A structural invariance analysis of the acceptance model of intuitive eating across black, hispanic, and white young-adult women.

In this cross-sectional study, structural invariance of the acceptance model of intuitive eating was examined between a sample of Black (n = 420), Hispanic (n = 420), and White (n = 435) cisgender women between the ages of 18-30 years old residing in the United States. Mean age for the total sample (n = 1275) was 24.17 years old (SD = 3.65). Women were recruited via Qualtrics Sampling, and self-report measures were administered online. Multigroup analyses were employed within a structural equation modeling framework, and measurement invariance at the configural, metric, scalar, and strict/residual levels was investigated first. After uncovering and accounting for several error variances that were non-invariant, multigroup structural invariance analyses indicated that paths within the model were invariant across the three ethnicities of women. BMI was also incorporated into the model, which, likewise, showed invariance in its associations with specific constructs. With due cautions related to the impact of cultural ideals regarding appearance and the interplay of ethnicity and body-related experiences among women, these results provide preliminary evidence that the model may apply to Black, White, and Hispanic women in the U.S.

Measurement invariance of the Broad Conceptualization of Beauty Scale (BCBS) across Black, Hispanic, and White women in the United States.

The Broad Conceptualization of Beauty Scale (BCBS) assesses the degree to which women perceive diverse appearances and internal qualities as being beautiful. Although the instrument is increasingly used in diverse national and linguistic contexts, no previous study has examined measurement invariance of the BCBS across racial groups. To rectify this, we asked 395 Black, 406 Hispanic, and 423 White women from the United States to complete the BCBS. Confirmatory factor analysis indicated that a unidimensional model of BCBS scores had poor fit to the data in the total sample, but freely estimating error covariances between six pairs of items resulted in adequate fit. Additionally, full configural and scalar invariance was supported, but metric invariance was not, with further testing indicating that the item loading for one item differed across groups. Comparison of latent means indicated that all between-groups comparisons in BCBS scores were non-significant. However, medium-sized group differences in BCBS scores emerged once group differences in key demographics were controlled for. Overall, these results suggest that the BCBS largely achieves measurement invariance across Black, Hispanic, and White women in the United States, suggestive of similarity in how the construct of broad conceptualisation of beauty is understood and experienced.

Weight loss prevents urinary incontinence in women with type 2 diabetes: results from the Look AHEAD trial.

PURPOSE: We determined the effect of weight loss on the prevalence, incidence and resolution of weekly or more frequent urinary incontinence in overweight/obese women with type 2 diabetes after 1 year of intervention in the Look AHEAD (Action for Health in Diabetes) trial. MATERIALS AND METHODS: Women in this substudy (2,739, mean ± SD age 57.9 ± 6.8 years, body mass index 36.5 ± 6.1 kg/m(2)) were randomized into an intensive lifestyle weight loss intervention or a diabetes support and education control condition. RESULTS: At baseline 27% of participants reported urinary incontinence on a validated questionnaire (no significant difference by intensive lifestyle intervention vs diabetes support and education). After 1 year of intervention the intensive lifestyle intervention group in this substudy lost 7.7 ± 7.0 vs 0.7 ± 5.0 kg in the diabetes support and education group. At 1 year fewer women in the intensive lifestyle intervention group reported urinary incontinence (25.3% vs 28.6% in the diabetes support and education group, p = 0.05). Among participants without urinary incontinence at baseline 10.5% of intensive lifestyle intervention and 14.0% of diabetes support and education participants experienced urinary incontinence after 1 year (p = 0.02). There were no significant group differences in the resolution of urinary incontinence (p >0.17). Each kg of weight lost was associated with a 3% reduction in the odds of urinary incontinence developing (p = 0.01), and weight losses of 5% to 10% reduced these odds by 47% (p = 0.002). CONCLUSIONS: Moderate weight loss reduced the incidence but did not improve the resolution rates of urinary incontinence at 1 year among overweight/obese women with type 2 diabetes. Weight loss interventions should be considered for the prevention of urinary incontinence in overweight/obese women with diabetes.

Depressive symptoms, race, and circulating C-reactive protein: the Coronary Artery Risk Development in Young Adults (CARDIA) study.

OBJECTIVE: To examine the prospective association of depressive symptoms with circulating C-reactive protein (CRP) and to determine the direction of that association. METHODS: Using data from 2,544 healthy participants in the Coronary Artery Risk Development in Young Adults study (ages, 33-45 years; 55% female; 42% black), we examined the prospective association of depressive symptoms, as measured by the Centers for Epidemiologic Studies Depression Scale, with circulating CRP 5 years later. RESULTS: Depressive symptoms in the Coronary Artery Risk Development in Young Adults study Year 15 predicted CRP at Year 20, independent of demographic characteristics, biological and medical risk factors, health behaviors, and Year 15 CRP. This association, however, was conditional on race such that the increase in CRP with increasing depressive symptoms was present in blacks but not whites. In neither blacks nor whites did Year 15 CRP predict Year 20 depressive symptoms. Among black participants, when examined in separate analyses, higher scores on the depressed affect and somatic symptoms subscales of the Centers for Epidemiologic Studies Depression Scale and lower scores on the positive affect subscale were associated with greater Year 20 CRP. The interpersonal problems subscale was unrelated to CRP. When all four subscale scores were entered simultaneously in the same model, black participants' scores on the positive affect and somatic symptoms subscales emerged as independent predictors of Year 20 CRP, whereas the depressed affect and interpersonal problems subscales did not. CONCLUSIONS: Depressive symptoms may be linked more closely to inflammation in blacks than in whites.

Stress, race, and body weight.

OBJECTIVE: Stress has been identified as a significant factor in health and in racial/ethnic health disparities. A potential mediator in these relationships is body weight. DESIGN: Cross-sectional and longitudinal relationships between stress, race, and body weight were examined in an ethnically diverse sample of overweight and obese women with Type 2 diabetes (n = 217) enrolled in a behavioral weight loss program. MAIN OUTCOME MEASURES: Stress (Perceived Stress Scale) was assessed at baseline only and body weight (body mass index) was assessed at baseline and 6 months. RESULTS: Stress was not related to baseline body weight. With every 1 unit lower scored on the baseline stress measure, women lost 0.10 kg +/- .04 more at 6 months (p < .05). When women were divided into tertiles based on baseline stress scores, those in the lowest stress group had significantly greater weight loss (5.2 kg +/- 4.9) compared with those in the highest stress group (3.0 kg +/- 4.0) (p < .05). There was a trend for African Americans to report higher levels of stress (20.7 +/- 8.8) than Whites (18.3 +/- 8.3) (p = .08). CONCLUSION: The association between higher stress and diminished weight loss has implications for enhancing weight loss programs for women with Type 2 diabetes.

Design and Methods of a Synchronous Online Motivational Interviewing Intervention for Weight Management.

BACKGROUND: While Internet-based weight management programs can facilitate access to and engagement in evidence-based lifestyle weight loss programs, the results have generally not been as effective as in-person programs. Furthermore, motivational interviewing (MI) has shown promise as a technique for enhancing weight loss outcomes within face-to-face programs. OBJECTIVE: This paper describes the design, intervention development, and analysis of a therapist-delivered online MI intervention for weight loss in the context of an online weight loss program. METHODS: The MI intervention is delivered within the context of a randomized controlled trial examining the efficacy of an 18-month, group-based, online behavioral weight control program plus individually administered, synchronous online MI sessions relative to the group-based program alone. Six individual 30-minute MI sessions are conducted in private chat rooms over 18 months by doctoral-level psychologists. Sessions use a semistructured interview format for content and session flow and incorporate core MI components (eg, collaborative agenda setting, open-ended questions, reflective listening and summary statements, objective data, and a focus on evoking and amplifying change talk). RESULTS: The project was funded in 2010 and enrollment was completed in 2012. Data analysis is currently under way and the first results are expected in 2016. CONCLUSIONS: This is the first trial to test the efficacy of a synchronous online, one-on-one MI intervention designed to augment an online group behavioral weight loss program. If the addition of MI sessions proves to be successful, this intervention could be disseminated to enhance other distance-based weight loss interventions. TRIAL REGISTRATION: Clinicaltrials.gov NCT01232699; https://clinicaltrials.gov/ct2/show/NCT01232699.

Television viewing and snacking.

With the rise in obesity in America, the search for potential causes for this epidemic has begun to include a focus on environmental factors. Television (TV) viewing is one such factor, partially due to its potential as a stimulus for eating. The current study investigated the relationship between food intake and self-reported TV viewing in an effort to identify the impact of TV viewing on specific eating behaviors. Seventy-four overweight women seeking obesity treatment completed questionnaires assessing dietary habits and TV viewing behaviors. Results suggest that snacking, but not necessarily eating meals, while watching TV is associated with increased overall caloric intake and calories from fat. Therefore, interventions targeting stimulus control techniques to reduce snacking behavior may have an impact on overall caloric intake.

Motivational interviewing for weight loss.

MI is a patient-centered directive counseling style that aims to facilitate patients' likelihood of making behavior change through the exploration and strengthening of personal motivations. Hallmarks of MI include a collaborative relationship between patient and practitioner, a focus on the elicitation and enhancement of change talk, a nonconfrontational style, and a concerted effort to minimize resistance. MI has been applied to a variety of health-related behaviors, and a growing body of research suggests that this approach may be useful in the context of behavioral weight management. Although results are not uniform, the majority of research suggests that MI delivered as an independent component in addition to a behavioral weight loss program can augment weight loss and likely exerts its beneficial effects through enhancement of treatment engagement and adherence to behavioral recommendations. Furthermore, preliminary research suggests that MI may be helpful in promoting weight maintenance after an initial loss has been achieved. Given that behavioral weight management is a relatively new application of MI, a variety of issues merit further investigation. Of particular interest are issues related to the type and extent of provider training necessary to ensure adequate skill development, cost-effectiveness of MI, and translational research to determine the feasibility and effectiveness of incorporating MI strategies into real-world weight loss settings.

Weight loss goals among African-American women with type 2 diabetes in a behavioral weight control program.

African-American women with type 2 diabetes experience limited weight loss in behavioral weight control programs. Some research suggests that overly ambitious weight loss expectations may negatively affect weight losses achieved but it is unknown whether they affect weight loss among African-American women. The current study examined personal weight loss goals and expected satisfaction with a reasonable weight loss among African-American women with type 2 diabetes starting a behavioral obesity treatment. We also explored associations among these factors and weight loss treatment outcomes. Self-identified African-American women (N = 84) in a 24-session group program were assessed at baseline and 6-month follow-up. At baseline, women indicated weight loss goals of 14.1 ± 6.6 kg (14% of initial weight). They also reported relatively high expected satisfaction with a reasonable weight loss (7-10%). On average, participants lost 3.0 ± 3.9 kg (3% of initial weight) and attended 73 ± 21% of group sessions. Neither weight loss goals nor expected satisfaction with a reasonable weight loss was correlated with either actual weight loss outcome or attendance. Having higher personal weight loss goals was associated with lower expectations of satisfaction with a reasonable weight loss. This suggests that African-American women with type 2 diabetes enter treatment hoping to lose far more weight than they are likely to achieve. It is important to understand the psychosocial sequelae of failing to reach these goals on subsequent weight maintenance and future weight loss attempts within this population.

Prevalence and risk factors for urinary incontinence in overweight and obese diabetic women: action for health in diabetes (look ahead) study.

OBJECTIVE To determine the prevalence and risk factors for urinary incontinence among different racial/ethnic groups of overweight and obese women with type 2 diabetes. RESEARCH DESIGN AND METHODS Cross-sectional analysis of baseline data from the Action for Health in Diabetes (Look AHEAD) study, a randomized clinical trial with 2,994 overweight/obese women with type 2 diabetes. RESULTS Weekly incontinence (27%) was reported more often than other diabetes-associated complications, including retinopathy (7.5%), microalbuminuria (2.2%), and neuropathy (1.5%). The prevalence of weekly incontinence was highest among non-Hispanic whites (32%) and lowest among African Americans (18%), and Asians (12%) (P < 0.001). Asian and African American women had lower odds of weekly incontinence compared with non-Hispanic whites (75 and 55% lower, respectively; P < 0.001). Women with a BMI of > or =35 kg/m(2) had a higher odds of overall and stress incontinence (55-85% higher; P < 0.03) compared with that for nonobese women. Risk factors for overall incontinence, as well as for stress and urgency incontinence, included prior hysterectomy (40-80% increased risk; P < 0.01) and urinary tract infection in the prior year (55-90% increased risk; P < 0.001). CONCLUSIONS Among overweight and obese women with type 2 diabetes, urinary incontinence is highly prevalent and far exceeds the prevalence of other diabetes complications. Racial/ethnic differences in incontinence prevalence are similar to those in women without diabetes, affecting non-Hispanic whites more than Asians and African Americans. Increasing obesity (BMI > or =35 kg/m(2)) was the strongest modifiable risk factor for overall incontinence and stress incontinence in this diverse cohort.

Binge eating and weight loss outcomes in overweight and obese individuals with type 2 diabetes: results from the Look AHEAD trial.

CONTEXT: Binge eating (BE) is common in overweight and obese individuals with type 2 diabetes mellitus, but little is known about how BE affects weight loss in this population. OBJECTIVE: To determine whether BE was related to 1-year weight losses in overweight and obese individuals with type 2 diabetes participating in an ongoing clinical trial. DESIGN, SETTING, AND PARTICIPANTS: The Look AHEAD (Action for Health in Diabetes) trial is a randomized controlled trial examining the long-term effect of intentional weight loss on cardiovascular disease in overweight and obese adults with type 2 diabetes. A total of 5145 overweight and obese individuals aged 45 to 76 years with type 2 diabetes participated in this study. INTERVENTIONS: Participants were randomly assigned to an intensive lifestyle intervention or to enhanced usual care (a diabetes support and education control condition). MAIN OUTCOME MEASURES: At baseline and 1 year, participants had their weight measured and completed a fitness test and self-report measures of BE and dietary intake. Four groups were created based on BE status at baseline and 1 year (yes/yes, no/no, yes/no, and no/yes). Analyses controlled for baseline differences between binge eaters and non-binge eaters. RESULTS: Most individuals (85.4%) did not report BE at baseline or 1 year (no/no), 7.5% reported BE only at baseline (yes/no), 3.7% reported BE at both times (yes/yes), and 3.4% reported BE only at 1 year (no/yes), with no differences between intensive lifestyle intervention and diabetes support and education conditions (P = .14). Across intensive lifestyle intervention and diabetes support and education, greater weight losses were observed in participants who stopped BE at 1 year (mean [SE] weight loss, 5.3 [0.4] kg) and those who reported no BE at either time (mean [SE] weight loss, 4.8 [0.1] kg) than in those who continued BE (mean [SE] weight loss, 3.1 [0.6] kg) and those who began BE at 1 year (mean [SE] weight loss, 3.0 [0.6] kg) (P < .001). Post hoc analyses suggested that these differences were due to changes in caloric intake. CONCLUSION: Overweight and obese individuals with type 2 diabetes who stop BE appear to be just as successful at weight loss as non-binge eaters after 1 year of treatment. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00017953.

Motivational interviewing improves weight loss in women with type 2 diabetes.

OBJECTIVE: We sought to determine whether adding motivational interviewing to a behavioral weight control program improves weight loss outcomes and glycemic control for overweight women with type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted a randomized, controlled, clinical trial in which participants all received an 18-month, group-based behavioral obesity treatment and were randomized to individual sessions of motivational interviewing or attention control (total of five sessions) as an adjunct to the weight control program. Overweight women with type 2 diabetes treated by oral medications who could walk for exercise were eligible. Primary outcomes were weight and A1C, assessed at 0, 6, 12, and 18 months. RESULTS: A total of 217 overweight women (38% African American) were randomized (93% retention rate). Women in motivational interviewing lost significantly more weight at 6 months (P = 0.01) and 18 months (P = 0.04). Increased weight losses with motivational interviewing were mediated by enhanced adherence to the behavioral weight control program. African-American women lost less weight than white women overall and appeared to have a diminished benefit from the addition of motivational interviewing. Significantly greater A1C reductions were observed in those undergoing motivational interviewing at 6 months (P = 0.02) but not at 18 months. CONCLUSIONS: Motivational interviewing can be a beneficial adjunct to behavioral obesity treatment for women with type 2 diabetes, although the benefits may not be sustained among African-American women.

Binge eating disorder and night eating syndrome in adults with type 2 diabetes.

OBJECTIVE: To determine the prevalence of binge eating disorder (BED) and night eating syndrome (NES) among applicants to the Look AHEAD (Action for Health in Diabetes) study. RESEARCH METHODS AND PROCEDURES: The Eating Disorders Examination-Questionnaire (EDE-Q) and the Night Eating Questionnaire (NEQ) were used to screen patients. Phone interviews were conducted using the EDE for those who reported at least eight episodes of objective binge eating in the past month and using the Night Eating Syndrome History and Interview for those who scored > or =25 on the NEQ. Recruitment at four sites (Birmingham, n = 200; Houston, n = 259; Minneapolis, n = 182; and Philadelphia, n = 204) yielded 845 participants (58% women; mean age = 60.1 +/- 6.7 years; mean BMI = 36.2 +/- 6.3 kg/m(2)). RESULTS: Screening scores were met by 47 (5.6%) applicants on the EDE-Q and 71 (8.4%) on the NEQ. Of the 85% (40/47) who completed the EDE interview, 12 were diagnosed with BED, representing 1.4% of the total sample. Of the 72% (51/71) who completed the Night Eating Syndrome History and Interview, 32 were diagnosed with NES, equal to 3.8% of the total sample. Three participants had both BED and NES. Participants with eating disorders were younger, heavier, and reported more eating pathology than those without eating disorders. DISCUSSION: Among obese adults with type 2 diabetes, NES was reported more frequently than BED, which, in turn, was less common than expected.

The effect of a psychosocial intervention and quality of life after acute myocardial infarction: the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial.

PURPOSE: The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) clinical trial was designed to test whether intervening on depression or low perceived social support reduces mortality and reinfarction in patients with acute myocardial infarction (MI). This report analyzes the effect of the intervention on quality of life (QOL), which was an important secondary outcome. METHODS: ENRICHD was a randomized controlled clinical trial comparing a psychosocial intervention based on cognitive behavioral therapy to usual medical care in 2,481 patients from 8 clinical centers. Patients with acute MI were included if they met criteria for depression, low perceived social support, or both. QOL was assessed at the 6-month clinic visit in the first 1,296 patients. QOL measures included the Medical Outcomes Study Short Form summary measures of physical functioning (SF12-PCS) and mental functioning (SF12-MCS), a Life Satisfaction Scale (LSS), and a measure of overall QOL based on the ladder of life (LOL) technique. RESULTS: There were significant treatment differences on the SF12-MCS (difference 2.2, 95% confidence interval [CI] 1.2-3.2), the LSS (difference 1.0, 95% CI 0.5-1.5), and the LOL (difference 0.3, 95% CI 0.1-0.6), but not on the SF12-PCS (difference 0.8; 95% CI = -0.5-2.0). Effect sizes for the intervention on QOL outcomes were modest. CONCLUSIONS: Psychosocial interventions of limited duration confer modest QOL benefits in post-MI patients who are depressed or have low perceived social support. Interventions of longer duration or greater intensity may be required to produce more substantial improvements in QOL in these patients.

Factors associated with the failure of patients to complete cardiac rehabilitation for medical and nonmedical reasons.

PURPOSE: Cardiac rehabilitation (CR) provides effective secondary prevention services, but many patients fail to complete the recommended program. The purposes of this study were to describe completion rates in a hospital-based outpatient CR program, and to identify factors associated with patients failing to complete CR because of nonmedical and medical reasons. METHODS: Data used for the analyses were from a hospital-based CR program involving 526 discharged patients between January 1996 and February 2002. Patient discharge status was classified into three categories: complete, noncomplete-medical reasons, and noncomplete-nonmedical reasons. Logistic regression modeling identified factors associated with the groups failing to complete CR. RESULTS: The rate of CR completion was 58% (304/526). Among the 222 patients who did not complete CR, 139 (63%) had nonmedical reasons. As compared with the patients who completed CR, the adjusted odds ratio (AOR) for those who did not complete CR because of nonmedical reasons were more likely to be employed (AOR 2.2), to be obese (AOR 2.5), to be smokers (AOR 2.1), and to have shorter 6-minute walk distances (AOR 1.7). They were less likely to be women (AOR 0.6) or have diabetes (AOR 0.5). Patients not completing CR for medical reasons were more likely to be categorized as being at high clinical risk (AOR 4.2) and having shorter 6-minute walk distances (AOR 1.9). CONCLUSION: Except for low functional capacity, baseline factors associated with patients failing to complete CR differed on the basis of medical or nonmedical reasons. The development of interventions that address the special needs of patients with low functional capacity may be especially important in attempts to retain this high-risk group in CR therapy.