Relapse as a model of nonadherence to dietary treatment of diabetes.

The generality of Marlatt and Gordon's (1980, 1985) model of relapse to dietary treatment of diabetes was tested. Forty-six adults with insulin-dependent diabetes mellitus (IDDM) and 43 obese adults with non-insulin-dependent diabetes mellitus were interviewed regarding their most recent dietary violations, and the results were coded using the schema developed by Marlatt and Gordon. As the model would predict, most nonadherence episodes occurred in a limited range of high-risk situations. Although the two diagnostic groups lapsed in remarkably similar situations, there was a tendency for the IDDM adults to report a larger proportion of lapses in situations characterized by negative emotions. Approximately 27% of the dietary lapses occurred when the person was busy with a competing activity or had no choice, and these lapses did not fit into Marlatt and Gordon's coding schema. These violations consistently differed from those studied by Marlatt and Gordon in that they were errors of omission rather than errors of commission. Evidence for the abstinence violation effect was not found in this sample. Overall, the results suggest that most nonadherence to dietary treatment of diabetes may be best understood as intermittent lapses that typically do not develop into full-blown relapses.

Bulimia: clinical characteristics, development, and etiology.

Bulimia is characterized by recurrent episodes of binge eating and severe self-deprecation, often accompanied by self-induced vomiting and/or laxative abuse. It is most often found among young women in their late teens to mid-30s. Estimates of the disorder's prevalence vary widely, depending on the diagnostic criteria used, but usually range from 5% to 20% of college age women. Binge eating typically begins in late adolescence, frequently after a period of dieting to lose weight. Self-induced vomiting usually follows the onset of binge eating by about a year. To date, theories of the disorder's etiology have included several biological models, a psychosocial model, and a biopsychosocial model. The biological models proposed have viewed bulimia as a form of biological depression, neurological disturbance, or metabolic disturbance. The psychosocial model suggests that society's pressure on young women for extreme thinness leads to excessive dietary restraint, deprivation, and, paradoxically, binge eating. The presence of anxiety or depression exacerbates the process. The biopsychosocial model appears to be the most promising. It proposes that young women with biological predispositions toward overweight, depression, or metabolic disturbance are particularly vulnerable to social pressure for thinness, the binge eating that may result from excessive dieting, and, hence, bulimia. The complex nature of bulimia suggests that a multidisciplinary team approach treatment is appropriate.

A summer day camp approach to adolescent weight loss.

Twenty-five overweight adolescents completed a summer weight loss day camp program on the Stanford University campus. All participants attended camp four days per week for four hours to learn and practice eating and exercise skills conducive to weight loss. Parents met weekly to discuss the program content and to explore their role in their adolescent's weight management. At posttreatment, reductions were achieved in weight, percent overweight, and skinfold, with greater changes observed for the eight-week group than for the four-week group. Improvements were also evident in participants' self-reported habits and knowledge of weight management concepts. Parent and participant assessment of the camp experience was very positive. The results of the summer weight loss day camp suggest that an intensive program of eating and exercise habit instruction, practice, and monitoring, which allows the participants to remain in the home setting, may provide benefits not found in other more traditional approaches to adolescent weight loss.