Healthy lifestyle change and subclinical atherosclerosis in young adults: Coronary Artery Risk Development in Young Adults (CARDIA) study.

BACKGROUND: The benefits of healthy habits are well established, but it is unclear whether making health behavior changes as an adult can still alter coronary artery disease risk. METHODS AND RESULTS: The Coronary Artery Risk Development in Young Adults (CARDIA) prospective cohort study (n=3538) assessed 5 healthy lifestyle factors (HLFs) among young adults aged 18 to 30 years (year 0 baseline) and 20 years later (year 20): not overweight/obese, low alcohol intake, healthy diet, physically active, nonsmoker. We tested whether change from year 0 to 20 in a continuous composite HLF score (HLF change; range, -5 to +5) is associated with subclinical atherosclerosis (coronary artery calcification and carotid intima-media thickness) at year 20, after adjustment for demographics, medications, and baseline HLFs. By year 20, 25.3% of the sample improved (HLF change ≥+1); 40.4% deteriorated (had fewer HLFs); 34.4% stayed the same; and 19.2% had coronary artery calcification (>0). Each increase in HLFs was associated with reduced odds of detectable coronary artery calcification (odds ratio=0.85; 95% confidence interval, 0.74-0.98) and lower intima-media thickness (carotid bulb ß=-0.024, P=0.001), and each decrease in HLFs was predictive to a similar degree of greater odds of coronary artery calcification (odds ratio=1.17; 95% confidence interval, 1.02-1.33) and greater intima-media thickness (ß=+0.020, P<0.01). CONCLUSIONS: Healthy lifestyle changes during young adulthood are associated with decreased risk and unhealthy lifestyle changes are associated with increased risk for subclinical atherosclerosis in middle age.

The potential of virtual reality technologies to improve adherence to weight loss behaviors.

A significant proportion of the global population is obese, foreshadowing an epidemic of chronic disease. Self-monitoring (of diet, exercise, and body weight), decreasing energy intake, and increasing energy expenditure are robust predictors of successful weight loss. However, few individuals consistently practice these behaviors, making long-term weight loss and maintenance unlikely. Technologies afford unique opportunities to overcome barriers and increase the reach of traditional obesity interventions. In this article, we introduce ENGAGED, a technology-enhanced modification of the Diabetes Prevention Program designed to improve adherence to weight loss behaviors. Using a treatment implementation framework, we suggest how virtual reality technologies might further improve the delivery, receipt, and enactment of ENGAGED to maximize patient impact.

PDA+: A Personal Digital Assistant for Obesity Treatment - an RCT testing the use of technology to enhance weight loss treatment for veterans.

BACKGROUND: Obese adults struggle to make the changes necessary to achieve even modest weight loss, though a decrease in weight by as little as 10% can have significant health benefits. Failure to meet weight loss goals may in part be associated with barriers to obesity treatment. Wide-spread dissemination of evidence-based obesity treatment faces multiple challenges including cost, access, and implementing the programmatic characteristics on a large scale. AIMS: The PDA+: A Personal Digital Assistant for Obesity Treatment randomized controlled trial (RCT) was designed to test whether a PDA-based behavioral intervention enhances the effectiveness of the existing group weight loss treatment program at VA Medical Centers Managing Overweight/Obese Veterans Everywhere (MOVE!). We also aim to introduce technology as a way to overcome systemic barriers of traditional obesity treatment. METHODS/DESIGN: Veterans enrolled in the MOVE! group at the Hines Hospital VAMC with BMI ≥ 25 and ≤ 40 and weigh < 400 pounds, experience chronic pain (≥ 4 on the NRS-I scale for ≥ 6 months prior to enrollment) and are able to participate in a moderate intensity exercise program will be recruited and screened for eligibility. Participants will be randomized to receive either: a) MOVE! treatment alone (Standard Care) or b) Standard Care plus PDA (PDA+). Those randomized to PDA+ will record dietary intake, physical activity, and weight on the PDA. In addition, they will also record mood and pain intensity, and receive biweekly telephone support for the first 6-months of the 12-month study. All participants will attend in-person lab sessions every three months to complete questionnaires and for the collection of anthropomorphic data. Weight loss and decrease in pain level intensity are the primary outcomes. DISCUSSION: The PDA+ trial represents an important step in understanding ways to improve the use of technology in obesity treatment. The trial will address barriers to obesity care by implementing effective behavioral components of a weight loss intervention and delivering high intensity, low cost obesity treatment. This RCT also tests an intervention approach supported by handheld technology in a population traditionally considered to have lower levels of technology literacy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00371462.

Chronic dieting among extremely obese bariatric surgery candidates.

BACKGROUND: Extremely obese bariatric surgery candidates report numerous episodes of both successful and unsuccessful dieting attempts, but little is known about the clinical significance of frequent dieting attempts in this patient group. METHODS: The current study examined psychological and weight-related correlates of self-reported dieting frequency in 219 bariatric surgery candidates (29 men and 190 women). Prior to surgery, patients completed a battery of established self-report assessments. Patients were dichotomized into chronic dieters (n=109) and intermittent dieters (n=110) based on a median split of self-reported percent time spent dieting during adulthood. The two dieting groups were compared on demographics, eating and weight history, eating disorder psychopathology, and global functioning. RESULTS: Chronic dieters had significantly lower pre-operative body mass indexes (BMIs), lower highest-ever BMIs, more episodes of weight cycling, and earlier ages of onset for overweight and dieting than intermittent dieters. After controlling for differences in BMI, chronic dieters were found to have statistically but not clinically significant elevations in eating concerns, dietary restraint, and body dissatisfaction than infrequent dieters. The two groups, however, did not differ significantly on depressive symptoms, self-esteem, or health-related quality of life; nor did they differ in binge-eating status. CONCLUSIONS: Chronic dieting is commonly reported among extremely obese bariatric candidates and is not associated with poorer psychological functioning or binge eating and may be beneficial in attenuating even greater weight gain. Our findings provide preliminary data to suggest that requiring additional presurgical weight loss attempts may not be warranted for the vast majority of extremely obese bariatric candidates.

The metabolic syndrome and behavioral correlates in obese patients with binge eating disorder.

This study examined the frequency of the metabolic syndrome (MetSyn) and explored behavioral eating- and weight-related correlates in obese patients with binge eating disorder (BED). Ninety-three treatment-seeking obese BED patients (22 men and 71 women) with and without the MetSyn were compared on demographic features and a number of current and historical eating and weight variables. Sixty percent of the obese patients with BED met criteria for the MetSyn, with men and whites having significantly higher rates than women and African Americans, respectively. Patients with vs. without coexisting MetSyn did not differ significantly in self-reported frequency of binge eating or severity of eating disorder psychopathology. Multivariate hierarchical logistic regression analysis revealed that, after controlling for gender, ethnicity, and BMI, fewer episodes of weight cycling and regular meal skipping were significant predictors of the MetSyn. These findings suggest that lifestyle behaviors including weight loss attempts and regular meal consumption may be potential targets for prevention and/or treatment of the MetSyn in obese patients with BED.

Dieting frequency in obese patients with binge eating disorder: behavioral and metabolic correlates.

This study examined the clinical significance of self-reported frequency of time spent dieting in obese patients with binge eating disorder (BED). A total of 207 treatment-seeking obese BED patients (57 men and 150 women) were dichotomized by dieting frequency and gender and compared on a number of historical, psychological, and metabolic variables. Frequent dieters reported significantly earlier age of onset for binge eating, dieting, and obesity, more episodes of weight cycling, greater weight suppression, and greater eating disorder pathology than infrequent dieters; no differences, however, emerged on current binge eating frequency or psychological distress. Among women but not among men, frequent dieters had consistently lower chances of abnormalities in total cholesterol, high-density lipoprotein (HDL) cholesterol, and the total/HDL cholesterol ratio while infrequent dieters had greater chances of abnormalities on these variables. Dietary restraint was inversely correlated with abnormalities in triglycerides, HDL cholesterol, and the total/HDL cholesterol ratio but was unrelated to low-density lipoprotein (LDL) cholesterol. In summary, frequent dieters of both genders had greater lifetime and current eating and weight concerns, and in women, decreased chance of metabolic abnormalities than infrequent dieters. Our findings suggest that frequent dieting attempts, particularly in women, are associated with greater eating disorder pathology but may have a beneficial effect on metabolic functioning and cardiovascular disease risk independent of actual weight status. These findings may have implications for clinical advice provided to obese BED patients.

Compensatory eating disorder behaviors and gastric bypass surgery outcome.

OBJECTIVE: This study prospectively examined the role of compensatory eating disorder behavior on gastric bypass (GB) surgery weight-loss outcome. METHOD: The compensatory behaviors of 199 GB patients were evaluated presurgically using the Questionnaire of Eating and Weight Patterns. Hierarchical linear regression was used to assess the presence of compensatory behavior on 6-month postsurgery body mass index (BMI), and 1-year postsurgery BMI, controlling for age, sex, race, age becoming overweight, number of weeks postsurgery, and presurgery BMI. RESULTS: The presence of presurgery compensatory behavior emerged as a small but significant predictor of lower BMI 6-months postsurgery although not at 1-year postsurgery. Other common predictors for lower BMI at 6-months and 1-year postsurgery were lower presurgery BMI and greater number of weeks postsurgery. Female sex also predicted lower BMI 1-year postsurgery. DISCUSSION: These results must be taken with caution as they contradict clinical guidelines. Future research is needed to replicate these findings.

Appearance motives to tan and not tan: evidence for validity and reliability of a new scale.

BACKGROUND: Risk for skin cancer is increased by UV exposure and decreased by sun protection. Appearance reasons to tan and not tan have consistently been shown to be related to intentions and behaviors to UV exposure and protection. PURPOSE: This study was designed to determine the factor structure of appearance motives to tan and not tan, evaluate the extent to which this factor structure is gender invariant, test for mean differences in the identified factors, and evaluate internal consistency, temporal stability, and criterion-related validity. METHOD: Five-hundred eighty-nine females and 335 male college students were used to test confirmatory factor analysis models within and across gender groups, estimate latent mean differences, and use the correlation coefficient and Cronbach's alpha to further evaluate the reliability and validity of the identified factors. RESULTS: A measurement invariant (i.e., factor-loading invariant) model was identified with three higher-order factors: sociocultural influences to tan (lower order factors: media, friends, family, significant others), appearance reasons to tan (general, acne, body shape), and appearance reasons not to tan (skin aging, immediate skin damage). Females had significantly higher means than males on all higher-order factors. All subscales had evidence of internal consistency, temporal stability, and criterion-related validity. CONCLUSIONS: This study offers a framework and measurement instrument that has evidence of validity and reliability for evaluating appearance-based motives to tan and not tan.

Effects of dieting-related messages on psychological and weight control variables.

OBJECTIVE: The current study sought to empirically examine the immediate and short-term effects of dieting-related psychoeducational messages on established risk factors for eating pathology and weight control variables. METHOD: One-hundred thirty nine participants were randomly assigned to a prodieting, antidieting, or control message condition. Variables were assessed at baseline, post-test, and 2-week follow-up. RESULTS: The prodieting condition produced significantly greater dieting intentions, perceived pressure to lose weight, and internalization intentions, whereas the antidieting message yielded significantly lower bulimic intentions. Healthy eating significantly increased from baseline to follow-up in the prodieting condition. No other behavioral changes were found. Perceived pressure to lose weight mediated the relationship between diet message and post-test weight control intentions, state negative-affect, and body dissatisfaction. CONCLUSION: The findings provide initial support for the short-term efficacy of the prodieting message to increase healthy eating behaviors; however, immediate increases in established risk factors for eating pathology also emerged. Implications are discussed.

Day-to-day body-image states: prospective predictors of intra-individual level and variability.

Most body-image research has focused on the trait level of body-image evaluation, often neglecting the momentary fluctuations many people experience in everyday life. The present prospective study investigated whether theory-relevant body-image measures, perfectionistic self-presentation, and eating attitudes would predict average day-to-day body-image levels and their intra-individual variability. A convenience sample consisted of 121 women from two universities. In Phase 1 of the study, participants completed an online battery of selected body-image and personality questionnaires. In Phase 2, participants went online to complete the dependent measure, the Body Image States Scale, once per evening over 10 days. As hypothesized, more favorable body-image state levels were associated with less investment in appearance for self-worth, less body-image disturbance, fewer body-image cognitive distortions, less disturbed eating attitudes, and lower body mass. Moreover, greater day-to-day body-image variability was predicted by greater psychological investment in appearance, more body-image cognitive distortions, and higher perfectionistic self-presentation. Implications and future directions for research are discussed.

Considerations for the use of the Beck Depression Inventory in the assessment of weight-loss surgery seeking patients.

BACKGROUND: The Beck Depression Inventory (BDI) is an assessment frequently used in pre-surgical evaluation for patients seeking bariatric surgery. Items on the BDI reflect both cognitive and somatic symptoms associated with depression. However, many patients seeking bariatric surgery have medical symptomatology and health concerns independent of the syndrome of depression, and thus scores on the BDI may inflate their actual level of depression. With depression viewed by some clinicians as contraindicated for bariatric surgery, clarification of the BDI items is necessary. METHODS: Pre-surgical BDIs of 259 bariatric patients were reviewed. An exploratory factor analysis was conducted to examine the factor structure of the BDI in this population. Independent sample t-tests compared the means of the cognitive and somatic items. RESULTS: A clear two-factor solution emerged on the BDI, indicating items mapped on to either a cognitive or a somatic domain. The patients in the present sample also were more likely to endorse somatic and health-related symptoms on the BDI. CONCLUSIONS: The factor structure of the BDI in this population is similar to that in other non weight-loss surgery populations. However, this population is more likely to endorse somatic complaints that may not be indicative of depression, rather an acknowledgement of actual medical complaints. Thus, assessors should be mindful of specific symptom endorsement, rather than a total depression score when utilizing the BDI to help determine surgery suitability.

Depressed mood in class III obesity predicted by weight-related stigma.

BACKGROUND: Greater depressed mood in Class III obese surgery-seeking clients may be due to weight-related stigma, weight-related physical disability (e.g. mobility) or the presence of binge-eating (BE). METHODS: 60 Class III obese surgery-seeking adults were administered the Beck Depression Inventory (BDI), weight-related physical disability (IWQOL-PF) and another weight-related stigma (IWQOL-PD), and assessed for BE (SCID-1 or Questionnaire of Eating and Weight Patterns) before surgery. RESULTS: In a hierarchical regression analysis, BMI, gender, and age of obesity onset did not account for a significant portion of the variance in BDI scores in the first step. The second step of the model was statistically significant (F(3,53)=8.469, P<0.000), accounting for 33.6% of the variance in BDI scores. IWQOL-PD scores were the only significant predictor of BDI scores (b=0.518, P=0.001), and this independently contributed to 32.6% of the variance in BDI scores. CONCLUSION: This suggests that depressed mood seen in Class III obese surgery-seeking individuals may be most related to weight-related stigma rather than BE status, or weight-related physical disability.

Why patients seek bariatric surgery: a qualitative and quantitative analysis of patient motivation.

BACKGROUND: Bariatric surgery is becoming a common procedure to control the obesity problem in the United States. However, despite the prevalence of the surgery, little is known regarding the motivation of patients who seek out these procedures. This present study aims to qualitatively and quantitatively examine in a moderate-sized sample of bariatric seeking patients their reported reasons for wanting surgery. METHODS: 109 severely obese patients (mean BMI 49.9) seeking either the duodenal switch or gastric bypass surgery between 1999 and 2002 were surveyed as to their motivations for seeking weight loss surgery. Their responses were coded into psychological, medical and quality of life categories for analysis. Depression and Quality of Life data was also obtained. RESULTS: Descriptive analysis of the data indicated the vast majority (73.4%) of respondents endorsed current medical ailments as their primary reason for seeking weight loss surgery. Patients who responded with a secondary reason for desiring surgery reported primarily psychological and quality of life reasons. Scores on depression and quality of life measures did not impact their endorsed reasons for seeking surgery. CONCLUSIONS: Patients in the present sample appear motivated for surgery primarily to control current medical problems. However, a significant portion of patients do endorse psychological and quality of life factors as important in their decision to seek weight loss surgery.

Dissonance-based eating disorder prevention program: a preliminary dismantling investigation.

OBJECTIVE: A dissonance-based program aimed at reducing thin-ideal internalization has been found to significantly decrease levels of bulimic symptoms in young adult and adolescent females. Because this program is multifaceted, containing psychoeducation, counterattitudinal advocacy, and behavioral exposure components, the current study sought to investigate the mechanisms involved in symptom reduction. METHOD: The current study compared the original treatment program with a dismantled version of the full package, which consisted solely of the specific dissonance component (i.e., the counterattitudinal advocacy procedure). Seventy-eight women were randomly assigned to either the full treatment condition or the counterattitudinal advocacy condition. RESULTS: Findings suggest that both interventions significantly reduced established risk factors for eating pathology as well as bulimic symptoms at termination and at 1-month follow-up. CONCLUSION: Both treatments appear to be equally effective at reducing eating pathology in at-risk college women. Limitations of the study are discussed, and directions for future research are offered.

An investigation of appearance motives for tanning: The development and evaluation of the Physical Appearance Reasons For Tanning Scale (PARTS) and its relation to sunbathing and indoor tanning intentions.

Motives for UV exposure have been shown to be related to appearance concerns, yet little research has examined specific tan appearance attitudes. Given this lacuna, Study 1 involved the identification of six factors among college female tanners: general attractiveness, media influence, family/friends influence, physical fitness appearance, acne reasons, and skin aging concerns. In Study 2, a separate sample of college female tanners were used to validate a higher order factor model, which demonstrated acceptable fit. Additionally, the factors converged in the expected directions, with the general attractiveness and skin aging concerns being the best correlate of UV exposure and sun-protection intentions. The relevance of these findings to skin cancer prevention is discussed.

The influence of communicator weight on psychoeducational message acceptance in females with high vs. low levels of body image disturbance.

Researchers have yet to examine the effect of the communicator's weight status on participants' responses to an eating disorder or body dissatisfaction prevention program. It is plausible that participants may be reactive to the weight of the communicator (e.g., therapist), which might adversely affect acceptance of the message contained in the program. In the current study, 217 college females were randomly assigned to three communicator weight conditions (underweight, average weight, and overweight). Participants in each group were subdivided by trait body dissatisfaction level, based on a median split. The procedure involved the implementation of a well-established psychoeducational intervention designed to decrease endorsement of the thin-ideal. Results supported the overall efficacy of the intervention but indicated a minimal effect for participant's trait dissatisfaction level and communicator weight status on a variety of outcome measures. Limitations of the current study are provided, as well as recommendations for future research.

Female college students and cosmetic surgery: an investigation of experiences, attitudes, and body image.

This large, multisite study investigated female college students' experiences with and attitudes about cosmetic surgery. The study also assessed the relationship between several aspects of body image, including appearance satisfaction and investment and symptoms of body dysmorphic disorder, and interest in cosmetic surgery. Thirty (5 percent) of the 559 women surveyed reported that they had undergone cosmetic surgery. Two thirds of respondents reported knowing someone who had received cosmetic surgery, and approximately one third indicated that a family member had undergone surgery. Overall, participants held relatively favorable attitudes about surgery. Regression analysis suggested that a greater psychological investment in physical appearance and greater internalization of mass media images of beauty predicted more favorable attitudes toward cosmetic surgery. Fourteen women (2.5 percent) screened positive for body dysmorphic disorder based on the nature and severity of their self-reported body-image concerns. Results of this study provide new information on young women's experiences and attitudes about cosmetic surgery and how these attitudes relate to body image.

Media exposure, mood, and body image dissatisfaction: an experimental test of person versus product priming.

In the current study, 138 college females were randomly assigned to four media exposure conditions based on the presence or absence of an attractive person (fashion model) and the presence or absence of an appearance-related product. Outcome measures consisted of visual analogue ratings of multiple body image and mood variables. The results revealed a significant main effect for person, indicating that the presence of a model increased levels of body dissatisfaction and negative mood. No product effect emerged and there was no significant interaction between person and product. These findings suggest that the appearance priming effect of media exposure on body dissatisfaction and mood is specific to a person stimulus, with no additional effect promoted by a generic appearance-relevant stimulus.

Reliability assessment of the somatomorphic matrix.

OBJECTIVE: The appearance of muscularity is an emerging topic of research interest within the body image field. However, the most widely used measure to assess attitudes toward muscularity, the somatomorphic matrix, lacks pertinent reliability data. METHOD: In response to this dearth of information, the current study assessed the test-retest reliability of this measure in samples of men and women. RESULTS: Surprisingly, the somatomorphic matrix demonstrated inadequate reliability for the majority of assessed rating protocols. DISCUSSION: The implications of this finding on assessment of the muscularity construct are discussed.

The sociocultural attitudes towards appearance scale-3 (SATAQ-3): development and validation.

OBJECTIVE: The goal of this investigation was to develop and validate a revision of a widely used measure of societal influences on body image and eating disturbances-the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ). METHOD: Two independent samples of college females completed a revision and extension of the SATAQ and factor analyses were conducted to determine the underlying structure of the revised scale. RESULTS: Factor analyses indicated two distinct internalization factors: one appeared to reflect a generic media influence related to TV, magazines, and movies. A second factor clearly reflected internalization of athletic and sports figures. Two other factors, reflecting media pressures and media as an informational source, also emerged. Another widely used measure of thin-ideal internalization, the Ideal Body Internalization Scale-Revised (IBIS-R), was included in factor analyses to determine its empirical relationship with the revised SATAQ. None of the IBIS-R items loaded with any of the internalization items or items reflective of media pressures or information. Instead, the IBIS-R appeared to tap into an awareness of appearance norms dimension. The SATAQ-3 subscales had excellent convergent validity with measures of body image and eating disturbance. Eating-disturbed and eating-disordered samples had higher scores on SATAQ-3 subscales than a control sample. DISCUSSION: The SATAQ-3 measures multiple aspects of a societal influence and should prove useful for basic risk factor work as well as for gauging the efficacy of prevention and treatment programs.