Linda Houtkooper

Pretreatment predictors of attrition and successful weight management in women.

OBJECTIVE: This study analyzed baseline behavioral and psychosocial differences between successful and nonsuccessful participants in a behavioral weight management program. Success was defined by commonly used health-related criteria (5% weight loss). Noncompletion was also used as a marker of a failed attempt at weight control.SUBJECTS: A total of 158 healthy overweight and obese women (age, 48.0±4.5 y; BMI, 31.0±3.8 kg/m2; body fat, 44.5±5.3%).INTERVENTION: Subjects participated in a 16-week lifestyle weight loss program consisting of group-based behavior therapy to improve diet and increase physical activity, and were followed for 1 y after treatment.METHODS: At baseline, all women completed a comprehensive behavioral and psychosocial battery assessing dieting/weight history, dietary intake and eating behaviors, exercise, self-efficacy, outcome evaluations, body image, and other variables considered relevant for weight management. Participants who maintained a weight loss of 5% or more at 16 months (or 10% or more of initial fat mass) were classified as successful. Nonsuccessful participants were those who dropped out and completers who had not lost weight at follow-up.RESULTS: Of all participants, 30% (n=47) did not complete initial treatment and/or missed follow-up assessments (noncompleters). Noncompletion was independently associated with more previous weight loss attempts, poorer quality of life, more stringent weight outcome evaluations, and lower reported carbohydrate intake at baseline. In logistic regression, completion status was predicted correctly in 84% of all cases (χ 2=45.5, P<0.001), using baseline information only. Additional predictors of attrition were initial weight, exercise minutes, fiber intake, binge eating, psychological health, and body image. A large variation in weight loss/maintenance results was observed (range: 37.2 kg for 16-month weight change). Independent baseline predictors of success at 16 months were more moderate weight outcome evaluations, lower level of previous dieting, higher exercise self-efficacy, and smaller waist-to-hip ratio. Success status at follow-up was predicted correctly in 74% of all starting cases (χ2=33.6, P<0.001).CONCLUSION: Psychosocial and behavioral variables (eg, dieting history, dietary intake, outcome evaluations, exercise self-efficacy, and quality of life) may be useful as pretreatment predictors of success level and/or attrition in previously overweight and mildly obese women who volunteer for behavioral weight control programs. These factors can be used in developing readiness profiles for weight management, a potentially important tool to address the issue of low success/completion rates in the current management of obesity.

Why bioelectrical impedance analysis should be used for estimating adiposity.

The whole-body bioelectrical impedance analysis (BIA) approach for estimating adiposity and body fat is based on empirical relations established by many investigators. Properly used, this noninvasive body-composition assessment approach can quickly, easily, and relatively inexpensively provide accurate and reliable estimates of fat-free mass (FFM) and total body water (TBW) in healthy populations. The estimated FFM or TBW values are used to calculate absolute and relative body fat amounts. When different investigators follow the same standard BIA procedures and use the same population and criterion method, similar prediction equations and relatively small prediction errors have been reported for measurement of FFM and TBW (SEE: 1.7-3.0 for FFM and 0.23-1.5 kg for TBW). The BIA approach is most appropriate for estimating adiposity of groups in epidemiologic and field studies but has limited accuracy for estimating body composition in individuals. When used as a simple index (stature2/ resistance), BIA is more sensitive and specific for grading average adiposity in groups than some other anthropometric indexes such as the body mass index. Prediction equations based on BIA have been validated and cross-validated in children, youths, adults, and the elderly, in primarily white populations and, to a limited extent, in Asian, black, and Native American populations.

Weight Loss Readiness in Middle-Aged Women: Psychosocial Predictors of Success for Behavioral Weight Reduction

Accurate prediction of weight loss success and failure has eluded researchers for many years. Thus, we administered a comprehensive psychometric battery before a 4-month lifestyle behavioral weight reduction program and analyzed weight changes during that period to identify baseline characteristics of successful and unsuccessful participants, among 112 overweight and obese middle-aged women (age, 47.8 ± 4.4 years; BMI, 31.4 ± 3.9 kg/m2). Mean weight and percentage fat losses among the 89 completers were −5.4 kg and −3.4%, respectively ( p < .001). A higher number of recent dieting attempts and recent weight loss, more stringent weight outcome evaluations, a higher perceived negative impact of weight on quality of life, lower self-motivation, higher body size dissatisfaction, and lower self-esteem were associated with less weight loss and significantly distinguished responders from nonresponders among all participants. These findings are discussed as to their usefulness (i) to screen individuals before treatment, (ii) to provide a better match interventions to participants, and (iii) to build a weight loss readiness questionnaire.

Maintenance of Weight Loss in Overweight Middle-aged Women Through the Internet

Objective: The purpose of this study was to compare weight regain in a group of perimenopausal women (48.0 ± 4.4 years old), randomized to a 12‐month weight maintenance Internet intervention or to self‐directed weight maintenance after a 4‐month weight loss treatment.

Resistance Training in Postmenopausal Women with and without Hormone Therapy

PURPOSE The main purpose of this study was to analyze the impact of a 1-yr resistance-training program on body composition and muscle strength in postmenopausal women, and to describe the impact of hormone replacement therapy (HRT) on body composition changes, with and without exercise. Secondarily, we wanted to study dose-response relationships between measures of program compliance and changes in primary outcomes. METHODS Subjects were postmenopausal women (40-66 yr) randomly assigned to an exercise (EX) group (N = 117) and a nonexercise group (N = 116). The EX group participated in a 1 yr trainer-supervised resistance-training program, 60-75 min.d-1, 3 d.wk-1. Lean soft tissue (LST) and fat tissue (FT) changes were measured by dual-energy x-ray absorptiometry and strength by one-repetition maximum testing. RESULTS Significant (P < 0.001) gains in LST were observed for women who exercised, regardless of HRT status, whereas women who did not exercise lost LST (P < 0.05) if they were not taking HRT, and gained LST (P = 0.08) if they were on HRT. The only significant FT losses were observed for women who exercised while on HRT (P < 0.05). Strength increases were observed at all sites (P < 0.001). Total weight lifted by subjects in their training sessions was a significant predictor of changes in LST (P < 0.001) and strength (P < 0.01). CONCLUSIONS Resistance and weight-bearing exercise significantly changed total and regional body composition in postmenopausal women by increasing LST in all women and decreasing FT in women on HRT. Hormone therapy showed no independent effects on body composition, but it protected nonexercising women from losses in LST. The lean and muscle strength changes observed were partially dependent on the volume of training, as expressed by attendance and total weight lifted in 1 yr of training.

Weight Lifted in Strength Training Predicts Bone Change in Postmenopausal Women.

PURPOSE The aim of this study was to examine the relationship between weight lifted in 1 yr of progressive strength training and change in bone mineral density (BMD) in a group of calcium-replete, postmenopausal women. METHODS As part of a large clinical trial, 140 calcium-supplemented women, 44-66 yr old, were randomized to a 1-yr progressive strength-training program. Half of the women were using hormone replacement therapy. Three times weekly, subjects completed two sets of six to eight repetitions in eight core exercises at 70-80% of one repetition maximum. BMD was measured at baseline and 1 yr. RESULTS In multiple linear regression, the increase in femur trochanter (FT) BMD was positively related to total weight lifted (0.001 g.cm (-2)) for a SD of weight lifted, P< 0.01) after adjusting for age, baseline factors, HRT status, weight change, cohort, and fitness center. The weighted squats showed the strongest (0.002 g.cm(-2)) for a SD of weight lifted, P< 0.001), whereas the back extension exhibited the weakest (0.0005 g.cm(-2)) for a SD of weight lifted, P< 0.26) association with change in FT BMD. The amount of weight lifted in the weighted march exercise was significantly related to total body BMD (0.0006 g.cm(-2)) for a SD of weight lifted, P< 0.01). The associations between weight lifted and BMD for the femur neck or lumbar spine were not significant. CONCLUSION Evidence of a linear relationship between BMD change and total and exercise-specific weight lifted in a 1-yr strength-training program reinforces the positive association between this type of exercise and BMD in postmenopausal women.

Validity of self-reported energy intake in lean and obese young women, using two nutrient databases, compared with total energy expenditure assessed by doubly labeled water

Objective: To compare self-reported total energy intake (TEI) estimated using two databases with total energy expenditure (TEE) measured by doubly labeled water in physically active lean and sedentary obese young women, and to compare reporting accuracy between the two subject groups.Design: A cross-sectional study in which dietary intakes of women trained in diet-recording procedures were analyzed using the Minnesota Nutrition Data System (NDS; versions 2.4/6A/21, 2.6/6A/23 and 2.6/8.A/23) and Nutritionist III (N3; version 7.0) software. Reporting accuracy was determined by comparison of average TEI assessed by an 8 day estimated diet record with average TEE for the same period.Results: Reported TEI differed from TEE for both groups irrespective of nutrient database (P<0.01). Measured TEE was 11.10±2.54 and 11.96±1.21 MJ for lean and obese subjects, respectively. Reported TEI, using either database, did not differ between groups. For lean women, TEI calculated by NDS was 7.66±1.73 MJ and by N3 was 8.44±1.59 MJ. Corresponding TEI for obese women were 7.46±2.17 MJ from NDS and 7.34±2.27 MJ from N3. Lean women under-reported by 23% (N3) and 30% (NDS), and obese women under-reported by 39% (N3) and 38% (NDS). Regardless of database, lean women reported higher carbohydrate intakes, and obese women reported higher total fat and individual fatty acid intakes. Higher energy intakes from mono- and polyunsaturated fatty acids were estimated by NDS than by N3 in both groups of women (P≤0.05).Conclusions: Both physically active lean and sedentary obese women under-reported TEI regardless of database, although the magnitude of under-reporting may be influenced by the database for the lean women.Sponsorship: USDA Hatch Project award (ARZT-136528-H-23-111) to LB Houtkooper and WH Howell.European Journal of Clinical Nutrition (2001) 55, 940–950

Effects of Exercise Training on Bone Remodeling, Insulin-Like Growth Factors, and Bone Mineral Density in Postmenopausal Women With and Without Hormone Replacement Therapy

The purpose of this study was to determine the effects of 12 months of weight bearing and resistance exercise on bone mineral density (BMD) and bone remodeling (bone formation and bone resorption) in 2 groups of postmenopausal women either with or without hormone replacement therapy (HRT). Secondary aims were to characterize the changes in insulin-like growth factors-1 and -2 (IGF-1 and -2) and IGF binding protein 3 (IGFBP3) in response to exercise training. Women who were 3–10 years postmenopausal (aged 40–65 years) were included in the study. Women in the HRT and no HRT groups were randomized into the exercise intervention, resulting in four groups: (1) women not taking HRT, not exercising; (2) those taking HRT, not exercising; (3) those exercising, not taking HRT; and (4) women exercising, taking HRT. The number of subjects per group after 1 year was 27, 21, 25, and 17, respectively. HRT increased BMD at most sites whereas the combination of exercise and HRT produced increases in BMD greater than either treatment alone. Exercise training alone resulted in modest site-specific increases in BMD. Bone remodeling was suppressed in the groups taking HRT regardless of exercise status. The bone remodeling response to exercise training in women not taking HRT was not significantly different from those not exercising. However, the direction of change suggests an elevation in bone remodeling in response to exercise training, a phenomenon usually associated with bone loss. No training-induced differences in IGF-1, IGF-2, IGF-l:IGF-2 (IGF-1 : IGF-2), and IGFBP3 were detected.

Osteoporosis prevention: knowledge and behavior in a southwestern community.

Prior to developing an osteoporosis prevention education program and social marketing campaign, we sought to (a) establish current status of osteoporosis-related knowledge and behavior among women aged 25–55 years in Maricopa County, Arizona, and (b) assess factors that segment the population by age and ethnicity. Two-hundred women were surveyed by telephone using random-digit dialing selection. Data demonstrated knowledge of need to consume adequate calcium, but mixed understanding of forms of exercise that help prevent osteoporosis. Knowledge of osteoporosis prevention did not differ as a function of menopause status. Differences for Hispanic versus non-Hispanic womens knowledge showed fewer correct responses for Hispanics for dietary and physical activity questions, and more correct responses on the relationship between body weight and osteoporosis risk. Hispanic women and post-menopausal women generally fit the pattern of higher risk behaviors with Hispanic women exercising and using HRT less and postmenopausal women reporting lower calcium intake and physical activity and more tobacco use. Hispanic women appeared to have similar intake of dietary calcium despite lower levels of milk products. Social marketing campaigns for osteoporosis prevention should be segmented for cultural and age differences, especially considering differences in orientations toward exercise, milk consumption, and competing emphasis on other diseases.

Nutrition for throwers, jumpers, and combined events athletes

Abstract Throwers, jumpers, and combined events athletes require speed, strength, power, and a wide variety of technical skills to be successful in their events. Only a handful of studies have assessed the nutritional needs of such athletes. Because of this, recommendations for nutritional requirements to support and enhance training and competition performances for these athletes are made using research findings from sports and exercise protocols similar to their training and competitive events. The goals of the preparation cycle of nutrition periodization for these athletes include attaining desirable body weight, a high ratio of lean body mass to body height, and improving muscular power. Nutritional recommendations for training and competition periods include: (1) meeting energy needs; (2) timing consumption of adequate fluid and electrolyte intakes before, during, and after exercise to promote adequate hydration; (3) timing consumption of carbohydrate intake to provide adequate fuel for energy demands and to spare protein for muscle repair, growth, and maintenance; (4) timing consumption of adequate protein intake to meet protein synthesis and turnover needs; and (5) consuming effective nutritional and dietary supplements. Translating these nutrient and dietary recommendations into guidelines these athletes can apply during training and competition is important for enhancing performance.