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Biomedical subjects

A J Stunkard

Publications and source records attributed to A J Stunkard.

At least 109 records · Page 6Linked to original sources
PubMed1986

Psychological and social aspects of the surgical treatment of obesity.

New surgical procedures have revolutionized the treatment of morbid obesity (more than 100% overweight), a condition associated with serious medical complications and for which conservative treatment has been largely ineffective. These procedures, which are surprisingly safe, produce large weight losses and marked improvement in hypertension, diabetes, and other disorders influenced by obesity. Striking changes also occur in vocational and psychosocial functioning, including marital and sexual relations, in eating behavior, in food preferences, and in body image. The emotional state of patients during weight loss following surgery is far superior to that during attempts at weight reduction by other methods. The surgical procedures appear to produce a major biological change, perhaps lowering a body weight set point.

Adaptation, Psychological↗
PubMed1985

The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger.

This report describes the construction of a questionnaire to measure three dimensions of human eating behavior. The first step was a collation of items from two existing questionnaires that measure the related concepts of 'restrained eating' and 'latent obesity', to which were added items newly written to elucidate these concepts. This version was administered to several populations selected to include persons who exhibited the spectrum from extreme dietary restraint to extreme lack of restraint. The resulting responses were factor analyzed and the resulting factor structure was used to revise the questionnaire. This process was then repeated: administration of the revised questionnaire to groups representing extremes of dietary restraint, factor analysis of the results and questionnaire revision. Three stable factors emerged: (1) 'cognitive restraint of eating', (2) 'disinhibition' and (3) 'hunger'. The new 51-item questionnaire measuring these factors is presented.

Adolescent↗
PubMed1985

Health promotion at the worksite. I. A process for establishing programs.

A 14-step process for establishing health promotion programs at the worksite is described. During a period of 3 years, it has been used to establish 58 such programs in 12 small industries that employ 4,200 persons in a rural county in Pennsylvania. Few problems have been encountered; the most serious is the very limited record-keeping system of industries. The process is flexible and can be readily generalized to different settings. The major strengths of the process are the sense of ownership it gives to employees, and the modesty of its costs and the costs of the resulting programs.

Health Promotion↗
PubMed1985

A comparison of two very-low-calorie diets: protein-sparing-modified fast versus protein-formula-liquid diet.

This study investigated the acceptability of two very-low-calorie diets in 16 moderately overweight persons participating in a weight reduction program. Subjects were prescribed a 1000-1200 kcal balanced diet the first month and asked to complete appetite and mood scales on a weekly basis. They were then randomly assigned to either a protein-sparing-modified fast (PSMF) or a protein-formula-liquid diet, each of which provided about 400 kcal daily. Analysis of the appetite data showed that PSMF subjects reported significantly less hunger and preoccupation with eating than did liquid diet subjects during 2 of the 4 weeks on a very-low-calorie diet. Subjects in both conditions reported significant reductions in anxiety. Results are discussed in terms of possible advantages of PSMF.

Adult↗
PubMed1985

What is behavior therapy? A very short description of behavioral weight control.

Behavior therapy of obesity is very widely used and is the subject of numerous reports in the medical literature. The background of this therapy is described and a table lists the 49 most commonly used elements of behavioral weight control as abstracted from five of the most widely read publications on the topic.

Behavior Therapy↗
PubMed1985

Weight reduction at the work site: a promise partially fulfilled.

Three consecutive studies of weight reduction at the work site were conducted with 172 female union members, who participated in 16-week behavioral group programs. There was no significant difference in weight loss over the three studies, but attrition decreased from 57.5% to 33.8% and weight loss maintenance improved. Groups that met three to four times weekly had less attrition than those which met once a week, but had no more weight loss. These behavioral weight reduction programs were as effective as self-help and commercial groups, and lay leaders produced results equivalent to those produced by professional therapists at one-third the cost.

Appointments and Schedules↗
PubMed1985

Social and psychological consequences of obesity.

The strong prejudice in this country against obese persons is evident in children as young as 6 years of age. There is discrimination against obese persons in both academic and work settings. Despite this discrimination, overweight persons in the general population show no greater psychological disturbance than do non-obese persons. Similarly, obese patients seen for medical or surgical procedures generally show no more psychopathology than do non-obese patients. Serious psychiatric disturbances associated with obesity include disparagement of body image and negative emotional reactions to dieting. Dieting may also be responsible for the increased incidence of bulimia observed in this country in recent years. Women, adolescent girls, and the morbidly obese appear to suffer the most deleterious consequences of society's contempt for the obese.

Adolescent↗
PubMed1984

The Master Questionnaire: preliminary report on an obesity assessment device.

Behavioral obesity researchers are increasingly concerned with thorough assessment of obesity. The present report describes the preliminary testing and refinement of the Master Questionnaire (MQ), a true-false scale developed expressly for use in obesity research. It was initially divided into four subscales: Spouse Support, Energy Balance Habits, Cognitive Factors, and Energy Balance Knowledge, and was intended for use as an outcome measure and as a predictor of change in obesity status. Its stability, internal consistency, sensitivity to treatment-related change, and predictive validity were examined. Test-retest reliability and sensitivity to treatment-related change were each found to be acceptable for three out of four subscales. Two subscales, Energy Balance Knowledge and Cognitive Factors, predicted outcome. The major weakness of the subscales was a lack of unidimensionality which would limit their utility. Cluster and factor analyses were used to develop five new subscales with acceptable levels of internal consistency. While some additional development and validation is still needed, the available evidence suggests that we have the nucleus of a strong assessment tool for obesity research.

Adult↗
PubMed1984

Weight loss competitions at the work site: impact on weight, morale and cost-effectiveness.

Three weight loss competitions were held in business/industrial settings. One competition was between three banks; the other two were within industries, either between employee teams selected at random or between divisions of the industry. Attrition in the competitions was less than 1 per cent and weight loss averaged 5.5 kg. Both employees and management reported positive changes in morale and employee/management relations, and both considered the competition important to the success of the program. The cost-effectiveness ratio ($ 2.93 per 1 per cent reduction in percentage overweight) is the best yet reported.

Body Weight↗
PubMed1984

The current status of treatment for obesity in adults.

This review has considered the current status of the treatment of obesity from the point of view of a new theory and a new classification. The theory states that obesity is the result of regulated, homeostatic processes that maintain body fat at an elevated level. The classification divides obesity into three categories--mild, moderate, and severe. Severe obesity, more than 100% overweight, which afflicts 0.5% of the female obese population is most effectively treated by surgical measures, particularly ones that reduce the size of the stomach and of its opening into the lower gastrointestinal tract. Such surgery may produce very large weight losses with relatively few untoward consequences, suggesting that it acts by lowering a body weight set point. Moderate obesity, 41 to 100% overweight, afflicts 9% of the female obese population. It is currently treated under medical auspices either by diets that may achieve satisfactory weight loss but poor maintenance of this loss, or by behavior modification that achieves good maintenance, but only modest weight loss. Medication is of limited value because of its continued efficacy, rather than because, as was thought, tolerance develops to its effects. It appears to lower a body weight set point and cessation of medication is followed by a rapid rebound in body weight. For this reason, medication should probably be used either for an indefinite period of time or not at all. Mild obesity, 20 to 40% overweight, afflicts 90% of the female obese population and today is largely managed by large organizations, both commercial and nonprofit. The basis of treatment is behavior modification in groups, a liberal, balanced diet, and exercise. Despite very high drop-out rates from these organizations, their low costs result in favorable cost/effective ratios, and they are continuing to increase the number of obese people that they treat.

Behavior Therapy↗
PubMed1983

Obesity and psychoanalysis: treatment and four-year follow-up.

Psychoanalysts provided information about 84 obese patients and 63 patients of normal weight at the beginning of this study, 18 months later, and 4 years later. Treatment lasted from 3 to more than 7 years. Although obesity was the chief complaint of only 6% of the obese patients, their weight loss and maintenance of it compared favorably with results reported for other psychological treatments for obesity. Severe body image disparagement was present in 39% of the obese patients at the beginning of treatment but in only 18% at the 4-year follow-up. Most patients improved in their chief complaint and presenting symptoms. The study indicates that large-scale collaborative research in psychoanalysis is feasible.

Adolescent↗
PubMed1983

Very low calorie diets: their efficacy, safety, and future.

Very low calorie diets used to treat moderate and severe obesity produce average weight losses of 20 kg in 12 weeks. This paper reviews the development of very low calorie diets from research on fasting in the late 1950s and examines data on the amount of dietary protein needed to achieve positive nitrogen balance. The desirability of including carbohydrate in the diet, the choice of protein sources (formula versus animal protein), and the anorectic value of ketosis are discussed, as are patient selection and the clinical course of the diet. As contrasted to the earlier "liquid protein" diets that were associated with at least 60 deaths, very low calorie diets of high-quality protein appear safe when limited to 3 months or less under careful medical supervision. Evidence of this safety is provided by the results of 24-hour Holter monitoring and the fact that no diet-related fatalities have been reported in over 10 000 cases. The major problem to be resolved is the maintenance of the large weight losses achieved with these diets.

Arrhythmias, Cardiac↗