Nutrient and plant secondary compound composition and iron-binding capacity in leaves and green stems of commonly used plant browse (Carolina willow; Salix caroliniana) fed to zoo-managed browsing herbivores.

Plant secondary compounds are diverse structurally, and associated biological effects can vary depending on multiple factors including chemical structure and reaction conditions. Phenolic compounds such as tannins can chelate dietary iron, and supplementation of animal species sensitive to iron overload with tannins may prevent/treat iron overload disorder. We assessed the nutrient and phenolic composition and iron-binding capacity of Carolina willow (Salix caroliniana), a plant fed to zoo-managed browsing herbivores. Based on studies in other plant species and the chemical structures of phenolic compounds, we hypothesized that the concentration of condensed tannins in willow would be inversely related to the concentration of phenolic glycosides and directly related to iron-binding capacity. Our results indicated that willow nutrient composition varied by year, season, and plant part, which could be taken into consideration when formulating animal diets. We also found that the predominant plant secondary compounds were condensed tannins with minimal phenolic glycosides. Instead of binding to iron, the willow leaf extracts reduced iron from the ferric to ferrous form, which may have prooxidative effects and increase the bioavailability of iron depending on animal species, gastrointestinal conditions, and whole animal processes. We recommend identifying alternative compounds that effectively chelate iron in vitro and conducting chelation therapy trials in vivo to assess potential effects on iron balance and overall animal health.

Managed care and mental health: the silencing of a profession.

Rapid change in the organization and financing of health care has created a bewildering and threatening climate for psychotherapists. Fearful of exclusion from preferred provider and health maintenance organizations, and aware that patient advocacy is interpreted as antagonism to these organizations' goals, many therapists have fallen silent, acquiescing to practices they do not support. Crystallization of these practices into policy and law is now imminent. It is crucial that therapists reclaim their authority, speaking out on behalf of current and future patients as well as the concealed constituency of historically disenfranchised persons for whom psychotherapy has provided a voice.

Outcome evaluation of an intensive residential treatment program for bulimia.

A 1-month intensive treatment program for bulimic women (ITP) was evaluated. Patients followed up after 1 year had reduced the frequency of purging by 86%, and 38% were symptom free. Patients reported improvements in important relationships and in progress toward life goals. They rated the program highly. Results from the Eating Disorders Inventory, Symptom Checklist 90-R, Eating Attitudes Test, Zung Depression and Anxiety, Body-Cathexis, MMPI, and Color-A-Person Body Dissatisfaction measures indicated highly significant improvement. Patients not followed up had improved similarly but were more impaired. Dropout rate was 1.5%. Results compare well with those of other established eating disorder programs and suggest that the ITP is an effective alternative to hospitalization.

Obesity treatment: the high cost of false hope.

Although millions seek treatments for obesity, the benefits of treatment have been overstated. For most people, treatment is not effective; the majority of the obese struggle in vain to lose weight and blame themselves for relapses. Repeated experiences of failure add to the psychologic burden caused by the social stigma and the presumption of psychopathologic conditions attached to obesity. Many therapists may be contributing to this psychologic damage by giving their patients false hope for success and by failing to recognize that seeking treatment for obesity may be triggered by psychologic problems that are not addressed in obesity treatment.

Theoretical, practical, and social issues in behavioral treatments of obesity.

Although showing superior maintenance, behavioral treatments of obesity typically produce small weight losses at a decelerating rate. Rather than reflecting poor compliance with treatment, these findings are consistent with known compensatory metabolic changes that operate to slow weight loss and promote regain. Other problems associated with dieting include failure of caloric regulation, hyper-responsivity to food palatability, and hunger, which is greater under conditions of moderate restriction and unpredictability of access to food. The inevitability of treatment failure in many instances must be faced and efforts made to prevent further worsening of the obese patient's self-esteem. Prognosis and treatment planning may be aided by consideration of the historical difficulties of weight loss, the degree of hunger experienced on diets, which may reflect important physiological differences among individuals, and the use of food to optimize arousal level. Full involvement of the patient in setting goals and planning treatment is recommended.

A learning theory model of chronic illness behavior: theory, treatment, and research.

Over 300 patients have been treated on an inpatient psychosomatic service employing a learning model of chronic illness behavior. This model stresses social reinforcement and avoidance of occupational and social activities in the development of a syndrome characterized by somatic complaints and care-eliciting interpersonal behaviors. Preliminary studies showed that patients reinforced others for care-giving responses but showed improved tolerance of experimental pain and lower rates of drug use when care-taking responses were minimized and self-control encouraged. Treatment was designed to involve the patient in his own care, including behavior modification techniques to reduce symptomatology, social skills training, and family therapy. One-year follow-up shows that most patients achieve self-set goals, with generalization of beneficial treatment effects. Patients who return to an intact family show continuing decreases in somatic complaints and increases in achievement orientation. Treatment failures are characterized by lack of an intact family and return to the medical care system.

Differential effects of amphetamine and fenfluramine on appetite for palatable food in humans.

Amphetamine (10 mg), but not fenfluramine (40 mg), suppressed appetite (ie salivation elicited by a palatable food) in ten subjects of normal weight one hour after ingestion. This result supports the hypothesis that the drugs operate through different neural mechanisms. Neither drug affected hunger and food appeal ratings.

Effect of calories on appetite for palatable food in obese and nonobese humans.

Palatable food stimuli were presented to 11 obese and 11 nonobese male human subjects (in three experiments) 1 hr after ingestion of 900-calorie liquid lunches and (on separate days) indentically tasting 450-calorie liquid lunches of equal volume. Salivary responses to the presentation of the stimuli (i.e., appetite) by the nonobese were inhibited by the high-calorie meal, but those by the obses were less inhibited. Hunger ratings were unaffected by calories in either group. Food stimuli were rated as more appetizing by the nonobese after high-calorie meals, but not so by the obese. Parallels with animal findings suggest that salivary responses reflect lateral hypothalamic activity.