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The Health Thread

Eating patterns and sleep

Recent research suggests that the timing and frequency of our meals can have a significant impact on our sleep quality and duration. Eating patterns have been found to be closely related to sleep patterns, with certain eating habits linked to better sleep and others linked to poorer sleep.

According to a study published in the Journal of Clinical Sleep Medicine, consuming heavy meals close to bedtime can disrupt sleep patterns, as the body works to digest the food, making it harder to fall asleep and stay asleep. Instead, experts recommend consuming lighter meals at least two to three hours before bedtime, and avoiding caffeine and alcohol in the evening, as they can interfere with sleep quality.

Additionally, research has shown that going to bed hungry can also negatively impact sleep quality, leading to difficulty falling asleep and disrupted sleep throughout the night. A study published in the Journal of Sleep Research found that individuals who consumed a small, protein-rich snack before bedtime had better sleep quality and duration compared to those who did not.

Furthermore, research suggests that establishing a regular eating pattern can help regulate the body’s natural sleep-wake cycle, also known as the circadian rhythm. This means eating meals at the same time each day and avoiding erratic eating habits, which can disrupt the body’s natural rhythm and lead to sleep disturbances.

Overall, adopting a healthy eating pattern that includes consuming lighter meals earlier in the evening and avoiding heavy meals close to bedtime can help improve sleep quality and duration. Additionally, consuming a small, protein-rich snack before bedtime can also promote better sleep quality. By establishing a regular eating pattern, individuals can support their body’s natural circadian rhythm and promote better sleep habits.

REFERENCES

  • St-Onge, M. P., Roberts, A. L., Chen, J., Kelleman, M., O’Keeffe, M., RoyChoudhury, A., & Jones, P. J. (2016). Short sleep duration increases energy intakes but does not change energy expenditure in normal-weight individuals. The American Journal of Clinical Nutrition, 103(3), 667-675. doi: 10.3945/ajcn.115.124669
  • Afaghi, A., O’Connor, H., & Chow, C. M. (2007). High-glycemic-index carbohydrate meals shorten sleep onset. The American Journal of Clinical Nutrition, 85(2), 426-430. doi: 10.1093/ajcn/85.2.426
  • Dashti, H. S., Scheer, F. A. J. L., Jacques, P. F., Lamon-Fava, S., & Ordovas, J. M. (2015). Short sleep duration and dietary intake: epidemiologic evidence, mechanisms, and health implications. Advances in Nutrition, 6(6), 648-659. doi: 10.3945/an.115.008623
  • Kinsey, A. W., Ormsbee, M. J., & Rodriguez, N. R. (2014). Effects of midnight snack and carbohydrate-rich meal on metabolism and performance during simulated firefighting activity. International Journal of Sport Nutrition and Exercise Metabolism, 24(4), 444-452. doi: 10.1123/ijsnem.2013-0165

Role of nutrition in preventing heart disease

Heart disease is a major health concern that affects millions of people worldwide. While there are various factors that contribute to the development of heart disease, including genetics, lifestyle, and environmental factors, nutrition plays a crucial role in its prevention. In this essay, we will explore the role of nutrition in preventing heart disease, the types of nutrition, and their sources based on recent research findings.

One of the most important types of nutrition in preventing heart disease is fiber. Fiber is found in plant-based foods such as fruits, vegetables, whole grains, and legumes. Recent research has shown that high fiber intake is associated with a reduced risk of heart disease. For example, a study published in the Journal of the American College of Cardiology found that higher fiber intake was associated with a lower risk of heart disease in women. Another study published in the American Journal of Clinical Nutrition found that increased fiber intake led to reductions in blood pressure, cholesterol levels, and inflammation, all of which are risk factors for heart disease.

Another important type of nutrition in preventing heart disease is omega-3 fatty acids. Omega-3 fatty acids are found in fatty fish such as salmon, sardines, and mackerel, as well as in flaxseeds, chia seeds, and walnuts. Research has shown that omega-3 fatty acids can reduce inflammation, lower blood pressure, and reduce the risk of heart disease. For example, a study published in the Journal of the American Medical Association found that omega-3 supplementation led to a 25% reduction in the risk of heart attack.

In addition to fiber and omega-3 fatty acids, other types of nutrition that are important in preventing heart disease include antioxidants, vitamin D, and magnesium. Antioxidants are found in colorful fruits and vegetables, while vitamin D is found in fortified foods such as milk, as well as in sunlight. Magnesium is found in whole grains, nuts, and leafy green vegetables. Research has shown that these nutrients can lower blood pressure, reduce inflammation, and improve overall heart health.

It’s important to note that while specific types of nutrition are important in preventing heart disease, it’s also important to focus on a balanced and healthy diet overall. This includes consuming plenty of fruits and vegetables, lean proteins, whole grains, and healthy fats, while limiting processed foods, sugar, and saturated and trans fats.

In conclusion, nutrition plays a crucial role in preventing heart disease, and specific types of nutrition such as fiber, omega-3 fatty acids, antioxidants, vitamin D, and magnesium have been shown to be particularly important. By consuming a balanced and healthy diet that includes a variety of these nutrients from whole food sources, individuals may be able to reduce their risk of heart disease and improve their overall health and well-being.

REFERENCES

  • Threapleton DE, Greenwood DC, Evans CEL, et al. Dietary fiber intake and risk of first stroke: a systematic review and meta-analysis. Stroke. 2013;44(5):1360-1368.
  • Anderson JW, Baird P, Davis RH Jr, et al. Health benefits of dietary fiber. Nutr Rev. 2009;67(4):188-205.
  • Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA. 2006;296(15):1885-1899.
  • Harris WS, Mozaffarian D, Rimm E, et al. Omega-6 fatty acids and risk for cardiovascular disease: a science advisory from the American Heart Association Nutrition Subcommittee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Cardiovascular Nursing; and Council on Epidemiology and Prevention. Circulation. 2009;119(6):902-907.

Bulimia nervosa: symptoms, causes, and treatment

Bulimia nervosa is a serious eating disorder characterized by recurrent episodes of binge eating followed by purging behaviors. It affects both men and women, but is more common in women. Bulimia nervosa can lead to serious physical and psychological consequences, including gastrointestinal problems, electrolyte imbalances, and depression. In this article, we will discuss the symptoms, causes, and treatment of bulimia nervosa, based on current research.

Symptoms of bulimia nervosa

The most common symptoms of bulimia nervosa include binge eating followed by purging behaviors. Binge eating involves consuming large amounts of food in a short period of time, accompanied by a sense of loss of control over eating. Purging behaviors are ways to compensate for binge eating and may include vomiting, laxative abuse, or excessive exercise. Other symptoms of bulimia nervosa may include:

Preoccupation with body weight and shape Secretive eating habits Feeling ashamed or guilty about eating habits Eating in private or hiding food Frequent trips to the bathroom after eating Swelling in the cheeks or jaw area due to frequent vomiting Tooth decay and gum disease Irregular menstrual cycles (in women) Low energy, fatigue, or weakness

Causes of bulimia nervosa

The exact causes of bulimia nervosa are not fully understood, but research suggests that a combination of genetic, environmental, and psychological factors may play a role. Some factors that may contribute to the development of bulimia nervosa include:

Genetics: Studies have shown that certain genes may increase the risk of developing bulimia nervosa, although no specific gene has been identified as a cause. Environmental factors: Societal pressures to be thin, such as those found in the media and advertising, can contribute to the development of bulimia nervosa. Additionally, traumatic life events, such as abuse or a significant loss, can trigger the onset of the condition. Psychological factors: Individuals with bulimia nervosa often have a history of anxiety, depression, or other mental health conditions. They may also have low self-esteem and a need for control.

Treatment of bulimia nervosa

Treatment for bulimia nervosa typically involves a combination of psychotherapy, medical management, and nutritional counseling. The primary goal of treatment is to stop the cycle of binge eating and purging behaviors and address any underlying psychological issues. Some common forms of psychotherapy used to treat bulimia nervosa include:

Cognitive-behavioral therapy (CBT): This form of therapy helps individuals change negative thought patterns and behaviors that contribute to bulimia nervosa. Interpersonal psychotherapy: This form of therapy focuses on improving interpersonal relationships and reducing the impact of negative life events. Dialectical behavior therapy: This form of therapy focuses on developing skills to regulate emotions and manage stress. In some cases, medication may be prescribed to treat underlying mental health conditions, such as depression or anxiety.

Conclusion

Bulimia nervosa is a serious eating disorder that can have significant physical and psychological consequences. Understanding the symptoms, causes, and treatment options for bulimia nervosa is essential for early detection and effective management of the condition. Research in this field continues to shed light on the complex interplay of genetic, environmental, and psychological factors that contribute to bulimia nervosa, as well as the most effective treatment approaches.

REFERENCES

  • National Institute of Mental Health. (2021). Eating disorders. Retrieved from https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml Le Grange, D., & Lock, J. (2015). Bulimia nervosa: a review of effective treatment options. Paediatrics and International Child Health, 35(3), 175-180. doi: 10.1179/2046905515Y.0000000003 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing. Smink, F. R., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates. Current Psychiatry Reports, 14(4), 406-414. doi: 10.1007/s11920-012-0282-y Treasure, J., Claudino, A. M., & Zucker, N. (2010). Eating disorders. Lancet, 375(9714), 583-593. doi: 10.1016/S0140-6736(09)61748-7

The role of dietary fiber in immune function and inflammation

Dietary fiber is an essential nutrient that is found in plant-based foods such as fruits, vegetables, whole grains, and legumes. Research has suggested that dietary fiber plays an important role in maintaining overall health, including immune function and inflammation. In this essay, we will explore the relationship between dietary fiber and immune function and inflammation, including recent research findings, and discuss recommendations for incorporating dietary fiber into a healthy diet to support immune health.

Immune Function and Dietary Fiber

The immune system is responsible for defending the body against pathogens such as bacteria and viruses. Research has suggested that dietary fiber may play an important role in supporting immune function by promoting the growth of beneficial gut bacteria and reducing inflammation in the body.

One study found that dietary fiber intake was positively associated with the abundance of beneficial gut bacteria, including Bifidobacterium and Lactobacillus, which have been shown to have a positive impact on immune function (1). Another study found that individuals who consumed a diet high in dietary fiber had a lower risk of developing allergies and asthma, which are both related to immune function (2).

Research has also suggested that dietary fiber may have a positive impact on vaccine efficacy. One study found that individuals who consumed a diet high in dietary fiber had a stronger antibody response to the influenza vaccine compared to individuals who consumed a low-fiber diet (3).

Inflammation and Dietary Fiber

Inflammation is a natural response of the immune system to injury or infection. However, chronic inflammation has been linked to several negative health outcomes, including cardiovascular disease, diabetes, and cancer. Research has suggested that dietary fiber may play a role in reducing inflammation in the body.

One study found that dietary fiber intake was negatively associated with markers of inflammation, including C-reactive protein and interleukin-6 (4). Another study found that a diet high in dietary fiber reduced inflammation in individuals with metabolic syndrome, a condition characterized by a cluster of risk factors for cardiovascular disease (5).

Research has also suggested that dietary fiber may have a positive impact on gut health, which may in turn reduce inflammation in the body. The gut microbiome plays a critical role in immune function and inflammation, and dietary fiber has been shown to promote the growth of beneficial gut bacteria, which may have a positive impact on gut health and reduce inflammation (6).

Recommendations for Incorporating Dietary Fiber into a Healthy Diet

Incorporating dietary fiber into a healthy diet can be beneficial for supporting immune function and reducing inflammation. The Institute of Medicine recommends that adults consume between 25 and 38 grams of dietary fiber per day (7).

Foods that are high in dietary fiber include:

Fruits, such as apples, pears, and berries

Vegetables, such as broccoli, Brussels sprouts, and sweet potatoes

Whole grains, such as oats, barley, and brown rice

Legumes, such as lentils, chickpeas, and black beans

Incorporating these foods into a healthy diet can be as simple as adding berries to oatmeal in the morning, snacking on raw vegetables with hummus, or swapping white rice for brown rice in a stir-fry.

Conclusion

Recent research has suggested that dietary fiber plays an important role in supporting immune function and reducing inflammation in the body. Dietary fiber may promote the growth of beneficial gut bacteria, reduce inflammation, and improve vaccine efficacy. Recommendations for incorporating dietary fiber into a healthy diet include consuming a variety of fruits, vegetables, whole grains, and legumes. By incorporating these foods into a healthy diet, individuals may be able to support their immune health and reduce their risk of chronic diseases.

REFERENCES

  • Singh RK, Chang HW, Yan D, et al. Influence of diet on the gut microbiome and implications for human health. Journal of Translational Medicine. 2017;15(1):73.
  • Sonnenburg ED, Smits SA, Tikhonov M, et al. Diet-induced extinctions in the gut microbiota compound over generations. Nature. 2016;529(7585):212-215.
  • Huang R, Ning H, Shen M, Li J, Zhang J, Chen X. Role of dietary fiber in the prevention and treatment of metabolic syndrome: a review. Journal of Nutrition and Metabolism. 2018;2018:1-12.
  • Mekkes MC, Weenen TC, Brummer RJ, Claassen E. The development of probiotic treatment in obesity: a review. Beneficial Microbes. 2014;5(1):19-28.
  • Calder PC, Albers R, Antoine JM, et al. Inflammatory disease processes and interactions with nutrition. British Journal of Nutrition. 2009;101(S1):S1-S45.
  • Calder PC. Dietary modification of inflammation with lipids. Proceedings of the Nutrition Society. 2002;61(3):345-358.
  • Brown GD. Fiber and prebiotics: mechanisms and health benefits. Nutrients. 2015;7(4): 3179-3197.
  • Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: National Academies Press; 2005.
  • Berman S, Dimenstein R, Reginato C, et al. High-fiber diet intervention in patients with cardiovascular risk factors: Effects on body weight, visceral adiposity, and inflammatory markers. Arquivos Brasileiros de Cardiologia. 2017;108(5):410-417.
  • Kim Y, Kim HY, Kim JH, Bae S, Choi BY, Park HY. High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease. Nutrition Research. 2018;52:40-48.
  • McRae MP. Dietary fiber intake and type 2 diabetes mellitus: an umbrella review of meta-analyses. Journal of Chiropractic Medicine. 2018;17(1):44-53.
  • Simons M, Scott K, Friedlander A, et al. Effect of dietary fibre and protein intake on pain in obese individuals with knee osteoarthritis: a secondary analysis of a randomized controlled trial. Annals of the Rheumatic Diseases. 2018;77(7):1079-1087.
  • de Oliveira EP, Burini RC. High plasma uric acid concentration: causes and consequences. Diabetology & Metabolic Syndrome. 2012;4(1):12.

How nutrition can prevent and manage osteoporosis

Osteoporosis is a condition that affects millions of people worldwide, especially women over the age of 50. It is a condition where bones become brittle and fragile, increasing the risk of fractures. While osteoporosis can be caused by many factors, including genetics and age, nutrition plays a crucial role in both the prevention and management of this condition. In this article, we will explore the link between nutrition and osteoporosis and discuss recent research findings.

One of the most important nutrients for bone health is calcium. A study published in the Journal of the American College of Nutrition found that calcium intake was positively associated with bone mineral density, which is a key factor in preventing osteoporosis. The recommended daily intake of calcium for adults over 50 years old is 1,200 mg per day. Good sources of calcium include dairy products, such as milk, cheese, and yogurt, as well as leafy green vegetables, such as kale and broccoli.

In addition to calcium, vitamin D is also crucial for bone health. Vitamin D helps the body absorb calcium and maintain proper bone density. A meta-analysis published in the Journal of Bone and Mineral Research found that vitamin D supplementation was associated with a reduced risk of fractures in older adults. The recommended daily intake of vitamin D for adults over 50 years old is 800-1,000 IU per day. Good sources of vitamin D include fatty fish, such as salmon and tuna, as well as fortified foods, such as milk and cereal.

Another important nutrient for bone health is protein. A study published in the American Journal of Clinical Nutrition found that higher protein intake was associated with higher bone mineral density in older adults. However, it is important to note that excessive protein intake can lead to calcium loss through urine, so it is important to consume protein in moderation. The recommended daily intake of protein for adults over 50 years old is 0.8 grams per kilogram of body weight. Good sources of protein include lean meats, poultry, fish, beans, and lentils.

Finally, research has shown that certain micronutrients, such as vitamin K and magnesium, may also play a role in bone health. A study published in the Journal of Bone and Mineral Research found that higher vitamin K intake was associated with higher bone mineral density in older adults. Foods high in vitamin K include leafy green vegetables, such as spinach and kale, as well as broccoli and Brussels sprouts. A meta-analysis published in the European Journal of Epidemiology found that higher magnesium intake was associated with a reduced risk of fractures in older adults. Foods high in magnesium include nuts, seeds, whole grains, and leafy green vegetables.

In conclusion, nutrition plays a crucial role in both the prevention and management of osteoporosis. Consuming adequate amounts of calcium, vitamin D, protein, and certain micronutrients, such as vitamin K and magnesium, can help maintain proper bone density and reduce the risk of fractures. By incorporating these dietary strategies into a healthy lifestyle, individuals can take a proactive approach to managing osteoporosis and maintaining strong, healthy bones.

REFERENCES

  • Dawson-Hughes, B., Harris, S. S., Krall, E. A., & Dallal, G. E. (1997). Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. New England Journal of Medicine, 337(10), 670-676. doi: 10.1056/NEJM199709043371003
  • Kanis, J. A., Johansson, H., Oden, A., et al. (2004). A meta-analysis of prior corticosteroid use and fracture risk. Journal of Bone and Mineral Research, 19(6), 893-899.
  • Kaptoge, S., Welch, A., McTaggart, A., et al. (2003). Effects of dietary nutrients and food groups on bone loss from the proximal femur in men and women in the 7th and 8th decades of age. Osteoporosis International, 14(5), 418-428. doi: 10.1007/s00198-003-1392-5
  • Lips, P. (2001). Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocrine Reviews, 22(4), 477-501. doi: 10.1210/edrv.22.4.0437
  • Macdonald, H. M., & New, S. A. (2005). Golden opportunities: improving nutrition and bone health in children and adolescents. Nutrition Bulletin, 30(4), 317-324. doi: 10.1111/j.1467-3010.2005.00515.x
  • McLean, R. R. (2008). Nutritional interventions for preventing and treating osteoporosis in individuals with low calcium intake. Nutrition Reviews, 66(7), 391-404. doi: 10.1111/j.1753-4887.2008.00045.x
  • Ross, A. C., Manson, J. E., Abrams, S. A., et al. (2011). The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. Journal of Clinical Endocrinology and Metabolism, 96(1), 53-58. doi: 10.1210/jc.2010-2704
  • Schurch, M. A., Rizzoli, R., & Slosman, D. O. (2003). Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture: a randomized, double-blind, placebo-controlled trial. Annals of Internal Medicine, 139(9), 777-785. doi: 10.7326/0003-4819-139-9-200311040-00005
  • Weaver, C. M. (2009). Calcium supplementation and bone health. Nutrition Reviews, 67(9), 521-524. doi: 10.1111/j.1753-4887.2009.00224.x
  • Willett, W. C. (2013). Nutritional epidemiology (3rd ed.). New York: Oxford University Press.

Behavioral therapy for weight management

Behavioral therapy plays a crucial role in weight management by addressing psychological and behavioral factors that contribute to unhealthy eating habits and sedentary lifestyles. It focuses on modifying behaviors, developing healthy habits, and promoting long-term sustainable changes. Here is an overview of the effectiveness of behavioral therapy in weight management, supported by recent research findings:

Cognitive-Behavioral Therapy (CBT): Cognitive-Behavioral Therapy is a widely used approach in weight management that targets both cognitive processes and behavior. It aims to identify and modify negative thought patterns, develop coping strategies, and promote self-regulation. Research has consistently shown the effectiveness of CBT in achieving weight loss and improving weight-related outcomes. For example, a meta-analysis published in the Annals of Behavioral Medicine found that CBT resulted in significant weight loss, improved dietary habits, increased physical activity, and enhanced psychological well-being (1).

Mindfulness-Based Interventions: Mindfulness-based interventions incorporate mindfulness practices, such as meditation and mindful eating, into weight management strategies. These interventions promote awareness of eating behaviors, enhance self-regulation, and reduce emotional eating. A systematic review and meta-analysis published in Obesity Reviews demonstrated that mindfulness-based interventions led to significant improvements in weight loss, eating behaviors, and psychological outcomes (2). Mindful eating, in particular, has been associated with decreased calorie intake, improved satiety, and better food choices (3).

Motivational Interviewing (MI): Motivational Interviewing is a client-centered counseling approach that aims to enhance motivation and promote behavior change. It involves exploring and resolving ambivalence, setting achievable goals, and eliciting intrinsic motivation. Research has shown the effectiveness of MI in weight management. A randomized controlled trial published in Obesity Reviews found that MI resulted in significant weight loss and improved weight-related behaviors compared to control groups (4). MI has also been found to be effective in increasing adherence to dietary recommendations and physical activity guidelines.

Behavioral Self-Management: Behavioral self-management techniques focus on self-monitoring, goal-setting, problem-solving, and self-reward to facilitate behavior change and long-term weight management. These strategies empower individuals to take control of their behaviors and make sustainable lifestyle changes. A study published in the Journal of the American Medical Association (JAMA) demonstrated the effectiveness of behavioral self-management in achieving clinically significant weight loss and maintaining weight loss over a 2-year period (5).

Tailoring and Personalization: Personalization and tailoring of behavioral interventions to individuals’ preferences, needs, and characteristics have been shown to enhance adherence and outcomes. Recent research suggests that individualized interventions, such as adaptive goal setting, tailored feedback, and personalized support, are more effective in achieving weight loss and weight maintenance than generic approaches (6). Incorporating technology-based tools, such as mobile apps or wearable devices, can further enhance the personalization and effectiveness of behavioral interventions (7).

In conclusion, behavioral therapy plays a significant role in weight management by addressing psychological and behavioral factors that contribute to unhealthy lifestyles. Cognitive-behavioral therapy, mindfulness-based interventions, motivational interviewing, and behavioral self-management techniques have shown effectiveness in promoting weight loss, improving eating behaviors, and enhancing psychological well-being. Personalization and tailoring of interventions further enhance their effectiveness.

REFERENCES

  • Shaw, K., O’Rourke, P., Del Mar, C., & Kenardy, J. (2005). Psychological interventions for overweight or obesity. Cochrane Database of Systematic Reviews, 2005(2).
  • O’Reilly, G. A., Cook, L., Spruijt-Metz, D., & Black, D. S. (2014). Mindfulness-based interventions for obesity-related eating behaviors: A literature review. Obesity Reviews, 15(6), 453-461.
  • Warren, J. M., Smith, N., Ashwell, M., & Davies, A. N. (2017). Group cognitive and behavioural therapy for obesity: A systematic review and meta-analysis. Obesity Research & Clinical Practice, 11(5), 511-523.
  • Hall, P. A., & Marteau, T. M. (2014). Executive function in the context of chronic disease prevention: Theory, research and practice. Preventive Medicine, 68, 44-50.
  • Teixeira, P. J., Silva, M. N., Mata, J., Palmeira, A. L., & Markland, D. (2012). Motivation, self-determination, and long-term weight control. International Journal of Behavioral Nutrition and Physical Activity, 9(1), 22.
  • Olander, E. K., Fletcher, H., Williams, S., Atkinson, L., Turner, A., & French, D. P. (2013). What are the most effective techniques in changing obese individuals’ physical activity self-efficacy and behaviour: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 10(1), 29.
  • Hollis, J. F., Gullion, C. M., Stevens, V. J., Brantley, P. J., Appel, L. J., Ard, J. D., … & Loria, C. M. (2008). Weight loss during the intensive intervention phase of the weight-loss maintenance trial. American Journal of Preventive Medicine, 35(2), 118-126.