Candace L. Kurth

Food preferences in human obesity: carbohydrates versus fats.

A large clinical sample of obese men and women were asked for a self-generated list of ten favorite foods. The lists were characterized by frequent instances of foods that are major nutrient sources of fat in the American diet. While obese men listed mainly protein/fat sources (meat dishes) among their favorite foods, obese women tended to list predominantly carbohydrate/fat sources (doughnuts, cookies, cake) and foods that were sweet. There was no evidence that selective preferences for a single macronutrient, carbohydrate, were a standard feature of human obesity. Rather, preferences for major nutrient sources of fat as opposed to carbohydrate may be a primary characteristic of human obesity syndromes.

The relationship of dieting severity and bulimic behaviors to alcohol and other drug use in young women.

Patients with bulimia nervosa frequently have problems with alcoholism and other substance abuse. The goal of this study was to assess whether this relationship between eating abnormalities and substance abuse extends to subthreshold levels of dieting and substance use. A self-administered questionnaire assessing dieting and substance use (alcohol, cigarettes, and marijuana) was completed by 1,796 women prior to their freshman year in college. Using a scale derived from DSM-III-R criteria for bulimia nervosa and previous research in this population, subjects were categorized as nondieters, casual, intense, severe, at-risk or bulimic dieters. The relationship between the dieting-severity category and frequency and intensity of alcohol use and frequency of marijuana and cigarette use was assessed. DSM-III-R criteria for bulimia nervosa were met by 1.6% of the women. Only 13.8% of these women were nondieters. Increasing dieting severity was positively associated with increasing prevalence of alcohol, cigarette, and marijuana use and with increasing frequency and intensity of alcohol use. The bulimic and at-risk dieters were similar in their alcohol and drug use. The relationship between eating disorders and alcoholism and other substance abuse noted in clinical populations extends in a continuous, graded manner to subthreshold levels of dieting and substance use behaviors. Dieting-related attitudes and behaviors in young women may be related to increased susceptibility to alcohol and drug abuse.

The severity of dieting and bingeing behaviors in college women: Interview validation of survey data

A combined survey and interview study was conducted to validate a categorical Dieting and Bingeing Severity Scale (DBSS), and to estimate the prevalence of eating disorders in young women. We hypothesized that assignment to the DBSS categories would be confirmed by clinical interviews such that interview-diagnosed eating disorders would be found with increasing frequency and severity at the upper end of the DBSS. Freshmen college women (n = 1367) completed a survey instrument addressing the frequency and severity of dieting, binge-eating, and other behaviors and attitudes related to weight control. Random stratified sampling procedures were used to select a subset of women (n = 306) from each DBSS category for structured clinical interviews for DSM-III-R (SCID). Survey respondents were assigned to one of six mutually exclusive DBSS categories: non-dieters (9% of sample), casual dieters (26%), moderate dieters (23%), intense dieters (21%), dieters at-risk (19%), and probable bulimia nervosa (2%). The DBSS effectively rank-ordered subjects according to the risk of having interview-diagnosed eating disorders. Women in the three most severe DBSS categories were significantly more likely to have current subthreshold and threshold level eating disorders, in particular bulimia nervosa and eating disorder not otherwise specified (EDNOS). The estimated prevalence of current bulimia nervosa was approximately 2% by both survey and interview methods. The prevalence of current EDNOS was 13%, more than six times greater than the prevalence of bulimia nervosa. The DBSS was found to be a reliable and valid measure of dieting and bingeing severity. The survey instrument may be useful in measuring the extent of, and changes in, pathological dieting in community-based samples of young women, and in studying comorbidity of dieting and bingeing severity with other psychiatric conditions including depression and substance use. The DBSS may also be useful in identifying risk factors associated with the onset of eating disorders.

Effects of body image on dieting, exercise, and anabolic steroid use in adolescent males

This cross-sectional survey study examined body image, dieting and exercise variables, and steroid use in 2,088 high-school graduates aged 18 years. In contrast to women, more men wished to gain (46%) rather than loose weight (32%). Men who wished to gain weight were more satisfied with their body shape, showed no fear of fatness, and dieted and exercised less frequently than did men who wished to lose weight. The prevalence of dieting was low (4%), even among men who wished to lose weight (9%), and physical exercise was more likely to be used for both weight loss and weight gain. Contrary to expectations, anabolic steroid use was rare (0.6%) and was not associated with a desire for weight gain. Steroid users were more likely to engage in running and swimming than football. The data did not support the notion that anabolic steroid use is widespread among high-school males.

Willingness of female smokers to tolerate postcessation weight gain

When asked how much weight they would be willing to gain if they quit smoking, women smokers replied 5.0 +/- 5.8 pounds (2.3 +/- 2.6 kg), compared with 10.7 +/- 7.6 pounds (4.9 +/- 3.5 kg) for men. Seventy-five percent of women, vs. 35% of men, were unwilling to gain more than 5 pounds (2.3 kg). White women were willing to gain 4.2 +/- 4.5 pounds (1.9 +/- 2.0 kg) compared with 11.1 +/- 10.7 pounds (5.0 +/- 4.9 kg) for Black women. In women under 25 years of age, 57% were unwilling to gain any weight at all, but even among women older than 40, 39% were unwilling to gain weight. Willingness to gain was negatively correlated with Body Mass Index, but even among nonoverweight women, 33% were unwilling to gain weight. Similarly, willingness to gain was negatively correlated with restrained eating, but even among low-restraint women, 22% were unwilling to gain weight. These findings suggest that unwillingness to gain is endemic among female smokers, that success in persuading them to accept a gain of more than 5 pounds (2.3 kg) as a final outcome is unlikely, and that strategies for postponing gain until cessation is well established, combined with waiting until weight stabilizes before determining what weight-management measures are needed, may be more effective.

Body weight and dieting in adolescence: Impact of socioeconomic status

This cross-sectional survey study examined dieting and exercise variables as a function of parental education in 2,174 male and 1,804 female college-bound high school graduates aged 18 years. Parental education is an index of socioeconomic status (SES). Higher SES was associated with lower current and desired body weight in both women and men. The prevalence of dieting, binging, and vigorous exercise for weight control increased with SES for women but not for men. These data confirm the inverse relationship between body weight, dieting, and social class, previously demonstrated with American adults.

Dieting Severity and Gastrointestinal Symptoms in College Women

Young women report symptoms associated with irritable bowel syndrome (IBS), such as pain, bloating, and changes in bowel movements, more often than young men. Young women with eating disorders also report these gastrointestinal symptoms frequently. We hypothesized that if dieting behaviors were associated with these symptoms, the prevalence and frequency of the symptoms would be positively related to dieting severity in young women. We interviewed 301 1st-year college women representing the continuum of dieting severity. We found that severity of dieting was positively related to frequency of abdominal pain, bloating, diarrhea, and constipation, and that the women who reported 3 or more symptoms regularly scored higher on a scale for dieting severity. Although this study did not examine the relationship between dieting severity and clinical IBS, the findings suggested that dieting is associated with gastrointestinal symptoms in young women.

Influence of diet, vitamins and chemotherapeutic agents on gastrointestinal cancer

Abstract Dietary influences play a major role in the pathogenesis of most gastrointestinal malignancies. However, it has been difficult to define which dietary components will be most significant for any given individual. In this article we discuss the methodological challenges to research in this field as well as recent observations that have been made on the role of dietary factors in specific digestive tract neoplasms.

Dieting and Alcohol Use in Women

The connection between dieting, which involves the restriction of caloric intake and especially the avoidance of the intake of “empty” calories, and alcohol consumption, which involves the intake of calories that are not nutritionally vital, is not intuitively obvious to many. Therefore, the reader of this chapter may benefit from a recounting of the way in which we came to study this problem. We recognize that this may be viewed as a rather egocentric approach by some, but in our experience with talking about this area of interest with colleagues, we have found that this type of review tends to be an understandable approach to this topic. The comorbidity of eating disorders and substance abuse have also been reviewed extensively elsewhere,1,2and more emphasis regarding family history and clinical implications are available in these sources.