Relationship of psychiatric diagnosis and weight loss maintenance in obese breast cancer survivors

OBJECTIVE: Obese breast cancer survivors are a unique population for weight loss counseling because both obesity and a diagnosis of breast cancer can increase the risk of depression. In this pilot study, weight loss maintenance was examined in obese breast cancer survivors with relationship to psychiatric diagnosis. RESEARCH METHODS AND PROCEDURES: Forty-eight subjects were enrolled. The intervention, which used individualized counseling for diet and exercise, lasted 24 months. After a 6-month period of no contact with study subjects, a follow-up body weight was obtained at 30 months. RESULTS: The nine subjects who dropped out of the study before 12 months all failed to complete a structured psychiatric interview. Of the remaining 39 subjects, 9 had major depressive disorder, and 10 had a definable psychiatric disorder of lesser severity such as adjustment disorder. Subjects with any type of psychiatric diagnosis displayed significantly less weight loss at the 12-month time-point than those with no diagnosis (6.3% vs. 12.6% loss of baseline weight, respectively). At the 30-month follow-up visit, subjects with any psychiatric disorder had a mean weight loss of 1.2% of baseline weight compared with 7.8% weight loss in subjects with no diagnosis. DISCUSSION: These results suggest that the presence of psychiatric disorders can interfere with weight loss. Therefore, recognition and treatment of psychiatric disorders may be important in attempts at weight reduction, and this will be especially important in populations such as cancer survivors, who seem to have higher rates of depression and other disorders than the general population.     

Combining weight-loss counseling with the weight watchers plan for obese breast cancer survivors

OBJECTIVE: The objective was to develop effective weight-loss methods for women who have had breast cancer, because obesity may result in an adverse prognosis. RESEARCH METHODS AND PROCEDURES: This randomized pilot study tested an individualized approach toward weight loss in obese women who have had a diagnosis of breast cancer. An individualized approach was applied either alone or combined with the commercial Weight Watchers program. Forty-eight women (body mass index of 30 to 44 kg/m(2)) were enrolled. RESULTS: Weight change after 12 months of intervention was as follows (mean +/- SD): 0.85 +/- 6.0 kg in the control group, -2.6 +/- 5.9 kg in the Weight Watchers group, -8.0 +/- 5.5 kg in the individualized group, and -9.4 +/- 8.6 kg in the comprehensive group that used both individualized counseling and Weight Watchers. Weight loss relative to control was statistically significant in the comprehensive group 3, 6, and 12 months after randomization, whereas weight loss in the individualized group was significant only at 12 months. Weight loss of 10% or more of initial body weight was observed in 6 of 10 women in the comprehensive group at 12 months. In the comprehensive and Weight Watchers-only groups, weight loss was significantly related to frequency of attendance at Weight Watchers meetings, and attendance was more frequent in the comprehensive group. DISCUSSION: These data indicate that the most weight loss was achieved when the counseling approach combined both Weight Watchers and individualized contacts. This was effective even though most of the individualized contacts were by telephone.     

Internet use among Chinese-American breast cancer survivors

This study describes information seeking behaviors and patient characteristics associated with Internet use by 72 Chinese-American breast cancer survivors diagnosed in the past 5 years and living in Houston, Texas. Face-to-face interviews showed that only 56% used the Internet for health information; only 9% used e-mail or visited a website to communicate with a doctor's office or get online provider advice. Results indicate that health providers who want to reach breast cancer patients with limited English skills need to take into account this low use of Internet resources and web-based information. Particularly important is the need to develop and make available culturally effective and appropriate health information in the native languages of the patients to promote greater health literacy.     

Effect of weight loss on bone metabolism in postmenopausal obese women with osteoarthritis

BackgroundThe choice of hypocaloric diets in obesity can affect bone health.AimsThe aim of this study is to assess the effect of a hypocaloric diet in postmenopausal obese women and to determine the influence of weight reduction on bone metabolism.MethodsThis was a non-randomised, single-treatment study in 96 postmenopausal women with a body mass index (BMI) greater than 35 kg/m² and osteoarthritis. The patients received a formula diet with two intake levels of a normocaloric hyperproteic formula (1035 kcal (25% protein)). Anthropometry and biochemistry with CrossLaps, osteocalcin, parathyroid hormone (PTH) and 25-OH vitamin D were measured. Consumption of protein, calcium and vitamin D were determined at the beginning of and 3 and 6 months into the study. The response to treatment was compared (high-responder (HR): weight loss greater than 15%, and low-responder (LR): weight loss less than 15%).ResultsThe mean age was 64.2 (7.5) years. After 6 months of treatment, a weight loss of 10.2% (8.2–13.8) was observed. There was a significant increase in vitamin D (HR: 21.8% (36.2) vs. LR: 22.7% (36.9), p = 0.93) and CrossLaps (HR: 26.8% (19.5–35.2)) vs. LR: 13.3% (?6.1 to 27.9), p = 0.01). The loss of more than 15% of initial body weight was an independent risk factor for an increase in CrossLaps (OR: 4.22 (1.1–16.8), p = 0.04).ConclusionsIn postmenopausal obese women, weight loss was associated with an increase in the biochemical parameters of bone resorption. The increase in resorption parameters was related to the magnitude of weight loss.     

Predicting weight loss success among obese clients in a hospital nutrition clinic

A retrospective study of 63 obese patients seen in a hospital outpatient nutrition clinic was reported. The majority suffered from one or more other medical problems. The relationship of amount of and rate of weight loss to various factors was examined. The multivariate analysis revealed that either the amount or rate of weight loss was greater in the patients who were more overweight initially, white, male, young, single, older at age of onset of obesity, visited the clinic for a longer period of time but less frequently. Conversely, the amount or rate of weight loss was less in those patients receiving conjugated estrogens, oral contraceptives, propranolol, thioridazine HCl, and those who were receiving behavior modification as treatment.     

Correlates of physical activity self-efficacy among breast cancer survivors

Objective: To determine physical activity (PA) self-efficacy correlates in breast cancer survivors. Methods: Mail survey of 192 breast cancer survivors. Results: Structural equation analyses demonstrated significant and direct associations for perceived PA barriers (beta=-.29), fatigue (beta=-.24), social support (beta=.12), enjoyment (beta=.12), and prediagnosis PA (beta=.11) with barriers self-efficacy. Prediagnosis PA (beta=.51), social support (beta=.26), and barriers self-efficacy (beta=.13) demonstrated direct associations with current leisure PA. Task self-efficacy analysis results were similar except perceived barriers and prediagnosis PA were not associated with task self-efficacy. Conclusions: Multiple potential efficacy correlates exist and may vary based on the aspect of self-efficacy examined.     

Beliefs and influences on weight loss diets among low-income obese individuals

Obesity has become an epidemic that requires immediate control, mainly among the poor, particularly women and the less educated. The WHO requests and several studies confirm that support is needed for research projects examining psychological and social behavior that hampers compliance with weight loss diets. This paper uses the Theory of Reasoned Action (TRA) of M. Fishbein (1975) in social psychology, comparing two series of open interviews (conducted in 2001 and 2005) that disclosed positive (advantageous) and negative (harmful) beliefs about weight loss diets among low-income obese patients in Jo?o Pessoa, Paraíba State, as well as their guides (people of influential opinion) on following their diets. The 2001 findings were corroborated in 2005, revealing fears of diseases related to obesity and the wish to feel healthier and lighter. Mothers, children and above all spouses were mentioned as diet supporters. It was stressed that will-power is not be enough, but also reflection and building up control skills, in addition to allocating and altering life styles. Concerns related to appearance were not high priority. This information may lead to better diet compliance.     

Lifetime health and economic benefits of weight loss among obese persons.

OBJECTIVES: This study estimated the lifetime health and economic benefits of sustained modest weight loss among obese persons. METHODS: We developed a dynamic model of the relationship between body mass index (BMI) and the risks and costs of 5 obesity-related diseases: hypertension, hypercholesterolemia, type 2 diabetes, coronary heart disease (CHD), and stroke. We then calculated the lifetime health and economic benefits of a sustained 10% reduction in body weight for men and women aged 35 to 64 years with mild, moderate, and severe obesity. RESULTS: Depending on age, gender, and initial BMI, a sustained 10% weight loss would (1) reduce the expected number of years of life with hypertension, hypercholesterolemia, and type 2 diabetes by 1.2 to 2.9, 0.3 to 0.8, and 0.5 to 1.7, respectively; (2) reduce the expected lifetime incidence of CHD and stroke by 12 to 38 cases per 1000 and 1 to 13 cases per 1000, respectively; (3) increase life expectancy by 2 to 7 months; and (4) reduce expected lifetime medical care costs of these 5 diseases by $2200 to $5300. CONCLUSIONS: Sustained modest weight loss among obese persons would yield substantial health and economic benefits.     

Weight change and its correlates among breast cancer survivors

We assessed weight change from diagnosis to approximately 18 mo after cancer diagnosis and evaluated its correlates in a large, population-based, cohort study of women diagnosed with stage 0-IV breast cancer. A total of 4,561 cases with weight information 1 yr prior to diagnosis, at diagnosis, and at the 18-mo postdiagnosis interview were included in the study. Multinomial logistic regression models were conducted to examine the association of weight change from diagnosis to 18 mo after diagnosis with sociodemographic, clinical, and lifestyle factors. The mean weight change from diagnosis to 18 mo after diagnosis was a gain of 1.7 kg (median: 2.0). Overall, 61% of women gained weight, 27% gained 2-5 kg, and 24% gained ≥5 kg, while approximately 14% lost >2 kg during the 18-mo postdiagnosis period. Greater weight gain was significantly related to younger age, premenopausal status, mixed receptor status, more advanced disease stage, prediagnosis weight loss, higher dietary intake, and cigarette smoking. Women with obesity and serious comorbidity were more likely to lose weight. Moderate exercise was not significantly related to weight change. Weight gain is common among breast cancer survivors. Sociodemographic, clinical, and lifestyle factors are related to weight change. Appropriate intervention strategies should be developed.     

Hypnotizability and weight loss in obese subjects

This study tested the effects of hypnosis for weight control. Hypnotizability was assessed by the Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C). Forty-five subjects completed the study with examiners who were blind with respect to hypnotizability scores. Subjects exposed to a simple self-management technique and to the Spiegel and Spiegel (1978) hypnosis intervention, modified to include specific food aversion, lost significantly more weight at a 3-month follow-up than subjects exposed only to the self-management treatment. The specificity of hypnosis in the program was supported by a significant correlation between weight loss and SHSS:C scores for the same group. Subject attrition was about equal across all treatment groups, suggesting all treatments were perceived as active.     

Determinants of quality of life among long-term breast cancer survivors

Purpose

To identify the impact of clinical and socio-economic determinants on quality of life (QoL) among breast cancer (BC) survivors 5 years after diagnosis.

Methods

A cross-sectional survey was conducted in women diagnosed in 2007 for primary invasive non-metastatic BC and identified through the Côte d’Or BC registry. QoL was assessed with the Medical Outcomes Study 12-item Short Form Health Survey (SF-12), the European Organization for Research and Treatment of Cancer Quality of Life (EORTC-QLQ-C30) and the breast cancer (EORTC-QLQ-BR23) questionnaires. Social support was assessed with Sarason’s social support questionnaire, and deprivation was assessed by the EPICES questionnaire. Clinical variables were collected through the registry database. Determinants of QoL were identified using multivariable mixed model analysis for each SF-12 dimension. A sensitivity analysis was conducted with multiple imputations on missing data.

Results

Overall, 188 patients on 319 patients (59 %) invited to participate to the survey completed the questionnaires. Five years after breast cancer diagnosis, the disease stages at diagnosis, as well as the treatment received, were not determinants of QoL. Only the age at diagnosis and comorbidities were found to be determinants of QoL.

Conclusions

Five years after BC diagnosis, disease severity and the treatment received did not affect QoL.

     

Low risk of hip fracture among elderly breast cancer survivors

PURPOSE: Prior research has shown that women with either osteoporotic fracture or low bone density are at a decreased risk of breast cancer. Little prior work has evaluated whether women with breast cancer are at a decreased risk of osteoporotic fracture. METHODS: We used data from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER)-Medicare program to study the risk of hip fracture among elderly female Medicare beneficiaries with and without histories of breast cancer. Using the SEER file, we identified elderly women survivors of stage 0, I, or II breast cancer (N=5980) diagnosed between the ages of 55 and 64 years; using the Medicare 5% file, we identified elderly women without histories of cancer (N=23,165) from SEER regions. Using Medicare claims from 1993 through 1998, we followed women for hospitalization for hip fracture or death until December 31, 1998. RESULTS: We found the rate ratio of hospitalization for hip fracture for breast cancer survivors relative to comparison patients was 0.63 (95% CI: 0.43-0.94) after adjusting for age, race, socioeconomic status, geographic location, cohort entry year, and medical comorbidity. CONCLUSIONS: We conclude that survivors of early stage post-menopausal breast cancer are at significantly lower risk of hip fracture than women who do not have histories of breast cancer.     

Maintenance of weight loss in obese subjects.

The records of a selected group of 215 subjects who had successfully lost surplus weight were followed-up for periods of one to six years. Mean initial weight was 131% of standard (19.5 kg surplus) and the mean time taken to achieve 'goal weight' was 7.05 months (range two to 20 months) at a mean rate of 2.9 kg per month (range 1.85 to 5 kg). Altogether 121 subjects (56.3%) maintained goal weights within plus or minus 2.3 kg of goal; 79 subjects (36.7%) maintained within plus or minus 4.5 kg. At time of examination of the records, 39 subjects (18.8%) had maintained constant weight for more than four years, 22 subjects (10.6%) for three to four years, 65 subjects (31.4%) for two to three years, 58 subjects (28.5%) for one to two years, and 23 subjects (11.1%) for periods of up to one year.     

健身肚皮舞处方对肥胖女大学生减肥效果评价

探讨健身肚皮舞运动处方对肥胖女大学生减肥效果,为科学开展肥胖女性运动减肥提供科学依据.方法 在广西民族大学校园以海报的形式招募符合我国肥胖判定标准(BMI≥28 kg/m2)的88名肥胖女大学生,随机分成对照组和实验组,每组44名.实验组进行4个月的健身肚皮舞运动,对照组按原来的方式生活、学习和工作.比较实验前后两组研究对象身体形态、身体功能、血液生化等指标的变化情况.结果 实验后,实验组身体形态指标、身体功能指标、血液生化指标与对照组相比(除身高外)差异均有统计学意义(P值均<0.05).实验后,实验组44名肥胖女大学生有18名(40.9%)体重恢复到正常状态,有26名(59.1%)处于超重状态.结论 健身肚皮舞运动处方对肥胖女大学生身体形态、身体功能和血液生化指标具有明显改善作用.     

Fluoxetine's effect on weight loss in obese subjects

Forty-five obese subjects with a mean weight of 102.9 kg and a body mass index (in kg/m2) of 37.6 were randomly assigned to a fluoxetine-diet group (n = 23) or a placebo-diet group (n = 22) for 52 wk. At week 29, 14 subjects on fluoxetine who completed the study attained their maximum weight loss of 12.4 kg, an amount significantly greater than the maximum weight loss of 4.5 kg for the 16 on placebo who completed the study. The fluoxetine group's significantly greater mean weight loss continued through week 45. However, those on fluoxetine regained a mean of 4.2 kg from their lowest weight (P less than 0.001) whereas the placebo group did not. By the end of the study, each group weighed significantly less than they did at baseline (fluoxetine: -8.2 kg; placebo: -4.5 kg; P less than 0.05) although the difference between groups was no longer significant (P greater than 0.05). Several factors were considered as possible causes for the regain with fluoxetine.