Martin Binks

Obesity and Sexual Quality of Life

Objectives: Reduced sexual quality of life is a frequently reported yet rarely studied consequence of obesity. The objectives of this study were to 1) examine the prevalence of sexual quality‐of‐life difficulties in obese individuals and 2) investigate the association between sexual quality of life and BMI class, sex, and obesity treatment—seeking status.

Utilization Patterns and User Characteristics of an Ad Libitum Internet Weight Loss Program

Background The Internet holds promise for the delivery of evidence-based weight loss treatment to underserved populations. However, most studies do not reflect the more naturalistic and common ad libitum, or freely at will, use of the Internet. Randomized clinical trials, for example, typically include at least some direct contact with participants and often have restrictive selection criteria. There is a paucity of research examining utilization patterns of online weight loss programs, particularly in the rapidly expanding direct-to-consumer arena. Objectives To examine self-reported characteristics (age, body mass index [BMI], gender), behaviors, and Internet site utilization patterns of a sample of users of a direct-to-consumer ad libitum Internet weight loss program. Methods This study is based on analysis of archival data from the initial 15 weeks of an ongoing, free, evidence-based, direct-to-consumer Internet weight loss program, the Healthy Weight Center, which included standard information about nutrition, fitness, and behavioral strategies; monitoring tools; and moderated support group message boards. Participants encountered the program through self-directed Internet searches and anonymously registered to utilize the site. Self-reported user characteristics and electronically tracked utilization data were extracted from existing program data, compiled, and examined. Pearson correlations were computed to examine the association of program utilization with age and BMI. One-way analysis of variance (ANOVA) was used for gender comparisons. Results We examined data from the first 204 adult users of the program who were classified as either overweight (BMI 25 to < 30 kg/m2) or obese (BMI ≥ 30 kg/m2). The mean age of participants was 42.0 years (SD 11.7), 81.9% (167/204) were women, and mean BMI was 32.01 kg/m2 (SD 6.26). The percent of participants who used program tools was as follows: 13.7%, meal planner; 10.8%, nutrition lookup: 17.6%, activity log; 14.2%, journal; and 22.1%, weight tracker. Participants also used the following educational resources: nutrition, 13.2%; fitness, 6.4%; and behavioral, 7.4%. Of the personal self-assessments available through the program, 57.8% of participants assessed personal barriers, and 50.5% assessed relationship with food. Only 7.8% used the support group message boards. No significant associations between site utilization and age, gender, or BMI were found. Reasons for wanting to lose weight were: health, 87%; appearance, 74%; mobility, 44%; doctor recommendation, 23%; and spouse/friend suggested, 12%. The age participants reported first becoming overweight was young adulthood, 31%; late adulthood, 28%; childhood, 22%; adolescence, 17%; and as a toddler, 3%. Self-perceived factors contributing to weight gain were lack of exercise for 70% of participants, emotions for 62%, overeating for 61%, and slow metabolism for 33%. Conclusions Internet weight loss programs reach many people who cannot access traditional treatment. However, users appear not to be optimally utilizing key aspects of the weight loss intervention, such as education, monitoring, and support. This study provides insight into the patterns of ad libitum use of an online weight loss program across multiple treatment-related domains in a naturalistic Internet environment.

Improvements in sexual quality of life after moderate weight loss

We evaluated changes in sexual quality of life as they relate to weight loss over a 2-year period in individuals undergoing weight loss treatment. Six dimensions of sexual quality of life were measured using items from the Impact of Weight on Quality of Life questionnaire (feeling sexually unattractive, lacking sexual desire, reluctance to be seen undressed, difficulty with sexual performance, avoidance of sexual encounters and lack of enjoyment of sexual activity). At baseline women were more likely than men to report lack of sexual enjoyment and reluctance to be seen undressed in spite of lower body mass index (BMI). Weight loss averaged 13.1% and was significantly associated with improvements in all sexual quality of life dimensions. A 3–4% regain did not appear to negatively affect sexual quality of life. The greatest improvements for women had occurred by 3 months and were observed in all dimensions, whereas for men only ‘not feeling sexually attractive’ showed marked improvement in this short time frame.

Associations of depression, anxiety and antidepressants with histological severity of nonalcoholic fatty liver disease.

Depression and anxiety are common in patients with nonalcoholic fatty liver disease (NAFLD). However, their associations with histological severity of NAFLD are unknown.

Remission of metabolic syndrome following a 15-week low-calorie lifestyle change program for weight loss

Objective:To evaluate the rate of remission of metabolic syndrome (Met Syn) among patients undergoing a brief, low-calorie lifestyle change weight loss intervention and to compare the baseline characteristics of patients who were remitted and not remitted from Met Syn at post-treatment.Research Methods and Procedures:Obese adults (N=36) meeting criteria for Met Syn enrolled in an outpatient fee-for-service behavioral weight loss intervention. Participants were assessed on key Met Syn variables (waist circumference, blood pressure, triglycerides, high-density lipoprotein (HDL) cholesterol and fasting blood glucose) at pre- and post-treatment.Results:The majority of patients (61%) responded to treatment after a 9.9% mean weight loss. Although Met Syn responders did not differ significantly from Met Syn non-responders on any baseline Met Syn criterion variable, responders had significantly lower baseline body mass indices (BMI; kg/m2) and met criteria for fewer baseline Met Syn variables. As expected, Met Syn responders, compared with Met Syn non-responders, had significantly lower post-treatment waist circumference, systolic and diastolic blood pressures, triglycerides and fasting blood glucose. Patient groups did not differ significantly on weight lost (kg or %), or on the proportion of patients losing ⩾10% of initial body weight.Discussion:In a community population, Met Syn responds to weight loss through a low-calorie lifestyle intervention; for some patients, however, the recommended 10% weight loss may not be enough for Met Syn remission.

Physical activity and obesity: what we know and what we need to know.

Creating a negative energy balance by decreasing caloric consumption and increasing physical activity is a common strategy used to treat obesity. A large number of review and original research papers have considered the role of physical activity in weight loss and maintenance. However, their conclusions are at times conflicting. In this review, we have critically evaluated the findings of systematic reviews and meta‐analyses and supplemented their conclusions with recently published, high‐quality clinical trials. We have eliminated studies that were methodologically flawed in an attempt to reduce the ambiguity in the literature. We further sought, through selective review of these publications, to isolate the effects of various types of exercise, independent of dietary interventions, to further clarify their independent contributions. Thus, our review describes (i) combined calorie restriction with physical activity interventions, (ii) physical activity interventions without calorie restriction and (iii) the role of physical activity on maintenance of weight loss. Through this critical examination of the literature, we have provided conclusions to address certain ambiguities regarding the role of physical activity in obesity treatment that will inform clinical practice. We have also identified several long‐standing gaps in knowledge that will inform future research.

Referral sources to a weight management program: relation to outcome.

AbstractOBJECTIVE: To examine the characteristics and outcomes of physician-referred weight management patients relative to self-referred patients. DESIGN: Review of clinic records of all individuals contacting a weight control program during a 2-year period with follow-up throughout consecutive levels of treatment (i.e., enrollment, completion, and outcome). SETTING: Medical school weight management center. PARTICIPANTS: A consecutive sample (N=1,392) of overweight and obese callers was categorized as physician-initiated (n=345), media (n=653), or personal (n=394) referrals. Attendees at initial consultation (n=571) were age 41.7±12.8 years, weight 113.9±36.1 kilograms, and body mass index (BMI) 40.3±11.3 kg/m2 (data expressed as mean ± standard deviation). INTERVENTIONS: Low-calorie-diet and very-low-calorie-diet programs. MAIN OUTCOME MEASURES: Gender comparisons, attendance at initial consultation, body mass index, motivation, comorbidities, enrollmenet and completion rates, and weight loss. RESULTS: Compared to callers from other referral sources, physician referrals included a larger minority of males (25.2%) and were more likely to attend an initial consultation (63.5%; P<.001). Among consultation attendees, physician referrals were heavier (mean BMI=44.8), reported more comorbidities, were less likely to join programs (16.9%), and scored as less motivated than other referrals (P<.007). Completion rates for physician referrals were higher than for self-referrals in the very-low-calorie-diet program (85.7%; P<.04) but not in the low-calorie-diet program (P>.05). Among completers, physician referrals did not differ on weight loss in either program (P>.05). CONCLUSIONS: Compared to self-referrals, physician-referred individuals are in greater need of weight loss, less motivated, less likely to enter treatment, but equally likely to profit from it. Therefore, physician referral for weight loss is beneficial for at least some patients and should be encouraged.

Sexual Functioning in Obese Adults Enrolling in a Weight Loss Study

The authors assessed sexual functioning among treatment-seeking obese men (n = 91) and women (n = 134) using the comprehensive validated Sexual Functioning Questionnaire. Scores were lower for women than for men, indicating reduced sexual functioning. Mens scores fell between those of a group of cancer survivors and a general population group, whereas women generally had lower scores than both of these groups. Increasing body mass index was associated with decreasing sexual functioning only for arousal and behavior. Sexual functioning was also reduced on most subscales for individuals who reported sexual inactivity in the past month.

Extended calorie restriction suppresses overall and specific food cravings: a systematic review and a meta-analysis

Multiple studies have concluded that calorie restriction for at least 12 weeks is associated with reduced food cravings, while others have shown that calorie restriction may increase food cravings. We addressed this ambiguity in a systematic review and meta‐analysis.

Sleep disturbance and pain in an obese residential treatment-seeking population

BackgroundThe relationships between body mass index (BMI) and sleep disturbance, sleep disturbance and pain, and obesity and pain are documented; however, there is a paucity of research exploring how sleep relates to pain in obese populations. MethodThe participants comprized 386 (234 women, 152 men) obese (BMI M=40.7) adult (age M=51.0 y) patients enrolling in a 4-week residential obesity treatment program. All information was gathered as part of the initial program evaluation. ResultsThe prevalence of patients reporting at least 1 disturbed sleep symptom was 84.8%. The prevalence of patients reporting at least 1 type of pain was 83.4%. After controlling for depression, anxiety, BMI, age, and sleep apnea treatment, regression analyses showed that daytime sleepiness, night sweats (P<0.01), difficulties falling asleep, and difficulties staying asleep (P<0.05) predicted the total number of pain symptoms reported by women. Among men, controlling for the same variables, fatigue (P<0.01), night sweats, and difficulty falling asleep (P<0.05) predicted the number of pain symptoms reported. DiscussionThese results suggest that in this obese population, disturbed sleep and pain are related, and that this relationship may be different in men and women. Given the prevalence of pain and disturbed sleep in obese populations, this represents a valuable first step in better understanding this relationship.