Executive functions predict weight loss in a medically supervised weight loss programme.

BACKGROUND: Deficits in executive functions are related to poorer weight loss after bariatric surgery; however, less is known about the role that these deficits may play during participation in nonsurgical weight loss programmes. This study examined associations between objectively measured executive functions and weight loss during participation in a medically supervised weight loss programme. METHODS: Twenty-three adult patients (age 50.4 ± 15.1, BMI 44.2 ± 8.8, 68% female, 92% White) enrolled in a medically supervised weight loss programme, involving prescription of a very low calorie diet and strategies to change eating and activity behaviours, underwent comprehensive computerized testing of executive functions at baseline. Weight was obtained at baseline and 8 weeks. Demographic and clinical information were obtained through medical chart review. RESULTS: Participants lost an average of 9.8 ± 3.4% of their initial body weight at 8 weeks. Fewer correct responses on a set-shifting task and faster reaction time on a response inhibition task were associated with lower weight loss percentage at 8 weeks after adjusting for age, education and depressive symptoms. There were no associations between performance on tests of working memory or planning and weight loss. CONCLUSIONS: This study shows that worse performance on a set-shifting task (indicative of poorer cognitive flexibility) and faster reaction times on a response inhibition test (indicative of higher impulsivity) are associated with lower weight loss among participants in a medically supervised weight loss programme. Pre-treatment assessment of executive functions may be useful in identifying individuals who may be at risk for suboptimal treatment outcomes. Future research is needed to replicate these findings in larger samples and identify underlying mechanisms.

The association between hypertension and sleep apnea in obese patients.

Strong associations have been demonstrated between hypertension (HTN) and obesity, and obesity and sleep apnea (SA). However, it is unclear whether previously suggested relationships between HTN and SA were based on causal mechanisms, or rather, were confounded by obesity. To investigate whether SA may be an independent predictor of HTN, we measured respiration during sleep and BP in 19 participants in a hospital-based weight control program. Additionally, subjects underwent cephalometry, measurement of weight and hip circumferences, and pulmonary function tests. Studies were repeated in 14 subjects following weight loss. Subjects consisted of 9 men and 10 women, ages 43 +/- 11 years (mean +/- SD), and weight of 114 +/- 20 kg. Hypertension (diastolic BP > 95 mm Hg, systolic BP > 160 mm Hg, or a report of current use of an antihypertensive medication) was present in 6 (32 percent) subjects. Sleep apnea was more prevalent among the hypertensive (5/6; 83 percent) than normotensive (2/13; 15 percent) subjects (p < 0.01); respiratory disturbance index (RDI) was 42.4 +/- 16.0 vs 6.2 +/- 2.3 (p < 0.01) in these groups. Compared with normotensive subjects, hypertensive subjects were of similar weight, but had greater central obesity and had lower levels of vital capacity. Regression analyses demonstrated that RDI was the strongest independent predictor of BP level, accounting for approximately 60 percent of the variability in this measurement. Following weight loss, BP and RDI both significantly declined, soft palate width decreased, and vital capacity increased. Thus, in this group of obese subjects, BP level was associated most significantly with the magnitude of sleep-related respiratory disturbances. The obese subjects who are most likely to have SA and HTN are male and/or subjects with greater central obesity and lower vital capacity.

Counseling strategies for obese patients.

Counseling strategies usually assume that an individual is ready to change; however this assumption is probably not true for many obese individuals seeking medical care. Since individuals progress through a series of stages of change, some may not yet be ready to change. The transtheoretical model of behavior change proposes that individuals move through stages of change: precontemplation, contemplation, preparation, action, and maintenance. This model has been successfully applied to a range of addictive behaviors. The application of the transtheoretical model of behavior change to obesity treatment holds promise because interventions that match treatment strategies to an individual's stage of change may be more effective than current treatments. This article reviews the potential benefits of using the transtheoretical model for weight management in the primary care setting. Medical Subject Headings (MeSH): obesity, counseling, behavior.

Increased saliva cotinine concentrations in smokers during rapid weight loss.

Although the effect of smoking cessation on weight gain is well-documented, little is known about the effect of weight loss on smoking. We examined the association between saliva cotinine levels and weight loss in a group of 9 obese female smokers during participation in a protein-sparing modified fast (Optifast). For the first 3 months of treatment, subjects consumed only the protein-sparing supplement; for the next 3 months, food was gradually reintroduced. Body mass index and saliva cotinine concentration were assessed at study entry and at 3 and 6 months. A significant weight loss was noted at 3 and 6 months, yet the cotinine level increased significantly over this time. It is unclear whether the cotinine increase is due to metabolic changes or an actual increase in nicotine intake. The results suggest that smoking-related health risks may increase during periods of significant weight loss.

History of sexual abuse and obesity treatment outcome.

In this study, clinical data from 22 obese women who reported a history of sexual abuse were compared to clinical data from 22 obese women who denied a history of sexual abuse. Subjects were matched for body mass index (BMI), sex, and age. All subjects were enrolled in a multidisciplinary outpatient hospital-based very-low-calorie diet (VLCD) weight-management program. Subjects completed a structured clinical interview, the Beck Depression Inventory (BDI), and the Weight Efficacy Life-Style Questionnaire (WEL). Subjects with a history of sexual abuse lost significantly less weight and reported more episodes of nonadherence. Possible explanations for these findings include both psychiatric distress and low weight self-efficacy. The difference between the groups in self-efficacy was greatest in situations involving negative affect or physical discomfort.

Depression, smoking, activity level, and health status: pretreatment predictors of attrition in obesity treatment.

Consistent predictors of attrition in obesity treatment have not been identified. This study examined whether pretreatment psychological and health behavior variables would predict attrition from a 26 week clinical multidisciplinary VLCD and behavior therapy program. Higher levels of depression, current smoking, being sedentary, and having nontreated high blood pressure were associated with treatment attrition. Thus, a biopsychosocial assessment which evaluates medical and psychiatric status may help clinicians to identify individuals at high risk for attrition.

Short-term results of combined radioimmunotherapy in inoperable lung cancer.

Fifty-three inoperable lung cancer patients were treated with radiotherapy combined with immunostimulation with BCG. A good response was obtained in 30 patients (56%); the results were not significantly different than those obtained with a control group of 50 lung cancer patients matched by age, sex and stage of the disease (24 out of 50 equals 46%). These short-term results were compared with the immunologic "status" of patients evaluated before treatment by the parameters monitoring in vivo and in vitro delayed type hypersensitivity. The good response to therapy was documented in a higher percentage of patients with positive skin tests to recall and standard antigens and with normal values of lymphocyte transformation with PHA and Rosette E-forming cells, in comparison with patients with low levels of immunocompetence. An impairment of the cell-mediated immune response was found after combined therapy, presumably due to radiotherapy. BCG was not able to restore the patient's immunocompetence, no effect on host's immune reactivity was demonstrated. As regards humoral immunity, the patients with low levels of IgG before treatment (12/14) showed a good response.

Current treatment of obesity: a behavioral medicine perspective.

Obesity is a complex biopsychosocial phenomenon. It has a profound effect on patients' physical and psychological health. Due to the complexity of the problem and the recidivism following treatment, it is recommended that obese patients receive in-depth interdisciplinary evaluation to match them appropriately to comprehensive treatment. Participation in an interdisciplinary comprehensive active weight loss treatment program followed by participation in a professionally led biweekly behavioral maintenance program that included social influence and aerobic exercise has generated maintenance of 83% of initial weight loss at an 18-month follow up. This comprehensive multi-disciplinary treatment approach, best offered in a behavioral medicine center setting, represents state-of-the-art treatment at this time and can result in long-term medical and psychological benefits for the obese patient.

Perceived changes in sexual functioning and body image following weight loss in an obese female population: a pilot study.

This study assessed perceived changes in sexual behavior and body image after weight loss in a clinically obese population. Thirty-two women enrolled in a hospital-based multidisciplinary weight management program completed retrospective questionnaires about their sexual functioning and body image before and after weight loss. Subjects reported significant increases in the frequency of their sexual activity. Subjects also perceived significant improvements in their body image. These findings suggest that obese people experience positive changes in sexual functioning and body image after weight loss.

Binge eating, body image, depression, and self-efficacy in an obese clinical population.

OBJECTIVE: Binge eating disorder appears to be an important factor in obesity treatment. Researchers have proposed that specialized treatment programs be developed to address chronic binge eating behavior. This study was conducted to examine the relationships between binge eating, depression, body image, and self-efficacy. Based on related research, it was hypothesized that depression and negative body image would be greater for binge eaters whereas weight self-efficacy would be lower. RESEARCH METHODS AND PROCEDURES: Subjects were 159 clinic patients participating in a multidisciplinary weight management program. Baseline measurements of binge eating status, body image and related eating behaviors, depression, and self-efficacy were obtained, whereas follow-up measures consisted of weight loss and attendance. Exploratory factor analyses were performed to obtain factors for items contained in the Eating Habits Questionnaire. Chi-square, t-tests, and logistic regression analyses determined relationships between binge eating, body image, depression, and self-efficacy. RESULTS: Univariate comparisons indicated that increased perceptions of poor body image were significantly related to binge eating. Higher levels of depression and lower weight self-efficacy were related to binge eating, but the results were qualified after applying corrective statistics for multiple comparisons. A stepwise regression analysis indicated that body image, particularly characterized by a sense of shame and concern with public appearance, had the strongest relationship to binge eating among all the factors examined in this study. DISCUSSION: These findings extend current understanding of the relationships between binge eating, body image, depression, and self-efficacy. The significance of body image, especially in relation to negative social consciousness, was determined when comparing several psychological and behavioral factors thought to influence binge eating. Further research is needed to determine the causal relationships between binge eating and the other factors examined in this study.

Changes in eating inventory scores following obesity treatment.

Eating Inventory scores may predict compliance, attrition, and outcome to obesity treatment. Research documenting change on the Eating Inventory subsequent to treatment is limited. In Study 1, 29 obese patients demonstrated significant improvement on all three factors of the Eating Inventory (Cognitive Restraint, Disinhibition, and Hunger) following a 26-week multidisciplinary weight management program. In Study 2, a second sample of 18 obese patients also demonstrated significant improvement on all three factors on the Eating Inventory following treatment. These results provide initial guidelines for the amount of change that patients may demonstrate on the Eating Inventory following treatment.

Changes in self-efficacy following obesity treatment.

Self-efficacy is an important component in the treatment of obesity. However, there is limited research examining changes in self-efficacy following obesity treatment. In this quasi-experimental study, 26 obese subjects demonstrated significant improvement on the Weight Efficacy Life-Style Questionnaire (WEL) following participation in a 26-week multidisciplinary VLCD program. Subjects demonstrated significant improvement from pre- to post-treatment on total WEL scores and on all five of the situational factors: Negative Emotions, Availability, Social Pressure, Physical Discomfort and Positive Activities. These results provide further construct validity for the WEL and offer guidelines for the amount of change that subjects may demonstrate on the WEL following obesity treatment.

Maintenance of weight loss: a needs assessment.

This study identified facilitators and obstacles to maintenance of weight loss following a very-low-calorie-diet and behavior modification program. A survey was mailed to a random sample of 178 program completers and received a 61% response rate; the most frequent follow-up period was more than 2 years. Twenty-nine percent reported weighing the same (within 10 lbs) or less than the end of their participation in the treatment program (maintainers), while 71% reported their present weight was a mean of 65% higher than their initial weight loss (regainers). Maintainers were significantly more likely to report engaging in regular aerobic exercise, attending a maintenance support group, and confidence in their ability to manage their weight in the future, while regainers were more likely to report stress and motivation as frequent weight management obstacles. Respondents consistently identified the need for low/no cost ongoing support. Maintainers and relapsers reported similar challenges in managing their weight, yet with different results, suggesting the need to identify subgroups for which different post-treatment support options could be applied.

Changes in self-efficacy and decisional balance for exercise among obese women in a weight management program.

OBJECTIVE: To assess changes in eating and exercise self-efficacy and decisional balance for exercise in an obese population enrolled in a multi-disciplinary weight management program. RESEARCH METHOD AND PROCEDURES: Thirty-two obese women were assessed at entry and after 12 weeks of treatment. RESULTS: Participants showed 15% mean weight loss after 12 weeks of treatment. Mean minutes of self-reported exercise increased by 229%. Participants demonstrated significant improvements in self-efficacy for both eating and exercise and health parameters but not in decisional balance for exercise adoption. DISCUSSION: These results may have implications for the practitioner in that self-efficacy changes occur during successful weight loss, but decisional balance for exercise may not change until individuals enter maintenance. These results imply that practitioners may be advised to shift from confidence building to relapse prevention early on in treatment, and that focusing on strengthening the pros of exercise and reducing the cons of exercise may need to remain constant during treatment.