Successful Weight Reduction Research Articles

Treatment of obesity by personality classification-oriented program.

It is apparent that personality is related to the pathogenesis of obesity, and that understanding the personality of the patient may be a key to successful treatment of the disease. Using the Rorschach test and interviews by a psychiatrist, the types of personality were classified into four groups according to the healthiness of personalities. The judgment of healthiness was based mainly on the scores obtained from the Rorschach test. This classification revealed that the occurrence of mental and physical symptoms during therapy with a very low calorie diet (VLCD) and subsequent rebound of bodyweight were more frequently observed in patients with relatively less healthy personalities. We used this classification to adapt our program to treat obese patients. In this program, severe diet restrictions were applied to patients with relatively healthy personalities. These restrictions were applied with modifications to patients with less healthy personality, because severe restrictions would be possibly very stressful for them and would bring about an undesirable reaction. For strengthening the patients' motivation for therapy, the significance of body weight reduction was explained in different ways to patients with different types of personality. The target of bodyweight reduction, reward for patients with successful weight reduction, and the duration of therapy were set up differently for patients with different personalities types. The results showed that bodyweight rebound one or two years after treatment was reduced with the personality-oriented therapy program compared to that observed with the previous conventional therapies. Also, the incidence of psychological problems was remarkably decreased.

Maintenance and relapse after weight loss in women: behavioral aspects

Obese women who regained weight after successful weight reduction (relapsers, n = 44); formerly obese, average-weight women who maintained weight loss (maintainers, n = 30); and women who had always remained at the same average, nonobese weight (control subjects, n = 34) were interviewed. Most maintainers (90%) and control subjects (82%) exercised regularly, were conscious of their behaviors, used available social support (70% and 80%, respectively), confronted problems directly (95% and 60%, respectively), and used personally developed strategies to help themselves. Few relapsers exercised (34%), most ate unconsciously in response to emotions (70%), few used available social support (38%), and few confronted problems directly (10%). These findings suggest the advisability of development and prospective evaluation of individualized treatment programs designed to enhance exercise, coping skills, and social support.

Fat calories may be preferentially stored in reduced-obese women: a permissive pathway for resumption of the obese state.

We previously demonstrated in unpaired studies that corn oil ingestion at the beginning of a euglycemic insulin clamp study decreased the responsiveness of gluteal adipose tissue lipoprotein lipase (ATLPL) to glucose/insulin in lean subjects. In this investigation, we performed paired euglycemic insulin clamp studies with glucose/insulin with or without oral corn oil in each of six lean [mean, 64 +/- 3 (+/- SE) kg] normal women and nine moderately obese (91 +/- 3 kg) women before and after 12.4 +/- 1.4-kg weight loss and 3 months of weight maintenance to determine if the inhibitory effect of fat calories existed in each of these states. In the obese women the fasting ATLPL activity [5.6 +/- 1.1 (+/- SE) neq FFA/10(6) cells.min] was greater than in the normal women (1.6 +/- 0.2) and did not change after weight loss and maintenance (5.0 +/- 0.7). As expected, in normal women corn oil ingestion diminished the responsiveness of ATLPL to glucose/insulin [change (delta), 0.2 +/- 0.2 vs. 3.3 +/- 0.8; P less than 0.02] during a 6-h euglycemic insulin (40 mU/m2.min) clamp. In obese women ATLPL activity did not change under either experimental condition (glucose/insulin with or without corn oil). However, after weight reduction ATLPL activity increased not only in response to glucose/insulin alone (delta, 7.7 +/- 2.4), but also in response to glucose/insulin when corn oil was ingested (delta, 7.9 +/- 2.8). Moreover, the response of ATLPL activity to glucose/insulin and corn oil was greater than that in lean women (P less than 0.05). Thus, in reduced-obese women not only did fasting ATLPL activity remain elevated and ATLPL responsiveness to glucose/insulin increase, but fat ingestion failed to blunt the ATLPL response. This inability of dietary fat to diminish the responsiveness of ATLPL to glucose/insulin and, therefore, the effect of the lipase on triglyceride deposition in adipose tissue could contribute to the resumption of the obese state that so commonly occurs after successful weight reduction.

Further evidence for the maintenance of successful weight reduction

In an expansion of an earlier project tracking people who had reached goal weight, the present study followed a sample of 60 people, who had reached goal weight, for 1 year. There were 90% that remained below the criterion of 75% overweight (compared with 94% in the prior sample); 62% succeeded in limiting regain to less than 20% of amount lost (compared with 58% in the prior sample). An eight-item score that predicted relapse successfully in the prior sample was not valid in the second group. Overall, successful maintenance of weight loss down to normal range appears to be a reliable result.

Towards Individual Profile Analysis for Obesity Treatment: Actual and Self-Judged Knowledge of Nutrition and Dieting and Perceived Self-Efficacy

Abstract This paper describes the first stage in the development of a diagnostic instrument for the individualization of obesity treatment, focused on cognitive and motivational factors likely to be relevant for successful and maintained weight reduction. A 145-item questionnaire was completed by 44 overweight subjects. The results indicate that most subjects were convinced that their knowledge of nutritional basics and physiology of dieting was sufficient or high, while in most cases it was actually low. Most subjects had strong self-percepts of efficacy. Another conspicuous finding was the great interindividual variability, frequently reflecting a lack of correspondence between the actual knowledge level, the self-judgement of it, and the perceived self-efficacy. The results support the idea of a diagnostic instrument yielding individual patient profiles including the factors mentioned above.

Overweight and obesity in preschool children in New York City

In an effort to ascertain the prevalence of obesity in young children, 48 nursery schools in Manhattan and Queens, New York City were surveyed. The weights and heights of 2606 children, ages 3 to 6 yr, were obtained. Three-hundred seventeen children (12.2%) were above 120% of ideal body weight and 122 (4.7%) were above 130% of ideal weight. Twenty percent of the children from schools attended by youngsters from low income families, 12% from schools attended by pupils from middle income families, and 5% from schools with pupils from families with a high income were classified as obese. Of the obese children's actual body weights 90% were at or greater than the 75th percentile for age while mean higher percentiles of the obese and nonobese children were not significantly different. Sex specific prevalence rates were similar for boys and girls. These data indicate that obesity is already prevalent in the nursery school population and that such obese children can be easily identified from weight and height measurements at a time when programs for successful permanent weight reduction and maintenance may be feasible.

Weight reduction in young obese children. I. Effects on adipose tissue cellularity and metabolism.

A 10-year longitudinal study was conducted on 16 prepubescent youngsters who had undergone successful weight reduction. Their ages ranged from 2 to 10 years when the study began. In all subjects, weight reduction proceeded only by a decrease in adipose cell size (from 0.62 +/- 0.02 to 0.46 +/- 0.02 micrograms lipid per cell) and resulted in a corresponding 33% decrease (from 177 +/- 6 to 144 +/- 5%) in percent ideal body weights. Cell numbers did not change appreciably during the period of weight loss (29.4 +/- 2.6 versus 28.7 +/- 2.3 x 10(9) total adipocytes). Three years after the start of the study, 14 of 20 youngsters had maintained their reduced percent ideal body weights, including eight who remained below 130% ideal body weight. Ten years later, only four remained below 130% ideal body weight. All four children had total adipose cell numbers below 20 x 10(9) total adipocytes at the start of the weight reduction program, a value below the lower limit for adult normal weight subjects. Thirteen other children have maintained or decreased their initial percent ideal weights. The remaining nine youngsters have further increased their percent ideal body weights. In vitro metabolic studies of the patient's adipocytes revealed a greater than 50% depression of epinephrine-stimulated lipolysis pre- and immediately postweight reduction; this decrease persisted for the entire period of study, irrespective of the maintenance of a normal percent ideal body weight. At the same time, normal 150% increases in the in vitro production of 14CO2 from [1-14C]glucose in the presence of insulin occurred.

Social Determinants of Successful Weight Loss: An Analysis of Behavioral Intentions and Actual Behavior

A prospective study associating prior beliefs with actual behaviors explored the relationship of behavioral intentions to success in weight reduction. Survey questionnaires were mailed to prospective clients of a weight-reduction clinic immediately prior to their beginning treatment. Questionnaires were returned by 115 female respondents who actually began the weight loss program. Of the 115 clients, 79 completed 6 weeks of the program, and 36 left the program in less than 6 weeks. Perceived social norms were significantly associated with behavioral intentions and with actual weight loss, whereas perceived personal consequences were not related to either behavioral intentions or actual behavior. The perceived expectations of close friends were the normative beliefs most predictive of weight-loss behavior.

Outcome expectation ratings as predictors of success in weight reduction.

Identification of obese persons likely to benefit from weight reduction programs presents considerable difficulty. Neither biological (e.g., adipose cellularity) nor psychological (e.g., MMPI profiles) measures thus far have been shown to differentiate reliably between those who do and those who do not lose weight in such programs. Fifteen obese persons about to enter a group program intended to produce "conditioned satiety" were asked to estimate the number of pounds that they expected to lose. Their outcome expectation was found to correlate significantly with weight loss recorded 7 weeks later. However, the magnitude of expected weight loss exceeded the actual amount of weight lost.

Attitudes toward obesity and the obese among professionals

Negative attitudes toward obese patients by health professionals have been attributed to termination of weight reducing attempts. This study measured attitudes concerning the obese held by professional participants in a continuing education conference on causes and treatment of obesity. Substantial variation was found on items comprising obesity-related belief dimensions: (a) Disparaging image of the obese; (b) causes of obesity; and (c) ways to lose weight. Evidence is presented for the association among measures of these dimensions. While background and educational characteristics and conditions of practice were not related to such attitudes, the professional's personal experience with successful weight reduction was the best predictor of favorable attitudes.

Locus of control and weight loss in joiners and non-joiners of weight reduction organizations.

70 female subjects who had attempted to lose weight responded to Rotter's I-E Scale and to a linear scale indicating their success in weight reduction. They also indicated whether they had ever joined an organized weight-reduction program and, if so, whether they had completed it. On the basis of their responses they were classified as Externals or Internals and as Joiners or Non-joiners producing four groups in a 2 × 2 factorial design. The groups were External Joiners, External Non-joiners, Internal Joiners and Internal Nonjoiners. The perceived locus of control did not affect self-rating scores of weight reduction. Nor did membership status affect ratings of success. An interaction between perceived locus of control and membership status was found. Internal Joiners reported greater success in weight loss than Internal Non-joiners. External subjects, however, reported greater success in weight reduction when they did not join a weight-reduction program. The least successful group in weight loss was composed of Joiners who dropped out of a program before its completion.

Energy expenditure and body composition during weight reduction in hyperplastic obese women

The energy expenditure and body composition changes in out-patients during a long-term weight reduction with a diet recommended to provide 1100 kcal were studied in eight hyperplastic obese women. The study was focused on finding plausible explanations for the decreasing weight loss rate after several weeks of successful weight reduction. Using a heart rate monitoring method, the energy expenditure was measured four times at selected intervals during the study. Then, the energy intake was calculated on the basis of three dietary recordings lasting from 4 to 7 days. The recorded energy intake increased at the end of the weight reduction, but no changes in daily energy expenditure were found. The oxygen consumption during standardized cycling, walking, and domestic work decreased, but when the patient was at rest, no changes occurred during the weight reduction. The weight loss predicted from the energy balance and body composition changes was considerably greater than the actually determined weight loss. Large discrepancies were found after 5 weeks on the weight reducing regimen between the recorded dietary intake and what could be calculated from urinary nitrogen losses. With the available methods for determining energy intake and expenditure, it was considered impossible to fully explain the reason for the weight plateau observed after long-term weight reduction in out-patients.

Familial hypertriglyceridemia in children: dietary management.

Summary: This study was designed to evaluate prospectively the continuing effects of dietary management in 44 children with familial hypertriglyceridemia. For obese children, weight reduction programs were instituted by metabolic dietitians. For nonobese children, for obese children with successful weight reduction (or for those who could not lose weight but would follow an altered diet), a modification of the National Institutes of Health (NIH) type IV diet was provided. Adherence to the diet program was monitored by monthly reassessment for 6 months in the outpatient clinic. In 43 children whose average age was 13 years at the time of diagnosis, mean ± SE plasma triglycerides were reduced after 6 months of weight reduction-NIH type IV diet from 253 ± 33 to 116 ± 8 mg/dl, P < 0.01. After 6 months on diet, the group mean decrement in weight (1 ± 1 kg) was not significant, and decrements in weight failed to correlate with decrements in plasma triglycerides, r = 0.131. Despite this failure to reduce weight appreciably, after 6 months on diet plasma triglyceride levels were reduced to normal (< 140 mg/dl) in 32 of the 43 children. At 8 months' follow-up in 13 children, mean plasma triglyceride was 170 ± 31 mg/dl, having been 290 ± 86 at time of diagnosis, P < 0.01. Plasma triglyceride levels at 8 months were normal in 5 of the 13 children. Plasma triglycerides were normal in 4 of 5 children with evaluation at 1 year, in 3 of 7 at 18 months, and in 4 of 14 at 22–26 months. When weight gain was proportionately greater than accretion of height, and where no attention to either caloric intake or composition was given, triglycerides remained elevated, whereas dietary adherence was generally accompanied by reduced or normal triglycerides. Amelioration of familial hypertriglyceridemia on the NIH type IV diet is a realizable goal in children, but requires persistent, repetitive reexamination and reinstruction. Speculation: Dietary management of pediatric familial hypertriglyceridemia may be important as a primary, longitudinal approach to reduction of the increased atherosclerotic risk attendant to familial hypertriglyceridemia.

The development of a rating scale for the prediction of success in weight reduction.

A valid and reliable rating instrument was developed that has predictive value with regard to the ability to lose weight. The major constructs that the test was intended to measure were knowledge of the pragmatics of weight reduction and obesity and the role of fantasy in weight loss. Test items were drawn from research findings in the obesity literature and from subject matter experts in the fields of nutrition, internal medicine and clinical psychology. Test-retest reliability coefficients for the new instrument range from .64 to .95. Construct validity was ascertained through administration of the scale to groups of high school students (N=20), college nutrition students (N=30) and successful and unsuccessful dieters (Ns=28 and 20, respectively). It appears that the scale, The Dash-Brown Survey of Fact and Fiction in Weight Reduction (DBS), may be employed usefully to assess the remediability of obesity for potential dieters. The data further suggest that cognitive awareness of diet-related issues is significant in weight reduction.

Alopecia in Crash Dieters

Nine patients experienced profuse hair loss two of five months after starting a vigourous weight reduction program resulting in weight loss of 11.7 to 24.75 kg. Telogen counts of 25% to 50% were observed. Regrowth of hair occurred within several months. Three patients had experienced hair loss closely following a successful weight reduction program on several occasions. Rigorous caloric restriction with subsequent inadequate energy supply of the hair matrix is thought to be the cause for the precipitation of the telogen effluvium of the crash dieter.

Personality characteristics in obesity: relation of MMPI profile and age of onset of obesity to success in weight reduction

A group of 142 obese subjects was seen in an obesity clinic over a 2-year period. Of these, 116 had assessment of personality factors by the Minnesota Multiphasic Personality Inventory (MMPI), and 71 were followed for periods of 4 to 28 months in order to determine success at weight reduction by means of a conventional dietary regimen. The MMPI profiles of the obese subjects were compared to those of a general medical population of 50,000 patients seen in the Department of Internal Medicine at the Mayo Clinic. Obese male subjects had significantly higher scores on the F and MA scales. Obese female subjects had significantly higher scores on the F, PD, PA, SC, and MA scales, and a significantly lower score on the Q scale than the reference population. Even though these findings show that certain personality traits as measured by the MMPI may occur more frequently in obese persons, the individual MMPI profile codes point out the presence of diverse behavior patterns among obese persons rather than a single personality pattern characteristic of obesity. There were no apparent differences in the success in achieving a loss of 10% or more of initial weight among the male and female obese subjects having normal or abnormal MMPI profiles. Obese subjects having onset of obesity before age 12 years were slightly more successful in weight reduction than those whose obesity began later than this, but the differences were not statistically significant for either the male or female subjects.

Predicting success in weight reduction as a function of locus of control: a unidimensional and multidimensional approach.

Data from 34 females in an overweight treatment program show significant correlations between internal scores on Rotter's Internal-External Control Scale and both completion and success in the program. Locus of control should be considered in the selection of applicants for self-control weight reduc

Self-reward and self-monitoring techniques for weight control

Obese adult volunteers ( N =49) were randomly assigned to one of fourconditions: (1) Self-Reward for Weight Loss, (2) Self-Reward for Habit Improvement, (3) Self-Monitoring, and (4) Delayed Treatment Control. Individuals in the first three groups were given information on basic stimulus control techniques for weight loss and self-monitored their weight and eating habits for a 2-wk baseline. Thereafter, Self-Monitoring subjects continued their recording and received standardized weight loss and habit change goals at individual weekly weight-ins. In addition to the above self-monitoring procedures, Self-Reward subjects awarded themselves portions of their own deposit for attainment of either their weight loss (SR-Weight) or their habit improvement (SR-Habit) goals. Control subjects received no treatment during the first 8 wk but thereafter participated in a program which combined the procedures of the previous Self-Reward groups. Weight reduction analyses revealed brief and variable losses during the self-monitored baseline. However, even after the addition of goal-setting, these reductions did not prove to be either enduring or significant. When self-reward was added to self-recording, substantial weight loss improvements were observed. These improvements were more pronounced when subjects rewarded themselves for habit change rather than weight loss. A significant relationship was found between successful weight reduction and degree of eating improvement. Clinical implications and contemporary research issues are briefly discussed.

Frequency of Feeding, Weight Reduction, and Body Composition1

Do more frequent, small meals really result in greater success in weight reduction, as some studies have indicated? These authors report a study with college men fed six, three, and one meal(s) a day during successive periods for comparisons of the effect on * weight loss; body composition; and nitrogen, sodium, and potassium balances.

COMMITTEE ON NUTRITION

Despite an imposing body of information derived from research, our ignorance concerning the etiology, pathogenesis, and treatment of obesity is remarkable. It is clear that when considering a given patient the terms "overweight" and "obese" are not necessarily synonymous. Evidence derived from various viewpoints suggests that obesity cannot be regarded as an etiologically unique metabolic disorder. It is likely that an excess of adipose tissue in man will ultimately prove to represent a clinical end-point common to a variety of hereditary and acquired disorders, as in the case of experimental animals, rather than a singular morbid condition with unique pathogenesis. The identification and evaluation of the inherited, acquired, metabolic, and psychogenic determinants of obesity still present an urgent challenge for future research. Mortality and morbidity rates for diabetes and cardiovascular disease are higher in obese adults than in those of average weight. These risks appear to be diminished by weight reduction. Because the majority of obese children do tend to remain obese as adults and because our society exerts considerable pressure towards relative leanness as a criterion for social acceptability, early treatment of obesity would seem to be a worthy objective. However, the fact is that no methods of treatment have as yet achieved more than minor success in significant sustained weight reduction. Since the natural history of childhood obesity remains ill-defined, the results of testimonials from inadequately controlled studies with short follow-up periods (less than 2 or 3 years) must be viewed with skepticism. Any attempts to achieve lasting weight reduction in obese children and adolescents should be tempered by a realization of the inherent difficulties of treatment and by sympathy for those children who, for reasons poorly understood by their physicians. lack the ability to regulate the delicate balance between physical activity and caloric intake. It appears that when treatment is directed at only a single element of the thermodynamic equilibrium, caloric intake, the chances of successful and lasting weight reduction are small. Prophylaxis may offer the most logical method for dealing with obesity. Prevention is necessary in high-risk families and should be undertaken by the family physician. The role of public health programs implemented by education may decrease the level of obesity in the remainder of the population. The efficacy of either approach remains to be determined. While there is knowledge of some of the metabolic derangements characteristic of the obese adult, little is known about these in childhood. In view of the apparent hazards of obesity in adult life, the patent failures characteristic of virtually all therapeutic approaches and the scientific void in knowledge of pathogenesis or pathophysiology make the study of obesity a compelling undertaking for the investigator.