Binge Eating (BE) and Obesity: Brain Activity and Psychological Measures before and after Roux-En-Y Gastric Bypass (RYGB)

Brain activity in response to food cues following Roux-En-Y Gastric Bypass (RYGB) in binge eating (BE) or non-binge eating (NB) individuals is understudied. Here, 15 RYGB (8 BE; 7 NB) and 13 no treatment (NT) (7 BE; 6 NB) women with obesity underwent fMRI imaging while viewing high and low energy density food (HEF and LEF, respectively) and non-food (NF) visual cues. A region of interest (ROI) analysis compared BE participants to NB participants in those undergoing RYGB surgery pre-surgery and 4 months post. Results were corrected for multiple comparisons using liberal (p < 0.006 uncorrected) and stringent (p < 0.05 FDR corrected) thresholds. Four months following RYGB (vs. no treatment (NT) control), both BE and NB participants showed greater reductions in blood oxygen level-dependent (BOLD) signals (a proxy of local brain activity) in the dorsomedial prefrontal cortex in response to HEF (vs. LEF) cues (p < 0.006). BE (vs. NB) participants showed greater increases in the precuneus (p < 0.006) and thalamic regions (p < 0.05 corrected) to food (vs. NF). For RYGB (vs. NT) participants, BE participants, but not NB participants, showed lower BOLD signal in the middle occipital gyrus (p < 0.006), whilst NB participants, but not BE participants, showed lower signal in inferior frontal gyrus (p < 0.006) in response to HEF (vs. LEF). Results suggest distinct neural mechanisms of RGYB in BE and may help lead to improved clinical treatments.

Illness intrusiveness: A key part of the cognition-mood link in multiple sclerosis

PURPOSE

The current study attempted to expand the literature on cognition and mood in MS by determining if illness intrusiveness may potentially serve as an intermediary factor in the well-established cognition-mood relationship in people with MS.

METHOD

This study employed a retrospective cross-sectional design to answer this question. Baseline neuropsychological test data and mood questionnaires from 199 participants with clinically definite MS were used in this study. The sample was middle-aged (M = 48.4, SD = 11.8), highly educated (M = 14.6, SD = 2.2), majority female (76.9%) and majority White (74.5%). Assumptions for parametric statistics and ordinary least squares regression were met. Conditional process models evaluated whether illness intrusiveness mediated the relationship between cognitive functioning and psychiatric symptoms.

RESULTS

In total, 33.2% of the sample met criteria for clinically significant anxiety, 41.7% met criteria for depression, and 27.8% of the sample met criteria for processing speed impairment, consistent with other MS samples. Illness intrusiveness was found to mediate the relationship between processing speed and depression, ab = -.07, 95% CI [-.15, -.002], processing speed and anxiety, ab = -.06, 95% CI [-.12, -.02], and processing speed and more general mood disturbance, ab = -.08, 95% CI [-.13, -.0005].

CONCLUSIONS

Illness intrusiveness was found to be a potential important intermediary mechanism by which the primary cognitive impairment in MS, processing speed, impacts mood in this disease population. Conclusions, treatment implications, and directions for future research in light of these findings were discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Relationship Between Age and Weight Loss in Noom: Quasi-Experimental Study

Background

The prevalence of obesity and diabetes among middle-aged and older adults is on the rise, and with an increase in the world population of adults aged 60 years and older, the demand for health interventions across age groups is growing. Noom is an mHealth behavior change lifestyle intervention that provides users with tracking features for food and exercise logging and weighing-in as well as access to a virtual 1:1 behavior change coach, support group, and daily curriculum that includes diet-, exercise-, and psychology-based content. Limited research has observed the effect of age on a mobile health (mHealth) lifestyle intervention.

Objective

The goal of the research was to analyze engagement of middle-aged and older adults using a mobile lifestyle or diabetes prevention intervention.

Methods

A total of 14,767 adults (aged 35 to 85 years) received one of two curricula via an mHealth intervention in a quasi-experimental study: the Healthy Weight program (HW) by Noom (84%) or the Noom-developed Diabetes Prevention Program (DPP), recognized by the US Centers for Disease Control and Prevention (CDC). The main outcome measure was weight over time, observed at baseline and weeks 16 and 52.

Results

Linear mixed modeling found age to be a significant predictor of weight at week 16 (F_2,1398.4=9.20; P<.001; baseline vs week 16: β=–.12, 95% CI –0.18 to –0.07), suggesting that as age increases by 1 year, weight decreased by 0.12 kg. An interaction between engagement and age was also found at week 52 (F_1,14680.51=6.70; P=.01) such that engagement was more strongly associated with weight for younger versus older adults (age × engagement: β=.02, 95% CI 0.01 to 0.04). HW users lost 6.24 (SD 6.73) kg or 5.2% of their body weight and DPP users lost 5.66 (SD 7.16) kg or 8.1% of their body weight at week 52, meeting the CDC standards for weight loss effects on health.

Conclusions

Age and engagement are significant predictors of weight. Older adults lost more weight using an mHealth evidence-based lifestyle intervention compared with younger adults, despite their engagement. These preliminary findings suggest further clinical implications for adapting the program to older adults’ needs.

Examining Food Addiction and Acculturation Among a Hispanic Bariatric Surgery-Seeking Participant Group

OBJECTIVE

This study examined food addiction (FA) and acculturation among a Hispanic bariatric surgery-seeking sample.

SETTING

University hospital.

METHOD

Four hundred forty-four (n = 215 English-speaking; n = 229 Spanish-speaking) Hispanic adults seeking bariatric surgery completed established self-report measures examining food addiction and acculturation.

RESULTS

35.8% met criteria for FA, which was significantly associated with acculturation level to the USA. Participants who endorsed greater acculturation also endorsed a significantly higher level of FA symptoms compared with those who endorsed less acculturation. Acculturation level was significantly associated with FA and BMI.

CONCLUSIONS

FA rate in this bariatric surgery-seeking Hispanic patient group is similar to rates reported among bariatric candidates of varying ethnic backgrounds. Our results suggest a relationship between FA symptom expression and acculturation to the USA. Improving understanding of the onset and progression of severity of FA symptoms may have clinical implications for Hispanic patients seeking bariatric surgery.

Triggers of Lapse and Relapse of Diet and Exercise in Behavioral Weight Loss

OBJECTIVE

This study aimed to (1) develop instruments to evaluate situations that lead to lapse and relapse in diet and exercise and (2) prospectively investigate when and which psychosocial situations predict failure to lose weight in a clinical trial of intentional weight loss.

METHODS

Participants were 469 individuals with overweight or obesity participating in a behavioral weight loss program (age: mean = 53.6 years, SD = 11.4; BMI: mean = 35.7 kg/m² , SD = 6.5).

RESULTS

The Cronbach alphas for the Diet Lapse and Relapse Triggers Scale and the Exercise Lapse and Relapse Triggers Scale were 0.93 and 0.91, respectively. Subscale alphas ranged from 0.60 to 0.96. Lapse and relapse were assessed at 3 and 9 months for associations with weight loss at 12 months. At 9 months, diet triggers were negative emotional states (beta = 0.11, P = 0.02) and urges (beta = 0.14, P = 0.01). Predicted social situations showed the opposite (beta = -0.09, P = 0.02). Exercise subscales were all nonsignificant.

CONCLUSIONS

Findings suggest the ongoing importance of addressing negative emotional states and the contributing influence of urges. The novel finding that participants whose difficulties arise in social situations may do better over time requires further study.

Caloric Intake on the Sabbath: A Pilot Study of Contributing Factors to Obesity in the Orthodox Jewish Community

The American Orthodox Jewish community has specific cultural factors that may contribute to overweight and obesity. This study aimed to look at caloric intake on the Sabbath and its contribution to overweight and obesity. Twelve married or previously married women who identify themselves as Orthodox Jews were recruited to do 24-h food recalls over the phone. The participants were divided into three weight groups (normal, overweight, and obese) based on their BMI. The overweight and obese participants' data were combined into one group for the purposes of statistical testing. Paired t tests looking at the data for all participants showed significantly great caloric intake during an average Sabbath day than an average weekday [t(4) = 7.58, p < 0.001]. A repeated-measures ANOVA showed significantly greater energy intake on the Sabbath for the overweight-obese women compared to the normal weight women [F(1) = 7.83, p = 0.02]. No statistical difference was seen between the weekday energy intake of the normal weight women as compared to the combined group of overweight-obese women [F(1) = 0.501, p = 0.499]. These results support the hypotheses that all groups eat significantly more on the Sabbath than on weekdays, and overweight and obese individuals eat significantly more on the Sabbath than normal weight individuals. This supports the theory that caloric intake on the Sabbath is a contributing factor to overweight and obesity within the American Orthodox Jewish community.

Point-of-Purchase Calorie Labeling Has Little Influence on Calories Ordered Regardless of Body Mass Index

The obesity epidemic has incited legislation aimed to inform consumers of the nutritional value of food items available in restaurants and fast food establishments, with the presumption that knowing the caloric content in a meal might enable patrons to make healthier choices when ordering. However, available research shows mixed results regarding consumers' use of calorie information to promote healthier purchases. The aim of this study was to determine whether menu type, specifically having viewed a menu with calorie disclosures or not, would have an impact on how many calories were in a lunch meal ordered by a patron. Additionally, we sought to identify body mass index (BMI) as a moderator of the relationship between viewing a menu with or without calorie information and the number of calories an individual orders for lunch. Two hundred forty-five adults participated in the study and completed the questionnaire. Results indicated neither menu type, nor reporting having seen calorie information, was significantly related to the number of calories in the foods that participants ordered, even after controlling demographic variables age, sex, income, education, race/ethnicity, and BMI. BMI did not serve as a moderator in the relationship between menu type and food calories ordered. Implications for policy change and clinical work with overweight and obese patients are discussed.

Social anxiety and disordered overeating: an association among overweight and obese individuals

OBJECTIVE

The study objectives were to evaluate the relationship between social anxiety, binge eating, and emotional eating in overweight and obese individuals and to evaluate the relationship between weight and social anxiety.

METHODS

Using an internet based survey, overweight and obese men and women (n=231; mean age=36.0±12.8; mean BMI=33.7 kg/m(2)±6.7) completed several self-report measures including: social anxiety, social physique anxiety, binge eating, and emotional eating. The relationships among variables were evaluated using Spearman's correlations, ANOVAs, and linear and logistic regression equations.

RESULTS

Clinically significant levels of social anxiety were reported in 59% of participants, and binge eating disorder criteria were met by 13%. Social anxiety was significantly associated with binge eating (r=.36; OR=1.06, CI=1.02-1.10) and emotional eating (r=.46; β=0.36), but was not associated with restrained eating. The association between social physique anxiety and emotional and binge eating did not remain significant in regression equations. BMI was associated with binge eating (r=.19) but not emotional eating. Level of social anxiety was not significantly higher among extremely obese participants, compared to overweight and obese participants.

CONCLUSIONS

In this study, social anxiety was associated with binge eating and emotional eating in overweight and obese men and women. When appropriate, interventions could address social anxiety as a barrier to normative eating patterns and weight loss.

Weight change, psychological well-being, and vitality in adults participating in a cognitive-behavioral weight loss program

OBJECTIVE

Excess weight has been associated with numerous psychological problems, including depression and anxiety. This study examined the impact of intentional weight loss on the psychological well-being of adults participating in three clinical weight loss interventions.

METHODS

This population consisted of 588 overweight or obese individuals randomized into one of three weight loss interventions of incremental intensity for 12 months. Psychological well-being was measured at baseline and 6, and 12 months using the Psychological Well-Being Index.

RESULTS

Mean weight loss was 5.0 pounds at 12 months. Weight change at 12 months was associated with higher overall psychological well-being (r = -.20, p < .001), lower levels of anxiety (r = -.16, p = .001) and depression (r = -.13, p = .004), and higher positive well-being (r = -.19, p < .001), self-control (r = -.13, p = .004), and vitality (r = -.22, p < .001). Vitality was found to be the best predictor of weight change at 12 months (p < .001).

CONCLUSIONS

Weight loss was associated with positive changes in psychological well-being. Increased vitality contributed the largest percentage of variance to this change.

Addictive personality and maladaptive eating behaviors in adults seeking bariatric surgery

This study examined the relationship between addictive personality and maladaptive eating behaviors in bariatric surgery candidates. Ninety-seven bariatric surgery candidates completed the Eysenck Personality Questionnaire (EPQ-R) Addiction Scale, the Overeating Questionnaire (OQ), binge-eating questions from the Questionnaire of Eating and Weight Patterns (QEWP-R), and the Eating Attitudes and Behaviors Questionnaire. Participants with Binge Eating Disorder (BED) displayed addictive personality scores comparable to individuals addicted to substances (M=17.5, SD=5.3). Addictive personality was associated with Overeating (r=.45, p<.001), Cravings (r=.31, p=.005), Affective Disturbances (r=.62, p<.001) and Social Isolation (r=.53, p<.001). Addictive personality was associated with maladaptive eating behaviors, suggesting the potential for addictive eating.

Maladaptive eating patterns, quality of life, and weight outcomes following gastric bypass: results of an Internet survey

Bariatric surgery is the most effective treatment for severe obesity. However, evidence suggests that maladaptive eating behaviors such as binge eating, grazing, and a loss of control when eating may impact postsurgical weight outcomes. The current study sought to characterize the weight outcomes, eating patterns, and perceived health-related quality of life of individuals 3-10 years following gastric bypass (GBP) surgery and to assess the relationships between eating behaviors, weight outcomes, and quality of life. Eligible participants (N = 497) completed an Internet survey of their eating behaviors, health-related quality of life, and weight history. Participants self-reported a mean maximum postsurgical loss of 81% of their excess weight and maintained a mean weight loss of 70% 3-10 years following surgery (mean 4.2 years). Eighty-seven percent reported weight regain ranging from 1 to 124 lb (mean 22.6 lb). Frequency of binge eating, a loss of control when eating, and grazing were all significantly correlated with greater weight regain (binge eating r = 0.24, P = 0.006; loss of control r = 0.36, P < 0.01; grazing r = 0.39, P < 0.001) and lesser excess weight loss (EWL) (binge eating r = -0.21, P = 0.013; loss of control r = -0.41, P < 0.001; grazing r = -0.27, P < 0.001). Poorer health-related quality of life was associated with binge eating disorder (BED) (t[463] = 9.7, P < 0.001) and grazing two or more times per week (t[361] = 9.0, P < 0.001). These findings suggest that eating disturbances and a loss of control when eating are significant following GBP and are risk factors for diminished weight outcomes.

The relationship between religion and cardiovascular outcomes and all-cause mortality in the Women's Health Initiative Observational Study

Some studies suggest that religiosity may be related to health outcomes. The current investigation, involving 92,395 Women's Health Initiative Observational Study participants, examined the prospective association of religious affiliation, religious service attendance, and strength and comfort from religion with subsequent cardiovascular outcomes and death. Baseline characteristics and responses to religiosity questions were collected at enrollment. Women were followed for an average of 7.7 years and outcomes were judged by physician adjudicators. Cox proportional regression models were run to obtain hazard ratios (HR) of religiosity variables and coronary heart disease (CHD) and death. After controlling for demographic, socioeconomic, and prior health variables, self-report of religious affiliation, frequent religious service attendance, and religious strength and comfort were associated with reduced risk of all-cause mortality [HR for religious affiliation = 0.84; 95% confidence interval (CI): 0.75-0.93] [HR for service attendance = 0.80; CI: 0.73-0.87] [HR for strength and comfort = 0.89; CI: 0.82-0.98]. However, these religion-related variables were not associated with reduced risk of CHD morbidity and mortality. In fact, self-report of religiosity was associated with increased risk of this outcome in some models. In conclusion, although self-report measures of religiosity were not associated with reduced risk of CHD morbidity and mortality, these measures were associated with reduced risk of all-cause mortality.

The effect of bioterrorism messages on anxiety levels

Public health messages sometimes use graphic language to discourage health-adverse behaviors. However, such messages could provoke adverse stress and anxiety reactions. To assess whether public health messages on bioterrorism might measurably increase stress and anxiety, we conducted a randomized controlled trial in which potent and neutral messages were randomly allocated to 116 graduate students. Pre- and post-message anxiety scores of the State-Trait Anxiety Inventory (STAI), a validated instrument, were recorded, and within- and between-group score changes compared. Reading the potent message significantly (p=.003) elevated STAI anxiety scores, while reading the neutral messages decreased scores (p<.001). The between-group difference was also statistically significant (p=.001). Potent smoking and drunk-driving cessation messages have clear benefits, but messages about bioterrorism do not. Our findings provide evidence that such messages have at least the potential of harm, so that weighing benefits and risks of such messages is warranted.

Is perceived family dysfunction related to comorbid psychopathology? A study at an eating disorder day treatment program

The role of the family in the development of eating disorders has been a predominant research focus. However, few studies of patients in an eating disorder (ED) day treatment program (DTP) have explored the relationship between self-reported family system functioning, self-reported comorbid psychopathology and current comorbid psychological symptom status. This study examined patients at presentation to an ED DTP, their self-reported perception of family functioning and the relationship with characteristics of their own comorbid psychopathology characteristics. Medical records of 51 day treatment female patients, ranging in age from 12 to 26 years, were examined by ED diagnosis and family type (using the FACES-II), and for significant differences on four self-report measures: SCL-90, EDI-2, BDI and TAS-20. Using MANOVA analyses and Bonferroni comparisons, significant differences on the self-report instruments for the entire sample and for the AN and BN patients were obtained when studying patients within different family types as defined by FACES-II. These data specific to DTP patients support previous findings for both IP and OP ED family studies. Overall, as family functioning was perceived to be more dysfunctional, the level of self-reported eating pathology and current comorbid psychological symptoms was also more severe.

Cognitive-behavioral approaches in the management of obesity

Many of the behavioral interventions designed to promote dietary change in individuals include medical assessment, initial assessment of diet history, assessing readiness, establishing dietary goals, self-monitoring, stimulus control training, training in problem solving, relapse prevention training, enlisting social support, nutrition education, dietary therapy, and ongoing contact to maintain progress. The comprehensive nature of a cognitive-behavioral weight management program is of value in modifying behaviors that are linked to adverse health effects and psychological distresses, without necessarily causing a drastic weight loss in obese individuals. The behavioral treatments for overweight and obesity directly modify behaviors that bear on health and illness, such as improving dietary choices, decreasing sedentary behaviors, and increasing habitual physical activity and exercises. Cognitive-behavioral treatment can be used to help overweight adolescents become more assertive in coping with the adverse social stigma of being overweight, enhance their self-esteem, and reduce their dissatisfaction with body image regardless of their weight loss. Cognitive-behavioral treatments seem to be more effective in children when delivered before puberty than they are for adults.

The relationship between eating pathology and perceived family functioning in eating disorder patients in a day treatment program

This study examines the perceived levels of family functioning and their relationships with eating pathology across three eating disorder diagnostic groups. Charts of 65 day treatment female patients, ranging in age from 12 to 27 years, were studied by diagnosis and assessed using the FACES-II and EDI-2. Using multiple regression analyses, it was determined that perceived family functioning yielded significant predictions for various EDI-2 subscales within both Anorexia Nervosa and Eating Disorder Not Otherwise Specified diagnoses. Significant correlations were found between FACESII and the EDI-2 for all three diagnostic groups. Using ANOVA analyses and Bonferroni comparisons, significant differences among diagnoses on the EDI-2 subscales were obtained when studying patients within different family types as defined by FACES-II. These data support previous findings that suggest that as family functioning is perceived to be more dysfunctional the severity level of eating pathology increases.

Computerized weight loss intervention optimizes staff time: the clinical and cost results of a controlled clinical trial conducted in a managed care setting

OBJECTIVE

To evaluate the costs and effects of incremental components of a weight-loss program.

DESIGN

A 3-arm, 12-month randomized controlled clinical trial to evaluate 3 incremental levels of intervention intensity.

SUBJECTS/SETTING

The study included 588 individuals (BMI > 25 kg/m2) in a freestanding health maintenance organizalion and achieved an 81% completion rate.

INTERVENTION

Using a cognitive behavioral approach for tailoring lifestyle modification goals, the incremental levels of intervention included a) a workbook alone, b) the addition of computerized tailoring using onsite computer kiosks with touch screen monitors, and c) the addition of both computers and staff consultation.

MAIN OUTCOME MEASURES

Endpoints included weight parameters, lipid profile, plasma glucose, blood pressure, intervention costs, dietary intake, and physical activity.

STATISTICAL ANALYSIS PERFORMED

Study endpoints were analyzed using analysis of variance for normally distributed variables and analysis of covariance to control for any baseline differences. Regression and correlation analysis assessed the relationship between weight loss and other variables.

RESULTS

For the increasing levels of intervention intensity, the mean 12-month weight losses were 2.2, 4.7, and 7.4 pounds, with the respective cost per participant being $12.33, $41.99, and $133.74. The decreases in mean BMIs for these respective intervelation levels were 0.4, 0.9 and 1.2. All groups reported a decrease in energy and fat intake and an increase in blocks walked (P<.01). Intervention variables that correlated with weight loss included more computer log-ons, achieving computer-selected goals, more self-monitoring, increased walking, and decreased energy and fat intake, as well as higher attendance in staff consultation group sessions for that treatment condition. Weight loss correlated with decreases in fasting glucose and blood pressure.

APPLICATIONS/CONCLUSIONS

In a weight-loss program, computers can facilitate selecting behavioral change goals. More frequent usage resulted in greater weight loss. Staff counseling to augment the computer intervention achieved the most weight loss.

Estimating software development costs for a patient multimedia education project

The authors compare alternative methods of cost estimation for a patient multimedia education (PME) program, using a computerized weight-reduction PME project as an example. Data from the project planning and budgeting process and actual costs of the completed project are analyzed retrospectively to calculate three different estimates-pre-work, post-work, and actual work. Three traditional methods of estimating the cost of computer programs (the lines-of-code, function point, and task ratio analyses) underestimate costs in this example. A commercial program (Cost Xpert) that calculates the cost of developing a graphical user interface provided a better estimate, as did a tally reflecting the complexity and quality of media material in the project.

The DIET study: long-term outcomes of a cognitive-behavioral weight-control intervention in independent-living elders. Dietary Intervention: Evaluation of Technology

OBJECTIVE

To describe the long-term outcomes of a cognitive-behavioral weight-control intervention implemented in a community-based sample of independent-living, older adults.

DESIGN

A quasi-experimental design was used to compare an intervention community with a wait-listed control community. Comparisons between the communities were made at 40 weeks (J Am Diet Assoc. 1994;94:37-42). The controlled trial ended at 40 weeks; then both communities received 2 years of intervention. Two-year data from both communities were combined and are presented in this article. Three-year outcome data from the initial intervention community were available and are also presented.

SUBJECTS

A total of 247 overweight (> 4.5 kg of age-adjusted weight), older (mean age = 71 years) adults in 2 independent-living retirement communities participated in the study.

INTERVENTION

The Dietary Intervention: Evaluation of Technology (DIET) study consisted of an intensive 10-week psychoeducational approach focused on lifestyle change, followed by a less intensive 2-year phase focusing on relapse prevention and maintenance of lifestyle changes.

OUTCOME MEASURES

Physiologic and behavioral variables were analyzed at baseline and at 2 years after baseline. This article reports the combined 2-year outcome data from both retirement communities. Results of an additional follow-up 1 year after intervention was withdrawn are reported for the initial intervention community.

STATISTICAL ANALYSIS

A within-subjects repeated measures analysis of variance design was used to test for significant changes in weight and lipid values over time.

RESULTS

At 2 years, 70% of those who started the intervention remained actively enrolled. This group showed significant decreases in body mass index (-1.2, P < .001) and glucose level (-0.80 mmol/L, P < .001). Although high-density lipoprotein cholesterol (HDL-C) levels had increased at 40 weeks after baseline, this was not maintained at 2 years. At the 3-year follow-up, changes in body mass index and glucose level were maintained.

APPLICATIONS/CONCLUSIONS

The purpose of this article was to describe the long-term outcomes of a community-based weight-reduction intervention for older adults. The findings may be of interest to clinicians who design community or worksite weight-reduction programs. Although the intervention was designed to be a low-intensity program, attrition over the length of the study was still problematic. Nevertheless, our follow-up study indicates that this intervention was efficacious in maintaining reductions in weight and glucose levels for overweight older adults for 3 years.

Electromyographic comparisons of the pelvic floor in women with dysesthetic vulvodynia and asymptomatic women

OBJECTIVE

To compare surface electromyographic (EMG) studies of the pelvic floor in women diagnosed with dysesthetic vulvodynia to those of women with no urologic or gynecologic symptoms.

STUDY DESIGN

Fifty women were chosen to participate and placed in one of two diagnostic categories, asymptomatic (no report of urogynecologic abnormalities, n = 25) and those diagnosed with dysesthetic vulvodynia (n = 25). Testing was completed utilizing electromyographic equipment; an inserted, single-user vaginal sensor; and the Glazer protocol. sEMG variables compared were pretest and posttest resting amplitudes, contractile amplitudes, contractile and resting stability, recruitment latency and recovery, and muscle contraction spectral analysis.

RESULTS

The most reliable predictors of symptomatic women were pelvic floor contractile amplitudes of the tonic, phasic and endurance contractions, though 9 of the 15 variables tested proved significant. The phasic (three-second) contractions of the symptomatic group were 46% less than in the pain-free group. Tonic (12-second) contractions were 49% less, and endurance (60-second) contractions proved to be only 47% of those produced by those with no dysfunction.

CONCLUSION

The results of EMG studies of the pelvic floor in women diagnosed with dysesthetic vulvodynia proved significantly different from those of their urogynecologically asymptomatic cohorts. Physiology of the pelvic floor is an essential piece of knowledge needed to further study the etiology and causative factors in dysesthetic vulvodynia. Though the sample size used in this study was not sufficient to quantify normal pelvic floor function, the study certainly suggests sufficient significant differences between the two groups to merit further study.

Treatment of vulvar vestibulitis syndrome with electromyographic biofeedback of pelvic floor musculature

Thirty-three women diagnosed as suffering from vulvar vestibulitis syndrome, marked by a significant history of long-term moderate to severe chronic introital dyspareunia and tenderness of the vulvar vestibule, were selected for treatment. Patients were given a computerized electromyographic evaluation of the pelvic floor muscles and were then provided with portable electromyographic biofeedback instrumentation and instructions on the conduct of daily, at-home, biofeedback-assisted pelvic floor muscle rehabilitation exercises. They received intermittent evaluations of pelvic floor muscles to ensure compliance and monitor their progress and symptom changes. The results show that after an average of 16 weeks of practice, pelvic floor muscle contractions increased 95.4%, resting tension levels decreased 68%, and the instability of the muscle at rest decreased by 62%. Subjective reports of pain decreased an average of 83%. Twenty-eight patients had abstained from intercourse for an average of 13 months. Twenty-two of these 28 patients resumed intercourse by the end of the treatment period. Six month follow-up indicated maintenance of therapeutic benefits.

A weight reduction intervention that optimizes use of practitioner's time, lowers glucose level, and raises HDL cholesterol level in older adults

OBJECTIVE

The effects of a cognitive-behavioral weight control intervention were compared in two independent-living, older adult (mean age = 70.5 years) communities.

DESIGN

The research design compared the experimental community (n = 163), which received the intervention, with the control community (n = 162).

SUBJECTS

Overweight individuals (> 4.5 kg of age-adjusted weight according to height-weight tables) were recruited from both communities.

INTERVENTION

Components of the Dietary Intervention: Evaluation of Technology (DIET) program included a video-tape, a workbook, computerized tracking of participants, a telephone hot line, educational group discussions, and individual consultation.

OUTCOME MEASURES

Changes in body weight, body mass index, and lipid and glucose measures were selected to evaluate the effectiveness of the intervention.

STATISTICAL ANALYSIS

One-way analysis of variance by group was done to compare changes in continuous variables between the intervention and control communities.

RESULTS

Baseline body mass index and weight were 30.8 and 79.5 kg, respectively, in the experimental community and 28.8 and 75.8 kg, respectively, in the control community. Mean weight change in the experimental community was -3.2 kg after 40 weeks of intervention, compared with no weight change in the control community (P < .0001). Mean plasma glucose level decreased -0.3 mmol/L and mean high-density lipoprotein cholesterol level increased 0.15 mmol/L in the experimental community, compared with no change in lipid parameter and a +0.3 mmol increase in glucose level in the control community (P < .0001).

APPLICATIONS

Our findings suggest that an intervention that optimizes use of the practitioner's time can achieve a moderate weight loss and metabolic improvement in a community of older adults.

The effect of dietary changes and intentional weight loss on high density cholesterol levels in older adults

The effect of a behaviorally-oriented program to reduce calories and increase physical activity on HDL cholesterol level was evaluated in overweight older adult subjects (n = 31). HDL cholesterol increased from 45.8 to 52.1 mg/dl (p < .0003), and total mean cholesterol increased from 238.0 to 249.5 mg/dl (p < .05). Body weight decreased from 175.0 lbs to 172.6 lbs (p < .03). Analysis of baseline and 40 week food frequency questionnaires indicated that the mean caloric intake had decreased from 1535 to 1303 kcal/day (p < .02), and total fat intake decreased by 9.8 gm/day (p < .01). Weight loss accounted for 13% of the variance in HDL cholesterol change (p < .05). Decreasing fat intake resulted in a smaller increase in HDL cholesterol (F, (1,29) = 5.91, p < .03). Our findings provide further support that a prudent approach to weight reduction can be beneficial in an older adult population.

Effect of antihypertensives on sexual function and quality of life: the TAIM Study

OBJECTIVE

To evaluate treatment of mild hypertension using combinations of diet and low-dose pharmacologic therapies.

DESIGN

Multicenter, randomized, placebo-controlled clinical trial.

SETTING

Three university-based tertiary care centers.

PATIENTS

Patients (697) 21 to 65 years of age with diastolic blood pressure between 90 and 100 mm Hg as well as weight between 110% and 160% of ideal weight.

INTERVENTION

Patients were stratified by clinical center and race and were randomly assigned to one of three diets (usual, low-sodium and high-potassium, weight loss) and one of three agents (placebo, chlorthalidone, and atenolol).

MEASUREMENTS

Changes in measures of sexual problems, distress, and well-being after 6 months of therapy were analyzed.

MAIN RESULTS

Low-dose chlorthalidone and atenolol produced few side effects, except in men. Erection-related problems worsened in 28% (95% CI, 15% to 41%) of men receiving chlorthalidone and usual diet compared with 3% (CI, 0% to 9%) of those receiving placebo and usual diet (P = 0.009) and 11% (CI, 2% to 20%) of those receiving atenolol and usual diet (P greater than 0.05). The weight loss diet ameliorated this effect. The low-sodium diet with placebo was associated with greater fatigue (34%; CI, 23% to 45%) than was either usual diet (18%; CI, 10% to 27%; P = 0.04) or weight reduction (15%; CI, 7% to 23%; P = 0.009). The low-sodium diet with chlorthalidone increased problems with sleep (32%; CI, 22% to 42%) compared with chlorthalidone and usual diet (16%; CI, 8% to 24%; P = 0.04). The weight loss diet benefited quality of life most, reducing total physical complaints (P less than 0.001) and increasing satisfaction with health (P less than 0.001). Total physical complaints decreased in 57% to 76% of patients depending on drug and diet group, and were markedly decreased by weight loss.

CONCLUSION

In general, low-dose antihypertensive drug therapy (with chlorthalidone or atenolol) improves rather than impairs the quality of life; however, chlorthalidone with usual diet increases sexual problems in men.

Weight reduction in the prevention and treatment of hypertension: a review of representative clinical trials

Elevated blood pressure is a risk factor for cardiovascular disease, and weight reduction is currently advocated as a nonpharmacologic approach for the management of hypertension. Results of clinical trials indicate weight reduction is effective in preventing and treating hypertension. Knowledge of the results of clinical trials is extremely important for health educators since: 1) these findings provide a scientific basis for educating other health professionals about the beneficial effects of dietary approaches to the management of hypertension; 2) discussion of these results with patients may provide a means for altering patients' expectations and achieving improved treatment compliance; and 3) the processes by which clinical trials have achieved their dietary goals can provide health educators with extensive clinical experience upon which to draw in working with nonstudy patients. The content and general results of clinical trial programs are reviewed as well as features associated with health promotion in clinical trial and behavioral weight loss research.

Trial of antihypertensive interventions and management. Design, methods, and selected baseline results

The Trial of Antihypertensive Interventions and Management was a multicenter randomized, placebo-controlled trial designed to assess the effectiveness of various combinations of pharmacologic and dietary interventions in the treatment of mild hypertension (diastolic blood pressure 90-100 mmHg). The primary outcome was blood pressure change between baseline and 6 months. The study consisted of a 3 X 3 factorial design wherein participants were randomly allocated to nine drug-diet treatment groups. Drugs included placebo, diuretic, and beta-blocker. Diets were usual, weight loss, and low sodium/high potassium. The basic strategy was to address clinical questions of interest by comparing mean blood pressure changes of selected drug-diet combinations. This paper describes the study including experimental design, sample size considerations, statistical analysis, organizational structure, and baseline findings.

Reduction of physiological, behavioral, and self-report responses in type A behavior: a preliminary report

Recent reports indicate that Type A Behavior may be reducible by behavioral and other psychotherapeutic methods. To date, however, there has been virtually no demonstration of reduction of the actual, observed behavior. Furthermore, the physiologic hyperresponsiveness that seems to characterize many Type A individuals when under stress, has received relatively little therapeutic attention. This preliminary, uncontrolled report describes a cognitive-behavioral group intervention program, before and after which patients underwent assessment on physiologic, behavioral, and self-report assessments. These included heart rate and blood pressure responsiveness under stressful conditions, trained observer ratings of Type A Behavior, and a variety of subjective measures of Type A Behavior and psychological distress and symptoms. Results showed limited improvement on most behavioral and self-report indices. Relatively greater reduction of Type A Behavior was associated with higher pre-treatment levels of Type A Behavior, with the absence of coronary artery disease and with male gender.