Index
A
Adult Behavior Knowledge Scale, 184
African-Americans, 51, 129-130, 214
Age
considerations in treatment strategies, 223
weight-gain patterns, 49
weight-loss patterns, 128
Alcoholism, 94-95
Assessment
body fat, 120
classification of obesity, 44-45
for drug therapy, 86
eating and dieting behaviors, 15-16, 105, 177-187, 200-204
for gastric surgery, 88-89
minimum expectations of programs, 10, 12, 103-105, 117, 140, 142, 143-144
obesity measures, 39-44
obesity-related comorbidities, 132-133
pediatric obesity, 115-116, 211-212
physical activity, 181, 187-197, 204-205
psychosocial, 15, 103, 117, 121, 133, 142, 173-184
state regulatory guidelines, 34
for treatment matching, 7, 95-98, 100, 140, 141
See also Monitoring for adverse events
B
Beck Depression Inventory, 182
Behavior modification
cognitive-behavioral strategies, 24, 84
contingency management, 83-84
group therapy, 122-123
in indicated prevention programs, 161-162
in pediatric obesity, 227
social support systems, 84
stimulus control, 83
stress management, 84
treatment goals, 83
Benefits of weight loss
health status, 2, 55-58, 62, 63
long-term, 58-61
Binge eating, 117, 177, 179, 222
Binge Eating Scale, 179
Bioelectric impedance analysis, 40
Blood pressure, 2, 27, 38, 50-51, 97
pediatric obesity and, 219
reduction in weight loss, 56-57
response to exercise, 196-197
Body-Cathexis and Self-Cathexis Scale, 176
Body fat
dietary fat and, 107-110
distribution of, 44-45
in obesity measurement, 40
pediatric assessment, 211
weight loss patterns, 120
Body mass index
calculation, 40
indications for surgical intervention, 88, 90
mortality risk, 58-59
as outcome indicator, 120
pediatric, 211-212
as risk indicator, 43, 50, 142
tables, 41-42
in treatment matching, 95
Body Parts Satisfaction Scale, 177
Body Satisfaction Scale, 176
Body Shape Questionnaire, 176-177
C
Caffeine, 122
Cancer, 38
CARDIA questionnaire, 193
Cardiovascular disorders, 2, 27, 38
benefits of weight loss in, 57
costs, 57
pediatric obesity and, 219
risk reduction program, 158
Causes of obesity, 38
dietary fat consumption, 107-110
environmental, 53
obesity trends and, 52
psychological dysfunction in, 174
research opportunities, 23-24, 164-165
Cerebrovascular disease, 38
Child Behavior Knowledge Scale, 184
Children and adolescents, 3
causes of obesity, 214-219, 231-232
definition of obesity, 210-212, 231
ethnicity in obesity patterns, 213-214
health risks in dieting, 221-222
health risks in obesity, 219-220
obesity treatment, 222-227, 231, 232
outcomes research, 227-230
physical activity assessment, 194-195
prevalence of obesity among, 210, 212-213
preventive interventions, 23, 159, 160, 161-162, 230-231, 233
safety precautions, 115-116
Cholesterol levels, 2
meal size and frequency and, 110
national trends, 51-52
Clinical programs
dietary program in, 132
health assessment in, 12, 15, 17, 19, 142, 143-144
outcomes evaluation in, 17, 145-146, 147
popular programs, features of, 73-80
subcategories, 66
very-low-calorie diets in, 82-83
Comorbidities
anti-obesity drug therapy and, 86
assessment for surgery and, 88-89
benefits of physical activity, 11
benefits of weight loss, 2, 55-58, 62, 63
definition, 44
health costs, 61
low-calorie diets and, 82
in obesity trends, 50-52
as outcome measure, 16, 131-132, 145, 146
research opportunities, 165
as target of preventive interventions, 153
treatment matching consideration, 8, 96-97, 100, 101, 140
See also specific condition
Costs of obesity
with cardiovascular complications, 57
with comorbid diabetes, 55
insurance issues, 62
socioeconomic factors, 61-62
spending on weight-loss programs, 2, 27, 61
Cuban-Americans, 214
Cystic fibrosis, 164
D
Definition of obesity, 40, 44-45, 169
assessment for, 182
pediatric obesity and, 220
benefits of weight loss, 55-56
health-related costs, 55
pediatric obesity and, 220
prevalence, 55
Dietary recommendations, 11, 105-107, 110-111, 132
Dieter's Inventory of Eating Temptations, 180
Dieting behaviors
age-related patterns, 128
in children and adolescents, 219
food-intake assessment, 185-187
national trends, 1
psychological assessment, 179-184
self-directed programs, 27-28
sociocultural factors in, 54
See also Eating behaviors
Dieting programs
antidieting movement, 62-63
balanced-deficit diets, 81
in clinical settings, 132
commercial meal replacement, 54, 81
good design/practice, 10-11, 111, 142-143
health risks in, 12, 31, 116-117, 143
low-calorie diets, 81-82
medical supervision, 11, 82, 111, 143
for pediatric obesity, 221-222, 225-227
protein-sparing modified fast, 225-226
research opportunities, 165
very-low-calorie diets, 82-83, 226
Dieting Readiness and Self-Efficacy, 179-180
Dieting Readiness Scale, 180
Dieting Readiness Test, 16, 104, 133, 142, 144, 198-205
Discrimination, 2, 39, 62-63, 174
Documentation
disclosure of program information, 20-22, 148-150
food intake, 186-187
outcomes, 17
Do-it-yourself programs
credentials of plan designer(s), 12, 143, 144-145
outcomes evaluation, 17, 146-147
popular programs, features of, 66-68
safety precautions, 12, 15, 117, 144-145
subcategories, 65
treatment matching in, 8-10, 140-141
truth and full disclosure in, 21, 148
Drop-out risk, 122-123
demographic variables, 129
Drug therapies
evaluation standards, 86-87
for hypertension, 56
individual responses in, 84, 87-88
informed consent issues, 144
outcomes, 84
over-the-counter/prescription, 54
for prevention, 167
research opportunities, 24, 165
Dual-energy X-ray absorptiometry, 40
E
Eating Attitudes Test, 178
Eating behaviors
assessment, 15-16, 105, 177-179, 185-187, 200-204
dietary recommendations, 11, 105-107, 110-111
eating disorders, 2, 17, 103, 117, 166, 177, 221-222
fat consumption, 107-110
gender differences, 127
meal size and frequency, 110
modification techniques, 83-84
as outcome measure, 16-17, 132
outcome predictors in, 124
in pediatric obesity, 214-215, 232-233
research opportunities, 165
trends, 53-54
weight-loss practices, 54-55
see also Dieting behaviors
Eating disorders, 2
outcomes assessment, 17
research opportunities, 166
Eating Disorders Examination, 178
Eating Disorders Inventory, 177
Eating Inventory/Three-Factor Eating Questionnaire, 177-178
Education
as obesity outcome predictor, 130
as obesity risk factor, 47
preventive interventions, 157
public policy goals, 169
school-based interventions, 228-230
Energy metabolism
dietary fat in, 107-110
doubly-labeled water method of measuring, 190, 196
good dietary practice, 10-11, 142-143
measurement, 106
metabolic-equivalent units, 188-189
in obesity, 38
as outcome indicator, 120
in pediatric obesity, 214-217
perceived energy, 122
physical activity and, 114
physical activity assessment, 187-197
socioeconomic status and, 52-53
as treatment goal, 105
in weight regain, 125
Environmental factors
in pediatric obesity, 217-218
in preventive interventions, 158-159
research needs, 24
Ethical practice, 20
Evaluation of weight-loss programs
conceptual basis, 5, 91-92, 135
criteria for, 5, 28, 91, 92, 137
NIH guidelines, 34-36
obstacles to, 21
outcome measures, 16-20, 28, 118, 130-131, 135-137, 145-148
role of recommendations, 22-23, 150-151
soundness and safety criteria, 10-16, 28, 102-117, 141-145
state efforts, 30-34
technique for, in drug therapy, 86-88
treatment matching, 7-10, 94-101
truth and full disclosure, 20-22, 148-150
See also Weighing the Options model
Exercise Specific Self-Efficacy Scale, 181
F
Families
obesity patterns, 230
pediatric obesity and, 217, 218, 233
in pediatric obesity treatment, 223-224, 225
preventive intervention in, 157, 161-162
Federal Trade Commission, 4, 20, 34, 138, 148
Fenfluramine, 86-87
Food and Drug Administration, 4, 138
Food Guide Pyramid, 11, 107, 142
Franchised programs
clinical, 66
nonclinical, 65
G
Gall bladder disease, 12
Gallstones, 116
Gastric bypass surgery, 62, 88-89
See also Surgical interventions
Gender differences
obesity patterns, 49
obesity prevalence, 47
pediatric obesity, 213
race/ethnicity as obesity variable and, 128, 129
in weight-loss outcomes, 127
in weight-loss strategies, 127
General Well-Being Schedule, 14, 15, 17, 133, 142, 175, 198, 205-209
Genetics
in pediatric obesity, 217
research opportunities, 23-24
research support, 169
Glucose metabolism
weight loss in diabetic patients, 55-56
Government health goals, 1, 37, 231
classification of obesity, 44
Group programs
drop-out risk in, 122-123
peer influence in, 124
H
Hamilton Psychiatric Rating Scale for Depression, 182
Harvard Alumni Study, 191
Health care costs
diabetes mellitus, 55
very-low-calorie diets, 83
See also Costs of obesity
Health care professionals
in administration of very-low-calorie diets, 82
knowledge of obesity, 104-105, 170
in public education effort, 169
Health risks
benefits of weight loss, 55-61, 62, 63
consumer right to know, 15, 31, 144
demographic factors, 159-160
in dieting, 12, 15, 31, 116, 143
gallstones, 116
in gastric surgery, 89
individual assessment for, 160-161
low-calorie diets, 82
pediatric obesity, 219-220
in physical activity program, 113
See also Monitoring for adverse events
Hispanic-Americans, 130
Human genome mapping, 165
benefits of weight loss in, 56-57
definition, 56
national trends, 50-51
stepped care treatment models, 97
Hyperthyroidism, 38
I
Ideal body weight, 43-44
Implementation of recommendations, 22-23, 137-138, 150-151
Individual differences
energy metabolism, 105
outcome prediction, 120-122
physical activity plan, 11-12, 83, 115
weight goals, 44
Informed consent, 144
See also Truth and disclosure in programs
Intestinal bypass surgery, 88
L
Large-Scale Integrated Motor Activity Monitor, 193
Licensure, 234-235
Life Events Checklist, 183-184
Life Experiences Survey, 183
Long-term weight management
definition, 16
as outcome measure, 16, 118, 131, 145, 146, 147
outcome predictors, 124-126, 134
pediatric obesity and, 227-228
as program evaluation criterion, 91
program performance, disclosure of, 22, 34, 149
in stepped care model, 98
traditional conceptualization, 29
M
Managed care, 62
Mazindol, 84
Menopause, 127
Metabolic-equivalent units, 188-189
Metropolitan Life Insurance Company, 43, 44
Mexican-Americans, 47, 51, 52, 130
Minnesota Leisure-Time Physical Activity questionnaire, 191, 195
Monitoring for adverse events as evaluation criterion, 16, 17, 145-148
low-calorie diets, 11, 82, 111, 143
need for, 12, 20, 115-116, 133, 143-144
psychological, 116-117
self-monitoring, 15-16, 140, 144, 145, 147
treatment matching considerations, 8, 101, 140
Mortality risk, 58-61
in gastric surgery, 89
in pediatric obesity, 219, 220
Motivation for weight loss, 27, 53
age-related patterns, 128
assessment of, 104, 142, 199-200
economic factors in, 123
gender differences, 127
as outcome predictor, 122
public policy initiatives for, 170
in treatment matching, 7, 100, 141
N
National Center for Health Statistics, 43
National Health and Nutrition Examination Survey III, 46-47
National Health Survey Interview, 53-54
National Institutes of Health
on choosing a program, 35-36
obesity research spending, 163
program evaluation guidelines, 20, 34-35, 148
Native American, 213
New York City regulations, 20, 30-31, 148
Nonclinical programs
assessment in, 10, 12, 15, 17, 19, 20, 103, 140, 142, 143-144
outcomes evaluation, 17, 65, 145-146
popular programs, features of, 68-73
safety precautions in, 12, 15, 117, 140
treatment matching in, 8, 10, 140, 141
Nutrition
in balanced-deficit diets, 81
dietary recommendations, 11, 105-107, 110-111, 132
eating behaviors assessment, 185-187
gastric surgery and, 88
in low-calorie diets, 81-82
outcome assessment, 132
in very-low-calorie diets, 82, 226
O
Obesity as disease, 24, 38-39, 139
assessment, 40
definition of obesity, 40, 44-45
as public health policy issue, 168-169
as psychopathology, 174
risk factors, 39-40
benefits of weight loss, 58
health-related costs, 61
Outcome predictors
age, 128
educational attainments, 130
gender, 127
in group treatment, 122-123
personal factors, 120-122
population characteristics, 126-127
process factors, 122-123
race/ethnicity, 129-130
research opportunities, 166
treatment factors, 124
of weight-loss maintenance, 17, 124-126
Outcomes evaluation
consumer perspective, 19-20, 147-148
data presentation, 149-150
definitional issues, 169
drug therapy, 84-87
health benefits of weight loss, 55-58, 63
health practices, 16-17, 132-133, 145, 146
for indicated prevention programs, 161
long-term measures, 16, 28, 58-61, 118, 131, 145, 146, 147
NIH guidelines, 35
obesity-related comorbidities, 16, 131-132, 145, 146
pediatric obesity, 227-228
for preventive interventions, 152-153
in program evaluation, 16-20, 28-29, 92, 118, 130-131, 145-148
program perspective, 17-19, 145-147
program-specific, 135-137
regulatory standardization, 31
for selective prevention programs, 160
surgical interventions, 59-60, 89
for universal prevention programs, 156
Overweight, vs. obese, 40, 43, 169
P
Peer influence, 124
Phentermine, 84
Physical activity
assessment, 181, 187-197, 204-205
barriers to, 113-114
benefits of, 112-113
blood pressure response, 196-197
duration and frequency, 113
gender differences, 127
as improved health practice, 16
individual planning, 11-12, 83, 115
metabolic-equivalent units, 188-189
as outcome predictor, 124, 132, 146
pediatric obesity, 215-217, 224-225
in preventing weight regain, 112, 125-126
research opportunities, 166
risk in, 113
in schools, 157
Physical Self-Efficacy Scale, 181
Prevalence of obesity, 1, 27, 46-47
age-related patterns, 49
among children and adolescents, 210, 212-213
with comorbid diabetes, 55
data sources, 46
demographic variables, 47, 128
as epidemic, 47
relevant comorbidities and, 50-52
socioeconomic factors and, 27, 47, 52-53
as target of preventive interventions, 153
Preventive interventions
definition of success, 152-153, 155, 162
genetic predisposition to obesity and, 53, 152
goals of, 155
harm reduction model, 167
indicated programs, 154, 155, 160-162
as maintenance intervention, 155
outcomes evaluation, 156
pediatric obesity, 230-231, 233
pharmacotherapy in, 167
prospects for success, 152
research cycle, 153-154
research opportunities, 23, 162, 166-168
risk reduction in, 153
terminology, 154-155
universal programs, 154, 155-159
Promotional claims, 4-5, 24-25, 138
consumer caution in evaluating, 36
professional accreditation and, 235
state regulation, 20, 30-31, 138
Protein-sparing modified fast, 225-226
Psychological factors
assessment of, 15, 103, 142, 144, 173-174
behavioral factors in dieting, assessment of, 177-179
body image assessment, 175-177
as costs of obesity, 2
in dieting behaviors, 54
distress in dieting, 116-117
in effects of dieting, assessment of, 179-184
pediatric obesity and, 219, 220
perceived energy, 122
perceived self-efficacy as outcome predictor, 120-121
self-esteem assessment, 175
sociocultural stress factors, 128-129
in weight regain, 17, 125, 126
Public Health Service, 170
Public opinion, bias against obese persons, 2, 39, 62-63, 174
Public policy
concept of obesity in, 168-169
health care reform, 170
obesity prevention in, 158-159
Puerto Ricans, 214
Q
Quality control, 17
Questionnaire on Eating and Weight Patterns, 178-179
Quetelet Index. See Body mass index
R
Race/ethnicity
as outcome predictor, 128-129
pediatric obesity patterns, 213-214
prevalence of obesity and, 47
stress as obesity factor, 128-129
Recent Life Changes Questionnaire, 183
Recommended Dietary Allowances, 107
Regain of weight
in gastric surgery, 89
likelihood, 37
outcome predictors, 124-126
physical activity in prevention of, 112, 125-126
psychological factors in, 125, 126
psychosocial factors in, 17
as weight-loss program outcome, 1
Regulatory oversight
accreditation of services, 234-235
disclosure requirements in programs, 4-5, 20, 30-31, 148
drug therapy evaluations, 86, 90
drug therapy guidelines, 4
federal efforts, 34
historical efforts, 30
preventive interventions, 158-159
of program practice, 32-34
Research on obesity
biological markers, 161
cellular processes, 169
comorbidities, 165
etiology, 164-165
gender differences, 127
goals, 2-3
longitudinal studies, 48-49
need for, 23-24, 25, 36, 48-49, 101, 170
outcome measures, 118-120
pediatric obesity, 230-233
pharmacotherapy, 24, 38, 84, 165
physical activity in weight regain, 112
preventive interventions, 153-154, 162, 166-168
public policy support, 168, 169
qualified practitioners for, 169
reimbursement systems, 170
Respiratory disease, 219
Risk factors
body mass index, 50
body weight, 43-44
categorizing, 39-40
comorbidities, 50
distribution of body fat, 44-45
identification of, methodology for, 40, 43
sociocultural, 134
stress, 128-129
in treatment matching assessment, 7, 100
Rosenberg Self-Esteem Scale, 175
S
assessment instruments, 179-181
Self-Efficacy for Eating Behaviors Scale, 180-181
Self-Efficacy for Exercise Behaviors Scale, 181
Self-esteem, 2, 27, 54, 174-175
antidieting movement and, 62-63
Severity of obesity
environmental influences in, 53
national trends, 50
as target of preventive interventions, 153
benefits of weight loss, 57-58
definition, 57-58
identification of, 58
Social Readjustment Rating Scale, 183
Social support systems, 84, 182-184
Sociocultural/socioeconomic factors
costs of obesity, 61-62
as outcome predictors, 130
in pediatric obesity, 218
in physical activity patterns, 112
in prevalence of obesity, 27, 47, 52-53, 128
in self-perception of weight, 54
Soundness and safety of programs
assessment of client health, 10-11, 103-105, 142
consumer perspective, 15-16, 144-145
dieting plans, 10-11, 116-117, 142-143
good practice, 12-15, 28, 102, 115-116, 117, 143-144
physical activity plan, 11-12, 143
as program evaluation criterion, 5, 10, 28, 141-143
program perspective, 12-15, 143-144
Staff qualifications, 12, 21, 143
in clinical programs, 66
in nonclinical programs, 65
program accreditation, 234-235
Stanford Eating Behavior Questionnaire, 179
State regulation
truth and full disclosure, 20, 148
of weight-loss industry practice, 30-34
Steroid use, 38
Stress
assessment, 182-184
socioeconomic factors in obesity and, 128-129
Surgical interventions, 39
current status, 4
informed consent issues, 144
long-term benefits, 59-60
racial/ethnic differences in outcome, 129-130
research opportunities, 24, 165
risk-benefit analysis, 88-89
third-party reimbursement, 62
types of, 88
Swedish Obesity Study, 56, 59-60, 89
T
Television, 218
Tennessee Self-Concept Scale, 175
Total body electrical conductivity, 40
Treatment matching, 92
conceptual development, 94-95
consumer perspective, 8-10, 141
decision-making factors, 7, 28, 90, 100-101, 139
good practice, 137
likelihood of success in, 7-8, 140-141
models, 95-98
program perspective, 8, 140-141
in regulatory guidelines, 34
stepped care models, 97-98, 137
Treatment of obesity
for children and adolescents, 222-230, 231, 232
current status, 38-39
duration and frequency, 165
goals of, 5, 20, 29, 98, 105, 131, 222-223
health as outcome measure, 28-29, 131
for hypertension, 56-57
sleep apnea identification in, 58
types of, 4
See also Dieting programs;
Drug therapies;
Surgical interventions;
Weight-loss programs
Trends in obesity, 156
government health goals and, 37
prevalence of obesity, 47-48
smoking cessation and, 48
socioeconomic factors, 52-53
weight-loss practices, 53-55
Truth and disclosure in programs
in do-it-yourself programs, 21, 148
long-term weight management outcomes, 22, 34, 149
NIH guidelines, 35
recommended practice, 15, 20-22, 144, 148-150
regulatory requirement, 4-5, 20, 30-31, 34
W
Waist-to-hip ratio, 2, 44-45, 46, 120, 150
Weighing the Options model
implementation, 22-23, 137-138, 150-151
See also Evaluation of weight-loss programs
Weight-for-height ratios, 43, 44, 211
Weight Loss Practices Survey, 54
Weight-loss programs
accreditation of, 234-235
drop-out risk, 122-123
enrollment patterns, 54
inappropriate candidates, 8, 140
minimum expectations, 10-15, 102, 117
need for scrutiny, 4, 22-23, 138-139
popular programs, features of, 66-80
prevention in, 159-160
refundable deposits, 123
as weight-management programs, 5, 29, 131
Weight-loss strategies
in clinical programs, 66
gender differences, 127
individual practices, 53-55
racial/ethnic differences, 129-130
See also Dieting programs;
Weight-loss programs
Weight-management concept, 5, 55, 131
Workplace interventions, 157