Self-Weighing and Weight Control Behaviors Among Adolescents with a History of Overweight

PurposeTo assess the relationships between self-weighing frequency, weight control behaviors, and weight status among male and female adolescents who have a history of being overweight.MethodsThis study compared weight control behaviors between two groups of adolescents with a history of being overweight (body mass index [BMI] >85th percentile): those who weighed themselves weekly or more (frequent self-weighers) and those who weighed themselves monthly or less (infrequent self-weighers). Participants completed a survey on weight control behaviors, dietary intake, physical activity, and sedentary activity. Height and weight were also measured. Logistic regression analyses were used for categorical outcomes and linear regressions for continuous outcomes.ResultsOf the 130 adolescents, 43% were frequent weighers and 57% were infrequent weighers. In comparison to infrequent self-weighers, frequent self-weighers were more likely to report using behavior change strategies, following a structured diet, and engaging in healthy weight control behaviors, especially decreasing caloric intake, high fat food intake, and “junk food” intake. Also, more frequent self-weighers reported engaging in more strenuous physical activity and spending less time playing videogames than infrequent self-weighers. Although not significant, a trend resulted indicating lower average BMI percentile among frequent self-weighers. No significant differences were found between the two groups in unhealthy weight control behaviors.ConclusionsThese results suggest that adolescents with a history of overweight who self-weigh at least weekly are more likely to report using healthy weight control behaviors than adolescents who self-weigh monthly or less frequently. Self-monitoring of weight may be a useful component of a comprehensive weight management plan for some overweight adolescents.     

Dieting Status and its Relationship to Eating and Physical Activity Behaviors in a Representative Sample of US Adolescents

Objective To determine whether adolescents engaging in extreme weight loss methods (ie, vomiting and diet pills) and those using more moderate methods differ from each other in dietary intake (fruits, vegetables, and higher-fat foods) and physical activity, and to compare these variables in dieting and nondieting adolescents.Design Data were obtained from the 1993 Youth Risk Behavior Survey.Subjects/settings The survey was administered to a nationally representative sample of 16,296 adolescents in grades 9 through 12 in a school setting.Statistical analyses Data were analyzed for 16,125 adolescents. Associations between weight control behaviors and dietary intake and physical activity were examined using mixed-model logistic regressions, controlling for grade in school, race, parental education, region of the country, and urban vs nonurban residence.Results Differences in dietary and physical activity were found among adolescents who use extreme weight loss methods and moderate methods, and between dieters and nondieters. Adolescents using moderate methods of weight control engaged in more health-promoting eating and exercise behaviors than did extreme dieters or nondieters. Girls categorized as extreme dieters were less likely to eat fruits and vegetables than were moderate dieters (odds ratio [OR]=.56) or nondieters (OR=.75), and were more likely than more moderate dieters (OR=.76) to have consumed 2 or more servings of high-fat foods during the previous day.Applications/conclusions Our findings suggest the importance of distinguishing between different types of dieting behaviors in clinical settings and research studies. Adolescents engaging in extreme weight control behaviors may be at particular risk for inadequate nutritional intake. In contrast, adolescents using more moderate methods may be consuming a more healthful diet than are nondieters. For all adolescents, nutrition guidance on healthful and safe weight control strategies is needed. J Am Diet Assoc. 1998;98:1127–1132,1135.     

Vitamin supplement intake is related to dietary intake and physical activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH)

OBJECTIVE: To explore the relationship of multiple-vitamin supplement use with selected food groups, physical activity, lifestyle behaviors, and weight status. SUBJECTS AND METHODS: Two thousand seven hundred sixty-one adolescents in the 12th grade who participated in the fourth Child and Adolescent Trial for Cardiovascular Health study had height and weight measured and completed health behavior survey and food frequency questionnaires. Logistic regression models were used to determine the likelihood of supplement use with health and activity behaviors and dietary intake. RESULTS: Prevalence of multiple-vitamin supplement use among adolescents was 25% and varied by sex and race/ethnicity. Supplement users had higher mean daily intakes of most food groups, but lower intakes of total fat and saturated fat than nonusers. Higher food index scores were positively associated with the likelihood of using multiple-vitamin supplements. Supplement users were more likely to be physically active, participate in team and organized sports, and less likely to be overweight and to watch more than an hour of television per day. CONCLUSIONS: Adolescents who use multiple vitamin supplements have more healthful dietary and lifestyle behaviors than nonusers. Further study on supplement use by adolescents, including other types of supplements used and reasons for use, is warranted.     

Effect of television viewing on food and nutrient intake among adolescents

ObjectiveAmong the behaviors associated with food intake, exposure to television is particularly important given the number of adolescents exposed. Also, increased time spent watching television has been associated with physical inactivity and with less desirable dietary intake among adolescents. The aim of this study was to examine the association between television viewing and dietary intake among 13-y-old adolescents.MethodsA cross-sectional evaluation was carried out in the 2003–2004 school year, including adolescents born in 1990 and enrolled in the schools of Porto, Portugal. Time spent watching TV was collected by self-administered questionnaires and dietary intake was evaluated using a food frequency questionnaire. Included in the analysis were 1436 adolescents.ResultsSpending more than 120 min per day watching TV was significantly associated with higher intake of total fat and polyunsaturated fat and with lower intake of magnesium, in both sexes. Additionally, in girls, spending more than 120 min per day watching TV was associated with lower intake of complex carbohydrates, fiber, total vitamin A, folate, vitamin C, calcium, iron, phosphorus, and potassium. In boys, higher intake of saturated fat and cholesterol was found among those spending more time watching TV.ConclusionsWe found that television viewing is associated with higher consumption of foods containing more fats and sugars and a lower consumption of fruits and vegetables. Consequently, adolescents who watched more television had a higher intake of total fat and polyunsaturated fat and a lower intake of minerals and vitamins. This dietary behavior among adolescents may have long-term health implications, not only limited to obesity.     

Physical Activity and Dietary Determinants of Weight Loss Success in the US General Population

Objectives. I studied lifestyle behaviors of long-term weight losers in a nationally representative sample.Methods. I categorized the dietary and physical activity data of 8012 adults from the 2009–2012 National Health and Nutrition Examination Surveys into (1) long-term weight losers (≥ 10% loss for ≥ 1 year), (2) recent weight losers (≥ 10% loss within past year), and (3) overweight or obese individuals who never lost 10% or more of their weight.Results. Long-term weight losers consumed fewer calories (2072; 95% confidence interval [CI] = 2011, 2134 kcal vs 2211; 95% CI = 2173, 2249 kcal; P < .001) and were more likely to report any vigorous leisure activity (24.5% vs 20.3%; P = .027) than did overweight or obese individuals. Among those engaging in vigorous leisure activity, long-term weight losers reported a greater quantity (188; 95% CI = 159, 223 min × wk^–1 vs 156; 95% CI = 142, 172 min × wk^–1; P = .047). Recent weight losers did not differ from overweight or obese individuals on absolute calorie intake but reported less fat (79; 95% CI = 75, 83 g vs 84; 95% CI = 82, 86 g; P = .016) and more activity.Conclusions. Balanced calorie restriction from all macronutrients and physical activity are important behaviors for successful long-term weight loss in the general population.Approximately 17% of children and adolescents and 35% of adults in the United States are obese.1 The societal costs of obesity are staggering, with direct and indirect costs rising in a curvilinear fashion with body mass index (BMI; defined as weight in kilograms divided by the square of height in meters).2 On an individual level, obesity is associated with numerous deleterious health outcomes, including type II diabetes, cancer, coronary artery disease, sleep apnea, and cognitive dysfunction.3As a result of these overwhelming societal and individual costs, much attention has been paid to evaluating the efficacy of various weight loss interventions. Randomized trials of diet and physical activity interventions demonstrate that substantial weight loss can be achieved by most individuals, especially during the initial 6 months of an intervention.4,5 Randomized trials of weight loss, however, are somewhat limited by the expense and difficulty of including extended follow-up periods. In addition, weight loss usually begins to regress toward baseline after a year or more,5,6 which suggests that some of the interventions used may not be optimal for long-term weight loss maintenance. Furthermore, the individuals included in these trials represent a small segment of the general population (e.g., educated non-Hispanic White women are often overrepresented),4–6 preventing inferences about the success or failure of these interventions on a larger scale.In light of these limitations of randomized trials, observational studies have attempted to characterize lifestyle behaviors of populations that have lost a substantial amount of weight.7–11 Although these investigations provide insight into some of the behaviors associated with successful weight loss, they have either used convenience sampling11 or failed to report extensive information on dietary nutrient intakes and physical activity patterns.7–10 Consequently, the findings from these investigations apply only to a select portion of the general population or lack detail on the specific dietary and physical activity patterns used by the most successful weight losers.The National Health and Nutrition Examination Survey (NHANES) uses a complex sampling design to achieve a representative sample of the noninstitutionalized US population. NHANES assesses the health status and lifestyle behaviors of Americans through interviews, examinations, and laboratory tests. Information on dietary intake is collected through standardized 24-hour recalls, and participants report physical activity participation and weight history. As a result, NHANES provides an opportunity to examine dietary nutrient intakes and physical activity patterns among Americans who have successfully lost weight as well as among those who have successfully maintained weight loss for a prolonged period.I compared the dietary and physical activity patterns of overweight or obese individuals with those who have maintained substantial weight loss for more than 1 year as well as those who have lost weight within the past year.     

Behavioral weight control for overweight adolescents initiated in primary care.

OBJECTIVE: This study evaluates the post-treatment and short-term follow-up efficacy of, as well as participant satisfaction for, a 4-month behavioral weight control program for overweight adolescents initiated in a primary care setting and extended through telephone and mail contact. RESEARCH METHODS AND PROCEDURES: 44 overweight adolescents were randomly assigned to either a multiple component behavioral weight control intervention (Healthy Habits [HH]; n = 23) or a single session of physician weight counseling (typical care [TC]; n = 21). Weight, height, dietary intake, physical activity, sedentary behavior, and problematic weight-related and eating behaviors and beliefs were assessed before treatment, after the 4-month treatment, and at 3-month follow-up. Participant satisfaction and behavioral skills use were measured. RESULTS: HH adolescents evidenced better change in body mass index z scores to post-treatment than TC adolescents. Body mass index z scores changed similarly in the conditions from post-treatment through follow-up. Behavioral skills use was higher among HH than TC adolescents, and higher behavioral skills use was related to better weight outcome. Energy intake, percentage of calories from fat, physical activity, sedentary behavior, and problematic weight-related or eating behaviors/beliefs did not differ by condition or significantly change over time independent of condition. The behavioral intervention evidenced good feasibility and participant satisfaction. DISCUSSION: A telephone- and mail-based behavioral intervention initiated in primary care resulted in better weight control efficacy relative to care typically provided to overweight adolescents. Innovative and efficacious weight control intervention delivery approaches could decrease provider and participant burden and improve dissemination to the increasing population of overweight youth.     

Associations between watching TV during family meals and dietary intake among adolescents

OBJECTIVE: To examine associations between watching television during family meals and dietary intake among adolescents. DESIGN: Cross-sectional study using survey data from a diverse sample of adolescents. SETTING: Data were collected from a school-based survey during the 1998-1999 school year. PARTICIPANTS: Middle and high school students (N = 4746) from 31 public schools in the Minneapolis-St. Paul area. Response rate was 81.5%. VARIABLES MEASURED: Intake of fruits, total vegetables, dark green/yellow vegetables, calcium-rich food, grains, soft drinks, fried food, snack food, calories, family meal frequency, and watching television during meals. ANALYSIS: General linear modeling comparing dietary intake across 3 groups. RESULTS: 33.5% of boys and 30.9% of girls reported watching television during family meals. Adolescents watching television were found to have lower intakes of vegetables, dark green/yellow vegetables, calcium-rich food, and grains and higher intakes of soft drinks compared to adolescents not watching television during meals. However, watching television during family meals was associated with a more healthful diet than not eating regular family meals. CONCLUSIONS AND IMPLICATIONS: Watching television during family meals was associated with poorer dietary quality among adolescents. Health care providers should work with families and adolescents to promote family meals, emphasizing turning the TV off at meals.     

Position of the American Dietetic Association: Weight Management

It is the position of the American Dietetic Association that successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity. Given the increasing incidence of overweight and obesity along with the escalating health care costs associated with weight-related illnesses, health care providers must discover how to effectively treat this complex condition. Food and nutrition professionals should stay current and skilled in weight management to assist clients in preventing weight gain, optimizing individual weight loss interventions, and achieving long-term weight loss maintenance. Using the American Dietetic Association's Evidence Analysis Process and Evidence Analysis Library, this position paper presents the current data and recommendations for weight management. The evidence supporting the value of portion control, eating frequency, meal replacements, and very-low-energy diets are discussed as well as physical activity, behavior therapy, pharmacotherapy, and surgery. Public policy changes to create environments that can assist all populations to achieve and sustain healthful lifestyle behaviors are also reviewed.     

A Simple Liking Survey Captures Behaviors Associated with Weight Loss in a Worksite Program among Women at Risk of Type 2 Diabetes

In a secondary analysis, we assessed the ability of dietary and physical activity surveys to explain variability in weight loss within a worksite-adapted Diabetes Prevention Program. The program involved 58 overweight/obese female employees (average age = 46 ± 11 years SD; average body mass index = 34.7 ± 7.0 kg/m² SD) of four long-term care facilities who survey-reported liking and frequency of dietary and physical activity behaviors. Data were analyzed using a latent variable approach, analysis of covariance, and nested regression analysis to predict percent weight change from baseline to intervention end at week 16 (average loss = 3.0%; range—6% gain to 17% loss), and follow-up at week 28 (average loss = 2.0%; range—8% gain to 16% loss). Using baseline responses, restrained eaters (reporting liking but low intakes of high fat/sweets) achieved greater weight loss at 28 weeks than those reporting high liking/high intake (average loss = 3.5 ± 0.9% versus 1.0 ± 0.8% S.E., respectively). Examining the dietary surveys separately, only improvements in liking for a healthy diet were associated significantly with weight loss (predicting 44% of total variance, p < 0.001). By contrasting liking versus intake changes, women reporting concurrent healthier diet liking and healthier intake lost the most weight (average loss = 5.4 ± 1.1% S.E.); those reporting eating healthier but not healthier diet liking (possible misreporting) gained weight (average gain = 0.3 ± 1.4% S.E.). Change in liking and frequency of physical activity were highly correlated but neither predicted weight loss independently. These pilot data support surveying dietary likes/dislikes as a useful measure to capture dietary behaviors associated with weight loss in worksite-based programs. Comparing dietary likes and intake may identify behaviors consistent (appropriate dietary restraint) or inconsistent (misreporting) with weight loss success.     

Trying to Lose Weight: Diet Strategies among Americans with Overweight or Obesity in 1996 and 2003

Background

Health professionals recommend that individuals with overweight and obesity lose weight by reducing energy intake while maintaining a healthful diet. This study was designed to examine trends in weight loss attempts and strategies for adults with overweight or obesity among different sociodemographic groups.

Methods

Data from the 1996 and 2003 Behavioral Risk Factor Surveillance System were used to estimate changes in weight loss attempts and strategies across population groups. Data were analyzed in 2009.

Results

Slightly more adults with overweight or obesity attempted weight loss in 2003 compared to 1996. There were substantial changes in the diet approaches reported: rates of those using energy restriction to lose weight doubled between 1996 and 2003, whereas low-fat dieting decreased by one third. Hispanic and less-educated adults did not shift away from low-fat diets. Attempted weight loss was associated with higher fruit and vegetable consumption for most population groups.

Conclusions

Increasingly more adults with overweight or obesity tried to lose weight through energy reduction, but some at-risk groups did not follow this beneficial trend between 1996 and 2003. Dietetics practitioners and public health campaigns should target such groups with concrete recommendations to reduce energy intake while maintaining a healthful diet, including adequate consumption of fruit and vegetables.     

Prevalence of leisure-time physical activity among overweight adults--United States, 1998

In the United States, overweight and obesity have reached epidemic proportions among all segments of the population and regions of the country (1). Obesity is a risk factor for numerous chronic health conditions and weight loss can reduce risk factors for these conditions (2). National guidelines recommend that weight reduction should involve reducing calorie intake and increasing physical activity (3). The National Heart, Lung, and Blood Institute's clinical guidelines (3) and the federal dietary guidelines for Americans (4) recommend at least 30 minutes of physical activity on most days of the week for all healthy adults. To assess patterns of physical activity among overweight U.S. adults trying to lose weight, and to estimate the proportion who engage in leisure-time physical activity (LTPA) from selected demographic groups, CDC analyzed data from the 1998 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicate that two thirds of overweight persons trying to lose weight reported using physical activity as a strategy for weight loss; however, only one fifth reported being active at recommended levels.     

Adolescents'' Perceptions of Relative Weight and Self-Reported Weight Loss Activities

Data from the 1990 North Carolina Youth Risk Behavior Survey (YRBS) were used to examine adolescents' perceptions of relative weight and the relationship of these perceptions to physical activity levels, efforts to lose weight, and time spent viewing television. A total of 3,437 ninth and 12th grade respondents to the May 1990 survey were included in the analysis. Of this sample, 25% perceived themselves as "too fat." Of that group, 68% were trying to lose weight. Females made up 75% of those reporting they were "too fat" and were trying to lose weight. White females were more likely to think of themselves as overweight and were more likely to be trying to lose weight than black females. Adolescents who perceived themselves as "too fat" reported fewer days of strenuous activity, fewer hours of strenuous exercise in physical education classes, and more hours spent viewing television on school days.     

Patterns and correlates of physical activity and nutrition behaviors in adolescents

BACKGROUND: Knowledge of the prevalence, clustering, and correlates of multiple adolescent health behaviors can inform the design of health promotion interventions. METHODS: A cross-sectional design was used to assess 878 adolescents aged 11 to 15 years (53.6% girls, 58% non-Hispanic white) recruited in primary care clinics in 2001-2002. Adolescent physical activity (assessed with accelerometers), television viewing time (reported), percent calories from fat, and servings of fruits and vegetables (assessed with multiple 24-hour recalls) were dichotomized into meeting or not meeting national guidelines. Parent health behaviors were assessed with self-reported measures. Analyses were conducted in 2006. RESULTS: Fifty-five percent of adolescents did not meet the physical activity guideline, and 30% exceeded 2 hours daily of television viewing time, with boys more active and less sedentary than girls (p <0.01). The majority of the adolescents did not meet dietary guidelines. Nearly 80% had multiple risk behaviors and only 2% met all four guidelines. The number of risk behaviors was associated with being older and being at risk for overweight or being overweight, for boys and girls (p <0.05). Two parent health behaviors-history of smoking and failure to meet the fruits and vegetables guideline-were significantly associated with a higher number of risk behaviors for girls (p <0.05). CONCLUSIONS: Eight of ten adolescents in this sample failed to meet guidelines for two or more diet, physical activity, and sedentary risk behaviors. Some parent health behaviors, along with the adolescent's weight status and age, were associated with a higher number of adolescent health risk behaviors.     

Physical activity, food choice, and weight management goals and practices among US college students

INTRODUCTION: Physical activity and a healthy diet have been recommended to help reverse the increasing prevalence of overweight among adolescents and adults in the United States. METHODS: Data is from the 1995 National College Health Risk Behavior Survey. A representative sample of US undergraduate college students (n = 4609) were analyzed to examine associations of physical activity and food choice with weight management goals and practices. RESULTS: Based on self-reported height and weight, 35% of students were overweight or obese (body mass index > or = 25.0). Nearly half (46%) of all students reported they were trying to lose weight. Female students were less likely than male students to be overweight, but more likely to be trying to lose weight. Among female and male students, using logistic regression to control for demographics, trying to lose weight was associated with participation in vigorous physical activity and strengthening exercises, and consumption of < or = 2 servings/ day of high-fat foods. Female and male students who reported using exercise to lose weight or to keep from gaining weight were more likely than those who did not to participate in vigorous, strengthening, and moderate physical activity, and were more likely to eat > or = 5 servings/day of fruits and vegetables and < or = 2 servings/day of high-fat foods. Among students who were trying to lose weight, only 54% of females and 41% of males used both exercise and diet for weight control. CONCLUSION: Colleges should implement programs to increase student awareness of healthy weight management methods and the importance of physical activity combined with a healthy diet.     

Nutrition Beliefs and Weight Loss Practices of Lakota Indian Adults

Primary objectives were to describe beliefs about diet and health, weight perceptions, and weight loss practices among Lakota Indian adults. In-person interviews were conducted with a total of 219 adults from two reservations in South Dakota. Overall, 55.5% of the sample was overweight. When asked how they perceived their body weight, 6% felt they were “too thin,” 43.4% thought they were “about right,” and 50.2% felt they were “too fat.” When asked what they were doing about their weight, 74% said they were either trying to lose weight or trying to keep from gaining more weight. Reducing the amount of food eaten (90%), eating more fruits and vegetables (86%), increasing physical activity (84%), and skipping meals (82%) were reported to have been used by most of those who had dieted. Of those who felt they needed to lose weight, 78% said they would join a weight loss program if one were offered. Findings indicate that most Lakota adults are concerned about obesity and are attempting to either lose excess weight or avoid gaining weight. Intervention efforts for this population should focus on providing individuals with guidance on effective strategies for weight loss or obesity prevention. Weight loss programs should include features identified as important by survey participants, such as information on how to fit a healthful diet and exercise into daily life.     

Weight Control Behaviors and Dietary Intake among Adolescents and Young Adults: Longitudinal Findings from Project EAT

Background

Cross-sectional research has found that dieting during adolesence and the use of extreme weight control behaviors are related to less healthful dietary patterns; however, little is known regarding longitudinal relationships.

Objective

To describe patterns of weight control behavior over 5 years and examine relationships with nutritional outcomes in adolescents and young adults.

Design

Population-based, longitudinal study in Minnesota. Youth completed Time 1 surveys in 1998-1999, and Time 2 surveys were completed in 2003-2004.

Subjects/setting

The Project EAT (Eating Among Teens) survey and the Youth and Adolescent Food Frequency Questionnaire were completed by 1,242 females and 1,007 males in school classrooms at Time 1 and by mail at Time 2.

Outcome measures and statistical analyses performed

Generalized linear modeling was used to predict each Time 2 outcome of interest (ie, meal and snack frequencies and dietary intake) across patterns of healthful and unhealthful weight control behavior (ie, never-engaging, stopping, starting, and persisting).

Results

Approximately 45% of females and 17% of males reported persistent use of unhealthful weight control behaviors at both time points. Persisting to use only healthful weight control behaviors was reported by 10% of females and 15% of males. Among females, persistent use of unhealthful weight control behavior was associated (P<0.05) with measures of poorer dietary intake (eg, lower intakes of calcium and vegetables) and less frequent meals, whereas persistent use of healthful weight control behavior was associated with measures (P<0.05) of better dietary intake (eg, less fast food and fewer sugar-sweetened drinks). Among males, few associations were observed between dietary intake and either unhealthful or healthful weight control behavior.

Conclusions

Health professionals should guide youth who have weight concerns by encouraging healthful eating habits to achieve or maintain appropriate weight and nutrition goals.     

Behavioral strategies of individuals who have maintained long-term weight losses.

OBJECTIVE: The purpose of the present study was to compare the behaviors of individuals who have achieved long-term weight loss maintenance with those of regainers and weight-stable controls. RESEARCH METHODS AND PROCEDURES: Subjects for the present study were participants in a random-digit dial telephone survey that used a representative sample of the U.S. adult population. Eating, exercise, self-weighing, and dietary restraint characteristics were compared among weight-loss maintainers: individuals who had intentionally lost > or =10% of their weight and maintained it for > or = 1 year (n = 69), weight-loss regainers: individuals who intentionally lost > or = 10% of their weight but had not maintained it (n = 56), and weight-stable controls: individuals who had never lost > or = 10% of their maximum weight and had maintained their current weight (+/-10 pounds) within the past 5 years (n = 113). RESULTS: Weight-loss maintainers had lost an average of 37 pounds and maintained it for over 7 years. These individuals reported that they currently used more behavioral strategies to control dietary fat intake, have higher levels of physical activity (especially strenuous activity), and greater frequency of self-weighing than either the weight-loss regainers or weight-stable controls. Maintainers and regainers did not differ in reported levels of dietary restraint, but both had higher levels of restraint than the weight-stable controls. DISCUSSION: These results suggest that weight-loss maintainers use more behavioral strategies to control their weight than either regainers or weight-stable controls. It would thus appear that long-term weight maintenance requires ongoing adherence to a low-fat diet and an exercise regimen in addition to continued attention to body weight.     

Relative Weight,Weight Loss Efforts and Nutrient Intakes among Health-Conscious Vegetarian,Past Vegetarian and Nonvegetarian Women Ages 18 to 50.

Objective: To compare relative weight, weight loss efforts and nutrient intakes among similarly health-conscious vegetarian, past vegetarian and nonvegetarian premenopausal women.

Methods: Demographic data, lifestyle practices and weight loss efforts (by questionnaire), body mass index (BMI;kg/m²) and dietary intake (via multiple-pass 24-hour diet recall) were compared in a convenience sample of 90 current vegetarians, 35 past vegetarians and 68 nonvegetarians.

Results: Age (31.9 ± 8.8), educational attainment, smoking status, alcohol use, physical activity and perceived health status were similar among the three groups of women. BMI did not differ by dietary pattern and averaged 23.7 ± 4.7 for all women combined. Participants had intentionally lost ≥ 10 pounds a mean of 2.1 times, and 39% of women perceived themselves to be overweight; again, no differences were observed among dietary groups. Dietary intakes of vegetarians and current nonvegetarians were consistent with current recommendations for macronutrient composition (<30% fat, <10% saturates). Compared to current nonvegetarians, current vegetarians had lower intakes of protein, saturated fat, cholesterol, niacin, vitamins B₁₂ and D, and higher fiber and magnesium intakes. Vegetarians’ mean vitamin B₁₂ and D intakes were well below recommendations.

Conclusions: Relative weight and weight loss efforts do not differ by dietary pattern among similarly health-conscious vegetarian and nonvegetarian women. The only differences in nutrient intake with potential health implications were vitamins D and B₁₂.     

The psychological ramifications of weight management

It has long been believed that food restriction leads to psychological disturbances, including depression, preoccupation with food, and binge eating. However, recent studies suggest that comprehensive weight loss programs that incorporate behavioral treatment, diet change, and encouragement of physical activity in fact can improve the psychological state, including mood. A study conducted on subjects participating in the Weight Watchers program demonstrated positive psychological changes and improved quality of life. These changes may help motivate overweight people to maintain the physical activity and nutritional practices necessary to lose and maintain weight. Programs that include group support, like Weight Watchers, have been associated with psychological benefits independent of the amount of weight lost. Furthermore, dieters who regain lost weight do not appear to experience adverse psychological consequences. The development or exacerbation of bulimia has been linked by some authors to strict dieting, but more moderate weight control programs do not appear to produce disordered eating and may help reduce binge eating among overweight people. Individuals who successfully lose and maintain weight have been shown to experience improved mood, self-confidence, and quality of life. Additionally, decreasing levels of psychological and behavioral symptoms have been associated with increasing duration of weight loss maintenance. It can be concluded that quality of life and other psychological measures improve in individuals on comprehensive weight management programs.     

Cognitive-behavioral approaches in the management of obesity

Many of the behavioral interventions designed to promote dietary change in individuals include medical assessment, initial assessment of diet history, assessing readiness, establishing dietary goals, self-monitoring, stimulus control training, training in problem solving, relapse prevention training, enlisting social support, nutrition education, dietary therapy, and ongoing contact to maintain progress. The comprehensive nature of a cognitive-behavioral weight management program is of value in modifying behaviors that are linked to adverse health effects and psychological distresses, without necessarily causing a drastic weight loss in obese individuals. The behavioral treatments for overweight and obesity directly modify behaviors that bear on health and illness, such as improving dietary choices, decreasing sedentary behaviors, and increasing habitual physical activity and exercises. Cognitive-behavioral treatment can be used to help overweight adolescents become more assertive in coping with the adverse social stigma of being overweight, enhance their self-esteem, and reduce their dissatisfaction with body image regardless of their weight loss. Cognitive-behavioral treatments seem to be more effective in children when delivered before puberty than they are for adults.