Biomedical subjects
H C Seim
Publications and source records attributed to H C Seim.
The diet prescription for obesity. What works?
Obesity is a chronic disease, and in most cases weight reduction is the first treatment for its concomitant conditions of hyperlipidemia, diabetes, and hypertension. Weight-reduction diets are controversial in both the popular press and among clinicians treating hyperlipidemia and obesity. Both high-carbohydrate/low-fat and higher-protein/low-carbohydrate diets will produce loss of body fat if the calorie level is low enough. But selecting effective diet prescriptions for bariatric patients requires understanding of both the science and art of nutrition. Low-calorie diets, protein-sparing modified fasts, and modified-carbohydrate diets seem to be the most effective for patient compliance, and modified-carbohydrate plans are probably necessary for maintenance of the weight loss.
Clinical preceptors: tips for effective teaching with minimal downtime.
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Rural family practice program for first-year students.
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Clinical characteristics associated with binge eating in obese females: a descriptive study.
OBJECTIVE: To investigate differences in clinical characteristics of obese female participants based on presence and degree of binge eating behavior. DESIGN: Descriptive comparison of various clinical characteristics of obese women diagnosed with binge eating disorder (BED) assessed by semi-structured interview to those for similar weight participants reporting subthreshold BED and those who do not binge eat. SUBJECTS. 185 healthy women seeking obesity treatment (age: 20-55 y, BMI: 28.4-51.5 kg/m2). MEASUREMENTS: Baseline self-report questionnaires included the Weight and Eating Patterns (QEWP), Eating Disorders Questionnaire (EDQ), Beck Depression Inventory (BDI); clinical interviews included the Hamilton Depression Rating Scale (HDRS) and Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P). RESULTS: In comparison to other obese women, obese participants meeting full BED criteria report an earlier onset of binge eating, increased food cravings, increased diet pill use, decreased fasting, greater fear of gaining weight, increased body perception disturbance, and increased depressive symptomatology and general psychopathology. CONCLUSIONS: Obese women with BED report greater eating-related and general psychopathology than non-binge eating disordered women of comparable weight. Although endorsement of food cravings unrelated to hunger was associated with binge eating diagnosis, the role of dietary restriction among this population remains unclear and requires further investigation. Theoretical and clinical implications that binge eating episodes for individuals with BED may be related to negative affect states and increased dietary disinhibition are discussed.
Comparison of training techniques using a patient-centered approach to smoking cessation.
This study compared the use of 2 1/2-hour multimedia workshop with distribution of an algorithm on the ability of fourth-year medical students to present a stop-smoking plan to a simulated patient. Results showed that students who participated in the workshop performed statistically significantly better on the skill areas of providing information, eliciting and responding to feeling and on content areas of past experience with quitting, resources available for change and negotiating a plan. There were no significant differences in the skill area of eliciting information and the content areas of motivation to stop smoking, factors that inhibit change and problems affecting the plan. Neither of the groups performed very well. The highest number of available points obtained by both groups was in eliciting information (53% in the algorithm group and 64% in the formal training group); however, most of the values were in the range of 10%-25% of possible points. Suggested reasons for the low values may be due to the specific items rated, the teaching methods or the time needed to assimilate new skills.
Life after medical practice. A retirement profile of Minnesota physicians.
This study investigates the current dynamics of physician retirement in Minnesota. A survey of all retired Minnesota physicians (878, with 65.7% response rate) revealed that 73% retired in their 60s, 22% at age 65. Good health was reported by 69% of the respondents, and fair health by 26%. Income was sufficient in most cases; 64% of respondents reported living comfortably, and only 14% said their incomes are barely adequate. The study also showed that retired physicians consider nonmedical activities much more important than medical activities; heading the list were visiting family (86%), reading (79%), and travel (63%). Finally, 35% of respondents found retirement to be better than they had expected, 54% found it about as expected, and only 9% felt retirement was not as good as expected. In retirement, Minnesota physicians are generally healthy, have sufficient funds to live comfortably, and generally spend their time doing nonmedical activities.
Electrocardiographic findings associated with very low calorie dieting.
OBJECTIVE: To determine the safety of very low calorie diets (VLCD) in regard to their effects on cardiac function. DESIGN: EKG changes were analyzed for 126 women on a VLCD of 3349 kJ/d (800 kcal/d). EKGs were done when the diet was begun, after 3 months of dieting, and at a 6 month follow up after being off the diet for 3 months. SETTING: Subjects were solicited through advertisements and charged $1,000 for participating after being screened for age, weight, and health status. MAIN OUTCOME MEASURES: EKG QTc intervals, PR interval, QRS interval, ST-T wave changes, and heart rate. RESULTS: Over one-fourth (27.0%) of subjects had normal EKGs at all three time points studied. Sinus bradycardia was the most common abnormality, observed in 60 subjects (47.6%) on at least one of the three EKGs. Fifty-eight (46%) patients had EKGs with ST-T wave abnormalities observed on at least one of the EKGs. Eight subjects (6.4%) had prolonged QTc (more than one standard deviation beyond the average for women) intervals on at least one EKG. None of these eight persons had significant untoward medical consequences. CONCLUSION: A VLCD diet of 3349 kJ/d (800 kcal/d) for up to 3 months is not associated with significant electrocardiographic abnormalities or clinical cardiac complications, provided the patients have low cardiovascular risk at baseline.
Eating related and general psychopathology in obese females with binge eating disorder.
One hundred obese women with a mean age of 39.2 years, and a mean body mass index (BMI) of 35.9 kg/m2 were evaluated before entering a treatment study for weight reduction. According to the results of a structured interview, subjects were divided into four groups: (1) no overeating episodes, (2) episodic overeating episodes without the feeling of loss of control, (3) overeating plus the sense of loss of control (binge eating), and (4) full diagnostic criteria for binge eating disorder (BED). One-way analyses of variance (ANOVAs) revealed significant positive associations between binge eating and eating/weight-related characteristics such as a history of frequent weight fluctuations, the amount of time spent dieting, drive for thinness, and a tendency for disinhibition of eating. Furthermore, subjects exhibited more feelings of ineffectiveness, stronger perfectionistic attitudes, more impulsivity, less self-esteem, and less interoceptive awareness the more problems with binge eating they reported. The results support the idea that binge eaters might be a distinct subgroup among the obese population, and corroborate the utility of a diagnosis of BED in identifying the most disturbed obese subjects with regard to the variables tested.
Diagnosing binge eating disorder: level of agreement between self-report and expert-rating.
We assessed the correlation between a self-report questionnaire and an expert-rating including an initial interview and a longitudinal evaluation on the diagnosis of binge eating disorder (BED) in a sample of 100 obese women participating in a treatment program for weight reduction. The level of diagnostic agreement between patient-rating and expert-rating with regard to the presence or absence of BED was modest, with a kappa value of .57. According to Shrout, Spitzer, and Fleiss (Archives of General Psychiatry, 44, 172-177, 1987) this represents fair to good agreement beyond chance. The self-report instrument did not produce higher estimates of the frequency of BED in this selected sample of treatment seekers than the expert-rating, as observed in studies on the epidemiology of bulimia nervosa in community samples. The questionnaire identified 40 cases of BED, the expert-rating 43 cases. The results indicate that the disagreement between self-report and interview was mainly due to discordances in three of the diagnostic criteria of BED--namely loss of control, marked distress regarding binge eating, and the frequency requirement of two binge eating episodes per week for a 6-month period. Inconsistencies between subjects and clinicians with regard to the definition of an overeating episode and with regard to the behavioral indicators of loss of control did not lead to differences between self-report and observer-rating in the final diagnosis of BED.
Treatment of obesity in the elderly.
Obesity is a common form of malnutrition among the elderly. Excessive weight gain is associated with decreased physical activity and a progressive decline in caloric requirements for weight maintenance. Obesity increases the risk of myocardial infarction, stroke, hypertension, noninsulin-dependent diabetes, osteoarthritis of the lower extremities and several types of cancer. Specific guidelines are recommended for weight-loss programs used in the elderly. While calories from dietary fats and carbohydrates are restricted, a protein intake of approximately 70 g per day is desirable. Exercise is an important part of the weight-loss program and contributes to a general sense of well-being. Limitation of motion may necessitate innovative forms of exercise for elderly patients.
Effects of a six-week, low-fat diet on serum cholesterol, body weight, and body measurements.
This study was done to determine if significant weight loss, decrease in body measurements, and lowering of serum lipids and blood pressure could be shown in people on a low-calorie, low-fat, high-fiber diet over a period of six weeks. Forty-one people (33 females and 8 males) between the ages of of 37 and 55 years old participated in a six-week calorie-controlled, low-fat, low-sodium, high-fiber diet using foods available in supermarkets. Participants also exercised moderately. The average weight loss was 10.3 pounds, or 5.8% of the original average weight. The body mass index decreased 1.7-a 6.0% decrease for women and a 5.3% decrease for men. The average of five body measurements decreased 4.9%. Total cholesterol decreased 16%, LDL-C decreased 12%, and HDL-C decreased 18%. All of these decreases were statistically significant at P < .001. No significant difference was noted in blood pressures at the start and completion of the study, as both values were in the normal range. This relatively short period of dieting using 1200 calories for women and 1500 calories for men, along with moderate exercise, shows that reasonable weight loss and a tendency toward lowering lipid values can be obtained. Weekly monitoring by physicians and their office staffs can enhance this process. Continued accountability and support for lifelong behavior changes are probably necessary to maintain reasonable body weight in these patients.
Approaching the protein-sparing modified fast.
The protein-sparing modified fast is a safe and effective method for losing a large amount of weight relatively quickly. This diet should be used in combination with an exercise program, behavior modification and patient education. Caloric intake is in the range of 400 to 800 per day. Candidates for the diet should be generally healthy; they should have at least 40 lb to lose or be at more than 120 percent of their ideal body weight.
A workshop program to train volunteer community preceptors.
This paper describes a program initiated in 1984 by the University of Minnesota Department of Family Practice and Community Health to train volunteer community preceptors for their instructional role in the Ambulatory Care Rotation (ACR), a six-week outpatient medicine offering for third- and fourth-year medical students. The preceptor training program consists of a full-day faculty development workshop for prospective community preceptors and periodic follow-up activities designed to reinforce workshop goals. Five workshops have been held from 1984 to 1987 and have provided a group of trained faculty preceptors for the ACR. The authors reviewed the methods and results of the workshops; self-ratings by participants demonstrated a significant gain in teaching skills and knowledge. Students' ratings of both the ACR course and the teaching by preceptors have been high and compare favorably with ratings of other preceptors and clinical rotations. There has been a 97% retention rate of the workshop-trained preceptors as active teachers in the ACR course, which suggests that the preceptors are satisfied with their role.
A comparison of attitudes and behaviors of men and women toward food and dieting.
This study compared attitudes and behaviors of men and women toward food and dieting. A questionnaire was administered to 198 consecutive adults coming to a family practice clinic; about one-fourth of these men and ten percent of the women were obese. Over 40 percent of the respondents had a high-self-esteem and 87 percent had a generally positive attitude toward themselves. Five times as many women were not satisfied with their weight and body image as men. Twice as many women as men felt the overweight condition had a moderate to strong effect on their self-esteem. Women thought about overeating and felt guilty when eating twice as often as men. Sixty-eight percent of women dieted monthly to a few times per year; seventy-five percent of men dieted once yearly or never dieted. Our society stresses thinness in its women; this study shows some of these effects.
Toilet training in first children.
Parents of 266 children were queried about the process they used to toilet train their first child. Results showed that they learned the training process most frequently from intuition, from their parents, and from friends with small children. Most children were put on the potty chair and were praised when successful. About three fourths of the parents responded that readiness of the child prompted initiation of toilet training. The largest number of children (42.6%) were 24 to 29 months old when training began and 30.5% were 18 to 23 months old. The mean ages for completion of training were between 24 and 27 months.
Prescription diuretic abuse in patients with bulimia nervosa.
Bulimia nervosa, a common eating disorder usually characterized by binge eating and self-induced vomiting, may also involve abuse of prescription diuretics. This article describes four patients who abused prescription diuretics in large quantities (up to 2 g/d of furosemide) for extended periods of time. Physical examination and laboratory values provided few clues to the diagnosis of bulimia nervosa. Other eating-related behaviors previously linked to bulimia nervosa--including abuse of diet pills, illicit amphetamines, and laxatives, as well as withholding of insulin in one diabetic patient--were present in these cases. Usually the patients' primary physicians were not aware of these problems. Physicians should be aware that patients requesting prescription diuretics may have bulimia nervosa.
Evaluation of serum testosterone and luteinizing hormone levels in sex offenders.
Testosterone levels were analyzed in a group of nonviolent sex offenders and compared to normal controls; the offenders had significantly lower levels (P = 0.0016). This finding differs from reports of violent offenders who have been shown to have higher testosterone levels than normals, but concurs with a previous study done at the University of Minnesota, Department of Family Practice and Community Health, which found nonviolent sex offenders to have significantly lower testosterone levels than normals. Luteinizing hormone levels were in the normal range for both groups.