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Biomedical subjects

A J Stunkard

Publications and source records attributed to A J Stunkard.

At least 19 recordsLinked to original sources
PubMed1992

Psychological aspects of severe obesity.

Studies of several overweight persons conducted before their undergoing antiobesity surgery have shown 1) that there is no single personality type that characterizes the severely obese; 2) that this population does not report greater levels of general psychopathology than do average-weight control subjects; and 3) that the complications specific to severe obesity include body image disparagement and binge eating. Studies conducted after surgical treatment and weight loss have shown 1) that self-esteem and positive emotions increase; 2) that body image disparagement decreases; 3) that marital satisfaction increases, but only if a measure of satisfaction existed before surgery; and 4) that eating behavior is improved dramatically. The results of surgical treatment are superior to those for dietary treatment alone. Practitioners should be aware that severely obese persons are subjected to prejudice and discrimination and should be treated with an extra measure of compassion and concern to help alleviate their feelings of rejection and shame.

Humans↗
PubMed1992

Relationship of dieting history to resting metabolic rate, body composition, eating behavior, and subsequent weight loss.

This study examined the relationship of dieting history to resting metabolic rate, body composition, and subsequent weight loss in 50 obese women. A preliminary study showed that the women were able to report with satisfactory reliability the number of diets in which they had engaged (mean = 4.9 +/- 0.5), as well as the total weight loss resulting from these diets (mean = 55.9 +/- 6.0 kg). We found no evidence that weight cycling, as measured by either of these variables, was associated at baseline with a reduced resting metabolic rate or an increased percentage of body fat. Nor did we find that weight cycling was associated with smaller weight losses in a prospective trial in which subjects were treated by very-low-calorie diet and behavior therapy. The clinical implications of these findings are discussed, as are the methodological problems encountered in conducting research on this topic.

Adipose Tissue↗
PubMed1992

Clinical correlates of short- and long-term weight loss.

This study was designed to identify psychological, behavioral, and physiological correlates of short- and long-term weight loss. Measures of psychological functioning, body composition, fat cell size and number, and attendance were evaluated in 76 obese women for their relationship to weight loss at the end of treatment and at a 1-y follow-up evaluation. Losing more weight during the first month of treatment and attending a higher percentage of treatment sessions were strongly associated with greater weight loss at the end of treatment and at 1-y follow-up. In addition, patients with the highest initial weights lost the most weight both at the end of treatment and at 1-y follow-up. Easily obtained measures are as successful in predicting weight loss as are more expensive and complicated measures.

Adipose Tissue↗
PubMed1992

Correlations of body mass index of adult adoptees and their biological and adoptive relatives.

Adult family members resemble each other in body mass index (weight/height2). Our aim was to assess the extent to which the genetic relationship can account for the resemblance in natural families. We estimated the correlations in body mass index between adult adoptees, their adoptive parents, and their biological parents and siblings and compared the correlations to those between the biological relatives. Height, current weight, and greatest ever weight were obtained for 3651 adoptees. Groups representing thin, medium weight, overweight and obese subjects were selected by current body mass index (n = 540) and similarly selected by maximum body mass index (n = 524). The heights and weights of their biological and adoptive family members were assessed. The correlation in current body mass index between the adoptees and biological mothers, fathers, and full siblings were 0.15, 0.11, and 0.23, respectively (all P less than 0.001). These correlations were compatible with those found among the biological relatives living together. The correlations exhibited no consistent gender-related pattern. There was no correlation in body mass index between the adoptees and their adoptive parents. Similar results were obtained for maximum body mass index. Moreover, the correlations between the adoptees and their biological relatives are very similar to those found in large population studies of natural families. This study suggests that the genetic relationship fully accounts for the familial resemblance in body mass index among adults.

Adoption↗
PubMed1992

Childhood body mass index--genetic and familial environmental influences assessed in a longitudinal adoption study.

Studies of twins and adoptees have shown that the resemblance of adult family members in body mass index (weight/height2) is due more to shared genes than to shared rearing environment. In the present adoption study we assessed the genetic and environmental influences on body mass index in childhood. Among 3651 adult Danish adoptees we selected 840, comprising thin, medium weight, overweight, and obese groups, and for 269 of them we obtained height and weight measured at school health examinations at ages 7-13 years. The correlation in body mass index between the adoptees at these ages and their biological and adoptive relatives as well as among these relatives were estimated. The correlations were stable across the ages 7-13 years. The average correlation of adoptees with biological mothers was 0.17 (95% confidence limits: 0.03, 0.31), with biological fathers, 0.16 (0.00, 0.32), and with biological full siblings at same ages, 0.59 (0.28, 0.90). These correlations were comparable to the correlations within the biological families and comparable to the previously reported correlations for adult adoptees. The correlations with members of the adoptive families were lower--with adoptive mothers, 0.10 (-0.03, 0.23), with adoptive fathers, 0.03 (-0.11, 0.17), and with adoptive siblings, 0.14 (-0.13, 0.41). In conclusion, a genetic influence on body mass index as strong as that in adult life is already expressed by age 7 years. The rearing environment shared by the family has a weak influence during childhood.

Adolescent↗
PubMed1992

Depressive symptoms and weight change in a national cohort of adults.

To assess the influence of depressive symptoms (defined using the CES-D) on weight change, we analysed data from 1794 adults, aged 25-74 years, who participated in the first National Health and Nutrition Examination Survey in 1971-1975 and the National Health Epidemiologic Follow-up Study in 1982-1984. After adjusting for baseline covariates using multiple linear regression, the data show that younger men (< 55 years) who were depressed at baseline gained nearly 3 kg more over the follow-up period than those who were not depressed. Among these younger men, however, education modified the effect of depression on weight change; those with < 12 years of education gained more weight with depression than those with more education (6.2 vs. 1.2 kg, respectively; P < or = 0.01). In contrast, depressed younger women gained slightly less weight than those who were not depressed. Among younger women, education also modified the effects of depression on weight change; those with < 12 years of education gained less weight with depression than those with more education (-3.2 vs. 0.6 kg, respectively; P < or = 0.01). Among older people (> or = 55 years), both men and women who were depressed lost more weight than those who were not depressed. Depression may play a substantial role in the patterns of weight change among adults in the United States. These patterns of weight change may contribute to the adverse health effects associated with depression.

Adult↗
PubMed1992

A multicenter evaluation of a proprietary weight reduction program for the treatment of marked obesity.

BACKGROUND: Congressional hearings initiated in March 1990 revealed that America's $10 billion a year weight loss industry is subject to minimal regulation by federal agencies. Consumers are forced to rely on advertisements and testimonials when selecting treatment because no proprietary program has provided a prospective assessment of its short- and long-term results of treatment. This report describes such an assessment. METHODS: A total of 517 obese patients (407 women and 110 men) participated in a proprietary program that included 12 weeks of treatment by very-low-calorie diet within a 26-week program of life-style modification. Patients were treated in two cohorts (6 months apart) according to a standardized protocol implemented at 18 hospital-based clinics across the nation. RESULTS: Fifty-six percent of women and 54% of men completed treatment, at which time their weight losses (mean +/- SEM) were 22.0 +/- 0.6 and 32.1 +/- 1.4 kg, respectively. Weight losses of women and men who discontinued treatment averaged 14.3 +/- 0.7 and 20.0 +/- 1.6 kg, respectively. Weight loss was associated with significant improvements in blood pressure and total serum cholesterol levels. A 1-year follow-up evaluation of 74% of patients in the second cohort who completed treatment revealed that they maintained 15.3 +/- 1.2 of their 24.8 +/- 1.0-kg end-of-treatment weight loss; 59% of patients maintained a loss of 10 kg or more. CONCLUSION: We hope that this report will lead to the systematic evaluation of other proprietary weight loss programs and to the publication of findings that will permit consumers to make informed treatment decisions.

Adult↗
PubMed1992

Intelligence and educational level in relation to body mass index of adult males.

In this study we explore the relationships between intelligence test score, educational level, and degree of body fatness. We collected data on intelligence test score, educational level, height, and weight from a sample of 26,274 young Danish men and computed body mass index (weight/height2) as a measure of fatness. Both intelligence test score and educational level had maximum values below the median for body mass index and declined monotonically thereafter. The decline was equal for test score and educational level and above 32 kg/m2 corresponded to almost half a standard deviation. These results are not readily explained by stigmatization of frank obesity, and other mechanisms, possibly genetic, may be responsible.

Adult↗
PubMed1991

Weight change in depression: influence of "disinhibition" is mediated by body mass and other variables.

The direction of weight change (gain or loss) in depression has recently been found to be a stable characteristic of patients across depressive episodes. A search for determinants of the direction of weight change revealed two candidates: the body mass index (BMI) (weight in kilograms/height in meters squared) and a psychological variable, "disinhibition" of dietary restraint. The present study, of 68 patients with a history of recurrent depression, found a significant correlation between BMI and weight change; in other words, heavier persons were more likely to gain weight if depressed. There was also a correlation between "disinhibition" and weight change. "Disinhibition" correlated with BMI and, when controlled for BMI, age and sex, the correlation between "disinhibition" and weight change fell to insignificance. We conclude that BMI along with age and sex mediated the correlation between "disinhibition" and weight change.

Appetite↗
PubMed1991

A twin study approach towards understanding genetic contributions to body size and metabolic rate.

The genetic and environmental determinants of a brief assessment of metabolic rate at rest and under psychological stress were studied in 40 pairs of monozygotic and 40 pairs of dizygotic young adult male twins. Height, weight and age were employed as covariates. Univariate analyses showed a high heritability for height and weight and moderate heritability for metabolic rate. Classical twin analyses and multivariate genetic modeling indicated that genetic influences on resting metabolic rate were entirely explained by body weight: there was no independent genetic contribution to resting metabolic rate. Metabolic rate under psychological stress, on the other hand, showed a significant genetic effect. The exponent (3/4) in the power function relating body weight to resting metabolic rate was the same as that found in a wide variety of animal species, a value that has been proposed as defining a body weight set point. We speculate that an adult body weight set point is genetically transmitted. Independent genetic effects on resting metabolic rate would be observed only when the normal equilibrium between body weight and metabolic rate is unbalanced during development, aging or disease. The study illustrates the use of multivariate genetic analyses of twin data which may be readily applied to widely used metabolic rate assessments.

Adolescent↗
PubMed1991

Weight loss and body fat distribution: a feasibility study using computed tomography.

Computerized tomography (CT) was used to assess the effect of a loss of body weight (18.8 kg) on the size of five fat depots in 11 obese postmenopausal women: the abdominal subcutaneous and visceral depots, the pelvic subcutaneous and intrapelvic depots, and the thigh subcutaneous depot. The mean decrease in total body fat was 34 percent, with comparable decreases in total abdominal fat (33 percent) and total pelvic fat (32 percent). In the abdomen, visceral fat was reduced by 35 percent and subcutaneous fat by 33 percent. In the pelvic region, intrapelvic fat decreased by 51 percent and subcutaneous fat by 25 percent. The decrease in the size of the abdominal visceral fat depot was highly correlated with fat loss during treatment (r = 0.68). By contrast, the decrease in the size of the subcutaneous abdominal fat depot correlated less highly with fat loss. These preliminary findings suggest that obese postmenopausal women with large visceral fat depots will decrease the size of their visceral fat depots by weight reduction. This is good news since the adverse health effects of obesity are believed to be associated with visceral fat.

Adipose Tissue↗
PubMed1991

Genetic contributions to human obesity.

Surprisingly, until the very recent past almost nothing had been known about genetic influences on human obesity. The powerful genetic effects described with such assurance in the textbooks were based almost entirely on extrapolation from animal studies. The first strong evidence of genetic influence on human obesity was obtained from an adoption study in Denmark that showed a high correlation of the body mass index of adoptees with that of their biological parents and no correlation with that of their adoptive parents. The body mass index of the adoptees was also highly correlated with that of their siblings and showed evidence of recessive transmission. These findings have been extended by a twin study that revealed very high heritabilities at both age 20 and age 45. A bivariate analysis of the identical twins of this population revealed high intrapair correlations among the normal weight twins and low correlations among the obese twins distributions, suggesting a strong environmental influence on the genetically vulnerable obese twins. The best estimate of heritability, the correlation coefficient of 93 identical twin pairs reared apart, from the Swedish Adoption Study of Aging, revealed high levels of heritability, indicating that traditional twin studies have overestimated the heritability of body mass index only slightly, if at all.

Adoption↗
PubMed1990

Metabolic rate and physical development in children at risk of obesity.

Children of obese (group O) and normal-weight (group N) parents who took part in a study of metabolic rates and food intakes when 3-5 years old were restudied 12 years later. There were striking differences between the sexes. Among the 15 adolescent boys, parental obesity predicted more rapid growth (but not adiposity) and an earlier decline in resting metabolic rate (RMR)/kg body weight, and childhood energy intake/kg body weight was not predictive. Among the 10 girls, the opposite pattern was observed; childhood energy intake/kg predicted both body size and adiposity, and parental obesity had less predictive value. The sex differences are consistent with the earlier maturation of girls, and the growth differences with the hypothesis that a low RMR/kg body weight is associated with a precocious pattern of growth and development in children predisposed to obesity.

Adolescent↗
PubMed1990

Genetic and early environmental components in sociodemographic influences on adult body fatness.

OBJECTIVE: To explore genetic and environmental contributions to the influence of parental social class and region of upbringing on adult human fatness. DESIGN: Survey of sample of adults who had been adopted in childhood to relate their body mass index to sociodemographic variables in a series of multiple linear regression analyses. SUBJECTS: 4643 Subjects traced from a register of 5455 non-familial adoptees registered in 1924-47, of whom 3651 gave details of current height, weight, and occupation. The final sample totalled 2015 adoptees for whom there was also information on their region of upbringing and on the social class of their adoptive and biological fathers. MAIN OUTCOME MEASURES: Age, sex, body mass index, social class (of adoptee and adoptive and biological father), and geographical region. RESULTS: There was a significant inverse relation of adoptees' body mass index with their own social class and that of both their biological and adoptive fathers. Adoptees raised in provincial areas had a significantly greater body mass index than did those raised in Copenhagen. A multivariate regression model, including age, sex, and social class of the adoptee, confirmed the significant independent influence of the social class of both adoptive and biological fathers and of region of rearing on adoptees' body mass index. CONCLUSION: Both familial environmental and genetic factors contribute to the relation of parental social class to adult fatness, and they are partly independent of the effect of an individual's own social class. The influence of region of upbringing on adult fatness is of environmental origin and is independent of social class characteristics.

Adoption↗
PubMed1990

The body-mass index of twins who have been reared apart.

To assess the relative importance of genetic and environmental effects on the body-mass index (weight in kilograms divided by the square of the height in meters), we studied samples of identical and fraternal twins, reared apart or reared together. The samples consisted of 93 pairs of identical twins reared apart, 154 pairs of identical twins reared together, 218 pairs of fraternal twins reared apart, and 208 pairs of fraternal twins reared together. The intrapair correlation coefficients of the values for body-mass index of identical twins reared apart were 0.70 for men and 0.66 for women. These are the most direct estimates of the relative importance of genetic influences (heritability) on the body-mass index, and they were only slightly lower than those for twins reared together in this and earlier studies. Similar estimates were derived from maximum-likelihood model-fitting analyses--0.74 for men and 0.69 for women. Nonadditive genetic variance made a significant contribution to the estimates of heritability, particularly among men. Of the potential environmental influences, only those unique to the individual and not those shared by family members were important, contributing about 30 percent of the variance. Sharing the same childhood environment did not contribute to the similarity of the body-mass index of twins later in life. We conclude that genetic influences on body-mass index are substantial, whereas the childhood environment has little or no influence. These findings corroborate and extend the results of earlier studies of twins and adoptees.

Aged↗
PubMed1990

Direction of weight change in recurrent depression. Consistency across episodes.

The direction and extent of weight change during two separate episodes of severe, unipolar depression were assessed in 53 (unmedicated) outpatients in the Pittsburgh (Pa) study of maintenance therapy of depression. There was a high concordance (45 of 53 patients) of direction of self-reported weight change during the two episodes. Twenty-three patients lost weight during both episodes, 17 gained weight, and 5 showed no change. The extent of weight change between the two episodes was highly correlated. Self-reported weight change corresponded closely to measured weight changes in a large sample of the study population. Changes in appetite paralleled those in body weight. Duration of the episode and body mass index were related to the weight change, but two features of depression with which weight loss in depression has been associated (the endogenous character of the depression and it severity) were not. Direction and extent of weight change in unipolar depression appear to be stable patient characteristics across episodes and are thus potential markers for subtypes of depression. This stability of weight change is in sharp contrast to the lack of stability of the endogenous subtype in consecutive episodes of major depression.

Adult↗
PubMed1990

Controlled trial of the metabolic effects of a very-low-calorie diet: short- and long-term effects.

Resting energy expenditure (REE), weight, and body composition were measured up to seven times in 13 obese women during a 24-wk study. Patients were randomly assigned to a very-low-calorie diet (VLCD, 500 kcal/d) or a balanced-deficit diet (BDD, 1200 kcal/d). After 8 wk of supplemented fasting, REE of the VLCD patients decreased by 17% whereas that of the BDD patients was virtually unchanged. REE of the VLCD patients increased during 12 subsequent weeks of realimentation such that differences in REE between the two groups were not statistically significant at week 24 (VLCD = -11%, BDD = -2%). Reductions in weight and fat-free mass (FFM) were 12.1% and 3.6% for the VLCD patients and 10.6% and 4.1% for the BDD patients, respectively. There were no significant differences between the groups in pre- to posttreatment changes in REE normalized to FFM. Results suggest that REE recovers partially after consumption of a VLCD. They also provide evidence of a possible metabolic advantage of weight loss by a more moderate restriction.

Body Composition↗