Weight reduction diets and health promotion.

Obesity is an important health problem. Despite record rates of dieting and the availability of numerous programs, the problem is not abating. This article discusses the popularity of fad diets, the safety and effectiveness of commonly used approaches to weight loss, and the health effects of weight change. We propose an approach in which the search for a best treatment is secondary to the development of criteria to match patients to different treatments. This approach provides an opportunity for the health professional to take advantage of the multiple weight reduction resources in the community.     

Weight reduction,fertility and contraception

The significance of weight and body composition with regard to the fertile menstrual cycle has excited much interest. There is global imbalance of resources and problems of widespread chronic malnutrition in many 3rd world countries. This emphasizes the great importance of the possible effects of diet, body weight, and body composition on fecundity (ability to reproduce), fertility (reproductive performance), and pregnancy outcome. Frisch and Revelle suggested that a critical body weight is required for a girl to progress through puberty, menstruate, and finally develop ovulatory cycles. They postulated a direct relationship between weight and menarche and suggested that before menarche will occur at least 17% of the body weight needs to be made up of fat. The Frisch hypothesis is not universally accepted, and it seems highly unlikely that a single age unrelated body weight is always the trigger for menarche. Many of the data used in Frische's original studies were derived rather than directly observed. It seems likely that both body weight and composition are important and that the peripheral conversion of androgens to estrogens in fat plays a role in pubertal development, but the actual signal whcih triggers the hypothalamic events leading eventually through puberty to menstruation and ovulation remains unkown. Acute malnutrition, as seen during famine, is assoicated with a dramatic decrease in fertility. It is usually secondary to amenorrhea and annovulation. In developing countries weight related amenorrhea and delayed menarche are largely the result of nutritonal deprivation and the demands of lactation on women of boderline body weight, but a different pattern is seen in Western countries. The outstanding example of weight reduction resulting in infertility is seen in patients with anorexia nervosa. These women have extreme self imposed weight loss, a distorted perception of their body image, and disturbance in their attitude towards their feelings of hunger and satiety. Self imposed weight loss is the most common single cause of secondary amenorrhea seen in the Western world. While diagnosis of the gross anoretic is perhaps rarely missed, the more subtle degrees of weight loss and their effect on the menstrual cycle are often overlooked. Simple weight loss of more than 30% of body fat will cause menstrual dysfunction and ultimately amenorrhea. There is no clearly defined threshold between infertility and normal reproductive health, and there will always be women who become pregnant despite suboptimal weight. Patients with simple weight loss may be sufficiently motivated to restore their weight to normal levels, with resultant spontaneous resumption of ovulation.     

Weight reduction methods of college women

Weight reduction attitudes and practices were obtained from a sample of 400 female students. Forty-eight percent reported using a weight loss program since admission to college. The programs most often selected included hypocaloric diets and exercise. Although the majority of subjects rated hypocaloric diets and exercise as good methods for weight reduction and indicated that they would recommend them to others, these methods supported the slowest rate of weight loss. Evidently, the side effects and costs of the other programs offset the rapid weight loss. Other methods, in descending order of use, included the Cambridge diet, drugs, weight loss clinics, and low-carbohydrate diets. Improved appearance was most often given as the reason for losing weight.     

Weight stigmatization and bias reduction: perspectives of overweight and obese adults

This study employed qualitative methods with a sample of overweight and obese adults to identify and describe their subjective experiences of weight bias. Participants (274 females and 44 males) completed an online battery of self-report questionnaires, including several open-ended questions about weight stigmatization. These questions asked them to describe their worst experiences of weight stigmatization, their perceptions of common weight-based stereotypes, their feelings about being overweight and their suggestions for strategies to reduce weight stigma in our culture. Participants reported experiencing weight stigma across a range of contexts and involving a variety of interpersonal sources. Close relationship partners (such as friends, parents and spouses) were the most common source of their worst stigmatizing encounters. Participants challenged common weight-based stereotypes (notably, that obese individuals are 'lazy') and reported that they would like the public to gain a better understanding of the difficulties of weight loss, the causes of obesity and the emotional consequences of being stigmatized. Education was reported as the most promising avenue for future stigma-reduction efforts. The experiences and opinions expressed were not significantly different for men versus women or overweight versus obese individuals. A minority of participants expressed beliefs suggestive of self-blame and internalization of weight-based stereotypes. These results indicate that while obese individuals experience weight bias across many domains, more stigma-reduction efforts should target stigmatizing encounters in close relationships, including parents, spouses and friends of obese persons.     

Weight loss and brown adipose tissue reduction in rat model of sleep apnea

Background -  

Obesity is related to obstructive sleep apnea-hypopnea syndrome (OSAHS), but its roles in OSAHS as cause or consequence are not fully clarified. Isocapnic intermittent hypoxia (IIH) is a model of OSAHS. We verified the effect of IIH on body weight and brown adipose tissue (BAT) of Wistar rats.     

Weight and sodium reduction for the prevention of hypertension: a comparison of group treatment and individual counseling.

Ninety-three overweight adult males with labile blood pressure elevation participated in a 20-week dietary intervention program to achieve a 10 per cent reduction in body weight and a reduction in dietary sodium intake to 70 milliequivalents per day. By random assignment, half were treated with intensive group treatment procedures and half with individual counseling. Written handouts and assignments were identical, as was the schedule of treatment visits. Both techniques produced significant decreases in weight, sodium intake, calorie intake, and blood pressure. Calorie and sodium knowledge also increased significantly with both intervention approaches. The two treatment modalities did not differ in effectiveness.     

Weight reduction on lactovegetarian and mixed diets. Changes in weight, nutrient intake, skinfold thicknesses and blood pressure

The purpose of this study was to investigate whether a weight reduction programme based on a lactovegetarian diet has any beneficial effects on the weight, nutrient intake, blood pressure and skinfold thickness of overweight subjects compared with a programme based on a balanced mixed diet. The subjects consisted of three groups of moderately overweight persons, with a mean age of 38 years and a mean overweight of 38 per cent. Two groups had a weight reduction programme for 1 year; group 1 (n = 31) had a 1200 kcal lactovegetarian diet and group 2 (n = 37) had an isocaloric mixed diet. Group 3 (n = 42) served as a control group which had no intervention. During the 1-year study period, group 1 lost 9.2 kg in weight, group 2 lost 10.4 kg and group 3 gained 1.6 kg in weight. Weight loss in both weight reduction groups was accompanied by a reduction in blood pressure, skinfold thickness and arm circumference. The results were slightly more favourable in the mixed diet group than in the lactovegetarian group. In the lactovegetarian group 7 persons were not able to follow the lactovegetarian diet throughout the whole year but ate some meat, fish and eggs during the latter part of the study year. The intake of fibre, vitamin C and calcium was greater and the intake of fat lower in the lactovegetarian than in the mixed diet group during the 1-year weight reduction period. The intake of most nutrients was above the recommended level in both weight reduction groups. The intake was somewhat below recommendations for niacin in the lactovegetarian group, for calcium in the mixed diet group and for iron for women in both groups. It seems desirable to recommend a low-calorie nutritionally well-balanced mixed diet, based on familiar foods and rich in vegetables, instead of a lactovegetarian diet, for long-term weight reduction of overweight persons. In the long term some nutrients may need to be supplemented in both diets.     

Weight control in university students.

A total of 1858 students of United Kingdom origin aged between 18 and 20 years of age completed questionnaires which investigated present weight, bingeing, vomiting and weight control. Men were significantly more likely than women to be overweight, while women were significantly more likely to be underweight. One-third of the women were actively controlling weight, with dieting as the preferred method, while over half had attempted weight control in the past three years. Daily or more frequent bingeing was reported by 1.9% of men and 1.2% of women. There was a statistically significant relationship between weight control and bingeing. Eleven percent of men and 24% of women thought they had a problem with weight control, although amongst both men and women the proportion who felt they were overweight was in excess of the proportion who actually were overweight. It is suggested that health education programmes should take account of the pressures upon young women to conform to predetermined ideals in terms of body weight.     

Weight reduction interventions for persons with a chronic illness: findings and factors for consideration

Obesity in persons with a concomitant chronic illness poses complex issues relating to the choice of appropriate interventions. More recent emphasis on modification of risk factors has resulted in the need to prescribe complex therapeutic regimens with multiple treatment goals. The traditional approach to weight reduction in such persons has been nutrition education. Studies have shown, however, that knowledge alone does not translate into self-care behaviors that in turn result in weight loss and weight maintenance. Although the latter outcomes continue to be primary goals of therapy in obese individuals with a chronic illness, improvement in the physiologic parameters associated with the illness is also a desired outcome. Behavior therapy and group support appear to be enabling factors that go beyond knowledge to facilitate behavior change and subsequent changes in health-related indexes. This article describes various approaches to the problem of combined interventions for patients education and weight reduction. Findings and factors are discussed about whether the primary goal of weight reduction interventions for persons with a chronic illness should focus on pounds lost or improvement in metabolic or physiologic status.     

Weight counseling patterns of U. S. Pediatricians

OBJECTIVE: To estimate the proportion and characteristics of U.S. pediatricians who reportedly counsel their patients about maintaining a healthy weight. RESEARCH METHODS AND PROCEDURES: Beginning in October 1998, information was collected from 813 primary care pediatricians randomly selected from a nationally representative sample. Pediatricians were asked how frequently they counseled about maintaining a healthy weight during the well-care visits of patients in three age groups. Multivariable logistic regression determined which physician characteristics were associated with counseling. RESULTS: Approximately fifty percent of pediatricians reportedly always counseled about maintaining a healthy weight. Those who always counseled were more likely to be women, to spend more time with patients during well-care visits, and to conduct more well-care visits per week from patients in one particular age group. Most pediatricians who responded that they always counseled about healthy weight reported that they counseled about physical activity and nutrition, but not about balancing caloric intake with expenditure. DISCUSSION: Although many pediatricians report counseling about healthy weight, the frequency of counseling might be further increased by increasing the amount of time the patient spends during office visits with the pediatrician or with other professional staff, such as nurses or dietitians.     

Weight reduction in the prevention and treatment of hypertension: a review of representative clinical trials

Elevated blood pressure is a risk factor for cardiovascular disease, and weight reduction is currently advocated as a nonpharmacologic approach for the management of hypertension. Results of clinical trials indicate weight reduction is effective in preventing and treating hypertension. Knowledge of the results of clinical trials is extremely important for health educators since: 1) these findings provide a scientific basis for educating other health professionals about the beneficial effects of dietary approaches to the management of hypertension; 2) discussion of these results with patients may provide a means for altering patients' expectations and achieving improved treatment compliance; and 3) the processes by which clinical trials have achieved their dietary goals can provide health educators with extensive clinical experience upon which to draw in working with nonstudy patients. The content and general results of clinical trial programs are reviewed as well as features associated with health promotion in clinical trial and behavioral weight loss research.