Biomedical subjects

M L Klem

Publications and source records attributed to M L Klem.

At least 19 recordsLinked to original sources

PubMed2000

Does weight loss maintenance become easier over time?

OBJECTIVE: Studies of health-related behaviors, including weight loss, have shown that risk of relapse decreases over time, although reasons for this relationship are unclear. The purpose of this cross-sectional study was to determine if subjects who have maintained weight losses for varying periods of time report different strategies for weight loss maintenance or differences in the effort and pleasure associated with weight maintenance behaviors. RESEARCH METHODS AND PROCEDURES: Subjects were 758 women and 173 men who had maintained losses of at least 30 lb (mean = 60 lb) for 2 years or longer (mean = 6.8 +/- 7.0 years). Self-administered questionnaires assessed subjects' use of weight maintenance strategies in the past year and their perceptions of the effort, attention, and pleasure associated with weight maintenance. RESULTS: Subjects who had maintained weight losses longer used fewer weight maintenance strategies and reported that less effort was required to diet and maintain weight and that less attention was required to maintain weight. The pleasure derived from exercise, low-fat eating, and maintaining weight was unrelated to duration of weight loss maintenance. DISCUSSION: As duration increases, a shift in the balance between the effort and pleasure of weight maintenance may occur. This shift may increase the likelihood of continued maintenance.

Adult↗

PubMed2000

Primary prevention of weight gain for women aged 25-34: the acceptability of treatment formats.

OBJECTIVE: To determine if treatment format will affect the willingness of women aged 25-34 to participate in a program for primary prevention of weight gain. DESIGN: 102 normal-weight women aged 25-34 were randomized to one of three treatment formats (group meetings, correspondence course, no-treatment control). Acceptability was evaluated by determining the proportion of women participating in their assigned format. Efficacy was assessed by determining mean weight changes at post-treatment (10 weeks) and 6-month follow-up, and the proportions of women who remained at baseline weights. RESULTS: Significantly fewer women chose to participate in a group format, compared to the correspondence course and no-treatment control (42%, 84% and 62%, respectively). However, the group format produced the largest short-term changes in weight (-1.9+/-1.8 kg, -1.1+/-2.1 kg and -0.2+/-1.3 kg, respectively). CONCLUSIONS: The format of prevention programs may influence the willingness of subjects to participate, as well as treatment outcome. Both format acceptability and efficacy should be considered in determining the overall effectiveness of a program. International Journal of Obesity (2000) 24, 219-225

Adult↗

PubMed2000

A case-control study of successful maintenance of a substantial weight loss: individuals who lost weight through surgery versus those who lost weight through non-surgical means.

OBJECTIVE: To determine if method of weight loss (surgery; non-surgery) is associated with current levels of psychosocial functioning or current weight maintenance behaviors in individuals who have lost large amounts of weight. DESIGN: Subjects were 67 cases and 67 controls selected from the National Weight Control Registry, a longitudinal study of individuals successful at long-term maintenance of weight loss. Cases had initially lost weight through bariatric surgery while controls had lost weight through non-surgical means. The current psychosocial functioning and weight maintenance behaviors of cases and controls were assessed and compared. RESULTS: Cases and controls were matched on gender, current weight and total weight loss. Surgical cases reported significantly higher fat intake and lower physical activity levels. There were no differences in cases' and controls' reports of the impact of weight loss on other areas of their lives, neither were there differences on measures of depression or binge-eating. CONCLUSIONS: Reported improvement in psychosocial functioning did not depend upon how weight was initially lost, but cases and controls appear to be using very different behaviors to maintain their weight losses.

Adult↗

PubMed2000

Successful losers. The habits of individuals who have maintained long-term weight loss.

One way to learn more about factors that are associated with maintaining weight loss is to study the habits of individuals who have successfully lost weight and kept it off. Members of the National Weight Control Registry, an observational study of socalled successful losers, report consuming healthy, low-fat diets and engaging in high levels of physical activity. Obesity and overweight are common health problems, and their prevalence has increased dramatically in the past 30 years. Currently, half of all U.S. adults are overweight or obese (defined as a body mass index of 25 or more). Excess weight is associated with an increased risk for numerous health problems, including dyslipidemia, hypertension, cardiovascular disease, type 2 diabetes, and some cancers, and it has been estimated that up to 325,000 deaths per year in the United States are attributable to obesity.

Adult↗

PubMed1999

Behavioral strategies of individuals who have maintained long-term weight losses.

OBJECTIVE: The purpose of the present study was to compare the behaviors of individuals who have achieved long-term weight loss maintenance with those of regainers and weight-stable controls. RESEARCH METHODS AND PROCEDURES: Subjects for the present study were participants in a random-digit dial telephone survey that used a representative sample of the U.S. adult population. Eating, exercise, self-weighing, and dietary restraint characteristics were compared among weight-loss maintainers: individuals who had intentionally lost > or =10% of their weight and maintained it for > or = 1 year (n = 69), weight-loss regainers: individuals who intentionally lost > or = 10% of their weight but had not maintained it (n = 56), and weight-stable controls: individuals who had never lost > or = 10% of their maximum weight and had maintained their current weight (+/-10 pounds) within the past 5 years (n = 113). RESULTS: Weight-loss maintainers had lost an average of 37 pounds and maintained it for over 7 years. These individuals reported that they currently used more behavioral strategies to control dietary fat intake, have higher levels of physical activity (especially strenuous activity), and greater frequency of self-weighing than either the weight-loss regainers or weight-stable controls. Maintainers and regainers did not differ in reported levels of dietary restraint, but both had higher levels of restraint than the weight-stable controls. DISCUSSION: These results suggest that weight-loss maintainers use more behavioral strategies to control their weight than either regainers or weight-stable controls. It would thus appear that long-term weight maintenance requires ongoing adherence to a low-fat diet and an exercise regimen in addition to continued attention to body weight.

Adult↗

PubMed1999

The behavioral characteristics of individuals who lose weight unintentionally.

OBJECTIVE: To determine whether individuals who unintentionally lost weight differ from individuals who intentionally lost weight in behavioral characteristics related to chronic disease risk factors. DESIGN: A random-digit dial telephone survey was conducted among a representative sample of American adults (n = 500). SUBJECTS: Of the 500 individuals sampled, 139 were currently > or = 10% below their lifetime maximum weight. These individuals were asked whether their weight loss was unintentional or intentional. Unintentional (n =49) and intentional (n = 89) weight losers were compared on measures of dietary intake, physical activity, smoking, drinking, and self-reported health status. RESULTS: Unintentional weight losers had higher levels of smoking and drinking, were less physically active, and were less concerned about their diet and fat intake. Unintentional weight losers did not report having higher levels of disease such as high blood pressure or diabetes. However, unintentional weight losers who reported having such diseases were more likely to report that their weight loss had no effect or had worsened their disorder. DISCUSSION: Compared to intentional weight losers, those who lost their weight unintentionally reported engaging in more negative health behaviors that are related to disease morbidity and mortality. These data suggest that unintentional weight loss may be part of a cluster of behaviors that have a negative health impact.

Adult↗

PubMed1999

What predicts weight regain in a group of successful weight losers? .

This study identified predictors of weight gain versus continued maintenance among individuals already successful at long-term weight loss. Weight, behavior, and psychological information was collected on entry into the study and 1 year later. Thirty-five percent gained weight over the year of follow-up, and 59% maintained their weight losses. Risk factors for weight regain included more recent weight losses (less than 2 years vs. 2 years or more), larger weight losses (greater than 30% of maximum weight vs. less than 30%), and higher levels of depression, dietary disinhibition, and binge eating levels at entry into the registry. Over the year of follow-up, gainers reported greater decreases in energy expenditure and greater increases in percentage of calories from fat. Gainers also reported greater decreases in restraint and increases in hunger, dietary disinhibition, and binge eating. This study suggests that several years of successful weight maintenance increase the probability of future weight maintenance and that weight regain is due at least in part to failure to maintain behavior changes.

Adult↗

PubMed1999

Resting energy expenditure in reduced-obese subjects in the National Weight Control Registry.

BACKGROUND: Weight loss in obese subjects is associated with a reduction in resting metabolic rate (RMR). Whether the reduction can be explained solely by a reduction in lean body mass remains controversial. OBJECTIVE: Our objective was to determine whether the reduction in RMR after weight loss was proportional to the decrease in lean mass alone or was greater than could be explained by body composition. DESIGN: We measured the RMR, fasting respiratory quotient (RQ), and body composition in 40 reduced-obese subjects [ie, 7 men and 33 women who had lost > or = 13.6 kg (30 lb) and maintained the loss for > or = 1 y] enrolled in the National Weight Control Registry and 46 weight-matched control subjects (9 men, 37 women). RESULTS: A stepwise multiple regression found lean mass, fat mass, age, and sex to be the best predictors of RMR in both groups. After adjusting RMR for these variables, we found no significant difference in RMR (5926 +/- 106 and 6015 +/- 104 kJ/d) between the 2 groups (P = 0.35). When we adjusted fasting RQ for percentage body fat and age, the reduced-obese group had a slightly higher (0.807 +/- 0.006) RQ than the control group (0.791 +/- 0.005, P = 0.05). This may have been due to the consumption of a diet lower in fat or to a reduced capacity for fat oxidation in the reduced-obese group. CONCLUSION: These results show that in at least some reduced-obese individuals there does not seem to be a permanent obligatory reduction in RMR beyond the expected reduction for a reduced lean mass.

Basal Metabolism↗

PubMed1998

Persons successful at long-term weight loss and maintenance continue to consume a low-energy, low-fat diet.

OBJECTIVES: To describe the dietary intakes of persons who successfully maintained weight loss and to determine if differences exist between those who lost weight on their own vs those who received assistance with weight loss (eg, participated in a commercial or self-help program or were seen individually by a dietitian). Intakes of selected nutrients were also compared with data from the third National Health and Nutrition Examination Survey (NHANES III) and the 1989 Recommended Dietary Allowances (RDAs). SUBJECTS: Subjects were 355 women and 83 men, aged 18 years or older, primarily white, who had maintained a weight loss of at least 13.6 kg for at least 1 year, and were the initial enrollees in the ongoing National Weight Control Registry. On average, the participants had lost 30 kg and maintained the weight loss for 5.1 years. METHODS: A cross-sectional study in which subjects in the registry completed demographic and weight history questionnaires as well as the Health Habits and History Questionnaire developed by Block et al. Subjects' dietary intake data were compared with that of similarly aged men and women in the NHANES III cohort and to the RDAs. Adequacy of the diet was assessed by comparing the intake of selected nutrients (iron; calcium; and vitamins C, A, and E) in subjects who lost weight on their own or with assistance. RESULTS: Successful maintainers of weight loss reported continued consumption of a low-energy and low-fat diet. Women in the registry reported eating an average of 1,306 kcal/day (24.3% of energy from fat); men reported consuming 1,685 kcal (23.5% of energy from fat). Subjects in the registry reported consuming less energy and a lower percentage of energy from fat than NHANES III subjects did. Subjects who lost weight on their own did not differ from those who lost weight with assistance in regards to energy intake, percent of energy from fat, or intake of selected nutrients (iron; calcium; and vitamins C, A, and E). In addition, subjects who lost weight on their own and those who lost weight with assistance met the RDAs for calcium and vitamins C, A, and E for persons aged 25 years or older. APPLICATIONS: Because continued consumption of a low-fat, low-energy diet may be necessary for long-term weight control, persons who have successfully lost weight should be encouraged to maintain such a diet.

Adult↗

PubMed1998

Psychological symptoms in individuals successful at long-term maintenance of weight loss.

Set point theory suggests that successful maintenance of weight loss ("weight suppression") may be associated with psychological distress. This study examined the association between psychological symptoms and body weight suppression by using a registry of 629 women and 155 men who lost at least 13.6 kg (mean loss = 30 +/- 15 kg) and maintained the loss for at least 1 year (mean duration = 5.5 +/- 6.8 years). Participants completed measures of mood, distress, restraint, disinhibition, bingeing, and purging. Maintainers' levels of distress and depression were lower than those of psychiatric samples and resembled those of community-based samples. Binge-eating and purging rates were comparable to rates of community samples. Maintainers' levels of restraint and disinhibition were markedly different from those of eating-disordered samples, resembling levels found in patients recently treated for obesity. There was no evidence that long-term suppression of body weight is associated with psychological distress.

Adaptation, Psychological↗

PubMed1998

Long-term maintenance of weight loss: do people who lose weight through various weight loss methods use different behaviors to maintain their weight?

OBJECTIVE: To evaluate whether individuals who lost weight on their own (n = 447), through organized programs (n = 313) or with liquid formula (n = 133) would differ in the strategies they used to maintain their weight losses. DESIGN: All subjects were members of the National Weight Control Registry, had lost > or = 13.6 kg (30 pounds), and kept it off at least one year (mean weight loss = 30.1+/-14.9 kg and mean duration of maintenance = 5.7+/-6.9 y). RESULTS: Liquid Formula users differed from the other two groups on many characteristics; they were more likely to be women, older, heavier, and to have had a medical disorder prior to weight loss. To maintain their weight loss, the Liquid Formula group reported greater use of dietary strategies (for example, counting calories, limiting the amount of calories from fat) and higher dietary restraint. Liquid Formula users reported that weight maintenance was more difficult than losing weight, whereas individuals who lost weight on their own reported the reverse. The On Own group reported expending a higher percentage of calories through strenuous activities such as running and weight lifting, and reported weighing themselves more frequently to maintain weight loss. Despite these behavioral differences, all three groups are maintaining their weight losses similarly by eating a low calorie diet (5792.3 kJ/d and 25% of daily calories from fat) and engaging in high levels of physical activity (11847.3 kJ/week). CONCLUSIONS: Despite using different methods to lose weight, individuals who lost weight on their own, through an organized program, or with a liquid formula, use similar behavioral strategies to maintain their weight loss.

Adolescent↗

PubMed1997

The psychological consequences of weight gain prevention in healthy, premenopausal women.

OBJECTIVE: This study examined the psychological consequences of a modest weight loss in a sample of healthy women aged 44 to 50. METHOD: Five hundred and thirty-five women, with body mass indices (BMIs) ranging from 20 to 34, were randomly assigned either to an intensive behavioral lifestyle intervention or to a no-treatment control group. Women in the lifestyle intervention received weight loss goals of 5 to 15 lb, depending on baseline BMI, and attended 20 weekly group meetings during which they received information on lowering dietary fat intake and increasing physical activity levels. Psychological measures administered at baseline and at a 6-month examination assessed perceived stress, mood, dietary restraint, and binge eating behaviors. RESULTS: Intervention subjects showed significant decreases in depressive symptoms over time, relative to control subjects, and this effect was observed for normal-weight, as well as heavier, subjects. Binge eating scores for all subjects declined significantly over time, with heavier subjects in the intervention showing the greatest decrease in scores. DISCUSSION: The current study found no evidence of negative psychological sequelae of participation in a behavioral lifestyle change program, regardless of weight status. Results further suggest that participation in these types of programs may exert a positive influence on the psychological status of both normal-weight and heavier women.

Adult↗

PubMed1997

A descriptive study of individuals successful at long-term maintenance of substantial weight loss.

The National Weight Control Registry (NWCR) is, to the best of our knowledge, the largest study of individuals successful at long-term maintenance of weight loss. Despite extensive histories of overweight, the 629 women and 155 men in the registry lost an average of 30 kg and maintained a required minimum weight loss of 13.6 kg for 5 y. A little over one-half of the sample lost weight through formal programs; the remainder lost weight on their own. Both groups reported having used both diet and exercise to lose weight and nearly 77% of the sample reported that a triggering event had preceded their successful weight loss. Mean (+/-SD) current consumption reported by registry members was 5778 +/- 2200 kJ/d, with 24 +/- 9% of energy from fat, Members also appear to be highly active: they reported expending approximately 11830 kJ/wk through physical activity. Surprisingly, 42% of the sample reported that maintaining their weight loss was less difficult than losing weight. Nearly all registry members indicated that weight loss led to improvements in their level of energy, physical mobility, general mood, self-confidence, and physical health. In summary, the NWCR identified a large sample of individuals who were highly successful at maintaining weight loss. Future prospective studies will determine variables that predict continued maintenance of weight loss.

Adult↗

PubMed1995

Prevention of cardiovascular risk factor elevations in healthy premenopausal women.

BACKGROUND: A number of factors contribute to increased risk of coronary heart disease (CHD) among postmenopausal women, including atherogenic changes in serum cholesterol profiles, weight gain, and decreases in physical activity during the menopause. To date, no study has attempted to prevent elevations in primary CHD risk factors as women experience menopause. METHODS: A sample of 535 healthy premenopausal women, ages 44-50, were recruited for an ongoing 5-year randomized prevention trial testing whether increases in low-density lipoprotein cholesterol (LDL-C) and body weight can be prevented during the menopause with a dietary and behavioral intervention. The aim was to reduce total dietary and saturated fat and cholesterol, prevent weight gain, and increase physical activity levels. Changes in CHD risk factors after the first 6 months of treatment were analyzed comparing 253 intervention and 267 assessment-only control participants. RESULTS: The intervention group showed significant reductions in total cholesterol (-0.34 mmol/liter), LDL-C (-0.28 mmol/liter), triglycerides (-0.04 mmol/liter), weight (-4.8 kg), waist-hip ratio (-0.008), systolic blood pressure (-3.5 mm Hg), diastolic blood pressure (-2.2 mm Hg), serum glucose levels (-0.06 mmol/liter), and HDL-C (-0.06 mmol/liter) and significant increases in physical activity (+383 kcal). No significant changes were observed in the control group. CONCLUSION: Six-month results suggested that participants were receptive to the preventive approach to CHD risk reduction and were successful in making initial positive lifestyle changes. Follow-up data will evaluate long-term adherence to the intervention and the interaction between adherence and physiological changes during menopause.

Analysis of Variance↗

PubMed1995

Effects of phenylpropanolamine on withdrawal symptoms.

A prior report (Klesges et al. 1990) suggested that phenylpropanolamine (PPA) was successful in reducing the smoking withdrawal symptom of weight gain in a sample of women. The current investigation evaluates whether the effects of phenylpropanolamine (PPA; up to 10/day PPA gums) on withdrawal symptoms associated with smoking cessation are specific to weight and weight-related symptoms or whether PPA alleviates withdrawal in general. One hundred and seven adult smokers (56 men, 51 women) were randomly assigned, in this double-blind trial, to chew either 8.33 mg phenylpropanolamine gum or a placebo gum. Subjects were then aided to quit smoking for 4 weeks. PPA did not enhance cessation rates. Results from the 47 subjects who successfully quit smoking indicated that postcessation weight gain and ratings of hunger were significantly reduced in both men and women for those assigned to the PPA group relative to the placebo group. Overall, no effects of PPA relative to placebo were observed for other smoking-related withdrawal symptoms. Thus, although PPA appears to reduce weight gain and alleviate weight-related symptoms, no effects on other withdrawal symptoms were observed. Future research directions are suggested.

Adult↗

PubMed1992

The relationship between changes in body weight and changes in psychosocial functioning.

Previous studies have indicated that obesity is related to a variety of psychosocial problems. Unfortunately, the literature on the relationship between weight status and psychosocial functioning has primarily utilized clinical samples and cross-sectional designs. The current study prospectively explored the relationship between weight gain and changes in psychosocial functioning. Subjects were 195 women and 204 men recruited as part of a larger longitudinal study of cardiovascular risk factors, who attended assessment sessions once per year for 2 consecutive years. Psychosocial functioning was assessed using the Dyadic Adjustment Scale (DAS), the Family Environment Scale (FES) and the Family Adaptability and Cohesion Scale 3rd Edition (FACES-III). Subjects were categorized based on their weight status at each year so the effect of a change in weight status on changes in psychosocial functioning could be evaluated. Multivariate measures indicated no changes in psychosocial functioning as a result of change in weight status over a 1-year period for either men or women. It appears that shifts in body weight, at least in a sample of subjects with generally good levels of psychological functioning, are not associated with changes in the measured levels of psychosocial functioning.

Adult↗

PubMed1991

A longitudinal evaluation of dietary restraint and its relationship to changes in body weight.

The purpose of this investigation was to evaluate the impact of changes in dietary restraint (chronic dieting) on changes in body weight over time. Subjects were 305 (98 male, 207 female) adults. At pretest, subjects completed a restrained eating questionnaire (Herman & Polivy, 1980), as well as reporting height, weight, gender, race, and age. Subjects were recontacted 2 1/2 years later and were reassessed on these same variables. Results indicated that restrained eating scores showed a high degree of consistency over a 2-1/2-year period (intraclass correlation = .74). Over time, males gained more weight than females and normal-weight subjects gained more weight over time than overweight subjects. No relationship was found between dietary restraint and weight gain over time. The potential interactions between energy balance and body weight are discussed.

Adult↗

PubMed1990

A psychometric study of restraint: the impact of race, gender, weight and marital status.

This investigation examined the psychometric characteristics of the Revised Restraint Scale and its two subscales (Weight Fluctuation, Concern for Dieting) in a university with a diverse student population. Subjects were 497 individuals (151 men, 346 women) ranging in age from 17 to 57 years (mean age = 21 years). Of the total sample, 70% were White (n = 348) and 22% were Black (n = 109). Results indicated significant between-groups differences on the total Restraint scores, with Whites scoring higher than Blacks, females scoring higher than males, and overweight individuals scoring higher than normal weight individuals. Similar results were found with both of the subscales. Despite the large number of between-groups differences observed, internal reliabilities of the total scale and the two subscales were similar and generally high within each of the categories surveyed. In general, however, lower reliabilities were observed for overweight subjects compared to normal weight subjects. The results of this study suggest that restraint status may vary as a function of individuals' demographic characteristics.

Adolescent↗