Lifestyle behaviour and prevalence of cardiovascular risk factors - a pilot study comparing Kiribati and European seafarers.

BACKGROUND: According to internal observations within a German shipping company, obvious risk-behaviour persists among the crew members coming from the Pacific Island State of Kiribati and representing a large part of the crew aboard merchant vessels of this company. These observations were related to excessive eating habits. This study aims to assess the cardiovascular risk among seafarers and to compare lifestyle factors between Kiribati and European crew members. METHODS: In the present maritime field study 81 sailors (48 Kiribati, 33 European, average age at 38.9 and 36.8 years respectively) were examined from April until August 2014 aboard four container ships crossing the Atlantic Ocean (participation rate of 90.9%). RESULTS: Based on the number of established risk factors, 35.4% of the Kiribati and 16.7% of the European crew members were regarded as a high risk group for cardiovascular diseases. The HDL-values of Kiribati were found to be considerably lower (34.9 mg/dl) than the references values given by the WHO and in comparison to the European crew members (44.8 mg/dl) (p = 0.002). 91.7% of Kiribati and 51.5% of European participants were found to be overweight according to WHO-criteria - with a mean Body Mass Index (BMI) of 30.3 kg/m2 and 25.6 kg/m2 (p <  0.001). Regarding lifestyle factors Kiribati often claimed to eat significantly larger amounts of food aboard while most European sailors stated to eat less or about the same during their shipboard stay (p = 0.017). Daily sleeping hours were slight on both sides; however with a mean of 5.2 h a day Kiribati crew members had significant fewer sleep (p = 0.038). The examined Kiribati sailors had a mean increase in weight of 6 kg over a 12 months period of observation. CONCLUSIONS: In total the compiled data points towards a higher risk of cardiovascular diseases particularly due to alimentary habits within the Kiribati crew members. The distinct weight-gain measured among the Kiribati in spite of higher energy consumption levels at sea is alarming. Thus, the results of this study confirm the necessity of health-improving interventions aboard cargo vessels.

Health service resource needs for pandemic influenza in developing countries: a linked transmission dynamics, interventions and resource demand model.

We used a mathematical model to describe a regional outbreak and extrapolate the underlying health-service resource needs. This model was designed to (i) estimate resource gaps and quantities of resources needed, (ii) show the effect of resource gaps, and (iii) highlight which particular resources should be improved. We ran the model, parameterized with data from the 2009 H1N1v pandemic, for two provinces in Thailand. The predicted number of preventable deaths due to resource shortcomings and the actual resource needs are presented for two provinces and for Thailand as a whole. The model highlights the potentially huge impact of health-system resource availability and of resource gaps on health outcomes during a pandemic and provides a means to indicate where efforts should be concentrated to effectively improve pandemic response programmes.

Problems in identifying predictors and correlates of weight loss and maintenance: implications for weight control therapies based on behaviour change.

Weight management is a dynamic process, with a pre-treatment phase, a treatment (including process) phase and post-treatment maintenance, and where relapse is possible during both the treatment and maintenance. Variability in the statistical power of the studies concerned, heterogeneity in the definitions, the complexity of obesity and treatment success, the constructs and measures used to predict weight loss and maintenance, and an appreciation of who and how many people achieve it, make prediction difficult. In models of weight loss or maintenance: (i) predictors explain up to 20-30% of the variance; (ii) many predictors are the sum of several small constituent variables, each accounting for a smaller proportion of the variance; (iii) correlational or predictive relationships differ across study populations; (iv) inter-individual variability in predictors and correlates of outcomes is high and (v) most of the variance remains unexplained. Greater standardization of predictive constructs and outcome measures, in more clearly defined study populations, tracked longitudinally, is needed to better predict who sustains weight loss. Treatments need to develop a more individualized approach that is sensitive to patients' needs and individual differences, which requires measuring and predicting patterns of intra-individual behaviour variations associated weight loss and its maintenance. This information will help people shape behaviour change solutions to their own lifestyle needs.

Dietary restraint and disinhibition: is restraint a homogeneous construct?

The homogeneity of the restraint construct is investigated in a study of 54,525 subjects participating in a weight reduction program. Using the German version of the TFEQ (Stunkard & Messick, 1985, Journal of Psychosomatic Research, 29, 71-83; Pudel & Westenhoefer 1989a, Fragebogen zum Essverhalten; Handanweisung), it is shown that different types of relations exist between the items measuring dietary restraint and the disinhibition scale. A discriminant analysis in a subgroup of moderately highly restrained eaters with either low or high disinhibition (n = 1759) reveals different sets of restraint behaviours and cognitions that differentiate between high and low disinhibition. These findings are replicated in an independent validation sample (n = 1693). Two restraint subscales are constructed, one associated with increasing disinhibition, the other with decreasing disinhibition. It is argued that different sets of restrained behaviours and cognitions should be differentiated when looking at the causal link between restraint and disturbances of eating behaviour.

Establishing good dietary habits -- capturing the minds of children.

OBJECTIVE: To review the psycho-social research with respect to relevance for the development of nutritional education strategies. RESULTS: The eating behaviour of the newborn baby is controlled by innate preferences and dislikes, and by biological self-regulation. These innate control-systems are modified by learning processes, most importantly by the mere exposure to unknown food, by social influences, and by associating the physiological consequences of food intake with taste cues. The last decades have witnessed a change of the social meaning of food and eating, and the social context of eating is subject to dramatic changes. While on the one hand, prevalence of overweight and obesity is increasing, even young children deliberately practise weight control measures ranging from selective food choice to self-induced vomiting thus including behaviours which are clearly symptomatic of eating disorders. Such behaviour is motivated by unrealistic conceptions of a healthy body weight and shape. Children are interested in a range of nutrition topics. However, these topics have to be related to direct perceivable benefits from nutrition. CONCLUSIONS: Educational strategies should: firstly, focus on providing a variety of foods, including a range of nutrient-dense 'healthy' food and encouraging children to taste it; secondly, provide a stable and predictive pattern of social eating occasions to promote the social meaning and importance of eating and to enable social learning of food preferences; and finally, encourage a positive body image by providing advice and reassurance regarding the range of healthy and acceptable body weights and shapes.

Prevalence of eating disorders and weight control practices in Germany in 1990 and 1997.

OBJECTIVE: To investigate whether the prevalence of bulimic behaviors and weight control practices changed between 1990 and 1997. METHOD: In November 1997, we surveyed a representative sample of 2,130 adult subjects in West Germany and 2,155 subjects in East Germany. We asked subjects about binge eating, vomiting, use of laxatives, appetite suppressants and diuretics, and about dieting, weighing, and exercise. As the same questions had been used in a representative survey (N = 1,773) in autumn 1990 in West Germany, trend comparisons for prevalence between 1990 and 1997 are possible. RESULTS: The prevalence of severe eating binges twice a week dropped nonsignificantly between 1997 and 1990 from 3.1% to 2.4% in men and from 2.3% to 1.3% in women. In men, the prevalence of binge eating disorder dropped nonsignificantly from 2.4% to 1.5%, the prevalence of bulimia nervosa from 2.1% to 1.1%. In women, the prevalence of binge eating disorder dropped nonsignificantly from 1.5% to 0.7% and that of bulimia nervosa from 2.4% to 1.1%. CONCLUSION: The prevalence of bulimic behaviors decreased slightly during 1990 and 1997 in the West German population.

The therapeutic challenge: behavioral changes for long-term weight maintenance.

OBJECTIVES: Long-term results of dietary and behavioral treatment of obesity fail to match the obese patients' expectations, as well as the professionals' requirements. The therapeutic challenge remains to induce behavioral changes during treatment which are maintained over a long period of time, thus enabling long-term weight maintenance. The paper develops a framework to improve lasting behavioral changes. RESULTS AND CONCLUSIONS: Four elements may enhance long-term success. First, patients' unrealistic expectations about the weight loss have to be modified and patients have to be supported in accepting moderate and modest weight losses as success. Second, behavioral change can only be achieved if treatment involves a long-lasting training process, which for most patients needs to continue more than a year. Third, behavioral and attitudinal change should be governed by the principle of flexible control of eating behavior, and rigid control should be discouraged. Forth, long-term success appears to be more likely, the more behavioral dimensions are involved in the process of behavioral change.

Cognitive control of eating behaviour and the disinhibition effect.

Restrained eaters have been reported to overeat following a high caloric preload, a phenomenon referred to as the disinhibition effect. However this effect has not been found when subjects were classified by the restraint subscales of the Three-Factor Eating Questionnaire (TFEQ; Stunkard & Messick, 1985) or the Dutch Eating Behaviour Questionnaire (van Strien et al., 1986). The present study investigates the disinhibition effect in 133 normal-weight young women, using a two-factorial classification including the TFEQ-restraint and the TFEQ-disinhibition scale. The subjects were requested to consume ice-cream ad libitum during a taste test following a 200-ml milkshake preload or without preload. The results show that the behavioural disinhibition effect occurs only in subjects with simultaneous high scores on both subscales. In addition, subjects with high disinhibition scores consumed more ice-cream than low disinhibition subjects irrespective of their degree of restraint. While subjects with a more rigid control of eating behaviour did not show a difference in the amount of ice-cream consumed with or without preload, subjects with a more flexible control of eating behaviour reduced their intake following the preload condition. With regard to the Revised Restraint Scale (RRS Herman & Polivy, 1980) multiple regression results show that high RRS scores may be due to either higher TFEQ-restraint or higher TFEQ-disinhibition scores. The interpretation of the results favours the renaming of the TFEQ-disinhibition scale to "susceptibility to eating problems" because high scores on this scale indicate overeating in a variety of situations without requiring prior inhibition i.e. dietary restraint. It is supposed that high susceptibility to eating problems may be caused by rigid control of eating behaviour, whereas flexible control of eating behaviour may be a less problematic strategy of long-term weight control.

Validation of the flexible and rigid control dimensions of dietary restraint.

OBJECTIVE: Two subscales for the Eating Inventory (Three-Factor Eating Questionnaire) are developed and validated: Rigid and Flexible control of eating behavior. METHOD: Study I is an analysis of questionnaire data and a 7-day food diary of 54,517 participants in a computer-assisted weight reduction program. Study II is a study of 85 subjects used to develop a final item pool. Study III is a questionnaire survey of a random sample (N = 1,838) from the West German population aged 14 years and above used to validate the developed subscales. RESULTS: Rigid control is associated with higher scores of Disinhibition, with higher body mass index (BMI), and more frequent and more severe binge eating episodes. Flexible control is associated with lower Disinhibition, lower BMI, less frequent and less severe binge eating episodes, lower self-reported energy intake, and a higher probability of successful weight reduction during the 1-year weight reduction program. DISCUSSION: Rigid and flexible control represent distinct aspects of restraint having different relations to disturbed eating patterns and successful weight control.

Behavioural correlates of successful weight reduction over 3 y. Results from the Lean Habits Study.

OBJECTIVE: To examine behavioural characteristics of subjects with successful long-term weight reduction. DESIGN: Prospective cohort study with 3 y follow-up. SETTING: Multicentre study of participants of a commercial weight-reduction programme (BCM-Programme). SUBJECTS: Until February 2000, 6857 voluntary study participants were included. Analyses are based on 1247 subjects with complete 3 y data. INTERVENTIONS: Open-group dietary and behavioural counselling with initial meal substitutions. RESULTS: Subjects show a number of significant behavioural improvements, for example, choice of low-fat food, flexible control of eating behaviour and coping with stress. Subjects who maintain these changes by the end of the first year have a higher probability of successful weight reduction after 3 y. CONCLUSIONS: Successful weight maintenance is associated with more pronounced improvements of health behaviours after 1 y. The likelihood of success increases with the number of behavioural patterns which are involved in the process of change.