Participation as a leader in immersion weight loss treatment: a 1-year follow-up study.

Non-overweight individuals may follow aggressive weight management approaches alongside overweight/obese friends or family members; thus, research has begun to evaluate subsequent effects among non-overweight populations. A prior study evaluated the short-term effects of an immersion weight loss programme on healthy young adult staff leaders. Results indicated that participation seemed to benefit, not harm, the young adults. The current investigation examined 1-year eating disorder and weight trajectories in this sample. The total sample (N = 244) consisted of staff leaders (44.3%) and demographically similar comparison participants who completed eating disorder and weight assessments across four time points: baseline, end of summer, 6-week follow-up and 1-year follow-up. Forty-seven per cent of the original sample responded to all time points (staff leaders n = 60; comparison n = 55). Over the course of 1 year, risk trajectories did not differ between groups. Staff leaders did not report significant changes in body mass index, suggesting that they maintained healthy weight over the course of 1 year. Participation as an immersion weight loss programme leader appeared to be protective against weight gain, without increasing eating disorder risk, for healthy young adults. This provides further support for using weight management interventions across a wide range of individuals.

Participation as a leader in immersion weight loss treatment may benefit, not harm, young adult staff members.

Despite the success of weight-management programmes, some researchers caution that participation in an aggressive approach to weight management could promote the development of eating pathology. The current study evaluated the risks and benefits for young adults of serving as staff members in an immersion treatment of adolescent obesity over the course of a summer. Participants included weight loss staff members (n = 108) along with a comparison group of young adults with similar demographic characteristics (n = 136). Participants completed assessments of eating disorder and obesity risk at three time points: the beginning of the summer, the end of the summer and a 6-week follow-up. Weight loss leadership participants who were initially overweight lost weight over the course of the summer, but those at healthy weights maintained their weight. Comparison participants also maintained their weight during the summer. Weight loss staff members also increased dietary restraint over the summer, and increases in dietary restraint appeared to facilitate appropriate weight reduction. Participation as a leader in an immersion weight loss programme seemed to benefit, not harm, young adults; this suggests potential advantages for using weight controlling interventions in a wide range of individuals, including as an obesity prevention strategy.

Immersion treatment of childhood and adolescent obesity: the first review of a promising intervention.

Obese children have attended weight loss camps and residential programmes for more than 40 years. This paper provides the first systematic review of the effects of those programmes. Twenty-two studies met inclusion criteria (targeted and assessed change in weight status, minimal stay of 10 days and nights). Similar components across programmes included controlled diet, activities, nutrition education, and therapy and/or education regarding behaviour change. Participants lost substantial amounts of weight in all 22 studies, as measured by reductions in per cent-overweight during intervention. Eleven programmes included long-term follow-up evaluations. Compared with results highlighted in a recent meta-analysis of out-patient treatments, these immersion programmes produced an average of 191% greater reductions in per cent-overweight at post-treatment and 130% greater reduction at follow-up. Furthermore, mean attrition rates were much lower when compared with standard out-patient treatment. Inclusion of a cognitive-behavioural therapy (CBT) component seemed especially promising; follow-up evaluations showed decreased per cent-overweight at follow-up by an average of 30% for CBT immersion programmes vs. 9% for programmes without CBT. Explanations for the potentially greater impact of immersion relative to out-patient treatments are presented, including possibly differential effects on self-efficacy for both children and their parents.

Weight loss and changes in generic and weight-specific quality of life in obese adolescents.

PURPOSE: To investigate how weight loss correlates with changes in generic and weight-specific quality of life (QoL). METHODS: Youth generic (YQOL-S) and weight-specific instruments (YQOL-W) from 133 youth age 11-19 were analyzed at the beginning and end of 4-week immersion camp sessions known to produce weight loss. Paired samples t tests were used to test mean difference between baseline and final Body Mass Index (BMI) and YQOL-S and YQOL-W scores. YQOL-S and YQOL-W scores were transformed to values between 0 and 100, with higher values indicating better QOL. Cohen's d effect sizes were calculated to assess magnitude of effects. Percent weight loss (as % of baseline weight), change in BMI (baseline kg/m²-follow-up kg/m²), and change in % overweight ((BMI-50th% BMI for age and sex)/50th% BMI for age and sex × 100) were calculated. Multiple regressions were used to model final YQOL scores in the 11-14 and 15-19 age groups as functions of each measure of weight change, sex, age, and baseline YQOL score. RESULTS: Youth experienced significant reductions in BMI (Mean change = 3.7, SD = 1.4, t = 34.1, P < 0.001) and in the other measures of weight change. YQOL-S and YQOL-W scores improved significantly (P < 0.001), and effect sizes were 0.61 and 0.66, respectively. CONCLUSION: Changes in generic and weight-specific quality of life scores are associated with weight loss. The weight-specific measure is slightly more sensitive to weight changes; however, when controlling for modifiers, the YQOL-W remained significantly associated with weight loss, while the generic QoL measure did not.

Helping young weight controllers develop healthy obsessions: preliminary test of the Healthy Obsession Model.

The Healthy Obsession Model posits that successful weight controllers must develop a preoccupation with the planning and execution of target behaviours, including eating on programme, consistent activity and self-monitoring. When barriers emerge, committed weight controllers are expected to feel distressed (e.g. anxious or frustrated), which should motivate them to reinstate these behaviours. This study investigated the effects on moods of sudden withdrawal of self-monitoring among obese adolescents within an immersion treatment programme. Fifty-five (55% female) adolescents participated in a weight loss camp and received four weekly cognitive-behaviour therapy sessions focused on maximizing commitment to programme behaviours. During the fourth week, campers and staff completed daily mood ratings using the Positive and Negative Affect Schedule. After 3 d of ratings, campers' self-monitoring journals were removed without warning for 1 d. As expected, journal removal resulted in decreased positive affect for the campers, according to staff ratings. Also in accord with hypotheses, campers who demonstrated heightened commitment to the programme based on higher levels of activity and more writing in their journals reacted more negatively to the withdrawal of the opportunity to self-monitor. Mood ratings by campers did not show the effects hypothesized by the Healthy Obsession Model. These results provide preliminary support for the Healthy Obsession Model by showing some of the anticipated negative reactions to the removal of access to self-monitoring, especially among those who demonstrated strong commitments to the process.

Do as I do? Prospects for parental participation 1.5 years after immersion treatment for adolescent obesity.

This study compared successful with unsuccessful participants and their mothers 1.5 years following completion of an immersion programme for the treatment of adolescent obesity. Teenagers (M age = 14.5; 69.5% female) participated in a 4- to 8-week therapeutic camp; those who continued losing weight 1.5 years post-camp were identified as 'Losers'; those who regained weight were considered 'Gainers'. Twenty-six Loser campers, 23 Gainer campers and all mothers were interviewed about their current weights and lifestyle habits. Losers' and Gainers' mothers both reported losing weight significantly. Relative to Gainer mothers, however, Loser mothers reported 26% fewer high-fat foods in the house and greater likelihood of self-monitoring. Loser campers, relative to Gainer campers, reported self-monitoring more consistently; using trainers more frequently; and consuming fewer calories and less fat. Gainer campers also reported a tendency to use family therapy more than Loser families. The Loser campers reported following the dictates of the programme more than the Gainer campers, as expected. One striking and unique finding, however, was that Gainer mothers seemed to follow the programme for themselves as much as Loser mothers. Apparently for some participants in immersion treatment (like the Loser campers in this study), parents who participate fully may promote sustained success; for other adolescent weight controllers (like the present Gainer campers), having 'Do as I do' mothers clearly does not guarantee sustained changes in lifestyle for the teenagers. A hypothesis based on these results is that additional cognitive-behaviour therapy subsequent to immersion may be useful for this latter group.

The role of the coronoid process in elbow stability. A biomechanical analysis of axial loading.

BACKGROUND: The current treatment of coronoid process fractures of the ulna is based on the classification system of Regan and Morrey. We found no biomechanical studies that specifically addressed the role of the coronoid process in elbow stability. In the present investigation, the elbows of cadavera were tested before and after fracture of the coronoid process to assess the stabilizing contribution of the coronoid process under axial loading. METHODS: Six fresh-frozen cadaveric elbows were tested mechanically. All soft tissue surrounding the elbow, including the skin, was left intact. An axial load compressing the elbow joint was applied along the shaft of the forearm in the sagittal plane. A displacement of fifteen millimeters per minute was applied until a load of 100 newtons was attained. Each elbow was tested in 15, 30, 45, 60, 75, 90, 105, and 120 degrees of flexion. Next, less than 25 percent, 25 to 50 percent, or more than 50 percent of the coronoid process was fractured with an osteotome under radiographic guidance, and the testing was repeated. Each elbow served as its own control, and one elbow was used for two tests; therefore, a total of seven situations were investigated. The difference in displacements between the intact and osteotomized elbows was measured. RESULTS: There was no significant difference, at any flexion position, in posterior axial displacement between the intact elbows and the elbows in which 50 percent or less of the coronoid process was fractured (type I and type II) (p = 0.43). There were significant differences, across all flexion positions, in posterior axial displacement between the intact elbows and the elbows in which more than 50 percent of the coronoid process was fractured (type III) (p = 0.006). Specimens with a type-III fracture also showed a significant increase in displacement compared with specimens with a type-I or type-II fracture (p = 0.012). Specifically, from 60 to 105 degrees of flexion, a significant increase in posterior translation of up to 2.4 millimeters was found (p<0.05). CONCLUSIONS: In response to axial load, elbows with a fracture involving more than 50 percent of the coronoid process displace more readily than elbows with a fracture involving 50 percent or less of the coronoid process, especially when the elbow is flexed 60 degrees and beyond.

How can obese weight controllers minimize weight gain during the high risk holiday season? By self-monitoring very consistently.

This study examined the efficacy of augmenting standard weekly cognitive-behavioral treatment for obesity with a self-monitoring intervention during the high risk holiday season. Fifty-seven participants in a long-term cognitive-behavioral treatment program were randomly assigned to self-monitoring intervention or comparison groups. During 2 holiday weeks (Christmas-New Years), the intervention group's treatment was supplemented with additional phone calls and daily mailings, all focused on self-monitoring. As hypothesized, the intervention group self-monitored more consistently and managed their weight better than the comparison group during the holidays. However, both groups struggled with weight management throughout the holidays. These findings support the critical role of self-monitoring in weight control and demonstrate the benefits of a low-cost intervention for assisting weight controllers during the holidays.

Weight control during the holidays: highly consistent self-monitoring as a potentially useful coping mechanism.

The study examined the extent to which trait self-monitoring (the systematic observation and recording of target behaviors) was related to weight control during the high-risk holiday season. The participants (32 women, 6 men) averaged 223.1 lbs (101.41 kg), 57.2% overweight, 50.2 weeks of participation, and 21.3 lbs (9.68 kg) lost at the beginning of the study. Consistency of self-monitoring and weight changes were assessed for 3 holiday versus 7 nonholiday weeks. Analyses of variance (Consistency of Self-Monitoring Groups x Holiday/Nonholiday Weeks) revealed that participants gained 500% more weight per week during holiday compared with nonholiday weeks. Only participants in the most consistent self-monitoring quartile averaged any weight loss over the 10 weeks of the study and during the holiday weeks.

Further support for consistent self-monitoring as a vital component of successful weight control.

OBJECTIVE: This study attempted to replicate that of Baker and Kirschenbaum by providing a descriptive analysis of the relationship between self-monitoring and weight control. PROCEDURES: Fifty-nine women and men in long-term cognitive-behavioral treatment for obesity participated over an 8-week period. Percentages of participants who self-monitored consistently and the relationship between the variability in self-monitoring and weight change were examined. RESULTS: As in the previous study, a substantial minority of the participants in this research (26.3%) self-monitored all foods eaten on less than half of the days evaluated. The assertion of Baker and Kirschenbaum that self-monitoring is most appropriately viewed as both a state and a trait was supported by finding that the most consistent self-monitors lost more weight than the least consistent self-monitors; however, regardless of overall self-monitoring consistency, participants lost much more weight during their two most consistent weeks compared with their two least consistent weeks. Again, as in the previous study, only the more consistent quartile of self-monitors lost a substantial amount during the course of this study. DISCUSSION: The results of both studies taken together suggests that a reasonable target for consistency for self-monitoring within the context of a professional cognitive-behavioral treatment program may be self-monitoring all foods eaten on at least 75% of the days. If participants generally self-monitor on less than half of the days during participation in such programs, they may be very unlikely to succeed at weight loss both during the program and afterward.

Affect and self-regulation in binge eaters: effects of activating family images.

OBJECTIVE: This study examined the impact of activating internalized family images on affective states and behavioral self-regulation. METHOD: Sixty-four female binge eaters and normal controls were randomly assigned to family- or neutral-state inductions. RESULTS: The family induction had a differentially negative impact on binge eaters. When their family images were activated, binge eaters felt more negatively about the experiment, more hostile, experienced greater sensations of hunger, and were more preoccupied with their family images than their counterparts in the other groups. Behaviorally, they also required a relatively greater amount of time to complete a visual-motor task, with a degree of accuracy comparable to that of other subjects. DISCUSSION: The present findings suggest that for women with eating disorders, the activation of internalized images of their family relationships may produce distress and perhaps problems in behavioral self-regulation as well.

Contributions of liver and kidneys to glycerol production and utilization in the dog.

The classical concept holds that liver and kidneys are the main sinks of glycerol released by adipose tissue. However, rates of glycerol appearance (Ra) exceed the rate of glycerol delivery to liver and kidneys. We measured the hepatic and renal contributions to glycerol production and utilization in anesthetized dogs that were fasted either overnight or for 24 h after 3 days on a carbohydrate-free diet. Dogs were infused with [2H5]glycerol, and the concentration and 2H enrichment of glycerol were measured across liver and kidney. After a baseline period, either norepinephrine or glucose plus insulin was infused to alter the rate of glycerol production. Our study shows that the production of glycerol by liver and kidneys amounted to 4-9% and 4-7% of the Ra of glycerol, respectively. Uptake of glycerol by liver and kidneys amounted to 26-30 and 10-19% of the Ra of glycerol, respectively. Thus, contrary to the classical concept, the bulk of glycerol utilization occurs in nonhepatic, nonrenal tissues that have very low glycerol kinase activity per gram.

Arthrography of the wrist. Assessment of the integrity of the ligaments in young asymptomatic adults.

Fifty-two asymptomatic adults who were between twenty and thirty-five years old had arthrography of the wrist with use of a single injection into the radiocarpal joint. The purpose of the study was to evaluate the integrity of the triangular fibrocartilage, the scapholunate ligament, and the lunotriquetral ligament. Contrast medium was injected under fluoroscopic guidance, and posteroanterior and lateral radiographs of the wrist were made after the subjects had performed exercises of the wrist. No patient who had a history of trauma to the wrist, pain in the wrist, or inflammatory arthritis was included in the study. All of the subjects had an examination of both upper extremities that included measurement of the active motion of the wrist with a goniometer, strength-testing with a Jamar dynamometer, ballottement and testing for impingement, and palpation for tenderness. Plain radiographs were evaluated, and the ulnar variance was recorded. The arthrograms revealed an abnormal communication of the contrast medium in fourteen wrists (27 per cent), and four of the fourteen had multiple areas of communication. The abnormal communication was through the triangular fibrocartilage alone in six wrists, the scapholunate ligament alone in two wrists, the lunotriquetral ligament alone in two wrists, and in more than one of these areas in four wrists. A positive arthrogram was associated with a greater positive ulnar variance. All of the subjects had symmetrical motion of the wrists and grip strength, and none of them had tenderness in the wrist. There were no complications related to the arthrography. Perforation of a ligament in the wrist is common in young asymptomatic adults.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors associated with weight control in older adults.

Dieting behaviors in a sample of 183 overweight older adults were studied to assess how they were influenced by six cognitive, behavioral, emotional, and social variables. Membership in a weight control program was also evaluated to assess whether it affected these relationships. Responses indicated that reports of high quality dieting behaviors were associated with higher levels of depression and less effective coping skills. Dieting behaviors among subjects who were participants in weight loss programs were not as strongly associated with less effective coping skills, but were associated with external health locus-of-control. The degree of social support had a limited impact on dieting behaviors, while measures of optimism and health status were unrelated to dieting behaviors. We concluded that older adults, especially those who diet independently, are likely to experience significant stress associated with weight loss efforts. Weight loss programs for older adults might produce better outcomes if they focus on reducing depression and stress associated with dieting.

Meta-monitoring: Case illustrations of a potential "Slump-Buster" for self-regulatory problems.

Meta-monitoring has been defined as a secondary feedback system in which people monitor their rates of progress in attaining their primary self-regulatory goals. The purpose of this study was to explore the effects of adding an explicit version of meta-monitoring to a long-term cognitive-behavioral treatment program for obesity. It was expected that meta-monitoring in this therapeutic context might increase positive affect and, thereby, improve self-regulated cognitive and behavioral changes. Four obese women who were in treatment for 1 to 2 years prior to the study served as subjects. They meta-monitored by rating their self-monitoring, affect, and eating and thinking patterns for each of 34 weeks. Weight changes and measures of self-monitoring, affect, and eating/thinking patterns suggested some initially positive effects (during the first 2 weeks, especially). While the duration of the impact of meta-monitoring in this clinical trial seemed modest, the approach may have promise as a means of reenergizing self-regulatory efforts during lapses or slumps. Experiments on various methods of operationalizing meta-monitoring, examining its effects on different problems, and testing its hypothesized mechanisms seem warranted.

Chronic lunotriquetral instability: diagnosis and treatment.

Fourteen patients with chronic lunotriquetral instability were evaluated. Forced wrist extension was the most common mechanism of injury. Fourteen patients underwent lunotriquetral arthrodesis. Arthrograms were positive in 9 of the 12 performed. In three cases abnormalities not identified by arthrography were demonstrated by arthroscopy. The follow-up period averaged 27 months. X-ray films showed fusion in 12 cases. One pseudarthrosis was asymptomatic. A second pseudarthrosis required a rearthrodesis that became solid 8 weeks after surgery. One patient had persistent wrist pain. Wrist motion compared to the contralateral side averaged 85%, 88%, 83% and 80%, respectively, for flexion, extension, ulnar deviation, and radial deviation. Grip strength compared to the contralateral side averaged 93%. Lunotriquetral instability is a clinical diagnosis confirmed by arthrography or arthroscopy. Lunotriquetral fusion reliably relieves pain while maintaining functional wrist motion and grip strength. The long-term effects of lunotriquetral fusion on carpal kinematics and wrist function are unknown.

Scaphoid excision and capitolunate arthrodesis for radioscaphoid arthritis.

Eighteen patients with symptomatic radioscaphoid arthritis had scaphoid excision and capitolunate arthrodesis. Eight patients also had a silicone scaphoid replacement. The follow-up period averaged 3 years. Fusion was solid in 12 cases at an average of 8 weeks, and pain was significantly less at follow-up evaluation. Six patients had a pseudarthrosis and five had persistent pain. Immobilization in the pseudarthrosis group averaged 6 weeks, which was significantly less than the group that fused. Two patients underwent successful repeat fusions. Wrist extension averaged 26 degrees, flexion 34 degrees, radial deviation 11 degrees, and ulnar deviation 24 degrees. Grip strength averaged 25 kg. Presence of an implant had no significant effect on motion or strength. Pin track infection and pseudarthrosis were the main complications. Pain relief, functional motion, good strength, and patient satisfaction can be expected after scaphoid excision and solid capitolunate arthrodesis. Kirschner wires should be buried subcutaneously to avoid infection. The addition of a scaphoid implant offered no advantage over simple scaphoid excision.

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.

Shoulder strength with rotator cuff tears. Pre- and postoperative analysis.

Twenty-five patients with rotator cuff tears had bilateral isokinetic shoulder strength evaluations after a pain-relieving subacromial lidocaine injection. Shoulder strength testing was repeated at six months and again at 12 months after rotator cuff surgery. Strength was recorded as a ratio of peak torques comparing the operative with the nonoperative shoulder. Preoperative strength averaged 37%, 36%, and 33% for abduction, external rotation, and forward flexion. Six-month postoperative strength increased to 68%, 76%, and 66% for abduction, external rotation, and forward flexion, respectively. Twelve-month postoperative strength increased to 104%, 142%, and 97% for abduction, external rotation, and forward flexion. Shoulders with rotator cuff tears demonstrate major objective signs of weakness. Shoulder pain obscures objective evaluation of weakness. Preoperative strength can be accurately measured after subacromial lidocaine injection. Shoulder strength is significantly improved by rotator cuff repair.