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.     

Weight-Related Attitudes and Behaviors of Women Who Diet to Lose Weight: A Comparison of Black Dieters and White Dieters

Obesity is a significant health problem among black women in the United States. Black women are two to three times more likely than white women to be obese. The present study sought to examine race differences in attitudes and beliefs about dieting, motivations underlying dieting efforts, and actual dieting strategies and behaviors. To achieve this aim, a subset of female survey respondents (n = 324) was drawn from a pool of more than 20,000 subscribers to Consumer Reports. All survey respondents had made at least one dieting effort within 3 years of the time of the study. For this study, we used all black female respondents (n = 162) and a matched sample (i.e., matched on age, educational attainment, and personal income) of white women (n = 162). Black women did weigh significantly more than Caucasian women, therefore, BMI was used as a covariate in all subsequent analyses. Black and white women were significantly different in a number of domains. Compared to white women, black women experienced less social pressure about their weight, initiated dieting later in life, and were significantly less likely to diet at each developmental milestone. However, the two groups of women did not differ in reasons for undertaking their most recent dieting efforts, or in the types of weight loss strategies they had employed. Nor were there differences between the black and white women in methods for coping responses with dietary relapse or in rates of disordered eating. These findings are discussed in terms of their implications for both treatment and prevention of obesity in black women.     

The Eating Inventory and Body Adiposity from Leanness to Massive Obesity: a Study of 2509 Adults

Objective: To examine how chronic dietary restraint, disinhibition, and hunger, as assessed by the Eating Inventory, vary over a broad range of BMI values from leanness to massive obesity, in subjects with family obesity. Eating Inventory factors were also studied as a function of personal weight history. Research Methods and Procedures: Subjects were 2509 participants in a genetic study of obesity. BMIs ranged from 15 to 87 kg/m². Six BMI groups were formed (<27, 27 to 30, 30 to 35, 35 to 40, 40 to 45, and >45). Results: Multivariate analyses showed that restraint and disinhibition were significantly associated with BMI in men, whereas only disinhibition was in women. Disinhibition scores correlated strongly with hunger scores in both genders in all BMI categories; dietary restraint tended to correlate with the other two factors positively in leaner subjects and negatively in the highest BMI categories. Highly restrained normal‐weight subjects were likely to exhibit disinhibition and hunger, whereas massively obese persons with very high disinhibition scores showed high hunger but little restraint. The highest restraint scores were observed in nonobese adult women with previous obesity in childhood and/or adolescence. Discussion: The factor most strongly associated with BMI in this large population was disinhibition, suggesting that obesity treatment should target behaviors associated with disinhibition, especially in individuals showing a low level of dietary restraint. High restraint scores in formerly obese normal‐weight women suggest that dietary restraint may exert a beneficial influence on body weight control under conditions that deserve further investigation.     

Comparison of Carotid Intima-Media Thickness in Children and Adults With and Without Obesity: A Hysteresis Model

ObjectiveTo describe a third-degree polynomial function (hysteresis) of the effect size of age, obesity, and insulin sensitivity over the carotid intima-media thickness (c-IMT), in the pediatric and adult groups.MethodsA quasi-experimental study with fixed factor analysis of age (children aged 8-12 years, n = 73; adults aged 21-45 years, n = 82) and obesity (yes, n = 76; no, n = 79) was conducted to analyze the effect on the c-IMT and Matsuda insulin sensitivity index values. This quasi-experimental design was analyzed with robust regression modeling.ResultsThe additive effect of obesity, independent of age, was evident in the case of the c-IMT values. There was no interaction effect, but a significant difference between participants with normal weight and those with obesity was found (P < .0001). The difference between adults and children was also significant, but the effect size was smaller. A model was created based on age, Tanner stage, and obesity using the c-IMT and Matsuda insulin sensitivity index values. A linear function fit as R², and the cubic function estimated parameters like a polynomial model.ConclusionThis practical study design showed that children with obesity displayed the same levels of carotid intima-media abnormalities as adults with obesity. The polynomial shape of the model suggests potentially poor outcomes that resemble the hysteresis process and may predict chronic cardiometabolic events during early adulthood.     

Anthropometrics Do Not Influence Dual X-ray Absorptiometry (DXA) Measurement of Fat in Normal to Obese Adults: A Comparison with In Vivo Neutron Activation Analysis (IVNA)

Dual-energy X-ray absorptiometry (DXA) is now a commonly used method for the determination of bone mineral status and body composition in humans. The purposes of this study were to compare fat mass by in vivo neutron activation analysis (FM_IVNA) with that by DXA (FM_DXA) in an anthropometrically heterogeneous sample of healthy adult men (n=33) and women (n=36) (19=≤BMI≤39), and to determine whether differences in fat mass estimates between the two methods (ΔFM) were attributable to subject anthropometry as defined by several circumference (waist, iliac crest, thigh) and skinfold thickness (umbilical, suprailiac, abdominal) measurements. No significant differences between FM_DXA and FM_IVNA were observed in men (p=0.46) or women (p=0.09). The two methods were very highly correlated in both sexes (women r²=0.97, p<0.001, men r²=0.91, p<0.001), although the regression line for men was significantly different from the line of identity (p=0.043). These results suggest modest trends toward underestimation of FM_DXA in men when FM_IVNA<18 kg, and overestimation in men when FM_IVNA>18 kg. ΔFM (IVNA-DXA) was not significantly related to any combination of skinfold thicknesses and circumferences in either gender. Age explained 27% of the variance in ΔFM for the men (p=0.008). Furthermore, ΔFM was not significantly related to inter-method disparity in total-body bone mineral measurements in men or women (p<0.05). The present study demonstrates strong correlation in fat measurements between IVNA and DXA in men and women ranging from normal to markedly obese. Correction for subject anthropometry does not significantly improve this relationship.