Bonnie J. Brehm

This study examined associations among eating disorder characteristics, excessive exercise, and selected psychological attributes in college students (N = 499). Male and female participants were recruited from university psychology courses and administered the Obligatory Exercise Questionnaire (OEQ), Mental Health Inventory, Eating Self-Efficacy Scale, Revised Restraint Scale, and Eating Disorder Inventory. Results confirmed the multidimensionality of excessive exercise for both males and females. Profiles of male and female exercisers were developed based on the clustering of scores on the OEQ’s factor analytically derived subscales. Specific qualitative aspects of exercise (e.g., emotionality and obsession), rather than the quantity of exercise, were found to be associated with eating disorder traits and, for some groups, psychological distress (PD). For other groups, such as female excessive exercisers, exercise seems to act as a coping mechanism, thereby lessening PD and enhancing well-being.

Purpose: To determine the effects of an environmental intervention on obesity, disease risk factors, and dietary intake in an employee population. Design: Randomized controlled community trial. Setting: Eight manufacturing companies in Kentucky with ~ 150 to 350 employees each. Subjects: Randomly selected employees. Intervention: Multicomponent environmental intervention that included employee advisory committees, point-of-decision prompts, walking paths, cafeteria/vending changes, and educational materials. Measures: Height; weight; body fat; blood pressure; fasting lipids, glucose and insulin; and dietary intake were assessed prior to and 3, 6, and 12 months after initiation of the intervention. Analysis: Mixed-model repeat-measure analyses of covariance were used to analyze data collected over the study period. Categorical data were analyzed in contingency tables. A p value of .05 was used to judge statistical significance. Results: There were no intervention effects for outcome variables, with the exception of lower intake of saturated fat and dietary cholesterol in the intervention group compared to the control group. Over the course of the study, changes in anthropometry and biomeasures were similar in both groups. Conclusions: Findings indicate that subtle environmental changes alone may not impact employees' weight and health; however, such institutional-level approaches may be essential to support healthy lifestyle habits that are initiated by more intensive efforts. Academic researchers should continue to partner with employers and practitioners to develop, implement, and evaluate innovative health promotion strategies including environmental interventions. (Am J Health Promot 2011;25[5]:334-340.)

OBJECTIVE—The purpose of this study was to compare the effects of high–monounsaturated fatty acid (MUFA) and high-carbohydrate (CHO) diets on body weight and glycemic control in men and women with type 2 diabetes. RESEARCH DESIGN AND METHODS—Overweight/obese participants with type 2 diabetes (n = 124, age = 56.5 ± 0.8 years, BMI = 35.9 ± 0.3 kg/m2, and A1C = 7.3 ± 0.1%) were randomly assigned to 1 year of a high-MUFA or high-CHO diet. Anthropometric and metabolic parameters were assessed at baseline and after 4, 8, and 12 months of dieting. RESULTS—Baseline characteristics were similar between the treatment groups. The overall retention rate for 1 year was 77% (69% for the high-MUFA group and 84% for the high-CHO group; P = 0.06). Based on food records, both groups had similar energy intake but a significant difference in MUFA intake. Both groups had similar weight loss over 1 year (−4.0 ± 0.8 vs. −3.8 ± 0.6 kg) and comparable improvement in body fat, waist circumference, diastolic blood pressure, HDL cholesterol, A1C, and fasting glucose and insulin. There were no differences in these parameters between the groups. A follow-up assessment of a subset of participants (n = 36) was conducted 18 months after completion of the 52-week diet. These participants maintained their weight loss and A1C during the follow-up period. CONCLUSIONS—In individuals with type 2 diabetes, high-MUFA diets are an alternative to conventional lower-fat, high-CHO diets with comparable beneficial effects on body weight, body composition, cardiovascular risk factors, and glycemic control.

High-protein diets, often with carbohydrate restriction, are quite popular among overweight Americans pursuing strategies for weight control. Recently, well designed clinical trials have evaluated the anthropometric and metabolic effects of these diets. This review focuses on the impact of high-protein diets on energy expenditure and satiety; the diets' effects on weight loss, body composition, cardiovascular risk, and glycemic control; and potential detrimental consequences of high-protein intake. Current evidence indicates that protein-induced energy expenditure and satiety contribute to weight control. Randomized, controlled trials continue to show comparable, if not superior, effects of high-protein diets compared with lower protein diets on weight loss, preservation of lean body mass, and improvement in several cardiovascular risk factors for up to 12 months. Evidence that chronic high-protein intake affects glucose metabolism is inconclusive at present. Further study of the long-term safety of diets with varying amounts of protein is warranted. On the basis of patients' metabolic profiles and preferences, practitioners can recommend individualized, nutrient-rich diets within current nutritional guidelines for weight control. Diets moderately increased in protein and modestly restricted in carbohydrate and fat, particularly saturated fat, may have beneficial effects on body weight, body composition, and associated metabolic parameters. Key issues must be resolved regarding the long-term compliance and safety of chronic high-protein intake.

Nature Clinical Practice Endocrinology & Metabolism

Objective. To provide interdisciplinary structured activities in academic and clinical settings for introducing the concept of professionalism to health professions students. Design. Undergraduate ...

We have recently reported that obese women randomized to a low-carbohydrate diet lost more than twice as much weight as those following a low-fat diet over 6 months. The difference in weight loss was not explained by differences in energy intake because women on the two diets reported similar daily energy consumption. We hypothesized that chronic ingestion of a low-carbohydrate diet increases energy expenditure relative to a low-fat diet and that this accounts for the differential weight loss. To study this question, 50 healthy, moderately obese (body mass index, 33.2 ± 0.28 kg/m²) women were randomized to 4 months of an ad libitum low-carbohydrate diet or an energy-restricted, low-fat diet. Resting energy expenditure (REE) was measured by indirect calorimetry at baseline, 2 months, and 4 months. Physical activity was estimated by pedometers. The thermic effect of food (TEF) in response to low-fat and low-carbohydrate breakfasts was assessed over 5 h in a subset of subjects. Forty women completed the trial. The low-carbohydrate group lost more weight (9.79 ± 0.71 vs. 6.14 ± 0.91 kg; P < 0.05) and more body fat (6.20 ± 0.67 vs. 3.23 ± 0.67 kg; P < 0.05) than the low-fat group. There were no differences in energy intake between the diet groups as reported on 3-d food records at the conclusion of the study (1422 ± 73 vs. 1530 ± 102 kcal; 5954 ± 306 vs. 6406 ± 427 kJ). Mean REE in the two groups was comparable at baseline, decreased with weight loss, and did not differ at 2 or 4 months. The low-fat meal caused a greater 5-h increase in TEF than did the low-carbohydrate meal (53 ± 9 vs. 31 ± 5 kcal; 222 ± 38 vs. 130 ± 21 kJ; P = 0.017). Estimates of physical activity were stable in the dieters during the study and did not differ between groups. These results confirm that short-term weight loss is greater in obese women on a low-carbohydrate diet than in those on a low-fat diet even when reported food intake is similar. The differential weight loss is not explained by differences in REE, TEF, or physical activity and likely reflects underreporting of food consumption by the low-fat dieters.

Objective: To investigate psychosocial effects of a 6-month pilot multidisciplinary weight-management program for young females. Methods: Participants (n=57), ages 8-15, completed the Revised Children's Manifest Anxiety Scale (RCMAS) and Self-Perception Profile for Children (SPPC) at baseline, 6 months, and 12 months. Results: Positive changes were noted in the scores of both surveys. Significant decreases occurred in the RCMAS mean Total Anxiety and Worry/Oversensitivity scores; significant increases were found in the SPPC mean Social Acceptance and Athletic Competence scores. Conclusions: Enrollment in multifaceted weight-management programs that include stress management and social support may reduce anxiety level and enhance self-perception.

Untested alternative weight loss diets, such as very low carbohydrate diets, have unsubstantiated efficacy and the potential to adversely affect cardiovascular risk factors. Therefore, we designed a randomized, controlled trial to determine the effects of a very low carbohydrate diet on body composition and cardiovascular risk factors. Subjects were randomized to 6 months of either an ad libitum very low carbohydrate diet or a calorie-restricted diet with 30% of the calories as fat. Anthropometric and metabolic measures were assessed at baseline, 3 months, and 6 months. Fifty-three healthy, obese female volunteers (mean body mass index, 33.6 +/- 0.3 kg/m(2)) were randomized; 42 (79%) completed the trial. Women on both diets reduced calorie consumption by comparable amounts at 3 and 6 months. The very low carbohydrate diet group lost more weight (8.5 +/- 1.0 vs. 3.9 +/- 1.0 kg; P < 0.001) and more body fat (4.8 +/- 0.67 vs. 2.0 +/- 0.75 kg; P < 0.01) than the low fat diet group. Mean levels of blood pressure, lipids, fasting glucose, and insulin were within normal ranges in both groups at baseline. Although all of these parameters improved over the course of the study, there were no differences observed between the two diet groups at 3 or 6 months. beta- Hydroxybutyrate increased significantly in the very low carbohydrate group at 3 months (P = 0.001). Based on these data, a very low carbohydrate diet is more effective than a low fat diet for short-term weight loss and, over 6 months, is not associated with deleterious effects on important cardiovascular risk factors in healthy women.