The effect of obesity management on body image in patients seeking treatment at medical centers

Objective: Body image dissatisfaction is common in treatment‐seeking patients with obesity. We aimed to investigate the effects of obesity management on body image in patients with obesity attending Italian medical centers for weight loss programs. Research Methods and Procedures: A total of 473 obese patients seeking treatment in 13 Italian medical centers (80% females; age, 45.9 ± standard deviation 11.0 years; BMI, 36.8 ± 5.7 kg/m²) were evaluated at baseline and after a 6‐month weight loss treatment. Body uneasiness, psychiatric distress, and binge eating were tested by Body Uneasiness Test (BUT, Part A), Symptom CheckList‐90 (SCL‐90), and Binge Eating Scale (BES), respectively. Results: At 6‐month follow‐up, the percentage weight loss was significantly higher in men (9.0 ± 6.3%) than in women (6.8 ± 7.3%; p = 0.010). Both men and women had a significant improvement in BUT Global Severity Index and in all of the BUT subscales with the exception of the Compulsive Self‐Monitoring subscale. Linear regression analysis selected baseline psychological and behavioral measures (global score of BUT and SCL‐90) and improved psychiatric distress and binge eating as independent predictors of changes in basal body dissatisfaction in females, whereas in males, changes were associated only with baseline BUT‐Global Severity Index score, binge eating, and its treatment‐associated improvement. Pre‐treatment BMI and BMI changes did not enter the regression. Discussion: Obesity treatment, even with a modest degree of weight loss, is associated with a significant improvement of body image, in both females and males. This effect depends mainly on psychological factors, not on the amount of weight loss.     

The Influence of Parenting Change on Pediatric Weight Control

Objective: Parenting style was examined as a predictor of weight loss maintenance in behavioral family‐based pediatric obesity treatment. Research Methods and Procedures: Fifty obese children who participated in a behavioral family‐based pediatric obesity treatment were studied. Hierarchical regression tested the incremental effect of baseline parenting and parenting during treatment on children's percentage overweight change over 12 months, beyond demographics and adherence to targeted behaviors. Results: Children's percentage overweight significantly decreased at 6 (?16.3) and 12 (?11.1) months. Adherence to program goals significantly increased variance accounted for in the regression model by 10.8%, whereas adding baseline father acceptance and change in father acceptance accounted for another 20.5%. The overall model accounted for 40.6% of the variance in pediatric weight control. ANOVA showed significantly greater percentage overweight decrease from baseline for youth with fathers who increased their acceptance vs. those who decreased acceptance at 6 (?19.8 vs. ?14.6) and 12 (?17.4 vs. ?8.1) months. Discussion: Youth who perceive an increase in father acceptance after treatment had better changes in percentage overweight over 12 months than youth with lower ratings of father acceptance. Future directions include examining how other parenting dimensions impact pediatric obesity treatment outcome and how parental acceptance can be enhanced to improve child weight control.     

Sibutramine Treatment in Obesity: Predictors of Weight Loss Including Rorschach Personality Data

Objective: To study personality and clinical factors in weight loss by sibutramine (Meridia and Reductil), an anti‐obesity drug enhancing satiety. Research Methods and Procedures: The subjects were 30 obese patients [43 ± 12 years (mean ± SD), BMI 40 ± 4 kg/m²]. The treatment comprised 15 mg of sibutramine administered daily and monthly dietary advice. Weight loss after 6 months of treatment was evaluated. For psychological assessment, the Rorschach method (Comprehensive System) and the Beck Depression Inventory were used. Results: A multiple linear regression model including the Rorschach predictors’ physical demand states (animal movement, designated as FM) being intrusive or difficult to hold and a dependency orientation (food contents) could explain 47% of 6 months of weight loss. A model including initial weight loss in addition to the Rorschach predictors explained 58% of the 6‐month weight loss. Discussion: The personality factors predicted greater weight loss. In particular, patients with difficulties concerning physical demand states, which would include hunger, could have reduced their eating behavior with enhanced satiety, resulting in greater weight loss. Enhanced satiety could also have helped patients with a dependent need for food to limit food intake. Being enrolled in a treatment program could also have provided essential support for patients with dependency needs. Furthermore, initial weight loss was a predictor of greater weight loss in sibutramine treatment, in accordance with prior research.     

Trust in scientific experts on obesity: implications for awareness and behavior change

Objective: To explore the relationship between public trust in scientific experts on obesity and public attention to nutrition recommendations, to investigate trust as a predictor of weight‐related behaviors, and to identify the sociodemographic characteristics associated with high and low trust in scientific experts on obesity. Research Methods and Procedures: This analysis used survey data from two sources: 1) a 2005 Harvard School of Public Health Obesity Survey (N = 2033), and 2) the 2004 General Social Survey (N = 2812). Five outcome measures were used. Three were used to explore trust as a predictor of attention and weight‐related behaviors. Two were used to identify the sociodemographic predictors of trust. Logistic regression analysis was used to model the outcome variables. Results: Trust in scientific experts was the strongest predictor of public attention to nutritional recommendations from scientific experts, but it was not directly related to weight‐related behaviors. Public attention was significantly associated with two weight‐related behaviors: tracking fruit and vegetable intake and exercise. Women and more educated individuals had significantly higher odds of trusting scientific experts. Characteristics associated with distrust in scientific experts included Hispanic race and older age (over 50). Discussion: Public health experts should work toward building trust as an important step in stemming the obesity epidemic. Further, more research is necessary to better understand the factors driving trust in scientific experts on obesity. A deeper insight in this area will certainly be of great benefit to obesity‐related risk communication and potentially lead to positive behavior change.     

Predictors of attrition and weight loss in an adolescent weight control program

Objective: To evaluate demographic and psychosocial predictors of attrition and weight loss in a behaviorally based adolescent weight control trial. Methods and Procedures: Adolescents (N = 76) aged 13–16 years and 20–80% overweight (M = 60.56%, s.d. = 15.17%) received standard group‐based behavioral treatment as part of a randomized trial comparing different activity interventions for overweight adolescents. Anthropometric and psychosocial measures were obtained at baseline and after the 16‐week intervention. Results: Higher parent (P < 0.01) and adolescent BMI (P < 0.05) at baseline, as well as ethnic minority status (P < 0.05) were significantly associated with attrition in univariate analyses. Parent BMI remained the only significant predictor of attrition in multivariate analyses. BMI change for completers (N = 62) was highly variable, ranging from ?6.09 to +1.62 BMI units. Male gender (P < 0.01) was a significant predictor of reduction in BMI, whereas not being from an ethnic minority group (P < 0.05) and attendance at group sessions (P = 0.05) were associated with ≥5% absolute weight loss in multivariate analyses. Absolute weight loss during the first 4 weeks of the program was strongly associated with weight loss (pr = 0.44, P < 0.001) during the remainder of the intervention. Psychosocial variables were unrelated to attrition or treatment outcome. Discussion: These findings highlight the potential importance of attending to parental BMI in efforts to retain adolescent participants in treatment, as well as the need to develop weight control interventions that are more effective for ethnic minority youth.     

The role of parental motivation in family-based treatment for childhood obesity

This study investigated the role of parental motivation (importance, confidence and readiness) for predicting dropout and outcome from family-based behavioral treatment for childhood obesity. Parent and child demographics, adherence to treatment, and weight loss parameters were also explored as potential predictors. Eighty-four obese children (BMI-standard deviation scores (SDS) >2.14) and a participating parent with each child started treatment consisting of 12 weeks of group and individual treatment sessions (24 sessions total) delivered over a period of 18 weeks. Sixty-one families (73%) completed treatment and attended follow-up at 1 year after treatment. Child session attendance and completion of self-monitoring records served as measures of adherence. In regression analyses, parent reports (pretreatment) of confidence for doing well in treatment was the strongest predictor of treatment completion (P = 0.003) as well as early treatment response (weight loss at week 5) (P = 0.003). This variable remained a significant predictor of child weight loss at post-treatment (P = 0.014), but was not associated with child outcome at 1-year follow-up (P > 0.05). The only significant predictor of child weight loss at that point was child baseline weight (P = 0.001). However, pretreatment parent ratings of importance of and readiness for treatment did not predict dropout or weight loss at any point. The results underscore the importance of addressing parental motivation, specifically parental confidence for changing lifestyle related behaviors, early in the treatment process. Doing so may reduce treatment dropout and enhance treatment outcome.     

Do Psychosocial Variables Predict Weight Loss or Mental Health after Obesity Surgery? A Systematic Review

Objective: The objective of this study was to present a systematic review of psychological and psychosocial predictors of weight loss and mental health after bariatric surgery. This systematic review included all controlled and noncontrolled trials of the last 2 decades with either a retrospective or prospective design and a follow‐up period of at least 1 year. Research Methods and Procedures: The relevant literature was identified by a search of computerized databases. All articles published in English and German between 1980 and 2002 were reviewed. Results: Using the above inclusion/exclusion criteria, 29 articles were identified focusing on psychosocial predictors of weight loss and mental health after obesity surgery. Discussion: Personality traits have no predictive value for the postoperative course of weight or mental state. Apart from serious psychiatric disorders including personality disorders, psychiatric comorbidity seems to be of more predictive value for mental and physical well‐being as two essential aspects of quality of life than for weight loss postsurgery. However, depressive and anxiety symptoms as correlates of psychological stress with regard to obesity seem to be positive predictors of weight loss postsurgery. The severity of the symptoms or the disorder is more relevant for the outcome of obesity surgery than the specificity of the symptoms. It is also not solely the consumption of distinct “forbidden” foods, such as sweets or soft drinks, but rather a general hypercaloric eating behavior, either as an expression of the patient's inadequate compliance or a dysregulation in energy balance, which is associated with a poor weight loss postsurgery.     

Personality as a Predictor of Weight Loss Maintenance after Surgery for Morbid Obesity

Objective: Personality characteristics are assumed to underlie health behaviors and, thus, a variety of health outcomes. Our aim was to examine prospectively whether personality traits predict short‐ and long‐term weight loss after laparoscopic adjustable gastric banding. Research Methods and Procedures: Of patients undergoing laparoscopic adjustable gastric banding, 168 (143 women, 25 men, 18 to 58 years old, mean 37 years, preoperative BMI 45.9 ± 5.6 kg/m²) completed the Dutch Personality Questionnaire on average 1.5 years before the operation. The relationship between preoperative personality and short‐ and long‐term postoperative weight loss was determined using multilevel regression analysis. Results: The average weight loss of patients progressively increased to 10 BMI points until 18 months after surgery and stabilized thereafter. A lower baseline BMI, being a man, and a higher educational level were associated with a lower weight loss. None of the personality variables was associated with weight outcome at short‐term follow‐up. Six of seven personality variables did not predict long‐term weight outcome. Egoism was associated with less weight loss in the long‐term postoperative period. The effect sizes of the significant predictions were small. Discussion: None of the personality variables predicted short‐term weight outcome, and only one variable showed a small and unexpected association with long‐term weight outcome that needs confirmation. This suggests that personality assessment as intake psychological screening is of little use for the prediction of a poor or successful weight outcome after bariatric surgery.     

Weight Loss Expectations in Obese Patients Seeking Treatment at Medical Centers

Objective: To investigate weight loss expectations (expected 1‐year BMI loss, dream BMI, and maximum acceptable BMI) in obese patients seeking treatment and to examine whether expectations differ by sex, weight, diet and weight history, age, psychological factors, and primary motivations for weight loss. Research Methods and Procedures: 1891 obese patients seeking treatment in 25 Italian medical centers (1473 women; age, 44.7 ± 11.0 years; BMI, 38.2 ± 6.5 kg/m²) were evaluated. Diet and weight history, weight loss expectations, and primary motivation for seeking treatment (health or improving appearance) were systematically recorded. Psychiatric distress, binge eating, and body image dissatisfaction were tested by self‐administered questionnaires (Symptom CheckList‐90, Binge Eating Scale, and Body Uneasiness Test). Results: In 1011 cases (53.4%), 1‐year expected BMI loss was ≥9 kg/m², dream BMI was 26.0 ± 3.4 kg/m² (corresponding to a 32% loss), and maximum acceptable BMI was 29.3 ± 4.4 kg/m² (?23%). BMI and age were the strongest predictors of weight goals. Weight loss necessary to reach the desired targets was largely in excess of weight loss observed during previous dieting. Psychiatric distress, body dissatisfaction, and binge eating did not predict weight loss expectations. The primary motivation for weight loss was concern for future or present health; women seeking treatment to improve appearance had a lower grade of obesity, were younger, and had first attempted weight loss at a younger age. Discussion: Obese Italian patients had unrealistic weight loss expectations. There were significant disparities between patients’ perceptions and physicians’ weight loss recommendations of desirable treatment outcome.     

Sex Hormones and Sexual Function in Obese Men Losing Weight

Objective: To study the impact of a weight‐loss program on sex hormones and sexual function among 38 middle‐aged obese men (BMI ≥35 kg/m²). Research Methods and Procedures: A randomized controlled clinical trial was conducted. The treatment group (n = 19) participated in a 4‐month weight‐loss program including 10 weeks on a very‐low‐energy diet (VLED) and 17 behavior modification visits. There was no intervention in the control group (n = 19). Both groups were followed for 8 months, i.e., 22 weeks after the active weight loss in the treatment group. The outcome measures (weight, sex hormones, sexual function, leptin, and metabolic variables) were obtained at baseline and at three time‐points during follow‐up. Results: The mean weight loss in the treatment group was 21 kg at the end of the 10‐week VLED. At the end of follow‐up, the maintained weight loss was 17 kg of baseline weight. The control group was weight stable throughout the study. In the treatment group, increases in sex hormone‐binding globulin, testosterone, and high‐density lipoprotein‐cholesterol, as well as decreases in insulin and leptin, were maintained until the end of follow‐up, although with VLED, the level of several hormones and metabolic variables improved transiently during the rapid weight loss. There were no significant changes in the questionnaire scores on sexual function in either group. Discussion: We conclude that obese men lose weight and increase their serum testosterone level on a weight‐loss program with VLED and behavior modification. However, they do not change their sexual function scores.     

Are Unrealistic Weight Loss Goals Associated with Outcomes for Overweight Women?

Objective: To examine cross‐sectional correlates of current, goal, and dream weight and their prospective associations with weight loss in treatment. Research Methods and Procedures: Goal and dream weights, demographic characteristics, and psychosocial factors were assessed by self‐report questionnaire in 302 adult women enrolled in a weight loss trial. Height and weight were assessed at baseline, after 8 weeks of active treatment, and at 6‐ and 18‐month follow‐up. Regression techniques examined associations among baseline, goal, and dream weights, psychosocial factors, and treatment outcomes. Results: On average, goal and dream weight losses were unrealistically high (?24% and ?30%, respectively). High goals were associated with greater expected effort and greater expected reward but were not associated with psychological distress. Goal and dream weight losses were only weakly associated with behavioral or weight outcomes. An association between higher dream weight losses and greater weight loss at 18 months was the only outcome result to reach statistical significance. Discussion: Results suggest that lack of realism in weight loss goals is not important enough to justify counseling people to accept lower weight loss goals when trying to lose weight.     

Lipid Profile in the Severely Obese: Changes with Weight Loss after Lap‐Band Surgery

Objective: To characterize dyslipidemia before and after weight loss in the severely obese. Research Methods and Procedures: Five hundred fifteen subjects who had Lap‐Band surgery were followed with yearly conventional lipid profiles for up to 4 years. Preoperative data were collected from the most recent 381 subjects, and predictors of dyslipidemia were sought. One hundred seventy‐one subjects completed a 1‐year review, providing data to assess predictors of change in lipids. Results: Favorable changes in fasting triglycerides (TG), high‐density lipoprotein‐cholesterol (HDL‐C), and total cholesterol (TC):HDL‐C ratio occurred within 1 year. All improvements were maintained up to 4 years. Male gender, central obesity, elevated fasting glucose, and insulin resistance were associated with less favorable lipid levels. Fasting plasma glucose best predicted TG (r = 0.46, p < 0.001), whereas insulin sensitivity using the homeostatic model assessment (HOMA %S) correlated best with the HDL‐C (r =0.34, p < 0.001). Higher preoperative fasting glucose best predicted the decrease in TG; improved HOMA %S with weight loss correlated best with HDL‐C. The extent of weight loss had limited influence on lipid changes. However, low preoperative HOMA %S was associated with lower weight loss. Greater weight loss was associated with more favorable lipid measures after controlling for preoperative HOMA %S. Discussion: Dyslipidemia of obesity is related to weight distribution, insulin sensitivity, and impaired glucose tolerance. Improvement with weight loss is related to the decrease in fasting glucose, improvement in insulin sensitivity, and the extent of weight lost. Improvement in dyslipidemia is sustained with long‐term weight loss.     

Changes in obesity-related attitudes in women seeking weight reduction

Objective: To examine changes in obesity‐related attitudes in a sample of obese women who participated in either dieting or non‐dieting interventions. Research Methods and Procedures: A total of 123 obese women were randomly assigned to one of three weight control programs: meal replacement diet, balanced deficit diet, or a non‐dieting program. (The first two groups were combined as a single dieting condition.) Participants completed questionnaires (at baseline, Week 20, and Week 40) to assess beliefs and attitudes about obesity, along with measures of self‐esteem, depression, and body image. Results: At Weeks 20 and 40, participants in the non‐dieting condition reported significantly less negativity about obesity than those in the dieting group. Women in the dieting condition did not report an increase in negative attitudes toward obesity, despite losing significantly more weight than non‐dieting participants. Both groups experienced improvements in self‐esteem, body image, and depressive symptoms. Improvement in self‐esteem was associated with a reduction in negativity about obesity and with improvements in body image. Discussion: The non‐dieting program produced greater reductions in negative attitudes toward obesity than the dieting intervention. Dieting (with successful weight loss), however, did not result in greater negativity toward obesity. Non‐dieting programs seem to be useful in obese women for improving self‐esteem, body image, and internalized negative attitudes about obesity.     

Changes in Health State Utilities With Changes in Body Mass in the Diabetes Prevention Program

Health utilities are measures of health‐related quality of life (HRQL) used in cost‐effectiveness research. We evaluated whether changes in body weight were associated with changes in health utilities in the Diabetes Prevention Program (DPP) and whether associations differed by treatment assignment (lifestyle intervention, metformin, placebo) or baseline obesity severity. We constructed physical (PCS‐36) and mental component summary (MCS‐36) subscales and short‐form‐6D (SF‐6D) health utility index for all DPP participants completing a baseline 36‐item short form (SF‐36) HRQL assessment (N = 3,064). We used linear regression to test associations between changes in body weight and changes in HRQL indicators, while adjusting for other demographic and behavioral variables. Overall differences in HRQL between treatment groups were highly statistically significant but clinically small after 1 year. In multivariable models, weight change was independently associated with change in SF‐6D score (increase of 0.007 for every 5 kg weight loss; P < 0.001), but treatment effects independent of weight loss were not. We found no significant interaction between baseline obesity severity and changes in SF‐6D with changes in body weight. However, increases in physical function (PCS‐36) with weight loss were greater in persons with higher baseline obesity severity. In summary, improvements in HRQL are associated with weight loss but not with other effects of obesity treatments that are unrelated to weight loss. Although improvements in the SF‐6D did not exceed commonly reported thresholds for a minimally important difference (0.04), these changes, if causal, could still have a significant impact on clinical cost‐effectiveness estimates if sustained over multiple years.     

The Relation of Body Mass Index,Cardiorespiratory Fitness,and All‐Cause Mortality in Women

Objective: To examine the relation of body mass index (BMI), cardiorespiratory fitness (CRF), and all‐cause mortality in women. Research Methods and Procedures: A cohort of women (42.9 ± 10.4 years) was assessed for CRF, height, and weight. Participants were divided into three BMI categories (normal, overweight, and obese) and three CRF categories (low, moderate, and high). After adjustment for age, smoking, and baseline health status, the relative risk (RR) of all‐cause mortality was determined for each group. Further multivariate analyses were performed to examine the contribution of each predictor (e.g., age, BMI, CRF, smoking status, and baseline health status) on all‐cause mortality while controlling for all other predictors. Results: During follow‐up (113,145 woman‐years), 195 deaths from all causes occurred. Compared with normal weight (RR = 1.0), overweight (RR = 0.92) and obesity (RR = 1.58) did not significantly increase all‐cause mortality risk. Compared with low CRF (RR = 1.0), moderate (RR = 0.48) and high (RR = 0.57) CRF were associated significantly with lower mortality risk (p = 0.002). In multivariate analyses, moderate (RR = 0.49) and high (RR = 0.57) CRF were strongly associated with decreased mortality relative to low CRF (p = 0.003). Compared with normal weight (RR = 1.0), overweight (RR = 0.84) and obesity (RR = 1.21) were not significantly associated with all‐cause mortality. Discussion: Low CRF in women was an important predictor of all‐cause mortality. BMI, as a predictor of all‐cause mortality risk in women, may be misleading unless CRF is also considered.     

An Observational Study of Slimming Behavior in Denmark in 1992 and 1998

Objective: To elucidate how frequent weight‐loss attempts are made, the methods used to achieve weight loss, and the extent to which the outcome is positive. Research Methods and Procedures: Two independent interviews were conducted in 1992 and in 1998, each with 1200 randomly selected adult subjects. Each survey was designed to ensure an equal distribution of age, gender, and geographical regions in Denmark. Results: The proportion of subjects having attempted weight loss did not change from 1992 to 1998, although the prevalence of overweight and obesity increased from 1992 (overweight, 30%; obesity, 6%) to 1998 (overweight, 35%; obesity, 8%). Almost twice as many women (61%) than men (32%) had attempted weight loss (p < 0.0001). Slimming occurred more often in subjects <50 years (51%) than >50 years (39%) (p < 0.0001), although overweight and obesity were more frequent in the elderly. Over‐the‐counter diet pills or meal replacements were associated with a negative outcome of slimming treatment (p < 0.0001). Discussion: Approximately half of all adult Danes have attempted weight loss, particularly women and individuals <50 years. This finding is inconsistent with the fact that overweight and obesity are more prevalent in men and in individuals >50 years. Changes in habitual diet and increased physical activity are the most prevalent modes of slimming, whereas the use of over‐the‐counter diet pills or meal replacements has decreased from 1992 to 1998. This development may have a positive impact on future body‐ weight‐management strategies.     

Impact of Diet‐Induced Weight Loss on the Cardiac Autonomic Nervous System in Severe Obesity

Objective: To determine the impact of diet‐induced weight loss on cardiac autonomic nervous system modulation and arrhythmias in subjects with severe obesity and the influence of a high‐fat or a high‐carbohydrate diet regimen on heart rate variability in reduced‐obese individuals. Research Methods and Procedures: Eight severely obese subjects (BMI ≥ 40.0 kg/m²) underwent a 3‐month weight loss program followed by a 3‐month reduced‐weight maintenance regimen. Thereafter, each subject was admitted for an inpatient period of 17 days on two separate occasions. A high‐carbohydrate (60%) or high‐fat (55%) diet of appropriate energy content for weight maintenance was prescribed during each inpatient phase. Heart rate variability was derived from a 24‐hour Holter monitoring system in all subjects during their inpatient stay. Cardiac Holter monitoring was performed at three occasions (baseline, diet phase I, and diet phase II), including the second night of a two overnight calorimetry chamber stay. Results: After the diet regimen, there was a 10% decrease in weight. There were no significant changes in systolic and diastolic blood pressure, arrhythmias, glucose, insulin, total cholesterol, low‐density lipoprotein‐cholesterol, high‐density lipoprotein‐cholesterol, respiratory exchange ratio, and resting energy expenditure between experiments. Mean heart rate was lower after weight loss compared with baseline (p < 0.001). After weight loss, there was an increase in the parasympathetic indices of heart rate variability showing an increase in cardiac vagal modulation (all p < 0.05). Discussion: Weight loss is associated with significant improvement in autonomic cardiac modulation through enhancement of parasympathetic modulation, which clinically translates into a decrease in heart rate.     

Psychological Adjustment of Obese Youth Presenting for Weight Management Treatment

Objective: To determine the prevalence of psychological maladjustment in clinic‐based treatment‐seeking obese children and adolescents (BMI ≥ 95th percentile) and the degree to which maternal, demographic, and youth factors correlate to the youths’ psychological adjustment. Research Methods and Procedures: Anthropometrics, demographics (race, sex, insurance status), measures of youth psychological adjustment (self‐ and mother‐report; Behavior Assessment System for Children), and maternal self‐report of psychological distress (Symptom Checklist 90‐Revised) were collected from 121 obese children and adolescents (55% white, 45% black) and their mothers. Results: Approximately one‐third of youths self‐reported some psychological maladjustment, but two‐thirds of youth were described by their mothers as experiencing some degree of psychological maladjustment. Adjustment difficulties were specific to social functioning, low self‐esteem, and internalizing symptoms. Forty‐one percent of mothers of child participants and 56% of mothers of adolescent participants reported clinically significant psychological distress. Youth self‐report and mother‐report of youths’ psychological difficulties were often most strongly associated with mothers’ level of psychological distress and/or family socioeconomic status rather than to youth characteristics (e.g., percent overweight, race). Discussion: Psychological maladjustment levels among obese youth and their mothers were higher in this clinic‐based sample than in treatment research‐based samples. Present correlate findings extended to obese adolescents and reaffirm a potent association between youth self‐report of their own psychological adjustment and their mother's level of psychological distress. Demographic characteristics and youth weight status were not consistent correlates of youths’ psychological functioning. Findings have implications for the translation of empirically supported pediatric obesity interventions to clinic‐based treatment samples.     

Men Gain Additional Psychological Benefits by Adding Exercise to a Weight‐Loss Program

Objective: Adding exercise to a comprehensive weight‐loss program might not only attenuate any psychological distress associated with weight‐loss attempts but also may provide psychological benefits. This study examined whether a diet‐plus‐exercise weight‐loss program improved psychological outcomes more than a diet‐only weight‐loss program or an assessment‐only control group. Research Methods and Procedures: This study was part of a larger 1‐year randomized weight‐loss trial examining the effects of diet and exercise on cardiovascular disease risk factors in 264 overweight adults. Psychological measures specific to weight control (e.g., cognitive restraint, disinhibition, hunger, and body dissatisfaction) as well as traditional measures of psychological distress (e.g., symptoms of depression, anxiety, and stress) were obtained at baseline and 1 year. Results: Men and women in either weight‐loss program reported greater restraint, less disinhibition, and less hunger at 1 year than those in no program. Men in the diet‐plus‐exercise program experienced additional increases in restraint and decreases in hunger than did men in the diet‐only program. Women in the diet‐plus‐exercise program did not experience additional psychological benefits specific to weight control than those in the diet‐only program, despite increases in aerobic capacity. Discussion: The pattern seen for overweight men in the diet‐plus‐exercise program at 1 year—greater restraint, less disinhibition, and less hunger—is similar to the pattern seen in successful weight maintainers. These results underscore the need for innovative strategies that will enhance and sustain the pattern of psychological benefits specific to weight control associated with successful weight loss, especially for overweight women.     

Predictors of Weight Loss in Adults with Topiramate‐Treated Epilepsy

Objective: We examined predictors of weight loss with topiramate, an anticonvulsant associated with weight loss in adults. Research Methods and Procedures: In this uncontrolled, prospective clinical trial, topiramate was added to existing anticonvulsants in adults (40 to 110 kg) with partial‐onset seizures. Primary measurements were change from baseline weight after 3 months and 1 year in patients completing 1 year of topiramate treatment (N = 38). Physiological and metabolic measures were analyzed for correlation with weight loss during topiramate treatment. Results: In patients who completed 1 year of topiramate treatment, baseline weight was reduced in 82% at 3 months and in 86% at 1 year. Mean body weight was reduced 3.0 kg (3.9% of baseline) at 3 months and 5.9 kg (7.3%) at 1 year. In obese patients [body mass index (BMI) ≥ 30 kg/m²], mean weight loss was 4.2 kg (4.3%) at 3 months and 10.9 kg (11.0%) at 1 year. Weight loss was primarily caused by reduction in body fat mass. For all patients, weight loss at 3 months correlated most strongly with reduced caloric intake (p = 0.02). At 1 year, caloric intake had returned to baseline levels; weight loss correlated most strongly with higher baseline BMI (p = 0.0007). Discussion: Our results suggest that weight loss occurs in most adults treated with topiramate and is sustained for at least 1 year. Reduced caloric intake may account, in part, for weight loss during early treatment. The pattern of weight loss differs according to baseline BMI, with obese patients experiencing greater weight loss during continued therapy.