FIT & STRONG! PLUS: DESCRIPTIVE DEMOGRAPHIC AND RISK CHARACTERISTICS IN A COMPARATIVE EFFECTIVENESS TRIAL FOR OLDER AFRICAN-AMERICAN ADULTS WITH OSTEOARTHRITIS.

OBJECTIVES: The prevalence of osteoarthritis (OA) has increased in the US. We report on a comparative effectiveness trial that compares Fit & Strong!, an existing evidence-based physical activity (PA) program, to Fit & Strong! Plus, which combines the Fit & Strong! intervention with a weight management intervention. METHODS: Participants included 413 overweight/obese (BMI 25-50 kg/m2) adults with lower extremity (LE) OA. The majority of the sample was African-American and female. Both interventions met 3 times weekly for 8 weeks. Primary measures included diet and weight. RESULTS: The baseline mean BMI for all participants was 34.8 kg/m², percentage of calories from fat was high, and self-reported PA was low. DISCUSSION: This sample of overweight/obese African-American adults had lifestyle patterns at baseline that were less than healthful, and there were differences between self-report and performance-based measures as a function of age.

Systematic review of behavioural interventions with culturally adapted strategies to improve diet and weight outcomes in African American women.

Behavioural interventions incorporating features that are culturally salient to African American women have emerged as one approach to address the high rates of obesity in this group. Yet, the systematic evaluation of this research is lacking. This review identified culturally adapted strategies reported in behavioural interventions using a prescribed framework and examined the effectiveness of these interventions for diet and weight outcomes among African American women. Publications from 1 January 1990 through 31 December 2012 were retrieved from four databases, yielding 28 interventions. Seventeen of 28 studies reported significant improvements in diet and/or weight change outcomes in treatment over comparison groups. The most commonly identified strategies reported were 'sociocultural' (reflecting a group's values and beliefs) and 'constituent involving' (drawing from a group's experiences). Studies with significant findings commonly reported constituent-involving strategies during the formative phases of the intervention. Involving constituents early on may uncover key attributes of a target group and contribute to a greater understanding of the heterogeneity that exists even within racial/ethnic groups. Available evidence does not, however, explain how culturally adapted strategies specifically influence outcomes. Greater attention to defining and measuring cultural variables and linking them to outcomes or related mediators are important next steps.

Weight loss and African-American women: a systematic review of the behavioural weight loss intervention literature.

The excess burden of obesity among African-American women is well documented. However, the behavioural weight loss intervention literature often does not report results by ethnic group or gender. The purpose of this article is to conduct a systematic review of all behavioural weight loss intervention trials published between 1990 and 2010 that included and reported results separately for African-American women. The criteria for inclusion included (i) participants age ≥18 years; (ii) a behavioural weight loss intervention; (iii) weight as an outcome variable; (iv) inclusion of African-American women; and (v) weight loss results reported separately by ethnicity and gender. The literature search identified 25 studies that met inclusion criteria. Our findings suggest that more intensive randomized behavioural weight loss trials with medically at-risk populations yield better results. Well-designed and more intensive multi-site trials with medically at-risk populations currently offer the most promising results for African-American women. Still, African-American women lose less weight than other subgroups in behavioural weight loss interventions. It is now critical to expand on individual-level approaches and incorporate the biological, social and environmental factors that influence obesity. This will help enable the adoption of healthier behaviours for this group of women disproportionately affected by obesity.

Binge eating disorder and bulimia nervosa: differences in the quality and quantity of binge eating episodes.

OBJECTIVE: This study sought to examine the differences in the quantity and quality of binges between binge eating disorder (BED) and bulimia nervosa. METHOD: Patients (N = 77) seeking treatment for eating disorders were assessed on binge content. RESULTS: Results suggest no differences in binge quantity with BED and bulimia, but there were differences in the binge quality. The binges of bulimics were higher in carbohydrates and sugar than those with BED. DISCUSSION: The higher levels of obesity of our BED individuals may account for the lack of differences between those with bulimia and BED. The importance of increasing our knowledge of the continuum of weight and binging is discussed.

The relationship between body image discrepancy and body mass index across ethnic groups.

OBJECTIVE: This study sought to examine at what body mass index (BMI) body image discrepancy (BD) was reported in a community sample of 389 white, Hispanic, and black women. In addition, we assessed the trajectory of the BMI-BD relationship as BMI increases by ethnic group. RESEARCH METHODS AND PROCEDURES: All participants were assessed on height and weight and completed the Figure Rating Scale. RESULTS: We found no difference in the proportion of women in each ethnic group reporting BD. However, white women experienced BD at a lower BMI level (BMI = 24.6), and below the criterion for overweight (BMI = 25). In contrast, black and Hispanic women did not report BD until they were overweight (BMIs of 29.2 and 28.5, respectively). Compared with black and white women, Hispanic women registered increases in BD at smaller increases in BMI. DISCUSSION: These findings could have unhealthful implications for weight control behavior. The results encourage a closer look at ethnicity and BD, and their relationship to obesity and weight control.

Correlates of binge eating in Hispanic, black, and white women.

OBJECTIVE: We sought to compare the severity and correlates of binge eating in White, Black, and Hispanic women. METHOD: Our sample consisted of 351 (55 White, 179 Black, and 117 Hispanic) women who were assessed on three proposed factors associated with binge eating (weight, depression, and ideal body image). RESULTS: Our results showed that binge eating symptoms were more severe in our sample of Hispanic versus Black or White women. Across all ethnic groups, women who binged more were heavier, more depressed, and preferred a slimmer body ideal. Binge eating severity was predicted by weight and depression in Hispanics and by depression in Whites. None of the proposed factors significantly influenced binge eating in Blacks. DISCUSSION: These results show ethnic differences in the correlates of binge eating and highlight the need for further comparative research on aberrant eating patterns.

Quantitative assessment of recruitment efforts for prevention trials in two diverse black populations.

BACKGROUND: Prevention efforts to reduce the morbidity and mortality disparity between blacks and whites in the United States present a national health priority. However, participation of blacks in prevention trials has been low. The present study reports successful recruitment processes from two economically diverse black populations. METHODS: The two studies were independent projects, but both were part of a nationally funded collaboration on cardiovascular health. "Hip Hop to Health" is a 4-year randomized controlled trial aimed at dietary fat reduction and increased exercise among inner-city black families. The Fat Reduction Intervention Trial in African-Americans project is a 5-year trial to reduce total fat, saturated fat, and cholesterol intake among black families from a working class community. RESULTS: The two populations differed on demographic characteristics. Direct presentation was the most effective recruitment strategy in the "Hip Hop to Health" program. In contrast, telephone recruitment and neighborhood canvassing were the more successful strategies for FRITAA. CONCLUSIONS: Although both populations were black and at comparable cardiovascular disease risk, the differing demographics between the groups made different recruitment strategies necessary. This study documented the labor-intensive quality of successful recruitment, and results suggest that successful recruitment requires strategies tailored to the needs, experiences, and environment of the target group.

Effects of an obesity prevention program on the eating behavior of African American mothers and daughters.

Cardiovascular disease (CVD) is the number one cause of death in the United States. Obesity is highly related to CVD risk, especially in African American women. This study explored the efficacy of a culturally specific obesity prevention program. Designed for low-income, inner-city African American girls and their mothers, the program addressed the importance of eating a low-fat, low-cholesterol diet and increasing activity. Mother-daughter dyads were randomly assigned to a 12-week treatment or an attention placebo group. Participants were assessed at pre- and posttreatment on dietary intake, including daily fat intake, daily saturated fat intake, percentage of daily calories from fat, and daily cholesterol intake. Results showed significant differences between the treatment and control mothers for daily saturated fat intake and percentage of calories from fat. Differences among treatment and control groups were also noted for the daughters on percentage of daily calories from fat. Implications of the findings for developing culturally specific health risk reduction programs are discussed.

Involving parents in cancer risk reduction: a program for Hispanic American families.

The authors explored changes in dietary behavior, nutrition knowledge, and parental support among inner-city, low-income, Hispanic American families. Thirty-eight families were randomly assigned to receive a 12-week, culture-specific dietary intervention or be in a control group. Results showed that parental support was related to changes in diet, nutrition knowledge, and attendance for both mothers and children. Dietary behavior changes (e.g., reduction in dietary fat) were seen only in the treatment group. Distribution of health-related pamphlets to the control group may have promoted cognitive changes (e.g., increased nutrition knowledge) seen in this low-literacy sample. Further research is needed to document behavioral changes after ethnic-specific interventions and the maintenance of those changes over time.

The clinical significance of binge eating in an obese population: support for bed and questions regarding its criteria.

The present study examined the prevalence of binge eating disorder (BED) among 192 obese individuals seeking treatment in a university-based eating disorders program. Subjects responded to a self-report questionnaire on the presence and severity of binge eating and were divided into two groups: (a) 48 non-binge eaters and (b) 144 binge eaters, 72 of whom met criteria for BED. Binge eaters reported earlier onset of obesity, higher levels of psychopathology, and less competence in relation to weight control. Comparison between the 72 individuals diagnosed with BED and the 72 binge eaters not meeting BED criteria indicated that the former group evidenced more severe binge eating and a higher level of depression. Given the differences across a range of psychological variables between binge eaters and non-binge eaters, these findings support the clinical and research value of BED as a new diagnostic category. However, they also indicate that severity of binge eating, regardless of frequency and associated behavioral features, is the most important distinguishing characteristic. Further research is needed to determine the most appropriate threshold for BED diagnosis.

Obese people who seek treatment have different characteristics than those who do not seek treatment.

A group of obese people who had not sought treatment, an obese group who had sought treatment in a professional, hospital-based program, and normal-weight controls (N = 547) were compared in regard to level of psychopathology, binge eating, and negative emotional eating. Because the groups differed significantly on several demographic variables, 3 demographically matched groups were created and compared (n = 177, 59 per group). In the matched subgroups, obese people who had sought treatment reported greater psychopathology and more binge eating than did those who had not sought treatment or did normal-weight controls. Both obese groups (including those who had not sought treatment) endorsed more symptoms of distress, negative emotional eating, overeating, difficulty resisting temptation, and less exercise than did normal-weight controls.

Evaluation of an intensive weight control program using a priori criteria to determine outcome.

This study evaluated the effectiveness of a comprehensive obesity treatment program which incorporated open-ended treatment duration, pre-treatment assessments, protein-sparing modified fasts (PSMFs), and the use of six a priori outcome categories to analyse outcomes. Subjects were the first 291 obese individuals (mean weight = 235 lb, 66% overweight) to participate in the program's intake procedures. Data obtained after 55 weeks of treatment (on average) showed that the program seemed quite effective for 65% of those who participated for at least 12 weeks (mean = 62 and 30 lb lost in the two successful groups). Analyses supported the continued use of pre-treatment assessments, extended treatment times, and a priori categorizations of outcomes. In addition, correlational analyses showed that binge eating, high levels of psychological distress, and low income levels were associated with poorer outcomes.

Distressed binge eaters as a distinct subgroup among obese individuals.

This study was conducted to examine the degree to which binge eating and psychological distress among obese adults are associated with a variety of behavioral patterns and competencies that could substantially affect weight control. Subjects were 167 obese people who sought help in a long-term cognitive behavioral treatment program. Subjects were divided into three groups depending on their level of psychological distress and severity of binge eating. Subjects were also assessed on coping style, subjective distress, weight history, and exercising and eating patterns. Results demonstrated substantial differences between those reporting relatively few problems with binge eating or psychological distress as opposed to those with noteworthy problems in both. The presence of either severe binge eating or psychological distress was associated with problems in regulating food-related behavior and, more generally, to problematic coping styles. These findings support the importance of in-depth assessment when treating obesity, more intensive treatment for some subgroupings, and long-term studies that incorporate comprehensive pretreatment process measure of eating style and psychological distress.

Heterogeneity of clinical presentation among obese individuals seeking treatment.

This study provides a test for the assumption of psychological homogeneity among 60 individuals who sought treatment for obesity and were referred for cognitive-behavioral group treatment. Subjects were divided along the dimension of severity of psychopathology and were assessed on subjective distress, binge eating, coping ability, and a variety of historical and demographic dimensions. Twenty-three percent of the sample scored in a range indicative of significant personality disturbance on the Borderline Syndrome Index. This distressed group did not differ from the less distressed cohort in weight, but reported more extensive symptoms of psychopathology, more chaotic eating patterns, more binge eating, and evidenced less effective coping skills. These findings provide support for the importance of a thorough assessment prior to initiating treatment for obesity.

Approach to the medically ill borderline patient: a case study.

Description and discussion are provided of the problems involved in the medical treatment of a patient with borderline character structure who has become seriously medically ill.

Motor slowing in asymptomatic HIV infection.

To examine neuropsychological deficits associated with the human immunodeficiency virus (HIV), 25 asymptomatic homosexual men and sexual partners of intravenous drug users and 25 seronegative homosexual men and nonhigh-risk heterosexuals were assessed on measures of fine motor control, visual scanning, attention, depression, and global psychological functioning. Analysis suggested that HIV infection is associated with reduced fine motor control. Seropositivity is associated with elevated depression and global psychological maladjustment. When depression and global adjustment were analyzed as covariates, motor slowing was evident in the seropositive group. These findings suggest an association between motor slowing and HIV infection in asymptomatic subjects and point to the necessity of measuring affect at least as a control variable. Further study is needed to determine whether the fine motor deficit evident in this sample is limited to distinct subgrouping of the over-all sample.

Redundancy in measures of depression.

Three different scales of depression were administered to 108 subjects including hospitalized inpatients with a diagnosis of major depression (N = 36), inpatients on a renal service (N = 36), and nonhospitalized, healthy volunteers (N = 36). Subjects completed the Beck Depression Inventory and the Depression Adjective Checklist and were rated by a trained clinician on the Hamilton Depression Rating Scale. Correlations were calculated for the total sample, each group individually, and a random sample of 36 (12 from each group). Results suggest that correlations are sufficiently high to advocate the use of only one measure of depression when one is assessing a heterogeneous group.