Weight loss in obese Mexican Americans treated for 1-year with orlistat and lifestyle modification.

OBJECTIVE: To evaluate the effectiveness of a culturally appropriate lifestyle intervention combined with orlistat in producing weight loss with obese Mexican-American women. SUBJECTS: Mexican-American women (N=108), aged 21-65 y, with a body mass index (BMI) > or =27 kg/m(2) were randomized to 1 y of treatment with orlistat and a culturally tailored lifestyle modification intervention (OLM; n=56) or a wait-list control group (WLC; n=52). DESIGN: A randomized, controlled, open-label 12-month study. Orlistat was dosed at 120 mg, three times per day. The OLM intervention included behavior modification, a low-fat (< or =30% of total daily calories) diet, and moderate physical activity (> or =150 min/week). MEASUREMENT: Primary outcomes included changes in body weight (kg), BMI, waist circumference, blood pressure, glucose, and lipids. RESULTS: A total of 72 (37 OLM, 35 WLC) and 66 participants (32 OLM, 34 WLC) completed the 6- and 12-month follow-ups, respectively. Repeated-measures ANOVA demonstrated a significant time x treatment interaction (Wilks' lambda=12.61; P<0.001), indicating that OLM-treated patients achieved significant weight loss relative to the WLC group during the study (mean percentage weight loss+/-s.e.m.; -8.1%+/-1.2 vs -1.6%+/-0.7 at 6 months and -8.8%+/-1.5 vs -0.2%+/-1.0 at 12 months, respectively). OLM-treated patients also experienced significant reductions in waist circumference, low-density-lipoprotein, and total cholesterol. CONCLUSIONS: This study demonstrates the effectiveness of an intervention combining orlistat and lifestyle modification with Mexican-American women, a population with substantial risk for obesity.

A randomized trial of a dissonance-based eating disorder prevention program.

OBJECTIVE: As psychoeducational eating disorder prevention programs have not been shown to reduce bulimic pathology, we developed and evaluated a dissonance-based intervention for high-risk populations. METHOD: Young women (N = 87) with body image concerns were randomized to this intervention, which involves verbal, written, and behavioral exercises requiring them to critique the thin-ideal, or to a healthy weight management control group. Participants completed a baseline, termination, and 4-week follow-up survey. RESULTS: Participants in the dissonance intervention reported decreased thin-ideal internalization, body dissatisfaction, dieting, negative affect, and bulimic symptoms at termination and at 4-week follow-up. Unexpectedly, participants in the healthy weight management control group also reported some benefits. DISCUSSION: Taken in conjunction with past findings, these preliminary results suggest that the dissonance intervention, and to a lesser extent the healthy weight management intervention, may reduce bulimic pathology and risk factors for eating disturbances.

Body image, social comparison, and eating disturbance: a covariance structure modeling investigation.

OBJECTIVE: To evaluate the role of appearance-based social comparison processes as a possible mediational link between developmental factors (negative social feedback, i.e., teasing about appearance; biological status, i.e., early physical maturation) and levels of body dissatisfaction, eating disturbance, and global psychological functioning. METHOD: In this study of 173 female undergraduates, covariance structure modeling (CSM) was used to examine direct and mediational relationships among these variables. RESULTS: Appearance-based social comparison mediated the effect of appearance-related teasing on body image and eating disturbance; body image mediated the effect of teasing on eating disturbance; eating disturbance had a direct effect on overall psychological functioning. DISCUSSION: Implications for devising and testing other theoretical models are discussed.

Proximal femoral focal deficiency.

Proximal femoral focal deficiency (PFFD) is an uncommon congenital defect that involves the femur and acetabulum in varying degrees. It may occur with or without fibular hemimelia and can be unilateral or bilateral in presentation. Children with PFFD and their families are faced with many treatment decisions, both nonsurgical and surgical. Nursing care is central in the care of these children and their families both for psychosocial support and teaching during the decision-making process and for being a patient advocate to help meet postoperative and rehabilitation goals.

Chronic pain/dysaesthesiae in spinal cord injury patients: results of a multicentre study.

The aim of the multicentre study entitled 'Description and Documentation of Painful States in Spinal Cord Injury Patients', in addition to the description and documentation of chronic pain and stressful dysaesthesiae in SCI patients, was the search for correlations between these symptoms and medical and psychosocial variables. To this end, the sample was selected to be as representative as possible. All patients referred for in-patient or out-patient treatment at the centres taking part were enrolled in the study in order of presentation, providing they gave consent and met the inclusion criteria. Psychosocial, medical and demographic data were elicited by a standardized battery of questions and a standardized physical examination, as were any chronic pain/dysaesthesiae (P/D) present in any localization. Among 901 patients, 34% had no chronic pain or dysaesthesiae, 50% had pain only, 11% had painful dysaesthesiae and 5%, non-painful but chronic and distressing dysaesthesiae. The intensity of P/D was noted as seven or more on a 10 cm visual analogue scale by 61% of the patients affected and was experienced as rather or very distressing in 75% of cases. Most (86%) P/D were located below the spinal lesion or in the transition zone. There were significant correlations between the presence of P/D and age on questioning and at onset of the paraplegia/tetraplegia, problems with rectal paralysis, expectations of life as a paraplegic/tetraplegic, and subjective assessment of changes in working life. Highly significant correlations were found with subjective distress resulting of paraplegia/tetraplegia as such, depressed mood and psychosomatic disturbances of wellbeing. Overall, among the selected variables of our study, we found that correlations between P/D and psychosocial variables were more frequent and closer than those between P/D and medical variables.

Explanations of body image disturbance: a test of maturational status, negative verbal commentary, social comparison, and sociocultural hypotheses.

OBJECTIVE: A number of hypotheses have been offered to explain the development and/or maintenance of body image disturbance. In this study, four factors which have been hypothesized to lead to body image problems were tested: maturational status (early physical development), negative verbal commentary (a history of being teased regarding physical appearance), behavioral social comparison, and awareness/internalization of sociocultural pressures. METHODS: One hundred sixty-two college females completed measures designed to index these four influences. Predictors were regressed onto multiple measures of body image and two indices of eating disturbance. RESULTS: Even with self-esteem and level of obesity removed as influences, social comparison and societal factors were significant predictors of body dissatisfaction and eating disturbance. Negative verbal commentary also explained a small part of the variance, however, maturational status did not contribute uniquely in any analysis. DISCUSSION: The findings offer further support for emerging theories of body image and eating disturbance.

Development and validation of the Sociocultural Attitudes Towards Appearance Questionnaire.

The Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) was developed to assess women's recognition and acceptance of societally sanctioned standards of appearance. In Study 1, factor analyses revealed two clearcut factors: awareness/acknowledgment of a societal emphasis on appearance and an internalization/acceptance of these standards. These findings were cross-validated in Study 2, resulting in a six-item Awareness subscale (alpha = .71) and an eight-item Internalization subscale (alpha = .88). Study 3 obtained good convergence between both scales and multiple indices of body image and eating disturbance. Regression analyses indicated that both factors accounted for unique variance associated with body image and eating dysfunction, however, internalization of standards was a stronger predictor of disturbance. The SATAQ should prove useful for researchers and clinicians interested in body image and eating disorders.

Factor analysis of multiple measures of body image disturbance: are we all measuring the same construct?

Two studies were conducted to determine the overlap among multiple measures of subjective body image disturbance. Study 1 was conducted on 219 adolescent females (ages 14-18 years) who completed seven widely used indices of self-reported body image disturbance. Study 2 involved 162 college females (ages 17-35 years) and six measures of disturbance, five of which were identical with those instruments used in Study 1. Factor analyses indicated the existence of two factors in the adolescent sample, however, one factor was quite strong and accounted for most of the variance. Analyses on the adult subjects revealed the existence of a single body image factor. It was concluded that the measures under investigation largely reflect an underlying single factor of body image, despite their common usage in the literature as indicators of multiple aspects of body image disturbance.

Cardiovascular reactivity, anxiety and anger during perceived controllability.

The purpose of this study was to investigate the relationship between emotional and cardiovascular responses in an aversive active coping situation. A letter detection task was presented to 64 male students. From a stream of letters scrolling over a screen, subjects were required to eliminate specific letters. Task difficulty was varied by changing the speed with which the stream moved along on the screen. Perceived control over an aversive loud tone was manipulated by instruction. While blood pressure differences in the experimental conditions could not be found, the group with perceived control displayed greater increases in heart rate and greater shortening of pulse transit time. In subjects low in trait anger, belief of control over aversive tones led to heightened cardiovascular reactivity compared with subjects high in trait anger. The results are discussed with respect to suppression of anger and a possibly opposite effect of emotion and mental effort in aversive active coping situations.