Petra Platte

The Eating Inventory in obese women: Clinical correlates and relationship to weight loss

OBJECTIVES: Describe the physical and psychological correlates of the Eating Inventory (EI) (also known as the Three-Factor Eating Questionnaire) factors in an obese sample, and determine the relationship between the three EI factors and weight loss.DESIGN: Consecutive series of obese women enrolled between 1987 and 1996 in clinical trials of weight loss treatments.PARTICIPANTS: 223 obese women with a weight of 100.7±15.5 kg, an age of 41.4±8.8 y and a body mass index (BMI) of 37.2±5.6 kg/m2.MEASURES: The EI and a variety of physical (weight, body composition and resting energy expenditure) and psychological (mood and binge eating) measures were assessed before and after 5–6 months of treatment.RESULTS: Before treatment, higher restraint scores were associated with lower body weights (P=0.02), while higher disinhibition scores were associated with greater binge eating severity (P<0.0001). Weight loss treatment was associated with significant increases in restraint and decreases in disinhibition and hunger (all Ps<0.0001). Greater increases in restraint during treatment were associated with larger weight losses (P<0.0001).CONCLUSIONS: The three factors of the EI showed clinical utility in a sample of women receiving treatment for obesity.

Differences in food-choice frequencies between restrained and unrestrained eaters

Reported frequency of consumption for certain food items was studied in young normal-weight women, classified into 19 unrestrained and 20 restrained eaters by the Three-Factor Eating Questionnaire of Stunkard & Messick (1985). Neither group differed in the consumption of basic foods and snacks but restrained eaters showed a strong tendency to avoid fat. A large percentage of this group was used to consuming artificial sweeteners and other calorie-reduced foodstuffs. These qualitative alterations in the everyday eating behavior of restrained eaters may be one of the links between dietary restraint and binge eating.

Biological and psychological correlates of intermittent dieting behavior in young women. A model for bulimia nervosa

The eating disorder bulimia nervosa is characterized by alternating periods of strict dieting and overeating. Patients also report mood fluctuations, frequent eating related thoughts, fear of loss of control over eating, impairment of cognitive abilities such as concentration, and somatic complaints. The present study attempted to clarify to what extent these symptoms are consequences of the dieting behavior. Nine healthy young women, classified as unrestrained eaters, were set on a intermittent dieting schedule over 4 weeks. Four days each week (Tue, Wed, Thu, Fri) they had to reduce their intake below 600 kcal/day, the other 3 days they could eat without restrictions. Psychological variables were assessed by means of a standardized diary. Biological indices of starvation were also measured repeatedly. There was no substantial weight loss after the 4 weeks, although subjects had significantly increased levels of beta-hydroxybutyric acid during the dieting periods, and decreased levels of t3 after 2 weeks. The reported tendency to overeat and the actual calorie intake during the days of unlimited access to food showed a significant increase over the 4-week period. Eating-related thoughts, feelings of hunger, and fear of loss of control were significantly more frequent during periods of dieting, compared to days of normal eating. Subjects also reported worse mood, heightened irritability, difficulties concentrating, and increased fatigue. These results suggest that a substantial part of symptoms of bulimic patients might be associated with the frequent periods of an extremely restrained eating behavior.

A study of linkage and association of body mass index in the old order Amish

Obesity is thought to have a genetic component with the estimates of heritability ranging from 0.25–0.40. As part of an ongoing study of obesity in the Old Order Amish, seven two‐ and three‐generation families (157 individuals) were assessed for 21 traits related to obesity, including body mass index (BMI) and BMI‐percentile (a standardized distribution of BMI adjusted for age and sex). Genotyping was performed using a panel of 384 short‐tandem repeat markers. In this sample, the estimates of heritability ranged from 0.16–0.31 for BMI and from 0.40–0.52 for BMI‐percentile. Model‐independent linkage analysis identified candidate regions on chromosomes 1, 5, 7, 8, and 11. Given that several markers on 7q were significant for both BMI and BMI‐percentile (P ≤ 0.001) and that the structural locus for leptin was located on 7q, this region was considered to be the primary candidate region. Subsequent typing of additional flanking markers on 7q corroborated the original findings. Tests of intrafamilial association for alleles at markers in this candidate region were significant at similar levels. Although there is some evidence for linkage and association in the region containing leptin, there appears to be stronger evidence for linkage (P ≤ 0.001) and association (P ≤ 0.00001) with BMI in a region 10–15 cM further downstream of leptin, flanked by markers D7S1804 and D7S3070 with peak values from D7S495–D7S1798. Evidence from linkage and association studies suggests that this region (D7S1804–D7S3070) may be responsible, at least in part, for variation in BMI and BMI‐percentile in the Old Order Amish. Published 2003 Wiley‐Liss, Inc.

Resting metabolic rate and total energy expenditure in acute and weight recovered patients with anorexia nervosa and in healthy young women

Because little is known about energy requirements in anorectic patients before and after weight gain we measured resting metabolic rate (RMR) by indirect calorimetry and total energy expenditure (TEE) by the doubly labeled water method in 6 patients with anorexia nervosa (body mass index [BMI] = 15.1 +/- 1.3 kg/m2), in 6 weight-recovered anorectics (BMI = 21.2 +/- 2.1 kg/m2), and in 12 healthy age-matched women (BMI = 20.5 +/- 1.9 kg/m2). No significant differences were found between the weight-recovered anorectic women and the healthy controls in RMR (1,330 +/- 131 kcal/day [weight-recovered]; 1,419 +/- 197 [controls]) and in TEE (2,602 +/- 637 kcal/day [weight-recovered]; 2,596 +/- 493 kcal/day [controls]). The RMR was significantly lower in the acutely ill anorectic patients (1,171 +/- 113 kcal/24 hr) than in weight-recovered anorectics and in healthy controls. The TEE was significantly lower in the anorectic group (1,946 +/- 192 kcal/day) than in the healthy controls.

Cholecystokinin, gastrin and stress hormone responses in marathon runners

The purpose of this investigation was to determine the influence of long-distance running on the secretion of the gastrointestinal peptide hormones cholecystokinin (CCK) and gastrin. Several known stress hormones, ACTH, cortisol and norepinephrine, were also measured. The hormones were estimated before and after a competitive marathon run of 46.5 km and under control conditions a few weeks later. Except gastrin, all hormones were significantly higher under prerun conditions than under control conditions and were highest after the run. The most marked prerun elevation was in CCK. Therefore, CCK seems to be an important regulation factor in response to anticipatory stress.

Reduced resting metabolic rate in athletes with menstrual disorders.

PURPOSE This study investigated metabolic and nutritional determinants in association with menstrual disorders in athletes. Athletes with normal menstrual function (AN; N = 21) and athletes with menstrual disorders (AD: N = 12) participated in this study. METHODS The quality of the menstrual cycle was judged according to salivary progesterone concentrations. Resting metabolic rate (RMR) and diet-induced thermogenesis (DIT) were measured by indirect calorimetry. Body composition, energy intake and restrained eating scores were obtained. RESULTS When adjusted for body composition by ANCOVA, RMR was significantly (approximately 460 kJ, P < 0.02) lower in athletes with menstrual disorders than in athletes without menstrual disorders. The DIT and the daily energy intake of the groups did not differ. Athletes with menstrual disturbances scored significantly higher on the Restraint Eating Scale (TFEQ). Thyroid hormones (fT3 and fT4), analyzed by a competitive chemiluminescent immunoassay, were in the normal range and not different between groups. CONCLUSIONS The results provide evidence that restrained eating and low RMR are associated with menstrual cycle disturbances in athletes.

Average total energy expenditure in anorexia nervosa, bulimia nervosa, and healthy young women

The double-labeled water method was used to measure average daily total energy expenditure (EE) in 11 healthy normal-weight women classified as unrestrained eaters, in 8 patients with anorexia nervosa, and in 8 patients with bulimia nervosa. The body mass index was 20.0 +/- 1.3 kg/m2 in the control group, 15.2 +/- 5.6 kg/m2 in the anorectic groups, and 19.7 +/- 1.9 kg/m2 in the bulimic group. EE was measured over a 2-week period during which weight remained constant in all groups and was 2357 +/- 504 kcal/day for the controls, 2510 +/- 920 kcal/day for the bulimics, and 2899 +/- 656 kcal/day for the anorectics. Differences were not significant among groups. Physical activity was recorded in diaries by all subjects. Anorectic patients showed significantly more activity than all other groups. The data suggest that EE is high in anorectic patients as a consequence of physical activity.

ADRENOCORTICAL ACTIVATION FOLLOWING STRESSFUL EXERCISE: FURTHER EVIDENCE FOR ATTENUATED FREE CORTISOL RESPONSES IN WOMEN USING ORAL CONTRACEPTIVES

Free cortisol, heart rate and affective responses to bicycle ergometry were studied in 31 women using oral contraceptives (OC) and 22 control women. While OC users and control women showed significant increases in both free cortisol and heart rate, OC users had significantly attenuated cortisol responses. Individual workload, peak heart rates and affective responses were similar in both groups. No effect of menstrual or pill cycle phase could be observed on the parameters studied. It is concluded that OC users are able to mount a significant free cortisol response to strenuous exercise but the response magnitude is lower than in women who do not use oestrogen-containing medication. Possible mechanisms and health implications are discussed briefly.

The effect of a mental challenge test of plasma norepinephrine and cortisol in bulimia nervosa and in controls

Recent studies have related stress to the etiology and maintenance of bulimia nervosa (Cattanach and Rodin 1988, Cattanach ei al 1988). Katzman et al (1985) reported poorer stress-coping strategies in bulimic patients. Cattanach et al (1988) studied stress in the laboratory and observed normal physiological responses to stress, although their patients reported an increased desire to binge under stressful conditions. In order to further evaluate the stress response in bulimic patients the response to two stress hormones, norepinephrine (NE) and cortisol, to a mental stress, and to a control condition was studied in 17 female bulimics and in 20 age-matched and sex-matched controls.