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Biomedical subjects

R Koeske

Publications and source records attributed to R Koeske.

18 recordsLinked to original sources
PubMed1987

Long-term effects of modest weight loss in type II diabetic patients.

Since most obese patients with type II diabetes are unable to achieve ideal body weight, this study examined whether more modest weight losses would provide a long-term benefit. Type II diabetic patients (N = 114) were treated in a behavioral weight control program and followed up for one year. Weight loss was significantly correlated with improvements in glycosylated hemoglobin values at posttreatment (r = .55) and one year (r = .51). Patients who lost more than 6.9 kg or had more than 5% reduction in body weight had significant improvements in glycosylated hemoglobin values at one year, while patients losing less weight had nonsignificant changes and those gaining weight had significant worsening. Thus, modest weight loss can have a long-term impact on glycemic control. However, the improvement in glycemic control for a given weight loss was greater initially than at one year, suggesting that energy restriction, in addition to weight loss, may contribute to initial improvement. Neither percent overweight nor diabetes treatment affected weight loss.

Adult↗
PubMed1986

Does self-monitoring of blood glucose levels improve dietary compliance for obese patients with type II diabetes?

Self-monitoring of blood glucose levels is currently being recommended for obese patients with type II diabetes to improve weight loss and glycemic control. To determine whether self-monitoring of blood glucose levels improves dietary compliance in these patients, 50 obese patients with type II diabetes were randomly assigned either to a standard behavioral weight control program or to a weight control program that included self-monitoring of blood glucose levels and focused on the weight-blood glucose relationship. Both groups lost significant amounts of weight and maintained their losses for at least one year; reductions in medication could be made for 70 percent of patients. These data suggest that the behavioral weight control used in this study may be of benefit to patients with type II diabetes. However, there was no evidence that the addition of self-monitoring of blood glucose levels to the treatment program improved the outcome in terms of weight loss, reduction in medication, dietary compliance, or mood state.

Adult↗
PubMed1986

Calorie-counting compared to exchange system diets in the treatment of overweight patients with type II diabetes.

Patients with diabetes are usually placed on exchange system diets to ensure a nutritionally adequate intake. However, there have been few studies which have actually compared the nutritional adequacy of diets selected by patients on exchange system diets, with that selected by patients on the calorie-counting diets typically used in behavioral weight control programs. This study compared the nutritional adequacy of the diets selected by overweight patients with Type II diabetes who had been randomly assigned to either an exchange system diet or a calorie-counting diet. Three-day food diaries were completed by all patients at the start and end of a 16-week weight control program. No significant differences were observed between patients on the calorie-counting diet compared to those on the exchange system diet with respect to nutrient intake, macronutrient distribution, or percent of the RDA obtained. Patients on both types of diet reported decreases in the proportion of calories from fat. The average intake exceeded 100% of the RDA for all nutrients except calcium. This study suggests that patients are able to improve the nutritional adequacy of their intake while following either a calorie-counting or an exchange system diet.

Behavior Therapy↗
PubMed1986

The effect of family variables on child weight change.

Previous research has shown that family size, the number of obese persons living at home, and parental weight influence the development of childhood obesity. Our study reports the relevance of these factors to child weight loss during a 1-year treatment period. Multiple linear regression procedures showed that the amount of relative weight change was related to initial treatment success, the number of children in the family, and the gender of the child. Children who were more successful lost more weight initially, had fewer siblings, and were female. These results suggest that family size may interact with treatment to determine weight change. The effects of family size on outcome may be operating simply by reducing the amount of time that a parent has to spend with the child in promoting behavior change. Likewise, increased family size may be operating as a stressor, reducing the effectiveness of parents in effectively managing their children.

Adult↗
PubMed1986

Family-based behavioral weight control in obese young children.

The effects of a family-based, behavioral weight control program on weight, linear growth, and nutrient intake among 17 obese children aged 1 to 6 were studied. The 1-year behavioral treatment involved three components: diet, exercise, and child management. Treatment meetings were held weekly for 10 weeks and then monthly for the remainder of the year. Relative body weight decreased significantly from 42.1% at baseline to 24.0% overweight at 1 year and 27.8% overweight at 2 years, while height increased normally over the 2 years of observation, suggesting that the children were obtaining adequate calories to maintain growth. The caloric and nutrient intakes of the children were analyzed from 3-day food records kept by the mothers during baseline and the tenth week of treatment. The mean caloric intake was 1,457 kcal prior to treatment and 1,025 kcal during treatment. Nutrient intake exceeded the Recommended Dietary Allowances at pretreatment for the nutrients investigated and continued to exceed the RDAs for all nutrients except calcium (96% of RDA) and iron (84% of RDA) during treatment. Improvements in nutrient density were shown for all nutrients. The results suggest that obesity can be treated successfully in young children without detrimental effects on growth or nutrient intake.

Behavior Therapy↗
PubMed1984

Dietary approaches to the reduction of blood pressure: the independence of weight and sodium/potassium interventions.

This study was designed to determine the feasibility of teaching mildly hypertensive individuals to select a diet, using normally available food products, that either would produce a 5% reduction in percentage of overweight (without altering sodium (Na), potassium (K), or Na:K ratio) or would decrease Na to less than 70 mEq and increase K to greater than 100 mEq (without affecting weight) and to compare the resulting changes in blood pressure. Fifty-two participants with mild hypertension were randomly assigned to either a weight-loss or a Na:K intervention. Blood pressure, weight, 3-day diaries, and 24-h urinary excretion of Na and K were measured before and after an 8-week intervention. Participants in the weight-loss intervention had significantly greater changes in weight and calorie intake than those in the Na:K intervention, while changes in Na:K ratio were greatest in the intervention targeted for that change. The percentage of participants who were able to meet the dietary goals is presented and the implications of these data for the selection of dietary goals are discussed.

Blood Pressure↗
PubMed1983

Effects of weight loss on fitness in obese children.

The relationship between weight and fitness change was established in 113 obese preadolescents participating in a six-month behavioral weight control program. Results showed significant improvements for both weight and fitness. Program success was strongly related to changes in exercise heart rate. Children who were most successful in the program decreased their maximal and recovery heart rates by 10.1 and 17.8 beats per minute, children with medium success had decreases of 4.9 and 11.8 beats per minute, and least successful children had decreases of 3.9 and 6.4 beats per minute. Analyses revealed that the combination of effective weight loss and an initially moderate degree of overweight (40% to 50%) combined to produce the greatest fitness changes. Children who entered treatment more than moderately overweight achieved comparable fitness improvements only if their weight loss was dramatic.

Behavior Therapy↗
PubMedDate not supplied

Compliance to self-monitoring of blood glucose: a marked-item technique compared with self-report.

This study compared subjects' self-reported rates of compliance to self-monitoring of blood glucose (SMBG) with an objective measure based on a "marked-item" technique. We followed 25 obese patients with type II diabetes who were participating in a behavorial weight control program and monitoring their blood glucose with Chemstrips bG (Bio-Dynamics, Inc., Indianapolis, Indiana). Subjects' self-report significantly overestimated actual compliance as assessed by the marked-item technique. Moreover, the self-report measure failed to identify 35-45% of the noncompliant patients. Compliance decreased steadily over the course of the 37-wk program. Accuracy of SMBG was less problematic than compliance; 85% of patients were able to read Chemstrips bG within 20% of actual blood sugar, and the average blood sugar reading obtained from 2 mo of SMBG correlated highly (r = 0.78, P less than 0.01) with HbA1. Our data suggest that objective measures such as the marked-item technique described in this article should be used to assess compliance to SMBG and behavioral strategies to improve compliance should be developed.

Adult↗
PubMedDate not supplied

Subclinical eating disorders and glycemic control in adolescents with type I diabetes.

Several recent case reports have shown that anorexia nervosa and bulimia negatively affect glycemic control in diabetic patients. However, there have been no systematic studies to assess the prevalence of clinical or subclinical eating disorders among diabetic patients or to determine the impact of such disturbances on glycemic control. This study reports a survey of 202 adolescents, aged 12-18 yr, seen in the Diabetes Clinic, Children's Hospital of Pittsburgh, who were asked to complete the Binge Eating Scale (BES) and the EAT-26 questionnaire. Responses of diabetic patients to the EAT-26 questionnaire were compared with those of a nondiabetic control group and were related to measures of glycemic control. Diabetic subjects scored higher on the total EAT-26 than nondiabetic control subjects, ordinarily indicative of more eating pathology. However, diabetic subjects scored higher only on the dieting subscale of this questionnaire, probably reflecting adherence to the diabetes dietary regimen. Subjects with diabetes scored lower, or did not differ significantly, from nondiabetic control subjects on measures of oral control and bulimia. Among diabetic subjects, self-reported bulimic behaviors were related to poorer glycemic control. Patients with the highest scores on the BES had an average HbA1 of 13.1% compared with 11.8% for age- and sex-matched patients at the 50th percentile, and 10.8% for patients in the lowest 10th percentile. Further studies are needed to determine whether modification of these eating behaviors would improve glycemic control.

Adolescent↗
PubMedDate not supplied

Behavioral skills in self-monitoring of blood glucose: relationship to accuracy.

Sixty-two children and adolescents with IDDM were observed while performing self-monitoring of blood glucose (SMBG) to determine which of the behaviors involved in SMBG were most likely to be performed incorrectly and which errors had the greatest effect on the accuracy of SMBG readings. Behaviors related to cleanliness and timing were performed most poorly; only 60% of the subjects correctly timed the first minute, and 30-33% correctly timed the second interval. The duration of SMBG and frequency of monitoring were not related to proper performance of the behaviors involved in SMBG. Accuracy of SMBG was assessed by comparing subjects' readings to laboratory values obtained immediately afterward. The behavior that had the greatest effect on the accuracy of SMBG readings was that concerning whether the blood was adequately wiped from the Chemstrip bG. This behavior should receive more emphasis in SMBG training programs. The systematic observation procedure used in this study may help to identify errors made by patients while performing SMBG and may serve as the basis for training programs to improve SMBG accuracy.

Adolescent↗