Vicki DiLillo

Television viewing and snacking.

With the rise in obesity in America, the search for potential causes for this epidemic has begun to include a focus on environmental factors. Television (TV) viewing is one such factor, partially due to its potential as a stimulus for eating. The current study investigated the relationship between food intake and self-reported TV viewing in an effort to identify the impact of TV viewing on specific eating behaviors. Seventy-four overweight women seeking obesity treatment completed questionnaires assessing dietary habits and TV viewing behaviors. Results suggest that snacking, but not necessarily eating meals, while watching TV is associated with increased overall caloric intake and calories from fat. Therefore, interventions targeting stimulus control techniques to reduce snacking behavior may have an impact on overall caloric intake.

Weight loss treatment influences untreated spouses and the home environment: evidence of a ripple effect

Objectives:To examine whether a weight loss program delivered to one spouse has beneficial effects on the untreated spouse and the home environment.Methods:We assessed untreated spouses of participants in three sites of Look AHEAD, a multicenter randomized controlled trial evaluating the impact of intentional weight loss on cardiovascular outcomes in overweight individuals with type 2 diabetes. Participants and spouses (n=357 pairs) were weighed and completed measures of diet and physical activity at 0 and 12 months. Spouses completed household food and exercise environment inventories. We examined differences between spouses of participants assigned to the intensive lifestyle intervention (ILI) or to the enhanced usual care (DSE; diabetes support and education).Results:Spouses of ILI participants lost −2.2±4.5 kg vs −0.2±3.3 kg in spouses of DSE participants (P<0.001). In addition, more ILI spouses lost ⩾5% of their body weight than DSE spouses (26 vs 9%, P<0.001). Spouses of ILI participants also had greater reductions in reported energy intake (P=0.007) and percent of energy from fat (P=0.012) than DSE spouses. Spouse weight loss was associated with participant weight loss (P<0.001) and decreases in high-fat foods in the home (P=0.05).Conclusion:The reach of behavioral weight loss treatment can extend to a spouse, suggesting that social networks can be utilized to promote the spread of weight loss, thus creating a ripple effect.

Binge Eating Disorder and Night Eating Syndrome in Adults with Type 2 Diabetes

Objective: To determine the prevalence of binge eating disorder (BED) and night eating syndrome (NES) among applicants to the Look AHEAD (Action for Health in Diabetes) study.

Incorporating motivational interviewing into behavioral obesity treatment

Motivational interviewing may be an appealing addition to a comprehensive behavioral weight loss program. Behavioral strategies have been shown effective in achieving modest weight reduction; however, not all individuals are successful at initial weight loss and many struggle with continued weight maintenance. Theory-based strategies that may enhance overall treatment efficacy or facilitate behavior change for specific clients are needed. Motivational interviewing has been demonstrated effective in facilitating behavior change in addictive disorders, and preliminary applications as an adjunct to obesity treatments are promising. The article presents fundamentals of motivational interviewing and specific examples of applications within a behavioral weight control program.

Weight loss prevents urinary incontinence in women with type 2 diabetes: results from the Look AHEAD trial.

PURPOSE We determined the effect of weight loss on the prevalence, incidence and resolution of weekly or more frequent urinary incontinence in overweight/obese women with type 2 diabetes after 1 year of intervention in the Look AHEAD (Action for Health in Diabetes) trial. MATERIALS AND METHODS Women in this substudy (2,739, mean ± SD age 57.9 ± 6.8 years, body mass index 36.5 ± 6.1 kg/m(2)) were randomized into an intensive lifestyle weight loss intervention or a diabetes support and education control condition. RESULTS At baseline 27% of participants reported urinary incontinence on a validated questionnaire (no significant difference by intensive lifestyle intervention vs diabetes support and education). After 1 year of intervention the intensive lifestyle intervention group in this substudy lost 7.7 ± 7.0 vs 0.7 ± 5.0 kg in the diabetes support and education group. At 1 year fewer women in the intensive lifestyle intervention group reported urinary incontinence (25.3% vs 28.6% in the diabetes support and education group, p = 0.05). Among participants without urinary incontinence at baseline 10.5% of intensive lifestyle intervention and 14.0% of diabetes support and education participants experienced urinary incontinence after 1 year (p = 0.02). There were no significant group differences in the resolution of urinary incontinence (p >0.17). Each kg of weight lost was associated with a 3% reduction in the odds of urinary incontinence developing (p = 0.01), and weight losses of 5% to 10% reduced these odds by 47% (p = 0.002). CONCLUSIONS Moderate weight loss reduced the incidence but did not improve the resolution rates of urinary incontinence at 1 year among overweight/obese women with type 2 diabetes. Weight loss interventions should be considered for the prevention of urinary incontinence in overweight/obese women with diabetes.

Factors associated with the failure of patients to complete cardiac rehabilitation for medical and nonmedical reasons.

PURPOSE Cardiac rehabilitation (CR) provides effective secondary prevention services, but many patients fail to complete the recommended program. The purposes of this study were to describe completion rates in a hospital-based outpatient CR program, and to identify factors associated with patients failing to complete CR because of nonmedical and medical reasons. METHODS Data used for the analyses were from a hospital-based CR program involving 526 discharged patients between January 1996 and February 2002. Patient discharge status was classified into three categories: complete, noncomplete-medical reasons, and noncomplete-nonmedical reasons. Logistic regression modeling identified factors associated with the groups failing to complete CR. RESULTS The rate of CR completion was 58% (304/526). Among the 222 patients who did not complete CR, 139 (63%) had nonmedical reasons. As compared with the patients who completed CR, the adjusted odds ratio (AOR) for those who did not complete CR because of nonmedical reasons were more likely to be employed (AOR 2.2), to be obese (AOR 2.5), to be smokers (AOR 2.1), and to have shorter 6-minute walk distances (AOR 1.7). They were less likely to be women (AOR 0.6) or have diabetes (AOR 0.5). Patients not completing CR for medical reasons were more likely to be categorized as being at high clinical risk (AOR 4.2) and having shorter 6-minute walk distances (AOR 1.9). CONCLUSION Except for low functional capacity, baseline factors associated with patients failing to complete CR differed on the basis of medical or nonmedical reasons. The development of interventions that address the special needs of patients with low functional capacity may be especially important in attempts to retain this high-risk group in CR therapy.

Prevalence and Risk Factors for Urinary Incontinence in Overweight and Obese Diabetic Women: Action for Health in Diabetes (Look AHEAD) study

OBJECTIVE To determine the prevalence and risk factors for urinary incontinence among different racial/ethnic groups of overweight and obese women with type 2 diabetes. RESEARCH DESIGN AND METHODS Cross-sectional analysis of baseline data from the Action for Health in Diabetes (Look AHEAD) study, a randomized clinical trial with 2,994 overweight/obese women with type 2 diabetes. RESULTS Weekly incontinence (27%) was reported more often than other diabetes-associated complications, including retinopathy (7.5%), microalbuminuria (2.2%), and neuropathy (1.5%). The prevalence of weekly incontinence was highest among non-Hispanic whites (32%) and lowest among African Americans (18%), and Asians (12%) (P < 0.001). Asian and African American women had lower odds of weekly incontinence compared with non-Hispanic whites (75 and 55% lower, respectively; P < 0.001). Women with a BMI of ≥35 kg/m2 had a higher odds of overall and stress incontinence (55–85% higher; P < 0.03) compared with that for nonobese women. Risk factors for overall incontinence, as well as for stress and urgency incontinence, included prior hysterectomy (40–80% increased risk; P < 0.01) and urinary tract infection in the prior year (55–90% increased risk; P < 0.001). CONCLUSIONS Among overweight and obese women with type 2 diabetes, urinary incontinence is highly prevalent and far exceeds the prevalence of other diabetes complications. Racial/ethnic differences in incontinence prevalence are similar to those in women without diabetes, affecting non-Hispanic whites more than Asians and African Americans. Increasing obesity (BMI ≥35 kg/m2) was the strongest modifiable risk factor for overall incontinence and stress incontinence in this diverse cohort.

Binge eating and weight loss outcomes in overweight and obese individuals with type 2 diabetes: results from the Look AHEAD trial.

CONTEXT Binge eating (BE) is common in overweight and obese individuals with type 2 diabetes mellitus, but little is known about how BE affects weight loss in this population. OBJECTIVE To determine whether BE was related to 1-year weight losses in overweight and obese individuals with type 2 diabetes participating in an ongoing clinical trial. DESIGN, SETTING, AND PARTICIPANTS The Look AHEAD (Action for Health in Diabetes) trial is a randomized controlled trial examining the long-term effect of intentional weight loss on cardiovascular disease in overweight and obese adults with type 2 diabetes. A total of 5145 overweight and obese individuals aged 45 to 76 years with type 2 diabetes participated in this study. INTERVENTIONS Participants were randomly assigned to an intensive lifestyle intervention or to enhanced usual care (a diabetes support and education control condition). MAIN OUTCOME MEASURES At baseline and 1 year, participants had their weight measured and completed a fitness test and self-report measures of BE and dietary intake. Four groups were created based on BE status at baseline and 1 year (yes/yes, no/no, yes/no, and no/yes). Analyses controlled for baseline differences between binge eaters and non-binge eaters. RESULTS Most individuals (85.4%) did not report BE at baseline or 1 year (no/no), 7.5% reported BE only at baseline (yes/no), 3.7% reported BE at both times (yes/yes), and 3.4% reported BE only at 1 year (no/yes), with no differences between intensive lifestyle intervention and diabetes support and education conditions (P = .14). Across intensive lifestyle intervention and diabetes support and education, greater weight losses were observed in participants who stopped BE at 1 year (mean [SE] weight loss, 5.3 [0.4] kg) and those who reported no BE at either time (mean [SE] weight loss, 4.8 [0.1] kg) than in those who continued BE (mean [SE] weight loss, 3.1 [0.6] kg) and those who began BE at 1 year (mean [SE] weight loss, 3.0 [0.6] kg) (P < .001). Post hoc analyses suggested that these differences were due to changes in caloric intake. CONCLUSION Overweight and obese individuals with type 2 diabetes who stop BE appear to be just as successful at weight loss as non-binge eaters after 1 year of treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00017953.

Prevalence and risk factors for urinary incontinence in overweight and obese diabetic women: the Look AHEAD study

OBJECTIVE To determine the prevalence and risk factors for urinary incontinence among different racial/ethnic groups of overweight and obese women with type 2 diabetes. RESEARCH DESIGN AND METHODS Cross-sectional analysis of baseline data from the Action for Health in Diabetes (Look AHEAD) study, a randomized clinical trial with 2,994 overweight/obese women with type 2 diabetes. RESULTS Weekly incontinence (27%) was reported more often than other diabetes-associated complications, including retinopathy (7.5%), microalbuminuria (2.2%), and neuropathy (1.5%). The prevalence of weekly incontinence was highest among non-Hispanic whites (32%) and lowest among African Americans (18%), and Asians (12%) (P < 0.001). Asian and African American women had lower odds of weekly incontinence compared with non-Hispanic whites (75 and 55% lower, respectively; P < 0.001). Women with a BMI of ≥35 kg/m2 had a higher odds of overall and stress incontinence (55–85% higher; P < 0.03) compared with that for nonobese women. Risk factors for overall incontinence, as well as for stress and urgency incontinence, included prior hysterectomy (40–80% increased risk; P < 0.01) and urinary tract infection in the prior year (55–90% increased risk; P < 0.001). CONCLUSIONS Among overweight and obese women with type 2 diabetes, urinary incontinence is highly prevalent and far exceeds the prevalence of other diabetes complications. Racial/ethnic differences in incontinence prevalence are similar to those in women without diabetes, affecting non-Hispanic whites more than Asians and African Americans. Increasing obesity (BMI ≥35 kg/m2) was the strongest modifiable risk factor for overall incontinence and stress incontinence in this diverse cohort.

Stress, race, and body weight.

OBJECTIVE Stress has been identified as a significant factor in health and in racial/ethnic health disparities. A potential mediator in these relationships is body weight. DESIGN Cross-sectional and longitudinal relationships between stress, race, and body weight were examined in an ethnically diverse sample of overweight and obese women with Type 2 diabetes (n = 217) enrolled in a behavioral weight loss program. MAIN OUTCOME MEASURES Stress (Perceived Stress Scale) was assessed at baseline only and body weight (body mass index) was assessed at baseline and 6 months. RESULTS Stress was not related to baseline body weight. With every 1 unit lower scored on the baseline stress measure, women lost 0.10 kg +/- .04 more at 6 months (p < .05). When women were divided into tertiles based on baseline stress scores, those in the lowest stress group had significantly greater weight loss (5.2 kg +/- 4.9) compared with those in the highest stress group (3.0 kg +/- 4.0) (p < .05). There was a trend for African Americans to report higher levels of stress (20.7 +/- 8.8) than Whites (18.3 +/- 8.3) (p = .08). CONCLUSION The association between higher stress and diminished weight loss has implications for enhancing weight loss programs for women with Type 2 diabetes.