Ellen S. Parham

Position of the American Dietetic Association: weight management.

It is the position of the American Dietetic Association that successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity. Americans are increasing in body fat as they become more sedentary. Obesity has reached epidemic proportions and health care costs associated with weight-related illnesses have escalated. Although our knowledge base has greatly expanded regarding the complex causation of increased body fat, little progress has been made in long-term maintenance interventions with the exception of surgery. Lifestyle modifications in food intake and exercise remain the hallmarks of effective treatment, but are difficult to initiate and sustain over the long term. The dietitian can play a pivotal role in modifying weight status by helping to formulate reasonable goals which can be met and sustained with a healthy eating approach as outlined in the Dietary Guidelines for 2000. Any changes in dietary intake and exercise patterns which decrease caloric intake below energy expenditure will result in weight loss, but it is the responsibility of the dietitian to make sure the changes recommended are directed toward improved physiological and psychological health. A thorough clinical assessment should help define possible genetic, environmental, and behavioral factors contributing to weight status and is important to the formulation of an individualized intervention. The activation of treatment strategies is often limited by available resources and cost. Reimbursement by third party payers for services is limited. Health care dollars are consumed for treatment of weight-related diseases. Public policy must change if the obesity epidemic is to be stopped and appropriate weight management techniques activated.

The National Weight Control Registry: A Critique

This article is a critique of the claim that the National Weight Control Registry provides data showing that a significant number of adults in the United States have achieved permanent weight loss. We believe that promoting calorie-restricted dieting for the purpose of weight loss is misleading and futile. We advocate the adoption of a health-at-every-size (HAES) approach to weight management, focusing on the achievement and maintenance of lifestyle changes that improve metabolic indicators of health.

Enhancing social support in weight loss management groups

This review draws on the literature in nutrition and dietetics and in the behavioral sciences to explore the association of social support and weight management and to identify effective means of enhancing support. Social support, the resources provided by other people, has been demonstrated to correlate directly with weight loss maintenance. Programs have attempted to increase the level of support experienced by clients by teaching them to elicit support through activities such as self-exploration, modeling, and skill-building exercises. Another approach, teaching significant others how to be more supportive, is limited by the willingness of the others to become involved. Most commonly, weight management programs rely on the group itself to provide support. The effectiveness of group support, however, has not been evaluated apart from other aspects of a program. Most efforts to enhance social support are hampered by lack of knowledge about what types of support are most effective, failure to monitor perceived levels of support, and the brevity of the program. Nevertheless, the potential value and minimal risk of improved social support justify continued attention to this aspect of weight management programs.

Weight Control as Portrayed in Popular Magazines.

Abstract In order to investigate the attitudes toward weight control expressed in popular magazines, we assigned 66 articles from 34 issues of 22 contemporary magazines to 3 nutritionists and 16 laypersons for evaluation with a specially developed instrument. Our judges viewed the articles as fairly accurate, optimistic, supportive, and sympathetic. They scored the task of maintaining ideal weight as represented as moderately difficult and requiring a largely chronic effort. The judges reported that the articles conveyed diet, will power, and behavioral modification as most important in weight control, closely followed by self-understanding. Only minor differences emerged between the ratings of professional and lay judges. Home service and fashion magazines tended to convey slightly different emphases on some concepts, but in most cases no significant differences emerged. However, wide variability even within types of magazines emphasize the need to evaluate individually the weight control articles in popular magazines.

Nutrition education research in weight management among adults

Abstract Nutrition education research related to weight management of adults has been reviewed with the purpose of summarizing the current knowledge, identifying future research needs, and clarifying implications for practice. Three areas of research have been identified: 1) descriptions and characterizations of obesity; 2) the search for theoretical bases for human behavior in weight management situations; and 3) experimental, quasi-experimental, and evaluation studies of nutrition education interventions. Among the theories of human behavior applied to understanding obesity and designing interventions are theories of behaviorism, social cognition theory, and reasoned action, as well as the health belief model. Treatment advances have led to longer, multi-faceted approaches that include behavior modification, cognitive interventions, social support, and relapse prevention. In spite of these advances, there is no approach that leads to significant and sustained weight losses by the majority of participants. In light of this fact, nutrition education researchers need a) to continue their search for means to meet the needs of obese individuals and b) to give high priority in future research to the prevention of obesity.

The interaction of eating restraint and stressful life events on women's weight and weight changes.

Abstract The interaction of eating restraint and experience of stressful life events upon body mass index (BMI) and weight changes over a year were studied among women. The subjects were 71 volunteers of middle socio-economic status and varying adiposity. They were recruited without association to a weight loss program. Assessment instruments included Herman and Macks Revised Restraint Scale (excluding weight fluctuation items), Holmes and Rahes Life Events Scale, and several questions related to attempts to control eating and coping behaviors. These were assessed at the beginning of the study and related to weight changes over the following year. Two 3×2 analyses of variance were performed using either BMI or weight changes as the dependent variable and three levels of eating restraint and two levels of stressful life events as classification variables. In neither model was there a main effect of restraint or stress, but there was an interaction of restraint and stress upon BMI. Women with low or medium restraint scores and high stress scores had lower BMIs than women with low stress scores. However, women with high restraint scores and high stress had higher BMIs. Weight changes over a year showed no significant differences.

Use of statistical techniques in nutrition education research publications

Abstract We identified sources of statistical information and categorized statistical techniques used in research published in the Journal of Nutrition Education (JNE) and compared the statistical techniques to those used in nutrition and food science journals. We also evaluated the level of statistical knowledge required to interpret JNE research. We examined 101 JNE research articles published from 1980–86 and 120 research articles from a sample of nutrition and food science journals. The latter were selected based on frequency of citation in the JNE articles. Descriptive statistics, Pearson r , Students t -test, one-way ANOVA, and measures of reliability were used in at least 20% of both JNE and nutrition and food science research articles. The JNE articles used factor analysis, item analysis, and measures of reliability and validity significantly more often than did the nutrition and food science articles. JNE research articles used more complex statistical techniques, which required a higher level of statistical knowledge, and provided a more thorough explanation of the statistics used than did the nutrition and food science research. This study provides a baseline for evaluating trends in use of statistics in nutrition education research, it may help improve the communication of research needs and results between researchers and practitioners, and it can help academic programs in nutrition education to evaluate their curricula.

Responsiveness to Internal Cues to Hunger among Young Children

The purpose of this study was to investigate the ability of children to sense and to respond to internal hunger cues and to determine the role certain demographic, physiologic, and environment factors played in their responses. The eating behavior of ninety-nine children in seven day-care centers was observed on two occasions. The children consumed morning snacks of low or high caloric density (internal cue variable), followed by standardized lunches at noon. Each child participated twice, serving as his own control. Weights of food consumed at snacks and lunches were determined. A child was considered responsive to internal cues if he modified his lunch consumption to compensate for snack calorie intake; 42 percent failed to meet this criterion. Lunch calorie consumption was significantly affected by the order of treatments and by day-care centers, but not by age, sex, weightlheight ratio, social status, race, or number of siblings. The immediate environment was concluded to have a greater effect on eating be havior than internal cues. Children tended to eat more at lunch on the first day of the experiment, regardless of the type of snack, apparently responding to a Hawthorne effect created by the novelty of the situation. This effect is itself interpreted as an external stimulus to eat. Children exhibiting insensitivity to their internal cues and overresponsiveness to their external cues were considered at risk of developing food habits contributing to problems of control of energy balance.

Effectiveness of the Food Guide Pyramid, the Nutrition Facts Food Label, and Work Site Wellness Program in the Task of Making Healthy Food Choices

Abstract LEARNING OUTCOME: To describe the effectiveness of the Food Guide Pyramid, the Nutrition Facts Food Label and work-site Wellness Programs in teaching consumers to make healthy food choices. The purpose of this study was to determine the relationship of participation in work-site Wellness Programs and awareness of and knowledge of the Food Guide Pyramid and the Nutrition Facts Food Label to success in the task of making healthy food choices. A questionnaire designed by the researcher contained questions relating to wellness program participation, and use and application of the Food Guide Pyramid and Nutrition Facts Food Label. A sample one day menu was used for the task of choosing a healthy diet. The questionnaires were handed out to a stratified random sample of 215 employees from a company with an ongoing Wellness Program. One hundred seventy questionnaires were returned. The data was analyzed using Chi-square and Fishers Exact Test. A statistically significant positive relationship was found (p values=.02, .029, .03) between all three educational factors and the task of making healthy food choices. Mistakes in choosing a healthy diet were made both in underestimating and overestimating needs. The food group that was most frequently overestimated was the meat and protein group (71%) while the most underestimated groups were the bread, cereal and grains group (39%) and the milk and dairy group (37%). Both the vegetable group and the fruit group were underestimated as much as overestimated (29% and 18%, 25% and 39% respectively). Only 9 respondents (5%) overestimated the fat and sweets group. The Food Guide Pyramid, the Nutrition Facts food label and work-site Wellness Programs are all effective tools in teaching healthy food choices, however, the best use of these tools is to show how they are interrelated in choosing a healthy diet. Nutrition educators need to find ways in which to make consumers more aware of these tools and how to apply them in choosing healthy foods. Possibly new tools need to be created such as putting the Food Guide Pyramid on the label highlighting in which food group the item belongs. Nutrition related wellness programs can also offer practice in tasks similar to the choosing of a healthy diet as in this study.

Factors related to eating attitudes of pregnant women

Abstract Disordered attitudes toward eating held by pregnant women can affect the nutritional status of the mother and fetus. This retrospective study consisted of 264 pregnant women who attended an obstetrics clinic during their first prenatal visit. Data from their medical records and nutritional evaluations including the Eating Attitudes Test - 26 (EAT-26) were used to pursue the objective. Mean EAT-26 scores were compared among subgroups representing the various factors by the Students t test or one-way analysis of variance (ANOVA) followed by a Scheffes test utilizing SPSS computer software. The typical participant was white, in her twenties, married, having her first child, a non-smoker, consumed alcohol, and had no history of drug use or physical or emotional abuse. The majority or 69.1% reported adequate calcium servings and 80.9% reported adequate protein servings. The mean prepregnancy BMI was 24.7 ± 5.5 (mean + standard deviation), while the mean measured first-visit BMI was 25.6 ± 5.6. The mean EAT-26 score was 5.18 ± 4.58 with a score of ≤10 considered normal. Also, 5.3% scored in the moderate disturbance range of 11-20 and six women or 2.3% scored in the abnormal eating attitudes range of ≥21 on the EAT-26. The abnormal eating attitudes percentage was consistent with the literature on the prevalence of eating disorders in the general population. The means of all factor subgroups were within normal EAT-26 score range. However, the mean EAT-26 scores were found to be significantly different for age, prepregnancy BMI, marital status, and abuse categories. Teenagers scored significantly higher than women in their thirties or forties. The group having a prepregnancy high BMI range of ≥26.0-29.0 scored higher than the normal BMI group range of 19.8-26.0. Married women had lower scores than unmarried women. Women who reported having been abused scored approximately 5.5 points higher on the EAT-26. Since significant differences found were within the normal range of the EAT-26, therefore, they have limited clinical usefulness.