Alice K. Lindeman

Energy balance in highly trained female endurance runners

Anecdotal and scientific reports have suggested that some female endurance athletes may have an inexplicable imbalance between energy intake and energy expenditure. We compared energy intake (EI) from food diaries (FD) with assessment of free-living energy expenditure (EE) using doubly labeled water (DLW) and a food attitude survey for 7 d in nine female distance runners. Daily EE via DLW (2990 +/- 415 kcal) was greater (P < 0.01) than daily EI via FD (2037 +/- 298 kcal): a 32% imbalance. Body weight did not change during the 7 d (day 1, 55.3 +/- 6.2 kg; day 7, 55.1 +/- 5.6 kg). A positive relationship was observed between EE and body weight (r = 0.82) while a negative correlation existed between EE vs EI (r = -0.83) and between EI vs body weight (r = -0.74). A negative correlation was observed between body weight and food attitude/body image (r = -78), i.e., the heavier women self-reported lower EI and also reported lower body image scores. These female athletes had a significant imbalance between EI and EE by our measures. Since body image and EI were related to body weight, the estimates of EI may be low due to underreporting particularly by the heavier athletes.

Gastroplasty for respiratory insufficiency of obesity

Three patients with the obesity hypoventilation syndrome and one patient with the sleep apnea syndrome underwent gastroplasty for weight reduction. A tracheostomy was also performed in the patient with sleep apnea. The PaOo rose from an average of 51 ± 9 to 71 ± 5 torr and the PaC02 fell from an average of 51 ± 12 to 41 ± 6 torr within two to ten months following bariatric surgery. The improved arterial blood gases were associated with an increased forced vital capacity in each patient. The change in maximum voluntary ventilation was variable. Sleep capneography demonstrated cure of the patient with sleep apnea permitting removal of the tracheostomy. All four patients have returned to productive lives in society. Given proper pre- and postoperative care, patients with respiratory insufficiency tolerate the operation well. Respiratory insufficiency associated with morbid obesity should be considered an indication for the gastroplasty procedure, rather than a contraindication as previously suggested.

Quest for ideal weight: costs and consequences

The quest to achieve the ideal weight comes with notable costs. Dieting carries the financial costs of professional consulting, low-calorie foods, books and materials, and diet programming. Club memberships, clothing, equipment, and time all contribute to the cost of exercise. Cosmetic surgery to achieve the desired physique carries a significant financial, and sometimes psychological, burden. Women often pursue thinner bodies despite already being at a healthy weight. This pursuit is motivated primarily to enhance appearance. The ideal body portrayed in the media has stabilized in thinness, but it is becoming increasingly tubular, i.e., taller with slimmer hips and thicker waist. This ideal is presented to adult and adolescent women in their popular magazines, and to little girls with their dolls. Exercise is promoted as an optimal means to achieve the ideal physique. Young American women tend to idealize an athletic body shape, especially with upper-body muscularity. This shape can be attained only through sustained exercise and upper-body strength training. High-level exercise may be a precursor to eating disorders. Women who exercise to excess, who are highly preoccupied with weight, and who are characterized by perfectionism and an obsessive compulsive personality are at risk for eating disorders. When body weight and shape are kept in perspective and realistic goals are set, the physical, psychological, and financial costs of achieving or maintaining a healthy weight may be minimized.

SUCCESSFUL WEIGHT LOSS IN A SELF-TAUGHT, SELF-ADMINISTERED PROGRAM: 427

There is little evidence concerning the effectiveness of self-help materials for weight control. The purpose of this research was to evaluate a self-help weight-loss program. Obese (body fat > or = 25.0%, range = 25.0-48.6%, mean +/- SEM = 36.5 +/- 1.3%) men (n = 14) and women (n = 21) were given a workbook detailing a behavior modification approach to weight loss that emphasizes self-monitoring of diet and exercise behaviors, and then sent home for 6 months to learn how to lose weight on their own. A group of 9 controls (CONT) who did not get a workbook were used for comparison. ANOVA showed that the experimental group (EXP) lost 8.1 +/- 0.9 (mean +/- SEM) kg body weight, 6.4 +/- 0.8 kg fat, and 3.9 +/- 0.6% body fat; all significant over time (p < 0.001) and different from the CONT (p < 0.0001) who showed no change in these variables. The EXP also reduced their fat intake (% of joules) from 36.1 +/- 1.0% to 27.9 +/- 1.3% (p < 0.0001), increased their carbohydrate intake from 45.7 +/- 1.2% to 50.0 +/- 1.7% (p < 0.007) and their protein intake from 16.3 +/- 0.05% to 20.7 +/- 0.7% (0 < 0.03), all of which were significantly different (p < 0.03) than the CONT who did not change. Dietary fiber increased in the EXP from 19.8 +/- 1.4 to 27.3 +/- 2.2 g/d (p < 0.001) even with a significant reduction in energy intake (11.3 +/- 0.6 vs. 8.9 +/- 0.5 Mj/d; p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)