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Biomedical subjects

T A Wadden

Publications and source records attributed to T A Wadden.

At least 19 recordsLinked to original sources
PubMed1995

Relation of weight loss to changes in serum lipids and lipoproteins in obese women.

Several reports have suggested that modest weight losses, as little as 10% of initial weight, are sufficient to control many of the health complications of obesity. This study examined the relation between changes in weight and those in serum lipids and lipoproteins in obese women who participated in a 48-wk weight-reduction study. Subjects were 66 obese women who were prescribed a 3870-kJ (925-kcal)/d diet for the first 16 wk and a balanced-deficit diet of 5029-6279 kJ (1200-1500 kcal)/d thereafter. Anthropometric measures were assessed at baseline and weeks 8, 24, and 48, as were serum triacylglycerols (triglycerides), total cholesterol, and low-density-lipoprotein- and high-density-lipoprotein-cholesterol concentrations. Weight decreased 11.1% during the first 8 wk, during which time triacylglycerols and total cholesterol fell 22.7% and 15.7%, respectively. Subjects lost an additional 4.7 kg (equal to a total reduction of 16.4%) between weeks 8 and 24 but triacylglycerols and total and low-density-lipoprotein cholesterol increased by 5.2%, 4.2%, and 4.5%, respectively during this time. Multiple-regression analyses showed that at no time did weight loss account for > 6% of the variance in the reductions in triacylglycerol and cholesterol concentrations. These findings indicate that modest weight losses are associated with significant improvements in serum lipids, but that factors including the energy and macronutrient content of the diet prescribed contribute significantly to the improvements observed.

Adult↗
PubMed1995

Gallstone formation in obese women treated by a low-calorie diet.

This study assessed the incidence of gallstone formation in 47 obese women who consumed a low-calorie diet (LCD) for the first 16 weeks of a 26-week weight loss program. The LCD consisted of four daily servings of a liquid diet combined with an evening meal of a pre-packaged dinner entrée and provided approximately 925 kcal/d. Six of the 47 patients (12.8%) displayed gallstones at week 17, as determined by sonography. Five patients were asymptomatic when followed for up to 48 weeks. The sixth, however, reported severe abdominal pain 30 weeks after beginning treatment and required a cholecystectomy. Patients who developed gallstones, as compared with those who did not, had significantly higher baseline triglyceride and total cholesterol levels and had a significantly greater rate of weight loss. Results of this study indicate that an increased risk of gallstones is not limited to very-low-calorie diets and that the incidence of this complication should be assessed in persons who consume popular over-the-counter meal replacement plans.

Adult↗
PubMed1995

The energy cost of walking before and after significant weight loss.

The purpose of this study was to determine whether significant weight loss reduced the energy cost of activity more than that expected based on decreased body weight. Standing energy expenditure was measured and subtracted from the total energy cost of walking to determine ambulatory energy expenditure (AEE). The energy cost of walking was determined in 11 obese women at baseline, week 9 [after 8 wk of a 1758-3349 kJ.d-1 diet], and week 22 (after 2 wk of weight stability). AEE accounted for 80% of the energy cost of walking. Body weight was the principal determinant of AEE, but the relationship was not 1:1. Subjects reduced body weight by 13% at week 9 and 21% at week 22. Analyses which controlled for the relationship between AEE and weight at baseline, showed no change in AEE at week 9. By contrast, at week 22, AEE was reduced more than expected based on a lower body weight. These findings suggest that after significant weight loss, reduced-obese persons will expend less energy for the same activity, even after accounting for the decrease in body weight. These data also suggest that weight-based estimates of exercise energy expenditure may be inappropriate after significant weight loss.

Adult↗
PubMed1994

Binge eating disorder, weight cycling, and psychopathology.

This study examined differences among a total of 70 obese binge eaters, nonbingers, and problem eaters in depression, cognitive function, weight- and eating-related disturbances, and weight cycling. Subjects diagnosed with binge eating disorder (BED) scored significantly higher on depression and on several measures of cognitive dysfunction than did subjects in the other two groups. In addition, they reported significantly greater preoccupation with thinness and feelings of ineffectiveness, as well as a greater likelihood of eating in response to negative emotions. No relationship, however, was found between binge eating and weight cycling. Comparison of subjects identified as low- and high-weight cyclers revealed no significant differences between these two groups on depression, cognitive dysfunction, or the majority of the other measures of weight- and eating-related disturbance. The findings are discussed in terms of the implications for treating persons with BED and/or a history of weight cycling.

Adaptation, Psychological↗
PubMed1994

One-year behavioral treatment of obesity: comparison of moderate and severe caloric restriction and the effects of weight maintenance therapy.

This study compared the weight losses of 49 obese women randomly assigned to a 52-week behavioral program combined with either moderate or severe caloric restriction. Subjects in the balanced deficit diet (BDD) condition were prescribed a 1,200-kcal/day diet throughout treatment, and those in the very-low-calorie diet (VLCD) condition were given a 420-kcal/day liquid diet for 16 weeks and a 1,200-kcal/day diet thereafter. The VLCD subjects lost significantly more weight than the BDD subjects at all periods through Week 26, at which time mean losses were 21.45 and 11.86 kg, respectively. VLCD subjects, however, regained weight during the next 26 weeks of weekly therapy and during a 26-week weight maintenance program that provided biweekly meetings. Mean weight losses at the end of the maintenance program were 10.94 and 12.18 kg, respectively. Reports of binge eating declined in both groups, and no relationship was observed between binge eating and weight loss or attrition.

Adult↗
PubMed1994

Decline in delayed-type hypersensitivity response in obese women following weight reduction.

The effect of weight loss on immuno function was evaluated in 14 middle-aged obese women. Cutaneous delayed-type hypersensitivity to five recall antigens was measured before a weight loss of 21 kg and again after weight had been stabilized. Weight loss was associated with a decrease in both number and magnitude of delayed-type hypersensitivity responses. The number of positive skin tests decreased from 3.1 +/- 0.2 to 2.4 +/- 0.3 per subject, and the mean cutaneous induration size decreased by 38%. The decrease in induration size was positively correlated with the decrease in body mass index (r = 0.63), weight (r = 0.59), and fat mass (r = 0.52). These preliminary findings suggest that large weight losses may result in decreased expression of immune function.

Adult↗
PubMed1992

Etiology and treatment of obesity: understanding a serious, prevalent, and refractory disorder.

Obesity remains a leading public health problem because of its complications, prevalence, and resistance to change, despite record rates of dieting. Risk factors exist at both population and individual levels, thus obesity has diverse etiologies and consequences. Dieting is often grounded in the notion that the body can be molded at will and that the rewards justify the effort, creating a drive for unrealistic goals. This article argues for establishing a "reasonable weight," which may differ from health and aesthetic ideals. Intervention is less a matter of finding a "best" treatment but of finding the approach with "best fit" for the individual. Advances in treatment are most likely when research is driven by theory on the etiology of weight gain, the relapse process, and methods for permanent behavior change. This article integrates information on etiology, social beliefs about body weight, theory, and treatment into a comprehensive and compassionate model for intervention.

Adaptation, Psychological↗
PubMed1992

Response of obese binge eaters to treatment by behavior therapy combined with very low calorie diet.

This study examined attrition and weight loss in 235 female obese binge eaters, episodic overeaters, and nonbingers treated by a 26-week program of behavior modification and very low calorie diet. No significant differences were observed among conditions in the number of Ss who completed treatment. Episodic overeaters, however, were more likely than Ss in the other 2 conditions to drop out during the last 7 weeks of treatment, when Ss resumed consumption of a conventional diet. End-of-treatment weight losses for the 3 conditions, which did not differ significantly, averaged 21.5, 19.4, and 21.7 kg, respectively. No significant differences were observed among conditions in weight regain (which averaged 8.8 kg) in the year following treatment, although small sample sizes prevented an adequate evaluation.

Adult↗
PubMed1992

Psychological aspects of severe obesity.

Studies of several overweight persons conducted before their undergoing antiobesity surgery have shown 1) that there is no single personality type that characterizes the severely obese; 2) that this population does not report greater levels of general psychopathology than do average-weight control subjects; and 3) that the complications specific to severe obesity include body image disparagement and binge eating. Studies conducted after surgical treatment and weight loss have shown 1) that self-esteem and positive emotions increase; 2) that body image disparagement decreases; 3) that marital satisfaction increases, but only if a measure of satisfaction existed before surgery; and 4) that eating behavior is improved dramatically. The results of surgical treatment are superior to those for dietary treatment alone. Practitioners should be aware that severely obese persons are subjected to prejudice and discrimination and should be treated with an extra measure of compassion and concern to help alleviate their feelings of rejection and shame.

Humans↗
PubMed1992

A controlled comparison of three very-low-calorie diets: effects on weight, body composition, and symptoms.

To determine the optimal energy intake of very-low-calorie diets (VLCDs), 76 obese women were randomly assigned, in a double-blind fashion, to one of three liquid-formula diets: 1758 kJ/d (420 kcal/d), 2763 kJ/d (660 kcal/d), or 3349 kJ/d (800 kcal/d). Weight, body composition, symptoms, mood, and acceptability of the diet were assessed throughout the 6-mo study. There were no significant differences in weight losses or changes in body composition among the three dietary conditions at the end of treatment, nor were there significant differences among conditions in acceptability of the diet, symptoms, or mood. These results suggest that there is no clinical advantage to using VLCDs that provide less than 3349 kJ/d (800 kcal/d).

Adult↗
PubMed1992

Relationship of dieting history to resting metabolic rate, body composition, eating behavior, and subsequent weight loss.

This study examined the relationship of dieting history to resting metabolic rate, body composition, and subsequent weight loss in 50 obese women. A preliminary study showed that the women were able to report with satisfactory reliability the number of diets in which they had engaged (mean = 4.9 +/- 0.5), as well as the total weight loss resulting from these diets (mean = 55.9 +/- 6.0 kg). We found no evidence that weight cycling, as measured by either of these variables, was associated at baseline with a reduced resting metabolic rate or an increased percentage of body fat. Nor did we find that weight cycling was associated with smaller weight losses in a prospective trial in which subjects were treated by very-low-calorie diet and behavior therapy. The clinical implications of these findings are discussed, as are the methodological problems encountered in conducting research on this topic.

Adipose Tissue↗
PubMed1992

Clinical correlates of short- and long-term weight loss.

This study was designed to identify psychological, behavioral, and physiological correlates of short- and long-term weight loss. Measures of psychological functioning, body composition, fat cell size and number, and attendance were evaluated in 76 obese women for their relationship to weight loss at the end of treatment and at a 1-y follow-up evaluation. Losing more weight during the first month of treatment and attending a higher percentage of treatment sessions were strongly associated with greater weight loss at the end of treatment and at 1-y follow-up. In addition, patients with the highest initial weights lost the most weight both at the end of treatment and at 1-y follow-up. Easily obtained measures are as successful in predicting weight loss as are more expensive and complicated measures.

Adipose Tissue↗
PubMed1992

A multicenter evaluation of a proprietary weight reduction program for the treatment of marked obesity.

BACKGROUND: Congressional hearings initiated in March 1990 revealed that America's $10 billion a year weight loss industry is subject to minimal regulation by federal agencies. Consumers are forced to rely on advertisements and testimonials when selecting treatment because no proprietary program has provided a prospective assessment of its short- and long-term results of treatment. This report describes such an assessment. METHODS: A total of 517 obese patients (407 women and 110 men) participated in a proprietary program that included 12 weeks of treatment by very-low-calorie diet within a 26-week program of life-style modification. Patients were treated in two cohorts (6 months apart) according to a standardized protocol implemented at 18 hospital-based clinics across the nation. RESULTS: Fifty-six percent of women and 54% of men completed treatment, at which time their weight losses (mean +/- SEM) were 22.0 +/- 0.6 and 32.1 +/- 1.4 kg, respectively. Weight losses of women and men who discontinued treatment averaged 14.3 +/- 0.7 and 20.0 +/- 1.6 kg, respectively. Weight loss was associated with significant improvements in blood pressure and total serum cholesterol levels. A 1-year follow-up evaluation of 74% of patients in the second cohort who completed treatment revealed that they maintained 15.3 +/- 1.2 of their 24.8 +/- 1.0-kg end-of-treatment weight loss; 59% of patients maintained a loss of 10 kg or more. CONCLUSION: We hope that this report will lead to the systematic evaluation of other proprietary weight loss programs and to the publication of findings that will permit consumers to make informed treatment decisions.

Adult↗
PubMed1991

Long-term evaluation of cardiac function in obese patients treated with a very-low-calorie diet: a controlled clinical study of patients without underlying cardiac disease.

Twenty obese women were randomly assigned to consume (for 16 wk) either a 420-kcal/d liquid diet (n = 12) or a 1200-kcal/d balanced diet (n = 8). Thereafter, patients in both conditions were prescribed a 1200-kcal/d diet for the remainder of treatment (week 45). Six obese nondieters served as control subjects. Ambulatory electrocardiographic (Holter) monitor readings were obtained on all patients at baseline and weeks 3, 9, 13, 17, 19, and 45 of the study and were analyzed for ventricular premature depolarizations (VPDs) per hour, paired forms, and runs of ventricular tachycardia. There were no statistically significant changes in VPDs in any condition during treatment. Similarly, there were no significant changes in the PR, QRS, and corrected QT intervals. The results indicate that under appropriate medical supervision, very-low-calorie diets can be used safely for up to 16 wk by significantly obese patients free of pre-existing cardiac disease.

Diet, Reducing↗
PubMed1991

Weight loss and body fat distribution: a feasibility study using computed tomography.

Computerized tomography (CT) was used to assess the effect of a loss of body weight (18.8 kg) on the size of five fat depots in 11 obese postmenopausal women: the abdominal subcutaneous and visceral depots, the pelvic subcutaneous and intrapelvic depots, and the thigh subcutaneous depot. The mean decrease in total body fat was 34 percent, with comparable decreases in total abdominal fat (33 percent) and total pelvic fat (32 percent). In the abdomen, visceral fat was reduced by 35 percent and subcutaneous fat by 33 percent. In the pelvic region, intrapelvic fat decreased by 51 percent and subcutaneous fat by 25 percent. The decrease in the size of the abdominal visceral fat depot was highly correlated with fat loss during treatment (r = 0.68). By contrast, the decrease in the size of the subcutaneous abdominal fat depot correlated less highly with fat loss. These preliminary findings suggest that obese postmenopausal women with large visceral fat depots will decrease the size of their visceral fat depots by weight reduction. This is good news since the adverse health effects of obesity are believed to be associated with visceral fat.

Adipose Tissue↗
PubMed1990

Long-term effects of dieting on resting metabolic rate in obese outpatients.

There is growing concern that dieting may adversely affect the metabolic rate and exacerbate efforts to control weight. In this study we measured the resting metabolic rate nine times over 48 weeks in 18 obese women (108.0 +/- 3.1 kg) who were randomly assigned to one of two dietary conditions. Nine patients consumed approximately 5021 kJ/d (1200 kcal/d) throughout the 48 weeks, while the other nine consumed a 1757-kJ/d (420-kcal/d) diet for 16 of the first 17 weeks and a conventional reducing diet for the remainder of treatment. All patients increased their physical activity, primarily by walking. During the first 5 weeks, the fall in metabolic rate was more than double the relative reduction in weight. By contrast, at week 48, the metabolic rate of patients in the two conditions was reduced by 9.4% +/- 4.0% and 8.3% +/- 2.2%, respectively, while weight was reduced by 16.6% +/- 2.7% and 19.5% +/- 2.7%, respectively. Thus, neither dietary regimen, combined with modest physical activity, was associated with long-term reductions in resting metabolic rate that exceeded decreases anticipated with the achievement of a lower body weight.

Adult↗