Photocopy of typescript. / Digitized by Kansas Correctional Industries

Objective: Since short-term weight loss is often achievable in overweight individuals but long-term weight maintenance is generally poor, this thesis examines the effect of the nature of support programmes and macronutrient composition on weight maintenance following weight loss. Research design and methods: A 2x2 multifactorial design was used to compare two support programmes and two diets differing in macronutrient composition on maintenance of weight loss over a 2-year period. Two hundred women who had recently lost at least 5% of initial body weight were randomised into one of two support programmes. One provided intensive expert, health professional support with regular circuit training classes. The other provided brief and frequent �weigh-ins� and support facilitated by a nurse. Participants were also randomised with regard to recommended diet composition. One eating plan was high in carbohydrate and dietary fibre, emphasising low glycemic index foods. The second eating plan was relatively high in monounsaturated fat and protein and had a low overall glycaemic load. At baseline, 1 and 2-years, weight, waist circumference and blood pressure were measured and body composition was estimated using bioelectrical impedance. Three-day weighed diet records were collected to estimate dietary intake. A fasting blood sample was used to measure glucose, insulin and lipids. Results: At 2-years weight was measured for 87% of participants. On average those randomised to the Expert Support Programme reduced weight by 2.5kg while those on the Nurse Support Programme reduced weight by 3.6kg (difference between support programmes, P=0.976). On the High Carbohydrate Diet average weight loss was 2.4kg compared with a loss of 3.8kg on the High Monounsaturated fat Diet (difference between diets, P=0.419). At follow-up, there were no signficant differences between the support programmes with regards to body composition, systolic and diastolic blood pressures, blood lipid levels, glucose, insulin, and predicted insulin sensitivity. From a health system perspective and relative to the Nurse Support Programme, the Expert Support Programme cost $NZ 928, 970 per QALY gained (or $9, 290 per person). At follow-up, there were no signficant differences between the dietary prescriptions with regard to body composition, systolic and diastolic blood pressures, triglycerides, HDL-cholesterol, glucose, insulin and predicted insulin sensitivity. However, total and LDL cholesterol were significantly lower on the High Carbohydrate Diet compared with the High Monounsaturated fat Diet (total cholesterol 0.2mmol/l, P=0.044, LDL cholesterol 0.2mmol/l, P=0.042). At follow-up those on the High Monounsaturated fat Diet reported significantly higher intakes of saturated fat (1.5%TE), total fat (5%TE), monounsaturated fat (2.4%), and a significantly lower intake of carbohydrate (-5%TE) than those on the High Carbohydrate Diet. Conclusion: A relatively inexpensive nurse led programme appears to be as effective as a more costly expert health professional led programme in achieving weight maintenance over a 2-year period. This inexpensive and successful weight maintenance programme offers a feasible option for implementation in primary health care in New Zealand. Similarly, both dietary approaches produced comparable beneficial effects in terms of weight loss maintenance. However the High Carbohydrate Diet was associated with lower levels of total and LDL cholesterol, possibly due to a lower intake of saturated fat.

The purpose of this study was to determine if a didactic approach to assertion training (AT) that focused on cognitive skills was as effective as a behavioral approach to assertion training in a study population of overweight women who resided in an American military community in Germany. The study sought to determine if the two approaches differed statistically significantly in effecting decrease in degree of discomfort and increase in response probability of making an assertive response when in a stressful interpersonal situation.A review of assertive literature reflected a preponderance of studies that utilized college students, psychiatric in-patients or hospitalized patients as subject populations. Thus, a non-college and non-psychiatric in-patient population of overweight women, depicted in the literature as non-assertive and unhappy, was selected as the study's population.The 23 subjects were volunteers from self-help weight loss groups who professed difficulty in their dieting efforts. The subjects were randomly assigned to either the didactic approach group or the behavioral approach group.The didactic approach to AT focused on the cognitive aspects of AT with little interaction or overt involvement on the part of the subject. The behavioral approach to AT utilized the behavior therapy techniques of rehearsal, role play, practice, modeling, and combinations thereof with active participation on the part of the subject.The design of the study was a two factor mixed design with repeated measures on one factor (pre- and post-test scores). The dependent variables in the study were the scores on the measures of degree of discomfort and response probability on the Gambrill and Richey Assertion Inventory (GRAI), a self-report measure of assertive behavior.Difference of means t tests disclosed no statistically significant differences for pre-test scores on the GRAI or demographic data measures between the two groups. A repeated measures analysis of variance was computed for both degree of discomfort and response probability measures; there were no statistically significant differences between the groups at the .05 level of acceptance. However, statistical significance was found at the .01 level for trials on both measures.The conclusion reached was that since the two approaches did not differ statistically significantly in outcome measures there was no real difference between the two approaches to AT. The findings of statistical significance on trials reflects that both approaches increased assertiveness at a greater than chance level of confidence. The success of the didactic approach offered support for concluding that one can learn or change psychologically while only sitting, looking, and listening.Implications of the study include: (1) the behavioral approach to AT need not be the only presentation method to effect assertive change in the subject and (2) a didactic approach to AT or other aspects of human behavior may be of importance in that the method allows for larger groups of subjects and therefore, a more efficient use of therapeutic time and resources. In addition, (3) do we often place too much emphasis on the need for the individual to be involved or "active" in our processes to reflect or demonstrate internal change?Recommendations for possible replication of this study included:Include a third treatment group that utilizes a cognitive-behavioral approach to further investigate the cognitive aspects of the treatment. 2. If a similar population is used, obtain three and six month post treatment data relative to assertiveness and weight loss to test treatment effectiveness over extended periods of time. 3. Include an IN VIVO assertive experience to investigate if the didactic approach effectively transfers to real life situations.

Thesis (M. Nurs.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 95-103).

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Objective: Since short-term weight loss is often achievable in overweight individuals but long-term weight maintenance is generally poor, this thesis examines the effect of the nature of support programmes and macronutrient composition on weight maintenance following weight loss. Research design and methods: A 2x2 multifactorial design was used to compare two support programmes and two diets differing in macronutrient composition on maintenance of weight loss over a 2-year period. Two hundred women who had recently lost at least 5% of initial body weight were randomised into one of two support programmes. One provided intensive expert, health professional support with regular circuit training classes. The other provided brief and frequent �weigh-ins� and support facilitated by a nurse. Participants were also randomised with regard to recommended diet composition. One eating plan was high in carbohydrate and dietary fibre, emphasising low glycemic index foods. The second eating plan was relatively high in monounsaturated fat and protein and had a low overall glycaemic load. At baseline, 1 and 2-years, weight, waist circumference and blood pressure were measured and body composition was estimated using bioelectrical impedance. Three-day weighed diet records were collected to estimate dietary intake. A fasting blood sample was used to measure glucose, insulin and lipids. Results: At 2-years weight was measured for 87% of participants. On average those randomised to the Expert Support Programme reduced weight by 2.5kg while those on the Nurse Support Programme reduced weight by 3.6kg (difference between support programmes, P=0.976). On the High Carbohydrate Diet average weight loss was 2.4kg compared with a loss of 3.8kg on the High Monounsaturated fat Diet (difference between diets, P=0.419). At follow-up, there were no signficant differences between the support programmes with regards to body composition, systolic and diastolic blood pressures, blood lipid levels, glucose, insulin, and predicted insulin sensitivity. From a health system perspective and relative to the Nurse Support Programme, the Expert Support Programme cost $NZ 928, 970 per QALY gained (or $9, 290 per person). At follow-up, there were no signficant differences between the dietary prescriptions with regard to body composition, systolic and diastolic blood pressures, triglycerides, HDL-cholesterol, glucose, insulin and predicted insulin sensitivity. However, total and LDL cholesterol were significantly lower on the High Carbohydrate Diet compared with the High Monounsaturated fat Diet (total cholesterol 0.2mmol/l, P=0.044, LDL cholesterol 0.2mmol/l, P=0.042). At follow-up those on the High Monounsaturated fat Diet reported significantly higher intakes of saturated fat (1.5%TE), total fat (5%TE), monounsaturated fat (2.4%), and a significantly lower intake of carbohydrate (-5%TE) than those on the High Carbohydrate Diet. Conclusion: A relatively inexpensive nurse led programme appears to be as effective as a more costly expert health professional led programme in achieving weight maintenance over a 2-year period. This inexpensive and successful weight maintenance programme offers a feasible option for implementation in primary health care in New Zealand. Similarly, both dietary approaches produced comparable beneficial effects in terms of weight loss maintenance. However the High Carbohydrate Diet was associated with lower levels of total and LDL cholesterol, possibly due to a lower intake of saturated fat.

Thesis (M. Nurs.)--University of Hong Kong, 2007.

Thesis (M.S.)--Auburn University, 2007. / Abstract. Vita. Includes survey instrument. Includes bibliographic references (ℓ. 63-75)

Thesis (M.A.)--Kutztown University of Pennsylvania, 1991. / Source: Masters Abstracts International, Volume: 45-06, page: 3295. Typescript. Includes bibliographical references (leaves 79-85).

Thesis (Ph. D.)--Washington State University, May 2008. / Includes bibliographical references.