Moms in motion: a group-mediated cognitive-behavioral physical activity intervention

Background  

When examining the prevalence of physical inactivity by gender and age, women over the age of 25 are at an increased risk for sedentary behavior. Childbearing and motherhood have been explored as one possible explanation for this increased risk. Post natal exercise studies to date demonstrate promising physical and psychological outcomes, however few physical activity interventions have been theory-driven and tailored to post natal exercise initiates. The purpose of this study was to compare the effects of a group-mediated cognitive behavioral intervention based upon social-cognitive theory and group dynamics (GMCB) to a standard care postnatal exercise program (SE).     

Weight loss during the intensive intervention phase of the weight-loss maintenance trial

BACKGROUND: To improve methods for long-term weight management, the Weight Loss Maintenance (WLM) trial, a four-center randomized trial, was conducted to compare alternative strategies for maintaining weight loss over a 30-month period. This paper describes methods and results for the initial 6-month weight-loss program (Phase I). METHODS: Eligible adults were aged > or =25, overweight or obese (BMI=25-45 kg/m2), and on medications for hypertension and/or dyslipidemia. Anthropomorphic, demographic, and psychosocial measures were collected at baseline and 6 months. Participants (n=1685) attended 20 weekly group sessions to encourage calorie restriction, moderate-intensity physical activity, and the DASH (dietary approaches to stop hypertension) dietary pattern. Weight-loss predictors with missing data were replaced by multiple imputation. RESULTS: Participants were 44% African American and 67% women; 79% were obese (BMI> or =30), 87% were taking anti-hypertensive medications, and 38% were taking antidyslipidemia medications. Participants attended an average of 72% of 20 group sessions. They self-reported 117 minutes of moderate-intensity physical activity per week, kept 3.7 daily food records per week, and consumed 2.9 servings of fruits and vegetables per day. The Phase-I follow-up rate was 92%. Mean (SD) weight change was -5.8 kg (4.4), and 69% lost at least 4 kg. All race-gender subgroups lost substantial weight: African-American men (-5.4 kg +/- 7.7); African-American women (-4.1 kg +/- 2.9); non-African-American men (-8.5 kg +/- 12.9); and non-African-American women (-5.8 kg +/- 6.1). Behavioral measures (e.g., diet records and physical activity) accounted for most of the weight-loss variation, although the association between behavioral measures and weight loss differed by race and gender groups. CONCLUSIONS: The WLM behavioral intervention successfully achieved clinically significant short-term weight loss in a diverse population of high-risk patients.     

Menu Modeling with MyPyramid Food Patterns: Incremental Dietary Changes Lead to Dramatic Improvements in Diet Quality of Menus

The MyPyramid food guidance system provides recommended food intake patterns for members of each sex at various age and activity levels. These food intake patterns are based on recommendations of the Dietary Guidelines for Americans 2005. Actual consumption patterns of American adults compared to MyPyramid recommendations indicate that substantial changes are needed to meet the goals of MyPyramid. One method for encouraging dietary change, known as the small steps approach, involves small, gradual changes to meet a desired endpoint. Menu modeling was used to evaluate the effects of gradual dietary changes on diet quality. Seven days of baseline menus were developed to model the intake of adult women aged 31 to 50 years. Incremental changes were made to each baseline menu to create a series of three transitional menus and a final target menu. Target menus met MyPyramid energy and nutrient intake goals. Diet quality was measured for each baseline, transitional, and target menu using the Healthy Eating Index-2005. The average Healthy Eating Index-2005 score for baseline menus compared to target menus increased by more than 50 points with incremental increases observed for each transitional menu. This analysis demonstrates that small, practical changes in food choices that bring consumers closer to meeting MyPyramid recommendations result in gradual and dramatic improvements in diet quality. Food and nutrition professionals can use menu modeling to provide concrete examples and specific guidance for making progressive changes in food selections to meet current dietary recommendations.     

Use of alcohol during conception, pregnancy and lactation

Recently, the Dutch Health Council published a report on the risks of the use of alcohol during conception, pregnancy and lactation. Because the medical literature does not prove the safety of the use of small amounts of alcohol, the Health Council recommends using no alcohol whatsoever. One may wonder whether the advice of the Health Council is not too rigid. Since Karl Popper, it is evident that the truth of the hypothesis that the consumption of small amounts of alcohol is safe will never be verified. Because the medical literature also does not prove the harmfulness of the irregular use of small amounts of alcohol, it is not necessary to upset pregnant women who occasionally take an alcoholic beverage. It is preferable to use no alcohol; however, the rare consumption of a single glass does not seem to be harmful.     

减重干预对超重与肥胖成人代谢指标的影响

目的观察减重干预对超重、肥胖成人代谢指标的影响。方法在2008年3月至2009年12月我院体检社区人群中,人选排除高血压、糖尿病且未曾服用过于预血压、血脂及血糖药物、自愿接受减重干预的超重、肥胖成人共116例,按年龄分为青年组、中壮年组、老年组,对各组实施为期6个月的强化健康教育、膳食、运动管理等综合减重干预措施,分别对干预前后的体质指数（BMI）、体脂率、血压、空腹血糖、口服75g葡萄糖2h后血糖（OGTT 2h血糖）、血清三酰甘油（TG）、总胆固醇、高密度脂蛋白胆固醇（HDL）及低密度脂蛋白胆固醇（LDL）的测值进行t检验。结果干预后各组BMI、空腹血糖、TG及LDL均较干预前明显下降（P〈0．05）;各组HDL较干预前明显上升（P〈0．05）;青年组、中壮年组干预后体脂肪率、收缩压、舒张压及OGTT 2h血糖均较干预前明显下降（P〈0．05）,但老年组干预后体脂肪率、收缩压、舒张压及OGTT 2h血糖与干预前差异无统计学意义。结论减重干预可有效改善各年龄段超重、肥胖成人的体格及代谢指标,降低肥胖相关疾病的患病风险,是超重肥胖人群防病健身安全可靠的有效方法;老年超重、肥胖人群在减重干预的同时应尽早结合药物治疗。     

Eating behaviors,victimization, and desire for supportive intervention among adolescents in weight-loss camps

This study examined links between eating behaviors, weight-based victimization (WBV) and preferences for bullying intervention among adolescents. Adolescents enrolled in weight loss camps participated in an online survey (N = 361). Regression models examined relationships between key variables. Almost half of adolescents who experienced WBV engaged in unhealthy eating behaviors, which corresponded to less desire for supportive intervention. Unhealthy eating behaviors may offset adaptive coping strategies to deal with WBV, such as support from peers and family.     

Prevalence of weight-loss strategies and use of substances for weight-loss among adults: a population study

This paper concerns a cross-sectional population-based study conducted with adults living in the city of Pelotas, Rio Grande do Sul State, Brazil. It aims to determine the prevalence of weight-loss practices and use of substances for weight-loss during the 12 months preceding the interview. The prevalence of weight-loss attempts was 26.6%. Although dietary control and regular physical exercise were the most commonly used strategies, the prevalence of the combined use of these methods was only 36% for individuals trying to lose weight. The prevalence of use of substances for weight-loss was 12.8% (48.4% of those who tried to lose weight). The use of dietary control and substances was more common among women, while men practiced physical exercise with greater frequency. Teas were the most frequently used substances for weight-loss. Multivariate analysis identified being female, excess weight and self-perception of excess weight as major associated factors for the use of substances for weight-loss. Finally, we found that, although weight-loss attempts are common, the majority of obese individuals do not make attempts to lose weight and only a minority follows the recommended practices.     

Use and costs of bariatric surgery and prescription weight-loss medications

The extent of use of bariatric surgery and weight-loss medications is unknown. Using the Nationwide Inpatient Sample, we estimate that the number of bariatric surgeries grew 400 percent between 1998 and 2002; such surgeries were performed on 0.6 percent of the 11.5 million adults clinically eligible in 2002. Hospital costs for bariatric surgery grew sixfold to $948 million in 2002. The inpatient death rate declined 64 percent. Among employers that covered weight-loss drugs in 2002, less than 2.4 percent of adults clinically eligible for these drugs used them, with average annual spending of $304 per user.     

Use of maternal reserves as a lactation strategy in large mammals

The substrate demands of lactation must be met by increased dietary intake or by mobilization of nutrients from tissues. The capacity of animals to rely on stored nutrients depends to a large extent on body size; large animals have greater stores, relative to the demands of lactation, than do small animals. The substrate demands of lactation depend on the composition and amount of milk produced. Animals that fast or feed little during lactation are expected to produce milks low in sugar but high in fat, in order to minimize needs for gluconeogenesis while sustaining energy transfers to the young. The patterns of nutrient transfer are reviewed for four taxonomic groups that fast during part of or throughout lactation: sea lions and fur seals (Carnivora: Otariidae), bears (Carnivora: Ursidae), true seals (Carnivora: Phocidae) and baleen whales (Cetacea: Mysticeti). All these groups produce low-sugar high-fat milks, although the length of lactation, rate of milk production and growth of the young are variable. Milk protein concentrations also tend to be low, if considered in relation to milk energy content. Maternal reserves are heavily exploited for milk production in these taxa. The amounts of lipid transferred to the young represent about one-fifth to one-third of maternal lipid stores; the relative amount of the gross energy of the body transferred in the milk is similar. Some seals and bears also transfer up to 16-18 % of the maternal body protein via milk. Reliance on maternal reserves has allowed some large mammals to give birth and lactate at sites and times far removed from food resources.     

Contraception during lactation: a comparison of methods

A comparative study was conducted on nursing mothers using various contraceptives: 120 used Norplant; 117 used the progestogen-only pill (Lynestrenol, 0.5 mg daily); 187 used the progesterone vaginal ring; and 122 used the copper IUD. The contraceptives were begun at 57 days postpartum; those using the pill or vaginal ring were advised to change methods after weaning. The 256 controls were women with similar characteristics who used lactational infertility. Follow-up visits at maternal and child health clinics occurred frequently; mother and child were examined, and histories included feeding and bleeding patterns, and any symptom or side-effect. Supplementary feeding began after 6 months. Only 2 pregnancies occurred (in the pill group) in the women using contraceptive methods; 48 of the control group became pregnant at the end of the year. 26 women gave up their vaginal rings because of use-related problems. More than 50% of the contraception group bled in the first month; 26% of controls did. Women in the progesterone group had 1-5 months more amenorrhea than controls and those with the copper IUD. There were few cases of prolonged bleeding.     

护理干预对早期乳汁分泌的影响

目的探讨护理干预对早期乳汁分泌的影响.方法对100例产妇分两组进行护理研究.实验组50例,给予护理干预(产前宣教,孕期保健知识培训,产时乳房护理,早接触,有效的早吸吮,乳房热敷、按摩,饮食护理,保证产后舒适、温馨的休养环境等)措施;对照组50例,未在我院进行产前检查及接受孕期健康教育.按产后护理常规给予早接触、早吸吮,按需吸吮乳房,在产后1～4 d乳量少时,还适当给予婴儿添加辅食.结果实验组产妇乳房分泌乳汁时间提前、乳腺管提早通畅、乳量充足时间提早.两组对照P＜0.01.结论加强产前、产时及产后的护理干预是促进产后早期乳汁分泌、保证乳量充足的关键.     

Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation

After validation of test-weighing procedures milk volumes produced by 13 multiparous Caucasian women were followed longitudinally through the first year of lactation. All practiced exclusive breast-feeding for at least 5 mo. Milk transfer to the infant was low on days 1 and 2 and increased rapidly to 498 +/- 129 g/d (means +/- SD) on day 5 and then more slowly to 753 +/- 89 g/d during months 3-5. There was a characteristic milk volume for each mother-infant pair that was significantly related neither to milk yield on days 4-6 nor to birth weight. It was, however, strongly related to infant weight at 1 mo, suggesting that infant and/or maternal factors coming into play during the first month of life are strong determinants of subsequent milk transfer to the infant.