A mvev Ge me mew WW sums we came: wameee. eeaflcwms 2e: weesm' emote m A? 1mm azure wweasm sesame Thesis he 1'?“ Mm of M. S. W‘W SYATE UNWRWY Aim: Jam Biak'a W62 E: LIBRARY ! N13111:}?! n f: ta tc UHi'VL‘[;;: y “hall-W'fi MSU RETURNING MATERIALS: P1ace in book drop to LIBRARIES remove this checkout from . _—_—- your record. FINES wiH be charged if book is returned after the date stamped below. " "f2 . 1 ,1 _, v u-AI Q4” "4"?“ ‘31"; Abstract A Survey of the Present Weight Status of College Women - Participants in Weight Reduction Studies at Michigan State University 1950-1960 By Alma Jean Blake Subjects who participated in weight reduction studies at Michigan State University 1950-1960 were contacted by mailed questionnaires. Forty-three of the sixty-four questionnaires sent were completed and returned. The purpose of this survey was to determine the pre- sent weight status of the subjects surveyed and to examine factors which may have related to success or failure in weight reduction. Questions were asked concerning physical status, age, marital status, activity, eating habits, history of overweight among family members, and factors which the subjects believed influenced their success or failure. The success or failure of a subject was based on a predetermined "ideal weight" related to subject‘s age and height. Subjects were classified as successful or un— successful and the data for each group were examined. Forty-six per cent of the respondents had attained ideal weight at the time of the survey. A higher percentage (56%) of the subjects who were successful in weight reduction in the earlier Michigan State studies had attained ideal Alma Jean Blake weight at the present time than those who failed (35%) when previously participating in the Michigan State research study. Results of data examination indicated: (1) thirty- five per cent of the subjects who found sufficient motivation for weight loss in the Michigan State studies continued to practice successful weight reduction; (2) the younger (20-25) unmarried women showed a greater tendency to maintain a successful weight reduction program than did the older married women; (3) a greater percentage of the subjects having an income of $SOOO-8000 attained ideal weight than those above or below that amount; (4) the successful sub- jects were more active in Sports, household duties, and their jobs than were the unsuccessful; (5) fewer successful subjects purchased ”Special low calorie foods"; (6) the greatest success (61%) was reported by the group that used low calorie diets only; (7) a higher percentage of the un- successful subjects had overweight family members as com- pared with the group of ideal weight; (8) the percentage of success was slightly higher among the career women; (9) the degree of success attained by the home economics students was 56 per cent as compared with 39 per cent for the non- home economics students. Seventy-five per cent of the subjects who attained ideal weight and 65 per cent of the overweight subjects seemed to realize that will power is one of the most important factors in weight control. A SURVEY OF THE PRESENT WEIGHT STATUS OF COLLEGE WOMEN - PARTICIPANTS IN WEIGHT REDUCTION, STUDIES AT MICHIGAN STATE UNIVERSITY 1950-1960 BY Alma Jean Blake A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of ‘ MASTER OF SCIENCE Department of Foods and Nutrition l962 Approved by Z Ofl/QZ/i/é’fl/‘f/c 1/731. (lwf. // ACKNOWLEDGMENT The author acknowledges with sincere grati- tude Dr. Dena Cederquist for her patience and guidance throughout this study, Dr. Dorothy Arata for her invaluable aid in examination of data, Dr. Pearl Aldrich for her aid in formulation of the questionnaire and her editorial suggestions during the actual writing, and Dr. Olaf Mickelsen for his editorial suggestions. I would also like to express my thanks to Mrs. Grace Scribner for her secretarial aid and.Mrs. Bette Smith for her help in producing the figures. ii LIST OF TABLES . . . LIST OE FIGURES . . LIST OF APPENDICES . INTRODUCTION . . . REVIEW OF LITERATURE The Questionnaire Dietary Records Measurement of Success Factors Which Affect Body Weight Pollow-up Studies Conducted . . TABLE OF EXPEREWENTAL PROCEDURE . . RESULTS AND DISCUSSION . . SUMMARY AND CONCLUSION . . LITERATURE CITED . . iii CONTENTS as a Survey Technique PAGE iv Vi vii \ICS‘UIJ>--l>l-l 10 l4 18 45 47 TABLE 10. ll. 12. 13. 14. 15. LIST OF TABLES The relationship between marital status and success or failure in weight reduction The relationship between age and success or failure in weight reduction . . . . . . . . The relationship between educational back- ground and success or failure in weight reduction . . . . . . . . . . . . . . . . . The relationship between income and success or failure in weight reduction . . . . . . . Activity pattern . . . . . . . . . . . . . Activity pattern (frequency of participation) The relationship between success or failure and the planning of meals . . . . . . . . . General eating pattern: foods eaten often . . The mean and range of nutrient intake . . . . Low calorie foods purchased . . . . . . . . . Types of weight reduction aids used . . . . . Subject's overweight family members . . . . . The success or failure in weight reduction Of the career woman vs the homemaker . . . . Comparison of the uses of low calorie diets . Comparison of the use Of dietary aids and types Of supervision . . . . . . . . iv PAGE 21 21 25 28 29 31 32 34 36 37 38 39 4O 42 42 LIST OF TABLES (Con‘t) TABLE 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Factors listed most Often as influencing - weight reduction . . Personal statistics of subjects . . . . . Personal statistics of subjects . . . . . . General eating pattern subjects . . . . General eating pattern subjects . . . . . . Nutrient intake of the Nutrient intake of the the successful the unsuccessful of the successful of the unsuccessful successful subjects unsuccessful subjects . Activity pattern of the successful subjects . Activity pattern of the unsuccessful subjects Factors influencing weight reduction as listed by subjects . . . . PAGE 44 6O 61 62 63 64 65 66 67 68 LIST OF FIGURES F IGURE PAGE - 1. Relationships between age and success or failure of weight reduction program . . . . . 22 2. Relationships between marital status and success or failure of weight reduction program . . . . . . . . . . . . . . . . . . . 23 3. Relationship between the number Of children and success or failure of a weight reduction program . . . . . . . . . . . . . . 24 4. Relationship between degree of education and success or failure in weight reduction program . . . . . . . . . . . . . . 26 5. Relationship between income and success or failure of a weight reduction program . . . . 27 vi APPENDIX PAGE COVER LETTER . . . . . . . . . . . . . . . . . . . . . 52 QUESTIONNAIRE . . . . . . . . . . . . . . . . . . . . 53 COMPLETE DATA . . . . . . . . . . . . . . . . . . . . 60 vii INTRODUCTION Researchers in the field of weight reduction agree that the success of any weight reduction program can be measured only on a long-term basis. According to COOper et a1. (10), to achieve and maintain a desired lower weight is the goal of weight reduction. The two stages for accomplishing re- duction are the period of active dieting, during which weight is lost, and the subsequent attempt to maintain the desired level over an extended period. What occurs in the second stage will determine a patient's ultimate success. Long-term performance is the most significant evidence of dietary accomplishment. Berkowitz and Beck (4) stated that although much has been spoken and written on the subject of obesity, the management of the overweight person for a long period is rarely mentioned. These authors emphasized that careful follow-up studies are lacking in an otherwise pro- lific literature on weight reduction. There is a real need for further study on methods of weight reduction and on effective methods of changing food habits (McCann and Trulson 19). The almost unanimous Opinion of the persons involved in weight reduction programs is that obesity is one of the more serious health hazards of our time. Weight control is a positive approach to the maintenance Of health and the prevention Of the major diseases of middle and later life (Cooper, et a1. 10, Mayer 21). Although the definitions of obesity and overweight are vague in many reports, these concepts are basic to this study. Armstrong, et a1. (3), in a comprehensive review based on data from a large life insurance company, consider variations within 10 per cent above or below average weight (according to the MetrOpolitan Life Insurance Company Weight Tables) as normal, 10-20 per cent above as overweight, and more than 20 per cent above as obese. Leverton (18) indicated there is reason for persons working in the field of weight control to be concerned with the preposterous claims made by some Of the faddists con- cerning their products. Early claims made were so ridiculous that it seemed unnecessary to be concerned with refuting them. However, in recent years misleading claims have played up certain known facts concerning weight control and have made general statements about the beneficial effects Of particular items. The food faddists are capitalizing on the public's awareness Of the importance of health and on its interest in scientific development. Such misinformation and false claims for Special foods tend to complicate rather than to Offer long-term aid in the problem of losing weight. This follow-up study should give relevant information about the way students who have had nutrition education react to the claims of the faddists, indicating whether or not nutrition educated students are more discriminating in choos- ing methods Of weight reduction than the students who are not nutrition educated. The present study was designed to: 1. Obtain the current weights Of individuals who previously participated in the weight reduction studies at Michigan State University. 2. Compare the present weights Of subjects who were successful in the Michigan State studies with those who were not. 3. Compare the recent success of and methods of weight reduction used by subjects who had nutrition education with those who did not. 4. Identify the factors which may have contributed to the maintenance of ideal weight. The study presented in this thesis is based on data from a Survey, by mailed questionnaire, of college women who participated in weight reduction programs at Michigan State University sometime between 1950 and 1960. REVIEW OF LITERATURE The Questionnaire as a Survey Technique Because most subjects included in the survey had left the campus and were scattered over the country, the question- naire was chosen to Obtain the necessary information for the study. A questionnaire may be defined as a set of questions to be answered by the informant without the personal aid of an investigator or enumerator (Gee l3). Eigelberner (11) reports that the chief advantages of the questionnaire are range and economy. In range the questionnaire has practically no limitations since it can be sent to anyone served by the mails. It is economical be- cause the cost includes only those of preparation, mailing, and handling of the replies. Also, the questionnaire is Often most convenient for those persons from whom the in- formation is desired because it can be filled out at any time suitable to the subject (Gee l3, Eigelberner 11). The Darmouth Manual on Research and Reports (1) out— lines a number of points concerning the use of the question- naire, cautioning that if such a procedure is to be followed, the document should be constructed with exceptional care. The questionnaire requires an attempt to visualize the per- sons receiving it and their reaction to every line in it. Eigelberner (11) emphasizes that the questionnaire Should be 4 adequately and competently constructed to make it as fool— proof as possible. The Darmouth Manual indicates that the care with which the questionnaire is constructed can do a great deal to safeguard against some of the disadvantages such as the representativeness of replies received, the accuracy and adequacy Of replies, and percentage of returns. Dietary Records Young, et al. (31) reported that some authorities feel the data Obtained about dietary habits will not be accurate unless records of seven consecutive days or twenty consecutive meals are obtained. However, groups such as the United States Public Health nutrition field units (2) believe a larger number of accurate one-day records are as useful as a smaller number of seven-day records. Young, et al.(31) postulated that when the time for collection and analysis of data and the time and cooperation of the partici- pants is Of the utmost importance the Shorter more expedient 24-hour recall can be substituted for the more time consum- ing seven-day record if some errors of 10 per cent can be tolerated in calculating the mean intake of fifty or more persons. Also, since considerably less of the participant‘s time is involved, a more representative sampling of a popu— lation should be possible. Young cautioned that interchange- able use Of the 24-hour recall and the seven-day record applies only when One wishes to describe the mean intake of a group as a whole. Chalmers, et a1. (9) support the above theory for characterizing a group by its mean intake, stating that a one-day record or a 24-hour recall would appear to be the most efficient method of study. Although the day Of the week seems generally to be unimportant, an investigation of a Special group such as students, must take into account the "which day effect." Some researchers, in defending the 24-hour recall, maintain that some persons asked to keep a one-day record of food intake, will tend to eat the foods which will indicate a good balanced diet if aware Of the food essentials. In such cases more valid results would probably be Obtained by use of a 24-hour recall than by the one-day records. In the investigation reported by Young (31) essentially the same results were Obtained for the seven-day record and the 24- hour recall. This again indicated that for the sake of expediency and convenience the 24-hour recall may be justifi- ably substituted for the seven-day record. Measurement of Success In recent years, much interest in the subject of weight reduction has developed. However, of the many types Of treatment available and the new techniques which are be- ing reported in obesity therapeutics, few can be objectively evaluated by scientific standards (Feinstein 12). Such discrepancies as insuffiCient data, techniques used in describing individual performances, criteria used in stating results, and absence of data on persons who were ex- posed but did not adhere to treatment, have hampered the evaluation of the programs by scientific standards. These difficulties seem to have arisen because of the lack of a standard definition of success in the treatment of obesity and the lack of uniform criteria for measuring dietary accomplishment. The relationship of the patient's initial obese status to the amount of loss desired would appear to be the best measurement of dietary ”success." How much time is required or whether the patient adheres to the prescribed diet are of secondary importance as long as loss of weight is achieved. The easiest way to get all the desired factors into a single expression would be to modify the percentage of excess weight loss by some factor which compensates for the degree of overweight. Multiplication by the "relative initial obesity" provides this factor (Feinstein 12). Reduction Index (Feinstein 12) - WL (WI) x 100 W5 WT- WL = Weight Loss WI = Initial Weight WS = Surplus Weight ST = Target Weight Factors Which Affect Body Weight Researchers in the field of weight control have ac- cepted the theory that the intake of calories in excess of metabolic demands is the basic cause of obesity (Pollack, et a1. 23). However, many factors such as calorie intake, energy expenditure, and metabolism relate to body weight. According to Proudfit and Robinson (24), food intake may be affected by economic status, social custom, and psychological disturbances. In many persons overweight re— sults from family customs of using concentrated high-calorie foods, of including rich party foods for entertaining in addition to usual mealtime eating, and of consuming excess amounts of carbohydrate foods because they are inexpensive. Proudfit and Robinson (24) report an increasing aware- ness of the psychological aSpectS of obesity in recent years. Researchers have emphasized that eating is sometimes a solace and pleasure to the individual who is bored, feels lonely or unloved, has become discontented with his family or his social or financial standing, or who needs an excuse to avoid the realities of life.. Muscular activity is the largest single influence on energy requirements. Mayer (21) approaches this subject from the basis of natural selection. He hypothesizes natural selection, operating for hundreds of years, made men active and resourceful creatures, well prepared to be hunters, fishermen, or farmers. He theorizes the body’s food regu— lating mechanism was adapted to this type of life and not to the modern age of mechanization and sedentary work. To avoid obesity under these modern conditions, a person would have to step up activity or endure mild or acute hunger throughout life. Since few would elect to follow the latter recommendation, the former one Should be carefully considered. Mayer does not recommend strenuous exercise for the already obese untrained person but suggests a reorganization of the individual's life to include regular exercise adapted to his physical capacity. Age, sex, glandular malfunction, and genetic differ- ences may influence metabolism and, subsequently, body weight. According to Armstrong, et a1. (3), age is a factor in determining the basal activity level. As a result, daily food intake, chosen by the young individual no longer corresponds to his actual requirements, as he grows Older and his metabolic rate tends to decrease. Several diseases, due to their influence on metabolism, are accompanied by a gain in body weight (McLester and Darby 20). In some cases this is primarily due to a disturbance in water balance; under other conditions genuine accumu- lation of fat, which is abnormal in amount and distribution, occurs. The precise nature of the metabolic disturbance which leads to such accumulation Of fat is unknown, but it is significant that all recognized disorders of this type are believed to be related to some derangement of the glands of internal secretion (McLester and Darby 20). Mayer (21) supports the above theory, but Sebrell (25) is Of the Opinion that many people believe their Obesity to be Of endocrine origin. He indicates that although this factor cannot be disregarded in the etiology of obesity, cases in which endocrine disfunction is the sole basis for the condition are rare indeed. Some researchers feel that heredity plays a part in obesity. Hereditary obesity is claimed to be the result of some anomaly of metabolism or other physiological errors which favor the accumulation of fat (McLester and Darby 20). 10 Sebrell (25) discredited the theory that overweight is inherited and believed that this is a fallacy which has not been proven. Mayer (21) takes a different stand on this issue, stating that it has been repeatedly shown that obesity "runs in families" with genetic as well as environ— mental factors involved. Mayer reports that studies in the United States have Shown less than 10 per cent of the children whose parents have normal weight are Obese; the proportion rises to 50 if one and 80 per cent if both parents are Obese. Identical and fraternal twins have been studied and reports indicate food habits are not the main factors in- volved in the occurrence of obesity. Follow-up Studies Conducted Although mOSt weight reduction programs which have been reported were conducted in six to nine month periods, some thought was given to the long-term results as early as 1939. Gray, et a1. (14) conducted a study of Obese patients who attended an endocrine clinic from June, 1933 to March, 1938. The permanence of the weight loss was Observed. Forty-five patients were considered suitable for this analysis. During the total course of the study, weight loss averaged 25 pounds. In the follow-up period, however, an average gain of 1.2 pounds was observed. Young (30) conducted a follow-up Of the weight reduction of ten college women, l7-21 years of age, who were 17.2 to 28.2 per cent overweight. These women were studied for a three-week pre-reducing maintenance period. The subjects 11 were then studied 8-1/2 weeks on a 1400 calorie diet, in which 50 per cent of the calories were furnished by fat. Subjects lost an average of 17 pounds in 8-1/2 weeks. After, six months, Six of the eight subjects on whom follow-up information was available had maintained weight loss; one, recently married, had been only partially successful, the eighth, due to psychological factors, had reverted to her previous weight status. AS the researchers in the field become more aware of the value of the long-term study of weight reduction pro- grams, follow-up studies are being conducted over longer periods of time. Kurlander (l7) conducted a two-year follow- up of the Boston Pilot Study. In this study, groups of 15 to 20 persons met each week for counsel and guidance in weight reduction. The desirable weight for each individual was determined at the beginning of the study according to Metropolitan Life Insurance Company weight standards. Because the loss of 20 pounds may bring one person to his desirable weight but repre- sent only a beginning for another, achievement was measured in terms of the percentage of excess weight loss. Kurlander (17), assuming the ultimate goal was loss of 100 per cent of excess weight and long-term maintenance of that weight loss, Observed the percentage of success and reported as follows: 1. Of 95 persons who attended two or more sessions and whose records were followed for two years, 12 one showed a loss of 100 per cent excess weight after one year. After two years, this subject had regained about one-third of the weight lost. Since a large proportion Of the group members were ex- tremely overweight (several weighing nearly twice the de- sirable weight), Kurlander (17), after examining the second group Of reported: 1. One subjeCts who lost 50 to 100 per cent excess weight, Of 95 persons who attended two or more sessions and were followed for two years, eight Showed a loss Of 50 to 100 per cent excess weight after one year. At the end of two years, four Of the eight still showed a loss Of 50 to 100 per cent excess weight. Of 95 persons who attended two or more sessions, 43 showed a loss Of 10-100 per cent of excess weight after one year. After two years 29 of the 43 still Showed a loss of 10-100 per cent of excess weight. phase of a study conducted by Burgess (8) evaluated the results Of a weight reduction program in Virginia begun in 1953 by the Virginia Department of Public Health and Virginia Agricultural Extension Service. The final data indicated women who were overweight by 50 IPer cent or less had a tendency to maintain weight loss afteercnmpletion of a group program. On the other hand, nearly 13 half of the women who were more than 51 per cent overweight gained more than five pounds after completion of the class. Burgess stated physicians' records showed that the people who lost weight at a rapid rate while under treatment had a greater tendency to regain weight than those who lost weight less rapidly. The weight regained frequently exceeded that which was lost. Burgess reported the high percentage of women who maintained the new weight attained in this study might have been attributed to the fact that a group of women were completing the class at the time of initiation Of the survey and sufficient time needed to determine long-term maintenance had not elapsed. Burgess concluded that after the completion Of group weight reduction classes, moderately overweight women were more apt to maintain the weight losses or to lose additional weight than the markedly overWeight women. EXPERDMENTAL PROCEDURE A number of college women have served as subjects in weight reduction studies at Michigan State University in the past. The subjects entered the programs on a voluntary basis because they wanted to lose weight. All of their meals were planned and prepared by the investigators conducting the studies. The dates of participation in the studies, the amount Of Weight lost, and the addresses of participants were available. The questionnaire used in the present survey was mailed to 64 Of the original 74 subjects whose current addresses were available. A copy Of the questionnaire and the accompanying letter are included in the appendix. The questionnaire was formulated to Obtain information about the present weight status of the persons who partici- pated in the Michigan State weight reduction programs and 'factors which were thought to have possible relevance in assessing the success or failure in weight reduction or Inaintenance of weight loss. Each subject was asked to record birth date, height, .Present weight, lowest weight since the Michigan State study, ltighest weight Since the study, a one-day dietary recall and general health (major illnesses and accidents) which may have: greatly affected weight. These data were examined to detezrmine similarities and differences in personal statistics 0f tile successful and unsuccessful groups. 14 15 Success in this study was arbitrarily defined as a weight which did not exceed the recommendations of the National Research Council Publication 589 (22) by more than four pounds. For example, the publication indicates that 112 1 11 pounds is the ideal weight for a woman 58 inches tall. A subject of this height was classified as successful if her weight did not exceed 127 pounds (112 pounds plus 11 pounds plus 4 pounds). This was done to allow for the error in the reSpondent's estimation of weight and the interpolation of the tables for persons between the height designations in the tables. When the success of each person had been calcu- lated, these data were tabulated to Obtain the percentage Of: 1. The subjects successful at Michigan State and at the present time. 2. The subjects unsuccessful at Michigan State and unsuccessful at the present time. 3. The subjects successful at Michigan State and unsuccessful at the present time. 4. The subjects unsuccessful at Michigan State and successful at the present time. The subjects were requested to record yearly incomes, types Of work performed, and number Of children. These data were Obtained to examine possible relationships between success or failure in the maintenance of ideal weight and income, professional status (homemaker vs career woman), number of children and marital status. Information concerning educational background was re- quested. The subjects were asked to indicate major area of 16 college program, non-degree or degree and degree level. This information was requested to determine possible relationships between the success or failure in the maintenance of ideal weight and the amount Of education, and type of major (home economics students vs non-home economics students). The percentage of home economics students who used low calorie diets only, who dieted with or without supervision, and who used commercial low calorie foods was cOmpared with the per— centage of non-home economics students who did the same. Various questions were asked concerning the eating habits of the subjects surveyed to determine possible trends in the successful vs unsuccessful groups. Check lists were provided for the persons to indicate how often meals were planned in advance (possible answers: never, sometimes, occasionally, usually, or always); how the decision was made to include or exclude certain foods in the diet (alternatives: what I like best, what fits into the money I can Spend, things which do not take long to prepare, and foods I think will supply the necessary nutrients); and what foods were eaten more frequently than others (all food groups were included). The data concerning the decision to include or exclude certain foods in the diet were not used because of the ambiguity of the question. A 24-hour recall was requested to obtain information about the eating pattern Of the group as a whole recognizing that a 24-hour recall is not sufficient to characterize individual intakes. The calorie, protein, calcium, and iron content of the 24-hour recall was calcu- lated by using the food tables of Bowes and Church (6), 17 Taylor (27), and United States Department of Agriculture Bulletin 72 (28). A chart was provided for the subjects to enumerate the types of prescribed or self-selected diets used since the Michigan State study. These data were examined to determine the percentage of successful vs unsuccessful subjects who used them and the percentage Of previous home economics stu- dents who used them. Some researchers theorize that heredity and environment play an important part in the occurrence Of overweight in the individual. To obtain information on this point, the subjects were asked to list the family members (father, mother, brothers, sisters, husband, and children) who were overweight. To Obtain information concerning the self-perception of the overweight individual or of the participant with ideal weight about her weight status and reasons for success or failure, each subject was asked to elaborate on the factors which She felt influenced her success or failure in weight re- duction or maintenance. These data were compiled and the frequency of listing certain factors by each group, success- ful or unsuccessful, was noted. RESULTS AND DISCUSSION Of the 64 questionnaires initially mailed to the sub- jects in the survey, 33 were returned completed without further correSpondence. Two weeks after the initial mailing a follow-up letter and anOther copy of the questionnaire was mailed to subjects who had not reSponded. Ten more question— naires were received after the second mailing bringing the total to 43. Seven questionnaires were returned due to in- correct addresses and 14 subjects did not respond. According to Gee (13) and Eigelberner (11), the return of 68 per cent can be considered good. Eigelberner suggested that a return Of between 8 and 10 per cent is considered good for question- naires sent to dealers, consumers, and similar groups. In the case of Special questionnaires sent to scientists and technicians, a larger percentage of replies is Often Ob— tained. The questionnaire used in the survey reported here could be Considered a Special type because the participants were definitely interested in their weight problem and, in most cases, did not mind disclosing information about this problem. The data were examined to determine whether or not the subjects Obtained any lasting benefit from their partici- PErtion in the Michigan State University weight reduction stludies. The data were then studied to discover character- ist ics common to the successful group relative to eating 18 19 habits, activity, history of overweight family members, type of work, marital status, number of children, age, college major, and methods of weight reduction. The first phase of data examination considered the overall success of the group. Of the subjects reSponding, 46.5 per cent succeeded in attaining ideal weight. A subject was considered successful if her weight fell within four pounds of the ideal weight given in the National Research Council publication 589 (22) for a specified height. Fifty- six per cent of the subjects successful and 35 per cent of those unsuccessful in weight reduction programs at Michigan State reported ideal weight at the present time. Therefore, one-half of the subjects who were able to find sufficient motivation for weight loss while in the Michigan State study were inclined to continue a successful weight control program. The incidence of failure was far greater among the persons who were unable to lose under the experimental conditions of the Michigan State University studies. The percentage of the present success of the group surveyed as a whole and of persons successful at Michigan State is relatively high. Stunkard and.McLaren-Hume (26) reported that two years after treatment of 100 obese patients only two had maintained their weight loss. McCann and Trulson (19) did a one- and two-year follow-up of 147 patients in the Harvard School Of Public Health and found the types of treatment used were not effective for the large majority of those who had participated. Kurlander (17) re- ported in a two-year follow-up of the Boston Pilot Study 20 that of 95 persons in the original study only one Showed a loss Of 100 per cent excess weight after one year. After two years this participant had regained about one—third of the weight lost. The second phase of data examination considered the Similarities in personal statistics of the successful and unsuccessful groups surveyed. The average age of the sub- jects in the present survey was 27.5 years and the range was 22 to 35 years. The average height was 65.4 inches and the average weight was 159 pounds with a range of 120 to 239 pounds. The ideal weight for the group as a whole would be 135 1 14 pounds (22). Therefore, the group as a whole was 10 per cent overweight.“ Averages of personal statistics for subjects in these groups may be found in Tables 1 and 2 and complete data in the appendix. Forty-two per cent of the successful persons fell in an agefirange Of 20 to 25 years, whereas only 26 per cent of the unsuccessful persons fell in the same age range (Table 2). A greater percentage of the unsuccessful subjects were in the 26 to 30 age range and in the 31 to 35 age range. The percentage success and failure within each age range may be seen in Figure 1. Maritah status also appeared to be a factor in the tendency to maintain a successful weight reduction program. Fifty-five per cent of the successful subjects were un- married, whereas only 35 per cent of the unsuccessful sub- jects were single. Thus, the younger unmarried women showed a greater tendency to maintain a successful weight reduction 21 Table l The Relationship between Marital Status and Success or Failure in Weight Reduction Single Married Divorced number % number % number % Successful 11 55 9 45 - - Unsuccessful 8 35 14 61 1 4 Table 2 The Relationship between Age and Success or Failure in .Weight Reduction Age Range in Years 20-25 26-30 I_ .; 31-35 number % number % number % Successful 8 42 8 37 4 21 Unsuccessful 7 26 10 44 7 30 program than did the Older, married women. Doubtless, the social pressures exerted by job demands and the desire to be attractive to members of the Opposite sex are strong motivations in maintaining ideal weight. The relationship between marital status and the success or failure in weight reduction may be seen in Figure 2. The number of children was identical in both groups (Figure 3). More than half (60%) of the total number Of respondents had completed a Bachelor's degree. The percentage success among the subjects with a Bachelor's degree was lower than the percentage success among the subjects who had no degree 22 —-- smssm. WEIGHT REDUCTION --- museum. m newc'nou “.- P 60h- E - R "I C ‘0' 7— I‘ I E t — I I N 50- _- T r-j l | :- T " I 20— ' ' I l ' I | I I I b I I ' I ' Io - I i I ' l I T I I I I I I 1 I II I I II | I _ I 7 II I I I 20-25 mas 25-250 mm: was vans AGE FIGURE I. RELATIONSHIPS BETWEEN AGE AND SUCCESS (NR FAILURE OF WEIGHT- REDUCTION PROGRAM 23 -— smear-III. Imam aroucnou ...... mausoleum. mm newcnou p E. R C '. E N R T h- b so - “ ‘ “ I I , If... I I 50 e- l I _ ,__ I I ‘0 _ I I I I ' F”1 ' I so ,. I . I I _ I I I I 20 I— : I I I I | I I I Io .. ‘ ' I | | I I I I I . I I smou: MARRI- F'IGURE 2. RELATIONSHIPS BETWEEN MARITAL STATUS AND SLDCESS OR FAILURE OF WEIGHT EDUCTION PROGRAM. 24 _ .woouam wont acumen -..- Wt mom 'Icouo'nou J "__-"'1 ...——————4 FIGURE 3. RELATIONSHIP BETWEEN NLMBER W G'IILEREN AND SUCCESS OR FAILURE OF A WEIGHT REDUCTION PROGRAM . 25 (44% vs 50%). However, the difference was small and, in terms Of sample size, probably was not Significant. Tabu— lated data on education may be found in Table 3 and Figure 4. Table 3 The Relationship between Educational Background and Success or Failure in Weight Reduction Successful Unsuccessful Degree number % number % Non-degree 4 50 4 50 Bachelor's 12 44 15 56 Master's 4 57 3 43 Over one-third Of the total number of respondents were in an income bracket higher than the national average of $7,020 per year. Tabulated data may be found in Table 4. Fifty per cent of the persons with incomes of $5,000-$8,000 Were in their ideal weight range (Figure 5). When success was compared with failure in the group earning under $5,000, the results were 25 per cent vs 75 per cent; in the group earning over $8,000, it was 28 per cent vs 72 per cent. One reason for the low percentage of success in the group earning under $5,000 could be the lack of understanding of good planning practices. The subjects may tend to buy less expensive foods which are higher in carbohydrates and consume diets high in calories but not well balanced. The failure of the group earning over $8,000 could be due to less physical activity or consumption Of rich foods. 26 —— (WI. WEIGHT stcnou --- unsuccessrut WEIGHT aewcnou 50- '- - I I I I ' I ' I I I II I I I I I I -II I I I I I , I I I I E I' I I E f -_ ,_..II_ - N0 DEGREE B. 8. (A) M. 8. DEGREE OF EDUCATION Ir— ~ - —- -——- —- .- —- — —— FIGURE 4. RELATIONSHIP BETWEEN DEGREE OF EDUCATION AND SUCBESS' OR FAILURE OF WEIGHT FEILTION PROGRAM . 27 CUXEENML WBGHT HHUGHON WEMMT IIDUCHON 'Ill’l’nll'l "III'I’IIIL OVER 0000 RELATIONSHIP. BETWEEN FWMREIS AND INCOME OF IX WEBHT RHMDTKN SUXISS OR I¥MURE HKXWMM. 28 Table 4 The Relationship between Income and Success or Failure in Weight Reduction Successful Unsuccessful Income number % number % Under $5000 2 25 6 75 $5001-éooo 4 so 4 50 $6001-7000 2 50 2 50 $7001-8000 1 50 1 50 Over $8000 5 28 9 72 The third phase of the examination of data considered the Similarities and differences in the activity patterns Of the group who succeeded in attaining ideal weight and the group who failed. Several types Of activity were listed (complete data in the appendix). Neither group could be considered highly active in thOse activities listed (Table 5). A larger percentage Of the successful group bowled than did the unsuccessful group (60% vs 52%). Data on exercise of both groups indicated that the group which maintained ideal weight seemed to realize the importance of exercise in weight reduction more than did the overweight (65% vs 52%). Taking care of several children and doing housework could be Considered to require reasonable physical activity. In light of this, subjects were asked to indicate whether or not they did their own housework and 75 per cent of the subjects answered yes. Another facet of activity considered was the type of work done outside the home. Subjects were 29 Table 5 Activity Pattern Participation Successful Unsuccessful Type Number % Number % Bowling 12 60 12 52 Tennis 3 15 3 13 Swimming 13 65 11 47 Ice Skating 7 35 5 21 Skiing 4 20 2 8 Exercise 13 65 12 52 Walking 17 85 19 82 Gardening 1 5 3 13 Square Dancing — _ 4 17 Golf - - 1 4 Softball 1 5 1 4 Speedball 1 5 - - Badminton _ _ 1 4 Volleyball - — 1 4 Farm Chores - - l 4 Housework 15 75 14 60 Laundry 17 85 16 65 Outside Work Sedentary l 5 l 4 Adtive 11 55 5 21 3O asked to indicate whether an active, moderately active, or sedentary job was held. Fifty-five per cent Of the success- ful and 21 per cent of the unsuccessful Subjects held moderately active jobs. On the whole, a higher percentage of the subjects who attained ideal weight participated in sports, household duties, and their jobs than did overweight subjects. Data were also examined to determine the frequency of participation by the subjects. Examination indicated the successful subjects participated more frequently in most of the activities than did the unsuccessful subjects. Percent- ages may be found in Table 6 and complete data in the appendix. The results obtained lend support to the theory that overweight is basically an imbalance between calorie intake and energy output (Pollack, et a1. 23); although many other influencing factors exist. The fact that the subjects who possessed moderately active jobs were more successful may be more related to absence Of readily available food than to increased activity. To characterize the successful and unsuccessful sub- ject in weight reduction, food habits must be considered. Researchers in the field have found that the eating pattern plays an important part in maintaining ideal weight; there— fore, the fourth phase of this study was concerned with the eating patterns Of the subjects surveyed. In analyzing eating patterns, methods of control are important. One way Of controlling eating habits is the plan- ning of meals in advance. Eleven per cent of the successful subjects practiced this always, 65 per cent usually, and 24 31 Table 6 Activity Pattern Subjects Who Participated in Activities Listed - Everyday, Twice per Week, Once per Week, or Often =====-.--—-—-______. ;== Successful Unsuccessful Number % Number % Bowling 3 15 3 13 Tennis 1 5 l 4 Swimming 5 25 1 4 Ice Skating 1 5 -- -_ Skiing 1 5 -- __ Exercise 7 35 7 30 Walking 17 85 15 65 Gardening 1 5 2 8 Square dancing -- —— 1 4 Golf —- __ -- _- Softball 1 5 l 4 Speedball l 5 -_ __ Badminton -- -- 1 4 Volleyball -- -- 1 4 Farm chores -- -- l 4 Housework 15 75 12 52 Laundry 9 45 12 52 Outside work -- -- -- __ Sedentary l 5 l 4 Active 11 55 5 21 32 per cent occasionally. The unsuccessful group used this method of control less frequently: only 5 per cent reported planning in advance always, 59 per cent usually, 27 per cent occasionally, and 9 per cent never. ReSponseS from four sub- jects were not used because three lived in dormitories and one was in the Navy. From examination of data, the pre- planning of meals appeared to have exerted some influence on success and failure in weight reduction by the subjects sur— veyed. Compiled data concerning the relationship Of success or failure and the planning of meals may be found in Table 7. Table 7 The Relationship between Success and Failure and the Planning of Meals - Successful Unsuccessful Frequency Number % Number % Never -_ __ 2 9 Occasionally 4 24 6 27 Usually ll 65 13 59 Always 2 11 l 5 Information collected relative to the general eating pattern of the subjects indicated approximately 5 to 10 per cent fewer successful subjects than unsuccessful subjects Often ate foods such as canned fruits, potatoes, potato chips, fried foods, gravy, homemade breads, cake and ice cream. Five to 10 per cent more successful subjects Often ate fresh yellow vegetables, poultry, fish, eggs, and cereals. 33 Tabulation of the data on all food groups which were eaten Often may be found in Table 8 and complete data may be found in the appendix.‘ Data examination infers that the successful group ate less often those foods high in fat and carbohydrate and more Often foods low in these particular nutrients. Table 9 presents the mean intake and the range Of calories, protein, calcium, and iron consumed by the two groups. The National Research Council Allowances (22) for these nutrients, computed for women of ideal weight between 1“ .~.~' I. 25 and 45 years of age, are also listed in the table. The calorie intake reported by both groups was lower than the recommended allowances; but this is to be expected, especially in a group of persons who are overweight and are trying to remedy the situation. In this study, the mean intake of the successful group was approximately 100 calories less than the mean intake of the overweight group, but this difference is negligible. The mean protein intake of the successful and overweight group was higher than the recommended amount; the mean calcium intake was a little low in both groups, and the mean iron intake was above the recommended amount. The data on individual intakes may be found in the appendix. The data collected on subjects‘ intakes may not give a true picture of individual intake because only a 24-hour recall was used and some subjects were not eating as usual due to the Lenten Season or some other special occasion. However, according to Young, et a1. (31), the 24—hour recall Should give a fair estimate Of the group intake. 34 Table 8 . General Eating Pattern: Foods Eaten Often Successful UnsuCCessful Subjects Subjects Number % Number % Fruits Fresh 14 70 17 74 Canned 10 50 13 56 Frozen 5 25 6 26 Green Vegetables Fresh 11 55 13 56 Canned 8 40 9 39 Frozen 13 65 14 61 Other Vegetables Fresh 12 60 ll 48 Canned 5 25 10 43 Frozen 8 40 ll 48 Potatoes 7 35 11 48 Macaroni, noodles, Spaghetti 3 15 4 l7 Potato chips -- _- 1 4 Sandwiches 10 50 7 30 Meat- 19 95 22 95 Poultry 17 85 17 73 Fish ‘ 9 45 9 39 Fried Foods 2 10 4 17 Gravy 2 10 3 13 35 Table 8 (continued) Successful Unsuccessful Subjects Subjects Number %I Number 4% Eggs 7 85 18 78 Homemade breads l 5 4 17 Cookies 9 45 7 30 Cake 1 5 2 8 Pie 2 10 __ __ Cereals 13 65 13 56 Ice cream 8 40 10 43 36 moonesoaa< Hfionnoo wemwn we cow am on comm nonoomom Honoapoz HeIo ea NmNHIbnm on» OVHIHV wh ommmuwou mmma Hammmooonmna NOIO SH wwoauwom won moHImv me mommIbow vaa HDmeooonm owned nmoz owned nmoz owned nmoz owned nooz Awav nOnH Awnv nnfloamo Anwv neopond moMnOHoo i odmunH nnoflnpnz mo owned one nooz oFH o oases 37 One of the problems of nutritionists and other persons in the field is convincing the public of the practicability of using low calorie foods instead of purchasing "special low calorie foods.” Data collected from subjects (Table 10) Showed that 45 per cent Of the successful subjects and 56 per cent of the unsuccessful subjects purchased some or all Of the Special foods listed. These results suggest that items sold as "Special low calorie" foods may not possess the magic attributed to them by the advertisements and that reducing the intake of high calorie foods may be more rewarding than using the Special foods to effect weight control. Table 10 Low Calorie Foods Purchased Successful Unsuccessful Low Calorie Foods Number % Number % Salad dressing 9 45 13 56 Crackers -- -- 3 13 Breads 6 30 4 l7 Canned fruits 1 5 2 5 Artificial sweetners 6 30 6 26 At the present time, numerous regimens for dieting are being promoted. The value Of most Of these dieting methods is very doubtful.' TO determine the degree of success attained by the use of some of these methods, subjects were asked to indicate the methods used in dieting since participation in the Michigan State studies. 38 The highest percentage of success (61%) was Observed in the group that used low calorie diets only. Tabulated data Showing the relationship Of success and other methods Of dieting may be found in Table 11. The results of this examination lead one to believe that the low calorie diet used consistently in most cases of overweight due to an .1 energy imbalance will lead to a higher percentage Of success IT on a long-term basis than the pills, liquid diets, and A similar types of aids. Table 11 Types of Weight Reduction Aids Used Successful Unsuccessful Diet and Supplementary Aids Number $6 Number % Low calorie ll 73 7 35 Liquid 1 o 1 5 Low calorie + pills I 6 3 15 Liquid, pills + commercial diets 1 6 —— ~- Pills -- -- 2 10 Liquid + low calorie -- -- 4 20 Liquid, pills + other medicine -- —- 2 10 All methods 1 6 l 5 To determine whether heredity played any role in the success or failure of these subjects to maintain their ideal weights, information on the existence Of overweight among the subject's family members was examined. The data relative to overweight family members is presented in Table 12. Twenty- five per cent of the subjects of ideal weight had no 39 overweight family members but all of the subjects still overweight reported at least one overweight family member. It is not possible to draw conclusions from these limited data with relation to the effect of heredity on weight con- trol. The small differences Observed could indicate some environmental influences not identified in this study. Mayer (21) suggested that experiments with identical and fraternal twins have indicated that food habits are not always the sole cause Of overweight and that heredity cannot be ignored. Some researchers, however, disagree with this theory (Sebrell 25). Table 12 Subject's Overweight Family Members Successful Unsuccessful Family Members Number %I Number 73 Father or mother 2 10 6 26 Father and mother 4 20 l 4 Father, mother, sisters and/or _ brothers 1 5 2 8 Mother, sisters and/or brothers 5 25 8 40 Father, Sisters and/or brothers 1 5 -- -- BrotherCs) -- -— 2 8 Sister(s) -- -- 2 8 Husband 3* 3* Children 1* 1* Yes** 1 5 1 4 NO one 5 25 —- —- No answer 1 5 1 4 *In addition to others **Members of family not identified 40 Some subjects in listing factors which influenced success or failure in weight reduction suggested that working away from home played an important part by limiting constant access to food. The fifth phase of data examination was cone ducted to determine any difference in the success Of the homemaker and the career woman. Fifty-two per cent of the career women maintained ideal weight while only 45 per cent of the homemakers accomplished this goal (Table 13). The slightly greater success of the career woman may be related to being away from the temptation and easy availability Of food. It may also be due to the fact that the person who must make a public appearance every day is more conscious about how she looks. Some employment Situations may re- quire that the employee be Slim and attractive and keeping a job is sometimes sufficient motivation for weight control. Table 13 The Success or Failure in Weight Reduction of the Homemaker vs Career Woman Homemaker Career Woman Status Number % Number % Successful 9 45 12 52 Unsuccessful 11 55 11 47 The sixth phase Of this examination was conducted to determine whether more of the successful subjects surveyed were previously home economics or non-home economics students. 41 Overweight is of great concern to nutritionists and other workers in the field at the present time. If success- ful methods of weight reduction and ways of changing food habits are to be devised, it would be helpful to know how persons whose education provides reasonable knowledge of good food habits go about losing weight. The degree of Success attained by home economics students as compared with non-home economics students was 56 per cent to 39 per cent in favor of the home economics students. It was also inter- esting to see what percentage of home economics students used some of the Special dietary products on the markets. As shown in Table 14, 62 per cent of the home economics students who dieted used low calorie diets only, compared with 58 per cent non-home economics students. Twelve per cent of the home economics students, as compared with 25 per cent Of the non-home economics students, used liquid diets. The home economics students used these only under the supervision of a physician. A higher percentage Of the home economics students (37% vs 9%) used drugs, but only with doctor‘s supervision (Table 15). Supervision in dieting is important - when drugs and products about which consumers know little are used. Even when low calorie diets are used, supervision is important because most persons are not familiar with food values and the nutrient intake desirable for adequate nutrition. The inference here is that home economics train- ing may have exerted some favorable influence on the success Of subjeCts but the difference is not as great as might be ex- pected if persons used conscientiously the knowledge acquired. 42 Table 14 Comparison Of the Use Of Low Calorie Diets Low Calorie Diets Only Major Number % Home Economics Students (8) 5 62 Non-Home Economics Students (24) 14. 58 Table 15 Comparison of the Use Of Dieting Aids and Types Of Supervision Crash & Liquid Drugs Self— Self? Prescribed selected. iPrescribed selected Major Number %I Number % Number %I Number % Home Economics 1 12 -- —- 3 37 -— -_ Non-Home Economics 4 l7 2 8.3 2 8.3 4 -- Although it has been established that food habits possibly play the major role in success or failure in weight control, it was of interest to find out what factors the sub- jects felt affected their ability to maintain the strict regimens necessary in weight reduction. A necessary step to- ward successful weight reduction is recognition of factors which influence success or failure. Table 16 shows the tabu- lation of factors listed most often by all subjects (complete data in the appendix). These have been divided into the two ' ‘ .1‘hfll'7 43 main groups successful and unsuccessful discussed throughout this thesis. Seventy-five per cent of the subjects who had attained ideal weight compared with 65 per cent of the over- weight subjects seemed to realize that will power is one Of the most important factors influencing successful weight re- duction. Emotional state was also recognized as playing a Significant role. A high percentage (56%) of the unsuccess- ful persons indicated emotional status influenced success or failure. This may be explained by the fact that they were still trying to reduce and were more aware of the effect of emotions than the already successful subjects. The subjects of ideal weight (30%) placed the knowledge of food values and good nutrition high on the list of influencing factors. Even though not all the subjects surveyed were successful, most of them seemed to realize that one of the first steps toward success is the desire and determination to lose weight. After Observation of the low percentage of success among per- sons using all types of methods of weight reduction, persons in the field have come to the conclusion that will power is the most important determinant. 44 Table 16 Factors Listed Most Often as Influencing Weight Reduction Successful Unsuccessful .Factors Number %I Number '% Will power (desire and determination) 15 75 15 65 Emotional status 5 25 13 56 Motivation 4 20 4 l7 Encouragement (family, friends, etc.) 2 10 4 17 Knowledge of food values and good nutrition 6 30 3 13 Environment 2 10 -_ -_ SUMMARY AND CONCLUSION A follow-up study of subjects who participated in weight reduction studies at Michigan State University between 1950 and 1960 was conducted to determine the present weight status of these persons and possible factors influencing their success or failure in weight control. The subjects were contacted through a mail question- naire Which contained questions about physical status, age, educational background, activity, history of overweight among family members, economic status, eating habits, and factors which the subjects felt influenced success or failure in weight reduction. Forty-three of the 65 questionnaires were completed. 2 All data were examined to determine trends within the group that attained ideal weight and the group that failed. Upon examination of all the conditions which seemed to influence success or failure in weight reduction in the sur- vey reported here, most Of the successful subjects may be characterized as those who: a. Are single and between the ages of 20 and 25. b. Are in the income bracket between $5,000-$8,000. c. Are moderately active. d. Have none or very few overweight family members. e. Have a career outside the home. 45 46 Have had some nutrition education. Realize that the desire and determination to lose weight is one of the first steps tO successful weight reduction. _ d A .‘K-’ ‘- I .)O‘..a LITERATURE CITED Amos Tuck School of Administration and Finance, Darmouth College 1937 Manual on Research and Reports. McGraw- Hill, Inc., New York. Anderson, R. K. and H. R. Sandstead 1947 Nutritional appraisal and demonstration program of the United States Public Health Service. J.A.D.A. 23:101. Armstrong, D. B., L. 1. Dublin, G. M. Wheatly, and H. H. Marks 1951 Obesity and its relation to health and disease. J.A.M.A. 147:1007. Berkowitz, D. and N. Beck 1960 Long-term management Of Obesity in a union health center-analysis of suc- cess and failures. J.AWM.A. 172:7381. Bloom, E. O. 1959 Fasting as an introduction to the treatment Of Obesity. Metabolism 8:214. Bowes, A. and C. F. Church 1956 Food Values Of Portions Commonly Used, 8th ed. College Offset, Philadelphia, Pennsylvania. Brown, D. 1941 Evaluation and Investigation in Home Economics. Appleton-Century Crofts, Inc., New York, New York. 47 10. 11. 12. 13. 14. 15. 48 Burgess, M. J. 1961 A study of the progress Of weight control groups in Virginia and New York State. Thesis: Virginia Polytechnic Institute. Chalmers, F. W., M. Clayton, L. Gates, R. Tucker, A. Wertz, C: M. Young and W. D. Foster 1952 The dietary record - how many and which days. Massachu- setts Agric. Exp. Sta. Bull. 469:39. Cooper, L. F., E. M. Barber, H. S. Mitchell and H. J. Rybergen 1958 Nutrition in Health and Disease 13th ed. J. P. Lippincott, Philadelphia, Pennsylvania and Montreal, Canada. Eigelberner, J. 1926 The Investigation and Business Problems. McGraw—Hill, New York. Feinstein, A. R. 1959 Measurement of success in weight reduction. An analysis of methods and a new index. J. Chron. Dis., 10:439. Gee, W. 1950 Social Science Research Methods. Appleton-Century Crofts, Inc., New York. Gray, H. and D. E. Kallenbach 1939 Obesity treatment: Results on 212 outpatients. J.A.D.A., 15:239. Harvey, H. I. and W. D. Simmons 1954 Weight re- duction: A study of the group method: Report Of pro- gress. Amer. J. Med. Sci., 227:521. 16. 17. 18. 19. 20. 21. 22. 23. 24. 49 Hundley, J. M. 1952 Weight Control Symposium, ed. E. Eppright. Iowa State College Press. Kurlander, A. 1953 Group therapy in reducing-A two year follow-up of the Boston Pilot Study. J.A.D.A., 29:337. Leverton, R. 1952 Weight Control Symposium, ed. E. Eppright. Iowa State College Press. McCann, M. and.M. F. Trulson 1955 Long-term effect 1.. a of weight reducing programs. J.A.D.A., 31:108. 5 McLester, J. S. and W. J. Darby 1952 Nutrition and Diet in Health and Disease. W. B. Saunders CO., Philadelphia, Pa. Mayer, J. 1957 Correlation between metabolism and feeding behavior and multiple etiology of obesity. Bull. New York Acad. Med., 33:744. National Research Council 1958 Recommended Dietary Allowances publication 589. National Academy of Sciences, N.R.C. Washington, D. C. Pollack, H., C. F. Consolazio and G. Isaac 1958 Metabolic demands as a factor in weight control. J.A.M.A., 167:261. Proudfit, F. T. and C. H. Robinson 1958 Nutrition and DietflTherapy. The Macmillan CO., New York, New York. 25. 26. 27. 28. 29. 30. 31. 50 Sebrell, W. H. 1957 Symposium on obesity: Meta- bolic aSpectS of Obesity facts, fallacies and fables. Metabolism 6:411. Stunkard, A., and M. McLaren-Hume 1959 The results of treatment for obesity. Archives of Internal Med., 103:79. Taylor, C. M. 1959 Food Values in Shares and Weights. Macmillan CO. New York, New York. United States Department of Agriculture 1960 Nutritive Value of Foods. Home and Gardens Bulletin 72, United States Department of Agriculture, Washing- ton, D.C. United States Department of Commerce and Bureau of the Census 1962 Statistical Abstract Of the United States 83 Ed., ed. E. D. Goldfield. Young, C. M. 1952 Weight reduction using a moderate fat diet. 1. Clinical reSponses and energy meta- bolism. J.A.D.A., 28:414. Young, C. M., G. C. Hagan, R. Tucker and W. Foster 1958 Comparison of dietary history and seven day record with 24-hour recall. Research Bulletin 469, Massachusetts Agric. Exp. Station, Amherst, Mass. APPEND IX v.3-fl'.‘ MICHIGAN STATE UNIVERSITY East Lansing College of Home Economics . Department of Foods and Nutrition March 27, 1962 Dear As you no doubt remember, you participated in the weight reduction studies carried out here at Michigan State University. Several studies have been completed and the time has come for us to take a look at our research program and evaluate the work done these past years. This evaluation is being done with the hope that we will be able to plan more meaningful programs in the future. The attached question- naire has been designed to bring our files up to date with respect to your present physical status and to assist in the evaluation of the research program. Would you therefore please complete the questionnaire and return it to us by April the 15th? I hope you understand how much your help is needed in com- pleting this project and how much your cooperation will be appreciated. You may be certain the data in this study will be coded and that you will not be identified as an individual. With kindest personal regards, Sincerely, Dena C. Cederquist, Chairman Foods and Nutrition Department 52 QUESTIONNAIRE l mun-gs Code 1. Address 2. College Major DegreeCS) B.S. M.S. Ph.D. 3. Date of Birth . 4. Present Ht. Present Wt. Highest wt. (Since participation in study Approx. date . Lowest wt. (since participation in study Approx. date 5. Marital status. Single Married Divorced 6. Children: e an was Date S of Birth (5 bottle fed Breast fed 7. Present family income (if single-yours) under 5000 5001-6000 6001-7000 7001-8000 Over 8000 8. Work (outside the home since participation in study) Approx. Hrs. Kind Worked/Week Duration a. 19 __ to 19_ b. 19 _ to 19_ c 19 __ to 19_ d. 19 __ to 19_ e. 19 __ to 19_ 9. Do you do all of your house work? Yes NO Laundry? Yes NO - 53 “£32.. _ 54 10. Recreation Frequenc Since Study - Twice Oncelper Once per per Every Kind Week 2 Weeks Week day; Often Occasionally Bowling Tennis Swimmingi 1.. Ice Skating Skiing Sitting up exercises Walking - Other 11. a. Have you had a thorough physical examination since C. participation in the study? Yes NO How often have you had a physical examination? Every six months. Annually. During pregnancy. Occasionally (no regular time). Any recommendations for weight loss? 12. Physical status (Since participation in study) 3.. Operations Approx. date Length Of Con- finement 13. 14. 55 b. Illnesses or accidents which caused you to be confined. Approx. date Length Of Confinement 1.‘ 2. '3. 4. c. Allergies which affect your eating habits. 1. 2. 3. an..." '- . u 4. Do other members Of your family (father, mother, brothers, sisters, husband, children) have problems in maintenance of normal weight? What factorCs) do you feel contribute to success or failure in losing weight? 56 oumo mmo mpowm :mpofio muofim ofinoamo mmoa .On 0 .on o .n> n30 .Ovo .xonnd< pnwfioy .Eoo nmmAO: Oflnvflq 30H n30» no .pmfinOfiufinp nonpo onfiumwmz .Eoo mooom Inn .mnoPooov so noone so oooa< so noon< nenooaz eoaon>nooom condemn noon: onfip mo OOMHod nOMmfi>nodnm .Aono nomo mo mo oddp doonov mmoa pnwfios one poop mo odd» .oswp mo powwon .noamfl>nodnm .D.m.2 pa wnfipmdMOHnnmd oonfiw Coma muowm nowponood pnwfioz .mn 57 16. DO you plan menus for your family's meals in advance? never occasionally usually always 17. How do you decide what to serve (to eat) at meals? a. What they (I) like best b. What fits into the money I can spend c. Things which don't take long to prepare d. Foods I think will supply necessary nutrients . e. What I have on hand 18. Foods I serve myself or my family (Please check one column after each food). Fruit - Fresh anne rozen Green Vegetables Fresh anne rozen Other Vegetables Fresh anne rozen Potatoes acaroni a e O a O 1 S an W1C es ea ou r s .rie O S ra s omema e rea OO ies a e 1e erea S ce ream Often Occasionally Seldom Never 1 19. 58 DO you buy any special foods for use in low calorie diets? Salad dressing Crackers Breads Canned fruit Artificial sweetners 59 20. 24 Hour Recall Record. (Record the kinds and amount Of all foods eaten by you in the previous 24 hours. Be sure to include beverages, soft drinks - beer, wine, mixed drinks, cream and sugar used in beverages). Breakfast Lunch Dinner Snacks 21. Comments - 60 Table 17 Personal Statistics Successful Subjects Marital Number Of (code) Age Height Weight Status Children 176 -- 5'3" 130 S —— 137 22 6'0" 160 s -- 175 31 5'9” 148 M 4 142 26 5'4" 145 S -- 145 22 5'8” 160 S -- 141 22 5'2" 124 s -- 135 29 5'2" 129 M 3 143 26 5'5-1/2" 141 M -- 147 23 5'6-1/4" 153 S -- 168 30 5'6" 145 M —— 165 25 5'8-1/4" 160 S -— 119 26 5'6" 138 M 5 115 29 5'1/2" 120 M. 1 113 28 5'2-1/2" 125 M 4 151 35 5'5" 145 M 3 131 34 5'2" 124 M 2 183 34 5'9—1/2n 164 S -— 189 22 5'7" 142 s —— 191 24 5'65 130 S -— 188 24 5'7-1/2" 157 S —— 61 Table 18 Personal Statistics Unsuccessful Subjects Marital Number Of (code) Age Height Weight Status Children 139 23 5'7" 165 S —- 123 28 5'3-1/2" 155 M 1 116 30 5‘6-3/4” 185 M 1 114 33 5'3" 239 M 4 122 26 5'2" 153 S -— 156 32 5'1" 141 S —- 162 30 5'4" 147 S -— 149 30 5'6" 170 M 5 164 31 5'4-1/2n 150 M 2 166 25 5'11" 182 S -— 158 31 5'4-1/2n 175 M 7 126 28 5'2—1/4" 167 M 2 148 24 5'4” 170 S -— 134 25 5'8-1/2" 200 D 1 159 31 5'5" 163 M 4 177 25 5'9" 190 M —— 169 29 5'6" 155 M 3 125 27 5'8" 236 M 1 170 31 5'1/2" 167 S -— 186 22 5'8-1/2" 174 S —— 184 31 5'6" 160 M —— 124 27 5'2-1/2" 166 M. 2 185 30 5'6-1/4" 220 M 1 General Eating Pattern (Successful subjects) 62 Table 19 Often Occasionally Seldom Never Fruits - fresh l4 5 l - canned 10 7 3 - frozen 5 9 3 1 Green vegetables fresh ll 6 3 - canned 8 5 4 2 frozen l3 5 2 - Other vegetables fresh 12 7 1 — canned 5 10 2 2 frozen 8 6 2 l Potatoes 7 5 7 l Macaroni, noodles, Spaghetti 3 8 7 3 Potato chips - 5 13 1 Sandwiches 10 7 2 - Meat 19 1 1 - Poultry 17 1 2 - Fish 9 8 3 - Fried foods 2 8 9 l Gravy 2 4 8 5 Eggs 17 2 1 - Homemade bread 1 3 12 3 Cookies 9 5 6 - Cake 1 12 7 - Pie 2 13 7 - Cereals l3 2 3 - Ice Cream 8 7 4 1 63 Table 20 General Eating Patterns (Unsuccessful Subjects) Often Occasionally Seldom Never Fruits fresh 17 5 —- -- canned 13 7 1 -- frozen 6 9 4 2 Green Vegetables fresh l3 8 -- l canned 9 7 3 1 frozen 14 6 2 -- Other Vegetables fresh 11 9 -- -- canned 10 8 2 -- frozen 11 9 -- 1 Potatoes ll 4 6 -- Macaroni, noodles, Spaghetti 4 9 8 -— Potato chips 1 7 13 1 Sandwiches 7 7 8 -- Meat 22 Poultry 17 5 -- -- Fish 9 10 3 -- Fried foods 4 7 11 -- Gravy 3 4 10 4 Eggs 18 4 -_ __ Homemade bread 4 5 6 6 Cookies 7 11 4 -_ Cake 2 9 ll -- Pie -- 7 12 1 Cereals l3 3 4 2 Ice Cream 10 9 2 1 64 Table 21 Nutrient Intake (Successful Subjects) Protein Calcium Iron Subjects Calories (gm) (mg) (mg) 137 982 47 305 19 175 2206 165 1988 37 142 1352 85 750 12 145 1921 82 430 20 141 1173 43 651 6 135 1054 62 187 29 143 2000 68 469 21 147 1795 77 815 10 168 1514 60 547 25 165 1328 52 1067 6 119 1582 59 857 62 115 1571 111 609 13 113 1371 52 580 8 151 1542 54 588 7 131 867 55 588 7 183 1284 67 758 8 189 2009 99 1163 14 191 ' 1131 51 395' 20 65 Table 22 Nutrient Intake (Unsuccessful Subjects) Protein Calcium Iron Subjects Calories (gm) (mg) (mg) 139 1142 46 481 7 123 1190 149 500 28 116 2197 66 507 13 122 1749 65 506 41 156 1959 68 367 12 162 1266 75 578 33 149 1456 100 902 14 164 1691 59 903 14 166 1540 56 1029 6 158 2184 69 954 9 126 1721 104 914 12 148 1594 114 636 11 134 1646 53 452 9 159 1540 107 975 19 177 1422 64 1234 8 169 708 68 465 7 125 1101 74 960 10 170 2230 92 762 11 186 2287 101 1192 13 184 865 41 483 7 124 1159 64 877 9 66 Table 23 Activity Pattern (Number of Successful Subjects Participating) TYPe Frequency Once/ . Once/ two Twice/ Every— wk. wks. wk. day Often Occas. Total Bowling 1 l -- -- 2 8 12 Tennis -- -- -- -- l ' 2 3 Swimming -- -- -- -- 5 8 13 Ice Skating -- 1 -- l -- 5 7 Skiing -- -- -- -- 1 3 4 Exercise -- 1 -- 5 2 5 13 Walking 1 -- -- 11 5 -- 17 Gardening -- -- -- -- l -— 1 Square dancing -- -- —— __ __ __ __ Golf -- -- -- -- -— -- -- Softball -- -- -- -- 1 -- 1 Speedball -- -- -- -- 1 -- 1 Badminton -- -- -- -- -- -- -- Volleyball -- -- -- -- -- -- -- Farm chores -- —— —- __ -- -- _- Housework -- -- 4 8 3 -- 15 Laundry 4 8 4 1 -- -- 17 Outside work Sedentary -- -- -- 1 -- -- 1 Active 2 -- -- 9 -- -- ll 67 Table 24 Activity Pattern (Number Of Unsuccessful Subjects Participating) -—-___-_u___-___________---u-_-.—-—-—-—-—-—-—=—==-—=—== TYPe Frequency I Once/ Once/ two Twice/ Every- wk. wks. wk. day Often Occas. Total Bowling 3 -- -- -- -- 9 12 Tennis -— —- -- -- 1 2 3 Swimming -- -- -- 1 -- 10 11 Ice Skating -— —- -- _- -- 5 5 Skiing -- -- -- -- -- 2 2 Exercise l-- -- 1 2 4 5 12 Walking 1 -- 2 6 6 4 19 Gardening 1 -- -- l 1 -- 3 Square dancing 1 2 -- -- -- l 4 Golf -- -- -- -- —- 1 1 Softball -- —— -- __ 1 __ 1 Speedball -- -- -- -- -- -— —- Badminton --- -- —— -- 1 _- 1 Volleyball -- -— __ -- 1 __ 1 Farm chores 1 -- -- -- -- -- l Housework 1 2 3 8 -- -- 14 Laundry 9 4 2 1 -- -— 16 Outside work Sedentary -- -- -- 1 -- -- 1 Active -- —— —_ 5 -_ _- 5 68 Table 25 Factors Influencing Weight Reduction as Listed by _ Subjects Successful Unsuccessful Factors Number % Number % Will power (desire and determination) 15 75 15 65 Emotional status 5 25 13 56 Motivation 4 20 4 20 Encouragement (family, friends, etc.) 2 10 4 20 Knowledge of food values and good nutrition 6 30 3 13 Exercise 3 15 -— _- Environment 2 10 5 21 Admission of weight problem 1 5 3 13 Type of work (sedentary or active) 2 10 2 9 Boredom 2 10 l 4 Working away from home 2 10 -- -- Companionship (others dieting too) 2 10 1 4 Metabolic disturbance -- -- 2 9 Substitution (doing some- thing to take mind off food) 2 10 1 4 Age -- -- 1 4 Long term dieting 2 10 2 9 Variety in food 3 15 -- -- ROOM USE ONLY