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At least 613 records · Page 34Linked to original sources

PubMed1998

Obesity evaluation and treatment: Expert Committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services.

OBJECTIVES: The development of recommendations for physicians, nurse practitioners, and nutritionists to guide the evaluation and treatment of overweight children and adolescents. METHODS: The Maternal and Child Health Bureau, Health Resources and Services Administration, the Department of Health and Human Services convened a committee of pediatric obesity experts to develop the recommendations. RESULTS: The Committee recommended that children with a body mass index (BMI) greater than or equal to the 85th percentile with complications of obesity or with a BMI greater than or equal to the 95th percentile, with or without complications, undergo evaluation and possible treatment. Clinicians should be aware of signs of the rare exogenous causes of obesity, including genetic syndromes, endocrinologic diseases, and psychologic disorders. They should screen for complications of obesity, including hypertension, dyslipidemias, orthopedic disorders, sleep disorders, gall bladder disease, and insulin resistance. Conditions that indicate consultation with a pediatric obesity specialist include pseudotumor cerebri, obesity-related sleep disorders, orthopedic problems, massive obesity, and obesity in children younger than 2 years of age. Recommendations for treatment evaluation included an assessment of patient and family readiness to engage in a weight-management program and a focused assessment of diet and physical activity habits. The primary goal of obesity therapy should be healthy eating and activity. The use of weight maintenance versus weight loss to achieve weight goals depends on each patient's age, baseline BMI percentile, and presence of medical complications. The Committee recommended treatment that begins early, involves the family, and institutes permanent changes in a stepwise manner. Parenting skills are the foundation for successful intervention that puts in place gradual, targeted increases in activity and targeted reductions in high-fat, high-calorie foods. Ongoing support for families after the initial weight-management program will help families maintain their new behaviors. CONCLUSIONS: These recommendations provide practical guidance to pediatric clinicians who evaluate and treat overweight children.

Adolescent↗

PubMed1996

Influence of three-week fasting on gonadotropin pulsatility in obese menstruating women.

OBJECTIVE: To evaluate the influence of three-week fasting on gonadotropin pulsatility in extremely obese women of reproductive age. DESIGN: Prospective study of 21-day fasting (400 kcal/day), under medical supervision. SUBJECTS: 20 females, average age of 35.1 +/- 5.9 y, and average BMI of 41.19 +/- 8.39 kg/m2, with regular menstrual cycles (26-34 days). The mean weight loss was 12.5 +/- 3.23 kg. MEASUREMENTS: Blood samples for LH and FSH were taken between 4th and 7th day of the menstrual cycle, before and in the first cycle immediately after weight reduction, for 6 h, starting at 09.00 with 10 min intersample intervals. Pulsatility analysis was done using Pulsar program. Statistical analysis was done using Wilcoxon's matched pairs signed ranking test and McNemar's test. RESULTS: There was no statistically significant difference (p > 0.05) in LH and FSH pulsatile secretion before and after diet including the number of pulses, amplitudes, interpulse intervals and peak lengths. There were no disturbances of menstrual cycle during or after the diet. CONCLUSION: These results suggest that a 21-day fast, accompanied with significant weight loss, does not affect gonadotropin pulse pattern in follicular phase and normal menstrual cycle length in extremely obese females of reproductive age, compared with the pattern before diet.

Adult↗

PubMedDate not supplied

Applications of a HOUDINI-based structure elucidation system.

SESAMI, a comprehensive program for the elucidation of the structure of complex compounds of carbon, incorporates a structure reduction-based structure genearator (COCOA). Observed limitations with this program in the solution of higher molecular weight unknowns prompted the development of a structure generator (HOUDINI) which embodies a new concept, convergent structure generation. A comparison of the performance of COCOA-based and HOUDINI-based SESAMI using a set of complex, naturally occurring compounds as a test set of unknowns revealed faster execution times and more efficient processing of ambiguous structural information for the latter.

Algorithms↗

PubMed2006

Effects of an educational intervention on weight gain in patients treated with antipsychotics.

BACKGROUND: Increasing numbers of reports have raised concerns about significant increases in weight and adiposity over both short- and long-term treatment in patients treated with antipsychotics (APs). The management of overweight and obesity in patients treated with APs has included pharmacological interventions, dietary suggestions, and behavioral strategies. Nevertheless, current evidence does not support the use of pharmacological management of this specific type of obesity, and only a limited number of studies have been published regarding prevention and treatment of weight gain with other strategies. OBJECTIVE: The aim of this study was to evaluate the effectiveness of an educational intervention (EI) that combines low-calorie diet with increased physical activity to prevent and treat weight gain in patients treated with APs. METHOD: Data were from 53 subjects whose body mass index (BMI) had increased by more than 7% after starting an AP therapy and who consented to participate in a 12-week educational intervention study aimed at preventing further weight gain and, when possible, at inducing a weight loss. Weight and BMI were measured at baseline (at each of the monthly follow-up visits) and at study completion 12 weeks from entry in the study. RESULTS: Twenty-six patients completed the 12-week program. Completers showed a significant mean body weight decrease of 3.15 kg, with a mean BMI reduction of 1.2 (kg/m) at the end of the 3-month period. CONCLUSIONS: Educational intervention can be an important tool for the management of weight increase in patients treated with APs. A larger prospective and controlled study is now needed to confirm our findings.

Adult↗

PubMed1987

Low-birth-weight rate reduced by the obstetrical access project.

Obstetrical (OB) access was a Medicaid pilot project that operated in 13 California counties from July 1979 through June 1982. The project goals were to both improve access to care in underserved areas and improve pregnancy outcomes by providing enhanced prenatal care, including psychosocial, health education, and nutrition services. The project registered 6,774 women. The findings were: 87 percent of the registrants started prenatal care during the first or second trimester; 84 percent of the registrants completed care in the project; OB access mothers had a low-birth-weight rate of 4.7 percent, compared with 7.0 percent for a matched control group, suggesting a 33-percent reduction in low birth weight through the project; and the benefit-cost ratio of this program was about 2 to 1 for the short run because of savings in neonatal intensive care services. The State of California approved legislation in 1984 authorizing the project's scope of services for the Medi-Cal recipients on a statewide basis.

California↗

PubMedDate not supplied

[Exercises involving strength in a physical rehabilitation program for obese women].

A comparative evaluation was done of two different 6-week physical rehabilitation schemes for obese women (n = 18) aged 39-45 years. On the basis of the above evaluation it has been shown that the program with elements of training involving strength was associated with a significantly greater reduction in specific weight of the adipose tissue than with conventional content of training sessions. The main cause of a higher effect of such a scheme can be attributed to increase in resting metabolism.

Adipose Tissue↗

PubMed1984

Insulin--not always a life sentence: withdrawal of insulin therapy in non-insulin dependent diabetes.

The extent of unnecessary insulin administration was assessed by reviewing the records of 350 patients with non-insulin-dependent diabetes (NIDDM). Subjects were included only if previously told that insulin therapy was to be permanent, and not if the need for insulin was known to be temporary (e.g. post-operatively). Fifty-one such patients were identified, 26 men and 25 women, mean age 59.5 (range 24-79) yr, with mean duration of diabetes 10.7 (1-34) yr. Insulin had been administered for a mean of 4.8 (0.3-34) yr in a mean daily dosage of 52.5 (12-280) units. Twenty-nine subjects (57%) were more than 110% of ideal body mass. Insulin therapy was ceased on an outpatient basis, using self blood glucose monitoring in nearly all cases. Mean duration of follow-up since ceasing insulin is 16 (3-48) months. Body mass in overmass subjects fell from (mean +/- S.D.) 92.3 +/- 20.5 to 82.1 +/- 17.8 kg (p less than 0.001). Mean HbA1 level fell from 12.0 +/- 2.2 to 11.0 +/- 2.0% (p less than 0.05). Sixteen patients are currently treated with diet, and 35 require diet and oral hypoglycemic agents. It appears that insulin therapy in NIDDM is often commenced for "dietary failure" rather than true secondary failure of oral hypoglycemic agents. Despite progressive increase in dosage, insulin may not improve diabetic control, and may cause weight gain. A management program of diet and exercise, based on self blood glucose monitoring allows reduction in dosage and withdrawal of insulin without hospitalization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2000

Cost-benefit analysis of mammography screening in Denmark based on discrete ranking data.

OBJECTIVE: Economic evaluations such as cost-effectiveness and cost-utility analyses generally fail to incorporate elements of intangible costs and benefits, such as anxiety and discomfort associated with the screening test and diagnostic test, as well as the magnitude of utility associated with a reduction in the risk of dying from cancer. This paper seeks to include all costs and effects incurred by introducing mammography screening through the application of discrete ranking modeling. METHODS: In the present analysis, 207 women were interviewed and asked to rank, according to priority, a number of alternative breast cancer screening setups. The alternative programs varied with respect to number of tests performed, risk reduction obtained, probability of a false-positive outcome, and extent of copayment. Using discrete ranking modeling, the stated preferences were analyzed and the relative weighting of the program attributes identified. For a range of hypothetical breast cancer programs, relative utilities and corresponding willingness-to-pay estimates were derived. RESULTS: A comparison of cost and willingness to pay for each of the programs suggested that net benefits are maximized when screening person aged 50-74 years biennially. More intensive screening produces lower or similar levels of utility at a higher cost. CONCLUSION: Discrete ranking modeling can aid decision making by identifying inferior healthcare programs, i.e., programs that are more costly but less beneficial.

Aged↗

PubMed2007

Behavior therapy and cognitive-behavioral therapy of obesity: is there a difference?

Current practice guidelines for management of overweight and obesity recommend a program of diet, exercise, and behavior therapy for all persons with a body mass index (calculated as kg/m(2)) of at least 30 (and those with body mass index > or =25 plus two weight-related comorbidities). In this tripartite treatment--often referred to as lifestyle modification--behavior therapy provides a structure that facilitates meeting goals for energy intake and expenditure. Although standard behavior therapy reliably induces mean weight losses of approximately 10% of initial weight, these reductions are difficult to maintain. Some authors argue that a shift in focus from behavior change to cognitive change will improve long-term results of lifestyle modification programs. This review describes, in detail, the standard behavioral treatment of obesity and compares it with an alternative treatment model that is based in a cognitive conceptualization of weight control. A review of the literature suggests that the differences between standard behavior therapy and cognitive-behavioral therapy of obesity lie more in their underlying theories than in their implementation. Empirical comparisons of the long-term effects of these approaches are needed.

Behavior Therapy↗

PubMed1985

Prevention of preterm births: a perinatal study in Haguenau, France.

A reduction in preterm births has been observed in Haguenau (Eastern France) during a 12-year intervention study with a program for prevention of preterm deliveries. The Perinatal Study of Haguenau was an observation tool used in a stable population, and it allowed measurement of the way women have progressively responded to the new proposals in prenatal care. It also allowed measurement of the results of the interventions: low birth weight (less than 2,500 g) and preterm birth rates (less than 37 weeks of gestation) among single live births. The total duration of the study was divided into three periods of four years (1971 through 1974, 1975 through 1978, and 1979 through 1982), for which the numbers of single live births are 5,763, 4,957, and 5,919, respectively. For the same periods, the low-birth-weight rates, 4.6%, 4.0%, and 3.8%, respectively, showed a significant decrease (P less than .001). Following a similar pattern, the rates of preterm birth were 5.4%, 4.1%, and 3.7% (a significant reduction with P less than .001). These improvements in pregnancy outcome do not disappear after standardization of mother's age, high blood pressure, or social class distribution. These findings, which concur with the results of others, enhance the hypothesis of a direct relationship between a prevention program and a reduction in preterm birth rates.

Birth Weight↗

PubMed1997

A randomized controlled trial of weight reduction and exercise for diabetes management in older African-American subjects.

OBJECTIVE: To evaluate a weight loss and exercise program designed to improve diabetes management in older African-Americans. RESEARCH DESIGN AND METHODS: Overweight African-Americans (n = 64) ages 55-79 years with NIDDM were randomized to either an intervention (12 weekly group sessions, 1 individual session, and 6 biweekly group sessions) or usual care (1 individual session, and 6 biweekly group sessions) or usual care (1 class and 2 informational mailings). Clinical and behavioral variables were assessed at 0, 3, and 6 months of treatment. RESULTS: Significant net differences in the intervention versus usual care were observed for weight (-2.0 kg, P = 0.006), physical activity, and dietary intake of fat, saturated fat, cholesterol, and nutrition knowledge at 3 months (all P < 0.05) and for weight at 6 months (-2.4 kg; P = 0.006) and mean HbA1c values at 3 and 6 months (respectively, -1.6 and -2.4%, both P < 0.01). After the adjustment for changes in weight and activity, the intervention participants were approximately twice as likely to have a one unit decrease in HbA1c value as those in usual care. Blood pressure increase sin usual care participants resulted in net differences (intervention minus control) at 3 and 6 months of -3.3 (P = 0.09) and -4.0 (P = 0.05) mmHg diastolic, respectively, and -8.4 (P = 0.06) and -5.9 (P > 0.10) mmHg systolic, respectively. Blood lipid profiles improved more in intervention than usual care participants, but not significantly. CONCLUSIONS: The intervention program was effective in improving glycemic and blood pressure control. The decrease in HbA1c values was generally independent of the relatively modest changes in dietary intake, weight, and activity and may reflect indirect program effects on other aspects of self-care.

Black or African American↗

PubMedDate not supplied

Effects of a weight maintenance program with or without exercise on the metabolic syndrome: a randomized trial in obese men.

BACKGROUND: Weight maintenance (WM) after weight reduction (WR) is difficult, but increased physical activity may help. We studied whether adding exercise to diet counseling decreases the occurrence of the metabolic syndrome (MBO). METHODS: Ninety voluntary middle-aged men with a BMI range of 30-40 and a waist girth >100 cm were recruited to the research institute's clinic in 1997. After a very-low-energy diet for 2 months (WR), the men were randomized into a walking, resistance training or control group for 6 months (WM). All groups received similar dietary advice. After WM, there was a 23-month follow-up. Diagnosis of MBO was based on >or= 3 components. RESULTS: After WR, the mean weight loss was 14.2 kg. At the end, the weight decrease was 4.8 kg (n = 68) with no statistically significant difference between the groups. All groups had improved some components (insulin, HDL cholesterol, body composition) of MBO. When the groups were combined, the odds ratio for the occurrence of MBO (vs. baseline) was 0.10 after WR, 0.08 after WM and 0.29 at the end. CONCLUSIONS: Adding structured exercise to diet counseling did not alleviate MBO better than diet only. However, the occurrence of MBO was reduced in all groups at the end.

Adult↗

PubMed1977

Nutritional benefits from federal food assistance: a survey of preschool black children from low-income families in Memphis.

Approximately 4,000 preschool black children from low-income families in South Memphis participated for three years in a supplementary food program sponsored by the US Department of Agriculture. Part of this group received additional benefit from food stamps, day-care centers, and an infant-feeding program. We evaluated the effects of this participation in 250 children selected randomly from the enrollment list of the supplemetary program. Each child was examined for height, weight, head circumference, and levels of hemoglobin, serum iron, and vitamins A and C. The data were then compared with those from a similar survey in the same area conducted three years before. The results of this comparison indicate considerable improvements in height and weight and a reduction in the incidence of anemia and in the numbers of children with low plasma vitamin A levels. In the absence of other recognizable intervening factors, we conclude that federal food assistance programs were primarily responsible for the observed nutritional improvements.

Body Height↗

PubMed1984

Return of hypertension after withdrawal of prolonged antihypertensive therapy, effect of weight loss, sodium reduction, and baseline factors.

The effect of dietary modification on continued blood pressure control after discontinuation of antihypertensive therapy has been studied. Participants who had been treated for 5 years in the Hypertension Detection and Follow-up Program were enrolled and randomly assigned to continue medication, discontinue medication with no dietary intervention, discontinue medication and reduce weight, discontinue medication and reduce sodium groups. Relapse of hypertension was slow, even without dietary modification. Both weight loss and sodium restriction slowed relapse. The severity of the hypertension and the number of drugs required for hypertension control had a marked effect on the rate of relapse. Relapse was slowest in the participants who had attained the lowest blood pressure on therapy.

Adult↗

PubMed2001

Modification of eating attitudes and behavior in adolescent girls: A controlled study.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a school-based eating disorder prevention program designed to reduce dietary restraint and concern about shape and weight among adolescent girls. METHOD: A total of 474 girls aged 13-14 years received the program as part of their normal school curriculum. An assessment-only control group included 386 pupils. Measures of eating disorder features, self-esteem, and knowledge were administered before and after the intervention and at 6-month follow-up. RESULTS: Immediately following the intervention, there was a small reduction in dietary restraint and attitudes to shape and weight in the index group, whereas there was no change in the control group. This reduction was not maintained at 6-month follow-up although the dietary restraint scores of the index group remained lower than those of the control group. DISCUSSION: This prevention program achieved change in eating attitudes and behavior, although the change was modest in size and not sustained. Focusing on a high-risk subgroup of dieters might be a more fruitful primary prevention strategy.

Adolescent↗

PubMed1995

Physicians' response to length-of-stay profiling.

One of the techniques adopted recently by certain hospitals to meet the competitive pressure for reducing costs is physician profiling. Profiling produces periodic reports that compare a physician's resource consumption to a benchmark figure. This study analyzes the effectiveness and implications of one hospital's introduction of physician patient length-of-stay profiling. Data for 24,000 patients treated by 400 physicians in 450 diagnosis-related groups over 42 months were analyzed, including both preprofiling and postprofiling periods. Statistical tests examined whether more physicians achieved the length-of-stay benchmark after profiling was introduced, controlling for physician, disease category (diagnosis-related group), and patient severity level. First, the results establish a significant increase in the percentage of physicians who achieve the length-of-stay benchmark after the introduction of profiling. Second, it was found that physicians who had initially failed to meet the benchmark reduced their patients' average length of stay much more than those physicians who initially achieved the benchmark. Further, reductions occurred primarily at intermediate severity levels, and in diagnosis-related groups with a large economic impact for the hospital. Although the profiling program did achieve the objective of reducing patient length of stay, further improvement may be possible. First, providing different benchmarks or targets for different physicians may extend the improvement to a greater percentage of all physicians involved. Second, an analysis of monthly data on total weighted procedures reveals that the reduction in length of stay resulted in an increase in the number of procedures performed per patient day. This finding suggests that to achieve a reduction in hospital costs and charges, profiling programs should be combined with process improvement initiatives.

Diagnosis-Related Groups↗

PubMedDate not supplied

Effects of a personalized system of skill acquisition and an educational program in the treatment of obesity.

This study tested whether the efficacy of behavioral treatment of obesity (BT) might be improved through the use of a personalized system of skill acquisition (PSA) with reinforcement contingent on the mastery of changes in eating and exercise behaviors. A total of 108 obese adults were randomly assigned to one of three conditions: (1) BT + PSA; (2) BT; or (3) a weight-loss educational (WLE) program. At posttreatment, the BT + PSA and BT conditions demonstrated significant beneficial changes in caloric consumption, intake of fats, and level of physical activity. Both conditions also produced equivalent reductions in body weight (Ms = 7.9 kg for BT + PSA and 9.5 kg for BT) that were significantly greater than the reduction accomplished in the WLE condition (M = 1.7 kg). These findings suggest that the addition of a PSA may not produce better outcome than standard behavioral treatment and that education alone is not sufficient to produce weight loss.

Adult↗

PubMed1985

A nutrition-physical fitness intervention program for low-income black parents.

An 8-week program taught nutrition and aerobic exercise to obese, low-income black mothers of children under 3 years. A reduction in risk factors for cardiovascular disease in the mothers was anticipated. Culturally adapted aerobic dancing was well-suited for exercise. It was assumed that children would ultimately adopt their parents' changed life style. The program demonstrated a significant reduction in heart rates at rest, but no significant change in heart rates with stress. A significant reduction in body-fat percentage was measured, whereas overall weight reduction was not significant. The consumption of vitamin C, protein, fat, and sodium was reduced. Intake of calcium, iron, carbohydrates, and vitamin A rose significantly. The results indicate the potential effectiveness of such dual intervention programs. Further study would be necessary for more conclusive results and recommendations.

Adult↗