Delia E. Smith

Motivational Interviewing to Improve Adherence to a Behavioral Weight-Control Program for Older Obese Women With NIDDM: A pilot study

OBJECTIVE The aim of this randomized pilot study was to examine whether the addition of motivational interviewing strategies to a behavioral obesity intervention enhances adherence and glucose control in older obese women with NIDDM. RESEARCH DESIGN AND METHODS Twenty-two older obese women (41% black) with NIDDM were randomly assigned to 1) a standard 16-week group behavioral weight-control program that provided instruction in diet, exercise, and behavioral modification or 2) the same group behavioral program with three individualized motivational interviewing sessions added. RESULTS The motivational group attended significantly more group meetings (13.3 vs. 8.9), completed significantly more food diaries (15.2 vs. 10.1), and recorded blood glucose significantly more often (46.0 vs. 32.2 days) than the standard group. Further, participants in the motivational group had significantly better glucose control post-treatment (9.8 vs. 10.8%). Although both groups demonstrated significant weight loss, no differences were apparent between groups. CONCLUSIONS These results suggest that augmenting a standard behavioral treatment program for obese women with NIDDM with a motivational interviewing component may significantly enhance adherence to program recommendations and glycemic control. Preliminary data warrant further investigation with larger samples and a longer follow-up.

Body image among men and women in a biracial cohort : The CARDIA study

OBJECTIVE To examine body image in a population-based, biracial cohort. METHOD Body image measures were obtained on 1,837 men (45% Black) and 1,895 women (51% Black) in the CARDIA study. Subscales of the Multidimensional Body Self-Relations Questionnaire (Appearance Evaluation and Appearance Orientation) and a measure of body size dissatisfaction were obtained. RESULTS Blacks were more invested in appearance than Whites and women were more invested than men. Women were more dissatisfied with size and overall appearance than men, and White men were more dissatisfied with appearance than Black men. Black and White women were similarly dissatisfied with size and appearance. However, after adjustment for age, body mass index, and education, Black women were more satisfied with both dimensions than White women. Obesity was strongly associated with body dissatisfaction across all gender-ethnicity groups. DISCUSSION Significant differences in body image were apparent by gender and ethnicity, and different patterns were evident depending on the dimension considered.

Prevalence of binge eating disorder, obesity, and depression in a biracial cohort of young adults

This article examined the prevalence of binge eating disorder (BED), obesity, and depressive symptomatology in a biracial, population-based cohort of men and women participating in a longitudinal study of cardiovascular risk factor development. The Revised Questionnaire on Eating and Weight Patterns was used to establish BED status among the 3,948 (55% women, 48% Black) participants (age 28–40 years). Body mass index (BMI: kg/m2) was used to define overweight (BMI>-27.3 in women and ≥27.8 in men). Depressive symptomatology was assessed with the Center for Epidemiologic Study Depression Scale. Prevalence of BED was 1.5% in the cohort overall, with similar rates among Black women, White women, and White men. Black men had substantially lower BED rates. Depressive symptomatology was markedly higher among individuals with BED. Among overweight participants, BED prevalence (2.9%) was almost double that of the overall cohort. There were no differences in BED rates between overweight Black and White women. Thus, BED was common in the general population, with comparable rates among Black women, White women, and White men, but low rates among Black men. Obesity was associated with substantially higher prevalence of BED. Treatment studies that target obese men and minority women with BED are indicated.

Assessing Medication Adherence by Pill Count and Electronic Monitoring in the African American Study of Kidney Disease and Hypertension (AASK) Pilot Study

The Medication Event Monitoring System (MEMS), an electronic monitor which records the date and time of bottle cap openings, and pill counts were used to assess patterns of adherence for the primary antihypertensive drug in the African American Study of Kidney Disease and Hypertension Pilot Study (AASK). Blacks with hypertension and moderately reduced renal function were randomized to one of two levels of blood pressure control and to one of three antihypertensive drug regimens: primary therapy with a calcium channel blocker, an angiotension converting enzyme inhibitor, or a beta-blocker. Of the 94 participants in AASK, 91 had MEMS recordings and pill counts for 313 regularly scheduled monthly follow-up visits. The average length of follow-up was 4.6 months. An acceptable level of adherence by pill count was achieved if 80% to 100% of the prescribed pills were not returned to the clinic. Adherence by MEMS to a once-a-day drug dosing schedule was acceptable if 80% of the time intervals between MEMS openings were within 24 +/- 6 h. Acceptable adherence by pill count was observed at 68% of the follow-up visits; MEMS indicated nonadherence at 47% of those visits. Blood pressure was within goal in 50% of the participants who were adherent by both pill count and MEMS throughout their follow-up visits, and only 14% of the participants who were identified nonadherent by one or both methods. These findings suggest that electronic monitoring is a useful adjunct to pill counts in assessing adherence to antihypertensive drugs. Feedback of electronically collected information on dosing intervals to participants and staff may enhance adherence.

Seven-year trends in body weight and associations with lifestyle and behavioral characteristics in black and white young adults: the CARDIA study.

OBJECTIVES This study estimated the amount of weight change in a biracial cohort of young adults and the separate components attributable to time-related and aging-related changes, as well as identified possible determinants of weight change. METHODS In this population-based prospective study of 18- to 30-year-old African-American and White men and women, body weight and prevalence of overweight were measured from 1985/86 to 1992/93. RESULTS Average weight increased over the 7 years, increases ranging from 5.2 kg (SE = 0.2, n = 811) in White women to 8.5 kg (SE = 0.3, n = 882) in African-American women. Significant time-related increases in weight, ranging from 2.0 kg (SE = 1.0) in White women to 4.8 kg (SE = 1.0, n = 711) in African-American men, accounted for 40% to 60% of the average total weight gain. Aging-related increases were also significant, ranging from 2.6 kg (SE = 0.8, n = 944) in White men to 5.0 kg (SE = 1.1) in African-American women. The prevalence of overweight increased progressively in each group. Decreased physical fitness was most strongly associated with weight gain in both sexes. CONCLUSIONS The observed dramatic time-related weight gains, most likely due to secular (period-related) trends, are a serious public health concern.

Cognitive‐behavioral treatment of obese binge eaters

Obese binge eaters may benefit from cognitive-behavioral treatment (CBT) approaches that target binge eating. In the present study, eight overweight women participated in a 16-week group CBT program. The Eating Disorder Examination (EDE), a clinical interview designed to assess the psychopathology specific to eating disorders, was administered pre- and post-treatment. Frequency of bulimic episodes during the 28 days prior to assessment was substantially reduced following treatment. Total days with bulimic episodes decreased from 13.4 to 1.2, with a mean reduction of 81%. As assessed by the EDE, dysfunctional concern for body shape and weight and disturbed attitudes about eating markedly diminished. Mood similarly improved. These find/rigs confirm that obese bingers improve after a CBT program designed to ameliorate binge eating and indicate the utility of the EDE in assessing treatment outcome with these patients.

Binge eating syndromes: a review of assessment and treatment with an emphasis on clinical application

Binge eating is characterized by the ingestion of a large amount of food accompanied by a sense of loss of control and is pathognomonic of bulimia nervosa and binge eating disorder (BED). Research on syndromes of binge eating has burgeoned in the previous decade. This paper reviews the literature on bulimia nervosa and BED, with particular attention to issues of diagnosis, etiology, assessment, and treatment that are relevant to clinicians treating individuals with binge eating syndromes

Effect of blood pressure control and antihypertensive drug regimen on quality of life: The African American Study of Kidney disease and hypertension (AASK) pilot study

The African American Study of Kidney Disease and Hypertension (AASK) Pilot Study evaluated the feasibility of carrying out a randomized, multicenter, 7-year clinical trial to determine the effects of two goal levels of blood pressure control and three antihypertensive drug regimens on decline in glomerular filtration rate in African Americans with clinically diagnosed hypertensive nephrosclerosis. Participants were randomized to either a usual mean arterial blood pressure (MAP) goal group (102-107 mm Hg) or a low-MAP goal group (< or = 92 mm Hg) and to a drug regimen (initial therapy with either atenolol, amlodipine, or enalapril). Quality of life was assessed by the Medical Outcomes Short-Form 36 (MOS SF-36) at baseline and the last follow-up visit for 84 of the 94 participants of the AASK Pilot Study. Symptoms were assessed at baseline and throughout the course of therapy by participant self-report. Mean SF-36 scores increased significantly on physical functioning (9.2), role limitations (physical) (19.0), social functioning (9.0), and vitality dimensions (5.6) from baseline to the last follow-up visit in the usual MAP goal group. Scores for the eight health dimensions assessed by the MOS SF-36 did not change significantly during the same time period either in the low-MAP goal group or in any of the drug regimens. The mean score for general health perception was significantly lower at the last follow-up visit in the enalapril drug regimen (49.9) compared to drug regimens with atenolol (65.4) or amlodipine (63.9). Physical functioning, role limitations (emotional), social functioning, mental health, vitality, and general health perception scores were negatively correlated with self-reported symptoms during treatment. We conclude that selected dimensions of quality of life improved during the AASK Pilot Study only in participants randomized to the usual MAP goal group. Significant differences between MAP goal groups and drug regimens at the end of follow-up were observed for only a few health dimensions.

Binge eating in ethnic minority groups

Eating disorders have generally been considered uncommon among ethnic minorities. However, there are data that suggest bulimia nervosa may not be all that rare in some minority groups. Furthermore, emerging data on binge eating disorder (BED) have indicated high rates in some ethnic groups, and these data prompt reconsideration of the view that minority populations are protected from eating disorders. The current report reviews data on bulimia nervosa and BED in ethnic minority groups. Ramifications of a broader diversity of affected individuals on our understanding of eating disorders will be addressed, and directions for further research will be discussed.

Appointment attendance, pill counts, and achievement of goal blood pressure in the African American Study of Kidney disease and hypertension pilot study

The African American Study of Kidney Disease and Hypertension (AASK) Pilot Study evaluated the feasibility of conducting a 7-year clinical trial to assess the effect of two levels of blood pressure control based on mean arterial pressure (MAP) (low goal < or = 92 mm Hg or usual goal of 102-107 mm Hg) and three antihypertensive drug regimens (atenolol, amlodipine, or enalapril) as initial therapy in slowing the decline of renal function in African Americans with clinically diagnosed hypertensive nephrosclerosis. Ninety-four African American men and women between 18 and 70 years of age were randomized and followed for an average of 4.6 months. On average participants attended 87.5% of the scheduled monthly follow-up visits and achieved an acceptable level of medication adherence (80%-100% of prescribed doses by pill count) at 65.4% of those visits Blood pressure levels within goal were observed in 17.5% and 25.6% of the participants in the low- and usual MAP goal groups, respectively. Neither attendance nor medication adherence by pill count was associated with attainment of goal blood pressure. Although AASK Pilot Study participants maintained excellent attendance, their pill counts were lower than previously reported among clinical trial participants and goal blood pressure levels were difficult to achieve during the short period of follow-up.