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PubMed1989

An assessment of the nutritional status of preschool children in Western Papua New Guinea, 1978 to 1986.

This paper reports the results of a cross-sectional survey of nutrition in children 0-5 years old carried out in Balimo District of southern Western Province, Papua New Guinea, between December 1985 and February 1986, and compares the level of undernutrition found in this survey with previous levels. The purpose of this comparison was to determine the effect of the National Food and Nutrition Policy introduced in 1978 and, more specifically, the Balimo Nutrition Education Program introduced in 1980. The major findings are that there has been a marked reduction in the level of undernutrition in children 0-5 years old, as determined by weight for age. In 1978, 44.6% of children were less than 80% of the standard, whereas in 1986 the corresponding figure was 22.3%. The level of undernutrition in the 0-12 month old age group was significantly lower than that of all other age groups, which correlates with the period of breastfeeding. The increase of undernutrition after this age can be partly accounted for by an inadequate weaning diet, an area in which further education is required. The level of attendance at maternal and child health clinics has not altered significantly between 1982 and 1986, being still only 45% of children enrolled in the clinics. This needs to be improved if possible by the local health centres.

Anthropometry↗

PubMed1995

Evaluation of the Navy's obesity treatment program.

This study evaluated the overall effectiveness of the Navy's three-tiered obesity treatment program and compared effectiveness across the three treatment levels. Height, weight, and body circumference measurements were obtained from 369 program participants at baseline and follow-up (6 weeks, 6 months, 12 months). Results demonstrated a significant and sustained reduction in percent body fat in all three program tiers, but the absolute losses at the end of 12 months were small: -3.7% fat for men, -4.5% fat for women. The level III tier, which employs a multidimensional approach to treatment, was the most effective program, even after differences in enrollees' initial percent body fat were taken into account. Changes in the approach to treatment and development of a supportive, long-term, behaviorally based aftercare program are recommended.

Female↗

PubMed1985

Emotional problems during weight reduction: advantages of a combined behavior therapy and antidepressive drug therapy for obesity.

Depressive symptoms may increase in a subgroup of obese individuals shortly after beginning a weight-reducing diet. Therefore an additional antidepressive medication should have a positive effect on the course and results of therapy. This hypothesis was tested in three different institutional settings, with identical therapeutic programs. In this study there were 23 obese women. Therapeutic strategies were concerned with an increase of self-control over eating behavior, the improvement of social skills, and the establishment of new problem-solving abilities. Doxepin was used as the anti-depressant in a double blind procedure. Our results seem to support the hypothesis of this study: depressive symptoms markedly increased soon after the beginning of weight-reduction; additional antidepressive medication helped to improve the symptoms and in the long term had a positive effect on the rate of weight loss.

Adult↗

PubMed1997

Defining success in obesity management.

Obesity is an exploding epidemic in the Western world, with severe consequences for the individual as well as being a burden to society. An increased awareness about the threat of obesity to health and life is therefore essential. Weight normalization is not necessary to achieve significant health benefits. Sustained moderate weight reduction has important effects on morbidity, probably affects mortality, and certainly affects psychosocial aspects of life. New realistic standards to define success should be developed.

Adult↗

PubMedDate not supplied

Impact of aging on hostility in coronary patients and effects of cardiac rehabilitation and exercise training in elderly persons.

Hostility is a coronary artery disease (CAD) risk factor affecting recovery after major CAD events. Yet, few data exist on the impact of aging on hostility in CAD patients or the effects of cardiac rehabilitation on elderly patients with high hostility. The authors studied 500 consecutive patients following CAD events to determine the impact of aging on hostility scores, the prevalence of hostility symptoms, and the response of elderly persons with hostility symptoms to cardiac rehabilitation programs. Overall hostility scores (p<0.01) and prevalence of hostility symptoms (8% in 268 elderly vs. 28% in 81 younger patients [aged <50 years]) were inversely related to age (p<0.01). Elderly persons with hostility symptoms had greater weight (p=0.02), four times higher anxiety and depression scores (p<0.0001), two times higher scores for somatization (p<0.0001), and 17% lower scores for quality of life (p<0.001) compared with elderly persons without hostility symptoms. Marked reduction in hostility and improvements in other risk factors occurred following rehabilitation. These results demonstrate the inverse relationship between age and hostility symptoms in patients with CAD. Although hostility symptoms are relatively uncommon in elderly persons with CAD, these patients have more adverse CAD risk profiles and still have marked improvements following cardiac rehabilitation and exercise training programs.

Aged↗

PubMed2000

Post-exercise substrate utilization after a high glucose vs. high fructose meal during negative energy balance in the obese.

OBJECTIVE: To assess the effects of negative energy balance on the metabolic response of a meal containing either glucose or fructose as the primary source of carbohydrate after exercise in obese individuals in energy balance, or negative energy balance. RESEARCH METHODS AND PROCEDURES: Fourteen adults with mean body mass index (BMI) 30.3 +/- 1 kg/m2, age 26 +/- 2 years, and weight 93.5 +/- 5.4 kg, adhered to an energy-balanced (EB) or a negative energy-balanced (NEB) diet for 6 days. On Day 7, subjects exercised at 70% VO2peak for 40 minutes then consumed either high glucose (50 g of glucose, HG) or high fructose (50 g of fructose, HF) liquid meal. Substrate utilization was measured by indirect calorimetry for 3 hours. Blood samples were collected before exercise and 0, 30, 60, 120, and 180 minutes after consuming the meal. RESULTS: The HG produced 15.9% greater glycemic (p < 0.05) and 30.9% larger insulinemic (p < 0.05) responses than the HF under both EB and NEB conditions. After the NEB diet, carbohydrate and fat oxidation did not differ for HG and HF. In contrast, carbohydrate oxidation increased 31%, and fat oxidation decreased 39% with HF compared with HG after the EB diet. Thus, HF and HG consumed after exercise produced marked differences in macronutrient oxidation when obese subjects followed an EB diet, but no difference when adhering to a NEB diet. DISCUSSION: The data suggest that the use of fructose in supplements/meals may provide no additional benefit in terms of substrate utilization during a weight loss program involving diet and exercise.

Adult↗

PubMed2004

Biliopancreatic diversion in the surgical treatment of morbid obesity.

Biliopancreatic diversion is a malabsorptive technique of bariatric surgery that has gained wide acceptance in the Western world. It is performed in one of two ways: In its classic form it consists of partial gastrectomy with a Roux-en-Y gastroenterostomy; in its duodenal switch form a vertical sleeve gastrectomy is combined with a duodenoenterostomy. Both techniques realize diversion of biliopancreatic juice, thereby creating a mild form of malabsorption. Weight loss has been approximately 70% of initial excess weight, exceeding that obtained with most other bariatric procedures. Iron, calcium, and vitamin deficiencies may occur, especially with classic biliopancreatic diversion, and must be prevented with adequate supplements during vigorous follow-up. Weight loss is followed by a substantial reduction in the co-morbidities that are present in many morbidly obese patients. Biliopancreatic diversion should be included in each obesity clinic program and be proposed for morbidly obese patients who are having difficulty with the prospect of continuous restraint of food intake or problems due to failed gastric restrictive interventions. The postoperative results in such patients have been good and have substantially improved quality of life and self-esteem in this category of morbidly obese patients.

Biliopancreatic Diversion↗

PubMed1995

An adjustable fetal weight standard.

The monitoring of fetal weight is an important aspect of antenatal care. To construct an individually adjustable standard, we developed a model to link the predicted birth weight to a fetal weight curve which outlines how this weight is to be reached in an uncomplicated pregnancy. A formula was derived which describes the median fetal weight at each gestation as a proportion of the optimal term weight, and also defines the 90th and 10th centile curves as normal limits. We analyzed a birth weight database of 38,114 singleton, routine ultrasound-dated pregnancies resulting in term deliveries. By stepwise multiple regression analysis, we derived coefficients for the factors that act as variables on term birth weight in our population. Apart from gestational age and sex, the maternal height, weight at first visit, ethnic group, parity and smoking all have significant and independent effects on birth weight. The variation due to ethnic group appears to be physiological in this population. Smoking is associated with a reduction in birth weight, which is independent of maternal physique and related to the number of cigarettes per day as reported at the first visit. We have developed a software program which calculates, on the basis of pregnancy variables entered at the first visit, an adjusted normal range for fetal size. This can be printed out as a chart and used for antenatal surveillance of growth.

Birth Weight↗

PubMed1979

Effects of behavioral and pharmacological weight loss programs on nutrient intake.

Behavior therapy is a widely used method for short-term weight control. Formal nutrition counseling is not included in many behavioral programs. To determine what types of diets were self-selected by patients and to see how they compared with individuals participating in a relaxation group with anorectic medication, the eating diaries compiled by participants in such a program were analyzed for 20 different nutrients. In general, pretreatment intakes were nutritious and typical for Americans. Both the behavioral and a relaxation-medication treatment produced weight loss and reduction in calorie intake. Both treatments were associated with the consumption of a fairly nutritious diet not much different from the pretreatment intake except for a reduction in the amount eaten.

Adult↗

PubMed2004

Rorschach personality predictors of weight loss with behavior modification in obesity treatment.

Weight loss outcome for 49 obese patients after 6 months treatment in a behavior modification program was related to Rorschach personality characteristics according to the Comprehensive System (Exner, 2003), also including the Rorschach Oral Dependency Scale (Bornstein, 1996; Masling & Rabie, 1967). Less weight loss was predicted by signs of perceptual and cognitive distortions indicated by the Schizophrenia Index. More weight loss was predicted by Food Contents, suggesting a food preoccupation and possibly a benign dependency orientation. Patients with a focus on food and dependent needs could benefit above all from the treatment program implying learning how to handle food and eating in a supportive setting, as evidenced by more weight loss. Distortions in perception and cognition could constitute more profound difficulties in weight reduction important to recognize in obesity treatment.

Adult↗

PubMed1984

A comparison of controlled feeding programs for maximizing returns of white Leghorn layers.

Three controlled feeding programs initiated after peak egg production and a full feeding program were evaluated for their effects on production and income performance of White Leghorn layers. Program 1 consisted of full feeding from 20 to 64 weeks of age. Controlled feeding programs were initiated at 36 weeks and consisted of feeding approximately 105 g/bird/day to 64 weeks (Program 2), a phase reduction feeding program consisting of feeding approximately 105 g/bird/day to 53 weeks of age followed by feeding approximately 95 g/bird/day to 64 weeks (Program 3), and feeding approximately 95 g/bird/day continuously from 36 weeks (Program 4). Controlled feeding programs resulted in significant (P less than .05) reductions in total feed usage compared to full fed birds. Eggs per hen, however, were significantly (P less than .05) reduced only for feeding Programs 3 and 4, and egg weights were reduced only with feeding Program 4. Egg mass production and body weights were significantly affected by controlled feeding programs. Egg grade distributions were not significantly (P greater than .05) different among Programs 1, 2, or 3; however, Program 4 produced a significant (P less than .05) increase in the percentage of medium grade eggs obtained. Egg incomes over pullet and feed costs favored all controlled feeding programs, demonstrating that maximum production levels do not always mean maximum returns.

Animal Feed↗

PubMed2005

Outcomes of comprehensive lifestyle modification in inpatient setting.

OBJECTIVE: To examine the effectiveness of a 4-week inpatient non-pharmacological risk factor modification programme for individuals with the metabolic syndrome. The aim of the program was to reduce patients' over risks for stroke and myocardial infarction. METHODS: A prospective clinical study including 2468 patients--1096 men and 1372 women--with and average age of 50 +/- 10 years. The patients were referred to the programme from primary care units and hospitals where treatment options were exhausted. RESULTS: All risk factor levels for stroke and myocardial infarction decreased. The reduction of weight among men was 4.7 +/- 2.6 kg and 3.8 +/- 1.8 kg among women from an initial weight of 96 +/- 17 kg and 85 +/- 16 kg, respectively. The patients systolic and diastolic blood pressure decreased by 15/10 mmHg for men and 14/9 mmHg among women from initial average for the whole population of 148/90 +/- 19/11 mmHg and 146/87 +/- 19/12 mmHg, respectively. The greatest decrease in weight and blood pressure occurred in men and women with an initial body mass index of > or = 30 and with a diastolic blood pressure of > or = 90; in this group, the average reductions in weight were 5.8 +/- 2.4 kg for men and 4.4 +/- 1.7 kg for women; the reductions in systolisk/diastolisk blood pressure were 22/15 +/- 16/9 mmHg (p < 0.001) for both men and women. A reduction of medication (DDD) although not a goal was also achieved. CONCLUSION: The results prove the value of a comprehensive and highly structured inpatient approach to lifestyle modification. PRACTICE IMPLICATIONS: The results should give cause to trials with half-way strategies integrating features from the inpatient programme into the design of risk factor interventions.

Aged↗

PubMed1999

Restoration of reproductive potential by lifestyle modification in obese polycystic ovary syndrome: role of insulin sensitivity and luteinizing hormone.

Weight reduction and exercise have been shown to help with menstrual disturbance and infertility in obese women with polycystic ovary syndrome. We studied the relationship between insulin sensitivity and ovulation patterns in 18 infertile anovulatory obese polycystic ovary syndrome (PCOS) women (NO) with normal glucose tolerance, aged between 22-39 yr with a body mass index of 27-45 kg/m2, before and after a 6-month diet and exercise program. This program promotes healthy lifestyle factors, but does not lead to rapid weight loss. The anthropometric, metabolic, and endocrine factors of these subjects were compared to those of 10 age- and weight-matched PCOS women with regular monthly ovulation (RO). Before lifestyle modification, the anovulatory subjects had greater central obesity than regular ovulators, as assessed by percent central fat (NO, 45.7 +/- 0.8%; RO, 42.2 +/- 1.6%; P < 0.05), higher glucose increment after glucose challenge (NO, 10.1 +/- 1.0 mmol/L; RO, 6.4 +/- 1.1 mmol/L; P < 0.02), lower insulin sensitivity index (NO, 1.2 +/- 0.2; RO, 2.8 +/- 0.6 micromol/kg x min/pmol/L; P < 0.005), higher plasma LH (NO, 8.9 +/- 0.9; RO, 4.6 +/- 0.9 IU/L; P < 0.005), and lower plasma sex hormone-binding globulin (NO, 18.0 +/- 2.5; RO, 27.8 +/- 5.7 nmol/L; P < 0.05]. Anovulatory subjects were classified as responders (R) to the intervention if they regained ovulation during the study. As a result of intervention, R showed an 11% reduction in central fat, a 71% improvement in insulin sensitivity index, a 33% fall in fasting insulin levels, and a 39% reduction in LH levels. None of these parameters changed significantly in nonresponders (NR). At the end of the study, R had lower fasting insulin (R, 13.6 +/- 1.7; NR, 23.0 +/- 3.5 mU/L) and LH levels (R, 5.0 +/- 1.7; NR, 7.4 +/- 1.4 IU/L), but similar androgen levels compared to NR. We conclude that lifestyle modification without rapid weight loss leads to a reduction of central fat and improved insulin sensitivity, which restores ovulation in overweight infertile women with PCOS. Lifestyle modification is the best initial management for obese women seeking to improve their reproductive function.

Adult↗

PubMed1991

The cost-effectiveness of work-site wellness programs for hypertension control, weight loss, and smoking cessation.

The cost-effectiveness of work-site wellness programs for reducing cardiovascular disease risks of employees was examined at three manufacturing plants. A fourth plant was used as a control site to estimate levels of risk reduction achieved from wellness screening and preexisting services, without further interventions. The cardiovascular disease risks included in the study were hypertension, obesity, and cigarette smoking. The annual direct cost per employee for postscreening interventions was $2.97 for site 1 (control site), $17.68 for site 2 (health education), $30.96 for site 3 (health education plus follow-up counseling), and $38.31 for site 4 (health education, follow-up counseling plus plant organization for health promotion). Of the three experimental sites, sites 3 and 4 were more effective and more cost-effective than was site 2, both in terms of engaging employees at risk of cardiovascular disease into treatment or program participation and of reducing their risks or preventing relapse. For engaging employees into treatment/program participation, sites 3 and 4 were nine to ten times more cost-effective than was site 2; for reducing risks/preventing relapse, sites 3 and 4 were five to six times more cost-effective than was site 2. At sites 3 and 4, the total direct cost per percent of risks reduced/relapse prevented was less than one dollar ($.67 and $.74, respectively) per employee per year. Program costs may vary considerably across companies because of differences in salary structures and overhead costs. These are held constant in this report for comparison across program models.

Adult↗

PubMed1990

Feed restriction of turkey breeder hens--a review.

Past research on feed restriction methods with turkey breeder hens has involved the feeding of 1) high-fiber or low-energy diets, 2) low dietary protein, 3) limited quantities of feed, 4) rations on a skip-a-day program, 5) distasteful compounds, or 6) combinations of these methods. In general, feed-restricted turkey breeder hens showed a reduction in BW and a delay in sexual maturity at time of lay with no effect on fertility, hatchability of fertile eggs, and hatchability of all eggs set. Egg weight was unaffected in 13 studies, but decreases and increases were reported for two and three studies, respectively. The results on egg production and feed efficiency (number of eggs/unit of feed) were more variable. Egg production decreased, increased, or had no effect in 6, 2, and 14 of the feed restriction programs, respectively. Feed efficiency of restricted hens either was poorer (two reports), improved (three studies), or had no effect (six studies). The larger parent-stock breeder candidate of today may not respond to these feed restriction programs in the same manner as the breeder hens of the 1970s and early 1980s. Most likely, more severe feed restriction programs will have to be designed to lower the BW of these larger hens.

Animals↗

PubMedDate not supplied

Savings achieved by giving WIC benefits to women prenatally.

The Special Supplemental Food Program for Women, Infants, and Children (WIC) provides supplemental food, nutrition and health education, and social services referral to pregnant, breastfeeding, and post-partum women, and their infants and young children who are both low-income and at nutritional risk. A number of statistically controlled evaluations that compared prenatal women who received WIC services with demographically similar women who did not receive WIC services have found WIC enrollment associated with decreased levels of low birth weight among enrolled women's infants. Several also have found lower overall maternal and infant hospital costs among women who had received prenatal WIC services compared with similar women who did not receive prenatal WIC services. A meta-analysis of the studies shows that providing WIC benefits to pregnant women is estimated to reduce low birth weight rates 25 percent and reduce very low birth weight births by 44 percent. Using these data to estimate costs, prenatal WIC enrollment is estimated to have reduced first year medical costs for U.S. infants by $1.19 billion in 1992. Savings from a reduction in estimated Medicaid expenditures in the first year post-partum more than offset the cost of the Federal prenatal WIC Program. Even using more conservative assumptions, providing prenatal WIC benefits was cost-beneficial. Because of the estimated program cost-savings, the U.S. General Accounting Office has recommended that all pregnant women at or below 185 percent of Federal poverty level be eligible for the program.

Cost Savings↗

PubMed1997

Outcome for patients with bulimia and breast hypertrophy after reduction mammaplasty.

OBJECTIVES: To determine the outcome of patients with bulimia nervosa and symptomatic breast hypertrophy (macromastia) who had reduction mammaplasty and to identify factors that were associated with positive outcomes. DESIGN: Case series with semistructured, retrospective, personal interviews performed an average of 4 years after the procedure. SETTING: University hospital-based adolescent eating disorder program. PATIENTS: Five adolescent and young adult females who had been treated for bulimia nervosa and underwent reduction mammaplasty. OUTCOME MEASURES: Presurgical and postsurgical report of physical symptoms, body image and weight control habits, ability to exercise, psychosocial functioning and self-esteem. RESULTS: All patients experienced improvement in physical symptoms (pain and inframammary dermatitis), in their posture, and in their ability to find clothes that fit properly, to exercise, and to avoid embarrassment in social situations. Preoperative eating disorder habits were a dysfunctional attempt to achieve more "normal" body proportions; postoperatively, symptoms of an eating disorder were completely eliminated or greatly reduced. Factors related to favorable outcome included professional validation of patient's symptoms, realistic patient expectations from the surgical procedure, supportive family dynamics, and ongoing treatment for the eating disorder. CONCLUSION: This series of patients with bulimia nervosa and macromastia experienced significant improvement in symptoms related to their eating disorder and their breast hypertrophy following reduction mammaplasty.

Adolescent↗

PubMed2004

Focus on lifestyle change and the metabolic syndrome.

The National Cholesterol Education Program's Adult Treatment Panel III identifies persons with multiple metabolic risk factors or "metabolic syndrome" as candidates for intensified therapeutic lifestyle changes. This article reviews the important role of weight reduction,diet, and exercise in improving the metabolic syndrome and its risk factors of abdominal obesity, impaired fasting glucose,dyslipidemia, and coagulation/inflammatory factors. The article also provides practical strategies.

Humans↗