From last supper to self-initiated weight loss: Pretreatment weight change may be more important than previously thought

Pretreatment and During-Treatment Weight Trajectories in Black and White Women

INTRODUCTION

Black participants often lose less weight than White participants in response to behavioral weight-loss interventions. Many participants experience significant pretreatment weight fluctuations (between baseline measurement and treatment initiation), which have been associated with treatment outcomes. Pretreatment weight gain has been shown to be more prevalent among Black participants and may contribute to racial differences in treatment responses. The purpose of this study was to (1) examine the associations between pretreatment weight change and treatment outcomes and (2) examine racial differences in pretreatment weight change and weight loss among Black and White participants.

METHODS

Participants were Black and White women (n=153, 60% Black) enrolled in a 4-month weight loss program. Weight changes occurring during the pretreatment period (41 ± 14 days) were categorized as weight stable (±1.15% of baseline weight), weight gain (≥+1.15%), or weight loss (≤-1.15%). Recruitment and data collection occurred from 2011 to 2015; statistical analyses were performed in 2021.

RESULTS

During the pretreatment period, most participants (56%) remained weight stable. Pretreatment weight trajectories did not differ by race (p=0.481). At 4-months, those who lost weight before treatment experienced 2.63% greater weight loss than those who were weight stable (p<0.005), whereas those who gained weight before treatment experienced 1.91% less weight loss (p<0.01).

CONCLUSIONS

Pretreatment weight changes can impact weight outcomes after initial treatment, although no differences between Black and White participants were observed. Future studies should consider the influence of pretreatment weight change on long-term outcomes (e.g., weight loss maintenance) along with potential racial differences in these associations. This study is registered (retrospectively registered) at ClinicalTrials.gov (NCT02487121) on June 26, 2015.

Real-time fluctuations in mindful awareness, willingness, and values clarity, and their associations with craving and dietary lapse among those seeking weight loss

Background

Mindful awareness, willingness and values clarity have been examined as protective factors across a wide range of problems, including overweight/obesity. However, these variables have almost exclusively been examined at the trait-level. It is possible that these variables also fluctuate within individuals in daily life, and that these intraindividual fluctuations may in turn be related to food craving and dietary lapse. The current study used ecological momentary assessment (EMA) to examine the extent to which momentary mindful awareness, willingness, and values clarity varied within-person, and were associated with craving and likelihood of dietary lapse among weight-loss seeking individuals with overweight/obesity prior to starting a weight loss program. We also examined the extent to which craving was associated with dietary lapse.

Methods

Adults with overweight/obesity (N = 126) completed one week of EMA prior to enrolling in a randomized controlled trial of behavioral weight loss treatments. They responded to EMA questions assessing dietary lapses, craving, mindful awareness, willingness, and values clarity six-times per day.

Results

Mindful awareness, willingness, and values clarity demonstrated substantial within-person variability, and higher within-person mindful awareness, willingness, and values clarity were concurrently (but not prospectively) associated with lower craving and likelihood of dietary lapse. Higher craving was concurrently (but not prospectively) associated with higher likelihood of dietary lapse. Between-person, higher mindful awareness, willingness, and values clarity were associated with lower craving and likelihood of dietary lapse, and higher craving was associated with greater frequency of dietary lapses.

Conclusion

Mindful awareness, willingness, and values clarity vary substantially at the daily level, and may be important mechanisms to target to reduce craving and dietary lapses in the daily lives of individuals with overweight/obesity.

"Last Supper" Predicts Greater Weight Loss Early in Obesity Treatment, but Not Enough to Offset Initial Gains

Background: Many participants experience clinically significant fluctuations in weight before beginning a behavioral weight loss program. Pre-treatment weight gain, often referred to as the “last supper” effect, may limit total weight loss from the time of the pre-treatment screening visit and could be an indicator that a participant will respond poorly to behavioral intervention.

Methods: Data were from the weight loss phase of a two-phase weight loss maintenance trial, in which 178 participants with obesity (screening BMI = 40.5 ± 6.0 kg/m², 87.6% female; 71.3% black) were provided with a 14 week lifestyle intervention that included a meal replacement diet. Participants were categorized as having gained >1.15%, remained weight stable, or lost >1.15% of initial weight between the pre-treatment screening visit and the first treatment session (48.7 ± 29.4 days). We first examined whether the weight change groups differed in baseline eating characteristics (e.g., emotional eating, self-regulation, craving frequency) using one-way ANCOVAs. Linear mixed models were then used to compare weight change groups on total weight loss from the screening visit to week 14 and in-treatment weight loss from weeks 1 to 14.

Results: Nearly half of the sample (48.9%) gained >1.15% of initial weight during the pre-treatment period (+2.5 ± 1.2%); 41.0% remained weight stable (+0.2 ± 0.6%); and 10.1% lost >1.15% of initial weight (-2.2 ± 0.9%). There were no significant differences between the groups in baseline eating characteristics. As measured from the screening weight, the weight-gain group had a lower total loss of 6.8%, compared to 7.8% in the weight stable group (p = 0.02) and 9.0% in the weight-loss group (p = 0.003). The weight-gain group lost more weight in the first 4 weeks of treatment, but in-treatment losses did not differ among the groups at week 14.

Conclusion: Pre-treatment weight gain was not an indicator of a poor response to a behavioral weight loss intervention and was associated with greater weight loss early in treatment. However, weight gain during the pre-treatment period may limit the total weight loss that participants achieve from the time that they first enroll in a weight loss program.

Early weight loss predicts weight loss treatment response regardless of binge-eating disorder status and pretreatment weight change

OBJECTIVE

Individuals seeking weight loss treatment have diverse pretreatment weight trajectories, and once enrolled, individuals' response to weight loss treatments also varies greatly and may be influenced by the presence of binge-eating disorder (BED). Reported average weight losses may obscure these considerable differences. This study examined whether BED status and different weight-related change variables are associated with successful weight loss treatment outcomes in a controlled treatment study.

METHOD

Participants (N = 89) with overweight/obesity, with and without BED, participated in a 3-month weight loss trial in primary care with 3- and 12-month follow-ups. We tested the prognostic significance of four weight-related change variables (the last supper, early weight loss, pretreatment weight trajectory, weight suppression) on outcomes (weight loss-overall, weight loss-"subsequent," weight loss during second half of treatment).

RESULTS

Early weight loss was positively associated with weight loss-overall at post-treatment, and at 3-month and 12-month follow-up. Early weight loss was positively associated with weight loss-subsequent at post-treatment only. No other weight-related variables were significantly associated with weight loss. Models including BED status and treatment condition were not significant.

DISCUSSION

Participants with early weight loss were more likely to continue losing weight, regardless of BED status or treatment condition. The results highlight the importance of early dedication to weight loss treatment to increase the likelihood of positive outcomes.

The association between previous success with weight loss through dietary change and success in a lifestyle modification program

Prior work has yielded mixed results regarding the association between previous weight loss and success in a current weight loss attempt. The present study evaluated differences in baseline psychosocial processes, changes in these over time, and weight loss during a yearlong behavioral weight loss program between individuals who have and have not previously been successful losing weight through self-regulating dietary intake. Individuals with prior success had greater weight losses over time than those without. Differences in baseline and change over time in some facets of motivation and self-efficacy were observed, but only differences in attendance accounted for differential weight loss. Prior success with dietary self-regulation may predict better adherence to and success in behavioral weight control programs. Evaluating the type of weight control efforts that have previously helped induce weight losses may help to better match individuals to treatments likely to yield success.

Small weight gains during obesity treatment: normative or cause for concern?

Objectives

The objectives of the study are to characterize the frequency and size of small weight gains during behavioural weight loss treatment and to evaluate the relationship between small weight gains and weight loss outcomes.

Methods

Participants (n = 281) in a year‐long behavioural weight loss programme were weighed at treatment sessions, and between‐session weight gains were classified into several categories based on size. The occurrence of different gain magnitudes and their relation to weight loss were examined during both the active weight loss (months 1–6) and weight loss maintenance (months 7–12) phases of treatment.

Results

Weight gains were common during both phases of treatment, with smaller gains occurring more frequently than larger gains. Greater frequency of all gain magnitudes was associated with lesser weight loss during both phases. Additionally, participants who had just one or two weight gains of the smallest size examined (1.0–1.9 lb) lost less weight than those who had no gains.

Conclusions

Small gains appear to reflect true weight gain due to poor adherence to behavioural recommendations and are associated with worse weight loss outcomes, even when limited in number. Future research should examine how best to prevent small weight gains from occurring and how clinicians and participants should respond when a weight gain does occur to promote weight control success.