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For the Psychological conditions of hyperthyroidism category.

WEIGHT MANAGEMENT: WHAT IS THE STORM TRIAL?

The STORM study (Sibutramine Trial of Obesity Reduction and Maintenance) is a 2-year, double-blind, randomized, placebo-controlled multinational trial of sibutramine over 24 months. It showed significantly improved weight maintenance in those patients treated with sibutramine compared with those offered dietetic and lifestyle change support alone. A total of 605 obese patients (BMI 30-45) from eight European centres were included. All patients were treated for the initial 6 months with sibutramine 10 mg/day together with a low-fat, low-energy, individualized diet (600 kcal/day deficit) and exercise regimen. Of the 499 patients who completed the 6-month run-in period, 93% achieved >5% weight loss after 6 months and were randomized to either sibutramine 10 mg/day plus diet and exercise or placebo plus the same diet and exercise over a further 18 months. Those patients randomized to sibutramine were able to maintain their weight loss for up to 2 years: 43% of sibutramine patients who completed the trial maintained 80% or more of their original weight loss, compared with 16% of the placebo subjects (odds ratio 4.6, P<0.001). In addition, sibutramine-treated patients achieved beneficial improvements in a range of cardiovascular and metabolic parameters, such as HDL-cholesterol, VLDL-cholesterol, triglycerides, insulin and uric acid concentrations.
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BIOLOGICAL REASONS WHY YOU BINGE: SEROTONIN

Binge eating may be driven by a need to increase serotonin, a brain chemical that produces a feeling of relaxed calmness. Serotonin levels increase when we eat carbohydrate foods. That is why, compared to protein or fatty foods, carbohydrates such as pasta, bread, and chocolate have a soothing, mood-altering effect on us.


Some experts feel that we binge on certain foods to increase serotonin to soothe us. That is why you want to eat when you’re stressed out. Food becomes your antidepressant or antianxiety medication. It may be that your brain does not produce enough serotonin and you are driven to eat in order to get more. It may also be that you enjoy the mood changes resulting from serotonin more than others.


Jackie, a 46-year-old woman from Atlanta, described her reaction to chocolate in this way:


When I eat candy I feel like a totally different person. It calms me. I feel tranquilized. It’s a drowsy, relaxed sensation. My body feels warm and heavy. I hate to admit this, but chocolate gives me a mental and physical pleasure that I don’t get from anything else. I feel like a drug addict.


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Weight loss

ACCURACY OF MEASURES OF FATNESS

The advantage of weight is that it is a simple, accurate and reliable measurement. The accuracy of any measure of body fatness, as with other physical and psychological tests, can be gauged in at least three ways; by its validity, reliability and sensitivity. Each of these are scored on a scale from 0 to 1.0, where 0 implies a low degree of accuracy and 1.0 a perfect measure.

Validity refers to the degree to which a measurement actually measures what it purports to. Without validity, any technique is useless.

Reliability refers to the degree to which the measurement used measures the same on different occasions.

Sensitivity refers to the degree to which the measurement instrument can detect subtle changes, and derive different scores as small changes occur.

Given these three factors, measures of fatness can then be rated for their usefulness in the practical situation. We have divided these into (a) manual measures, (b) machine measures of fatness, and 1 measures of body fat distribution.

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FEEED YOUR BODY RIGHT: SHE NEVER LEAVES HOME WITHOUT HER BUTTER SPRAY

How can you lose 100 pounds on a 1,200-calorie-a-day diet and still enjoy going out to restaurants?

Carry butter spray and fat-free salad dressing in your purse.

That’s what Alayne Gunto of Moundsville, West Virginia, did when she became determined to whittle her 242-pound figure.

Alayne comes from a family with a history of weight problems. While she tried on and off to slim down, she was never really successful. Then her mother, father, and grandmother all had heart surgery within months of each other. That was the wake-up call Alayne needed. She decided to lose weight because, as she says, “I didn’t want to put my husband and children through that experience.”

Alayne put herself on a strict 1,200-calorie-a-day eating plan. She paid attention to what and how much she ate, something she had never done before. She kept close tabs on her portion sizes by reading food labels and using measuring cups. She started eating breakfast every day but quit her habit of munching on high-fat

snacks. To bolster her resolve, she joined TOPS (Take Off Pounds Sensibly), where she participated in regular weigh-ins.

All of these strategies helped Alayne hold course on her self-styled weight-loss program. But there is one trick in particular that she says has kept her from blowing her calorie and fat budget. “I like to eat out, but I want to know exactly what’s going into my mouth,” she explains. “I don’t want to leave it up to the restaurant to tell me I’m eating low-fat. I don’t necessarily believe their advertising. So I order my salads and baked potatoes plain. I just open my purse and dress them myself.”

Alayne’s strategy worked. Within 15 months of starting her weight-loss program, which included daily walks, she reached her goal weight of 145 pounds. She has maintained this weight for 2 years.

These days, just looking in the mirror is incentive enough for Alayne, a 34-year-old homemaker, to keep her eating and exercise habits on track. And although she admits to occasionally going over her fat and calorie budget, she never goes to a restaurant without her condiments.

WINNING ACTION

Stick with your own low-fat or no-fat condiments. Salad dressing and butter pack a lot of calories for the little room that they take up. Take a tip from Alayne and pack your own when going to restaurants. These travel particularly well: Marzetti’s fat-free salad dressing, available in packets at the supermarket salad counter, and I Can’t Believe It’s Not Butter spray.

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