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OBJECTIVE: To examine characteristics of craved foods in relation to dietary energy restriction (ER) with high (HG) and low glycemic load (LG) diets. DESIGN: Assessments of food cravings before and during a randomized controlled trial of HG and LG diets provided for 6 months. SUBJECTS: Thirty-two healthy, overweight women aged 20-42 years. MEASUREMENTS: Self-reported food cravings and dietary intake, body weight, weight history and measures of eating behaviors. RESULTS: Foods craved at baseline were more than twice as high in energy density as the habitual diet (3.7+/-1.5 vs 1.7+/-0.3 kcal/g; P<0.001), and on average were lower in protein (P<0.001) and fiber (P<0.001) and higher in fat (P=0.002). There were no statistically significant changes in nutritional characteristics of craved foods after 6 months of ER. There was a significant relationship between reported portion size of craved food consumed at baseline and lifetime high body mass index (r=0.49, P=0.005). Additionally, there was a significant association between susceptibility to hunger and craving frequency at baseline, and there were significant relationships between hunger score, craving frequency, strength and percentage of time that cravings are given in to after 6 months of ER. In multiple regression models, subjects who lost a greater percentage of weight craved higher energy-dense foods at month 6 of ER, but also reported giving in to food cravings less frequently (adjusted R (2)=0.31, P=0.009). CONCLUSION: High energy density and fat content, and low protein and fiber contents were identifying characteristics of craved foods. The relationships between craving variables and hunger score suggest that the relative influence of hunger susceptibility on cravings may be important before and especially after ER. Portion size of craved foods and frequency of giving in to food cravings appear to be important areas for focus in lifestyle modification programs for long-term weight loss.

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Non-restrained and restrained American women (N=157) chose a portion of a fat-free or regular-fat hot fudge, to be eaten on a portion of fat-free or regular-fat (depending on the experimental condition) ice cream. The subjects had tasted and rated samples of both fudge and ice cream earlier in the same session and, prior to the choice, they were informed of their own hedonic ratings of both fudges and of the respective fat contents ("fat-free" vs. "regular-fat"). The higher the hedonic difference (fat-free minus regular-fat) between hot fudge samples and the higher the individual restraint score, the more likely was the choice of the fat-free option. Also, the less hungry the subjects were prior to testing, the more likely they were to choose the fat-free version. On average, the hedonic difference between the hot fudge samples was roughly -0.5 for those choosing the fat-free option, while the corresponding value for subjects choosing the regular-fat version was -3 (9-point scale). The type of ice cream did not affect the choice. The data demonstrate the effects of a food (its hedonic quality), person (restrained status), and context (perceived hunger) on food choice.

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Although traditional "NPO (nothing by mouth) after midnight" policies are being liberalized, noncompliance with NPO status remains a threat to patient safety and may result in delays of elective surgical procedures, decrease the efficiency of the ambulatory surgery setting, and waste healthcare dollars. The purpose of the present study was to examine how comprehensive NPO instructions affected group differences in knowledge and perceptions of importance of maintaining preoperative NPO status. In this posttest-only study, 122 ambulatory surgery patients were randomly assigned to the experimental group (n = 66), who received comprehensive NPO instructions, or the control group (n = 56), who received the usual NPO instructions. Outcome measures were taken on the day of surgery via a questionnaire developed by the investigator. Outcome differences were examined, and group means were compared using analyses of variance and covariance. Although findings revealed comparable compliance rates between the groups and no significant differences when knowledge about NPO status was compared, a significant difference was found when perception of importance of maintaining NPO status was compared. Findings from the study suggest that providing patients with the rationale for adhering to preoperative NPO orders can significantly increase the patient's perception of the importance of maintaining preoperative NPO status.

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BACKGROUND: Current theories of human health behaviors suggest that clients' preferences for specific aspects of a health regimen are an important influence on their decisions to initiate and continue use of the regimen. Despite low rates of participation in cardiac rehabilitation programs, especially among women, little research has been done to determine patient preferences for features of cardiac rehabilitation programs. The purpose of this study was to identify and compare women's and men's preferences for specific cardiac rehabilitation program features. METHODS: Using a descriptive survey design, a convenience sample of 65 individuals (33 men and 32 women) participating in a cardiac rehabilitation program completed a self-administered survey in which they indicated both the importance of each of 17 cardiac rehabilitation program features and the extent to which they had experienced each of the features. RESULTS: Convenience factors (drive time, transportation, noninterference with other life activities, and ease of learning the exercises) were well-met preferences for both women and men. Men's and women's preferences were not well met for being able to discuss their progress with professionals and the ability to choose their own exercises. Men indicated that the ability to set their own goals was their greatest unmet preference. Women's preferences for not having pain and not tiring while exercising were significantly less well met than those of men. CONCLUSIONS: These findings suggest that a cardiac rehabilitation program that is responsive to client preferences should emphasize joint goal setting with participants and discussion of progress, offer frequent encouragement from professionals, and provide a range of exercise choices. Attention to women's concerns about pain and fatigue while exercising should also be addressed in the program.

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The effect of breast-feeding on maternal anthropometric measures during the first 6 postpartum months was studied in 24 women. Mothers, who were seen in the hospital shortly after delivery and at monthly intervals thereafter, kept a record of their infant-feeding practices and provided three 24-hour dietary recalls per month. The women were placed in one of three groups according to their infant-feeding practices: breast-feeding exclusively, combination of breast- and formula-feeding, and formula-feeding only. Changes in anthropometric variables at 6 months postpartum were similar in the three groups, but mothers who breast-fed exclusively or partially had significantly larger reductions in hip circumference measurements (3.6% and 3.1%, respectively) and were less above their prepregnancy weights at 1 month postpartum (7.8% and 8.5% above prepregnancy weight, respectively) than mothers who fed formula exclusively (0.68% reduction in hip circumference and 13.7% above prepregnancy weight). Our findings indicate that a woman's choice of infant-feeding practice influences postpartum anthropometric changes, but these effects may be temporary.

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In societies such as the U.S.A. many foods are considered appropriate or inappropriate for particular meals. Although some previous work has indicated that hedonic ratings reflect these cultural patterns, little is known about the impact of time of day and "appropriateness" in particular on food acceptance and intake. The purpose of the present study was to explore the role of appropriateness on consumption and hedonic ratings of breakfast and non-breakfast foods. Experiment 1 examined these factors in the context of four meals in which the type of menu (breakfast or lunch) was factorially combined with time of day (breakfast time or lunchtime). Experiment 2 examined hedonic ratings obtained in the morning and afternoon using samples of the same foods and rating methods used in Experiment 1. Experiment 3 replicated Experiment 2 but employed the rating methods used in Birch et al. (1984). Results from the three experiments indicated that the appropriateness or inappropriateness of when foods were served had no effect upon hedonic ratings and no clear impact on food intake. Postmeal hunger ratings in Experiment 1, however, provided some support for the salience of appropriateness. These results suggest that appropriateness may be more relevant to food selection than to consumption or palatability per se.

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The Garren-Edwards Gastric Bubble (GEGB) was introduced in 1984 as an alternative to surgery (jaw wiring, gastrointestinal bypass, vertical banded gastroplasty) for the treatment of morbid obesity in patients who had failed behavior modification therapy or dietary management for weight reduction. Its mechanism of action is unclear and previous reports have not demonstrated any significant consistent alteration in gastric emptying (GE) as measured by radionuclide techniques. Other proposed mechanisms include: placebo, hormonal, mechanical "satiety", behavioral modification, and neuronal. In order to determine the effect of the GEGB on GE, ten obese (mean % overweight = 89%) patients, 27-50 yr old (mean = 36 yr), had solid GE scans before and 5 wk after endoscopic placement of the bubble. GE scans were performed in six patients after removal (12 = wk residence time). The meal consisted of 300 microCi [99mTc]sulfur colloid in the form of a 300 kcal egg sandwich (egg white 248 g, white bread 40 g, butter 6 g; composition = CHO 40:PR 40: FAT 20) with 180 ml deionized water. Images were obtained in the anterior and posterior projections at 15-min intervals for 1 hr (four patients) or 2 hr (six patients) and the %GE (decay corrected geometric mean) was calculated. Unlike other studies involving the GEGB, adjunctive therapy in the form of dieting and behavior modification were not employed in this study. The effect of the GEGB alone in the treatment of obesity has not been previously evaluated. There was a significant (p less than 0.025) delay in gastric emptying at 1 hr (pre-bubble mean % gastric retention = 46%; bubble mean = 57%; n = 10). After removal, GE returned toward baseline (mean % gastric retention = 51%; n = 6) (p less than 0.05) (Student's t-test). The average weight loss was 5.5 lb (n = 10; p less than 0.025). One mechanism of action of the GEGB may be delayed gastric emptying resulting in early satiety and decreased food intake with resultant weight loss.

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An evaluation of the Garren-Edwards gastric bubble in the treatment of obesity was done. Several clinical trials have compared the effects of behavior therapy with and without the bubble, but the effects of the bubble alone have not been previously evaluated. Ten obese women averaging 91% overweight received the bubble without adjunctive therapy during a 12-week treatment period. Frequent psychological and laboratory measures as well as weight were obtained during the study to explore the possible mechanisms of the bubble's effect and its side effects. Mean weight change was -2.5 kg, with a range of -8.8 to +1.6 kg. Four patients lost more than 3.5 kg, three lost less than 3.5 kg, and three gained weight. The Garren-Edwards gastric bubble alone does not appear to provide significant benefit to most obese patients.

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Much progress has been made in the development of behavioral programs in recent years. As a consequence, the behavioral approach now is integrated into most programs for weight loss. Because "behavior modification" is practiced so widely, there is a tendency to believe that it consists of little more than a series of techniques or tricks such as record keeping and slowing eating, and that programs do not vary much in how it is employed. This is mistaken. A modern day, comprehensive program is sophisticated and involves systematic work, not only on eating behavior, but on exercise, attitudes, social relationships, nutrition, and other factors. The better behavioral programs now are producing weight losses in the range of 25 to 30 lb. The greatest strength of the behavioral approach, however, lies in the maintenance of weight loss. This is an area where exciting developments are occurring. These developments are important, not only to clinicians and programs using behavior modification per se, but to professionals using nearly any approach to weight loss where the maintenance of loss is an issue. The horizon holds much promise for the potential of behavioral approaches, used alone or in combination with other treatments for obesity.

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Maintenance of weight loss continues to be a critical concern in behavioral treatment programs. Problems with the acquisition and/or application of behavioral skills are a likely contributor to relapse. However, biological models, especially the hypothesis of a body weight setpoint, are being offered increasingly as alternative explanations for maintenance failure. Within the context of these sometimes opposing viewpoints the present study describes long-term weight outcomes for 114 men and 38 women assessed annually for 4 or 5 years following completion of a 15 week behavioral weight loss program. Although significant mean weight loss was evident at long-term follow-up, a negatively accelerating pattern of weight regain was the predominant outcome. Less than 3 percent of the subjects were at or below their posttreatment weight on all follow-up visits. Consistent sex differences were found, with women having better weight loss maintenance than men. Implications and potential future directions are discussed.

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Twenty-one men and 38 women participated in a worksite smoking cessation/smoking reduction program that combined financial contracts, organized through payroll deduction, and biweekly group treatment sessions. At the end of the program the smoking cessation rate was 51%, validated by expired air carbon monoxide. Six months later the validated cessation rate was 12%. We conclude that payroll incentives may be effective in helping workers quit smoking and offer suggestions for ways to promote better maintenance of this important behavior change.

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This study evaluated the feasibility and effectiveness of a program for weight gain prevention in normal-weight adults. Two hundred nineteen participants were randomized to either weight gain prevention treatment or no treatment for a period of 12 months. Those in the treatment group received monthly newsletters relating to weight management, participated in a financial incentive system, and were offered an optional four-session education course in the sixth month of the program. Results demonstrated high interest in weight gain prevention among individuals who were not objectively overweight. Participation, as measured by return of postcards sent with each newsletter, was approximately 75%. Results after 1 year showed a net weight loss in the group receiving the program of 1.8 lb compared to those in the control group. Eighty-two percent of program participants maintained or lost weight, compared to 56% of the control group. It is concluded that programs for weight gain prevention are feasible in adults and may be more effective than weight loss treatment programs in addressing the problem of community-wide obesity.

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Psychological, psychosomatic and neuroendocrine (in blood) responses to mental task load were investigated in relation to Type A behaviour and borderline hyperventilation. For this purpose 32 apparently healthy, male volunteers were classified on the basis of their scores on the Jenkins Activity Survey (JAS) and on a questionnaire assessing hyperventilation related symptoms (HRS). The subjects performed a memory search task in which a monetary bonus could be won or lost. At rest higher HRS scores were related to increased acute psychosomatic symptom scores and higher JAS scores to higher prolactin levels. Task performance caused an increase of state anxiety, acute psychosomatic symptoms, adrenaline and cortisol, whereas prolactin decreased. Higher JAS scores were related to greater cortisol responses and higher HRS scores to smaller adrenaline responses.

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The purpose of this study was to determine whether former participants in weight-control programs would provide valid weight data by self-report in telephone interviews. Participants were 39 women and 107 men (aged 28 to 63 years) who were in year 4 or 5 post-treatment. These represented 95% of participants who had completed all annual clinic visits. Self-reported body weights obtained by telephone interview were validated against weight measured directly in a university clinic. Overall, self-reported weight was 5.9 lb (2.7 kg) (standard deviation = 7.0 lb) (2.9%) lower than the measured weight. Using regression analysis, the strongest predictor of measured weight was reported weight, for both men and women. The bias in self-report of weight seen here is of about the same magnitude and direction as that seen in population studies. We conclude that the use of self-reported weight is not adequate for the assessment of long-term weight-loss maintenance unless the magnitude of discrepancy is adjusted for.

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