History of Intentional and Unintentional Weight Loss in a Population-Based Sample of Women Aged 55 to 69 Years

FRENCH, SIMONE A, ROBERT W JEFFERY, AARON R FOLSOM, DAVID F WILLIAMSON AND TIM BYERS. History of intentional and unintentional weight loss in a population-based sample of women aged 55 to 69 years. Obes Res. 1995;3:163–170. Although both overweight and body weight fluctuation are related to chronic disease risk, little is known about the history of and reasons for body weight change in the general population. This paper reports the incidence of intentional and unintentional weight loss episodes during adulthood in a population-based sample of 26, 261 women aged 55 to 69 years. Intentional weight loss episodes of each of four amounts (5–9, 10–19, 20–49, 50+ lbs.) and unintentional weight loss episodes of 20 or more lbs. were recalled for each of three age periods (18–39, 40–54, 55+ years). At least one intentional weight loss episode of 5 or more lbs. was reported by 69% of women, 46% reported at least one intentional weight loss episode of 10 or more lbs, and 25% reported at least one intentional weight loss episode 20 or more lbs. At least one unintentional weight loss episode of 20 or more lbs. was reported by 29% of the women. Reasons for weight losses of 20 or more lbs. were also recalled. Women who had intentionally lost 20 or more lbs. were more likely to report weight losses due to low-calorie diets, exercise and weight loss groups, while women who had unintentionally lost 20 or more lbs. were more likely to report weight losses due to depression or stress. These findings question the common assumption that weight losses in adult women are primarily intentional and emphasize the need to distinguish the reasons for weight loss in studies examining the relationship between body weight changes and health outcomes.     

Weight Control Behaviors Among Adult Men and Women: Cause for Concern?

NEUMARK-SZTAINER, DIANNE, NANCY E. SHERWOOD, SIMONE A. FRENCH, AND ROBERT W. JEFFERY. Weight control behaviors among adult men and women: cause for concern? Obes Res. Objectives To examine gender differences in weight control behaviors; their duration and the consistency of their use over a 3-year period; and variations of these behaviors by body mass index (BMI). Research Methods and Procedures The study population included 714 women and 229 men participating in a community-based weight gain prevention program who completed surveys about their weight control behaviors annually for 3 years. General dieting behaviors (e.g., current, regular, and past dieting), dietary restraint (using Restrained Eating subscale of the Three-Factor Eating Questionnaire), and specific weight control practices (e.g., increasing exercise, skipping meals, and taking laxatives) were assessed. Results Women were more likely than men to report weight control behaviors, with particularly strong associations found between gender and “history of dieting” (odds ratio = 8.1) and “participation in an organized weight loss program” (odds ratio = 11.7). Among both genders, exercise was the most frequently reported specific weight loss practice (66% of women and 53% of men), followed by decreasing fat intake (62% of women and 48% of men). The use of at least one unhealthy weight control behavior over the past year was reported by 22% of the women and 17% of the men. Gender differences were not found for duration of use of most of the specific weight control practices over the past year, or for consistency of general dieting behaviors and dietary restraint over time. Although both gender and BMI were strongly associated with dieting behaviors, interactions between gender and BMI on prevalence rates of dieting were not significant. Discussion Although weight control behaviors were more prevalent among women than men, in general, large gender differences were not found in the types of behaviors used and the duration and consistency of their use. The high percentages of adults using healthy methods of weight control was encouraging. However, there is still cause for concern, in that unhealthy weight control practices were also reported by a significant percentage of the population.     

Who Are the Weight Maintainors?

To characterize people who maintain weight over long periods of time, normal weight and obese adults (n=385) were studied over five annual visits. Subjects were classified using a ± 5 lb change between the first and the fifth year visits to determine overall maintenance (M), with gain (G) or loss (L) being any change outside this range. This MGL status was cross-tabulated with a Fluctuation Index which counted the number of successive year-to-year weight changes of more than ± 5 lbs (F0 through F4). True maintainers were defined as those having all weight changes within ± 5 lbs during the 5-year period (M and F0). Nineteen percent (n=73) of the subjects were classified as True Maintainers and included three times as many normal weight as obese subjects. Obese subjects comprised only 25% of the True Maintainer group but 60% of the Non-Maintainer group. Age had no association with Maintainer status. Standard measures of weight variability were lowest among True Maintainers and highest in Non-Maintainers. In addition, True Maintainers had lower BMI, Percent Body Fat, and Waist-Hip Ratios than Non-Maintainers. Subjects classified as Non-Maintainers were more likely to engage in dieting, by a variety of measures, than True Maintainers—this was particularly true among obese subjects. Finally, changes in total cholesterol, LDL and HDL cholesterol, and systolic and diastolic blood pressure were not reliably associated with Maintainer status, although the ordering of the group means suggested that True Maintainers had slightly healthier levels of “risk” variables. Overall, the results suggest that True Maintainers comprise a potentially important and interesting group of individuals who need further study.     

Effects of Weight Cycling Induced by Diet Cycling in Rats Differing in Susceptibility to Dietary Obesity

LAUER, JOAN B., GEORGE W. REED, AND JAMES O. HILL. Effects of weight cycling induced by diet cycling in rats differing in susceptibility to dietary obesity. Obes Res. Objective Although the majority of evidence in rodents does not support the view that weight cycling (consisting of bouts of food restriction and refeeding) promotes obesity, the effects of weight cycling on body weight regulation remain controversial. We have previously demonstrated that some rats within a strain are more susceptible to develop obesity than others when given free access to a high-fat diet. In this study, we tested the hypothesis that rats most susceptible to weight gain on a high-fat diet would also be most susceptible to weight gain as a consequence of weight cycling. Research Methods and Procedures Rats were provided a low-fat diet (12% corn oil) for 2 weeks, then given a high-fat diet (45% corn oil) for 2 weeks to identify those most (obesity prone) and least (obesity resistant) susceptible to weight gain. Half of each group was then subjected to three 30-day cycles of food restriction (10 days) and refeeding (20 days) [weight cycler (WC) rats]. The other half were allowed free access to the high-fat diet [control (CO) rats]. All rats were then followed for an additional 10 weeks, with free access to the high-fat diet. Results When considering the entire 160 days of the study, we found no evidence that WC rats relative to CO rats had increased body weight, increased body fat content, or elevated energy efficiency. We found no evidence that rats most prone to dietary obesity were also prone to weight gain after weight cycling. During the weight cycling phase (days 1 to 90), weight cycled groups consumed less energy and gained less weight than controls. During the follow-up phase, WC and CO rats did not differ significantly in weight gain or energy intake. Discussion In this study, weight cycling did not exacerbate the obesity produced by high-fat diet feeding.     

What Is the Role of Cognitive-Behavior Therapy in Patient Management?

This review summarizes the role of cognitive-behavior therapy (CBT) in obesity treatment. Although not a specific intervention per se, CBT is the systematic application of principles of social cognitive theory to modify behaviors that are thought to contribute to or maintain obesity. Most forms of CBT include the use of five strategies: self-monitoring and goal setting; stimulus control for the modification of eating style, activity, and related habits; cognitive restructuring techniques that focus on challenging and modifying unrealistic or maladaptive thoughts or expectations; stress management; and social support. The use of these strategies in comprehensive obesity programs has been helpful in improving short-term weight losses, but long-term success remains elusive, even though these strategies are predictors of long-term weight loss maintenance. Given that obesity is a chronic condition, not unlike hypertension or diabetes, CBT interventions will need to focus on broader treatment outcomes, such as improved metabolic profiles, quality of life, psychological functioning, and physical fitness. In addition, new methods for delivering CBT interventions should be explored, including home-based programs and combination with adjunctive pharmacotherapy delivered in primary care centers.     

Dieting Status and Its Relationship to Weight,Dietary Intake,and Physical Activity Changes Over Two Years in a Working Population

The present study prospectively examined changes in dietary intake, physical activity and weight associated with self-reported efforts to lose weight in a cohort of 3671 men and women sampled from the general population. Dieting efforts, dietary intake, physical activity and weight were measured at two points in time, 24 months apart. At baseline, current dieters reported consuming fewer dairy products, sweets, meat, soft drinks and fried potatoes (all p's < .0001), and engaging more frequently in high-intensity physical activity (p < .0001) than those not currently dieting. At follow-up, current dieters reported consuming fewer sweets (p < .0001) and fried potatoes (p < .0008), and engaging more frequently in moderate-intensity physical activity (p < .02) than those not currently dieting. Prospectively, those who initiated weight-loss diets showed the largest decrease in consumption of sweets (p < .0001), soft drinks (p < .0001), and fried potatoes (p < .01), and increase in frequency of high-intensity physical activity (p < .0001) and moderate-intensity physical activity (p < .007). Those initiating weight-loss diets were the only group to lose weight (1 lb.). Those dieting at baseline but not at follow-up gained the most weight (4 lbs.). Self-reports of current dieting correspond to reported changes in dietary intake and physical activity, and to measured changes in weight over the same time period. Individuals who report dieting to lose weight have healthier eating and exercise patterns than those who do not report dieting.     

The Behavioral Characteristics of Individuals Who Lose Weight Unintentionally

MCGUIRE, MAUREEN T., RENA R. WING, MARY L. KLEM, AND JAMES O. HILL. The behavioral characteristics of individuals who lose weight unintentionally. Obes Res. Objective: To determine whether individuals who unintentionally lost weight differ from individuals who intentionally lost weight in behavioral characteristics related to chronic disease risk factors. Design: A random-digit dial telephone survey was conducted among a representative sample of American adults (n = 500). Subjects: Of the 500 individuals sampled, 139 were currently ≥10% below their lifetime maximum weight. These individuals were asked whether their weight loss was unintentional or intentional. Unintentional (n = 49) and intentional (n = 89) weight losers were compared on measures of dietary intake, physical activity, smoking, drinking, and self-reported health status. Results: Unintentional weight losers had higher levels of smoking and drinking, were less physically active, and were less concerned about their diet and fat intake. Unintentional weight losers did not report having higher levels of disease such as high blood pressure or diabetes. However, unintentional weight losers who reported having such diseases were more likely to report that their weight loss had no effect or had worsened their disorder. Discussion: Compared to intentional weight losers, those who lost their weight unintentionally reported engaging in more negative health behaviors that are related to disease morbidity and mortality. These data suggest that unintentional weight loss may be part of a cluster of behaviors that have a negative health impact.     

Factors Associated with Weight Control in Older Adults

Dieting behaviors in a sample of 183 overweight older adults were studied to assess how they were influenced by six cognitive, behavioral, emotional, and social variables. Membership in a weight control program was also evaluated to assess whether it affected these relationships. Responses indicated that reports of high quality dieting behaviors were associated with higher levels of depression and less effective coping skills. Dieting behaviors among subjects who were participants in weight loss programs were not as strongly associated with less effective coping skills, but were associated with external health locus-of-control. The degree of social support had a limited impact on dieting behaviors, while measures of optimism and health status were unrelated to dieting behaviors. We concluded that older adults, especially those who diet independently, are likely to experience significant stress associated with weight loss efforts. Weight loss programs for older adults might produce better outcomes if they focus on reducing depression and stress associated with dieting.     

Factors Related to Body Weight Changes During and After Pregnancy: The Stockholm Pregnancy and Weight Development Study

The Stockholm Pregnancy and Weight Development Study is a prospective study of body weight changes in women, whose maternity unit charts were reviewed and who were then invited for a 1-year follow-up, including weigh-in sessions and questionnaires on dietary habits, physical activity and socio-demographic factors. Total weight gain during pregnancy was related to weight gain already during the first trimester. Women reporting previous weight cycling had slightly higher weight gain during pregnancy. Successful return towards pre-pregnancy weight was found more often in women with regular breakfast and lunch habits. Lactation had only a small effect on weight loss after delivery, independent of eating habits. Lack of physical activity was more common in women who had low lactation scores. Twenty-eight percent reported an increased interest in sweets during pregnancy; these women increased 1 to 2 kg more than others in weight during pregnancy. Postpartum weight retention was more affected by lifestyle changes during and after pregnancy than by factors before pregnancy.     

Dietary Intake in Relation to Restrained Eating,Disinhibition, and Hunger in Obese and Nonobese Swedish Women

The aims of this study were to: describe dietary intakes of obese and nonobese middle-aged women using a validated food frequency questionnaire; to assess dietary restraint, disinhibition, and hunger by the three factor eating questionnaire (TFEQ) in obese and nonobese samples and determine which of the factors are independently associated with obesity; and to examine correlations between selected nutritional variables and the TFEQ factors. Subjects studied included 179 obese Swedish women (BMI>32) and 147 nonobese population-based controls (BMI<28). Age-adjusted mean energy intake was significantly higher in obese women (2730 ± 78 vs. 2025 ± 85 kcal, p<0.0001). In absolute and relative terms, fat intake was higher and alcohol intake was lower in the obese subjects. Disinhibition was the strongest TFEQ factor independently differentiating the obese and nonobese states, i.e., after adjustment for restraint and hunger. Within the obese sample, strong associations were seen between energy intake and disinhibition (p=0.0005) and hunger (p=0.0004). The association between energy intake and restrained eating was negative and weaker (p=0.04). No such associations were seen in nonobese women. Thus, using a dietary instrument that is valid and unbiased with respect to obesity, strong psychological correlates, possibly causal, of variability in energy intake were detected in middle-aged women with obesity. Disinhibition is associated with both obesity and high-energy intakes and is therefore an important factor to consider in the treatment of women with obesity.     

Maintenance of Weight Loss: A Needs Assessment

This study identified facilitators and obstacles to maintenance of weight loss following a very-low-calorie-diet and behavior modification program. A survey was mailed to a random sample of 178 program completers and received a 61% response rate; the most frequent follow-up period was more than 2 years. Twenty-nine percent reported weighing the same (within 10 lbs) or less than the end of their participation in the treatment program (maintainers), while 71% reported their present weight was a mean of 65% higher than their initial weight loss (regainers). Maintainers were significantly more likely to report engaging in regular aerobic exercise, attending a maintenance support group, and confidence in their ability to manage their weight in the future, while regainers were more likely to report stress and motivation as frequent weight management obstacles. Respondents consistently identified the need for low/no cost ongoing support. Maintainers and relapsers reported similar challenges in managing their weight, yet with different results, suggesting the need to identify subgroups for which different post-treatment support options could be applied.