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Biomedical subjects

A J Stunkard

Publications and source records attributed to A J Stunkard.

At least 73 records · Page 4Linked to original sources
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↗
PubMed1990

Obesity in black adolescent girls: a controlled clinical trial of treatment by diet, behavior modification, and parental support.

Recent findings indicate that nearly 50% of black American women are obese and that adolescence is a critical period for the development of their obesity. This study investigated the efficacy of a behavioral weight control program in 36 black female adolescents with a mean age of 14.0 years, weight of 95.0 kg, and height of 163.2 cm. All subjects participated in the same 16-week program but had different levels of parent participation: (1) child alone with no parent participation; (2) mother and child treated in the same session; and (3) mother and child treated in separate but concurrent session. At the end of the 16-week program, children in the three conditions lost 1.6, 3.7, and 3.1 kg, respectively. Differences among conditions were not statistically significant; however, a secondary analysis revealed that the greater the number of sessions attended by mothers, the greater their daughters' weight losses. Weight reduction was associated with significant improvements in body composition, serum total cholesterol concentrations, and psychological status. Results are discussed in terms of the need to improve the maintenance of weight loss in adolescents and to explore possible differences between black and white females in their preferred body types.

Adolescent↗
PubMed1990

Childhood onset (age less than 10) obesity has high familial risk.

We assessed risk for obesity in 1743 first-degree relatives (parents and siblings) of 566 obese patients at three sites in the USA and one in Argentina. Onset of obesity prior to adulthood, and especially by age 10, significantly increased relative risk (2.14) for obesity in adult first-degree relatives. This increase in risk was consistent across four different patient samples from two different countries. Higher levels of obesity in patients were also associated with increased familial risk. Age of onset of obesity may be used to select obese adults with high genetic loading--an approach that should facilitate the identification of specific genes for human obesity. The enhanced ability to identify persons at high genetic risk for obesity provided by this study should increase the effectiveness of efforts to prevent obesity.

Adolescent↗
PubMed1990

Predicting attrition and adherence to a very low calorie diet: a prospective investigation of the eating inventory.

This prospective study examined the use of the eating inventory and its association with adherence, attrition, and dysphoric emotional states on patients treated with a very low calorie diet (VLCD). Subjects were 81 severely (medically significant) obese patients (mean BMI (weight in kilograms/height in meters squared) for women 36.25; men 39.16) enrolled in a university-based weight reduction program employing a liquid protein supplement VLCD with behavior modification. The eating inventory's factors hunger and restraint successfully discriminated attrition/adherence groups while disinhibition did not. Subjects with scores above the mean on disinhibition and hunger and below the mean on restraint had consistently poorer outcomes. The hunger factor was significantly related to dietary nonadherence, with those scoring in the highest quartile on this dimension eating three times the number of calories of those scoring in the lowest quartile. Disinhibition and hunger were significantly related to anxiety and depression while restraint was not. These findings provide support for the use of the eating inventory in screening and treatment of severely obese patients receiving very low calorie diets.

Adult↗
PubMed1990

Effects of a very low calorie diet on weight, thyroid hormones and mood.

Changes in weight, thyroid hormones and mood were examined in 15 obese (113 kg) women over an 18-week period. After 4 weeks of a 1200 kcal/day diet, patients were randomly assigned to one of two dietary conditions: very low calorie diet (VLCD) (n = 8) or balanced deficit diet (BDD) (n = 7). VLCD patients consumed 400 kcal/day for 8 weeks and then gradually returned to a 1200 kcal/day diet. BDD patients consumed 1200 kcal/day for the entire 18 weeks. Differences in weight losses between the conditions were statistically significant only during the consumption of the VLCD. Serum T3 decreased by as much as 66 percent in VLCD patients during consumption of the 400 kcal/day diet, whereas rT3 increased by as much as 27 percent. T3 increased when patients were realimented with a 1000 kcal/day balanced diet but remained a significant 22 percent below baseline at the end of the study. BDD patients also showed marked reductions in T3, as great as 40 percent, so that the differences between the two conditions were not statistically significant. Multiple regression analyses, collapsing across conditions (n = 15), indicated that weight loss at week 12 and baseline T3 accounted for 63 percent of the variance in the change in T3 at week 12. Patients in both conditions showed improvements in mood. Changes in depression were not associated with changes in serum T3.

Adult↗
PubMed1990

The effects of weight reduction on blood pressure in 301 obese patients.

The effects of weight reduction on blood pressure were assessed in 301 obese patients. Weight reduction was achieved by behavior modification, medication, or their combination and was associated with significant reductions in systolic and diastolic blood pressure. The weight reduction method was less important than the amount of weight lost in determining reductions in blood pressure. The greatest reductions in weight and blood pressure occurred during the first half of weight loss, suggesting that even brief treatment (ie, 8 to 10 weeks) may benefit obese, hypertensive patients. Despite repeated measurements, 36 patients who failed to lose weight showed no decrease in blood pressure. Although blood pressure rose during follow-up in patients who regained weight, it remained below baseline levels. These findings provide further support for weight reduction in the control of hypertension.

Adult↗
PubMed1989

Genetics of obesity in adult adoptees and their biological siblings.

An adoption study of genetic effects on obesity in adulthood was carried out in which adoptees separated from their natural parents very early in life were compared with their biological full and half siblings reared by their natural parents. The adoptees represented four groups who by sampling from a larger population were categorised as either thin, medium weight, overweight, or obese. Weight and height were obtained for 115 full siblings of 57 adoptees and for 850 half siblings of 341 adoptees. In full siblings body mass index (kg/m2) significantly increased with weight of the adoptees. Body mass index of the half siblings showed a steady but weaker increase across the four weight groups of adoptees. There were no significant interactions with sex of the adoptees, sex of the siblings, or (for the half siblings) sex of the common parent. In contrast with the findings in half siblings and (previously) the natural parents there was a striking, significant increase in body mass index between full siblings of overweight and obese adoptees. The degree of fatness in adults living in the same environment appears to be influenced by genetic factors independent of sex, which may include polygenic as well as major gene effects on obesity.

Adoption↗
PubMed1989

Weight loss competitions at the worksite: how they work and how well.

Three studies were conducted to evaluate the effectiveness of competition as a method of weight loss at the worksite. Study 1 found team competitions more effective than either cooperation or individual competition for men, and more effective than individual competition for women. Study 2 replicated the effectiveness of team competitions at 10 worksites. The influence of four variables [gender, age, type of employment (blue-collar vs white-collar), and method of assignment to teams] upon four outcomes (recruitment, attrition, weight loss, and cost/effectiveness), was assessed. This study showed that the results of competition were robust and widely generalizable. Recruitment was high, attrition very low, weight losses large, and cost/effectiveness favorable. Study 3, however, found only limited maintenance of weight loss following competitions.

Adult↗
PubMed1989

Personal control and health promotion.

Personal control is an individual's belief about the degree that he or she can bring about good events and avoid bad events. High personal control is associated with intellectual, emotional, behavioral, and physiological vigor in the face of challenging situations and events; low personal control is associated with maladaptive passivity and poor morale. In this paper, we sketch the roots of the personal control concept and propose a composite theory of personal control. Then we apply this composite theory to health promotion, a field defined by a cluster of techniques without a unifying theory. We believe that the personal control concept can be the cornerstone for a theory of health promotion.

Attitude to Health↗
PubMed1989

Socioeconomic status and obesity: a review of the literature.

A review of 144 published studies of the relationship between socioeconomic status (SES) and obesity reveals a strong inverse relationship among women in developed societies. The relationship is inconsistent for men and children in developed societies. In developing societies, however, a strong direct relationship exists between SES and obesity among men, women, and children. A review of social attitudes toward obesity and thinness reveals values congruent with the distribution of obesity by SES in different societies. Several variables may mediate the influence of attitudes toward obesity and thinness among women in developed societies that result in the inverse relationship between SES and obesity. They include dietary restraint, physical activity, social mobility, and inheritance.

Adult↗
PubMed1989

Component distributions of body mass index defining moderate and extreme overweight in Danish women and men.

Skewness in the distribution of body mass index in a population of Danish men (n = 1,589) and women (n = 1,988) adopted in Copenhagen between 1923 and 1947 can be explained by mixture of three component distributions, after removing age and sex effects. Even when residual skewness was allowed for in component distributions, similar results were obtained. The upper component distributions corresponded to extreme overweight in both women and men. The results indicate that while there are differences in the means and ranges of body mass index in men and women, the component distributions are similar. Both genetic and environmental factors can produce such component distributions. The authors speculate that the underlying predisposition to obesity is distributed similarly in women and men. Finally, on the basis of the component distributions, the authors propose thresholds of body mass index which allow for 85-98 per cent separation of moderate and extreme overweight groups in men and women.

Adult↗
PubMed1989

Commingling analysis of obesity in twins.

Evidence is presented for multiple components in the distribution of human fatness across several large twin samples, after removing age effects and allowing for residual skewness in component distributions. The upper component distributions corresponded to overweight or obesity in samples of middle-aged or older individuals. A bivariate analysis demonstrated that, while monozygotic co-twins appeared to be drawn from the same component distributions (normal or overweight), the twin correlations varied across components, with the lowest correlation in the overweight group. While these analyses cannot provide a definitive test of competing genetic and environmental hypotheses, this approach is useful for generating hypotheses about the causes of obesity. When combined with other published literature, our results suggest that the genetic background largely determines the propensity to become obese. Whether a predisposed person becomes obese and the extent of obesity depend on environmental exposures that are largely independent of early family experience. Both genes and environment appear to be important in obesity, but it appears that some genotypes may be much more sensitive to the environment than are others.

Body Composition↗
PubMed1989

Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a five-year perspective.

Seventy-six obese women with a mean age of 42.1 years and weight of 106.0 kg were randomly assigned to one of three treatments: (a) very low calorie diet alone; (b) behavior therapy alone; or their combination (i.e. combined treatment). Weight losses for the three conditions at the end of treatment were 13.1, 13.0, and 16.8 kg, respectively, with losses for combined treatment significantly greater than those for the two other conditions. Weight losses 1 year after treatment were 4.7, 6.6, and 10.6 kg, respectively. A significantly greater percentage of subjects in the behavior therapy alone (36 percent) and combined treatment conditions (32 percent) maintained their full end-of-treatment weight losses than in the very low calorie diet alone condition (5 percent). Five years after treatment, a majority of subjects in all three conditions had returned to their pretreatment weight, and 55 percent of the total sample had received additional weight reduction therapy. The short and long term effects of treatment are discussed in terms of their implications for practice and research.

Adult↗
PubMed1989

Dissatisfaction with weight and figure in obese girls: discontent but not depression.

This study examined psychological functioning and satisfaction with weight and figure in a total of 393 obese and nonobese adolescent girls from lower-middle to middle-class families. No significant differences were observed between the two groups on measures of trait anxiety or depression, and all subjects scored well within normal limits. Obese girls did, however, report significantly greater dissatisfaction with their weight and figure than did nonobese girls. Many nonobese girls also expressed dissatisfaction with their weight, supporting the view that women's dissatisfaction with weight is a 'normative discontent'. Nearly 70 percent of the total sample had attempted to lose weight in the past year. The results of this study indicate that obese girls in the general population are dissatisfied with their weight but are not significantly anxious or depressed, as had been suggested by studies of overweight adolescents in clinical settings.

Adolescent↗
PubMed1989

Effect of the Garren-Edwards gastric bubble on gastric emptying.

The Garren-Edwards Gastric Bubble (GEGB) was introduced in 1984 as an alternative to surgery (jaw wiring, gastrointestinal bypass, vertical banded gastroplasty) for the treatment of morbid obesity in patients who had failed behavior modification therapy or dietary management for weight reduction. Its mechanism of action is unclear and previous reports have not demonstrated any significant consistent alteration in gastric emptying (GE) as measured by radionuclide techniques. Other proposed mechanisms include: placebo, hormonal, mechanical "satiety", behavioral modification, and neuronal. In order to determine the effect of the GEGB on GE, ten obese (mean % overweight = 89%) patients, 27-50 yr old (mean = 36 yr), had solid GE scans before and 5 wk after endoscopic placement of the bubble. GE scans were performed in six patients after removal (12 = wk residence time). The meal consisted of 300 microCi [99mTc]sulfur colloid in the form of a 300 kcal egg sandwich (egg white 248 g, white bread 40 g, butter 6 g; composition = CHO 40:PR 40: FAT 20) with 180 ml deionized water. Images were obtained in the anterior and posterior projections at 15-min intervals for 1 hr (four patients) or 2 hr (six patients) and the %GE (decay corrected geometric mean) was calculated. Unlike other studies involving the GEGB, adjunctive therapy in the form of dieting and behavior modification were not employed in this study. The effect of the GEGB alone in the treatment of obesity has not been previously evaluated. There was a significant (p less than 0.025) delay in gastric emptying at 1 hr (pre-bubble mean % gastric retention = 46%; bubble mean = 57%; n = 10). After removal, GE returned toward baseline (mean % gastric retention = 51%; n = 6) (p less than 0.05) (Student's t-test). The average weight loss was 5.5 lb (n = 10; p less than 0.025). One mechanism of action of the GEGB may be delayed gastric emptying resulting in early satiety and decreased food intake with resultant weight loss.

Adult↗
PubMed1989

Limited weight losses with a gastric balloon.

An evaluation of the Garren-Edwards gastric bubble in the treatment of obesity was done. Several clinical trials have compared the effects of behavior therapy with and without the bubble, but the effects of the bubble alone have not been previously evaluated. Ten obese women averaging 91% overweight received the bubble without adjunctive therapy during a 12-week treatment period. Frequent psychological and laboratory measures as well as weight were obtained during the study to explore the possible mechanisms of the bubble's effect and its side effects. Mean weight change was -2.5 kg, with a range of -8.8 to +1.6 kg. Four patients lost more than 3.5 kg, three lost less than 3.5 kg, and three gained weight. The Garren-Edwards gastric bubble alone does not appear to provide significant benefit to most obese patients.

Adult↗