Christie Zunker

Sexual Functioning and Obesity: A Review

We review the literature on the relationship between obesity and sexual functioning. Eleven population‐based studies, 20 cross‐sectional non‐population‐based studies, and 16 weight loss studies are reviewed. The consistency of findings suggests that the relationship between obesity and reduced sexual functioning is robust, despite diverse methods, instruments, and settings. In most population‐based studies, erectile dysfunction (ED) is more common among obese men than among men of recommended weight. Studies of patients in clinical settings often include individuals with higher degrees of obesity, with most studies showing a relationship between obesity and lower levels of sexual functioning, especially ED. The few studies that include both genders generally report more problems among women. Most studies of patients with comorbidities associated with obesity also find an association between obesity and reduced sexual functioning. Most weight loss studies demonstrate improvement in sexual functioning concurrent with weight reduction despite varying study designs, weight loss methods, and follow‐up periods. We recommend that future studies (i) investigate differences and similarities between men and women with respect to obesity and sexual functioning, (ii) use instruments that go beyond the assessment of sexual dysfunction to include additional concepts such as sexual satisfaction, interest, and arousal and, (iii) assess how and the degree to which obese individuals are affected by sexual difficulties. Given the high prevalence of obesity and the inverse association between body mass and sexual functioning, we also recommend that sexual functioning should be more fully addressed by clinicians, both in general practice and in weight loss programs.

Laxative abuse: epidemiology, diagnosis and management.

Laxatives have been used for health purposes for over 2000 years, and for much of that time abuse or misuse of laxatives has occurred. Individuals who abuse laxatives can generally be categorized as falling into one of four groups. By far the largest group is made up of individuals suffering from an eating disorder such as anorexia or bulimia nervosa. The prevalence of laxative abuse has been reported to range from approximately 10% to 60% of individuals in this group. The second group consists of individuals who are generally middle aged or older who begin using laxatives when constipated but continue to overuse them. This pattern may be promulgated on certain beliefs that daily bowel movements are necessary for good health. The third group includes individuals engaged in certain types of athletic training, including sports with set weight limits. The fourth group contains surreptitious laxative abusers who use the drugs to cause factitious diarrhoea and may have a factitious disorder.Normal bowel function consists of the absorption of nutrients, electrolytes and water from the gut. Most nutrients are absorbed in the small intestine, while the large bowel absorbs primarily water. There are several types of laxatives available, including stimulant agents, saline and osmotic products, bulking agents and surfactants. The most frequently abused group of laxatives are of the stimulant class. This may be related to the quick action of stimulants, particularly in individuals with eating disorders as they may erroneously believe that they can avoid the absorption of calories via the resulting diarrhoea.Medical problems associated with laxative abuse include electrolyte and acid/base changes that can involve the renal and cardiovascular systems and may become life threatening. The renin-aldosterone system becomes activated due to the loss of fluid, which leads to oedema and acute weight gain when the laxative is discontinued. This can result in reinforcing further laxative abuse when a patient feels bloated and has gained weight.Treatment begins with a high level of suspicion, particularly when a patient presents with alternating diarrhoea and constipation as well as other gastrointestinal complaints. Checking serum electrolytes and the acid/base status can identify individuals who may need medical stabilization and confirm the severity of the abuse. The first step in treating laxative misuse once it is identified is to determine what may be promoting the behaviour, such as an eating disorder or use based on misinformation regarding what constitutes a healthy bowel habit. The first intervention would be to stop the stimulant laxatives and replace them with fibre/osmotic supplements utilized to establish normal bowel movements. Education and further treatment may be required to maintain a healthy bowel programme. In the case of an eating disorder, referral for psychiatric treatment is essential to lessen the reliance on laxatives as a method to alter weight and shape.

Ecological momentary assessment of bulimia nervosa: Does dietary restriction predict binge eating?

The purpose of this study was to examine the relationship between caloric restriction (CR) and binge eating (BE) using ecological momentary assessment (EMA). Participants included 133 women with bulimia nervosa (BN) who completed an EMA protocol for 2 weeks. Logistic regression analyses tested whether CR increased the probability of BE episodes. The results revealed that the odds of BE increased on the day that restriction occurred as well as on the following day. In addition, both restriction and BE on one day predicted the likelihood of BE the subsequent day, but restriction for two days prior to the episode failed to add additional information for predicting BE. These findings support the cognitive behavioral therapy (CBT) model of BN, suggesting that self-reported dietary restriction is predictive of subsequent BE episodes, and that reducing dietary restriction in treatment may lead to improvements in bulimic symptoms.

Exercise interventions for women with anorexia nervosa: A review of the literature†

OBJECTIVE To identify exercise interventions in the empirical literature to help inform clinical decision making in the treatment of underweight individuals with anorexia nervosa (AN) and review any recommended differences in treatment planning for those who excessively exercise and those who do not. METHOD Online search engines and cross-referencing articles identified relevant studies. RESULTS Six exercise interventions in clinical settings were reviewed, including three conducted in hospitals. A few studies provided some evidence to support the implementation of moderate physical activity during treatment. Most did not include specific exercise program descriptions. Patient eligibility varied from obligatory for all patients to programs that specified weight requirements. DISCUSSION Few studies have systematically explored exercise as a part of treatment among patients with AN. Findings of the current review suggest a need for developing further research, but currently the field may benefit from standardized guidelines for treating excessive exercisers with AN.

Using Formative Research to Develop a Worksite Health Promotion Program for African American Women

ABSTRACT Objectives: To describe the development of a culturally appropriate worksite health promotion program (WHPP) designed to promote increased physical activity and improved nutrition in a high risk group of African American women. Methods: The program was based on EatRight, which is a lifestyle-oriented weight control program that focuses on food volume, rather than calories. Formative research included four nominal group technique (NGT) sessions conducted with 14 African American women from the selected worksite to gather input on job factors that affected their weight and daily life factors that affected their amount of physical activity. Their responses were used to adapt existing EatRight materials to target areas of special need for this unique group. Results: Themes emerged from the NGT sessions that indicated stress at work and an environment of unhealthy eating, in addition to social eating and lack of social support for healthy eating added to unhealthy eating patterns at work. In response to physical activity, the primary themes included lack of time to exercise, stress of multiple family roles and responsibilities, and perceived physical barriers to physical activity. Discussion: Based on the NGT themes, EatRight materials were adapted and additional topics (e.g., increasing social support, overcoming limitations, and time management) were included to develop a WHPP that addressed issues that the participants identified as relevant for their work and home lives. Conducting the NGT sessions and EatRight classes in the work environment, we were able to provide a convenient, familiar environment which fostered social support among participants. We believe that a culturally appropriate modification of EatRight holds great promise in addressing health disparities seen among African American women by offering education on lifestyle changes that will decrease weight through nutrition and physical activity.

Weight Suppression As a Predictor Variable in Treatment Trials of Bulimia Nervosa and Binge Eating Disorder

OBJECTIVE The purpose of this study was to examine weight suppression (WS) as a predictor of treatment outcome among individuals with binge eating disorder (BED) and bulimia nervosa (BN). METHOD Participants were diagnosed with BED or BN and took part in separate treatment studies. The current study examined WS as a predictor of treatment completion, weight change during treatment, and symptomatic abstinence, as well as percent reduction in binge eating and purging frequency. RESULTS WS did not significantly predict treatment completion or treatment outcome in either group. DISCUSSION Contrary to some previous findings, these results failed to demonstrate that WS was predictive of outcome at the end of treatment in BN. In addition, WS was not predictive of treatment outcome or dropout status in BED.

A receiver operator characteristics analysis of treatment outcome in binge eating disorder to identify patterns of rapid response

The purpose of this study was to perform a receiver operator characteristics (ROC) analysis on a treatment sample from a randomized controlled treatment trial of participants with binge eating disorder (BED). An ROC analysis was completed with 179 adults in a 20-week treatment trial for BED to predict abstinence from binge eating at end of treatment. Percent reductions in binge eating episodes were examined following weeks 1 through 10 of treatment. The rate of percent decrease in binge eating episodes during treatment for BED was a significant predictor of clinical outcome at end of treatment. Participants who demonstrated a 15% reduction in binge eating episodes at week one were more likely to respond positively to treatment and achieve clinical remission. Findings from the current study suggest that a significant reduction in binge eating during the first week of treatment may be predictive of end of treatment remission in those with BED.

A study of a culturally enhanced EatRight dietary intervention in a predominately African American workplace.

CONTEXT The workplace may be an ideal venue for engaging African American women in behavioral interventions for weight reduction. OBJECTIVE To examine the effectiveness of a culturally enhanced EatRight dietary intervention among a group of predominately African American women in a workplace setting. DESIGN Crossover design study. SETTING Workplace. PARTICIPANTS A total of 39 women volunteered for this study, of whom 27 completed it. INTERVENTION The control period involved observation of participants for 22 weeks after receiving standard counseling on lifestyle methods to achieve a healthy weight; following the control period, participants crossed over to the 22-week intervention period. The intervention was culturally enhanced using feedback derived from formative assessment and delivered as 15 group sessions. MAIN OUTCOME MEASURES The primary outcome measure was the difference in weight change between the control and intervention periods; changes in waist circumference and quality of life were secondary outcomes. RESULTS Most participants were obese, with a mean baseline body mass index of 36 kg/m², weight of 97.9 kg, and waist circumference of 111 cm. Weight increased during the control period by 0.7 kg but decreased by 2.6 kg during the intervention (net difference = -3.4 kg, P <.001), with 30% of participants losing 5% or more of body weight. Compared to the control period, there was a significant decrease in waist circumference (-3.6 cm, P =.006) and improvement in weight-related quality of life (5.7, P =.03). CONCLUSIONS This pilot study demonstrated the feasibility of a culturally enhanced behavioral weight loss intervention in a predominately African American workplace setting. The workplace may be conducive for targeting African American women who are disproportionately affected by obesity.

Design and implementation of a pilot obesity prevention program in a low-resource school: lessons learned and research recommendations.

Purpose – This paper seeks to describe the design, implementation, and lessons learned from an obesity prevention pilot program delivered in a low resource school in the USA.Design/methodology/approach – A planned program evaluation was conducted to: document explicitly the process of designing and implementing the program; and assess the feasibility and acceptability of the program to inform future planning. Evaluation data were gathered using document review (i.e. minutes from meetings with research staff and school personnel), key informant interviews, and focus groups. Qualitative data were analyzed using content analysis. Quantitative data were summarized using descriptive statistics.Findings – A total of 113 African‐American students (47 per cent female) participated in the program. Over half were overweight or obese and mean nutrition and physical activity behaviors were below recommended guidelines. A participatory process involving school administrators, teachers, parents, and students resulted i...

Moderators of the association between exercise identity and obligatory exercise among participants of an athletic event

Previous research has connected exercise identity with obligatory exercise, yet to date no empirical studies have identified moderator variables of this association. The current study included participants of an athletic event (full marathon, n=582; half marathon, n=1,106; shorter distance, n=733) who completed questionnaires about exercise behaviors, obligatory exercise, and internalization of both the thin-ideal and athletic-ideal body shapes. General linear model analyses were conducted to examine the exercise identity-obligatory exercise relationship; moderator variables included gender, internalization of the thin-ideal body shape, and internalization of the athletic-ideal body shape. After controlling for the effects of body mass index, age, and distance group, the three-way interaction of exercise identity, gender, and internalization of the athletic-ideal body shape predicted obligatory exercise. Findings suggest that women who report high identification with exercise and high value on having an athletic physique may be vulnerable to obligatory exercise.