Role of apathy in the effectiveness of weight management programmes
Omaha VA Medical Center, Omaha, NE, USA. Diabetes Obesity and Metabolism
(Impact Factor: 6.36).
12/2011; 14(5):419-23. DOI: 10.1111/j.1463-1326.2011.01544.x
Obesity, which is at epidemic proportions in the USA, is associated with a higher risk of several co-morbid diseases including, cardiovascular disease, cancer and sleep apnea. Weight loss and weight maintenance programmmes are difficult to sustain for long term. Mental health problems such as apathy may be a major factor in patients unsuccessful in adhering to weight loss programmes. We propose that treating apathy will result in better weight loss in obese patients.
This was a randomized prospective pilot study. Obese patients (n = 101) were randomized in a 1:2:2 ratio to either (i) standard nutrition counselling; or (ii) the Department of Veterans Affairs weight loss programme called 'motivate obese veterans everywhere ' (MOVE); or (iii) methylphenidate treatment plus the MOVE programme together. The intervention was for 6 months (26 weeks).
For the within groups analysis, the absolute changes in weight (kg) are as follows, for MOVE (mean: -1.84; 95% confidence interval (CI): -4.56 to 0.87; p = 0.25), Methylphenidate (mean: -4.61; 95% CI: -7.90 to -1.33; p = 0.04), standard nutrition counselling (mean: -0.60; 95% CI: -2.59 to 1.39; p = 0.21), which indicates that although all three groups lost weight, only the methylphenidate group achieved statistical significance. The between group differences of the relative change in weight were not statistically different. The apathy evaluation score and the patient activation measure improved in all groups.
Together these data suggest that treating apathy might be an important factor in the success of weight management programmes.
Available from: Fernando Torrealba
- "The latter impairments may diminish the likelihood of success for psychological programs that manage drug addiction. Thus, treating apathy with methylphenidate (see below) might be beneficial in the treatment of addiction, as it has proven effective in weight-reducing programs (Desouza et al., 2011). "
[Show abstract] [Hide abstract]
ABSTRACT: Brain histamine may affect a variety of different behavioral and physiological functions; however, its role in promoting wakefulness has overshadowed its other important functions. Here, we review evidence indicating that brain histamine plays a central role in motivation and emphasize its differential involvement in the appetitive and consummatory phases of motivated behaviors. We discuss the inputs that control histaminergic neurons of the tuberomamillary nucleus (TMN) of the hypothalamus, which determine the distinct role of these neurons in appetitive behavior, sleep/wake cycles, and food anticipatory responses. Moreover, we review evidence supporting the dysfunction of histaminergic neurons and the cortical input of histamine in regulating specific forms of decreased motivation (apathy). In addition, we discuss the relationship between the histamine system and drug addiction in the context of motivation.
Available from: pagepressjournals.org
[Show abstract] [Hide abstract]
ABSTRACT: The aim of this study was to assess the strength and direction of the correlation between cognitive appraisal, emotional state, social functioning and the effectiveness of a weight-loss program undertaken by obese subjects. The out-patient weight-loss program encompassed 150 obese women. Assessments were carried out at four time points: at the start of the weight-loss program and then after a 5%, 10% and a 15% reduction of the initial body mass. The research tools used were: a survey, the Situation Appraisal Questionnaire (SAQ), the Emotional State Questionnaire (ESQ), and the Q-Sort Social Functioning Questionnaire. The cognitive appraisal, emotional state and social functioning of the study group changed significantly (P<0.001). Significantly more individuals with a 15% body mass reduction, as compared with individuals with no body mass reduction, had an early obesity onset, i.e. at the age of <10 years old (P<0.001). Significantly more individuals with no body mass reduction, compared with individuals with a 15% reduction, had a later obesity onset, i.e. between the ages of 20 and 30 (P<0.001) and between 50 and 60 (P<0.001). Significantly more individuals with a 15% body mass reduction, compared with individuals with no mass reduction, had previously experienced the jojo effect (P<0.001) and had successfully lost weight (P<0.001). Significantly more individuals with no body mass reduction, compared with individuals with a15% reduction, had a history of unsuccessful attempts at reducing body mass (P<0.001). We conclude that the attitude of obese patients towards a weight-loss program is not a deciding factor for its effectiveness. As body mass reduces, the attitude improves.
[Show abstract] [Hide abstract]
ABSTRACT: We present a method for allocating treatment when subjects arrive in sequence. Based on the theory of propensity scores more commonly used in observational studies, the method balances both discrete and continuous covariates without assuming a model for the outcome. Although we allow for a number of possible specifications, we explore some specific instances in depth. The proposed method is compared with previously suggested sequential randomization and allocation procedures with relationships to some well-known methods highlighted. Through simulations, the deterministic version is shown to achieve both covariate balance and near optimum efficiency with minimal assumptions. We also investigate the properties of selected randomized versions with respect to both optimality and selection bias. We conclude with an application to a pilot study on weight loss. The proposed method is shown to be robust to the number of covariates balanced and the marginal and joint distributions of those covariates. Copyright © 2013 John Wiley & Sons, Ltd.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.