[Social and political aspects of adiposis]. / Adipositas -- ein gesellschaftspolitisches Problem?

There is a consensus in the scientific community on the diagnostic, health, and economic implications of overweight and obesity, but therapeutic results -- with a negative energy balance as the main concept of pathogenesis -- are limited. Latest scientific studies did change the paradigm: instead of attributing obesity to patients' lack of will power, genetic disposition and environmental factors are now recognized as the main contributors to this epidemic. In consequence, unsuccessful preventive strategies have to be replaced by setting orientated those that focus much more on environmental changes promoting more physical activity and less energy intake. This could even be done by changing relevant laws. Such changes could facilitate individual behaviour changes despite evolutionary predisposition. Acknowledging obesity as a chronic disease would be the first important step.

[Fifty years of nutrition counseling. Remarks and perspectives]. / 50 Jahre Ernährungsaufklärung. Anmerkungen und Zukunftsperspektiven.

Fifty years of nutrition information and education did not reach their goals. Nutrition-dependent diseases, obesity, and misinformation are still increasing. Cognitive information about nutrition does not induce changes in primary emotion-controlled eating habits. Better knowledge of nutrition on the part of consumers mainly activates their bad conscience when they rate their own eating habits. Future prevention campaigns, which clearly address consumer needs using social marketing principles, will be better able to change eating behavior.

Validation of the flexible and rigid control dimensions of dietary restraint.

OBJECTIVE: Two subscales for the Eating Inventory (Three-Factor Eating Questionnaire) are developed and validated: Rigid and Flexible control of eating behavior. METHOD: Study I is an analysis of questionnaire data and a 7-day food diary of 54,517 participants in a computer-assisted weight reduction program. Study II is a study of 85 subjects used to develop a final item pool. Study III is a questionnaire survey of a random sample (N = 1,838) from the West German population aged 14 years and above used to validate the developed subscales. RESULTS: Rigid control is associated with higher scores of Disinhibition, with higher body mass index (BMI), and more frequent and more severe binge eating episodes. Flexible control is associated with lower Disinhibition, lower BMI, less frequent and less severe binge eating episodes, lower self-reported energy intake, and a higher probability of successful weight reduction during the 1-year weight reduction program. DISCUSSION: Rigid and flexible control represent distinct aspects of restraint having different relations to disturbed eating patterns and successful weight control.

[Weight loss by changing eating behavior: the target goal in therapy of obesity]. / Gewichtsverlust durch Anderung des Essverhaltens: das Hauptziel der Adipositastherapie.

Obesity develops as an interaction of genetic disposition and environmental factors (nutrition, physical activity). Mental disturbances are considered to be a consequence but not the cause of overweight. For long term weight maintenance three factors are important: normalization of fat intake, flexible control of food intake and an increase in physical activity.

Omega-3 fatty acids and low carbohydrate diet for maintenance of remission in Crohn's disease. A randomized controlled multicenter trial. Study Group Members (German Crohn's Disease Study Group).

BACKGROUND: There is no established therapy for maintaining remission in patients with Crohn's disease. Following different suggestions from the literature, two potential interventions for maintaining remission were tested against placebo, using either 5 g/day of a highly concentrated omega-3 fatty acid compound or a carbohydrate-reduced diet (84 g/day). METHODS: A total of 204 patients were recruited after they had had an acute relapse. After remission (CDAI < or = 150) was attained with steroid therapy, patients were randomized to receive either omega-3 fatty acids (n = 70), placebo (n = 65), or diet (n = 69). Low-dose prednisolone was given to all patients for the first 8 weeks of intervention. CDAI and an acute-phase protein (CRP) were used as criteria for a relapse. RESULTS: The proportion of patients without relapse within a year were similar in the placebo and active treatment group (intention-to-treat analysis: placebo, 30%; active treatment, 30%; protocol-adhering patients, 29% versus 28%). Patients did gain benefit (53%; p = 0.023) for as long as they maintained the diet. However, intention-to-treat analysis (diet group, 40%) did not show a noticeable difference when compared with placebo. CONCLUSIONS: Omega-3 fatty acids did not show an effect on extending the remission in Crohn's disease. For the diet patients the question remains whether the noncompliant patients dropped out early because they sensed a relapse approaching or whether their condition deteriorated because they failed to comply with the diet.

[Ambulatory, comprehensive, behavior therapy-oriented weight reduction program (Optifast Program). An alternative therapy in obstructive sleep apnea]. / Die ambulante, ganzheitliche, verhaltenstherapeutisch orientierte Gewichtsreduktion (Optifast-Programm). Eine alternative Therapie beim obstruktiven Schlafapnoesyndrom.

We investigated the therapeutic effect of marked body weight reduction on the predominantly obstructive sleep apnea syndrome by the application of an out-patient, behaviour therapy based body weight reduction program (Optifast-program) in five of our obese apnea patients (mean overweight by Broca 53.6 +/- 24.8 kg). Mean body weight reduction was 32.7 +/- 15.8 kg after six months. The mean apnea-index of 34.5 +/- 23.1/h prior to the weight reduction dropped to 7.8 +/- 6.1/h after therapy. The mean apnea-hypopnea-index (so called "respiratory disturbance index", RDI) could be reduced from 45,7 +/- 26.0/h to 14.0 +/- 11.4/h. The best therapeutic effect on the sleep related respiratory parameters was seen in patients who reached their normal weight whereas the absolute weight reduction itself seems to be less important. Our results should encourage this causal therapy in appropriate patients.

[Chronification of sleep disorders. Results of a representative survey in West Germany]. / Chronifizierung von Schlafbeschwerden. Ergebnisse einer Repräsentativumfrage in Westdeutschland.

In a representative selection of German citizens who were older than 13 years of age, 1,997 were asked about their sleep complaints. They were also asked how frequently a physician was consulted and how often sleeping pills were taken. According to our results sleep disturbances are an important health problem in Germany. Every fourth person suffers at least sometimes from difficulties in falling asleep and/or staying asleep, problems which are not due to external influences. Seven percent suffer frequently or always from these complaints; 15% report that they are frequently tired or that they are always tired during the day. Ten percent of all persons suffering from sleep complaints take sleeping pills daily or at least sometimes during the week. Forty-five percent of all persons who take hypnotics daily still frequently or always suffer from difficulties in falling asleep and/or staying asleep. Furthermore, sleep complaints tend to become chronic: 75% of the sleep-disturbed population are chronically ill, having had complaints for more than 2 years of since childhood. They suffer from sleep disturbances and from reduced performance during the following day. Nevertheless, it appears as though neither patients nor physicians take insomnia seriously. This might answer the question of why only 17% of the persons who do not suffer more than 2 years from sleep disturbances and only 49% of the chronically ill population consult a doctor because of their sleep disturbances. The results of this study indicate the importance of informing patients and physicians about insomnia and different ways of treating it.

[Treatment of obstructive sleep apnea syndrome by ambulatory, comprehensive, behavior therapy oriented weight reduction (Optifast program)]. / Die Behandlung des obstruktiven Schlafapnoesyndroms durch eine ambulante, ganzheitliche, verhaltenstherapeutisch orientierte Gewichtsreduktion (Optifast-Programm).

We investigated the therapeutic effect of marked body weight reduction on the predominantly obstructive sleep apnea syndrome by the application of an out-patient, behaviour therapy based body weight reduction program (Optifast-program) in 5 of our obese apnea patients. Mean body weight reduction was 32.7 +/- 15.8 kg after 6 months. The mean apnea-index of 34.5 +/- 23.1/h prior to the weight reduction dropped to 7.8 +/- 6.1/h after therapy. The mean apnea-hypopnea-index could be reduced from 45.7 +/- 25.9/h to 14.0 +/- 11.4/h. The best therapeutic effect on the sleep related respiratory parameters, was seen in patients who reached their normal weight. Our results shows that even severe, predominantly obstructive sleep apnea syndromes could be treated successfully with a marked body weight reduction.

Interaction of vitamins with mental performance.

In the presence of a chronically insufficient vitamin supply which was verified by repeated measurements of the vitamin parameters, many unfavorable psychometric findings in the corresponding deficiency groups are observed for the vitamins C, thiamin, riboflavin, cobalamin and folate, depending on the degree of the insufficient vitamin supply. Vitamin supplementation in cases of initially insufficient vitamin supply indicate some effects in the sense of an improvement of behavior and cognitive functions. Supplemental vitamin intake in physiological dosages in addition to a vitamin-sufficient diet did not lead to an improvement of behavior and mental performance.

Cognitive control of eating behaviour and the disinhibition effect.

Restrained eaters have been reported to overeat following a high caloric preload, a phenomenon referred to as the disinhibition effect. However this effect has not been found when subjects were classified by the restraint subscales of the Three-Factor Eating Questionnaire (TFEQ; Stunkard & Messick, 1985) or the Dutch Eating Behaviour Questionnaire (van Strien et al., 1986). The present study investigates the disinhibition effect in 133 normal-weight young women, using a two-factorial classification including the TFEQ-restraint and the TFEQ-disinhibition scale. The subjects were requested to consume ice-cream ad libitum during a taste test following a 200-ml milkshake preload or without preload. The results show that the behavioural disinhibition effect occurs only in subjects with simultaneous high scores on both subscales. In addition, subjects with high disinhibition scores consumed more ice-cream than low disinhibition subjects irrespective of their degree of restraint. While subjects with a more rigid control of eating behaviour did not show a difference in the amount of ice-cream consumed with or without preload, subjects with a more flexible control of eating behaviour reduced their intake following the preload condition. With regard to the Revised Restraint Scale (RRS Herman & Polivy, 1980) multiple regression results show that high RRS scores may be due to either higher TFEQ-restraint or higher TFEQ-disinhibition scores. The interpretation of the results favours the renaming of the TFEQ-disinhibition scale to "susceptibility to eating problems" because high scores on this scale indicate overeating in a variety of situations without requiring prior inhibition i.e. dietary restraint. It is supposed that high susceptibility to eating problems may be caused by rigid control of eating behaviour, whereas flexible control of eating behaviour may be a less problematic strategy of long-term weight control.

[Consumer expectations concerning the quality of food from animals]. / Erwartungen der Verbraucher an die Qualität der von Tieren stammenden Lebensmittel.

Quality is the most important feature that a consumer expects from food. There is no objective concept for quality, but "quality" exists in the individual consumers opinion. The quality of a product is, from the consumers point of view, not just its characteristic, but the subjective feeling of each consumer. Empirical examinations show the existence of different "consumer-categories", where the criteria of quality differ elementary. Additional to this subjective opinion the discussion in the media about substances in food that may be harmful to ones health confuses the consumer and leads to a semantic separation between the terms "Eating" and "Nutrition". Especially meat-products are effected by this discussion. The recent increase of a consumers uncertainty concerning meat-products, which is influenced by information and reports about bad conditions in livestock breeding and animal transports as well as conditions in slaughterhouses is reflected. The consumers confrontation with the origin of meat-products causes feelings of guilt and therefore a decreasing request for meat. Although, there is no long term change in eating habits for the majority of the population because of the aspects mentioned before, it must be worked towards an improvement concerning this particular situation as soon as possible.

The effects of energy content and sweet taste on food consumption in restrained and non-restrained eaters.

To characterize restrained eating behavior, we fed pudding mixtures (preloads) varying in energy content and sweet taste to subjects before measuring their intake of a variety of appetizing foods in a laboratory setting. Twenty-four female subjects were divided into three groups: normal-weight restrained eaters (no. = 8), normal-weight non-restrained eaters (no. = 7), and over-weight restrained eaters (no. = 9). Classification of subjects was based on body mass and restrained eating score. Five preloads varying in energy content (393 or 67 kcal) and type of sweeteners (sucrose or cyclamate) were served 1/2 hour before test meals of assorted hors d'oeuvres. Subjects were not informed of the specific aim of the study, and were instructed to eat until full. Multivariate analysis of variance of repeated measures showed that food intake of all subjects was higher after eating low-energy preloads than after eating high-energy preloads, although subjects did not recognize the effect in self-reports (p less than .01). The energy intake of restrained normal-weight eaters was significantly (p less than .05) lower after eating sweet preloads than after eating non-sweet preloads. Findings suggest that a food-intake control mechanism responds to short-term energy deficits among subjects of varied body mass and restrained eating indexes. J Am Diet Assoc 90:1223-1228, 1990.

[Can one become dependent on sugar?]. / Kann man von Zucker abhängig werden?

Sugar consumption does not cause an addictive behaviour in the sense of psychiatry. In the public opinion sugar is thought to be a problematic food especially of the anticipated negative consequence for the body weight. The avoidance of sweet food evokes a craving for sugar, which is due to sensory deprivation as to physiological mechanisms as well. The preference of the sweet taste seems to be innate. Therefore the training of a moderate consumption of sweetened food is more effective than a rigorous avoidance of all sweet food.