Weight control practices in adults: results of a multistate telephone survey

Association between the use of weight management strategies and weight change among Australian adults over 12 months: an observational study

BACKGROUND

Obesity is a growing, global public health issue. This study aimed to describe the weight management strategies used by a sample of Australian adults; examine the socio-demographic characteristics of using each strategy; and examine whether use of each strategy was associated with 12-month weight change.

METHODS

This observational study involved a community-based sample of 375 healthy adults (mean age: 40.1 ± 5.8 years, 56.8% female). Participants wore a Fitbit activity monitor, weighed themselves daily, and completed eight online surveys on socio-demographic characteristics. Participants also recalled their use of weight management strategies over the past month, at 8 timepoints during the 12-month study period.

RESULTS

Most participants (81%) reported using at least one weight management strategy, with exercise/physical activity being the most common strategy at each timepoint (40-54%). Those who accepted their current bodyweight were less likely to use at least one weight management strategy (Odds ratio = 0.38, 95% CI = 0.22-0.64, p < 0.01) and those who reported being physically active for weight maintenance had a greater reduction in bodyweight, than those who did not (between group difference: -1.2 kg, p < 0.01). The use of supplements and fasting were associated with poorer mental health and quality of life outcomes (p < 0.01).

CONCLUSIONS

The use of weight management strategies appears to be common. Being physically active was associated with greater weight loss. Individuals who accepted their current body weight were less likely to use weight management strategies. Fasting and the use of supplements were associated with poorer mental health. Promoting physical activity as a weight management strategy appears important, particularly considering its multiple health benefits.

Annual rhythms in adults' lifestyle and health (ARIA): protocol for a 12-month longitudinal study examining temporal patterns in weight, activity, diet, and wellbeing in Australian adults

BACKGROUND

Almost one in three Australian adults are now obese, and the rate continues to rise. The causes of obesity are multifaceted and include environmental, cultural and lifestyle factors. Emerging evidence suggests there may be temporal patterns in weight gain related, for example, to season and major festivals such as Christmas, potentially due to changes in diet, daily activity patterns or both. The aim of this study is to track the annual rhythm in body weight, 24 h activity patterns, dietary patterns, and wellbeing in a cohort of Australian adults. In addition, through data linkage with a concurrent children's cohort study, we aim to examine whether changes in children's body mass index, activity and diet are related to those of their parents.

METHODS

A community-based sample of 375 parents aged 18 to 65 years old, residing in or near Adelaide, Australia, and who have access to a Bluetooth-enabled mobile device or a computer and home internet, will be recruited. Across a full year, daily activities (minutes of moderate to vigorous physical activity, light physical activity, sedentary behaviour and sleep) will be measured using wrist-worn accelerometry (Fitbit Charge 3). Body weight will be measured daily using Fitbit wifi scales. Self-reported dietary intake (Dietary Questionnaire for Epidemiological Studies V3.2), and psychological wellbeing (WHOQOL-BREF and DASS-21) will be assessed eight times throughout the 12-month period. Annual patterns in weight will be examined using Lowess curves. Associations between changes in weight and changes in activity and diet compositions will be examined using repeated measures multi-level models. The associations between parent's and children's weight, activity and diet will be investigated using multi-level models.

DISCUSSION

Temporal factors, such as day type (weekday or weekend day), cultural celebrations and season, may play a key role in weight gain. The aim is to identify critical opportunities for intervention to assist the prevention of weight gain. Family-based interventions may be an important intervention strategy.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry, identifier ACTRN12619001430123 . Prospectively registered on 16 October 2019.

Increased risk of diabetes development in individuals with weight cycling over 4 years: The Kangbuk Samsung Health study

AIMS

Weight cycling is defined as cyclical loss and gain of weight and recent studies suggest deleterious effects of weight cycling on cardiometabolic health. We aimed to analyze the risk for diabetes development in association with weight cycling over 4 years of follow-up.

METHODS

A retrospective study performed in 4,818 non-diabetic participants (mean age 43 years, 78.3% men) in a health screening program in whom serial health examinations were performed in 5 consecutive years from 2010 to 2014. Average successive variability of weight (ASVW) was defined by the amount of body weight change in absolute value between the successive years over 5 years summed and divided by four. The subjects were divided into two groups according to body mass index (BMI), normal weight (<23 kg/m²) and overweight (≥23 kg/m²).

RESULTS

Over 4 years, 3.2% developed diabetes. When the subjects were divided into 3 groups according to tertile groups of ASVW, those in the highest tertile showed significantly increased risk for diabetes development compared to those with the lowest tertile {odds ratio (OR) 1.860; 95% CI 1.130-3.063}. When similar analyses were performed according to the 4 groups divided by baseline body weight and ASVW over four years, those who were more than overweight at baseline with high ASVW showed significantly increased risk of diabetes development compared to those had normal weight and low ASVW (OR 2.266; 95% 1.123-4.572). When the subjects were divided into six group according to weight change and ASVW, those with increased weight over 4 years and high ASVW showed the highest risk for diabetes development among the groups compared to those with stable weight and low ASVW over four years (OR 3.660; 95% CI 1.402-9.553).

CONCLUSIONS

Those with high ASVW showed significantly increased risk for diabetes development over four years compared with those who had low ASVW. Weight cycling was significantly associated with increased risk for diabetes.

Weight Cycling and Its Cardiometabolic Impact

Dieting has multiple meanings including "intentional weight loss" or "a specific eating pattern." Although obesity is considered a deleterious health problem worldwide, there are many problems caused by "too strict" weight control and the need for excessive leanness. Many people with normal weight want to lose weight, and they repeat losing and gaining weight multiple times through their lives. This is called "weight cycling." Recent studies report not just the negative impact of being obese, but also the danger of weight cycling for cardiometabolic health. Many experimental studies support that weight cycling might cause fluctuations in cardiovascular risk factors, such as blood pressure, heart rate, sympathetic activity, and circulating levels of glucose, lipids and insulin. These repeated overshoots above normal values during periods of weight regain put an additional stress on the cardiovascular system. This paper reviews current evidence for the effects of weight cycling on cardiometabolic health.

Identification of factors contributing to successful self-directed weight loss: a qualitative study

BACKGROUND

Despite the number of weight management programmes and their wide promotion, most overweight and obese individuals tend to lose weight on their own. The present study aimed to understand the characteristics and strategies of those who successfully engage in self-directed weight loss, which could empower other overweight and obese individuals with information and strategies to manage their weight on their own.

METHODS

Men and women who had lost at least 5% of their body weight without direct interaction with professionals or weight management programmes were recruited. Demographic data were collected by questionnaire and participants' weight-loss experiences were explored using semi- structured interviews to elicit in-depth individual experiences and perspectives. Iterative thematic method data analysis was used to generate themes describing contributing factors to the success of self-directed weight loss identified by participants.

RESULTS

Most characteristics of those who successfully self-managed their weight loss were in line with those reported by successful weight losers participating in professional-led projects. However, strategies such as early embedding of new lifestyle behaviours into daily routine, the ability to learn from previous weight-loss experiences, and not requiring social support were identified as distinctive factors that contributed to the success of self-directed weight loss by participants of the present study.

CONCLUSIONS

Overweight or obese individuals with strong internal motivation, problem-solving skills and self-reliance are more likely to be successful at achieving self-directed weight loss. The patients identified with these characteristics could be encouraged to self-manage their weight-loss process, leaving the places available in more resource-intensive professional-led programmes to those individuals unlikely to succeed on their own.

Assessment of Weight Management Practices among Adults in the United Arab Emirates

With a rise in global incidence of overweight and obesity, the number of patients seeking weight management (WM) advice is likely to increase. Our aim was to explore the prevalence of WM practices and investigate association of WM goals with sociodemographic variables and practices among United Arab Emirates (UAE) adults. An exploratory, cross-sectional research was conducted on 1275 adult males and females, residing in UAE. A structured questionnaire was administered. WM goals to lose/maintain/gain weight were reported in 88.3% participants. WM goals were significantly associated with age, sex, marital status, education, current body weight perception, and medical condition. Out of 21 selected WM practices, popular strategies included increasing physical activity (52.9%), eating less fat (51.1%), consuming fewer calories (43.3%), joining gym (27.5%), skipping meals (26.1%), and consuming natural herbs and teas (20.7%). Visiting dietitian (12.3%) ranked ninth in the order of preference. Males focused on physical activity, gyms, and wellness centers and females on calories counting, dietitian visits, meals replacement, skipping meals, and natural herbs/teas. Married adults reported eating less fat (54.3% versus 47.3%, p = 0.020); singles opted calories counting, gyms, and meals replacement. Frequent referral sources were friends (37.8%) and Internet (32.1%). Most UAE adults had WM goals that were associated with sociodemographic variables and WM practices. Awareness about the ill-effects of unhealthy WM practices and importance of dietitian's consultation are imperative.

Leveraging EHRs for patient engagement: perspectives on tailored program outreach

OBJECTIVES

Electronic health records (EHRs) present healthcare delivery systems with scalable, cost-effective opportunities to promote lifestyle programs among patients at high risk for type 2 diabetes, yet little consensus exists on strategies to enhance patient engagement. We explored patient perspectives on program outreach messages containing content tailored to EHR-derived diabetes risk factors-a theory-driven strategy to increase the persuasiveness of health communications.

STUDY DESIGN

Convergent mixed methods.

METHODS

Within an integrated healthcare delivery system, women with a history of gestational diabetes participated in 1 of 6 ethnic-specific focus groups to elicit diverse perspectives and a survey yielding quantitative data to contextualize qualitative responses.

RESULTS

The sample included 35 participants (80% racial/ethnic minorities; mean age = 36 years). Themes regarding tailored messages centered on diabetes risk communication (opposing attitudes about whether to feature diabetes risk factors), privacy (how and whether patient data should be accessed), authenticity (perceiving messages as personalized vs generically computer generated), and preferences for messages sent by one's personal physician. Trust in the medical profession and perceived risk for diabetes were similar to levels reported in comparable samples.

CONCLUSIONS

Patient reactions highlight the challenges of leveraging EHRs for tailored messages. Some viewed messages as caring reminders to take preventive action and others raised concerns over intrusiveness. Optimal lifestyle program outreach to improve quality of care for women at high risk for diabetes may require communication from personal physicians, careful development to mitigate concerns over privacy and authenticity, and techniques to counteract the threatening nature of personalized risk communication.

Racial/Ethnic Differences in Weight-Loss Strategies among US Adults: National Health and Nutrition Examination Survey 2007-2012

BACKGROUND

Dieting, exercising, and seeking professional help have been associated with intentional weight loss among adults.

OBJECTIVE

This study examined the use of diet (eg, ate less, ate less fat, or switched to low-calorie foods), exercise, diet and exercise, and professional help (eg, weight-loss program or prescribed diet pills) for weight loss among non-Hispanic whites, Mexican Americans, and non-Hispanic blacks.

DESIGN

Cross-sectional data from the 2007-2012 National Health and Nutrition Examination Survey were used.

PARTICIPANTS

Males and females (n=9,046) aged 20 to 65 years were included.

MAIN OUTCOME MEASURE

The weight history questionnaire assessed weight-loss attempts and use of weight-loss strategies in the past year.

STATISTICAL ANALYSES PERFORMED

Multivariate logistic regression models were used to estimate associations of race/ethnicity with strategies to lose weight. Models controlled for age, sex, education, and body mass index. In fully adjusted models, interactions of race/ethnicity by sex were tested.

RESULTS

Lower proportions of Mexican Americans (35%) and non-Hispanic blacks (35%) than non-Hispanic whites (39%) reported trying to lose weight. Among those who tried to lose weight, non-Hispanic blacks were less likely than non-Hispanic whites to use diet (odds ratio [OR] 0.78, 95% CI 0.67 to 0.90) or exercise (OR 0.83, 95% CI 0.70 to 0.99) for weight loss. Mexican Americans (OR 0.71, 95% CI 0.53 to 0.95) and non-Hispanic blacks (OR 0.71, 95% CI 0.52 to 0.95) were also less likely than non-Hispanic whites to use professional help for weight loss. The relationships between race/ethnicity and weight-loss strategy were stronger for females than males.

CONCLUSIONS

Targeted efforts are needed to address racial/ethnic disparities in weight-loss attempts and use of recommended strategies especially among females.

Weight Goals, Perceptions, and Practices Among Hispanic and Anglo College Females

This study explored the weight management practices, rates overweight and obesity, perceptions of body weight, and weight management goals in a large sample ( N = 467) of Hispanic ( n = 421) and Anglo ( n = 46) female college students on the U.S.-Mexico border. Women self-reported their height and weight, weight perceptions, and weight management goals and practices. About one third of the sample was overweight and many reported using weight management methods, most notably exercise and restraint dieting. The only significant difference between Anglos and Hispanics was for exercise, where Hispanics reported exercising more frequently. Although most weight control practices positively intercorrelated, exercise and restraint dieting were negatively correlated. Path analyses showed that weight perceptions and weight management goals mediated associations between body mass index and weight management practices. Results suggest that weight management interventions emphasize increasing exercise and controlling calories, together, as a means to achieve healthy weight.

Gender Differences in Nutritional Risk Among Older Rural Adults

Older adults are vulnerable to nutrition-related health problems due to health and psychosocial changes that accompany aging. Those in rural communities face additional problems. This study characterizes the nutritional risk of rural older adults using the Nutritional Risk Index (NRI), paying particular attention to gender differences in risk. Data come from face-to-face interviews with a random sample of 638 White rural adults aged 55 and older. Women scored significantly higher on the NRI, indicating greater nutritional risk. Women were more likely to report NRI items related to oral health, special diets, disease interference with eating, gastrointestinal problems, and anemia, whereas men were more likely to report smoking regularly. A comparison with the application of the NRI in other populations indicates that it is sensitive to nutrition-related health conditions that may be more prevalent in rural populations, making it a useful tool for measuring nutritional risk.

“Is That All There Is?” Possible Selves, Self-Change, and Weight Loss

Possible selves typically are conceptualized as resources that facilitate identity development and that motivate and sustain self-change. The concept of possible selves, however, generally has not been extended to examining the aftermath of personal transformation. In this article I explore the self and social processes that operate during efforts to validate possible selves after self-change is complete. Using data gathered during in-depth qualitative interviews with 46 respondents who sustained weight loss over time, I analyze the role of possible selves in efforts to maintain intentional self-change. Findings show that many possible selves associated with weight loss are not fulfilled, and that the gap between potential and actual selves must be negotiated before persons can consider their weight loss both “successful” and “complete.” This gap is bridged by drawing on structural and cultural resources found within processes of self-verification and identity control and in the revision of personal narrative. By combining these resources, persons recognized and negotiated the gap between their expectations and the reality of intentional self-change.

Coping with Weight-related Discrepancies: Initial Development of the WEIGHTCOPE

PURPOSE

The present research sought to provide the initial development, validation and reliability for a measure (WEIGHTCOPE) to assess the variation in how women, who are currently trying to lose or maintain weight, cope with common, perceived weight-related discrepancies.

METHODS

To this end, two studies were conducted to 1) develop an initial list of coping responses to common weight-related triggers, 2) create an initial measurement model through exploratory factor analysis (study 1; n = 470), and 3) provide initial validation for the measure through confirmatory factor analysis (study 2; n = 310).

FINDINGS

Results support the initial validity and reliability of a 38-item, 10-factor structure: Physical Activity, Healthy Eating, Suppressed Eating, Supplement Use, Self-Regulation, Positive Reframing, Social Support, Disengagement, Camouflage, and Comfort Food. The present findings reiterate individual variation in coping choice in response to a perceived weight-related discrepancy, and its prospective assessment with the WEIGHTCOPE.

CONCLUSIONS

The WEIGHTCOPE can be an integral tool for public health and clinical practice, where triggers are common, and interventions are employed to enhance the use of more positive forms of weight control behaviors and/or avoid negative consequences of weight- and fat-related discrepancies. Future research can use the WEIGHTCOPE to help guide theoretical and pragmatic approaches to various triggering events and potential moderators of coping.

Integrating fundamental concepts of obesity and eating disorders: implications for the obesity epidemic

Physiological mechanisms promote weight gain after famine. Because eating disorders, obesity, and dieting limit food intake, they are famine-like experiences. The development of the concept of meeting an ideal weight was the beginning of increasing obesity. Weight stigma, the perception of being fat, lack of understanding of normal growth and development, and increased concern about obesity on the part of health providers, parents, and caregivers have reinforced each other to promote dieting. Because weight suppression and disinhibition provoke long-term weight increase, dieting is a major factor producing the obesity epidemic. The integrated eating disorder-obesity theory included in this article emphasizes that, contrary to dieters, lifetime weight maintainers depend on physiological processes to control weight and experience minimal weight change.

Dieting and weight cycling as risk factors for cardiometabolic diseases: who is really at risk?

Despite the poor prognosis of dieting in obesity management, which often results in repeated attempts at weight loss and hence weight cycling, the prevalence of dieting has increased continuously in the past decades in parallel to the steadily increasing prevalence of obesity. However, dieting and weight cycling are not limited to those who are obese or overweight as substantial proportions of the various population groups with normal body weight also attempt to lose weight. These include young and older adults as well as children and adolescents who perceive themselves as too fat (due to media, parental and social pressures), athletes in weight-sensitive competitive sports (i.e. mandatory weight categories, gravitational and aesthetic sports) or among performers for whom a slim image is professionally an advantage. Of particular concern is the emergence of evidence that some of the potentially negative health consequences of repeated dieting and weight cycling are more readily seen in people of normal body weight rather than in those who are overweight or obese. In particular, several metabolic and cardiovascular risk factors associated with weight cycling in normal-weight individuals have been identified from cross-sectional and prospective studies as well as from studies of experimentally induced weight cycling. In addition, findings from studies of experimental weight cycling have reinforced the notion that fluctuations of cardiovascular risk variables (such as blood pressure, heart rate, sympathetic activity, blood glucose, lipids and insulin) with probable repeated overshoots above normal values during periods of weight regain put an additional stress on the cardiovascular system. As the prevalence of diet-induced weight cycling is increasing due to the opposing forces of an 'obesigenic' environment and the media pressure for a slim figure (that even targets children), dieting and weight cycling is likely to become an increasingly serious public health issue.

Feasibility of utilising an all-volunteer workforce as a disruptive innovation for the US obesity epidemic

OBJECTIVES

As the prevalence of obesity in US adults continues to increase, addressing weight control will require an effective, lower-cost intervention. A model for delivering free peer-to-peer counselling has the potential to create a paradigm shift in the way weight and other chronic illnesses are addressed in the US. The objective of this study is to understand the potential for utilising successful peer volunteers as counsellors in weight control programmes and as a possible intervention strategy to address the global obesity epidemic in a cost-effective manner.

STUDY DESIGN

This cross-sectional study surveyed a nationwide panel of US adults (n=806) in 2010.

METHODS

We created survey items to identify participant interest in three specific types of weight control programmes: a free programme led by successful peers, a paid programme led by successful peers and a programme led by trained paid professionals. Statistical analysis was conducted in 2011. Logistic regression was used to adjust for the effect of potential confounders on participant interest in different weight control programmes and willingness to volunteer.

RESULTS

More than three times as many subjects (27.4% vs. 8.3%) were interested in the free peer-led programme versus the expert-led paid option. Of participants who had ever had successful weight loss, 15% were interested in volunteering to help others lose weight.

CONCLUSIONS

Individuals appear to be willing to both attend and conduct peer volunteer-led weight control groups. Further research is necessary to develop and test interventions to assess the effectiveness of such interventions.

Prevalence of weight-loss strategies of young adults from the 1982 birth cohort in Pelotas, RS

The objective of this article was to identify, among the members of the 1982 birth cohort in Pelotas, those who were trying to lose weight at the age of 23, and which strategies they used. From 2004 to 2005, 4,297 individuals from the 1982 cohort were interviewed. The effects of demographic, socioeconomic and behavioral factors on the prevalence of any strategy to lose weight in the past year were assessed in a cross-sectional analysis with the Poisson regression. Out of all the youngsters interviewed, 28.5% reported having used some strategy to lose weight. In the adjusted analysis, gender, schooling, family income, body mass index and smoking were associated with the use of some strategy. The strategy used by most of the young people was diet followed by physical activity. The results showed that appropriate preventive measures and body weight control are necessary, along with public policies aimed at encouraging healthy habits among young people, including physical and dietary education.

Bariatric Surgeries in North Carolina, 1990 to 2001: A Gender Comparison

OBJECTIVE

The purpose of this research was to determine the number of bariatric procedures in obese men and women in a well-defined population and to examine gender differences among bariatric patients.

RESEARCH METHODS AND PROCEDURES

Data on bariatric patients were taken from the North Carolina Hospital Discharge Database, which contains information on all nonfederal hospital discharges in North Carolina from 1990 to 2001. Using North Carolina Hospital Discharge Data, Census North Carolina resident estimates, and North Carolina obesity prevalence estimates, we constructed annual rates for bariatric procedures for the obese male and female population in North Carolina.

RESULTS

Overall, 2197 bariatric procedures were performed between 1990 and 2001. The annual rate of bariatric procedures in obese women increased rapidly, particularly between 1998 and 2001, whereas the increase for men was considerably less than that for women. Controlling for age and year of procedure, the odds ratio for obese female North Carolina residents of having a bariatric procedure was 4.96 (95% confidence interval: 4.39, 5.59) and of having a Roux-en-Y procedure was 5.57 (95% confidence interval: 4.67, 6.64) compared with obese male North Carolina residents. Controlling for age, comorbidity burden, payment source, and year of procedure, obese male North Carolina residents had a significantly greater (22%) amount of inpatient days than obese female North Carolina residents.

DISCUSSION

After controlling for population rates of obesity and year of procedure, women are more likely than men to undergo bariatric surgery, suggesting that gender-related factors may influence use. More research is needed to determine the causes for this large gender disparity.

Successful weight loss among obese U.S. adults

BACKGROUND

Little is known about weight control strategies associated with successful weight loss among obese U.S. adults in the general population.

PURPOSE

To identify strategies associated with losing at least 5% and 10% of body weight.

METHODS

Multivariable analysis of data from obese adult (BMI ≥30) participants in the 2001-2006 NHANES to identify strategies associated with losing ≥5% and ≥10% of body weight (conducted in 2009-2011).

RESULTS

Of 4021 obese adults, 2523 (63%) reported trying to lose weight in the previous year. Among those attempting weight loss, 1026 (40%) lost ≥5% and 510 (20%) lost ≥10% weight. After adjustment for potential confounders, strategies associated with losing ≥5% weight included eating less fat (OR=1.41, 95% CI=1.14, 1.75); exercising more (OR=1.29, 95% CI=1.05, 1.60); and using prescription weight loss medications (OR=1.77, 95% CI=1.00, 3.13). Eating less fat (OR=1.37, 95% CI=1.04, 1.79); exercising more (OR=1.36, 95% CI=1.12, 1.65); and using prescription weight loss medications (OR=2.05, 95% CI=1.09, 3.86) were also associated with losing ≥10% weight, as was joining commercial weight loss programs (OR=1.72, 95% CI=1.00, 2.96). Adults eating diet products were less likely to achieve 10% weight loss (OR=0.48, 95% CI=0.31, 0.72). Liquid diets, nonprescription diet pills, and popular diets had no association with successful weight loss.

CONCLUSIONS

A substantial proportion of obese U.S. adults who attempted to lose weight reported weight loss, at least in the short term. Obese adults were more likely to report achieving meaningful weight loss if they ate less fat, exercised more, used prescription weight loss medications, or participated in commercial weight loss programs.

Unhealthy and healthy weight control behaviours among bus operators

BACKGROUND

Urban bus operators are an occupational group with high rates of overweight and obesity. Understanding methods bus operators use for weight control may be important; there may be increased risk for these workers to engage in less healthy weight management behaviours due to stressful working conditions.

AIMS

To examine the prevalence of unhealthy and healthy weight control behaviours used by bus operators and examine associations between use of unhealthy weight control behaviours and work-related and sociodemographic variables.

METHODS

Bus operators from four different transit garages were invited to complete a self-administered survey; height and weight were measured by research staff. Unhealthy and healthy weight control behaviours, work hours, work schedule and social support were measured with self-report items on the employee survey. Logistic regression analysis was conducted to estimate associations.

RESULTS

Nearly 60% of bus operators endorsed at least one unhealthy method; over 50% reported skipping meals, 30% fasted and 10% reported taking diet pills in the past year. Bus operator gender, race, body mass index status and hours worked per week showed significant associations with using at least one unhealthy weight control behaviour.

CONCLUSIONS

Worksite interventions should emphasize the benefit of healthy eating and physical activity but should also address the use of less healthy methods for weight control for individuals employed in transportation occupations.

Socio-economic differences in weight-control behaviours and barriers to weight control

Objective

To examine socio-economic differences in weight-control behaviours (WCB) and barriers to weight control.

Design

A cross-sectional study.

Setting

Data were obtained by means of a postal questionnaire.

Subjects

A total of 1013 men and women aged 45–60 years residing in Brisbane, Australia (69·8 % response rate).

Results

Binary and multinomial logistic regression analyses were performed, adjusted for age, gender and BMI. Socio-economically disadvantaged groups were less likely to engage in weight control (OR for lowest income quartile = 0·60, 95 % CI 0·39, 0·94); among those who engaged in weight control, the disadvantaged group had a likelihood of 0·52 (95 % CI 0·30, 0·90) of adopting exercise strategies, including moderate (OR = 0·56, 95 % CI 0·33, 0·96) and vigorous (OR = 0·47, 95 % CI 0·25, 0·89) physical activities, compared with their more-advantaged counterparts. However, lower socio-economic groups were more likely to decrease their sitting time to control their weight compared with their advantaged counterparts (OR for secondary school or lower education = 1·78, 95 % CI 1·11, 2·84). They were also more likely to believe that losing weight was expensive, not of high priority, required a lot of cooking skills and involved eating differently from others in the household.

Conclusions

Marked socio-economic inequalities existed with regard to engaging in WCB, the type of weight-control strategies used and the perceived barriers to weight control; these differences are consistent with socio-economic gradients in weight status. These factors may need to be included in health promotion strategies that address socio-economic inequalities in weight status, as well as inequalities in weight-related health outcomes.

Testing a brief self-directed behavioral weight control program

Clinical obesity treatments are of limited reach. Self-directed weight control attempts are common, but little attention has been given to providing guidance for such efforts in the population. The present research tests a brief intervention approach to weight control. Pilot data were collected from 66 University of Minnesota employees (72.7% women, 81.8% white) randomized to an assessment-only control condition or a single intervention session to teach empirically valid self-directed weight-control methods. Mean baseline weight was 87.1 kilograms (range 64.0-120.3 kilograms). Though statistically nonsignificant, intervention participants averaged greater weight loss by 6 months than controls (-.80 kilograms vs. -.19 kilograms), F(1, 44)=.47, p=.50, Cohen's d=.21. There was a significant group×time interaction for self-weighing frequency, F(2, 41)=10.84, p<.001. With some enhancement and more attention to dissemination, a brief self-directed program has potential as a useful approach to population weight-gain prevention.

Perceptions of body weight, weight management strategies, and depressive symptoms among US college students

OBJECTIVE

To determine if inaccurate body weight perception predicts unhealthy weight management strategies and to determine the extent to which inaccurate body weight perception is associated with depressive symptoms among US college students.

PARTICIPANTS

Randomly selected male and female college students in the United States (N = 97,357).

METHODS

Data were from the 2006 National College Health Assessment. Analyses were conducted on students' body weight perceptions, weight loss strategies, and feelings of depression.

RESULTS

Females with an inflated body weight perception were significantly more likely to engage in unhealthy weight management strategies and report depressive symptoms than were females with an accurate body weight perception.

CONCLUSIONS

College women are concerned with weight and will take action to lose weight. Colleges may need to focus more on interventions targeting both diet and physical activity while also promoting positive body image.

Disparities by ethnicity and socioeconomic status in the use of weight loss treatments

BACKGROUND

Prior research suggests that ethnic minorities and individuals of low socioeconomic status (SES) may be more likely to attempt weight loss using unproven methods.

METHODS

Data were from a national, random-digit-dial telephone survey of weight loss practices. Seven modalities of weight loss were examined. Multivariable analysis controlled for clinical and sociodemographic variables (including race/ethnicity, SES, and body mass index), as well as self-perception of weight and weight loss attitudes.

RESULTS

In multivariable analysis, African Americans (OR, 1.71; 95% CI, 1.05-2.78; p =.03) and Latinos (OR, 1.69; 95% CI, 1.11-2.60; p = .016) were more likely than Caucasians to report use of over-the-counter (OTC) weight loss supplements. African Americans (OR, 0.39; 95% CI, 0.21-0.71; p = .002) and Latinos (OR, 0.56; CI, 0.33-0.97; p = .038) also were less likely than Caucasians to report use of commercial weight loss programs. Higher-SES individuals were more likely than low-SES persons to report self-directed attempts at weight loss (OR, 1.39; CI, 1.00-1.93; p = .05) and commercial programs (OR, 2.12; CI, 1.51-2.97; p < .001) and less likely to report use of OTC supplements (OR, 0.64; CI, 0.47-0.88]; p = .006). African Americans were more likely than Caucasians to report use of medically supervised programs (OR, 1.74; CI, 1.06-2.86; p = .028).

CONCLUSIONS

With the exception of medically supervised programs, ethnic minorities and low-SES individuals are generally more likely to report use of unproven methods for weight loss and less likely to report use of potentially beneficial treatments. These findings should be explored in more detail. Use of proven treatments for weight management should be encouraged.

Weight loss practices and body weight perceptions among US college students

OBJECTIVE

The authors assessed associations between body weight perception and weight loss strategies.

PARTICIPANTS

They randomly selected male and female college students (N = 38,204).

METHODS

The authors conducted a secondary data analysis of the rates of weight loss strategies and body weight perception among students who completed the National College Health Assessment survey.

RESULTS

Half of respondents (50%) were trying to lose weight, although only 28% of students were overweight or obese. Also, 12% of respondents had inaccurate body weight perception. Women and men with inaccurate body weight perception were significantly more likely to engage in inappropriate weight loss strategies than were those with accurate body weight perception. Of all students attempting to lose weight, 38% used both diet and exercise.

CONCLUSIONS

These data show that college students are interested in weight loss and that body weight perception plays an important role in the desire to lose weight.

Age group differences in diet and physical activity-related behaviors among rural men and women

OBJECTIVES

Age group variations in dietary intake and physical activity have been noted in large epidemiologic studies. In this study, specific measures of behavioral strategies add depth to our understanding of these variations and can contribute to the design of effective behavioral interventions.

DESIGN

Cross-sectional, behavioral epidemiologic study.

SETTING

Rural Midwestern US.

PARTICIPANTS

407 adults.

MEASUREMENTS

Measures included dietary intake, physical activity, body mass index (BMI), and specific behavioral strategies related to diet and physical activity.

RESULTS

Use of most strategies related to diet increased across age groups, which was consistent with declining caloric intake and a decline in the proportion of total caloric intake from fat. The same patterns were not found with regard to physical activity. Greater use of diet-related strategies was noted in the oldest age groups compared to the others even though BMI was lower.

CONCLUSIONS

In the oldest age group at least, strategy use may be more related to attempts to control health conditions than body weight. The findings provide a unique perspective on age group differences in diet and physical activity behavior. Longitudinal tracking of these specific behaviors and their measurement in other populations is warranted.

Prevalence and selected correlates of eating disorder symptoms among a multiethnic community sample of midlife women

BACKGROUND

There is little information about the symptoms of disordered eating or their association with psychological and physical parameters in midlife women.

PURPOSE

The aim is to examine (a) the prevalence of binge eating, inappropriate weight control behaviors, and weight and body image concerns among middle-aged community women; (b) whether rates of eating disorder symptoms vary among ethnic groups and are associated with socioeconomic status, weight-related variables, current depressive symptoms or history of major depression, substance abuse or dependence, or childhood abuse; and (c) whether the association between ethnicity and eating disorder symptoms persists after adjustment for covariates.

METHODS

The sample of 589 pre- and early perimenopausal African American, Hispanic, and White women were participants in the Study of Women's Health Across the Nation (SWAN), a U.S. multisite longitudinal study of menopause and aging. Women reported information on sociodemographic, symptom, health, psychosocial and lifestyle variables. DSM-IV disorders were determined, physical measures were obtained, and a questionnaire to assess symptoms of eating disorders was completed.

RESULTS

Rates of regular binge eating, dissatisfaction with eating patterns, and marked fear of weight gain were 11, 29.3, and 9.2%, respectively. African Americans were more likely than were Whites to report fasting. In multivariable analyses, high body mass index (or waist circumference), depressive symptoms, past depression, and history of childhood/adolescence abuse were significantly associated with the Binge Eating and Preoccupation with Eating, Shape and Weight subscale scores.

CONCLUSIONS

These data suggest that further examination of the relationship between eating problems and well being in older women is warranted.

Recurrent dieting and smoking among Finnish men and women

OBJECTIVE

To examine the association of smoking with recurrent dieting and BMI among Finnish adults.

RESEARCH METHODS AND PROCEDURES

We used questionnaire data from 1990 on 11,055 subjects from the Finnish Twin Cohort who were 33 to 61 years of age. Multinomial logistic regression analysis was carried out using lifetime dieting as the outcome variable and smoking as the main explanatory variable, adjusted for BMI and age. Twin pairs discordant for dieting and smoking were studied to examine the effect of environmental and genetic factors.

RESULTS

Among women, current smokers [odds ratio (OR), 1.09 to 1.41 at different ages] and former smokers (OR, 1.52 to 2.82) were more likely to have dieted recurrently than never smokers. Among men, current smokers were less likely (OR, 0.69; 95% confidence interval, 0.55, 0.87) and former smokers were more likely (OR, 1.30; 95% confidence interval, 1.05, 1.61) to have dieted recurrently at different ages. The differences between the discordant pairs were consistent with this, although not statistically significant.

DISCUSSION

Recurrent dieting was associated with former smoking in both sexes and with current smoking in women.

Self-efficacy and its association with use of diet-related behavioral strategies and reported dietary intake

The construct of self-efficacy has been widely used in studies of dietary behavior change and is accepted as a helpful process indicator. This study examined associations between self-efficacy and use of specific diet-related behavioral strategies and reported dietary intake over time. Data are from two community surveys of rural adults conducted 1 year apart (n=354). Results indicate that changes in self-efficacy are positively associated with changes in strategy use but not dietary intake. Strategies may be thought of as leading to a particular level of dietary intake but are not the only influence on intake. Findings therefore confirm hypothesized associations between these components of the behavior change process. By attending to and measuring these specific links in the process, researchers and practitioners can better determine where behavioral interventions are succeeding and where they are breaking down.

Adult obesity does not predict 6-year weight gain in men: the Aerobics Center Longitudinal Study

OBJECTIVE

To determine the longitudinal relation between history of adult obesity and the 6-year trajectory of weight change in men.

RESEARCH METHODS AND PROCEDURES

Subjects were healthy, affluent men (n = 761) between the ages of 20 and 78 years who completed at least four comprehensive medical exams at the Cooper Clinic between 1987 and 2003. Maximum adult weight was reported, and current height was measured at baseline. Body weight and cardiorespiratory fitness were measured at all examinations. Adult obesity status was determined from self-reported maximum weight and measured height at baseline as BMI > or = 30 kg/m(2). Weight at all examinations was regressed on a history of adult obesity using linear mixed effects modeling.

RESULTS

At baseline, men reporting a history of adult obesity were significantly heavier than men reporting no such history (BMI 29.8 vs. 25.0 kg/m(2); p < 0.05). However, the rate of weight gain among men with a history of obesity was slower than among men without a history of adult obesity (0.04 vs. 0.18 kg/yr; p = 0.09), although this difference was only marginally significant. Fitness modulated the relationship between history of obesity and weight change over time, and both higher levels of fitness and greater frequency of dieting were associated with attenuated weight gain. In contrast, chronic disease and depression were associated with accelerated weight gain.

DISCUSSION

Although a history of obesity was associated with higher weight, it did not seem to result in accelerated weight gain over time. Additionally, dieting and fitness were important for minimizing weight gain.

Preventing weight gain: a population cohort study of the nature and effectiveness of mid-age women's weight control practices

OBJECTIVE

To examine women's weight control practices and their effectiveness in preventing weight gain.

DESIGN

Retrospective cohort study of weight control practices and 2-year weight change among mid-age women participating in the Australian Longitudinal Study on Women's Health (ALSWH).

SUBJECTS

11,589 Australian women (aged 47-52 years).

MEASUREMENTS

The prevalence and types of self-reported weight control practices used were assessed by a nine-item instrument. Two-year weight change was self-reported and adjusted for baseline body mass index (BMI) and other potential confounders.

RESULTS

Seventy-four per cent of the cohort (N=8556) reported actively trying to control their weight. Dietary modification was used more frequently than exercise. Two-thirds of the weight-controlling women used a combination of practices, the two most common being 'decreased food quantity, cut down on fats/sugars and exercise' (32%, baseline BMI 25.87(0.10)), and 'decreased food quantity and cut down on fats/sugars without exercise' (15.6%, baseline BMI 27.04(0.14)). Potentially health-damaging practices (smoking, laxatives, fasting) were relatively uncommon, at 7.9%. Only one combination of practices (decreased food quantity, cut down on fats/sugars, use of a commercial weight loss programme and exercise) prevented mean weight gain (-0.03 kg), whereas the mean (s.d.) weight of the cohort increased (+1.19(4.78)) over the 2-year period.

CONCLUSIONS

The majority of mid-age women attempting weight control used practices consistent with public health messages. Despite their efforts, the group was mostly unsuccessful in preventing weight gain. Public health authorities and health practitioners may need to make more quantitative recommendations and emphasize the importance of balancing physical activity with dietary intake to achieve successful weight control for women at this life stage.

Weight management strategies reported by rural men and women in Iowa

OBJECTIVE

This study compares the specific behavioral strategies that rural men and women use when trying to lose weight.

DESIGN

A cross-sectional, in-person survey.

SETTING

Participants were part of a larger study in rural Iowa (n = 407) intended to identify community health promotion issues.

PARTICIPANTS

184 adults (56 men, 128 women) who reported currently trying to lose weight

VARIABLES MEASURED

Measures capture strategies for dealing with the social environment, food choice and preparation, physical activity planning, social support, self-efficacy, outcome expectations, dietary intake and physical activity level.

ANALYSIS

T-tests, chi-square, Cronbach alpha, descriptive statistics.

RESULTS

Women reported greater use of nearly all strategies measured. Men reported more social support for diet, whereas women reported more social support for physical activity. Results for self-efficacy and outcome expectations were mixed. No gender differences were found for fat intake, fruit and vegetable servings, or physical activity level.

CONCLUSIONS AND IMPLICATIONS

Men and women differ in the specific strategies they use to lose weight, including those related to the social environment. Practitioners planning weight management programs should be aware that men and women may have different levels of experience in using specific behavioral strategies.

Stage of Change for Healthful Eating and Use of Behavioral Strategies

OBJECTIVE

To examine the distribution of behavioral strategy use across stage of change for healthful eating, and to determine if baseline stage predicts change in use of strategies over 1 year in the absence of intervention.

DESIGN

Cross-sectional assessment and 1-year follow-up with no intervention.

SUBJECTS/SETTING

Adult men and women in two rural Midwest communities.

STATISTICAL ANALYSES PERFORMED

Multiple regression, with tests for group difference and trend, controlling for age and sex.

RESULTS

Use of behavioral strategies as measured by six scales (self-monitoring, planning, preparation and buying, portion control, social interactions, and cognitive strategies) followed a clear linear trend across stages of change for healthful eating. Strategy use was more strongly related to stage than energy intake, fat intake, and fruit and vegetable servings as measured via food frequency questionnaire. Baseline stage of change showed some relationship to change in strategy use over time, although most group differences were not statistically significant.

CONCLUSIONS

Use of a range of behavioral strategies is strongly related to stage of change for healthful eating, and more closely associated with stage than dietary intake. In the absence of intervention, baseline stage only weakly predicted changes in strategy use. Programs with the goal of encouraging a range of healthful eating behaviors may find these measures of strategy use to be helpful in defining stage of change, and possibly in tracking behavior change over time.

Weight-control practices among U.S. adults, 2001-2002

BACKGROUND

Approximately $50 billion a year is spent by Americans on weight-loss products and services. Despite the high cost, few national studies have described specific weight-loss and weight-maintenance practices among U.S. adults. This analysis describes the use of specific practices by U.S. adults who tried to lose weight or tried only not to gain weight during the previous 12 months.

METHODS

Data were analyzed from the 2001-2002 National Health and Nutrition Examination Survey (NHANES) conducted on a nationally representative sample of the U.S. population. This study focused on adults aged 20 years or older who were both interviewed and examined (n =5027).

RESULTS

Fifty-one percent of U.S. adults tried to control their weight in the previous 12 months, including those who tried to lose weight (34% of men, 48% of women) and those who tried only not to gain weight (11% vs 10%, respectively). Among 2051 adults who tried to control their weight, the top four practices were the same: ate less food (65% among those who tried to lose weight, 52% among those who tried only not to gain weight); exercised (61% vs 46%, respectively); ate less fat (46% vs 42%); and switched to foods with lower calories (37% vs 36%). Less than one fourth combined caloric restriction with the higher levels of physical activity (300 or more minutes per week) recommended in the 2005 dietary guidelines by the U.S. Department of Health and Human Services and U.S. Department of Agriculture.

CONCLUSIONS

Although weight control is a common concern, most people who try do not use recommended combinations of caloric restriction and adequate levels of physical activity.

Dietary supplements and weight control in a middle-age population

OBJECTIVES

Obesity is rapidly becoming a health problem of epidemic proportions, bringing with it a host of health concerns. This study investigates the association of long-term (10-year) use of 14 nutritional supplements, marketed as weight-control aids, with weight change over the past 10 years among individuals age 53 to 57 years.

METHODS

Data are from the VITamins And Lifestyle (VITAL) cohort study of western Washington. Participants (n = 15,655) completed questionnaires about 10-year supplement use, diet, health habits, height, and present and former weights. The following supplements that are sometimes marketed for weight control or loss were examined: multivitamins; vitamins B6 and B12; chromium; coenzyme Q10, dehydroepiandrosterone, essential fatty acids (EFAs), fiber, garlic (Allium sativum), ginkgo (Ginkgo biloba), ginseng (Panax spp.), melatonin, soy, and St. John's wort (Hypericum perforatum). Linear regression was used to model 10-year change in weight from age 45 to ages 53-57, stratified by sex and body mass index (BMI, kg/m2) (normal, overweight, or obese) at age 45 years. Models were controlled for race/ethnicity, education, energy intake, physical activity, weight at age 45 years, and smoking.

RESULTS

Among overweight or obese men and women, long-term use of multivitamins, vitamins B6 and B12, and chromium were significantly associated with lower levels of weight gain. For example, with chromium, weight gain in the past 10 years for obese men was 11.7 lb for no use, 6.1 lb for <150 microg/day (10-year average), and a weight loss of 3.1 lb for > or = 150 microg/day (p for trend, <0.05). Among obese women, weight gain was 14.1 lb, 7.9 lb, and 3.2 lb for the three groups respectively (p for trend, <0.01).

CONCLUSIONS

These data suggest that long-term users of certain supplements experienced less weight gain than individuals who did not use the supplements. Further study is necessary before recommendations regarding these supplements can be made.

Pediatric fatality following ingestion of dinitrophenol: postmortem identification of a "dietary supplement"

Dinitrophenol, a chemical currently used as an insecticide, is known to uncouple mitochondrial oxidative phosphorylation. A component of explosives, it has also been used in the past as a food coloring and clothing dye. In the 1930s, physicians prescribed it for weight loss, but this practice was discontinued when reports of cataracts, deaths, and other adverse outcomes came to light. We describe in our report the overdose and fatality of a teenager who purchased the product as a weight loss dietary supplement by mail order. We also describe a laboratory method that allowed postmortem determination of the dinitrophenol concentration in the victim's serum. Her death, despite prompt medical treatment, underscores the danger of dinitrophenol. The easy accessibility and apparent resurgent interest in dinitrophenol as a weight loss agent is extremely timely and troubling.

Attempting to lose weight: specific practices among U.S. adults

BACKGROUND

Americans spend over $33 billion annually on weight-loss products and services. Although weight-control methods are of considerable public health interest, few national data on weight-loss practices are available. This paper examines the prevalence of specific weight-loss practices among U.S. adults trying to lose weight.

METHODS

Data from the 1998 National Health Interview Survey, which was conducted through face-to-face interviews of a nationally representative sample of U.S. adults (n =32,440), were analyzed in 2003.

RESULTS

Twenty-four percent of men and 38% of women were trying to lose weight. Attempting weight loss was less common among normal weight (body mass index [BMI]<25 kg/m(2)) people (6% men, 24% women) than overweight (BMI>/=25 to 30 kg/m(2)) people (28%, 49%) or obese (BMI>/=30 kg/m(2)) people (50%, 58%). Among those trying to lose weight, the most common strategies were eating fewer calories (58% men, 63% women); eating less fat (49%, 56%); and exercising more (54%, 52%). Less frequent strategies were skipping meals (11% men, 9% women); eating food supplements (5%, 6%); joining a weight-loss program (3%, 5%); taking diet pills (2%, 3%); taking water pills or diuretics (1%, 2%); or fasting for >/=24 hours (0.6%, 0.7%). Only one third of all those trying to lose weight reported eating fewer calories and exercising more.

CONCLUSIONS

Increased efforts are needed among all those trying to lose weight to promote effective strategies for weight loss, including the use of calorie reduction and increased physical activity.

Is beauty in the eye of the beholder? Effects of weight and shape on attractiveness ratings of female line drawings by restrained and nonrestrained eaters

This study tested the differences between restrained and nonrestrained eaters' attractiveness perceptions of female line drawings, of their own figures, and the ideal female figure. Female line drawings varied systematically in body weight and in waist and hip circumference. Forty-six female undergraduate students, 23 nonrestrainers and 23 restrainers, rated stimuli in attractiveness, identified the figure which best represented their own body type (PAF), and the ideal body figure (IF) according to the Restraint Scale [RS; Herman, C. P., & Polivy, J. (1980). Restrained eating. In: A. Stunkard (Ed.), Obesity (pp. 208-225). Philadelphia, PA: Saunders]. Restrainers did not generally differ from nonrestrainers in attractiveness ratings or in their choice of IF. However, differences between IF and PAF were larger in restrainers than in nonrestrainers because restrainers chose PAFs with larger hips than nonrestrainers did. This difference between the restraint groups was independent of between-group differences in hip size. This discrepancy between IF and PAF may contribute to the restrainers' motivation to diet.

Preventive health practices: comparison of family caregivers 50 and older

The purpose of this study was to describe adherence to recommended preventive health practices among middle-aged and older male and female family caregivers of individuals receiving home health services. Perceptions of the burden and benefit of caregiving, wellness orientation, social participation, and community resource use by the caregiving dyad (caregiver and carereceiver) were also explored using the t test and the chi2 test to detect gender differences. A sample of 319 participants 50 and older was recruited from a home health agency in southwestern Pennsylvania to participate in a telephone survey. Results revealed that caregivers had performed 86% of age- and gender-appropriate preventive health practices, but they currently adhered to guidelines for 63% of such behaviors, regardless of gender. Men experienced less burden than women, and were more likely to acknowledge that caregiving made them feel useful and appreciated and gave more meaning to their lives. The study suggests that family caregivers may be as vigilant in their preventive health behavior as the general population, despite their responsibilities. Nurses in contact with middle-aged and older family caregivers are well positioned to encourage health promotion and disease prevention behaviors in this accessible population.

Correlates of weight loss behaviors among low-income African-American, Caucasian, and Latina women

OBJECTIVE

To examine the prevalence and correlates of weight reduction behaviors among low-income women.

METHODS

A total of 1,709 Caucasian, African-American, and Latina women aged 12-58 years attending a federally funded family planning clinic reported their weight loss behaviors during the past 30 days, including using diet pills, exercising, purging (vomiting, laxatives, diuretics), and dieting. Approximately 60% (n = 999) had a body mass index of 25 or greater.

RESULTS

Overall, 35.3% (n = 603) of women dieted, 43.7% (n = 746) exercised, 15.1% (n = 258) used diet pills, and 4.3% (n = 69) purged. Only 14.8% (n = 253) of the sample reported both dieting and exercising. The odds of exercising for weight loss decreased as parity increased. Those who smoked currently or in the past were more likely than nonsmokers to report purging (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.2, 5.4). African Americans were least likely to diet or exercise compared with Caucasians and Latinas. Exposure to family members using diet pills (OR 4.6; 95% CI 3.2, 6.5), dieting (OR 2.1; 95% CI 1.6, 2.8), or purging (OR 5.6; 95% CI 2.7, 11.9) was associated with increased odds of performing these behaviors oneself.

CONCLUSION

This research demonstrates that low-income women frequently use maladaptive strategies, such as diet pills and purging, to lose weight. Obesity and family exposure to these behaviors places women at increased risk of unhealthy behaviors. Interventions designed to reduce obesity must include precautions regarding the dangers of these practices.

LEVEL OF EVIDENCE

III

An attempt to identify predictors of treatment outcome in two comprehensive weight loss programs

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.

Beauty is as beauty does: body image and self-esteem of pageant contestants

Self-esteem, dieting, and body image of 131 female beauty pageant contestants (mean age 26.0 years) from 43 states were examined by an anonymous survey. Most (89.6%) reported being a pageant finalist or winner and 55.2% had competed at the nationa/international level Over one-fourth (26%) of the women had been told or perceived they had an eating disorder which reportedly began at 16.25 years. Almost half (48.5%) reported wanting to be thinner and 57% were trying to lose weight. Higher self-esteem scores were significantly associated with increased level of competition (i.e.: from local to international pageants), but not with the number of times the women were pageant finalists or winners. Future study is warranted to determine how pageant participation influences self-esteem, body image, and the development of eating disorders.

Americans on diet: results from the 1994-1996 Continuing Survey of Food Intakes by Individuals

OBJECTIVE

To examine the prevalence of dieting to lose weight or for a health reason in a representative sample of US adults.

DESIGN

Cross-sectional study design.

SUBJECTS/SETTING

Data from 10,144 participants of the 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII 1994-1996) were used in the analysis. All data were self-reported.

STATISTICAL ANALYSIS

Analysis included: cross-tabulation of dieting status by sociodemographic characteristics; comparison of the type of diet, the reason for dieting, and the source of diet used by men and women; comparison of the nutrient intake and health status of dieters and nondieters.

RESULTS

Prevalence of dieting varied by gender and race, being highest in white women (21%) and lowest in Hispanic men (8%). About 71% of all dieters reported that they were dieting to improve health, and 50% reported that they were dieting to lose weight. Dieters reported lower intakes of total fat, saturated fat, cholesterol, sodium, monounsaturated fat, polyunsaturated fat, calcium, and selenium compared with nondieters. The rate of chronic health conditions was higher among dieters than nondieters. Self-reported physical activity was similar in both groups.

CONCLUSIONS

The prevalence of dieting varies according to sociodemographic characteristics. The reason for dieting and the type of diet used by dieters also vary and need to be studied further. Our results suggest that the dieters generally consumed a more nutrient-dense diet than the nondieters but still low in certain nutrients.

Evaluating a 'non-diet' wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors

CONTEXT

Current public health policy recommends weight loss for obese individuals, and encourages energy-restricted diets. Others advocate an alternative, 'non-diet' approach which emphasizes eating in response to physiological cues (eg hunger and satiety) and enhancing body acceptance.

OBJECTIVE

To evaluate the effects of a 'health-centered' non-diet wellness program, and to compare this program to a traditional 'weight loss-centered' diet program.

DESIGN

Six-month, randomized clinical trial.

SETTING

Free-living, general community.

PARTICIPANTS

Obese, Caucasian, female, chronic dieters, ages 30-45 y (n=78).

INTERVENTIONS

Six months of weekly group intervention in a non-diet wellness program or a traditional diet program, followed by 6 months of monthly after-care group support.

OUTCOME MEASURES

Anthropometry (weight, body mass index); metabolic fitness (blood pressure, blood lipids); energy expenditure; eating behavior (restraint, eating disorder pathology); psychology (self-esteem, depression, body image); attrition and attendance; and participant evaluations of treatment helpfulness. Measures obtained at baseline, 3 months, 6 months and 1 y.

RESULTS

(1 y after program initiation): Cognitive restraint increased in the diet group and decreased in the non-diet group. Both groups demonstrated significant improvement in many metabolic fitness, psychological and eating behavior variables. There was high attrition in the diet group (41%), compared to 8% in the non-diet group. Weight significantly decreased in the diet group (5.9+/-6.3 kg) while there was no significant change in the non-diet group (-0.1+/-4.8 kg).

CONCLUSIONS

Over a 1 y period, a diet approach results in weight loss for those who complete the intervention, while a non-diet approach does not. However, a non-diet approach can produce similar improvements in metabolic fitness, psychology and eating behavior, while at the same time effectively minimizing the attrition common in diet programs.

Low-calorie diets and sustained weight loss

The principles of weight management in overweight and obesity are primarily to achieve clinically significant weight loss and secondarily (but perhaps more importantly) to maintain weight loss. The traditional approach to weight reduction has been the prescription of diets that provide an energy intake below that of energy expenditure, usually to provide a balanced ratio of protein, carbohydrate, and fat in reduced quantities to provide an energy intake of 800 to 1500 kcal/d. Evaluation of the efficacy of such interventions is difficult despite a wealth of publications, because few randomized trials have been conducted and various adjunctive therapies confound interpretation. Systematic reviews of low-calorie diets have been unable to come to any firm conclusions about the value of different ways of achieving energy restriction, but one meta-analysis of low-fat diets produced a mean weight loss of 10 kg of weight loss that was greater in those with a higher initial body weight. Greater weight loss was achieved by subjects prescribed a 600-kcal deficit diet, compared with a conventional low-calorie (1200 kcal/d) diet. This study has been influential for clinical dietetic practice, particularly with UK dietitians, but also in the design of dietetic support in clinical trials of pharmacotherapy. Low-calorie diets can be effective treatment, but the optimum way of delivering such diets remains unclear.

The perceived relative worth of reaching and maintaining goal weight

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<0.01).

CONCLUSION

Excessive value may be placed on attaining less than realistic weight goals, particularly but not exclusively by treatment-seeking and heavier obese people and those who desire greater weight loss. Clinicians should take this phenomenon into consideration, and public health initiatives should attempt to place body weight in a more balanced perspective.

Psychometric development of a multidimensional measure of weight-related attitudes and behaviors

Most weight control programs facilitate weight loss by encouraging participants to adopt healthy eating patterns and increase physical activity. There is a need for a relatively brief measure of eating habits and physical activity that could be used to evaluate changes in behavior during weight loss treatment. The purpose of this series of four studies was to develop and validate such a measure, which was subsequently named the Weight Loss Behavior Scale (WLBS). Study 1 (n = 533) included item and scale development and examination of the WLBS's factor structure and internal consistency. Study 2 (n = 226) evaluated the test-retest reliability and convergent validity of its subscales. Study 3 examined their reliability and internal consistency scales in a predominantly overweight sample (n = 36). Study 4 evaluated the WLBS as a treatment outcome measure in a weight loss intervention (n = 50). Study 1 found that the WLBS contained five internally consistent and stable factors: 1) Concern with Dieting and Weight, 2) Exercise, 3) Overeating, 4) Avoidance of Fattening Foods and Sweets, and 5) Emotional Eating. Study 2 found convergent validity for the WLBS by assessing the correlation of its factors/scales with established inventories of comparable constructs, e.g., dietary restraint, disinhibited eating, and physical activity. Test-retest reliability of the five scales was also supported in this second study. In Study 3, support for the internal consistency and test-retest reliability of the WLBS among overweight individuals was found. Study 4 found that all scales significantly changed in the expected directions after a 5-month behavioral weight loss treatment. The findings from this series of studies suggest that the WLBS is a reliable and valid self-report inventory of cognitive and behavioral scales associated with weight control that can be utilized as an outcome measure for weight loss interventions.