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Individuals with “insecure” adult attachment styles have been shown to experience more pain than people with secure attachment, though results of previous studies have been inconsistent. We performed a cross-sectional study on a large population-based sample to investigate whether, compared to pain free individuals, subjects with chronic widespread pain were more likely to report insecure adult attachment style. Subjects in a population-based cross-sectional study completed a self-rated assessment of adult attachment style. Attachment style was categorised as secure (i.e., normal attachment style); or preoccupied, dismissing or fearful (insecure attachment styles). Subjects completed a pain questionnaire from which three groups were identified: pain free; chronic widespread pain; and other pain. Subjects rated their pain intensity and pain-related disability on an 11 point Likert scale. Subjects (2509) returned a completed questionnaire (median age 49.9 years (IQR 41.2–50.0); 59.2% female). Subjects with CWP were more likely to report a preoccupied (RRR 2.6; 95%CI 1.8–3.7), dismissing (RRR 1.9; 95%CI 1.2–3.1) or fearful attachment style (RRR 1.4; 95%CI 1.1–1.8) than those free of pain. Among CWP subjects, insecure attachment style was associated with number of pain sites (Dismissing: RRR 2.8; 95%CI 1.2–2.3, Preoccupied: RRR = 1.8, 95%CI 0.98–3.5) and degree of pain-related disability (Preoccupied: RRR = 2.1, 95%CI 1.0–4.1), but not pain intensity. These findings suggest that treatment strategies based on knowledge of attachment style, possibly using support and education, may alleviate distress and disability in people at risk of, or affected by, chronic widespread pain.

Summary

The quality of social relationships may contribute to variations in biological stress responses, thereby affecting health risk. The association between an important indicator of social relationships, adult attachment style, and cortisol has been relatively unexplored. The present study examined adult romantic attachment style and cortisol responses to acute laboratory stress. Salivary cortisol was measured in response to two behavioural tasks, a colour/word interference task and mirror tracing task, in 498 healthy men and women from the Heart Scan study, a subsample of the Whitehall II cohort. Participants were classified as secure, fearful, preoccupied or dismissive on the basis of responses to the Relationship Questionnaire. Cortisol output was lowest in the fearful group, followed by the preoccupied group, with both secure and dismissive groups having higher levels. The results from this study tentatively support the proposition that attachment style is a factor in determining the manifestation of HPA dysregulation.

Background

Measures of attachment style are often used to appraise social and emotional health. In developmental literature, the concept of attachment is used to explain relationships between children and their adult caregivers. While both attachment styles and sleep patterns are conceived as developmentally organized systems, very few studies have explored the link between the two. The present study examined whether attachment styles and sleep measures are associated among older adults.

Methods

Relationships between attachment styles (i.e., secure, fearful, preoccupied, and dismissive) and subjective sleep measures were assessed utilizing data from 70 older participants (mean age: 68 ± 6 years; Blacks: 59% and Whites: 41%) in a community-based study assessing subjective health characteristics. After obtaining informed consent, each participant provided demographic and socioeconomic data, as well as relevant medical and subjective data.

Results

Independent of participants' demographic and subjective factors, significant correlations were found between the preoccupied attachment dimension and sleep measures. Specifically, individuals scoring high on the preoccupied attachment dimension were more likely to report daytime napping (rp = 0.31, p < 0.01) and to use sleep-inducing medications (rp = 0.37, p < 0.05). No significant correlations were found among sleep measures and the secure, dismissive, and fearful dimensions.

Conclusions

Important relations have been observed between specific attachment styles and subjective sleep factors in our data. Although only one dimension (preoccupied) demonstrated statistical significance, a trend was observed, suggesting possible associations between the secure attachment style dimension and subjective sleep measures. Future studies are needed to broaden our understanding of the relationship between attachment styles and sleep patterns.

Objectives: Successful long-term results are extremely rare in non-surgical obesity treatment. Interactional difficulties with the attending physicians and the limited compliance of obese patients are a frequently described dilemma in repeated psychotherapeutic group treatment attempts. The type of relationship initiation and the attachment behavior probably play a central role in this connection but have not yet been systematically investigated.

Methods: This paper focuses on the attachment styles of obese subjects and their effects on psychodynamic group therapy within the context of a weight-reduction program.

Results: The attachment styles are characterized in 107 pre-obese and obese patients, and their effects on patients and therapists in group therapy are described.

Conclusion: The paper surveys the motivational situation, clinical pictures, and repeated group topics.

The relation of attachment states of mind and self reported attachment relationship styles to romantic partner aggression was examined in a community sample of 93 adolescents. Higher levels of insecure-preoccupied and insecure-dismissing states of mind, as assessed by the Adolescent Attachment Interview at age 14, were predictive, respectively, of perpetration and victimization of psychological aggression in romantic relationships four years later. Partners’ romantic attachment anxiety was linked to both psychological and physical aggression perpetration in romantic relationships. Results are interpreted as suggesting the value of assessing aggression in adolescent romantic relationships in the context of broader patterns of regulation of affect and behavior via the attachment system.

Background

Depression among women with sexual abuse histories is less treatment responsive than in general adult samples. One contributor to poorer treatment outcomes may be abused women’s difficulties in forming and maintaining secure relationships, as reflected in insecure attachment styles, which could also impede the development of a positive therapeutic alliance. The current study examines how attachment orientation (i.e., anxiety and avoidance) and development of the working alliance are associated with treatment outcomes among depressed women with histories of childhood sexual abuse.

Method

Seventy women seeking treatment in a community mental health center who had Major Depressive Disorder and a childhood sexual abuse history were randomized to Interpersonal Psychotherapy or treatment as usual.

Results

Greater attachment avoidance and weaker working alliance were each related to worse depression symptom outcomes; these effects were independent of the presence of comorbid Borderline Personality Disorder and Post-Traumatic Stress Disorder. The effect of avoidant attachment on outcomes was not mediated by the working alliance. Further, working alliance had a stronger effect on depression outcomes in the Interpersonal Psychotherapy group.

Conclusion

Understanding the influence of attachment style and the working alliance on treatment outcomes can inform efforts to improve treatments for depressed women with a history of childhood sexual abuse.

The present study explored the possible relationship between romantic attachment and jealousy in 100 healthy subjects. The romantic attachment and jealousy were evaluated by means of, respectively, the “Experiences in Close Relationships” questionnaire (ECR), and the “Questionario della Gelosia” (QUEGE). The ECR anxiety scale was related to all QUEGE dimensions, while the ECR avoidance scale to three. Individuals with the preoccupied attachment style showed higher scores than secure subjects on the obsessionality, interpersonal sensitivity and fear of loss dimensions. Fearful-avoidant individuals had higher score than secure subjects on the fear of loss dimension only, while dismissing individuals had lower scores on the self-esteem dimension.

These findings suggest that romantic attachment and jealousy are intertwined.

Conceptualisations of attachment to one's nation of origin reflecting a symbolic caregiver can be found cross-culturally in literature, art, and language. Despite its prevalence, the relationship with one's nation has not been investigated empirically in terms of an attachment theory framework. Two studies employed an attachment theory approach to investigate the construct validity of symbolic attachment to one's nation of origin, and its association with acculturation (operationalized as heritage and mainstream culture identification). Results for Study 1 indicated a three-factor structure of nation attachment; the factors were labelled secure-preoccupied, fearful, and dismissive nation attachment. Hierarchical linear modelling was employed to control for differing cultures across participants. Secure-preoccupied nation attachment was a significant predictor of increased heritage culture identification for participants residing in their country of birth, whilst dismissive nation attachment was a significant predictor of decreased heritage culture identification for international migrants. Secure-preoccupied nation attachment was also associated with higher levels of subjective-wellbeing. Study 2 further confirmed the validity of the nation attachment construct through confirmatory factor analysis; the three-factor model adequately fit the data. Similar to the results of Study 1, secure-preoccupied nation attachment was associated with increased levels of heritage culture identification and psychological well-being. Implications of the tripartite model of nation attachment for identity and well-being will be discussed.

We report attachment classifications in a sample of pregnant women incarcerated in a state prison with a nursery program. Analyses were based on 69 women serving sentences for felony crimes who were followed from the birth of their child to completion of the prison nursery co-residence. They completed the Adult Attachment Interview shortly after entering the program and scales measuring depression, perceived parenting competency, and social support at study entry (Time 1) and program completion (Time 2). Incarcerated mothers had higher rates of insecure attachment than previous low-risk community samples. Compared with dismissing and secure mothers, preoccupied mothers reported higher levels of depressive symptoms, lower parenting competency, and lower satisfaction with social support at the conclusion of the nursery program. Higher scores on unresolved loss and derogation were associated with a history of substance abuse; higher scores on unresolved trauma were associated with depressive symptoms at program completion.

Since its first description four decades ago, attachment theory (AT) has become one of the principal developmental psychological frameworks for describing the role of individual differences in the establishment and maintenance of social bonds between people. Yet, still little is known about the neurobiological underpinnings of attachment orientations and their well-established impact on a range of social and affective behaviors. In the present review, we summarize data from recent studies using cognitive and imaging approaches to characterize attachment styles and their effect on emotion and social cognition. We propose a functional neuroanatomical framework to integrate the key brain mechanisms involved in the perception and regulation of social emotional information, and their modulation by individual differences in terms of secure versus insecure (more specifically avoidant, anxious, or resolved versus unresolved) attachment traits. This framework describes how each individual's attachment style (built through interactions between personal relationship history and predispositions) may influence the encoding of approach versus aversion tendencies (safety versus threat) in social encounters, implicating the activation of a network of subcortical (amygdala, hippocampus, striatum) and cortical (insula, cingulate) limbic areas. These basic and automatic affective evaluation mechanisms are in turn modulated by more elaborate and voluntary cognitive control processes, subserving mental state attribution and emotion regulation capacities, implicating a distinct network in medial prefrontal cortex (mPFC), superior temporal sulcus (STS), and temporo-parietal junction (TPJ), among others. Recent neuroimaging data suggest that affective evaluation is decreased in avoidantly but increased in anxiously attached individuals. In turn, although data on cognitive control is still scarce, it points toward a possible enhancement of mental state representations associated with attachment insecurity and particularly anxiety. Emotion regulation strategies such as reappraisal or suppression of social emotions are also differentially modulated by attachment style. This research does not only help better understand the neural underpinnings of human social behavior, but also provides important insights on psychopathological conditions where attachment dysregulation is likely to play an important (causal) role.

BACKGROUND:

The purpose of present study was to create and test a model that illustrates variables that influence the development of addiction susceptibility and determine how different styles of parenting may indirectly influence the addiction susceptibility of children through the mediators of attachment style and self-regulation.

METHODS:

Using random cluster sampling, 508 adolescent high school boys and girls aged 14-19 years were enrolled. Data were analyzed using structural equations modeling (path analysis).

RESULTS:

The results showed that authoritative and permissive parenting styles were associated with secure attachment whereas authoritarian and neglectful parenting styles were associated with insecure attachment. Insecure attachment was associated with a low level of self-regulation whereas secure attachment was associated with a high level of self-regulation. We found that a low level of self-regulation increased the adolescent's addiction susceptibility whereas a high level of self-regulation decreased their addiction susceptibility.

CONCLUSIONS:

The findings of present study suggest the authoritative and permissive parenting styles as the most efficient styles and authoritarian and neglectful parenting styles as the most inefficient styles in terms of addiction susceptibility. Accordingly, efficient parenting style training to parents should be the main goal of drug demand reduction program.

Cost-efficient prenatal assessments are needed that have the potential to identify those at risk for parent/infant relational problems. With this goal in mind, an additional attachment style description was added to the Relationship Questionnaire (Bartholomew & Horowitz, 1991), an established self-report attachment measure, to create the Relationship Questionnaire: Clinical Version (RQ-CV). The additional description represents a profoundly-distrustful attachment style: “I think it's a mistake to trust other people. Everyone's looking out for themselves, so the sooner you learn not to expect anything from anybody else the better.” The RQ-CV was applied to a sample of 44 low-income mothers who had participated in a previous study of the impact of family risk factors on infant development. After first controlling for demographic risk factors and for other insecure adult attachment styles, mother's profound-distrust was associated with three independent assessments of the quality of maternal interactions with the infant assessed 20 years earlier. In particular, profound-distrust was related to more hostile, intrusive, and negative behaviors toward the infant. The results are discussed within the framework of attachment theory.

Objective

Insecure attachment is associated with unhealthy physiologic and behavioral responses to stress, which could lead to the development of obesity. We estimated the association between children’s attachment security at 24 months of age and risk for obesity at 4.5 years of age.

Design

Cohort study.

Setting

National sample of US children born in 2001.

Participants

Children and mothers participating in the 2003 and 2005-2006 waves of the Early Childhood Longitudinal Study, Birth Cohort, conducted by the National Center for Education Statistics. Our analytic sample included 6650 children (76% of children assessed at both waves).

Main Exposure

Attachment security at 24 months was assessed by trained interviewers following observation in the child’s home. Insecure attachment was defined as lowest quartile of attachment security, based on the security score from the Toddler Attachment Sort.

Outcome Measure

Obesity at 4.5 years of age (sex-specific BMI ≥95th percentile for age).

Results

The prevalence of obesity was 23.1% in children with insecure attachment and 16.6% in those with secure attachment. For children with insecure attachment, the odds (95% confidence interval) of obesity was 1.30 (1.05, 1.62) times higher than for children with secure attachment, after controlling for the quality of mother-child interaction during play, parenting practices related to obesity, maternal body mass index, and sociodemographic characteristics.

Conclusions

Insecure attachment in early childhood may be a previously unrecognized risk factor for obesity. Interventions to increase children’s attachment security should also examine impacts on children’s weight.

Introduction:

This research examines the interrelations of attachment security, feelings towards the self, and attributions about others in middle childhood.

Methods:

Five-to nine-year-old children (n=176) completed the Separation Anxiety Test, which provided a measure of attachment security and a puppet interview was used to assess feelings towards the self. A subset of 89 participants received vignettes of social situations with ambiguous outcomes to assess the emotional valence of children’s attributions.

Results:

Secure children saw themselves more positively than insecure children. Children who were secure made more positive attributions about the intentions of others, regardless of whether the protagonist was a peer, parent, or teacher.

Conclusion:

The results suggest that attachment style is related to feelings about the self and attributions about the social behavior of others, and thus may provide a foundation for generalized social expectations that underlie working models of social behavior of significant others.

Objectives:

This pilot study explored the relationship between parental therapeutic alliance, maternal attachment style and child and family functioning in a sample of families with a child aged five to twelve years receiving child psychiatry day hospital treatment for complex co-morbid disorders.

Method:

Self-report measures of therapeutic alliance, maternal attachment style, child behaviour and family functioning were administered to parents at the end of the assessment period (T1) and at discharge (T2). The original study cohort included 90 families, and 44 families completed all the study measures at T2. Correlational analysis was conducted on these 44 families measuring parental alliance, maternal attachment style with child and family functioning scores. Comparisons were made between participants that completed T1 and T2 of the study with participants that only completed T1.

Results:

For the 44 families who completed both T1 and T2 measures, the combination of secure maternal attachment style and positive therapeutic alliance at T1 was associated with positive child outcomes, that is, improved scores on both the internalizing and externalizing dimensions as measured by the CBCL between T1 and T2. Significant changes were identified in family functioning with improvement on cohesion and expressiveness, enhanced intellectual-cultural orientation and improved family organization as measured by the FES.

Conclusions:

Capacity for secure attachment and positive alliance are associated with improved child and family systems outcomes in a high risk cohort of children with co-morbid disorders from a day and evening multimodal family treatment program.

Background

Infantile colic is a common problem of early infancy. There is limited data on the relation between postpartum maternal psychological problems and colic.

Aim:

To investigate whether infantile colic is associated with postpartum mood disorders or insecure adult attachment style of the mother.

Methods

Seventy eight mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened with Edinburgh Postpartum Depression Score (EPDS) and maternal anxiety was assessed with State‐Trait Anxiety Inventory (STAI). The Adult Attachment Scale was used to determine the attachment style of the mother. Infantile colic was defined according to Wessel criteria.

Results

Infantile colic was present in 17 infants (21.7%); 12.9% of the mothers had an EPDS ⩾13. The mean EPDS of the mothers whose infants had infantile colic (10.2±6.0) was significantly higher than that of the mothers of infants without colic (6.3±4.0). Among infants with infantile colic, 62.5% had mothers who had insecure attachment style, whereas only 31.1% of mothers had insecure attachment when the infant did not have infantile colic.

Conclusion

Postpartum maternal depressive symptoms and insecure attachment style are associated with infantile colic. Screening and early intervention of postpartum depression might promote the health of both the mother and infant.

Objectives:

The goal of this study was to determine whether obesity in adolescence is related to the quality of the early maternal–child relationship.

Methods:

We analyzed data from 977 of 1364 participants in the Study of Early Child Care and Youth Development. Child attachment security and maternal sensitivity were assessed by observing mother–child interaction at 15, 24, and 36 months of age. A maternal–child relationship quality score was constructed as the number of times across the 3 ages that the child was either insecurely attached or experienced low maternal sensitivity. Adolescent obesity was defined as a measured BMI ≥95th percentile at age 15 years.

Results:

Poor-quality maternal–child relationships (score: ≥3) were experienced by 24.7% of children compared with 22.0% who, at all 3 ages, were neither insecurely attached nor exposed to low maternal sensitivity (score: 0). The prevalence of adolescent obesity was 26.1%, 15.5%, 12.1%, and 13.0% for those with risk scores of ≥3, 2, 1, and 0, respectively. After adjustment for gender and birth weight, the odds (95% confidence interval) of adolescent obesity was 2.45 (1.49–4.04) times higher in those with the poorest quality early maternal–child relationships (score: ≥3) compared with those with the highest quality (score: 0). Low maternal sensitivity was more strongly associated with obesity than insecure attachment.

Conclusions:

Poor quality of the early maternal–child relationship was associated with a higher prevalence of adolescent obesity. Interventions aimed at improving the quality of maternal–child interactions should consider assessing effects on children’s weight and examining potential mechanisms involving stress response and emotion regulation.

Adult attachment style refers to individual personality traits that strongly influence emotional bonds and reactions to social partners. Behavioral research has shown that adult attachment style reflects profound differences in sensitivity to social signals of support or conflict, but the neural substrates underlying such differences remain unsettled. Using functional magnetic resonance imaging (fMRI), we examined how the three classic prototypes of attachment style (secure, avoidant, anxious) modulate brain responses to facial expressions conveying either positive or negative feedback about task performance (either supportive or hostile) in a social game context. Activation of striatum and ventral tegmental area was enhanced to positive feedback signaled by a smiling face, but this was reduced in participants with avoidant attachment, indicating relative impassiveness to social reward. Conversely, a left amygdala response was evoked by angry faces associated with negative feedback, and correlated positively with anxious attachment, suggesting an increased sensitivity to social punishment. Secure attachment showed mirror effects in striatum and amygdala, but no other specific correlate. These results reveal a critical role for brain systems implicated in reward and threat processing in the biological underpinnings of adult attachment style, and provide new support to psychological models that have postulated two separate affective dimensions to explain these individual differences, centered on the ventral striatum and amygdala circuits, respectively. These findings also demonstrate that brain responses to face expressions are not driven by facial features alone but determined by the personal significance of expressions in current social context. By linking fundamental psychosocial dimensions of adult attachment with brain function, our results do not only corroborate their biological bases but also help understand their impact on behavior.

In two studies, the present research tested the phenomenology and content of autobiographical memory as distinct mediators between attachment avoidance and anxiety and depressive symptoms. In Study 1, participants (N = 454) completed measures of attachment and depressive symptoms in one session, and retrieved and rated two self-defining memories of romantic relationships in a separate session. In Study 2, participants (N = 534) were primed with attachment security, attachment insecurity, or a control prime and then retrieved and rated a self-defining relationship memory. Memory phenomenology, specifically memory coherence and emotional intensity, mediated the association between attachment avoidance and depressive symptoms, whereas the negative affective content of the memory mediated the association between attachment anxiety and depressive symptoms. Priming attachment security led to retrieval of a more coherent relationship memory, whereas insecurity led to the retrieval of a more incoherent relationship memory. Discussion focuses on the construction and recollection of memories as underlying mechanisms of adult attachment and psychological distress, the importance of memory coherence, and the implications for counseling research and practice.

When people encounter threats, their attachment systems are activated and they become motivated to seek protection and support through proximity to their attachment figures. Theoretically, therefore, mental representations of attachment figures should be associated with goals related to attaining proximity and safety. The present studies explore this idea by examining the effects of a person’s chronic attachment style and exposure to a particular attachment figure’s name on the automatic activation of attachment-related goals. Studies 1 and 2 examine effects of exposure to the name of a security-providing attachment figure on willingness to self-disclose and seek support (two behaviors related to gaining proximity). Study 3 examines how exposure to names of different relationship partners (with whom a participant has felt secure, anxious, or avoidant) affects the mental accessibility of attachment-related goal words. Taken together, the studies support the idea that mental representations of attachment figures are associated with attachment-related goals.

We report the effects of a Mediterranean-style diet, with or without calorie restriction, on biomarkers of aging and oxidative stress in overweight men. 192 men were randomly assigned to either a Mediterranean-style diet or a conventional diet. The intervention program was based on implementation of a Mediterranean dietary pattern in the overweight group (MED diet group), associated with calorie restriction and increased physical activity in the obese group (lifestyle group). Both groups were compared with participants in two matched control groups (advice groups). After 2 years, there was a significant difference in weight loss between groups, which was −14 kg (95% CI −20 to −8) in lifestyle groups and −2.0 kg (−4.4 to 0) in the advice groups, with a difference of −11.9 kg (CI −19 to −4.7 kg, P < .001); moreover, there was a significant difference between groups at 2 years for insulin (P = .04), 8-iso-PGF2α (P = .037), glucose (P = .04), and adiponectin (P = .01). Prolonged adherence to a Mediterranean-style diet, with or without caloric restriction, in overweight or obese men is associated with significant amelioration of multiple risk factors, including a better cardiovascular risk profile, reduced oxidative stress, and improved insulin sensitivity.

According to attachment theory, attachment security or attachment style derives from social experiences that begin early in life and continue into the adult years. In this study we examined these expectations by examining associations between the quality of observed interaction patterns in the family of origin during adolescence and self-reported romantic attachment style and observed romantic relationship behaviors in adulthood (at ages 25 and 27). Family and romantic relationship interactions were rated by trained observers from video recordings of structured conversation tasks. Attachment style was assessed with items from Griffin and Bartholomew's (1994) Relationship Scales Questionnaire. Observational ratings of warmth and sensitivity in family interactions were positively related to similar behaviors by romantic partners and to self-reported attachment security. In addition, romantic interactions characterized by high warmth and low hostility at age 25 predicted greater attachment security at 27, after controlling for attachment security at age 25. However, attachment security at age 25 did not predict later romantic relationship interactions after controlling for earlier interactions. These findings underscore the importance of social experiences in close relationships for the development of romantic attachment security but they are inconsistent with the theoretical expectation that attachment security will predict the quality of interactions in romantic unions.

The Third Report of the National Cholesterol Education Program Adult Treatment Panel III emphasized the importance of management of the metabolic syndrome. However, little information is available about the effect of weight reduction on the metabolic syndrome in obese patients among Koreans. A longitudinal clinical intervention study from the 12-week of weight reduction program, including life style modification and adjuvant appetite suppressants, in 78 obese persons was performed. Anthropometry and metabolic risk factors were measured before and after weight reduction. Visceral (VAT), subcutaneous (SAT), and total adipose tissue (TAT) on abdomen were determined by CT scan. Moderate decrease in weight (9.3%) induced significant reduction of waist circumference, systolic and diastolic blood pressure, and triglyceride. Weight reduction also resulted in significant decrease in total cholesterol, LDL-C, uric acid, fasting insulin, and HOMA score. The subjects with metabolic syndrome showed more improvements of metabolic components than those without metabolic syndrome through weight reduction. The reductions of visceral-subcutaneous fat ratio (VSR) and waist circumference were observed as for the predictable variables related to the improvement of metabolic component and insulin resistance in Korean obese patients.

Many obese people who try to control body weight experience weight cycling (WC). The present study evaluated the importance of WC in a community-based obesity intervention program. We analyzed the data of 109 Korean participants (86% women) among 177 subjects who had completed a 12-week intervention program at two public health centers in Korea from April to December, 2007. Completion of a self-administrated questionnaire at baseline was used to obtain anthropometric measurements, and laboratory testing was done before and after the program. Differences in body composition change and obesity-related life style between the two groups were compared with respect to WC and non-weight cycling (NWC). After 12 weeks, both groups showed reductions in weight, waist circumference, and body mass index. The group differences were not significant. However, significant differences were evident for the WC group compared to the NWC group in fat percent mass (WC vs. NWC, -3.49±2.31% vs. -4.65±2.59%, P=0.01), fat free mass (WC vs. NWC, -0.95±1.37 kg vs. -0.38±1.05 kg, P=0.01), and total cholesterol (WC vs. NWC, -3.32±14.63 vs. -16.54±32.39, P=0.005). In conducting a community-based weight control program that predominantly targets women, changes of body composition and total cholesterol may be less effective in weight cyclers than in non-weight cyclers.

Objective. For successful sustainable weight reduction, a multimodal program including behaviour therapy is needed. Lifestyle modification is mostly used for obesity BMI <40 kg/m2. The present study demonstrated the effect of an in-patient nondiet lifestyle program for patients with BMI >40 kg/m2 with psychological comorbidity. Research Methods and Procedere. A retrospective data analysis of 99 participants who passed the program based on moderate activity, healthy and regular food intake over metabolic rate and behaviour therapy was conducted. Results. 64 had a BMI >40 kg/m2 (mean value 49.99 ± 8.74). The relative weight reduction was −6.9 ± 3.9%; (Friedman test P < 0.05). Binary logistic regression analysis for n = 79 revealed that the achievement of the weight reduction goal (0.5 kg per week; predictors: sex, incidence of MTS, duration of in-patient therapy, psychological symptoms, BMI and activity level at baseline) was associated with a shorter duration of in-patient therapy (P = 0.007) and higher BMI at baseline (P = 0.010). Conclusion. Participants with BMI >40 kg/m2 may achieve significant changes of weight reduction and psychological symptoms. However, the primary outcome should not be weight reduction. It is necessary to identify the benefits of lifestyle modification on changing risk profiles and emotional regulation of food intake.