Jamie S. Bodenlos

Association between adult attention deficit/hyperactivity disorder and obesity in the US population.

Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder that affects ∼2.9–4.7% of US adults. Studies have revealed high rates of ADHD (26–61%) in patients seeking weight loss treatment suggesting an association between ADHD and obesity. The objective of the present study was to test the association between ADHD and overweight and obesity in the US population. Cross‐sectional data from the Collaborative Psychiatric Epidemiology Surveys were used. Participants were 6,735 US residents (63.9% white; 51.6% female) aged 18–44 years. A retrospective assessment of childhood ADHD and a self‐report assessment of adult ADHD were administered. Diagnosis was defined by three categories: never met diagnostic criteria, met full childhood criteria with no current symptoms, and met full childhood criteria with current symptoms. The prevalence of overweight and obesity was 33.9 and 29.4%, respectively, among adults with ADHD, and 28.8 and 21.6%, respectively, among persons with no history of ADHD. Adult ADHD was associated with greater likelihood of overweight, (odds ratio (OR) = 1.58; 95% confidence interval (CI) = 1.05, 2.38) and obesity (OR = 1.81; 95% CI = 1.14, 2.64). Results were similar when adjusting for demographic characteristics and depression. Mediation analyses suggest that binge eating disorder (BED), but not depression, partially mediates the associations between ADHD and both overweight and obesity. Results suggest that adult ADHD is associated with overweight and obesity.

Male inclusion in randomized controlled trials of lifestyle weight loss interventions.

The prevalence of obesity is similar for men (32.2%) and women (35.5%). It has been assumed that lifestyle weight loss interventions have been developed and tested in predominately female samples, but this has not been systematically investigated. The aim of this review was to investigate total and ethnic male inclusion in randomized controlled trials of lifestyle interventions. PUBMED, MEDLINE, and PSYCHINFO were searched for randomized controlled trials of lifestyle weight loss interventions (N = 244 studies with a total of 95,207 participants) published in the last 10 years (1999–2009). A trial must be in English, included weight loss as an outcome, and tested a dietary, exercise, and/or other behavioral intervention for weight loss. Results revealed samples were on average 27% male vs. 73% female (P < 0.001). Trials recruiting a diseased sample included a larger proportion of males than those not targeting a disease (35% vs. 21%; P < 0.001). About 32% of trials used exclusively female samples, whereas only 5% used exclusively male samples (P < 0.001). No studies in the past 10 years specifically targeted minority males. Ethnic males identified composed 1.8% of total participants in US studies. Only 24% of studies that underrepresented males provided a reason. Males, especially ethnic males, are underrepresented in lifestyle weight loss trials.

Validation of the Beck Depression Inventory-II in a Low-Income African American Sample of Medical Outpatients.

The psychometric properties of the Beck Depression Inventory-II (BDI-II) are well established with primarily Caucasian samples. However, little is known about its reliability and validity with minority groups. This study evaluated the psychometric properties of the BDI-II in a sample of low-income African American medical outpatients (N=220). Reliability was demonstrated with high internal consistency (.90) and good item-total intercorrelations. Criterion-related validity was demonstrated. A confirmatory factor analysis supported a hierarchical factor structure in which the BDI-II reflected 2 first-order factors (Cognitive and Somatic) that in turn reflected a second-order factor (Depression). These results are consistent with previous findings and thus support the use of the BDI-II in assessing depressive symptoms for African American patients in a medical setting.

Association of Major Depression and Binge Eating Disorder with Weight Loss in a Clinical Setting

Objective: Obesity has been linked to both major depressive disorder (MDD) and binge eating disorder (BED) in clinical and epidemiological studies. The present study compared weight loss among patients with and without MDD and BED who participated in a hospital‐based weight loss program modeled after the Diabetes Prevention Program.

Predicting medical regimen adherence: the interactions of health locus of control beliefs

The present study examined the interactions between five dimensions of health locus of control beliefs and their relationships with medical regimen adherence in low-income individuals diagnosed with type 2 diabetes. One hundred and nine patients were administered an expanded Multidimensional Health Locus of Control (MHLC) scale. HbA1c was used as a biological indicator of medical regimen adherence. Multivariate regression analyses demonstrated that three interactions were significantly related to HbA1c. The present findings suggest that HLOC may be meaningfully related to medical outcomes. However, these relationships may not be captured through the examination of main effects and may be only found when interactions are considered.

Translating the diabetes prevention program into a hospital-based weight loss program.

OBJECTIVE Intensive lifestyle interventions have established efficacy, but translation to real-world settings has not been well demonstrated. Using the diffusion of innovations model, we describe the adoption of the Diabetes Prevention Program (DPP) Lifestyle Intervention into a hospital-based program and report feasibility, acceptability, and outcomes. DESIGN Patients (N = 118; 72% female, mean age = 48.8, mean baseline body mass index = 43.3) were enrolled into 16 weeks of DPP. MAIN OUTCOME MEASURE Weight loss (kg) was measured at baseline and after treatment. RESULTS Mean weight loss after 16 weeks was 5.57 kg (SD = 4.6) or 4.6% of baseline weight, and 30% met the 7% weight loss goal. Outcomes are compared with those reported in the DPP trial. Most participants (90.4%) were satisfied with the service; however, only 56% were satisfied with their weight loss. CONCLUSION The DPP was successfully translated into a real-world clinic with some protocol modifications. Weight loss was modest among heavier patients with more comorbidities than the original DPP sample. Diffusion of innovations theory provides a useful framework for adopting evidence-based programs in the clinical setting.

Association of Post‐Traumatic Stress Disorder and Obesity in a Nationally Representative Sample

Recent studies suggest a possible link between post‐traumatic stress disorder (PTSD) and obesity risk, which would have implications for the development of obesity‐related diseases in this population. The present study examined the association between PTSD and obesity and whether this association differed by sex in a representative sample of the US population. A secondary objective was to determine whether the association between PTSD and obesity was mediated by binge eating disorder (BED). Data were from the Collaborative Psychiatric Epidemiology Surveys (CPES), which comprises three nationally representative cross‐sectional surveys that were conducted between 2001 and 2003. Logistic regression analyses weighted to represent the general US adult population were performed. In the total sample of 20,013 participants, rates of obesity were 24.1% for persons without a lifetime history of PTSD and 32.6% among persons with PTSD in the past year. Adjusting for socio‐demographic characteristics, depression, substance and alcohol abuse/dependence, and psychotropic medication status, past year PTSD was associated with greater likelihood of obesity (odds ratio (OR) = 1.51; 95% confidence interval (CI) = 1.18, 1.95), with no differences by gender. BED did not statistically mediate the relationship between PTSD and obesity. The present study provides support for a link between PTSD and obesity. Findings further existing literature by indicating that the association is consistent across sexes and is not statistically mediated by BED.

The interaction of locus of control, self-efficacy, and outcome expectancy in relation to HbA1c in medically underserved individuals with type 2 diabetes

A common thread among health behavior theories is the importance of perceived control, often defined within the health psychology literature as locus of control. Inconsistencies have been found regarding the role of locus of control in predicting health behaviors. These inconsistencies may be resolved by exploring interactions between internal locus of control and other perceived control constructs such as self-efficacy and outcome expectancy. The present study tested the interaction of internal locus of control, self-efficacy and outcome expectancy in relation to HbA1c in patients with Type 2 diabetes. One hundred and nine medical patients who were diagnosed with Type 2 diabetes, predominantly from an African American as well as disadvantaged background, participated in the study. HbA1c was used to indicate gradations of medical regimen adherence. A three way interaction among the perceived control measures was related to HbA1c. Patients who reported low self-efficacy and low outcome expectancy tended to benefit the most from high internal locus of control. However, for patients with low self-efficacy and high outcome expectancy, higher scores on internal locus of control were related to poorer HbA1c levels. Future research examining perceived control constructs may benefit from investigating the interacting effects of such variables when evaluating health behaviors.

Initial investigation of behavioral activation therapy for co-morbid major depressive disorder and obesity

More than one-third of treatment-seeking obese patients are clinically depressed. No evidence-based treatments exist for individuals with comorbid depression and obesity. Behavioral activation (BA), an effective treatment for depression, might also facilitate weight loss. The objective of this study is to evaluate the feasibility and efficacy of BA plus nutrition counseling for weight loss among individuals with comorbid major depressive disorder (MDD) and obesity. The BA intervention targeted both weight reduction and depression in 14 obese patients (79% female; 86% Caucasian) who met criteria for MDD. At baseline, mean Beck Depression Inventory (BDI-II) score was 26.71, and mean Hamilton Depression Rating Scale (HDRS) score was 16.00. Significant reductions at 12-weeks in both BDI-II and HDRS were observed with 10 participants reaching full remission at post treatment. Reductions in body weight, daily caloric intake, and physical activity were observed. BA with nutrition counseling appears to have potential as a weight loss treatment in the context of depression. Results support the need for a randomized controlled trial to evaluate the efficacy of BA for both weight loss and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

The sunless study: a beach randomized trial of a skin cancer prevention intervention promoting sunless tanning.

OBJECTIVE To examine the impact of a skin cancer prevention intervention that promoted sunless tanning as a substitute for sunbathing. DESIGN Randomized controlled trial. SETTING Public beaches in Massachusetts. PARTICIPANTS Women (N = 250) were recruited to participate in the study during their visit to a public beach. Intervention The intervention included motivational messages to use sunless tanning as an alternative to UV tanning, instructions for proper use of sunless tanning products, attractive images of women with sunless tans, a free trial of a sunless tanning product, skin cancer education, and UV imaging. The control participants completed surveys. MAIN OUTCOME MEASURES The primary outcome was sunbathing 2 months and 1 year after the intervention. Secondary outcomes included sunburns, sun protection use, and sunless tanning. RESULTS At 2 months, intervention participants reduced their sunbathing significantly more than did controls and reported significantly fewer sunburns and greater use of protective clothing. At 1 year, intervention participants reported significant decreases in sunbathing and increases in sunless tanning relative to control participants but no differences in the other outcomes. CONCLUSION This intervention, which promoted sunless tanning as an alternative to UV tanning, had a short-term effect on sunbathing, sunburns, and use of protective clothing and a longer-term effect on sunbathing and sunless tanning. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00403377.