Results from the six-month program included less weight gain, improved body image, less consumption of fast food and more participation in family meals. The program included weekly peer meetings, consultations with primary care providers and separate meetings for parents.

Kaiser Permanente researchers have published their results online in the journal Pediatrics.

Experts say the study is the first to report long-term results from a weight management program designed specifically for teenage girls.

Most other programs have included younger children and interventions focused on the entire family. This program included separate meetings for parents with the rationale that teens are motivated more by peer acceptance than parental influence.

The study is also unique in that it was conducted in a primary-care setting, rather than an academic or specialty-care environment.

“Nearly one-third of teenage girls are overweight or obese, and many of them are likely to become obese adults,” said Lynn DeBar, Ph.D., M.P.H., lead author and senior investigator with the Kaiser Permanente Center for Health Research.

“Our study shows that intervention programs can help these girls achieve long-term success managing their weight and also learning new habits that will hopefully carry over into their adult life.”

“Many teenage girls are still growing taller, so for them, maintaining weight or slowing weight gain is an acceptable goal,” said Phil Wu, M.D., a pediatrician who leads Kaiser Permanente’s effort to prevent and treat childhood obesity and is also a co-author of the study.

“Girls in the program gained less weight than those who weren’t in the program, and they reduced their overall body mass index, improved their self-image and developed healthy lifestyle habits, so all of these are successes.”

Researchers followed 208 girls, ages 12-17. All of the girls were classified as overweight or obese, according to standards set by the Centers for Disease Control and Prevention standards.

Half of the girls were assigned to the intervention group and half to usual care.

Girls in the intervention group met weekly with their peers and a behavioral counselor during the first three months, and then every other week during months four and six.

The girls were weighed and asked to keep a food and activity diary, which they discussed during each meeting. The program focused on decreasing portion size, limiting consumption of energy-rich foods, establishing regular meal patterns, substituting water for sugar-sweetened beverages, reducing fast food, increasing fruit and vegetable consumption, and having more family meals.

A significant exercise prescription was delivered with girls encouraged to exercise at least five days a week for 30-60 minutes. Moreover, screen time was to be limited to two hours a day.

Participants also received yoga instruction, and a physical-activity video game to use at home. Discussion topics included ways to avoid disordered eating, coping with family and peer teasing and developing strategies to combat negative self-talk.

An important part of the problem included parental education on support for their daughters. This weekly meeting was not held in the presence of the daughters.

Health care providers received summaries of the girls’ current health habits, including meal and physical activity patterns. After receiving training in motivational techniques, the providers met with the girls at the beginning of the study to help them choose one or two behaviors to work on.

The providers had a second visit with the girls at the end of the six-month intervention to check their progress.

Girls assigned to the usual-care group received a packet of materials that included a list of online reading about lifestyle changes. They also met with their primary care provider at the beginning of the study, but the providers were not given health habit summaries for these girls.

Both groups had health assessments and lab tests at the beginning of the study, at six months, and then again at 12 months. The girls started out with an average weight in the 190 lb. range, and an average body mass index in the 97th percentile, which by CDC standards is considered to be obese.

At the end of the study, girls who participated in the program were in the 95th percentile, while girls in the usual-care group were in the 96th percentile.

Researchers say the weight changes were statistically significant but modest compared to some other weight loss interventions.

They point out that the girls were severely obese to begin with and possibly treatment-resistant due to previous involvement in other weight loss programs.

A salient feature of the program was a de-emphasis on calorie counting, focusing instead on lifestyle changes. However, researchers acknowledge that this approach may have produced more modest weight changes than they had expected.

This study is part of ongoing Kaiser Permanente research into weight loss. Previous studies include:

• A Kaiser Permanente Center for Health Research study published in the International Journal of Obesity in 2011 found that people trying to lose at least 10 pounds were more likely to reach that goal if they had lower stress levels and slept more than six hours, but not more than eight hours, a night.
• Another Kaiser Permanente Center for Health Research study published in 2010 found that the more people logged on to an interactive weight management website, the more weight they kept off.
• Researchers at the Kaiser Permanente Center for Health Research also reported in a 2008 study that keeping a food diary can double a person’s weight loss and that both personal contact and Web-based support can help with long-term weight management.

Source: Kaiser Permanente

Overweight teenager photo by shutterstock.

In a paper presented during the American Academy of Neurology’s Annual meeting, researchers report that consumption of between 2,100 and 6,000 calories per day may double the risk of mild cognitive impairment (MCI), among people age 70 and older.

The finding is significant as MCI is the stage between normal memory loss that comes with aging and early Alzheimer’s disease.

Mayo Clinic investigators discovered the more calories consumed each day, the higher the risk of MCI.

“We observed a dose-response pattern,” said study author Yonas E. Geda, M.D., M.Sc., with the Mayo Clinic in Scottsdale, Arizona.

Researchers followed 1,233 people between the ages of 70 and 89 and free of dementia residing in Olmsted County, Minn. Of those, 163 had MCI. Participants reported the amount of calories they ate or drank in a food questionnaire and were divided into three equal groups based on their daily caloric consumption.

The natural experiment resulted in a group that consumed between 600 and 1,526 calories per day; another group with caloric intake between 1,526 and 2,143 per day; and a third group that devoured between 2,143 and 6,000 calories per day.

Investigators discovered the odds of having MCI more than doubled for those in the highest calorie-consuming group compared to those in the lowest calorie-consuming group.

Researchers found the risk remained after adjusting for history of stroke, diabetes, amount of education, and other factors that can affect risk of memory loss.

There was no significant difference in risk for the middle group.

“Cutting calories and eating foods that make up a healthy diet may be a simpler way to prevent memory loss as we age,” said Geda.

Source: American Academy of Neurology

Furthermore, an obese person’s reward system seems to respond more vigorously to food pictures, whereas their responses in the frontal cortical regions involved in cognitive function appear lessened.

Since the central nervous system is highly involved in the processing of hunger signals and food intake control, researchers suggest that the cause of obesity might be rooted in the brain.  For the study, researchers used various brain imaging methods to measure the involved brain circuits in morbidly obese individuals as well as in lean controls.

Brain glucose metabolism was measured with positron emission tomography during conditions in which the participant’s body was satiated in terms of insulin signaling. Brain responses to food pictures were observed with functional magnetic resonance imaging.

“The results suggest that obese individuals’ brains might constantly generate signals that promote eating even when the body would not require additional energy uptake,” says adjunct professor Lauri Nummenmaa from the University of Turku.

“The results highlight the role of the brain in obesity and weight gaining. The results have major implications on the current models of obesity, but also on development of pharmacological and psychological treatments of obesity,” Nummenmaa says.

Source:  Academy of Finland

Specifically, investigators discovered the brain region to be more activated in response to food images after one night of sleep loss than after one night of normal sleep.

Investigators believes this finding suggests that poor sleep habits can affect a person’s risk of becoming overweight in the long run.

The findings are published in The Journal of Clinical Endocrinology and Metabolism.

In prior research, neuroscientists Drs. Christian Benedict and Helgi Schiöth found that a single night of total sleep loss in young normal weight men curbed the energy expenditure the next morning. This research also showed that subjects had increased levels of hunger, which indicates that an acute lack of sleep may affect human’s food perception.

In this new study, researchers examined how the regions in the brain involved in appetite sensation are influenced by acute sleep loss.

Investigators used functional magnetic resonance imaging (fMRI) to study the brains of 12 normal-weight males while they viewed images of foods. The researchers then compared the results after a night with normal sleep with those obtained after one night without sleep.

Said Benedict, “After a night of total sleep loss, these males showed a high level of activation in an area of the brain that is involved in a desire to eat.

“Bearing in mind that insufficient sleep is a growing problem in modern society, our results may explain why poor sleep habits can affect people’s risk to gain weight in the long run. It may therefore be important to sleep about eight hours every night to maintain a stable and healthy body weight.”

Source: Uppsala University

Researchers at the Fondazione di Ricerca e Cura Giovanni Paolo II (John Paul II Foundation for Research and Treatment) in Campobasso analyzed data from a sample of more than 1,000 people as a part of the Moli-sani Project, an epidemiological study of 25,000 subjects in Molise, a southern region of Italy.

The report is published online in the International Journal of Public Health.

“Scientific literature has mainly focused on television viewing, considered a risk factor for health mainly because it represents a measure of physical inactivity,” said Marialaura Bonaccio, first author of the study.

Watching TV is often linked to physical inactivity and snacking, with negative effects on obesity, a major cardiovascular risk factor.

“In our study we paid attention to the capacity of people to get informed by using mass media, including the Internet and newspapers or magazines. We sought to see whether most informed people had better eating habits than those less exposed to information.”

In addition to collecting standard information from study participants (medical information, lifestyle, dietary habits, etc) individuals also completed a specific questionnaire on mass media usage, from TV viewing to newspaper and magazine reading and surfing the Internet.

In turn, researchers created a score of mass media information exposure and discovered exposure to multiple media sources was associated with lifestyle improvement, said Americo Bonanni, head of the science communication unit of the Research Laboratories.

“We focused on eating habits, mainly on Mediterranean diet,” Bonanni said. “Results have shown that people most exposed to information delivered by any mass media source, reported higher adherence to the Mediterranean-like eating patterns. The latter are considered the most effective eating model for reducing the risk of chronic and neurodegenerative diseases.

“In particular, people who were more informed reported higher consumption of some key foods of the Mediterranean diet pyramid, such as fruits and fresh fish, and a lower consumption of less healthy food such as animal fats.”

Investigators say the next step will be to evaluate each source of information and study how the Internet is changing the way people, especially the youngest, get informed on health topics.

Source: Catholic University – Campobasso

A new study from Mark Conner, Ph.D., of the Institute of Psychological Science at the University of Leeds, and his colleagues Dr. Andrew Prestwich and Dr. Rebecca Lawton, has demonstrated that the effect of “implementation intentions” — where people make specific plans, with cues to prompt planned behavior — is strengthened when other people, such as friends, family and colleagues, get involved.

The Leeds team worked with volunteers who agreed to participate in two studies attempting to increase their levels of exercise or improve their diet. Some were left to do it on their own; others were asked to recruit a partner.

A third group were encouraged to develop “if…then…” plans. These take the form of “if I feel hungry before lunch, I’ll eat an apple, not a candy bar.” A fourth group was told to makes these “if…then” plans with a partner.

“We followed up after one, three and six months to see how the employees were doing,” he said. “It was quite clear that working together and joint planning really helped employees stick to their new exercise regimes. Moreover, the involvement of a partner in planning had a sustained effect that was still noticeable after six months.”

Conner warns that recruiting a buddy is not a guarantee for success. The real power, he says, is in matching your “ifs” and “thens” so you have powerful cues for your new behavior.

“When all else is equal, forming exercise plans with a partner will increase your chances of actually sticking to them,” he adds.

He notes that these findings could be applied to various government and health initiatives, such as smoking cessation programs or efforts to reduce obesity. Instead of putting all the onus on an individual, people should be encouraged to work with others and form clear “if… then…” plans, he said.

“Individual change can, of course, happen, but it is even better to have a friend on your side,” he concludes.

Source: Economic and Social Research Council

Two women talking photo by shutterstock.

Experts say that an exact determination of expected body weight for adolescents based on age, height and gender is critical for diagnosis and management of eating disorders such as anorexia and bulimia.

A new study published in the journal Pediatrics compares three common methods for calculating expected body weight of adolescents with eating disorders and found that the body mass index (BMI) percentile method is recommended for clinical and research purposes.

Body mass index is defined as the individual’s body weight divided by the square of his or her height. The method was developed in the 19th century to guide population health studies.

“There are no clear guidelines in the adolescent field,” said study author Daniel Le Grange, Ph.D., professor of psychiatry and director of the Eating Disorders Program at the University of Chicago.

“We set out to do something that is relatively straightforward that hasn’t been done before, and that is look at some of the most frequently used methods of calculating weight in the pediatric and adolescent eating disorder populations, and see whether we can come up with a gold standard for clinical as well as for research purposes.”

Le Grange and his colleagues analyzed data from adolescents seeking treatment for eating disorders at the University of Chicago. They calculated expected body weights using the BMI method along with two other commonly used measures: the McClaren and Moore methods.

The BMI method compares a patient’s current BMI to the 50th percentile BMI for a patient of the same age, height and gender according to charts published by the Centers for Disease Control and Prevention. That percentage can help determine whether a patient has an eating disorder.

Their analysis showed that of the three, the BMI method was the most useful for children and adolescents of all ages, heights and weights, and could account more accurately for very short and very tall patients as well.

Health reform calls for primary care physicians to take a lead role in managing the overall health of their patients. This means that many family practice and pediatric providers, who may not be as familiar with eating disorders and prevalence of eating disorders, must provide appropriate care management for children with eating disorders.

“Pediatricians are at the forefront of making these diagnoses,” said Le Grange. “We wanted to make a clear statement to the pediatric and adolescent eating disorder community that we should all talk the same language and move forward in this way.”

The study also recommends that researchers cite the method used to calculate expected body weight in their research and stresses the importance of using the term “expected” instead of “ideal” to describe body weight to avoid unrealistic body image expectations in patients with eating disorders.

“I think it’s a good clear clinical guide, and I hope pediatricians in the community feel they can pick it up and have a handy tool in their clinical practice,” Le Grange said.

Source: University of Chicago Medical Center

New research adds a small, albeit critical component to the weight control equation – journaling to maintain self-worth.

A study published in Psychological Science, found that women who wrote about their most important values, like close relationships, music, or religion, lost more weight over the next few months than women who did not have that experience.

“We have this need to feel self-integrity,” said Christine Logel, who cowrote the new study with Geoffrey L. Cohen. Logan believes the importance of self-worth is essential for successful lifestyle modifications.

For example, when something threatens your sense that you’re a good person, like failing a test or having a fight with a friend, “We can buffer that self-integrity by reminding ourselves how much we love our children,” she said .

In the current study, the researchers recruited 45 female undergraduates who had a body mass index of 23 or higher. A body mass index of 18.5 to 24.9 is considered normal weight.

Study participants were reflective of the national population with 58 percent of thewomen overweight or obese.

Each woman was weighed, and was then given a list of important values, like creativity, politics, music, and relationships with friends and family members. Each woman ranked the values in order of how important they were to her.

Then half the women were told to write for 15 minutes about the value that was most important to her. The other half, a control group, were told to write about why a value far down on their list might be important to someone else.

The women came back between one and four months later to be weighed again. Women who had written about an important value lost an average of 3.41 pounds, while women in the control group gained an average of 2.76 pounds, a pattern of weight gain that is typical for undergraduates.

“How we feel about ourselves can have a big effect,” Logel said. “We think it sort of kicks off a recursive process.”

Maybe when one of the women who wrote about an important value went home that night, she felt good about herself and didn’t eat to make herself feel better. Then the next day snacking wasn’t as much of a habit, so she skipped it. Over a few months, that could make a real difference in her life.

Reminding ourselves of values is a critical step toward working through times when we feel a threat to our integrity.

Many studies have found that even briefly thinking about values can have a big effect.

For example, Cohen used the same technique on minority seventh-graders who were underperforming relative to their white peers. Those who did the exercise were still performing better years later.

Researchers are unsure if journaling can help everyone to lose weight as more study is needed.

In fact, the women in the study didn’t know that writing about values was supposed to help them live better (although they may have wondered why this psychology study required a weigh-in).

“My dream, and my research goal, is to get this to the point where people can do it deliberately to benefit themselves,” Logel said.

In the meantime, she carries around a keychain that reminds her of a value that she considers to be important. And everyone else can do that, too.

“There’s certainly no harm in taking time to reflect on important values and working activities you value into your daily life,” Logel said.

Source: Association for Psychological Science

woman weighing self photo by shutterstock.

During a study of high-fat diets in the brains of mice and rats bred to become obese, researchers found evidence of early and lasting injury to a specific part of the hypothalamus.

Then using brain imaging, the researchers also found signs of similar damage in the same area of the brain in obese humans.

“Obese individuals are biologically defending their elevated body weight,” said Dr. Michael W. Schwartz, professor of medicine at the University of Washington, who led the study.

“To explain a biologically elevated body weight ‘set-point,’ investigators in the field have speculated about the existence of fundamental changes to brain neurocircuits that control energy balance.”

“Our findings are the first to offer direct evidence of such a structural change, and they include evidence in humans, as well as in mice and rats.”

Schwartz noted that the researchers did not prove cause and effect between the hypothalamic neuron injury and defense of elevated body weight.

“That comes next,” he said. “But this amounts to solid evidence of a change affecting the key hypothalamic area for body weight control with the potential to explain the problem.”

The paper, “Obesity Is Associated with Hypothalamic Injury in Rodents and Humans,” will be published in the Jan. 3 issue of the Journal of Clinical Investigation.

Source: University of Washington

A new study led by Dr. John Gunstad, associate professor of psychology at Kent State University in Ohio, found that memory and other mental abilities clearly influence the amount of weight people lose.

“The results of our latest study indicate that better performance on tests of memory and executive function is linked to greater weight loss in persons who have weight loss surgery,” he said.

“We believe this effect comes from a better ability to stick to the diet and exercise habits that promote weight loss.”

He is quick to add that these findings “should not be misinterpreted to indicate that cognitive impairment automatically leads to negative outcomes.”

“Instead, it might encourage cognitive screening to help identify those people who might benefit from additional support to help them reach their weight loss goals.”

If you want to lose weight and keep it off, you need a plan and reminders to stay on track, he said. He recommends that after talking with your doctor to identify the best weight loss plan for you, strategies such as planning your meals in advance or using alerts on your smartphone might make a big difference.

“Some people appear to have a better ability than others to keep themselves on task,” said Gunstad. “Fortunately, a little planning can help those of us that have a harder time doing so still achieve our weight loss goals.”

Gunstad’s findings will appear in an upcoming issue of Surgery for Obesity and Related Diseases.

Source: Kent State University

Those with celiac disease, an autoimmune reaction to eating gluten, often suffer from abdominal pain, constipation, decreased appetite, diarrhea, nausea and vomiting. The disease is typically controlled by avoiding foods with gluten, such as wheat, barley and rye.

“It is easy to see how people who are not managing their disease well can frequently feel unwell and, therefore, be more stressed and have higher rates of depression,” said Josh Smyth, Ph.D.,  professor of biobehavioral health and medicine at Penn State.

“But researchers had not carefully looked at whether people who are effectively managing celiac disease exhibit a greater risk for such difficulties.”

Smyth and his colleagues, including researchers from Syracuse University and Drexel University, surveyed 177 American women who reported a physician-provided diagnosis of celiac disease.

The web-based survey explored levels of adherence to a gluten-free diet and assessed various symptoms of the disease, how physical symptoms interfere with daily functioning, the management of stressful situations, symptoms of clinical depression, and frequency of thoughts and behaviors associated with eating and body image.

“We found that most participants frequently adhered to a gluten-free diet, and this greater compliance with diet was related to increased vitality, lower stress, decreased depressive symptoms and greater overall emotional health,” said Smyth.

“However, even those people who were managing their illness very well reported higher rates of stress, depression and a range of issues clustered around body image, weight and shape, when compared to the general population.”

It is understandable that women with celiac disease tend to suffer from eating disorders, as managing the disease requires them to pay careful attention to what and how they eat, he noted.

“What we don’t know is what leads to what and under what circumstances,” he said.

“It’s likely that the disease, stress, weight, shape and eating issues and depression are interconnected. But we don’t know if women who are higher stressed and have celiac disease are more likely to develop symptoms of disordered eating and then become depressed, or if women with celiac disease are depressed and then become stressed, which leads to disordered eating.”

The team’s results may have implications for people with food allergies and Crohn’s disease, a form of inflammatory bowel disease, as well as celiac disease, according to Smyth.

“Going out to eat with friends or to a holiday potluck is a much different experience for these people because they have to be vigilant and monitor their diets,” he said. “They may feel that they are a burden on a host or hostess. In many cases the only treatment option they are given is to manage their diets. I think we need to educate patients at diagnosis or post-diagnosis about some of the other associated difficulties they might experience and provide strategies for how to better manage those things. I am a proponent of elaborating our treatment models to not just address diseases, but also to address the psychological, social and behavioral aspects of disease as well, as they can influence disease outcomes and the well being of patients.”

The results of the study are posted online and will appear in a future issue of Chronic Illness.

Source: Penn State

Woman looking out window photo by shutterstock.

Researchers say the evidence suggest that young women who display signs of either depression or binge eating should be screened for both disorders.

“Binge-eating prevention initiatives should consider the role of depressive symptoms and incorporate suggestions for dealing with negative emotions,” say the authors.

This study could provide important new opportunities to address the nation’s obesity epidemic, according to senior author Alison Field, Sc.D., an epidemiologist at Harvard Medical School and the Harvard School of Public Health.

Researchers say the new investigation is the largest to look at the relationship between binge eating and depression during adolescence, when most eating disorders develop.

The study authors defined binge eating as eating a large amount of food in a short amount of time and feeling a lack of control over eating during the episode. Researchers labeled girls who ate large amounts of food but did not feel out of control “overeaters.”

The findings rely on surveys conducted as part of the nationwide Growing Up Today Study.

The authors focused on girls because eating disorders and depression are more common in females than in males. Investigators analyzed data from nearly 5,000 girls aged 12 to 18 who answered questions in 1999, with follow-up surveys in 2001 and 2003.

Teens and young women who reported in the first survey that they always or usually felt “down in the dumps” or “depressed” were about twice as likely as others were to start overeating or binge eating during the following two years.

“The most common approach to obesity has been to focus on eating better and exercising more, but many pathways can lead to being overweight,” said Marian Tanofsky-Kraff, Ph.D., who studies eating disorders, told the Health Behavior News Service. 

“There is a group of people where it may be more psychologically driven. Targeting some of these psychological factors might help prevent obesity.”

“Binge eaters or overeaters can be very secretive, so parents may be unaware that there’s a problem. That’s a really important message for clinicians,” added Field. “If they have patients who are depressed, they need to ask about disordered eating patterns and vice versa.”

Source: Health Behavior News Service

Teenager with mirror photo by shutterstock.

Neuroscience researchers from Tufts University report they have been able to block this response in mice. Investigators believe these critical receptors may be drug therapy targets for control of the stress-response pathway.

This finding may lead to a variety of new approaches to manage a wide range of neurological disorders involving stress.

“We have identified a novel mechanism regulating the body’s response to stress by determining that neurosteroids are required to mount the physiological response to stress,” said author Jamie Maguire, Ph.D. “Moreover, we were able to completely block the physiological response to stress as well as prevent stress-induced anxiety.”

The association between stress and cortisol has been well-established. Scientists believe a stress-control pathway, more technically known as the Hypothalamus-Pituitary-Adrenal (HPA) axis, determines the levels of cortisol and other stress hormones in the human body.

An imbalance of hormones is implicated in the types of emotional and psychological stress that can lead to major depression.

Disorders of the stress-control pathway are also associated with obesity, premenstrual syndrome, postpartum depression, Cushing’s syndrome (hypercortisolism) and diseases including epilepsy and osteoporosis.

Using the brain tissues of adult mice, the research team identified mechanisms controlling the activity of Corticotrophin Releasing Hormone (CRH) neurons involved in the control of the stress pathway.

By monitoring the activity of CRH neurons following stress and measuring levels of corticosterone in the blood, they found that the production of stress hormones required the action of neurosteroids on specific receptors on CRH neurons. Investigators also discovered that stress causes a neurosteroid-induced increase in blood corticosterone levels.

The researchers also found that blocking the synthesis of neurosteroids is sufficient to block the stress-induced elevations in corticosterone and prevent stress-induced, anxiety-like behavior in mice.

“We have found a definite role of neurosteroids on the receptors regulating CRH nerve cells and the stress response. The data suggest that these receptors may be novel targets for control of the stress-control pathway.

“Our next work will focus on modulating these receptors to treat disorders associated with stress, including epilepsy and depression-like behaviors,” said Maguire.

Source: Tufts University

Health plans often limit the duration of an individual’s hospitalization, and researchers are also concerned with the psychological and emotional impact that may result from rapid hospital discharge.

Anorexia is an eating disorder characterized by a refusal to maintain a healthy body weight, and an obsessive fear of gaining weight. This disorder may become life-threatening requiring hospitalization. Medical care is typically directed at refeeding to gain significant weight during their first week in the hospital.

According to the researchers, current guidelines recommend starting with about 1,200 calories per day and advancing slowly by 200 calories every other day.

This “start low and go slow” approach is intended to avoid “re-feeding syndrome” — a potentially fatal condition resulting from rapid electrolyte shifts, a well-known risk when starting nutrition therapy in a starving patient.

The new research is the first to test these recommendations, which have been in place since 2000.

“Our findings show that the current recommendations are just not effective,” said Andrea Garber, Ph.D., R.D., associate professor of pediatrics who led the research with colleagues in the UCSF Adolescent Eating Disorders Program.

Study participants were hospitalized due to signs of malnutrition, including low body temperature, blood pressure, heart rate and body mass index. The vast majority of the 35 primarily white, female adolescent patients received low-calorie diets based on the current recommendations.

Patients were fed six small meals per day, and when they refused food, they were given high calorie liquid supplements as a replacement. The patients’ vital signs were monitored closely, with their heart rates measured continuously and electrolytes checked twice a day.

While the low calorie diets did prevent refeeding syndrome for those patients, about 83 percent of them also experienced significant initial weight loss and no overall weight gain until their eighth day in the hospital. This finding represents “a missed opportunity,” according to Garber.

“Studies show that weight gain during hospitalization is crucial for patients’ long-term recovery,” she said. “We have to make the most out of their short time in the hospital.”

In the new study a range of diets were evaluated from 800 to 2,200 calories. This caloric variation allowed the researchers to examine the effect of increasing calories. According to Garber, two important findings emerged:

• The calorie level of the starting diet predicted the amount of weight that would be lost in the hospital. In other words, those on lower calorie diets lost significantly more weight.
• Higher calorie diets led to less time in the hospital. In fact, Garber said, “we showed that for every 100 calories higher, the hospital stay was almost one day shorter.”

While the study finds that current recommendations are too cautious, it raises other questions, according to the research team. For example, while a shorter hospital stay may reduce insurance costs, patients may not be ready to go home yet.

“Shorter is not necessarily better,” said Garber. “We have to consider the potential implications down the line, both psychological and emotional.”

Another unanswered question relates to refeeding syndrome, which remains “a very real fear,” according to Barbara Moscicki, M.D., a professor of pediatrics and senior author on the paper.

Moscicki says that the team is proceeding cautiously since more aggressive approaches to feeding and supplementation have not yet been well studied.

Nevertheless, the researchers say that the study results are a promising start because no adverse events were seen in the study subjects on the higher calorie diets. “If we can improve weight gain with higher calories,” Garber said, “then we’re on the right path.”

Research findings will be published in the January issue of the Journal of Adolescent Health with an accompanying editorial.

Source: University of California – San Francisco

Woman being weighed photo by shutterstock.

A new study moves beyond traditional behavioral therapy approaches that restrict what kids may eat, requiring them to track their food intake and engage in intensive exercise.

The new approach seeks to improve responses to internal hunger and satiety cues and decrease physiological and psychological responses to foods in the environment.

Researchers are excited about the new approach because for most children, behavioral therapy techniques don’t work long-term, according to Kerri Boutelle, Ph.D., associate professor of psychiatry and pediatrics at the University of California, San Diego School of Medicine.

Boutelle and colleagues are developing new ways to treat overeating in children and adults. Their study, published in the Journal of Consulting and Clinical Psychology, describes two new methods for reducing overeating.

The new approach seeks to train children on learning how to stop eating when we are no longer hungry.

In the study, one treatment group, called appetite awareness training, trained children and parents to recognize, and appropriately respond to, hunger and satiety cues. The other treatment group, called cue exposure training, trained children and their parents to resist the food that is in front of them.

“We teach children and parents how the environment tricks us into eating foods even when we’re not hungry,” said Boutelle, citing examples of food triggers such as TV commercials, the abundance of easy-to-eat and high-calories snacks, and the use of food as a reward.

In this study, 36 obese 8-to-12-year olds with high levels of overeating and their parents were assigned to eight-week-long training, either in appetite awareness or a cue-exposure treatment.

Children were given several strategies to help them “ride out their cravings” until the urges diminished (but only when they were not physically hungry).

Participants also learned how to manage potential overeating situations when they might not listen to their bodies’ signals, because of the availability of foods or even their own moods.

While the appetite awareness group focused on training the participants to regulate eating by focusing on internal cues of hunger and appetite, the cue exposure group trained the participants to tolerate cravings to reduce overeating.

Children and parents in the appetite awareness group brought dinner into the clinic and practiced monitoring their hunger and satiety cues throughout the meal. Children and parents in the cue exposure group brought in their highly craved foods and “stared them down” – holding, smelling and taking small bites of the food – for up to 20 minutes while rating their cravings, after which they threw away the food.

In post-treatment surveys, 75 percent of the children in the appetite awareness group and more than 50 percent of children in the cue exposure group liked the program “a lot” or “loved it.” A high percentage (81 and 69 percent, respectively) reported feeling more in control of their eating due to the program.

Outcomes from the two different eight-week treatments were compared using body weight, overeating, binge eating and caloric intake in both the children and parents as variables.

“While this was a pilot study, our initial results suggest that the ‘cue exposure’ approach might be very helpful in reduction of eating in the absence of hunger,” said Boutelle.

She added that significant reduction in such overeating was found in the cue-exposure group, even six months post-treatment, though there was very little long-term impact on overeating in the appetite awareness group. There was only a small effect on body weight and no effect on reported calories eaten in either group; however, both approaches resulted in decreased binge eating in children and their parents.

“These findings are exciting because they offer a completely new paradigm for controlling overeating and binge eating,” Boutelle said.

“By reducing overeating and binge eating, we hope to provide a new way of preventing weight gain and providing children with a sense of control over what they chose to eat. This is really important, because a loss of control can lead to depression and other psychiatric problems, and of course childhood obesity.”

Source: University of California – San Diego

Obese boy on scales photo by shutterstock.