. The aversion therapy and attention-placebo groups both downrated the palatability of favorite (target) foods, found the experiment to be helpful and sensible, and claimed reduced food intake. These subjective reports were discussed in terms of demand characteristics and suggestion effects.

In this study, costs were compared for moderate- and low-cost menus recommended by the USDA and for modified menus designed to lower serum cholesterol.

This study describes an aversive conditioning experiment in which favorite foods (CS) were paired with noxious odors (UCS) to help overweight Ss achieve and maintain a weight loss. After the nine-week conditioning period, a. significant (obtained p = 0.002, significant at p

Everyone should know his or her cholesterol level. The means are now available for lowering cholesterol in the general population. Such efforts should be coupled with identification of moderate- and high-risk individuals for whom special efforts should be made in cholesterol lowering. The dietary approach outlined by the American Heart Association, which is clearly described in The Living Heart Diet (6), provides the best overall strategy for reducing cholesterol and for battling the epidemic of cardiovascular deaths that represents the No. 1 health problem in our society.

A weight loss program for severely retarded adults based on behavioral controls consisted of: (1) a manual for parents of parents of retardates, (2) colored tokens to represent food groups, (3) monetary payments for weight lost, and (4) daily weighings. Despite very limited intellectual capacities, subjects were able to develop new eating behaviors resulting in weight losses that were maintained at follow-up.

A twelve-month pilot project was conducted to test public reaction to a special restaurant menu identifying food choices low in cholesterol and saturated fat. The Houston steak house in which the "Help Your Heart" menu was tested prepared foods according to guidelines from dietitians of the Diet Modification Clinic, Baylor College of Medicine. Two newspaper articles, a brief magazine feature, and regularly scheduled radio advertising spots publicized the special menu. At the end of each month of the test period, the number of orders from the special menu was tallied for fourteen randomly selected days. Monthly sales from the special menu ranged from 2.5 to 5.1 per cent, with an overall average of 3.4 per cent. There was no statistically significant change from the mean of the percentage of total sales from the special menu over the months. Despite the relatively low percentage of total sales, restaurant executives were pleased with the results of the study and planned to offer the low-cholesterol menu indefinitely, eventually in an expanded form.

In an attempt to demonstrate whether individuals with average plasma lipids would accept a diet low in saturated fat and cholesterol, members of a community organization were taught the HELP Your Heart Eating Plan. Results of 282 individuals suggest that reduced dietary cholesterol from selected foods could be sustained for up to 36 months. While both plasma cholesterol and triglycerides fell during a year of instruction, both rose to above initial values by 36 months. Overall, the results suggest that adults may be willing to accept a new style of eating temporarily but are not committed to making permanent dietary changes.

Recent reports indicate that weight cycling (repeated periods of weight gain and loss) cause an organism to become an energy conserver, meaning that the organism gains weight more quickly and loses weight more slowly during subsequent weight cycles. The effects of weight cycling on rates of weight gain and loss, caloric efficiency, and ad lib wheel running were investigated with three groups of adult female rats: 1) cycling (cycled twice); 2) maturity control (cycled once); and 3) chow control (not cycled). The cycled group evidenced weight-gain periods of 36 and 21 days, respectively, and showed a significant increase in food effeciency during the second weight-gain period, relative to the first. There was no evidence that maturation was responsible for this phenomenon. Time required to lose weight and ad lib wheel running were not influenced by weight cycling. These findings suggest that weight cycling may make maintenance of normal weight more difficult and have implications for human weight-control programs.

A behavioral treatment utilizing avoidance conditioning with an obese patient is described. Favorite foods (CS) were paired with a highly noxious odor (UCS) in the conditioning paradigm and a weight loss of 30 lb. over 22 wk. was reported. Problems of control over environment and habituation to the UCS are discussed.

Objective This prospective study examined whether stable personality traits, as measured by the Karolinska Scales of Personality (KSP), predicted initial weight loss or long-term maintenance in obesity patients. Method The KSP was administered to 102 obese patients prior to entering an 8-week weight loss program. Patients were weighed again at the end of treatment and at 3- and 12-month follow-up. Results The KSP did not predict initial weight loss after the 8-week program. Several of the KSP scales (Muscle Tension, Monotony Avoidance, Suspicion, and Guilt) had weak associations with 12-month relapse status. Weight gain at the 3-month follow-up was the strongest predictor of 12-month relapse status (O.R. = 0.46; 95% C.I. = 0.32, 0.66). Discussion Personality traits, as measured by the KSP, do not appear to be important predictors of initial weight loss or 12-month relapse status. Personality assessment may not substantially contribute to predicting treatment outcome in obesity research. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 25: 301–309, 1999.

This paper compares the efficacy of two widely used weight-loss diets differing in macronutrient composition - a low-carbohydrate diet versus a low-fat diet. Although "a calorie is a calorie" under the controlled conditions of a metabolic unit (i.e., only the level of calorie intake matters and not the source of calories), we conclude that these interrelationships are far more complex in the free-living situation. The different diet-related factors that condition energy balance, including total energy intake, satiety and hunger sensory triggers, and palatability, must be considered when assessing the efficacy of weight-reducing diets of different macronutrient composition.

A study assessed the effect of exercise in a very-low-calorie diet (VLCD) program in combination with behavioral techniques, nutrition education, and group therapy. The results suggested that excerise may have had a beneficial role beyond its assumed purpose. Two-year follow-up results indicated that exercisers had less weight regain than non-exercisers

Bistrian 1 has called attention to the continuing increase in degree of obesity in the United States for more than 100 years. Obesity is known to exacerbate risk factor abnormalities for cardiovascular disease, namely, hypertension, diabetes, and hyperlipidemia. Obesity per se becomes a risk factor for increased mortality at body weights greater than 130% of ideal. 2 Brownell and Stunkard 3 have recently observed a favorable effect of weight reduction on plasma lipoprotein levels in obese subjects. Over the last decade, there has been a proliferation of commercial weight-reduction clinics to serve this expanding market. These clinics have brought the promise of relatively inexpensive treatment for the masses; 1 million people in the United States participate in group weightloss programs each week. 4 However, physicians 5 and behavioral scientists 6,7 have failed to develop a treatment regimen that is effective and long-lasting for the majority of those treated. Since one