Biomedical subjects

N E Sherwood

Publications and source records attributed to N E Sherwood.

16 recordsLinked to original sources

PubMed2006

Mail and phone interventions for weight loss in a managed-care setting: weigh-to-be 2-year outcomes.

OBJECTIVE: Evaluate effectiveness of weight-loss interventions in a managed care setting. METHODS: Three-arm randomized clinical trial: usual care, mail, and phone intervention. Participants were 1801 overweight managed care organization (MCO) members. Measures included baseline height, weight at baseline and 24 months, self-reported weight at 18 months. Intervention and participation in other weight-related programs was monitored across 24 months. RESULTS: Weight losses were 2.2, 2.4, and 1.9 kg at 18 months in the mail, phone, and usual care groups, respectively. Mail and phone group weight changes were not significantly different from usual care (P<0.35). Weight losses at 24 months did not differ by condition (0.7 kg mail, 1.0 kg phone, and 0.6 kg usual care, P=0.55). Despite treatment availability over 24 months, participation diminished after 6 months. Participation was a significant predictor of outcomes in the mail and phone groups at 18 months and the mail group at 24 months. Cost-effectiveness of phone counseling was $132 per 1 kg of weight loss with mail and usual care achieving similar cost-efficiency of $72 per 1 kg of weight loss. CONCLUSION: Although mail- and phone-based weight-loss programs are a reasonably efficient way to deliver weight-loss services, additional work is needed to enhance their short- and long-term efficacy.

Adult↗

PubMed2006

The comparative and cumulative effects of a dietary restriction and exercise on weight loss.

OBJECTIVE: To assess the independence of changes made in diet and physical activity for weight loss; and, to examine the comparative and cumulative effects of these behavioral changes on weight loss outcomes. DESIGN: The observational study is based on longitudinal data collected from 674 women and 288 men enrolled in a 2-year weight loss program introduced into a managed care setting. MEASUREMENTS: The outcome variable was body mass index (BMI) change from baseline to 2-year follow-up. Primary independent variables were changes in physical activity and dietary fat intake, assessed as continuous measures using the Paffenbarger Physical Activity Questionnaire and Block Fat Screener Questionnaire, respectively. Two-way ANCOVA was used to assess the relative effect on BMI of behavioral changes. RESULTS: Study results showed no preference for diet or physical activity change as a weight loss strategy. For both genders, the relationship between the two behaviors was synergistic rather than compensatory. Examination of the comparative benefits of behavioral changes indicated that, for women and men, restricting fat intake was more effective than increasing exercise for weight loss. While fat restrictions alone contributed to weight loss in both genders, exercise alone provided weight loss benefits to men, only. The cumulative effect of weight loss behaviors varied by gender. In women, an interaction was observed. The response of weight to fat restriction was greater among those who increased their exercise moderately or substantially. In men, there was no interaction; exercise increases helped to offset weight gain or provided small weight loss benefits at all levels of dietary fat change. CONCLUSION: Dietary changes appeared to be more effective than increased physical activity for weight loss. For women, the cumulative effect of concomitant changes in diet and exercise on weight loss was more than additive.

Adult↗

PubMed2004

Binge eating disorder, weight control self-efficacy, and depression in overweight men and women.

OBJECTIVE: To examine binge eating, depression, weight self-efficacy, and weight control success among obese individuals seeking treatment in a managed care organization. DESIGN: Gender-stratified analyses of associations between binge eating, depression, weight self-efficacy, and weight change, using data from a randomized clinical trial that compared low-cost telephone-based, mail-based, and usual care interventions for weight loss. SUBJECTS: A total of 1632 overweight individuals (460 men, 1172 women; mean age: 50.7 y; mean body mass index: 34.2 kg/m(2)) were recruited from a large Midwestern US managed care organization. MEASUREMENTS: Height and weight were measured by study personnel at baseline, and self-reported weight was assessed at 6 and 12 months; self-reported depression status, binge eating, and self-efficacy for weight control were assessed at baseline. RESULTS: Lifetime prevalence rates for depression and probable binge eating disorder were high. Weight self-efficacy was inversely related to weight in both men and women. For women, depression was associated with lower weight self-efficacy and higher body weight. Women reporting depression or lower weight self-efficacy at baseline had less weight loss success at 6 and 12 months. Depression, binge eating disorder, and weight self-efficacy were not significantly associated with weight loss success in men. CONCLUSION: Negative emotional states are highly prevalent and predict poor treatment outcomes, particularly for obese women. As obese women with clinical depression typically are excluded from intervention studies, further research on how to address the intersection of obesity intervention and mood management may be warranted.

Adult↗

PubMed2003

Mail and phone interventions for weight loss in a managed-care setting: Weigh-To-Be one-year outcomes.

OBJECTIVE: To describe methods, recruitment success, and 1-y results of a study evaluating the effectiveness of phone- and mail-based weight-loss interventions in a managed care setting. DESIGN: Randomized clinical trial with three groups, that is, usual care, mail intervention, and phone intervention. SUBJECTS: In total, 1801 overweight members of a managed-care organization (MCO). MEASUREMENTS: Height, weight, medical status, and weight-loss history were measured at baseline. Participation in intervention activities was monitored for 12 months in the two active treatment groups. Self-reported weight was obtained at 6 and 12 months. RESULTS: More individuals assigned to mail treatment started it (88%) than did those assigned to phone treatment (69%). However, program completion rates were higher in the phone (36%) than mail (7%) intervention. The mean weight losses were 1.93, 2.38, and 1.47 kg at 6 months in the mail, phone, and usual care groups, respectively. The differences between the phone and usual care groups were statistically significant. The mean weight losses at 12 months did not differ by treatment group (2.28 kg mail, 2.29 kg phone, and 1.92 kg usual care). Greater weight loss was seen in men, older participants, and those with no prior experience in a weight-loss program. Heavier participants and those who reported current treatment for depression lost less weight. CONCLUSION: Although mail- and phone-based weight-loss programs can be delivered to large numbers of people in an MCO setting, additional work is needed to enhance their clinical efficacy as well as to assess their costs.

Female↗

PubMed2000

Smokers with multiple behavioral risk factors: how are they different?

OBJECTIVE: The first aim of the present investigation was to examine cross-sectional differences between smokers who engage in additional health risk behaviors (i.e., high-fat diets and low physical activity levels) and those who do not that could affect readiness for smoking cessation treatment and treatment prognosis. The second aim was to examine prospective associations between risk factor status and smoking outcomes (i.e., cessation and quit attempts). DESIGN: Data were derived from baseline and 1-year follow-up surveys for the SUCCESS project, a randomized trial of worksite smoking interventions conducted in 24 worksites in Minneapolis/St. Paul, Minnesota. Included in the analyses were 2,149 study participants who reported smoking at baseline. METHODS: Current smokers were categorized into one of three "risk groups": the "1 additional risk factor" group (i.e., either low physical activity level or high dietary fat intake), the "2 additional risk factor" group (i.e., both low physical activity and high dietary fat intake), and the "smoker only" group (i.e., neither low physical activity nor high dietary fat intake). Mixed model regression analyses examined cross-sectional associations between risk group status and baseline demographic variables, smoking dependency, social environments for smoking, and health problems. Prospective associations between baseline risk group status and 1-year follow-up cessation attempts and quits were also examined. RESULTS: At baseline, risk factor status was associated with smoking dependency for both men and women. Women smokers with at least one additional risk factor reported a greater number of cigarettes smoked per day, higher Fagerstrom Nicotine Dependence scores, and lower self-efficacy for refraining from smoking in a variety of situations compared with smokers with no additional risk factors. Men smokers with at least one additional risk factor reported higher Fagerstrom Nicotine Dependence scores compared with smokers with no additional risk factors. Women smokers with at least one additional risk factor were more likely to report being encouraged to quit by co-workers compared with smokers with no other risk factors. No relationship between risk factor status and social pressure to quit was observed among men. Prospective analyses indicated that baseline risk factor status was marginally related to smoking outcome at 1-year follow-up; however, these relationships were attenuated considerably when controlling for smoking dependence. Relationships between risk factor status and smoking outcomes were stronger for men. CONCLUSION: Results indicated that the presence of multiple health risk behaviors was related to more serious problems with smoking. However, the presence of additional risk factors did not strongly affect prognosis for smoking cessation.

Adult↗

PubMed2000

Weight-loss practices, nutrition beliefs, and weight-loss program preferences of urban American Indian women.

OBJECTIVE: To describe health beliefs, weight concern, dieting practices, and weight-loss program preferences of American Indian women residing in an urban setting. DESIGN: Face-to-face interviews using a semistructured questionnaire were conducted and height and weight were measured. SUBJECTS/SETTING: Subjects were 203 American Indian adult women in an urban community setting. STATISTICAL ANALYSIS: Frequency distributions and chi 2 analysis were performed using the Statistical Analysis System software. RESULTS: About two-thirds of the subjects were overweight. Most women were concerned about obesity and reported attempting to manage their weight. Healthful weight-loss practices (e.g., eating more fruits and vegetables, increasing physical activity) were used most frequently. However, unhealthful practices, such as skipping meals/fasting, using laxatives/diuretics, and self-induced vomiting were also mentioned. Regular bingeing was reported by 10% of respondents. APPLICATIONS: Weight-management intervention efforts should focus on helping clients modify their diet and physical activity patterns. Low-cost programs offered in convenient locations would attract more participants, as would the provision of child care. Education about the dangers and ineffectiveness of unhealthful weight-loss practices will be necessary, given the high rates of such behaviors in this population.

Adult↗

PubMed2000

Primary prevention of disordered eating among preadolescent girls: feasibility and short-term effect of a community-based intervention.

OBJECTIVE: To evaluate a community-based intervention aimed at the primary prevention of disordered eating among preadolescent girls. DESIGN: Girl Scout troop members were randomized into control and intervention groups. Program feasibility and effect at postintervention and 3-month follow-up were evaluated. SUBJECTS/SETTING: 226 girls (mean age = 10.6 years, standard deviation = 0.7) from 24 Girl Scout troops. INTERVENTION: Six 90-minute sessions focusing on media literacy and advocacy skills. MAIN OUTCOME MEASURES: Evaluation focused on program satisfaction and short-term effect on dieting behaviors, body image attitudes, and media knowledge, attitudes, and habits. STATISTICAL ANALYSES: Performed t tests, chi 2 tests, and analyses of covariance including troop as a random source of variation. RESULTS: At baseline, 29% of the girls were trying to lose weight. The program had a notable positive influence on media-related attitudes and behaviors including internalization of sociocultural ideals, self-efficacy to impact weight-related social norms, and print media habits. A modest program effect on body-related knowledge and attitudes was apparent at post-intervention (i.e., on body size acceptance, puberty knowledge, and perceived weight status) but not at follow-up. Significant changes were not noted for dieting behaviors, but they were in the hypothesized direction. Satisfaction with the program was high among girls, parents, and leaders. APPLICATIONS/CONCLUSIONS: It is feasible to use community youth settings, such as the Girl Scouts, to implement interventions to prevent disordered eating behaviors. The program led to positive trends in outcome variables; however, longer and more intensive interventions are needed for lasting changes in body image and dieting behaviors.

Body Image↗

PubMed2000

Predictors of weight gain in the Pound of Prevention study.

OBJECTIVES: This study examined cross-sectional and prospective relationships between macronutrient intake, behaviors intended to limit fat intake, physical activity and body weight. DESIGN: The overall goal was to identify diet and exercise behaviors that predict and/or accompany weight gain or loss over time. Specific questions addressed included: (a) are habitual levels of diet or exercise predictive of weight change; (b) are habitual diet and exercise levels associated cross-sectionally with body weight; and (c) are changes in diet and exercise associated with changes in body weight over time? PARTICIPANTS: Subjects were a sample of community volunteers (n=826 women, n=218 men) taking part in a weight gain prevention project over a 3-year period. MEASURES: Body weight was measured at baseline and annually over the study period. Self-report measures of diet and exercise behavior were also measured annually. RESULTS: Among both men and women, the most consistent results were the positive association between dietary fat intake and weight gain and an inverse association between frequency of physical activity and weight gain. Individuals who weighed more both ate more and exercised less than those who weighed less. Individuals who increased their physical activity level and decreased their food intake over time were protected from weight gain compared to those who did not. Frequency of high-intensity physical activity was particularly important for both men and women. Additionally, women who consistently engaged in higher levels of moderate physical activity gained weight at a slower rate compared to women who were less active. CONCLUSIONS: Overall results indicated that both cross-sectionally and prospectively, the determinants of weight and weight change are multifactorial. Attention to exercise, fat intake and total energy intake all appear important for successful long term control of body weight.

Adult↗

PubMed2000

The behavioral determinants of exercise: implications for physical activity interventions.

In light of the well-documented health benefits of physical activity and the fact that the majority of adult men and women are inactive, promoting regular physical activity is a public health priority. This chapter reviews current research findings regarding the determinants of exercise behavior. It also discusses the implications of this knowledge for individual and public health recommendations and intervention strategies for promoting physical activity. The discussion is predicated on the belief that physical activity is a complex, dynamic process. During their lives, individuals typically move through various phases of exercise participation that are determined by diverse factors. This chapter discusses physical activity determinants in two broad categories: individual characteristics, including motivations, self-efficacy, exercise history, skills, and other health behaviors; and environmental characteristics such as access, cost, and time barriers and social and cultural supports.

Attitude to Health↗

PubMed1999

Weight control behaviors among adult men and women: cause for concern?

OBJECTIVES: To examine gender differences in weight control behaviors; their duration and the consistency of their use over a 3-year period; and variations of these behaviors by body mass index (BMI). RESEARCH METHODS AND PROCEDURES: The study population included 714 women and 229 men participating in a community-based weight gain prevention program who completed surveys about their weight control behaviors annually for 3 years. General dieting behaviors (e.g., current, regular, and past dieting), dietary restraint (using Restrained Eating subscale of the Three-Factor Eating Questionnaire), and specific weight control practices (e.g., increasing exercise, skipping meals, and taking laxatives) were assessed. RESULTS: Women were more likely than men to report weight control behaviors, with particularly strong associations found between gender and "history of dieting" (odds ratio = 8.1) and "participation in an organized weight loss program" (odds ratio = 11.7). Among both genders, exercise was the most frequently reported specific weight loss practice (66% of women and 53% of men), followed by decreasing fat intake (62% of women and 48% of men). The use of at least one unhealthy weight control behavior over the past year was reported by 22% of the women and 17% of the men. Gender differences were not found for duration of use of most of the specific weight control practices over the past year, or for consistency of general dieting behaviors and dietary restraint over time. Although both gender and BMI were strongly associated with dieting behaviors, interactions between gender and BMI on prevalence rates of dieting were not significant. DISCUSSION: Although weight control behaviors were more prevalent among women than men, in general, large gender differences were not found in the types of behaviors used and the duration and consistency of their use. The high percentages of adults using healthy methods of weight control was encouraging. However, there is still cause for concern, in that unhealthy weight control practices were also reported by a significant percentage of the population.

Adult↗

PubMed1999

Mistreatment due to weight: prevalence and sources of perceived mistreatment in women and men.

OBJECTIVE: Previous research has documented prejudicial attitudes and discrimination against overweight people. Yet the extent to which overweight people themselves perceive that they have been mistreated because of their weight has not been carefully studied. The purpose of this study was to examine the prevalence of perceived mistreatment due to weight and sources of perceived mistreatment. METHODS AND PROCEDURES: A non-clinical sample of healthy adults (187 men and 800 women) enrolled in a weight gain prevention program comprised the study population. A self-administered questionnaire was used to measure perceived mistreatment due to weight. RESULTS: Overall, 22% of women and 17% of men reported weight-related mistreatment. The most commonly reported sources of mistreatment among women were strangers (12.5%) and a spouse or loved one (11.9%). Men were most likely to report mistreatment by a spouse or loved one (10.2%) and friends (7.5%). Somewhat surprisingly, sex differences in perceived weight-related mistreatment were significant only for stranger as the source. Perceived weight-related mistreatment was positively associated with body mass index (BMI) (r = 0.39, p<0.0001). Reported mistreatment was nearly ten times as pervalent among individuals in the highest quartile of the BMI distribution (42.5%) than among those in the lowest BMI quartile (5.7%), but was significantly greater than zero in all but the very lean. DISCUSSION: Perceived mistreatment due to weight is a common experience and is not restricted to the morbidly obese. Results are discussed in light of the sociocultural value for thinness.

Adult↗

PubMed1999

Age of initiation, smoking patterns, and risk in a population of working adults.

BACKGROUND: Early age of initiation is a significant risk factor for long-term dependent smoking and may also relate to other unhealthy behaviors and increased likelihood of illness, independent of duration of smoking. METHODS: The current study assessed age of initiation in relation to cigarette dependence, interest in quitting, social environment pertaining to smoking, behavioral risk factors, and current health problems. Subjects were 2120 current daily smokers in 24 worksites in the Minneapolis/St. Paul, Minnesota, metropolitan area. RESULTS: Findings were surprisingly consistent with early age of initiation predicting more dependent smoking, less interest and confidence in ability to quit, poorer diet, less use of seat belts, more illness and hospitalization, and greater likelihood of smoking among partner/spouse, friends, and co-workers. CONCLUSIONS: The overall strength of the findings was unexpected. Early initiation of regular smoking predicted a significant constellation of risk factors throughout adulthood. Interventions that significantly delay smoking onset, even in the absence of permanent prevention, could have important public health implications.

Adolescent↗

PubMed1999

Binge status as a predictor of weight loss treatment outcome.

OBJECTIVE: A widely held clinical belief is that individuals with binge eating problems fare poorly in weight loss programs. The empirical evidence regarding the prognostic significance of binge eating, however, is mixed. The goals of this study were to examine psychological and behavioral characteristics associated with binge eating and the prognostic significance of binge eating for short- and long-term weight loss in a large sample of women treated for obesity. DESIGN: The dataset used in the current study was a combined sample of women (n = 444) who participated in one of three behavioral weight loss research studies. MATERIALS AND METHOD: Measures of dieting and weight history were obtained at baseline. Body weight, the Binge Eating Scale (BES), a measure of perceived barriers to weight loss, the Beck Depression Inventory, the Block Food Frequency Questionnaire, and the Paffenbarger Physical Activity Questionnaire were assessed at baseline, 6 months and 18 months. Regression analyses examined cross-sectional associations between the BES and the other variables at baseline, prospective associations between baseline BES and changes in weight and the psychological and behavioral variables over time, and temporal covariations between BES and the other variables over time. RESULTS: Cross-sectional analyses showed baseline binge eating status to be strongly associated with dieting history, weight cycling, depressive symptomatology and perceived barriers to weight loss. Women with binge eating problems were also more likely to drop out of treatment. Baseline binge status was not associated with 6-month weight loss, but was weakly predictive of less weight loss success at 18 months. Binge status at baseline did not predict changes in dietary intake, physical activity, perceived barriers to weight loss or depressive symptomatology at either 6 months or 18 months. In time-dependent covariance analyses, changes in BES scores were significantly associated with changes in body weight, independent of changes in dietary intake and physical activity. However, when depression scores are included in the analysis, the association between binge score and body weight was no longer statistically significant. CONCLUSION: These findings suggest that baseline binge status was a weak prognostic indicator of success in women who are moderately obese and are seeking treatment for weight loss. Although assessments of binge status covary with weight loss and regain, the relationship appears to be mediated by psychological dysphoria.

Adult↗

PubMed1999

Prevalence and correlates of binge eating in a nonclinical sample of women enrolled in a weight gain prevention program.

OBJECTIVES: The aims of the present study were to examine the prevalence and correlates of binge eating in a nonclinical sample of women and to examine whether associations differed by overweight status. DESIGN: Cross-sectional comparison of women based on self-reported binge eating status (large amount of food eaten and feelings of lack of control during these eating episodes) and overweight status (measured body weight: overweight defined as body mass index (BMI) > or = 27.3 kg/m2). PARTICIPANTS: Subjects were 817 women aged 20-45y from the community who enrolled in a three year prospective intervention study to examine methods for preventing age-related weight gain. MEASURES: Body weight was measured at baseline and three-year follow-up. Self-report measures of binge eating, dieting practices, eating and exercise behaviours, depression, self-esteem and stressful life events were collected at the three-year follow-up. RESULTS: The prevalence of binge eating in the past six months was 9% among normal weight women and 21% among overweight women. The frequency of binge eating was low (> 50% of binge eaters binged less than once per week) and did not significantly differ by body weight status. Compared to non-binge eaters, binge eaters reported more dieting practices, more extreme attitudes about weight and shape, and higher levels of depression and stressful life events. Binge eating was not related to habitual eating and exercise behaviours. In multivariate models, weight/shape importance (odds ratio (OR) = 3.33; 95% confidence intervals (95% CI) = 2.10, 5.29), depression (OR = 1.73; 95% CI = 1.07, 2.79) and history of intentional weight loss episodes (OR = 1.68; 95% CI = 1.03, 1.13) were independently associated with increased odds of binge eating. CONCLUSIONS: Binge eating is about twice as prevalent among overweight women, compared to normal weight women, in a nonclinical sample, but has similar correlates (that is, dieting, depression, weight/shape preoccupation). Prospective research is needed to determine whether there are causal associations between binge eating, depression, dieting and weight gain.

Adult↗

PubMedDate not supplied

Consumer preferences in format and type of community-based weight control programs.

PURPOSE: The purpose of this study was to provide further information about preferences for types and formats (e.g., correspondence vs. face to face) of eating and exercise programs, actual participation rates in a variety of offered programs, and characteristics of program participants vs. nonparticipants. DESIGN: Over a 3-year period, a large sample of community volunteers was given the opportunity to participate in various forms of diet and exercise programs as part of a weight gain prevention study. SETTING: The study was conducted at a university and three local health department sites. SUBJECTS: Subjects in the study were 616 individuals participating in the Pound of Prevention study (POP), a 3-year randomized evaluation of an intervention for preventing weight gain. MEASURES: The primary outcomes assessed were participation rates for each program offering. Program participants were also compared to those who did not participate on demographic characteristics, smoking, diet behavior, exercise behavior, and weight concern. RESULTS: Survey results indicated that correspondence formats for delivery of health education programs were rated as more desirable than face-to-face formats. Participation for program offering ranged from 0 to 16% of the study population. Participation data were consistent with survey results and showed participants' preference for correspondence formats even more strongly. Program offering attracted health-conscious participants with higher education and income levels. CONCLUSIONS: These data suggest that some community members will get interested and take part in low-cost, minimal contact programs for exercise and weight control. Future research efforts should focus on investigating ways to increase participation in brief or minimal contact programs, particularly among groups that may be difficult to reach and at high risk for the development of obesity.

Adult↗

PubMedDate not supplied

Internalization of the sociocultural ideal: weight-related attitudes and dieting behaviors among young adolescent girls.

Questionnaires returned from 234 fifth and sixth graders from 24 Girl Scout Troops in the Midwest showed that 29.3% of all girls and 68.7% of those who were dieting thought they were overweight. Most of those who were trying to lose weight were using healthy methods, but a few were using dangerous methods. Very few were unhappy with their weight, shape, and various body parts. Most appeared to be aware of the influence of media on body image and were accepting of a wide range of body shapes and sizes among themselves and their friends.

Adolescent↗