Biomedical subjects

Albert J Stunkard

Publications and source records attributed to Albert J Stunkard.

26 records · Page 2Linked to original sources

PubMed2004

Circadian eating and sleeping patterns in the night eating syndrome.

OBJECTIVE: To compare the eating and sleep-wake patterns of persons with the night eating syndrome (NES) with those of matched control subjects. RESEARCH METHODS AND PROCEDURES: Forty-six overweight/obese NES subjects (mean age 43.3 +/- 9.8 years; 32 women) and 43 similar controls (mean age 39.0 +/- 11.0 years; 28 women) wore wrist actigraphs for 7 days and completed sleep and food diaries at home. RESULTS: There was no difference between the total energy intake of the NES and the control subjects, but the pattern of energy intake differed greatly. Relative to control subjects, the temporal pattern of food intake of night eaters was delayed. Food intake after the evening meal, as a proportion of the 24-hour intake, was more than 3-fold greater in NES subjects than in controls (34.6 +/- 10.1% vs. 10.0 +/- 6.9%, p = 0.001). NES subjects had sleep onset, offset, and total sleep duration times comparable with those of controls. NES subjects reported more nocturnal awakenings than did controls (1.5 +/- 1.0 per night vs. 0.5 +/- 0.5; p < 0.001), and their actigraphically monitored arousals occurred earlier during sleep (at 128 minutes after sleep onset vs. 193 minutes, p = 0.01). NES subjects consumed food on 74% of the awakenings vs. 0% for the controls. DISCUSSION: The pattern of cumulative energy intake of the night eaters suggests a phase delay in energy consumption relative to sleep-wake times. NES may involve a dissociation of the circadian control of eating relative to sleep.

Activity Cycles↗

PubMed2004

Parental feeding attitudes and styles and child body mass index: prospective analysis of a gene-environment interaction.

BACKGROUND: Parental feeding styles were linked to child weight in cross-sectional studies, which were unable to test the direction of effect. Prospective studies can best establish causal relationships among such variables. OBJECTIVE: We tested the 2-year stability of parental feeding attitudes and styles and investigated whether these variables predict child body mass index (BMI) z scores 2 years later. We evaluated whether these associations were dependent on children's predisposition to obesity. METHODS: Participants were 57 families enrolled in an Infant Growth Study of children born at high risk or low risk for obesity, on the basis of maternal prepregnancy overweight or leanness. Children were evaluated for weight and height at 3, 5, and 7 years of age. Measures of parental feeding attitudes and styles were ascertained with the Child Feeding Questionnaire at 5 and 7 years of age. Correlation and multiple regression analyses tested whether parental feeding styles at age 5 predicted increased child BMI z scores 2 years later. RESULTS: Parental feeding attitudes and styles were stable for child ages of 5 to 7 years. With respect to feeding attitudes, perceived responsibility at age 5 predicted reduced child BMI z scores at age 7 among low-risk families, whereas child weight concern and perceived child weight predicted increased child BMI z scores among high-risk families. With respect to feeding styles, monitoring predicted reduced child BMI z scores at age 7 among low-risk children. In contrast, restriction predicted higher BMI z scores and pressure to eat predicted reduced BMI z scores among high-risk children. These associations remained significant after controlling for child weight status at age 3. CONCLUSIONS: The relationship between parental feeding styles and child BMI z scores depends on child obesity predisposition, suggesting a gene-environment interaction. Among children predisposed to obesity, elevated child weight appears to elicit restrictive feeding practices, which in turn may produce additional weight gain. Parenting guidelines for overweight prevention may benefit from consideration of child characteristics such as vulnerability to obesity and current weight status.

Attitude↗

PubMed2003

Depression and obesity.

The prevalence of depression (10%) and overweight (65%) indicates that there is a probability that they will co-occur, but are they functionally related? This report used the moderator/mediator distinction to approach this question. Moderators, such as severity of depression, severity of obesity, gender, socioeconomic status (SES), gene-by-environment interactions and childhood experiences, specify for whom and under what conditions effects of agents occur. Mediators, such as eating and physical activity, teasing, disordered eating and stress, identify why and how they exert these effects. Major depression among adolescents predicted a greater body mass index (BMI = kg/m(2)) in adult life than for persons who had not been depressed. Among women, obesity is related to major depression, and this relationship increases among those of high SES, while among men, there is an inverse relationship between depression and obesity, and there is no relationship with SES. A genetic susceptibility to both depression and obesity may be expressed by environmental influences. Adverse childhood experiences promote the development of both depression and obesity, and, presumably, their co-occurrence. As most knowledge about the relationship between these two factors results from research devoted to other topics, a systematic exploration of this relationship would help to elucidate causal mechanisms and opportunities for prevention and treatment.

Adolescent↗

PubMed2003

Binge eating disorder: disorder or marker?

OBJECTIVE: To describe the evidence for the constellation of symptoms known as binge eating disorder (BED) and to evaluate the utility of this diagnosis. METHODS: Examination of the definition, prevalence, psychiatric comorbidity, and treatment of BED through a selective review of the literature. RESULTS: The objective definition of a binge (its size and duration) remains problematic. Persons with BED have extensive comorbid psychopathology. Pharmacologic treatments effectively reduce binge eating, but only somewhat more than placebos, whereas psychotherapeutic treatments reduce binge eating, but do not produce weight loss. Traditional behavioral weight loss programs produce both weight loss and decreases in binge eating. The course of BED is variable and often remits with nonspecific attention or during wait-list conditions. CONCLUSIONS: Although there is consensus on the criteria for BED, its great variability limits the implications that can be drawn from its diagnosis, and it may be most useful as a marker of psychopathology.

Bulimia↗

PubMed2003

Getting worse: the stigmatization of obese children.

OBJECTIVE: The prevalence of childhood obesity more than doubled in the period from 1961 to 2001. We replicated a 1961 study of stigma in childhood obesity to see what effect this increased prevalence has had on this stigma. RESEARCH METHODS AND PROCEDURES: Participants included 458 5th- and 6th-grade children attending upper-middle and lower-middle income U.S. public schools. Children ranked six drawings of same-sex children with obesity, various disabilities, or no disability ("healthy"), in order of how well they liked each child. RESULTS: Children in both the present and the 1961 study liked the drawing of the obese child least. The obese child was liked significantly less in the present study than in 1961 [Kruskal-Wallis H(1) = 130.53, p < 0.001]. Girls liked the obese child less than boys did [H(1) = 5.23, p < 0.02]. Children ranked the healthy child highest and significantly higher than in 1961 [H(1) = 245.40, p < 0.001]. The difference in liking between the healthy and obese child was currently 40.8% greater than in 1961. DISCUSSION: Stigmatization of obesity by children appears to have increased over the last 40 years.

Child↗

PubMed2003

Two forms of disordered eating in obesity: binge eating and night eating.

OBJECTIVE: Binge eating disorder (BED) and the night eating syndrome (NES) have been linked to obesity. This review summarizes their characteristics, implications of their diagnoses and treatment outcomes. METHOD: Selective review of the literature on BED and NES. RESULTS: BED was proposed as a distinctive disorder on the basis of two large multisite studies in the early 1990s. It is associated with more severe and earlier onset of obesity, earlier onset of dieting and greater psychopathology. It shows large placebo responses and reduction of bingeing in patients on waiting-list controls. Traditional weight reduction programs reduce bingeing at least as well as psychological treatments designed for this purpose. NES is a stress-related eating, sleeping and mood disorder that is associated with disordered neuroendocrine function. It follows a characteristic circadian pattern and has responded to an agent that enhances serotonin function. CONCLUSIONS: BED responds well to weight reduction programs. It is proposed that this diagnosis be used as a marker for psychological problems that deserve treatment in their own right. NES is an eating, sleep, and mood disorder with distinctive behavioral and neuroendocrine characteristics. Studies of treatment for NES are in their infancy but selective serotonin reuptake inhibitors (SSRI) show promise.

Bulimia↗

PubMed2002

Assessment of dietary and genetic factors influencing serum and adipose fatty acid composition in obese female identical twins.

Fourteen pairs of obese female monozygotic twins were recruited for a study of genetic influences on serum and adipose fatty acid (FA) composition. Following 1 wk of inpatient stabilization, fasting serum and adipose tissue obtained by surgical excision were analyzed by thin-layer and gas chromatography. Intrapair resemblances (IPR) for individual FA were assessed by Spearman rank correlation and by analysis of variance and were found in serum cholesteryl esters (CF), triglycerides (TG), and adipose TG. With two exceptions (CE linoleate and adipose eicosapentaenoate), these IPR were limited to the nonessential FA. Palmitate had significant IPR in four lipid fractions; in serum CE and adipose TG palmitate was strongly correlated with multiple measures of adiposity. In contrast to other lipid fractions, serum phosphatidylcholine (PC) FA had 12 [PR, of which 6 were essential FA including arachidonate (r = 0.76, P < 0.0005), eicosapentaenoate (r = 0.78, P < 0.0005), and docosahexaenoate (r = 0.86, P< 0.0001). The PC [PR could not be explained by analysis of preadmission 7-d food records. After dividing the pairs into two groups differing and nondiffering according to fat intake of individuals in the pair, there was no evidence of a gene-environment interaction between fat intake and FA composition. The IPR for nonessential FA indicate that there is active genetic control of either food choices or postabsorptive metabolic processing. The high level of IPR in the PC fraction in contrast to the other lipid fractions suggests strong genetic influence over selection of specific FA for this membrane fraction independent of diet.

Adipose Tissue↗

PubMedDate not supplied

Night eating syndrome and binge eating disorder among persons seeking bariatric surgery: prevalence and related features.

OBJECTIVE: To assess the prevalence of night eating syndrome (NES) and binge eating disorder (BED) and their related behavioral and psychological correlates in persons who sought bariatric surgery. RESEARCH METHODS AND PROCEDURES: A consecutive series of 215 persons with extreme obesity (82% women, 70% European American) completed the Weight and Lifestyle Inventory and a semistructured interview as part of a pre-surgery behavioral/psychological assessment. Diagnoses for NES and BED were based on graded diagnostic criteria. RESULTS: Percentages of participants who met diagnostic criteria for NES by interview were 1.9% for the strictest definition and 8.9% across all definitions of NES. After interview, full DSM-TR criteria for BED were met by 4.2%; an additional 1.4% reported binge eating at least once per week. Self-reported prevalence of NES and BED were higher. Those with NES or BED had significantly more symptoms of depression and a greater history of psychological complications than the remaining sample. DISCUSSION: The prevalence rates of NES and BED among this population of bariatric surgery candidates were lower than expected based on previous reports. Findings and hypotheses regarding lowered prevalence rates are discussed.

Adult↗