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Obesity is of major pathogenetic importance to type 2 diabetes, it contributes to poor glycemic control and increases the risk of cardiovascular disease. After obtaining a‰?5% of weight loss with a VLCD, participants will be randomly assigned to CPI or usual care for 10 weeks. When successful, we want to conduct an analysis of the cost effectiveness of the intervention as compared to usual care.
We expect that a CPI after a VLCD will be effective in maintaining weight loss and improving cardiovascular risk and glycaemic control, while being cost-effective and improving quality of life in patients with type 2 diabetes. BackgroundDiabetes has become a worldwide epidemic: the estimated global prevalence was 2,8% in 2000 and is expected to rise up to 4,4% in 2030. Patients with psychiatric disorders or major psychological disturbances are excluded from the trial. The statistician generates the allocation sequence and hands it over to the secretary of the department of Medical Psychology and Psychotherapy, who is not involved in the study, to guarantee allocation concealment. BlindingGiven the nature of the intervention, it is impossible to blind the participants, CPI-therapist and researcher (KACB).
In sessions 1a€“5 dysfunctional cognitions about eating, weight and shape are identified and challenged.
Systolic and diastolic blood pressure (mmHg) are measured twice in upright position, while the patient had rested for at least 5 minutes with an Omron M4-I Intelli-sense device.
Anxiety and depression are measured by the Hospital Anxiety and Depression Scale (HADS)[50, 51]. Somatic symptoms are measured by the VOEG-13 (a€?Vragenlijst Onderzoek Ervaren Gezondheida€™) [52], a Dutch 13-item questionnaire used to measure the health of a population, often used in social science research. Fatigue is measured by the Checklist Individual Strength (CIS) [53], which quantifies subjective fatigue and related behavioral aspects.
Eating disorders are measured by the Eating Disorder Examination-Questionnaire (EDE-Q) [56], a 36 item questionnaire that measures concerns about shape, weight and eating, restraint and binge eating.
We developed a lifestyle questionnaire on diet history, smoking, drinking habits, drug use and hours sleep. Physical activity is measured using the SQUASH (Short Questionnaire to Assess Health Enhancing Physical Activity) [58]. All reports agree that Type 2 diabetes is becoming increasingly prevalent: a 70% increase over 10 years.
Elderly diabetics are at significantly increased risk of vision loss, cataracts and glaucoma.
The economic impact is high – over half of the cases arise among people of working age.
Most of our information comes from the National Diabetes Surveillance System (NDSS), which links federal, provincial and territorial governments and NGOs. Our prevalence places us third among developed countries, after the US (over 10% prevalence) and Portugal. The net effect is that diabetics aged 25 to 39 can expect to live 9 years less than non-diabetics; diabetic patients aged 50 will live 7 years less (females) and 6 years less (males) compared to non-diabetics.
Of the new cases, roughly 40% will arise among those with a BMI of 25-30, while about 12% will arise among the very obese (those with a BMI > 35).
The National Diabetes Surveillance System has also reported some data on Aboriginal populations in BC and among the Cree of James Bay. We actually have no information from medical records (which might well under-estimate diabetes in the population). The rates for those living on-reserve are about three times that of the general population; when the data are adjusted for age, the difference is four-fold.
The American Diabetes Association concluded "Exercise plays a major role in the prevention and control of insulin resistance, prediabetes, GDM [gestational diabetes], T2DM, and diabetes-related health complications.
CMR Short Reviews The Concept of CMR Historical background on global cardiometabolic risk, epidemiological aspects of obesity and type 2 diabetes, ABCs of cardiovascular disease risk factors, intra-abdominal adiposity, metabolic syndrome and contribution to cardiometabolic risk.
Intra-abdominal fat is a strong predictor of metabolic abnormalities, disease, and mortality. In the 1950s, Jean Vague (1) noted that upper body or android obesity was an important predictor of atherosclerosis, diabetes, gout, and other diseases.
Cross-sectional data shows that individuals who are more physically active have lower amounts of intra-abdominal fat (12-14).
It was originally suggested that exercise alone produced only a marginal (1 to 2 kg) decrease in body weight (25).
Since weight loss generally causes a reduction in intra-abdominal fat, the interventions that produce the greatest weight loss will inevitably cause the greatest loss of intra-abdominal fat. Although diet and exercise may both lower body weight equally, the composition of the weight lost differs according to the strategy used (Figure 1).
With respect to exercise-induced intra-abdominal fat reduction, studies that claim women are resistant to intra-abdominal fat loss may be confounded by gender differences in exercise energy expenditure. Numerous cross-sectional studies have found that for a given amount of total fat mass, Asians have more intra-abdominal fat than Caucasians (55), who in turn have more intra-abdominal fat than African-Americans (56-58).
Abdominal obesity has long been identified as the phenotype that conveys the greatest health risk, independent of total body weight.
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. Effect of fructose on glycemic control in diabetes: A systematic review and meta-analysis of controlled feeding trials.
The content of this website is provided for educational and informational purposes only and is not to be used for medical advice, diagnosis or treatment. Expert car advice - check engine light diagnostic, auto, Check engine light, diagnostics, auto repair, question, timing belt, diagram, technician, obd, codes, diagnostic, car help, car repair, car advice. How di i tell the difference between a 46re and a 47re trans?, How di i tell the difference between a 46re and a 47re trans?
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Rear differential speed sensor above is mistakenly replaced because of a code for the transmission output speed sensor in the pictures below.. Copyright © 2012 Autos Weblog, All trademarks are the property of the respective trademark owners. Psychosocial parameters are also studied, as secondary outcomes as well as determinants for weight loss. In the year 2000 the excess global mortality attributable to diabetes was 5,2% making diabetes the fifth leading cause of death [1]. This arbitrary cut-off value was chosen because of its relatively large effect on the risk profile [3].
During week 10 of the diet, the intervention group starts with a total of 17 sessions of CPI. The follow-up will continue until 2015.Study populationPatients are recruited from the outpatient diabetes clinic of the Erasmus Medical Centre in Rotterdam by the medical team, based on the in- and exclusion criteria shown in Tablea€‰1. Patients with eating disorders (bulimia nervosa and binge eating disorder) or depression are not excluded, since it is expected that these conditions are common among patients with type 2 diabetes and previous research has shown that cognitive behaviour therapy can have beneficial effects in these patient groups [28, 41a€“43]. Nevertheless, we will try to keep the intervention as separate as possible from the diabetes treatment, by giving participants strict instructions not to communicate about the intervention with their medical team. The items consist of somatic symptoms like headache, nervousness and lethargy and respondents indicate whether they have these symptoms or not. The CIS consists of 20 statements for which the respondent has to indicate on a 7-point scale to what extent the particular statement applies to him or her (1 = Yes, that is true; to 7 = No, that is not true). How the participants value the sessions is measured by the Session Rating Scale (SRS) [57]. The SQUASH collects days per week, average time per day, and effort for physical activities such as commuting activities, leisure time and sport activities, household activities, and activities at work or school. The TiC-P measures direct medical costs due to healthcare utilization during the past four weeks.
It comes from a June 2010 report by ICES (the Institute for Clinical Evaluative Studies) on the risk of diabetes in Canada. Off-reserve Aboriginal populations show somewhat elevated rates compared to non-Aboriginals.
While the association between abdominal obesity and metabolic risk may be explained by excess fat accumulation in either of two distinct depots within the abdomen, namely intra-abdominal (visceral) fat and abdominal subcutaneous fat, the literature points to intra-abdominal fat as the depot that carries the greatest health risk.
Even for a given degree of obesity, individuals who are more active tend to have the lowest levels of intra-abdominal fat compared to their sedentary counterparts (15, 16). These earlier conclusions were based on evidence from intervention studies wherein the prescribed negative energy balance was too low to induce substantive weight loss (26). This suggests that intra-abdominal fat may be more sensitive to exercise-induced weight loss than other fat depots. A calorie-restricted diet has traditionally been the cornerstone of obesity reduction treatment (30). Carefully controlled studies have shown that when reduction of caloric intake is equal to the calories expended through exercise, which creates an equivalent energy deficit, the weight loss is identical between strategies (17, 18). For example, approximately two months of regular, moderate-intensity aerobic exercise can substantially reduce intra-abdominal fat (-41 to -45%) without causing weight change in samples of type 2 diabetic patients (45, 46). Exercise without weight loss can reduce both intra-abdominal fat (10-20%) and waist circumference. For example, 16 months of supervised aerobic exercise at the same exercise intensity and of the same duration reduced 5% of the intra-abdominal fat in young men but failed to produce a significant reduction in young women (24).
Since men have a greater exercise capacity compared to women (52), matching men and women on exercise intensity and duration alone results in a higher exercise energy expenditure in men and, consequently, a higher expected total and intra-abdominal fat loss. The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease. The atherogenic lipoprotein profile associated with obesity and insulin resistance is largely attributable to intra-abdominal fat. Visceral adipose tissue is an independent correlate of glucose disposal in older obese postmenopausal women. Effects of an energy-restrictive diet with or without exercise on abdominal fat, intermuscular fat, and metabolic risk factors in obese women. Relation of C-reactive protein to body fat distribution and features of the metabolic syndrome in Europeans and South Asians. Visceral adiposity is an independent predictor of incident hypertension in Japanese Americans. Visceral adiposity and risk of type 2 diabetes: a prospective study among Japanese Americans.


Abdominal fat distribution in pre- and postmenopausal women: The impact of physical activity, age, and menopausal status. Intra-abdominal adipose tissue, physical activity and cardiovascular risk in pre- and post-menopausal women. Cardiorespiratory fitness is associated with lower abdominal fat independent of body mass index.
Fitness alters the associations of BMI and waist circumference with total and abdominal fat.
Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men.
Exercise-induced reduction in obesity and insulin resistance in women: a randomized controlled trial.
Effects of a single bout of exercise and exercise training on steroid levels in middle-aged type 2 diabetic men: relationship to abdominal adipose tissue distribution and metabolic status. The effect of combined aerobic and resistance exercise training on abdominal fat in obese middle-aged women.
Effect of exercise on total and intra-abdominal body fat in postmenopausal women: a randomized controlled trial.
Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE--a randomized controlled study. Effects of a 16-month randomized controlled exercise trial on body weight and composition in young, overweight men and women: the Midwest Exercise Trial. Waist circumference and abdominal sagitttal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Effect of weight loss and regional fat distribution on plasma leptin concentration in obese women. One year of caloric restriction in humans: feasibility and effects on body composition and abdominal adipose tissue. Effects of hypocaloric diet and exercise training on inflammation and adipocyte lipolysis in obese postmenopausal women. Effect of calorie restriction with or without exercise on insulin sensitivity, beta-cell function, fat cell size, and ectopic lipid in overweight subjects.
Effect of weight loss with reduction of intra-abdominal fat on lipid metabolism in older men.
Effect of calorie restriction with or without exercise on body composition and fat distribution. Improvements in body composition, glucose tolerance, and insulin action induced by increasing energy expenditure or decreasing energy intake. Effects of energy restriction and exercise on skeletal muscle and adipose tissue in women as measured by magnetic resonance imaging. A descriptive study of individuals successful at long-term maintenance of substantial weight loss.
Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. Cardiorespiratory fitness attenuates metabolic risk independent of abdominal subcutaneous and visceral fat in men. Absence of exercise-induced variations in adiponectin levels despite decreased abdominal adiposity and improved insulin sensitivity in type 2 diabetic men. Mobilization of visceral adipose tissue related to the improvement in insulin sensitivity in response to physical training in NIDDM.
Preferential loss of visceral fat following aerobic exercise, measured by magnetic resonance imaging. Exercise without weight loss is an effective strategy for obesity reduction in obese individuals with and without Type 2 diabetes.
The effects of long-term, moderate intensity, intermittent exercise on aerobic capacity, body composition, blood lipids, insulin and glucose in overweight females. Alterations in body weight and composition consequent to 20 wk of endurance training: the HERITAGE Family Study.
Visceral fat accumulation in obese subjects: relation to energy expenditure and response to weight loss. Subcutaneous and visceral fat distribution according to sex, age, and overweight, evaluated by computed tomography. Race, visceral adipose tissue, plasma lipids, and lipoprotein lipase activity in men and women: the Health, Risk Factors, Exercise Training, and Genetics (HERITAGE) family study. Racial differences in amounts of visceral adipose tissue in young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) study. Neither the service provider nor the domain owner maintain any relationship with the advertisers. 1994 dodge caravan 3.3l understand iac is a stepper motor and pcm controls steps in and out. The increase in prevalence is associated with aging of the population, the increasing prevalence of obesity in combination with physical inactivity.
Moreover, we need a relevant weight loss to investigate weight maintenance after weight reduction. In our hospital, a tertiary referral centre, we see both patients with only oral antidiabetic agents and patients treated with one or more insulin doses daily.
We will analyze the effect of these background variables on the outcome of the intervention.RandomizationGroups of 20 patients will start with a VLCD concomitantly. Patients are given the possibility to discuss problems related to the study with an independent medical doctor.
Cognitive diaries are introduced and participants are encouraged to use these diaries at home to record personal critical situations and dysfunctional thoughts. Waist circumference (cm) is measured at the level midway between the lowest rib margin and the aliac crest. The statements refer to four fatigue aspects: (1) subjective fatigue (2) reduced motivation (3) reduced activity and (4) reduced concentration. The SRS is an ultra brief alliance measure designed specifically for every session clinical use. Total minutes of activity are calculated for each question by multiplying frequency (days per week) by duration (minutes per day). Also, it registers the indirect non-medical costs due to productivity loss during the past two weeks. In addition, numerous intervention studies have demonstrated that exercise training can reduce intra-abdominal fat through weight loss (17-24). The literature suggests, however, that exercise can produce a wide array of intra-abdominal fat changes, from a minor reduction of approximately 5% (21) up to a 50% reduction (20). This is supported by the degree of weight loss reported among diet versus exercise weight loss studies (5 to 18 kg versus 1 to 8 kg reduction, respectively).
Even non-obese premenopausal women experience a significant reduction in intra-abdominal fat (-25%) after 6 months of aerobic exercise despite no significant change in weight (47). However, exercise-induced weight loss leads to greater reductions in both intra-abdominal fat (30%) and waist circumference.
Further evidence from a trial using either diet or diet with exercise suggests a similar pattern (37). It has also been noted that the amount of intra-abdominal fat lost through intervention is contingent on the initial amount of intra-abdominal fat (53). Unfortunately, most of the current literature is based mainly on Caucasian populations, which hinders the identification of any possible racial differences. In case of trademark issues please contact the domain owner directly (contact information can be found in whois).
However, current treatment programs for obese DM type 2 patients are not effective in the long term.
After randomization, stratified to the achieved weight loss at 8 weeks, participants are assigned to one of the following conditions:1.
At 8 weeks (randomization after VLCD), only the primary outcome (weight) will be measured.Figure 1 shows the design of the study.
In general, our patients will have more complex disease and more comorbidity compared to the average diabetic patient referred to a GP. After 8 weeks of VLCD, the patients who lost a‰?5% of bodyweight are randomly assigned to either or the intervention group (usual care + CPI) or the control group (usual care) with an allocation ratio of 1:1. The CPI group sessions will take place in another part of the hospital, outside the diabetes clinic, to ensure that patients and medical team will not run into each other. Because binge eating cannot be measured reliably by the EDE-Q, we use a questionnaire composed by Werrij, et al.
The SRS consists of four 10-cm visual analogue scales (relationship scale, goals and topic scale, approach or method scale, overall evaluation scale), with instructions to place a hash mark on a line (continuum) with negative responses depicted on the left and positive responses indicated on the right.
Activity scores for separate questions are calculated by multiplying total minutes of activity by an intensity score (range 1a€“9). The scores on the three dimensions can be combined into one co called a€?utilitya€™ score, which represents the societal value of quality of life.
Since we expect that the treatment will be less effective when more then 8 sessions are missed, this non-compliant participants will be considered drop-outs.We have conducted a pilot study to improve our research protocol. Reducing daily caloric intake by 400 to 700 kcal can cause a 15 to 30% reduction in intra-abdominal fat. Women generally have less intra-abdominal fat than men (54), which may also play a role in any gender differences.
The limited evidence available suggests that Caucasians and African Americans do not differ in terms of intra-abdominal fat loss in response to a 20 week exercise intervention (51). For a given amount of weight loss, exercise can induce a greater relative reduction in intra-abdominal fat and better maintain muscle mass. In this RCT, we compare the effectiveness of a Combined Psychological Intervention (CPI) and usual care in maintaining the favourable effects on weight and risk profile during 2 years of follow-up after a Very Low Calorie Diet (VLCD).
An intensive pharmaceutical and behavioral therapy treatment has been estimated to reduce the risk of cardiovascular and micro vascular events by approximately 50% [2].Approximately 80% of the people with type 2 diabetes are overweight. The stratified randomization is computer controlled, carried out by a secretary and supervised by a statistician, who are both not involved in the trial.
Furthermore, the validity of the dysfunctional thoughts is tested and alternative thoughts are generated. Both waist- and hip circumference are measured by the nearest 0,5 cm, using a tape-measure. People with a score above this cut-off point are at an increased risk of long-term sickness absence.


Based on a total possible score of 40, any score lower than 36 overall, or 9 on any scale, could be a source of concern and therefore prudent to invite the client to comment.
The total activity score is calculated by taking the sum of the activity scores for the separate questions. For a given amount of weight loss, exercise preserves muscle mass and causes greater reductions in total and intra-abdominal fat compared to diet-induced weight loss. In general, the highest levels of exercise cause the highest energy deficit, which leads to greater weight loss and a greater reduction in intra-abdominal fat. In order for that obese man to produce the same energy deficit and expend 2,000 kcal, he would require approximately 3 hours of daily, moderate-intensity exercise (17). Data from the National Weight Control Registry suggests that individuals who are most successful at attaining and maintaining significant weight loss are likely to use a combination of diet and exercise to achieve their goal (42). In light of these findings, it seems doubtful that women are actually resistant to intra-abdominal fat loss. More research is needed to pinpoint the influence of race on intra-abdominal fat reduction. Lastly, of key importance is the notion that total body weight needs not change for intra-abdominal fat to decrease significantly. Losing weight is the cornerstone of prevention and treatment of type 2 diabetes: it decreases the resistance to insulin, improves glycaemic control and reduces hypertension and lipid abnormalities [3a€“5].
Patients interested in participating in the study will receive an information letter and a questionnaire to be filled in at home. The reason for a stratified randomization is to avoid an unsuccessful randomization with regard to weight loss during the VLCD. When after 8 weeks of VLCD a loss of 5% or more of the initial bodyweight is reached, random allocation to the intervention- and control group will take place. Guided by examples of the group, the group is acting as a research team, investigating the validity of dysfunctional cognitions and creating alternative and more realistic thoughts. This societal value of quality of life is used as input for so called Quality Adjusted Life Years (QALY) analysis, as the societal perspective is the preferred perspective in health economics. In this pilot study, we found that the protocol was feasible and that no major changes had to be done.
While intra-abdominal fat cannot be readily measured, waist circumference is recommended as a reliable measure of intra-abdominal fat (29).
The primary findings suggest that in obese Caucasian men and women, as well as in individuals with type 2 diabetes, exercise training can significantly reduce total and abdominal obesity even with little or no change in body weight. From a clinical perspective, exercise-induced weight loss therefore causes the greatest reduction in intra-abdominal fat and the greatest improvements in metabolic status. The waist circumference tape may therefore be a more reliable marker of obesity treatment success than the bathroom scale.
Weight loss interventions thus may contribute to a reduction of cardiovascular risk and is shown to reduce mortality in patients with type 2 diabetes and obesity [6].Unfortunately, interventions aimed at weight reduction have only a limited effect in the long run because of regain of the initial weight loss. Two weeks later they will visit the outpatient clinic for an intake interview with the researcher (KACB). It is not possible to correct afterwards in the analysis, as it is the primary outcome measurement.
Patients losing less then 5% of bodyweight in the first 8 weeks are excluded from the study and will receive usual care, including dietary advice.The use of a VLCD is an integrated part of the dietary treatment at our outpatient diabetes clinic. The EuroQol instrument contains also the EQ-VAS, a vertical visual analogue scale with the anchors best imaginable health (score of 100) and worst imaginable health (score of 0). The only change we made was in the lay-out of the questionnaires, making them better understandable to our participants.
The combination of diet and exercise is therefore the ideal strategy for losing weight and reducing intra-abdominal fat. However, given the challenges associated with losing large amounts of weight, it is equally important to reduce intra-abdominal adiposity and related health risk with minimal weight loss. Normally, the patients are free to choose between the different types of weight reduction strategies. Methods used for testing the validity of a persona€™s thoughts are the Socratic dialogue and behavioral experiments. A meta-analysis of weight loss interventions in adults with type 2 diabetes showed that multi-component interventions including Very Low Calorie Diets may hold promise for achieving weight loss [7, 8]. In the present study however, only one type of weight reduction therapy is used (VLCD).The product we use for this study is Glucerna SRA®, a product specifically developed for patients with diabetes and based on a combination of slow released carbohydrates, a low-fat, high monounsaturated fatty acid content and the addition of dietary fibre. Behavioral experiments are set up during the session, carried out at home, and discussed in the next session.The underlying schemas (a€?core beliefsa€™) are explored during sessions 6a€“10. Illustrating a dose-response relationship between exercise dose, weight loss, and intra-abdominal fat loss, Irwin et al. Various studies indicate that this product decreases the postprandial blood glucose levels, which may have a lowering effect on HbA1c.
The validity of self schemas is tested in the same way as the other dysfunctional thoughts and recorded in the diary.Subsequently, 7 relapse prevention meetings are held to stabilize behaviour change, with increasing intervals until the end of the study (2 years).
This diabetes-specific diet product is also used as a meal replacement for achieving weight reduction in people with type 2 diabetes, with positive effects on weight control, glycaemic control and lipid profile [46a€“48].
We have chosen to use a twice a day regimen of meal replacements, together with a small dinner, providing 750 kcal, 67 g carbohydrates, 54 g protein and 32 g fat (of which 16 g monounsaturated fatty acids (MUFA)) a day and RDA recommendations in micronutrients.
In addition, techniques of Problem Solving Therapy are used to help participants coping with everyday problems they encounter while implementing their lifestyle changes. We believe that enabling the participants to have dinner with their family during the VLCD will improve compliance.We have developed a protocol for the use of a VLCD in patients with type 2 diabetes, where we describe the different aspects of the treatment.
Based on individually set goals, experienced problems are identified and possible solutions will be put forward in a group brainstorm session. Oral anti-diabetic agents (except Metformin) and short-acting insulin analogues are discontinued, while the dosage of long-acting insulin analogues and biphasic mixtures is halved, to avoid severe hypoglycaemia. The participant will choose the most appropriate solution and creates and carries out an implementation plan. In this plan, the participant formulates the solution as a SMART (Specific, Measurable, Attainable, Realistic, Timely) goal and considers which steps should be taken to achieve this goal. During the VLCD and gradual transition to a normal diet, medication is adjusted by means of glucose self-control and frequent contact with diabetes nurses and dieticians. Subsequently, the participants will be encouraged to identify barriers that may arise while trying to achieve their goals.
Under guidance of the psychologist, activities will be defined which can be undertaken to prevent the occurrence or diminish the effect of these potentially threats (Proactive Coping).In following relapse prevention sessions, the implementation plan is evaluated and new (sub) problems are chosen to tackle.
The authors indicated that the success was based on the strong motivation of the patients to prevent a need for insulin and a slow reintroduction of normal diet. Usual care consists of a 3-monthly visit to the physician and diabetes nurse, including medical examinations. For this purpose, a variety of psychological interventions have been implemented in weight reduction programmes.
Patients are free to make additional appointments with their dietician in- or outside the hospital and they can choose to follow whatever diet they would like during the follow-up period. Behaviour therapy and cognitive behaviour therapy (CBT) are potential psychological interventions facilitating better maintenance of weight loss [20].
Both the number of visits to a dietician and the dieting methods, products and duration of the diet are noted during the follow-up period of 2 years. CBT is used to describe a wide range of techniques to change thinking patterns and behaviours. Dieticians in our hospital are all trained in motivational interviewing to motivate the patients in changing their lifestyle. All members of the diabetic team encourage the patients to get enough exercise, but we do not refer to an exercise programme. In the current study, we propose to combine them into an integrated weight maintenance programme.Cognitive behaviour therapyWithin cognitive psychology, humans are regarded as information processing systems, where knowledge is organized in so-called schemas. Patients in need of psychological help (ie psychological disorder, clinical depression, major eating disorder) are referred to a clinical psychologist in- or outside the hospital.
Cognitive schemas are activated by incoming information, leading to cognitions (thoughts), emotions and subsequently to behaviour. According to the founding father of the cognitive therapy, Aaron Beck, emotional disorders such as depression and anxiety disorders result from dysfunctional schemas.
Nonetheless, the number of visits to a psychologist as well as to other caregivers will be noted during this trial. Cognitive therapy focuses on changing dysfunctional schemas and cognitions, using behavioral experiments and challenges [21].
In eating disorders, the cognitive model was first used to treat bulimia nervosa by adjusting overvaluation of weight and shape based on low self-esteem [22, 23]. Two psychologists (HB and AVTS) are involved in this study, so we can investigate the a€?therapist-effecta€™.The first 10 weekly sessions consist of cognitive behaviour therapy, partly based on the method developed by Werrij and colleagues from the University of Maastricht [27]. Moreover, it was found that a longer duration of the intervention and more frequent clinical contact was associated with an increased effect. The problem-solving model for obesity treatment was first described by Perri, Nezu and Viegener in 1992 [34] and proposes that active problem solving efforts by a health care provider can help the obese person encounter everyday problems in their weight management. Moreover, a recent study showed that people with better problem-solving skills lost more weight and were more compliant to therapy [36].Proactive copingProactive coping (PC), directed at an upcoming instead of an ongoing stressor, is a new focus in positive psychology research. PC consists of efforts undertaken in advance of a potentially stressful event to prevent it or modify its form before it occurs. The theory described by Aspinwall and Taylor consists of five stages: PC starts with the a€?accumulation of resourcesa€™ such as time, money, planning or organizational skills and social support, so that one is prepared as much as possible to deal with future threats. The next stage consists of a€?initial coping effortsa€™: activities undertaken to prevent or minimize a recognized or suspected stressor. Finally, the a€?use of feedbacka€™ involves the evaluation of the stressful event itself and the effects of onea€™s preliminary efforts [37].Schwarzer and Taubert described PC as a way of aspiring a positive future by accumulating resources and realistic goal setting [38].
A recent publication has shown that the pursuit of goals was related to improved wellbeing, while preventing a negative future was not [39].A study of the effects of PC on the self-care behaviours of newly diagnosed DM patients revealed that the treatment was highly appreciated and even after 9 months improvements in eating and exercising habits were seen.
In addition, the intervention was effective in reducing both weight and blood pressure after 9 months, but had no effect on HbA1c or lipid profile [40].In the current randomized study, we compare the effect of a Combined Psychological Intervention (CPI) with usual care on weight maintenance after a Very Low Calorie Diet.




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Comments

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  2. NERPATOLUQ

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    19.05.2015