Thesis (Ph. D.)--University of Texas at Austin, 1999. / Vita. Includes bibliographical references (leaves 293-312). Available also in a digital version from Dissertation Abstracts.

Thesis (M.A.(HMS))--University of Pretoria, 2000. / Summary in English and Afrikaans. Includes bibliographical references.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2006. / Vita. Includes bibliographical references (leaves 93-99).

Introduction: Breast cancer is the most frequent cancer among women worldwide. Breast cancer treatments and treatment-related factors (type, dose, duration, and side-effects) have been found to be associated with weight gain in women. Overweight and obesity, in breast cancer survivors, is associated with increased risk of breast cancer-specific and all-cause mortality. Prognosis may be improved by maintaining a healthy weight but research in weight management in women treated for breast cancer is relatively limited. Aim: To design a weight loss trial for women treated for breast cancer and to evaluate its feasibility, and effect on body weight and quality of life (QoL). Methods: The development and evaluation of the trial was guided by the Medical Research Council framework for developing and evaluating complex interventions and involved mixed methods research. The development involved a systematic review of 13 randomised controlled trials (RCTs) targeting weight loss in women treated for breast cancer, and a mixed methods study [focus group meetings (n= 15), survey (n= 139), and interviews (n=20)] with the target population to understand their experiences and future preferences of a weight loss programme. The findings of these preliminary studies informed the design of a feasibility RCT of weight loss intervention. Results: 45 women (age 41-89 y; BMI 25.1–66.2 kg/m2) previously treated for breast cancer were randomly allocated to three groups: Weight Watchers vouchers for 12 weeks plus 5 dietitian-led support groups (WW plus: n=14); Weight Watchers vouchers only (WW: n=16) or waiting-list control (Weight Watchers vouchers after 3 months) (controls: n=15). Weight and QoL were measured at 0 and 12 weeks and data was available for 38 (84%) participants at 12 weeks. The trial was found to be feasible and acceptable for weight loss in this population. The controls, WW plus and WW group showed median (IQR) weight change of 0.07 (-0.4, 0.7) kg (p= 0.666), -2.90 (-6.5, -2.2) kg (p= 0.002) and -5.90 (-6.6, -5.1) kg (p= 0.001) respectively (between groups, p = 0.001). The regression model suggested that compared to participants in WW plus, participants in WW group lost significantly more weight (2.6 kg; 95% CI -0.38, -4.86) and control group participants lost significantly less weight (3.8 kg; 95% CI, 1.47, 6.16) over the 12 weeks. There were a number of significant improvements in different QoL scores in the intervention groups at 12 weeks. However, a significant difference in median (IQR) scores of the breast cancer specific QoL scale was observed between the three groups (p= 0.017) and it was higher in WW group [5.0 (1.5, 7.5)] compared to WW plus group [3.7 (2.0, 4.5)] and control [0.5 (-2.0, 2.2)]. Conclusions: The outcomes of this theoretically informed trial suggest that providing WW vouchers for overweight and obese women treated for breast cancer is feasible and shows promise for weight loss and improved QoL.

For many women, body weight is a health concern both in relation to physical health and to social and psychological health. Both overweight and underweight are associated with increased risks to health. Furthermore, the literature largely supports the view that sociological and psychological factors influence a woman's perception of weight and body image. In the Western world, weight loss efforts among women are high, and even those who are within or below the healthy weight range are trying to lose weight. Relatively little is known about weight loss efforts among Yukon women.. Moreover, it is not known whether societal pressures surrounding weight are similar in the Yukon and the rest of Canada. For reasons related mainly to its northern geographical location and culture, and because of the health implications related to women's weight issues, this study was conducted to determine the prevalence of Yukon women trying to lose weight; to determine the weight loss practices of Yukon women; and to compare the characteristics of women who are trying to lose weight vs. those who are not; women who are satisfied with their weight vs. those who are not; and women who are at health risk due to overweight or underweight vs. those with healthy weights. Data for a representative sample of non-pregnant, non-institutionalized women > 15 years of age (n=711) were obtained from the population-based 1993 Yukon Health Promotion Survey. Those living in the census unorganized portions of the Yukon were not included in the sample. The prevalence of weight loss efforts in the Yukon (51.8%) was higher than the published value for women in the rest of Canada (39%). Among Yukon women with body mass index (BMI) values classified as overweight, possible overweight, healthy weight, and underweight, 80%, 67%, 46%, and 9%, respectively, were trying to lose weight. The corresponding values for the rest of Canada are lower. The most frequent weight loss practices were dieting (35.8%), changing diet and exercise (26.1%), and sensible eating (17.2%). Compared to women not trying to lose weight, women trying to lose weight were younger (35.8 ± 13.2 vs 38.6 ± 15.0 yr, P<0.01), were more likely to be employed (71.6% vs 64%, P<0.05), had higher BMI values (25.7 ± 4.1 vs 22.3 ± 3.9 kg/m2, P<0.0001), and were more likely to be dissatisfied with their current weight (88.5% vs 35.6%, P<0.0001). Both groups reported similar food consumption and activity patterns, yet women trying to lose weight had more positive nutrition behaviours and health knowledge. The mean eating knowledge index (EKI) score was significantly higher (2.36 ± 2.89) for women trying to lose weight than for women not trying to lose weight (1.75 ± 3.44). Similarly, the mean eating behaviour index (EBI) score was higher (4.19 ± 3.83 vs. 3.46 ± 4.94, respectively). Weight loss efforts did not appear to be related to the Yukon environment since neither First Nations status nor length of residence in the Yukon varied for women trying to lose weight and women not trying to lose weight. Yukon women who were overweight were less likely to live in Whitehorse, were older, were more likely to be poor, and were less likely to engage in vigorous physical activity three or more times per week compared to those with healthy weights; however, their food consumption patterns and nutrition knowledge and behaviour scores did not differ. Overweight women expressed less satisfaction with their quality of life and with their physical health and social relationships. Yukon women who were underweight were more likely to be poor and to find it difficult to afford the basic necessities and less likely to indicate they were eating well enough to maintain good health compared to healthy weight women. Both groups had similar activity patterns and food consumption patterns; yet, underweight women had lower scores for nutrition knowledge and behaviour (EKI: 1.03 ± 2.97 vs. 2.38 ± 3.24; EBI: 2.68 ± 4.71 vs. 4.07 i 4.51). Underweight women and healthy weight women rated their quality of life similarly. Based on this study, it appears that many Yukon women, regardless of weight status, are engaging in weight loss efforts. Furthermore, the goal of losing weight, rather than relative weight status, seems to be an important motive for healthy eating and for seeking health knowledge. Being physically active in the Yukon appears to be influenced by time of year and other barriers. Self-ratings of health were associated with engaging in weight loss efforts and with relative weight status. Overall, the findings of this study suggest that weight loss efforts of Yukon women are similar to those of the dominant Western society. In view of the findings of this study, health promotion messages should incorporate healthy eating, regular physical activity, and the concept of healthy weight and positive body image to deter weight loss efforts among women who do not need to lose weight. Tailored approaches which consider the different characteristics of the groups in this study may prove to be useful. / Land and Food Systems, Faculty of / Graduate

published_or_final_version / Zoology / Doctoral / Doctor of Philosophy

Thesis (D. Phil.(Biokinetics, Sport and Leisure Sciences))--University of Pretoria, 2003. / Includes bibliographical references.

Thesis (Ph. D.)--University of Missouri-Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 80-89). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 80-89). Also available on the Internet.

The purpose of this study was to determine the influence of diet and physical activity behaviors on weight status and lipid profiles in low-income women in early postpartum. In addition, the relationship of nutrition knowledge with dietary intakes was evaluated. A convenience sample of low-income mothers was recruited from public health clinics, community centers, and doctor's offices. Inclusion criteria was Hispanic, African American, or Caucasian ethnicity; body mass index (BMI) [greater-than or equal to] 25 kg/m², low-income (annual household income <185% federal poverty line); parity<3 and ability to speak and write English. Demographic, dietary (24-hr recalls and 2 day food intake recalls), psychosocial, anthropometric, serum lipids (LDL, HDL and total cholesterol and triglycerides) and physical activity (pedometer steps) data were collected. For study 1, the Healthy Eating Index-2005 (HEI-2005) scores were computed as a measure of diet quality in a sample of 125 women. Analysis of Covariance and linear regression was performed to determine the relationship between HEI-2005 and serum lipids. The mean total index score of the sample was 51.4 and was associated inversely with BMI ([beta]=-0.117), LDL ([beta]=-.659) and total ([beta]=-.690) and positively with HDL ([beta]=.216) (P<0.05). Less than 20% of the sample failed to meet the recommendations for fruits, total vegetables, whole grains and oil and 60% had overconsumption of solid fats, alcohol and added sugars. In study 2, snacking frequency and choices of 134 postpartum women were evaluated. Influence of snacking frequency on HEI-2005 scores and disparities in snack choices by BMI categories was assessed by performing ANCOVA. A majority of the sample (82%) consumed snacks and the most favored snack group was sweets and desserts. Increase in snacking frequency was associated with higher mean total HEI-2005 scores, and total fruit, dark green vegetables and legumes, total grains, and saturated fat (P<0.05) component scores when adjusted for energy intakes. Snacking frequency was also associated with higher intakes of protein, vitamins A and C, and calcium (P<0.05). In study 3, 66 new mothers participated and completed an 8-week weight loss intervention promoting exercise by using pedometers. Paired t test revealed improvement in physical activity after intervention. Linear regression analysis determined the ability of pedometer steps to predict weight loss ([beta]=0.465), % body fat ([beta]=-0.316), triglycerides ([beta]=-0.549), LDL ([beta]=-0.391) and total cholesterol ([beta]=-0.418). In study 4, a nutrition knowledge scale was developed and validated in new mothers. Knowledge was associated with greater consumption of grains, low fat meats and dairy (P<0.01), fiber (p<0.01), calcium (p<0.001), and iron (p<0.05). Participants appeared to be more cognizant of information about vitamins and minerals and weight management and less of energy nutrients and calorie counting. Hierarchical regression model identified age, education, ethnicity and income as determinants of knowledge. / text