Evaluation of a web-based weight loss intervention in overweight cancer survivors aged 50 years and younger

Purpose

Half of adult cancer survivors under age 50 years are obese. Excess body weight is associated with cancer recurrence, and effective weight loss interventions for younger cancer survivors are needed. Commercially available, online weight loss programmes are readily accessible, but few have been studied in this population. This study employed a single‐arm, pre‐post intervention (baseline‐6 month/baseline‐12 month comparisons) to preliminarily explore feasibility, efficacy and safety of an online, commercially available weight loss programme in breast (n = 30) and testicular (n = 16) cancer survivors under age 50 years.

Methods

The intervention included three daily components: exercise, nutritional/behavioural modification strategies and health lessons. Intention‐to‐treat and completers analyses were conducted. Feasibility was measured by participation (number of participants enrolled/number screened), retention (number of participants attending 6/12 month study visit/number of enrolled) and self‐reported adherence rates (average of mean percent adherence to each of the three intervention components). Efficacy was assessed by changes in initial weight (percent weight loss). Safety was assessed by adverse events.

Results

The mean participation rate was 42%. The retention rate was 59% at 6 and 49% at 12 months. The adherence rate for all participants (completers/dropouts/lost‐to‐follow‐up) was 50.1% at 6 and 44% at 12 months. Completers reported adherence rates of 68% at 12 months. Study participants lost 5.3% body weight at 12 months; completers lost 9%. Only three unexpected adverse events (unrelated to the intervention) were reported.

Conclusion

Clinically significant weight loss was observed, although retention rates were low. Findings generally support preliminary feasibility, efficacy and safety of this online weight loss programme, and future randomized control trials should be explored.

Brimonidine gel 0.33% rapidly improves patient-reported outcomes by controlling facial erythema of rosacea: a randomized, double-blind, vehicle-controlled study

Background

Facial redness contributes to impaired psychosocial functioning in rosacea patients and the only approved treatment for erythema is topical brimonidine gel 0.33%.

Objectives

To evaluate patient‐reported outcomes, as well as efficacy and safety, in subjects with self‐perceived severe erythema treated with brimonidine gel 0.33% compared to vehicle.

Methods

An 8‐day multicenter, randomized study comparing once‐daily brimonidine gel 0.33% with vehicle gel using a facial redness questionnaire, subject satisfaction questionnaire and a patient diary of facial redness control to assess patient‐reported outcomes.

Results

Of the 92 included subjects with self‐perceived severe erythema, very few were satisfied with their appearance at baseline (4.2% brimonidine group, 0 vehicle group). On Day 8, significantly more brimonidine group subjects were satisfied with their facial appearance compared to vehicle group (36.9% vs. 21.5%; P < 0.05), with the overall treatment effect (69.6% vs. 40.4%; P < 0.01), and with the improvement in their facial redness (67.4% vs. 33.3%; P < 0.001). More brimonidine group subjects were able to control their facial redness daily (e.g. 83.0% vs. 38.9% on Day 1). On Day 8, significantly more brimonidine group subjects than vehicle group had at least a one‐grade improvement from baseline in the Clinician Erythema Assessment score (71.7% vs. 35.7%; P = 0.0011) and Patient Self‐Assessment score (76.1% vs. 47.6%; P = 0.004). More subjects in the brimonidine group (29.2%) reported treatment‐related adverse events than in the vehicle group (15.9%) but most were mild and transient.

Conclusions

Once‐daily brimonidine gel 0.33% allowed patients to rapidly control their facial redness and significantly improved patient‐reported outcomes in the treatment of persistent facial erythema of rosacea.

Changes in eating, physical activity and related behaviors in a primary care-based weight loss intervention

OBJECTIVE

To examine changes in eating behaviors and physical activity, as well as predictors of weight loss success, in obese adults who participated in a 2-year behavioral weight loss intervention conducted in a primary care setting.

DESIGN

A longitudinal, randomized controlled, multisite trial.

SUBJECTS

Three hundred ninety obese (body mass index, 30-50 kg m(-2)) adults, ≥ 21 years, in the Philadelphia region.

METHODS

Participants were assigned to one of three interventions: (1) Usual Care (quarterly primary care provider (PCP) visits that included education on diet and exercise); (2) Brief Lifestyle Counseling (quarterly PCP visits plus monthly lifestyle counseling (LC) sessions about behavioral weight control); or (3) Enhanced Brief LC (the previous intervention with a choice of meal replacements or weight loss medication).

RESULTS

At month 24, participants in both Brief LC and Enhanced Brief LC reported significantly greater improvements in mean (± s.e.) dietary restraint than those in Usual Care (4.4 ± 0.5, 4.8 ± 0.5 and 2.8 ± 0.5, respectively; both P-values ≤ 0.016). The percentage of calories from fat, along with fruit and vegetable consumption, did not differ significantly among the three groups. At month 24, both the Brief LC and Enhanced Brief LC groups reported significantly greater increases than usual care in energy expenditure (kcal per week) from moderately vigorous activity (+593.4 ± 175.9, +415.4 ± 179.6 and -70.4 ± 185.5 kcal per week, respectively; both P-values ≤ 0.037). The strongest predictor of weight loss at month 6 (partial R(2)=33.4%, P<0.0001) and at month 24 (partial R(2)=19.3%, P<0.001) was food records completed during the first 6 months. Participants who achieved a 5% weight loss at month 6 had 4.7 times greater odds of maintaining a ≥ 5% weight loss at month 24.

CONCLUSIONS

A behavioral weight loss intervention delivered in a primary care setting can result in significant weight loss, with corresponding improvements in eating restraint and energy expenditure. Moreover, completion of food records, along with weight loss at month 6, is a strong predictor of long-term weight loss.

The role of patients' expectations and goals in the behavioral and pharmacological treatment of obesity

OBJECTIVE

To investigate weight loss expectations and goals among obese treatment seekers and to examine the relationships of these expectations and goals to treatment outcomes.

METHOD

Participants were 180 obese men and women (age 43.8+/-10.1 years; body mass index 37.6+/-4.2 kg/m(2)) who received one of four-year-long treatments that combined behavioral and pharmacological methods. Before treatment, they reported the amount of weight they realistically expected to lose after 4, 12, 26 and 52 weeks of treatment, as well as their ultimate weight loss goals. Expectations and goals were compared across treatment groups and examined in relation to previous weight loss efforts, weight loss and regain in treatment, attrition, satisfaction with treatment and mood.

RESULTS

Participants in all treatment groups expected reductions at week 52 that were significantly greater than the 5-15% of initial weight they were told was realistic and significantly more than they had ever lost before. Weight loss expectations were unrelated to achieved weight loss in all groups but one, in which greater expectations were associated with greater losses. Failure to meet weight loss expectations for the first 26 weeks of treatment was related to lower satisfaction ratings, but was not related to weight regain or attrition over the next 26 weeks. Symptoms of depression were reduced from baseline, regardless of whether participants achieved or failed to achieve their expected weight losses.

CONCLUSION

Across groups, we observed no negative consequences of having (and failing to meet) unrealistic expectations for weight loss.

Impact of weight loss on the metabolic syndrome

OBJECTIVE

To evaluate the effects of weight loss on the risk of having metabolic syndrome after 1 year of treatment with lifestyle modification alone, pharmacotherapy alone (sibutramine) or the combination of the two.

DESIGN

Randomized, controlled, 1-year clinical trial.

PATIENTS

One hundred and eighty women and 44 men, 18-65 years of age, with a body mass index of 30-45 kg/m(2), free of uncontrolled hypertension or type 1 or 2 diabetes.

INTERVENTION

Fifteen milligrams of sibutramine per day alone, lifestyle modification counseling alone, sibutramine plus lifestyle modification counseling or sibutramine plus brief lifestyle modification counseling.

MEASUREMENTS

The metabolic syndrome, as defined by the Adult Treatment Panel III.

RESULTS

Before treatment, 34.8% of the participants had the metabolic syndrome. Metabolic syndrome was more prevalent in Caucasians than African Americans (42.5 vs 20.3%; P<0.03), in males than females (65.1 vs 34.9%; P<0.002) and in older (>44 years) than younger (</=44 years) participants (47.5 vs 20.8%; P<0.0001). After 1 year of treatment, a moderate decrease in weight (8.0+/-8.7 kg) resulted in significant reductions in the prevalence of metabolic syndrome from 34.8 to 27.2% of all participants (P<0.02). Logistic regression analyses indicated that for each 1 kg of weight lost, the odds of metabolic syndrome were reduced by 8% (CI=0.89-0.97; P<0.003). Lifestyle modification either alone (P<0.04), or in combination with sibutramine (P<0.05), significantly reduced the prevalence of metabolic syndrome compared with sibutramine alone. The group effect was removed after controlling for weight loss.

CONCLUSIONS

The metabolic syndrome was prevalent in over one-third of obese individuals who sought weight loss treatment, and the prevalence differed by age, sex and ethnicity. Moderate weight loss markedly reduced the odds of metabolic syndrome in this sample.

Childhood sexual abuse and obesity

The causes of the current obesity epidemic are multifactorial and include genetic, environmental, and individual factors. One potential risk factor may be the experience of childhood sexual abuse. Childhood sexual abuse is remarkably common and is thought to affect up to one-third of women and one-eighth of men. A history of childhood sexual abuse is associated with numerous psychological sequelae including depression, anxiety, substance abuse, somatization, and eating disorders. Relatively few studies have examined the relationship between childhood sexual abuse and adult obesity. These studies suggest at least a modest relationship between the two. Potential explanations for the relationship have focused on the role of disordered eating, particularly binge eating, as well as the possible "adaptive function" of obesity in childhood sexual abuse survivors. Nevertheless, additional research on the relationship between childhood sexual abuse and obesity is clearly needed, not only to address the outstanding empirical issues but also to guide clinical care.

Psychosocial aspects of obesity and obesity surgery

There is a growing consensus that bariatric surgery is the treatment of choice for extremely obese individuals who have failed to reduce their weight satisfactorily using behavioral or pharmacologic interventions. The gastric bypass in particular is associated with excellent long-term weight loss. Although most extremely obese individuals will have essentially normal psychological functioning, a significant minority suffer from depression, binge eating, trauma, or other emotional complications that may require treatment before or after bariatric surgery. A structured behavioral assessment, conducted by a mental-health professional and a registered dietitian, can readily identify those who are most likely to require adjunct counseling.

Obese patients' perceptions of treatment outcomes and the factors that influence them

BACKGROUND

Despite considerable professional consensus that modest weight losses of 5% to 10% are successful for reducing the comorbid conditions associated with obesity, obese patients often desire weight losses 2 to 3 times greater than this. Examining ways to reduce the disparities between treatment expectations and subsequent outcomes, this study evaluated the role of physical characteristics, treatment setting, and mood in patients' evaluations of treatment outcomes.

METHODS

This study was conducted in a university outpatient weight loss clinic with a sample of 397 obese individuals seeking weight loss by a variety of modalities. Before treatment, participants' heights and weights were measured, and the Beck Depression Inventory and the Goals and Relative Weight Questionnaire were administered.

RESULTS

Outcome evaluations ranged from 64.4 +/- 11.1 kg (mean +/- SD) for dream weight to 90.1 +/- 19.1 kg for disappointed weight. Initial body weight was the strongest predictor of disappointed, acceptable, and happy weights (beta =.90,.76, and.57, respectively). Sex (beta = -.37) and height (beta =.37) were the strongest determinants of dream weight. Heavier participants chose higher absolute weights, but the weight loss required to reach each of the outcomes was greater for heavier than for lighter patients.

CONCLUSIONS

These data signal a therapeutic dilemma in which the amount of weight loss produced by the best behavioral and/or pharmacologic treatments is viewed as even less than disappointing. Patients with the highest pretreatment weights are likely to have the most unrealistic expectations for success.

Benefits of lifestyle modification in the pharmacologic treatment of obesity: a randomized trial

BACKGROUND

Weight loss medications are recommended as an adjunct to diet and exercise modification but seem to be prescribed as a monotherapy by many physicians. This practice is likely to be associated with suboptimal weight loss.

METHODS

This 1-year, randomized trial compared the effects of sibutramine hydrochloride used alone (ie, the drug-alone group) to sibutramine plus group lifestyle modification, prescribed with either a 5021- to 6276-kJ/d diet (1200-1500-kcal/d diet) (ie, the drug-plus-lifestyle group) or, for the first 4 months, a 4184-kJ/d diet (1000-kcal/d diet (ie, drug-plus-lifestyle with a portion-controlled diet [the combined treatment] group). Participants were 53 women with a mean (+/-SD) age of 47.2 +/- 9.8 years and weight of 101.3 +/- 9.7 kg. At baseline, they reported the number of pounds they expected to lose at the end of treatment.

RESULTS

At month 12, patients treated with the drug alone lost (mean +/- SD) 4.1% +/- 6.3% of their initial body weight compared with significantly (P<.05) larger losses in the drug-plus-lifestyle group of 10.8% +/- 10.3% and the combined treatment group of 16.5% +/- 8.0%. Women in the 2 lifestyle groups achieved a significantly (P<.05) greater percentage of their expected weight loss than those in the drug-alone group and were significantly more satisfied with the medication and with changes in weight, health, appearance, and self-esteem (P<.05 for all). Significant reductions were observed at 12 months in triglyceride and low-density lipoprotein cholesterol levels but systolic and diastolic blood pressure both increased significantly (P<.05 for all).

CONCLUSION

The addition of group lifestyle modification to the pharmacologic management of obesity significantly improved weight loss and patients' satisfaction with treatment outcome.

Cosmetic breast augmentation surgery: a critical overview

Despite the ban on silicone gel breast implants in 1992, the last decade witnessed a dramatic increase in the number of cosmetic breast augmentation procedures performed in the United States. According to the American Society of Plastic Surgeons, over 132,000 women in this country underwent the procedure in 1998. This is an underestimate of the actual number of breast augmentations performed annually, as increasing numbers of nonsurgeon physicians are now performing cosmetic surgery. Given the rising number of women who now seek cosmetic breast augmentation surgery, it is likely that women's healthcare providers will be asked by their patients about breast augmentation. This review is designed to provide an overview of the medical and psychological literature on cosmetic breast augmentation. We begin with a history of breast augmentation, including an overview of the controversy of silicone breast implants and the Institute of Medicine's report on their safety published in 1999. We also discuss the psychological characteristics of breast augmentation patients, reviewing both preoperative and postoperative studies. We conclude with suggestions for future research as well as a discussion of the clinical relevance of this area for women's healthcare professionals.

Obese women's perceptions of their physicians' weight management attitudes and practices

BACKGROUND

Obesity has reached epidemic proportions in the United States. Primary care physicians will see increasing numbers of patients with long-term weight management problems.

OBJECTIVE

To examine obese women's perceptions of their physicians' weight management attitudes and practices.

DESIGN AND SETTING

Women who participated in obesity trials at a university clinic completed a questionnaire that assessed their views of weight control provided by their primary care physician.

PARTICIPANTS

The patients were 259 women whose age was 44.0 +/- 10.0 years; weight, 96.7 +/- 13.2 kg; and body mass index (calculated as weight in kilograms divided by the square of height in meters), 35.2 +/- 4.5 (all data given as mean +/- SD).

MAIN OUTCOME MEASURES

Using 7-point scales (1 indicates low; and 7, high), patients rated their satisfaction with care provided for their general health and that for their obesity. They also identified methods their physician recommended for weight management and the frequency of negative interactions with their physician concerning weight control.

RESULTS

Participants were generally satisfied with the care they received for their general health and with their physicians' medical expertise (mean scores, 6. 1 and 6.2, respectively). They were significantly (P<.001) less satisfied with care for their obesity and with their physicians' expertise in this area (mean scores, 4.1 and 4.3, respectively). Almost 50% reported that their physician had not recommended any of 10 common weight loss methods, and 75% indicated they looked to their physician a "slight amount" or "not at all" for help with weight control. Only a small minority of patients (0.4%-8.0%) reported frequent, negative interactions with physicians concerning their weight.

CONCLUSIONS

The last finding helps allay concerns that obese patients are routinely treated disrespectfully by physicians when discussing weight. The challenge, however, for primary care physicians appears to be providing patients better assistance with weight management.

Effects of sibutramine plus orlistat in obese women following 1 year of treatment by sibutramine alone: a placebo-controlled trial

OBJECTIVE

This study assessed whether adding orlistat to sibutramine would induce further weight loss in patients who previously had lost weight while taking sibutramine alone.

RESEARCH METHODS AND PROCEDURES

Patients were 34 women with a mean age of 44.1 +/- 10.4 years, weight of 89.4 +/- 13.8 kg, and body mass index (BMI) of 33.9 +/- 4.9 kg/m2 who had lost an average of 11.6 +/- 9.2% of initial weight during the prior 1 year of treatment by sibutramine combined with lifestyle modification. Patients were randomly assigned, in double-blind fashion, to sibutramine plus orlistat or sibutramine plus placebo. In addition to medication, participants were provided five brief lifestyle modification visits during the 16-week continuation trial.

RESULTS

Mean body weight did not change significantly in either treatment condition during the 16 weeks. The addition of orlistat to sibutramine did not induce further weight loss as compared with treatment by sibutramine alone (mean changes = +0.1 +/- 4.1 kg vs. +0.5 +/- 2.1 kg, respectively).

DISCUSSION

These results must be interpreted with caution because of the study's small sample size. The findings, however, suggest that the combination of sibutramine and orlistat is unlikely to have additive effects that will yield mean losses > or =15% of initial weight, as desired by many obese individuals.

Cosmetic surgery: surgical tools--psychosocial goals

What determines patients' goals for cosmetic surgery and their satisfaction with the outcome? Historical trends, body image theory, evolutionary biology, and clinical and experimental psychology each contribute answers. The physical changes that patients seek are typically a means to psychosocial goals. Individual objectives vary, but often share an origin in recurrent painful feelings, thoughts, or experiences. Surgical goals include: (1) changes in emotional states or cognitions; (2) improvement in interpersonal relationships; and (3) an altering of reactions of the larger society. Psychological studies of cosmetic surgery patients have been designed primarily to address two fundamental questions: (1) is there a preoperative psychological profile of cosmetic surgery patients; and (2) does cosmetic surgery produce enduring, beneficial psychological change? The use of specialized screening interview questions, and effective collaboration with mental health providers, help a wider range of patients achieve successful surgical outcomes.

The treatment of obesity: what's new, what's recommended

The prevalence of obesity in the United States has increased, with approximately one third of American men and women considered obese. Obese individuals who seek weight reduction frequently lose weight with the goal of returning to their ideal body weight. For the majority of obese persons, however, reaching their ideal body weight is an unattainable goal, few people are able to maintain even more modest weight losses over the long term. The result is that many obese persons end up feeling frustrated, if not defeated, by their weight loss efforts. Recent weight loss treatment recommendations have focused on helping patients lose 5%-10% of their body weight and maintaining these losses for longer durations. These more modest losses frequently are associated with reductions in obesity-related comorbidities and improvements in psychological status. The practitioner assisting obese individuals with weight reduction is presented with a variety of treatment options, including behavioral programs, pharmacotherapy, and low-calorie diets. Each of these approaches has been shown to be effective in producing the 5%-10% weight losses now recommended. A combination of these approaches, such as the use of pharmacotherapy with a behavioral modification program, ultimately may prove to be the most effective treatment for obese persons. We review the new weight loss recommendations and provide suggestions for assessing patients for weight loss treatment. We also discuss both existing and new treatment options and focus on their application in a primary care setting.

Behavioural treatment of the overweight patient

The goal of obesity treatment has changed significantly in the past decade. Where once the goal was a reduction to ideal weight, the current objective is the achievement of a healthier weight. For many obese individuals, this means losing as little as 5-15% of their initial weight. This article briefly describes behavioural methods to help obese individuals modify their eating and activity habits in order to achieve these new goals. A review of recent studies shows that patients treated by a comprehensive group behavioural programme lose approximately 9% of their initial weight in 20 weeks and, without further treatment, maintain a loss of 5% 1 year later. Methods of improving the maintenance of weight loss include increasing physical activity, extending the length of behavioural treatment and, with appropriately selected individuals, combining behavioural and pharmacological interventions. The importance of helping obese individuals adopt realistic treatment expectations is also discussed.

Adult psychological functioning of individuals born with craniofacial anomalies

This study represents an initial investigation into the adult psychological functioning of individuals born with craniofacial disfigurement. A total of 24 men and women born with a craniofacial anomaly completed paper and pencil measures of body image dissatisfaction, self-esteem, quality of life, and experiences of discrimination. An age- and gender-matched control group of 24 non-facially disfigured adults also completed the measures. As expected, craniofacially disfigured adults reported greater dissatisfaction with their facial appearance than did the control group. Craniofacially disfigured adults also reported significantly lower levels of self-esteem and quality of life. Dissatisfaction with facial appearance, self-esteem, and quality of life were related to self-ratings of physical attractiveness. More than one-third of craniofacially disfigured adults (38 percent) reported experiences of discrimination in employment or social settings. Among disfigured adults, psychological functioning was not related to number of surgeries, although the degree of residual facial deformity was related to increased dissatisfaction with facial appearance and greater experiences of discrimination. Results suggest that adults who were born with craniofacial disfigurement, as compared with non-facially disfigured adults, experience greater dissatisfaction with facial appearance and lower self-esteem and quality of life; however, these experiences do not seem to be universal.

A retrospective study of changes in physical symptoms and body image after reduction mammaplasty

Reduction mammaplasty is performed typically to alleviate the painful physical symptoms of macromastia. Women who suffer from macromastia also frequently present to the plastic surgeon with heightened body image dissatisfaction and maladaptive behavioral changes in response to their breast size. Numerous investigations have demonstrated improvement in physical symptoms after breast reduction surgery. Studies have also suggested that psychological improvement occurs postoperatively; however, they have not used well-validated, standardized psychological measures. The present study is a retrospective analysis of the physical and psychological status of women who underwent reduction mammaplasty. One hundred ten patients who underwent a reduction mammaplasty between 1982 and 1996 were mailed a packet of questionnaires designed to assess current physical symptoms and body image. Sixty-one of the 110 patients (55 percent) responded. The vast majority reported substantial improvement or elimination of neck, back, shoulder, and breast pain, grooving from bra straps, poor posture, skin irritation, and social embarrassment. In addition, they reported significantly less dissatisfaction with their breasts as compared with a sample of breast reduction patients assessed preoperatively. Symptom relief and improved body image occurred independently of preoperative body weight, as we found few significant differences between obese and non-obese women concerning the resolution of physical symptoms or improvement in body image. Results provide further evidence of the efficacy of reduction mammaplasty not only for relief of physical symptoms but also for alleviation of body image dissatisfaction.

Assessment of body image dissatisfaction in obese women: specificity, severity, and clinical significance

This study assessed the specificity, severity, and clinical significance of body image dissatisfaction in 79 obese women using the Body Dysmorphic Disorder Examination--Self-Report (J. C. Rosen & J. Reiter, 1996). The vast majority of obese women demonstrated body image dissatisfaction related to their obesity, with almost half reporting the greatest dissatisfaction with their waist or abdomen. On average, they reported significantly more body image dissatisfaction than did 43 nonobese controls. The 2 groups did not differ on self-reported symptoms of depression or self-esteem. Body image dissatisfaction correlated significantly with reports of depressive symptoms and lower self-esteem but was not correlated with body mass index. Results are discussed in terms of the role of body image dissatisfaction in understanding and treating obese individuals.

Assessment of body image dissatisfaction in obese women: specificity, severity, and clinical significance

This study assessed the specificity, severity, and clinical significance of body image dissatisfaction in 79 obese women using the Body Dysmorphic Disorder Examination--Self-Report (J. C. Rosen & J. Reiter, 1996). The vast majority of obese women demonstrated body image dissatisfaction related to their obesity, with almost half reporting the greatest dissatisfaction with their waist or abdomen. On average, they reported significantly more body image dissatisfaction than did 43 nonobese controls. The 2 groups did not differ on self-reported symptoms of depression or self-esteem. Body image dissatisfaction correlated significantly with reports of depressive symptoms and lower self-esteem but was not correlated with body mass index. Results are discussed in terms of the role of body image dissatisfaction in understanding and treating obese individuals.

Bigger is not always better: body image dissatisfaction in breast reduction and breast augmentation patients

This study investigated body image dissatisfaction in breast reduction and breast augmentation patients. Thirty breast reduction and 30 breast augmentation patients completed two body image measures preoperatively. Breast reduction patients reported greater dissatisfaction with their overall body image as compared with breast augmentation patients, part of which can be understood as a function of their increased body weight. When asked specifically about their breasts, reduction patients displayed increased body image dysphoria and maladaptive behavioral change, including embarrassment about their breasts in public areas and social settings and avoidance of physical activity. Results are discussed in the context of ideal body weight cutoffs by third-party payers for reimbursement for breast reduction. Recommendations for reimbursement criteria that de-emphasize the role of body weight are made.

Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients

This study was the first empirical investigation of body image dissatisfaction and body dysmorphic disorder in cosmetic surgery patients. Of 132 women, 100 women (response rate, 76 percent) completed two body image measures prior to surgery, the Multidimensional Body-Self Relations Questionnaire and the Body Dysmorphic Disorder Examination Self-Report. Cosmetic surgery patients did not demonstrate greater dissatisfaction with their overall appearance compared with the reported normal values of the measures. However, when asked about the specific bodily feature they were considering for cosmetic surgery, they reported significantly greater dissatisfaction than a normative sample. In addition, 7 percent of the sample met diagnostic criteria for body dysmorphic disorder, a potential psychiatric contraindication to cosmetic surgery. Implications of these findings are discussed with respect to the nature of body image dissatisfaction and the prevalence of body dysmorphic disorder in cosmetic surgery populations.

Body image concerns of reconstructive surgery patients: an underrecognized problem

This study assessed the body image concerns of reconstructive plastic surgery patients. Forty-three reconstructive surgery patients completed two measures of body image. Responses were compared with a group of patients seeking cosmetic procedures. The two groups did not differ in the degree of dissatisfaction with their overall appearance or dissatisfaction with the specific feature for which they were seeking surgery. Reconstructive patients did consider themselves less healthy and less invested in their appearance than did cosmetic patients. Seven of the reconstructive surgery patients (all scar revision patients) reported a level of dissatisfaction and preoccupation consistent with the psychiatric diagnostic of body dysmorphic disorder. These results underscore the importance of screening for body image dissatisfaction in persons with an objective deformity. Plastic surgeons are in an optimal position to identify body image concerns in these patients and provide appropriate referrals for psychotherapy.

Psychological investigations in cosmetic surgery: a look back and a look ahead

This article reviews the history of psychological investigations of cosmetic surgery patients. These studies have been designed to address two fundamental questions: (1) Are there "patient types" or forms of psychopathology that serve as contraindications to cosmetic surgery? and (2) What is the likelihood of psychological change following cosmetic surgery? This review suggests that the research has not fully answered these questions. In response, we propose a new direction for psychological investigation, focusing on issues of body image in cosmetic surgery patients. We discuss the relationship between body image and cosmetic surgery and pose several relevant questions for future research.

The "obsessive" cosmetic surgery patient: a consideration of body image dissatisfaction and body dysmorphic disorder

"Obsessive" cosmetic surgery patients often present as "hyper-focused" on their appearance. We may best be able to understand these patients through examining their thoughts and feelings about their body image. This paper reviews the relationship between physical appearance, body image dissatisfaction, and the pursuit of cosmetic surgery. An extreme form of body image dissatisfaction, Body Dysmorphic Disorder (BDD), which may characterize many "obsessive" patients, is also discussed. Recommendations for assessing patients' body image concerns include a comprehensive history as well as specific questions about appearance-related concerns.

Short- and long-term changes in serum leptin dieting obese women: effects of caloric restriction and weight loss

This study examined the effects of caloric restriction and weight loss on serum leptin concentrations in 49 obese women who participated in a 40-week weight loss program. During the first 12 weeks, half the subjects were provided a 1000 kcal/day low-calorie diet (LCD), compromised of portion-controlled foods, whereas the other half were prescribed a 1200 kcal/day balanced deficit diet (BDD) consisting of self-selected table foods. Thereafter, subjects in both conditions were instructed to consume approximately 1200-1800 kcal/day of self-selected foods, depending on their desired weight change. During the first 6 weeks, weight and serum leptin fell significantly more (P < 0.05) in women in the LCD condition than in the BDD condition. In the former group, the 55% reduction in baseline leptin was 10 times greater than the relative reduction in body weight. Stepwise multiple regression analysis revealed that degree of caloric restriction, but not weight loss, contribution significantly to the variance in the change in leptin at week 6. By contrast, long-term changes in leptin, when subjects had increased their calorie intake, were more strongly related to changes in weight and fat. At week 40, for example, weight loss account for 47% of the variance in the change in leptin. Serum leptin and body fat remained highly correlated after weight loss (r = 0.79, P < 0.001), as before (r = 0.66, P < 0.001). After treatment, however, we observed a greater-than-expected reduction in serum leptin concentrations, as expressed per kilogram of body fat. The significance of this finding remains to be determined.

The psychology of cosmetic surgery: a review and reconceptualization

This article discusses the psychology of cosmetic surgery. A review of the research on the psychological characteristics of individuals who seek cosmetic surgery yielded contradictory findings. Interview-based investigations revealed high levels of psychopathology in cosmetic surgery patients, whereas studies that used standardized measurements reported far less disturbance. It is difficult to fully resolve the discrepancy between these two sets of findings. We believe that investigating the construct of body image in cosmetic surgery patients will yield more useful findings. Thus, we propose a model of the relationship between body image dissatisfaction and cosmetic surgery and outline a research agenda based upon the model. Such research will generate information that is useful to the medical and mental health communities and, ultimately, the patients themselves.

Body image dissatisfaction in male cosmetic surgery patients

This study was the first empirical investigation of body image dissatisfaction in male cosmetic surgery patients. Thirty men completed two body image measures prior to their initial consultation. Results were compared to the norms for each of the measures and with a sample of 30 women seeking similar cosmetic procedures. Results indicated that patients did not demonstrate greater dissatisfaction with their overall appearance than men in a normative sample. However, when asked about the bodily feature they were considering for surgery, they reported significantly greater levels of dissatisfaction than the normative sample. As compared to male patients, female patients reported a greater investment in their physical appearance. Implications of these findings are discussed with respect to the nature of body image dissatisfaction and the relevance of body image in the psychology of male plastic surgery patients.

Psychological effects of weight cycling in obese persons: a review and research agenda

This review summarizes studies on the psychological effects of weight cycling (i.e., weight loss and regain) in obese persons and proposes an agenda for future research on this topic. Among general psychological constructs, the current literature suggests that weight cycling is not associated with depression, other psychopathology, or depressogenic cognitive styles. Weight cycling is associated with decreased perceptions of health and well-being, although the clinical significance of this relationship is uncertain. Among weight- and eating-related constructs, weight cycling does not appear to be related to restraint, hunger, or personality traits associated with eating disorders. Weight cycling, however, does appear to be associated with clinically significant reductions in eating self-efficacy and weak but consistent increases in binge eating severity. Definitive conclusions about the presence or absence of the psychological consequences of weight cycling are premature, given the small number of studies, as well as a variety of methodological and interpretive concerns. A new generation of research is necessary to determine the extent and nature of the psychological sequelae of weight cycling.

The relationship between childhood sexual abuse and adult male sexual dysfunction

OBJECTIVE

The present study investigated the relationship between childhood sexual abuse and adult sexual dysfunction in men. In addition, the investigation compared sexually abused men and women on the characteristics of the sexual abuse.

METHOD

Subjects were 359 men who sought sexual dysfunction treatment. Thirty men reported a history of sexual abuse. Characteristics of the sexual abuse experienced by these men also were compared to the sexual abuse experienced by 73 women initially investigated elsewhere (Sarwer & Durlak 1996).

RESULTS

Sexual abuse was not found to predict sexual dysfunction in these men. Rather, unemployment served as the only significant predictor of male sexual dysfunction. Comparisons of the sexual abuse reported by male and female victims indicated that males were more likely to experience physical force, but were less likely than female victims to be abused more than once and to be abused by an adult.

CONCLUSIONS

The results support the notion that childhood sexual abuse may not be as disruptive to adult sexual functioning in men as it is in women. This difference may be a function of the specific circumstances of the sexual abuse. Suggestions for future research on male sexual abuse are provided.

A field trial of the effectiveness of behavioral treatment for sexual dysfunctions

The present study was a field trial of behavioral sex therapy for 365 married couples presenting with a range of sexual dysfunctions. Treatment occurred at an outpatient sexual dysfunction clinic of a large medical center using a multidisciplinary staff. Findings supported the external validity of behavioral sex therapy. The success rate for the total sample (65%) was comparable to that of previous investigations, and there were very few dropouts (1.6%) from treatment. In addition, outcomes did not vary significantly as a function of diagnoses, gender, or a history of sexual abuse. The amount of sensate focus completed in the last week of treatment was the strongest predictor of successful treatment. For some diagnoses, however, couple comorbidity reduced treatment success. Results indicated that behavioral sex therapy is effective in real-world clinical settings.

Childhood sexual abuse as a predictor of adult female sexual dysfunction: a study of couples seeking sex therapy

The present study investigated 359 married adult women who sought sex therapy with their spouses. Discriminant function analyses indicated that childhood sexual abuse plus a college education significantly discriminated between women with and without a diagnosed sexual dysfunction. Among abused women, abuse involving sexual penetration significantly discriminated between dysfunctional and nondysfunctional women. Current findings confirm previous theory and research regarding a connection between childhood sexual abuse and adult female dysfunction. Furthermore, the findings suggest that abuse involving sexual penetration is specifically associated with adult sexual dysfunction. Between 75% to 94% of women with a sexual dysfunction could be accurately identified on the basis of prior abuse, but many nondysfunctional women were misclassified. Future research should examine additional variables that may contribute to sexual dysfunction such as levels of anxiety and depression, as well as features of the marital relationship such as marital satisfaction and communication skills.

Earvin "Magic" Johnson's HIV serostatus disclosure: effects on men's perceptions of AIDS

The effects of celebrity self-disclosure of human immunodeficiency virus (HIV) seropositivity on perceptions of HIV and Acquired Immunodeficiency Syndrome (AIDS) were investigated. AIDS-related interest and knowledge measures were collected from 468 men before and after basketball star Earvin "Magic" Johnson's self-disclosure of HIV seropositivity. Increased interest in AIDS paralleled media coverage of the announcement, with the most substantial effects occurring within 2 weeks. Perceived impact of the disclosure was greatest among African-American men and men who had not previously known someone with HIV-AIDS. Celebrity self-disclosure appears to affect perceptions through mechanisms similar to those involved in personally knowing someone infected with HIV.

Earvin "Magic" Johnson's HIV serostatus disclosure: effects on men's perceptions of AIDS

The effects of celebrity self-disclosure of human immunodeficiency virus (HIV) seropositivity on perceptions of HIV and Acquired Immunodeficiency Syndrome (AIDS) were investigated. AIDS-related interest and knowledge measures were collected from 468 men before and after basketball star Earvin "Magic" Johnson's self-disclosure of HIV seropositivity. Increased interest in AIDS paralleled media coverage of the announcement, with the most substantial effects occurring within 2 weeks. Perceived impact of the disclosure was greatest among African-American men and men who had not previously known someone with HIV-AIDS. Celebrity self-disclosure appears to affect perceptions through mechanisms similar to those involved in personally knowing someone infected with HIV.

Sexual aggression and love styles: an exploratory study

The relationship between sexual aggression and theoretical love styles was studied. Based on self-reported sexual history, 63 college men were grouped as having either consensual sexual experience only (n = 33) or having verbally coercive sexual experience (n = 30). Analyses were conducted using six love style scales, likelihood to rape, likelihood to use sexual force, masculinity, and sociopathy to predict sexual coercive group membership. Logistic regression indicated that the Ludus love style, a manipulative, game-playing orientation towards intimate relationships, was the best predictor of sexual coercion among the six love styles. Additionally, logistic regression indicated that the Ludus love style was as effective in classifying men as coercive or noncoercive as other dispositions related to sexual aggression. These results suggest that the Ludus love style may serve as a unifying construct for dispositions related to sexual aggression. This study constitutes an initial attempt to link sexually coercive behaviors to a theoretical model of intimate relationships. Results are discussed in the context of a situational model of sexual coercion.