Behavioral treatment of obesity

The past, present, and future of behavioral obesity treatment

Over the last century, hundreds of evaluations have been conducted to examine weight-management interventions related to diet, physical activity, and behavior therapy. These investigations have contributed to a growing body of knowledge that has consistently advanced the field of obesity treatment, while also revealing some persistent challenges. This narrative review summarizes key findings from randomized controlled trials conducted in adults that have combined diet, physical activity, and behavior therapy, an approach variously referred to as behavioral treatment, comprehensive lifestyle modification, or intensive lifestyle intervention. The review shows that current behavioral approaches induce average reductions in baseline body weight of 5 to 10% at 6 to 12 months. Such losses have proven effective in reducing the risk of type 2 diabetes in persons with impaired glucose tolerance and in improving other obesity-related complications. These benefits have also been associated with reductions in healthcare costs. Despite these advances, behavioral treatment is challenged by the need for larger losses to achieve optimal improvements in health, by difficulties associated with maintaining weight loss, and by barriers limiting access to treatment. New anti-obesity medications, when combined with behavioral obesity treatment, hold promise of addressing the first two issues.

Comparative Effectiveness of Cognitive Behavioral Therapy and Behavioral Therapy in Obesity: A Systematic Review and Network Meta-Analysis

We aimed to evaluate the effects of obesity treatment with behavioral therapy (BT) and cognitive behavioral therapy (CBT) interventions compared with multiple comparators and find effective techniques or combinations of techniques in BT and CBT interventions for weight loss. We systematically searched electronic databases and selected randomized controlled trials using CBT or BT intervention for obesity treatment in overweight adults or adults with obesity without psychological symptoms. Both pairwise meta-analysis and network meta-analysis were performed to comprehensively evaluate the comparative effects between interventions. We classified the techniques used in BT and CBT interventions and compared the treatment effects between techniques. Compared with no treatment as a common comparator, CBT was most effective for weight loss, followed by BT, usual care (UC), and minimal care (MC). CBT was a more effective intervention than BT, but the effect of CBT compared to BT was not remarkable in network estimates. The most used BT techniques were feedback and monitoring, and the most used CBT technique was cognitive restructuring. Our results indicated that CBT and BT are effective interventions for weight loss, and that successful weight loss requires more aggressive interventions such as BT or CBT than MC and UC.

Emotional Eating Interventions for Adults Living with Overweight or Obesity: A Systematic Review and Meta-Analysis

BACKGROUND

Emotional eating (EE) may be defined as a tendency to eat in response to negative emotions and energy-dense and palatable foods, and is common amongst adults with overweight or obesity. There is limited evidence regarding the effectiveness of interventions that address EE.

OBJECTIVES

To synthesize evidence on the effectiveness of EE interventions for weight loss and EE in adults living with overweight or obesity.

METHODS

This is a systematic review and meta-analysis. Adhering to the PRISMA guidance, a comprehensive electronic search was completed up to February 2022. Random effects meta-analysis was carried out to determine the percentage change in weight and EE scores.

RESULTS

Thirty-four studies were included. The combined effect size for percentage weight change was -1.08% (95% CI: -1.66 to -0.49, I² = 64.65%, n = 37), once adjusted for publication bias. Similarly, the combined effect size for percentage change in EE was -2.37%, (95% CI: -3.76 to -0.99, I² = 87.77%, n = 46). Cognitive Behavioural Therapy showed the most promise for reducing weight and improving EE.

CONCLUSIONS

Interventions to address EE showed promise in reducing EE and promoted a small amount of weight loss in adults living with overweight or obesity.

Hypophagia induced by salmon calcitonin, but not by amylin, is partially driven by malaise and is mediated by CGRP neurons

Objective

The behavioral mechanisms and the neuronal pathways mediated by amylin and its long-acting analog sCT (salmon calcitonin) are not fully understood and it is unclear to what extent sCT and amylin engage overlapping or distinct neuronal subpopulations to reduce food intake. We here hypothesize that amylin and sCT recruit different neuronal population to mediate their anorectic effects.

Methods

Viral approaches were used to inhibit calcitonin gene-related peptide (CGRP) lateral parabrachial nucleus (LPBN) neurons and assess their role in amylin’s and sCT’s ability to decrease food intake in mice. In addition, to test the involvement of LPBN CGRP neuropeptidergic signaling in the mediation of amylin and sCT’s effects, a LPBN site-specific knockdown was performed in rats. To deeper investigate whether the greater anorectic effect of sCT compared to amylin is due do the recruitment of additional neuronal pathways related to malaise multiple and distinct animal models tested whether amylin and sCT induce conditioned avoidance, nausea, emesis, and conditioned affective taste aversion.

Results

Our results indicate that permanent or transient inhibition of CGRP neurons in LPBN blunts sCT-, but not amylin-induced anorexia and neuronal activation. Importantly, sCT but not amylin induces behaviors indicative of malaise including conditioned affective aversion, nausea, emesis, and conditioned avoidance; the latter mediated by CGRP^LPBN neurons.

Conclusions

Together, the present study highlights that although amylin and sCT comparably decrease food intake, sCT is distinctive from amylin in the activation of anorectic neuronal pathways associated with malaise.

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CGRP neurons mediate the effect of the amylin agonist salmon calcitonin (sCT) on food intake.

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Amylin's hypophagic effect does not require CGRP neurons.

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sCT-induced anorexia but not amylin is associated with malaise.

Targeting executive function for weight loss in adults with overweight or obesity

Obesity is associated with a multitude of negative health sequalae. Behavioral weight loss (BWL) is currently the recommended behavioral treatment for obesity; however, it is not effective for approximately half of the individuals who participate. BWL requires individuals to carry out many tasks requiring executive function (EF; i.e., higher order cognitive functions such as planning and problem solving) in order to be successful. Growing research supports that lower EF may be associated with attenuated weight loss following BWL, and targeting EF in treatment could improve outcomes. This paper aims to describe the rationale for the development of Novel Executive Function Training for Obesity (NEXT), which adapts Compensatory Cognitive Training to be delivered in conjunction with BWL. We summarize evidence relating EF to obesity and reduced weight loss following BWL, as well as the past success of cognitive training on EF. Then we describe the treatment model for NEXT followed by initial data suggesting that NEXT is feasible and acceptable and may impact EF and weight. Obesity treatments incorporating cognitive training, especially those that train compensatory strategies, may improve weight-loss outcomes and provide a more durable treatment than traditional interventions, but larger randomized control trials are necessary.

What influences the "when" of eating and sleeping?A qualitative interview study

Timing of eating relative to sleep and endogenous circadian rhythm impacts weight and cardiometabolic health. We used qualitative methods to explore what influences the "when" of eating and sleeping. We conducted 37 one-on-one semi-structured interviews among participants with a body mass index (BMI) ≥ 25 kg/m² recruited from three internal medicine clinics affiliated with an urban academic hospital. Participants (70.3% Female; 51.4% White; Age range: 21-83 years old) completed measures of social jetlag, physical activity, eating habits, and mobile application use and participated in interviews following a guide developed by the study team. Responses were recorded, transcribed and coded sequentially by two trained researchers using editing-style analysis to identify themes. We identified two main themes, each with subthemes: 1) influences on the "when" of eating and sleeping, with subthemes including social jetlag and being overscheduled, and 2) contextualizing beliefs and perceptions about the "when" of eating and sleeping, with subthemes including perceived recommendations for timing of eating and sleeping, and alignment of behaviors with perceived recommendations. Many participants noted being more flexible in their eating and sleeping times on work-free vs work days. The themes this study identified should be considered when designing interventions that influence the timing of eating and sleeping for weight management.

Religion and Body Weight Among African-American Adults Attempting to Lose Weight: An Exploratory Study

Religion and body weight was explored at two time points among overweight and obese African-American adults. Baseline and follow-up data were collected from 26 adults participating in a weight loss intervention and analyzed using multiple regression analyses of religious measures, body weight, and other variables. Frequent church attendance was significantly associated with greater weight lost from baseline to 16-week follow-up. In this exploratory study, religious interactions and experiences may be involved in shaping body weight among African-Americans attempting to lose weight.

Developing an Acceptance-Based Behavioral Weight Loss Treatment for Individuals With Binge Eating Pathology: A Preliminary Proof of Concept Study and Clinical Case Series

Binge eating (BE; i.e., the consumption of a large amount of food in a discrete time period, accompanied by a sense of loss of control) is highly comorbid with overweight or obesity and is the primary symptom of binge eating disorder (BED). Current gold-standard treatment for BED (i.e., CBT) does not produce meaningful weight loss, thus failing to address a critical treatment target. This article describes the development of a novel acceptance-based behavioral treatment (ABBT) for individuals with clinically significant BE desiring to reduce BE symptoms and achieve concurrent weight loss. We discuss the development and structure of the novel treatment approach, and describe the test of a proof of concept version of the treatment in a clinical case series of four individuals. In the context of each clinical case description, we present initial acceptability of the treatment and challenges faced in treatment development and delivery. Finally, we discuss future research directions for the treatment, which could improve BE symptoms and weight loss outcomes for individuals with BE pathology.

Examining the Effects of Two Mindful Eating Exercises on Chocolate Consumption

Abstract. The present study aimed to investigate and compare the impact of the Mindful Construal Diary (MCD) and the Mindful Raisin Exercise on the sensory tasting experience of chocolate and participants’ chocolate consumption. Participants were randomly allocated into three conditions (MCD, mindful raisin exercise, and mindless control), and engaged with either the MCD, the mindful raisin exercise, or, were asked to read a news article, respectively, while they ate a piece of chocolate. They then rated their satisfaction and desire to consume more chocolate on a 10-point Likert scale, and filled in a state mindful eating scale. Afterward, participants were informed that the study had ended and were asked to wait while the experimenter recorded some information, and any extra chocolate consumption during this time was recorded. Participants in both mindfulness conditions consumed significantly less chocolate after the exercise than participants in the control condition. No significant differences were found between the three conditions on ratings of satisfaction and desire to consume more chocolate. Both the MCD and the raisin exercise can be used to successfully moderate the intake of calorific foods, while the MCD can be utilized as an alternative practice to the typical meditation-based interventions.

Effect of a motivational physical activity program on lipid parameters in patients with obesity and overweight

OBJECTIVE

To assess the effect of a motivated physical activity program on the lipid parameters most related to excess weight (triglycerides [TG], and high density lipoprotein cholesterol [HDL]) in a weight-loss intervention in obese and overweight patients.

METHODS

A randomised and controlled, 2-arm, clinical trial and a 12-months follow-up was conducted. The patients included in the study were randomised into 2 intervention groups: Motivational intervention of obesity with a previously trained nurse (G1), motivational group, with digital platform support and motivated physical activity program (iwopi [G2]). The anthropometric variables measured were height, weight, Body Mass Index (BMI), as well as the analytical variables, total cholesterol, TG and HDL-C.

RESULTS

A total of 123 patients participated in the study, of which 61 were randomised to G1, and 62 to G2. Both groups significantly decreased weight at the end of the study, with the decrease in G1 being 4.898kg, and 6.292kg in G2. In both groups there was also a significantly decrease (P<.05) in total cholesterol and TG, and increase in HDL cholesterol, with these changes being more intense in the G2 group, as well as being the group that lost more weight.

CONCLUSIONS

Weight reduction is accompanied by favourable changes in lipid parameters related to overweight and obesity, being more intense the greater the weight loss.

Effects of obesity therapies on sleep disorders

Obesity is a significant risk factor for obstructive sleep apnea syndrome (OSAS), and has also been linked to reductions in sleep quality and quantity. Weight loss has been shown to be an effective treatment for improving OSAS; however, there is a high degree of variability in improvements of OSAS in response to weight loss. There are three modalities of obesity therapies: 1) lifestyle modification, which includes changes in dietary intake and physical activity, along with behavioral interventions; 2) pharmacologic agents; and 3) bariatric surgery. Individuals have a highly variable response to the various obesity interventions, and maintenance of weight loss can be especially challenging. These factors influence the effect of weight loss on sleep disorders. There is still a need for large, well-controlled studies examining short- and long-term efficacy of weight loss modalities and their impact on long-term treatment of OSAS and other sleep parameters, particularly in youth. Nonetheless, given our current knowledge, weight reduction should always be encouraged for people coping with obesity, OSAS, and/or sleep disruptions and resources identified to assist patients in choosing a weight loss approach that will benefit them the most.

Return of the JITAI: Applying a Just-in-Time Adaptive Intervention Framework to the Development of m-Health Solutions for Addictive Behaviors

PURPOSE

Lapses are strong indicators of later relapse among individuals with addictive disorders, and thus are an important intervention target. However, lapse behavior has proven resistant to change due to the complex interplay of lapse triggers that are present in everyday life. It could be possible to prevent lapses before they occur by using m-Health solutions to deliver interventions in real-time.

METHOD

Just-in-time adaptive intervention (JITAI) is an intervention design framework that could be delivered via mobile app to facilitate in-the-moment monitoring of triggers for lapsing, and deliver personalized coping strategies to the user to prevent lapses from occurring. An organized framework is key for successful development of a JITAI.

RESULTS

Nahum-Shani and colleagues (2014) set forth six core elements of a JITAI and guidelines for designing each: distal outcomes, proximal outcomes, tailoring variables, decision points, decision rules, and intervention options. The primary aim of this paper is to illustrate the use of this framework as it pertains to developing a JITAI that targets lapse behavior among individuals following a weight control diet.

CONCLUSION

We will detail our approach to various decision points during the development phases, report on preliminary findings where applicable, identify problems that arose during development, and provide recommendations for researchers who are currently undertaking their own JITAI development efforts. Issues such as missing data, the rarity of lapses, advantages/disadvantages of machine learning, and user engagement are discussed.

Are individuals with loss-of-control eating more prone to dietary lapse in behavioural weight loss treatment? An ecological momentary assessment study

OBJECTIVE

Individuals with overweight/obesity and loss-of-control eating (LOC) may experience poorer outcomes from behavioural weight loss due to reactivity to internal (e.g., affective and physical) states that impact treatment adherence (e.g., dietary lapses). This study examined (a) whether the presence of LOC increased risk for dietary lapses and (b) the moderating role of LOC on the relation between internal states and dietary lapses.

METHOD

Individuals (n = 189) with overweight and obesity completed ecological momentary assessment early in behavioural weight loss.

RESULTS

LOC was positively associated with dietary lapse. LOC did not moderate the relation between momentary changes in internal states and dietary lapses. However, the effect of average levels of internal states on lapses was attenuated for those with LOC.

DISCUSSION

Results suggest that those with LOC are at higher risk of dietary lapse, whereas elevated average levels of internal states may contribute to early inadherence for those without LOC.

Telephone based weight loss intervention: Relevance for developing countries

Obesity is a major public health challenge not only for developed but developing countries as well. The World Health Organization recommends the immediate use of effective, efficient and widely accessible weight loss interventions. Telephone based weight loss intervention could provide a cheaper and wider reach of obese participants. Previous systematic reviews on telephone based weight loss interventions either excluded studies that had obese participants with co-morbidities or were silent on their inclusion. Obese/overweight individuals with co-morbidities constitute an important population in any weight loss intervention study due to the strong association of obesity with major chronic health conditions. This paper, reviews the efficacy of telephone based weight loss intervention solely in overweight/obese individuals with obesity related diseases and discusses its relevance for developing countries.

Pilot Test of an Acceptance-Based Behavioral Intervention to Promote Physical Activity During Weight Loss Maintenance

Behavioral interventions for obesity reliably facilitate short-term weight loss, but weight regain is normative. A high level of aerobic exercise may promote weight loss maintenance. However, adopting and maintaining a high level of exercise is challenging, and experiential acceptance may be important. The aim of this study was to pilot test the feasibility and efficacy of an acceptance-based behavioral treatment to promote moderate-to-vigorous physical activity (MVPA) among individuals who had recently lost weight. Adults (n = 16) who had recently lost ≥ 5% of weight were provided with a 12-week, group-based treatment. At 12 weeks, complete analyses indicated that participants had increased activity 69% (completing an average of 198.27 minutes/week of bouted MVPA, i.e., episodes of at least 10 minutes in duration). Medium-to-large effect sizes were observed for changes in process measures, including experiential acceptance. Future research to test this approach using an experimental design, a larger sample, and a longer period of observation is warranted.

Factors related to lifestyle goal achievement in a diabetes prevention program dissemination study

The U.S. Diabetes Prevention Program (DPP) showed that lifestyle participants who achieved ≥7% weight loss and ≥150 min/week physical activity experienced the greatest reduction in type 2 diabetes incidence. Demographic, clinical, and program factors that are related to achieving both these lifestyle goals have seldom been explored in community-delivered DPP programs. The purpose of this investigation is to examine factors associated with concurrent achievement of weight loss and physical activity goals in a 12-month community DPP lifestyle intervention. Adults [n = 223; age = 58.4 (SD = 11.5); BMI = 33.8 (SD = 6.0)] with glucose or HbA1c values in the pre-diabetes range and/or metabolic syndrome risk factors enrolled from one worksite and three community centers in the Pittsburgh, PA metropolitan area between January 2011 and January 2014. Logistic regression analyses determined the demographic, clinical and program adherence factors related to goal achievement at 6, 12, and 18 months. Participants achieving both intervention goals at 6 months (n = 57) were more likely to attend sessions [Adjusted Odds Ratio (AOR) =1.48], self-weigh (AOR = 1.19), and self-monitor behaviors (AOR = 1.18) than those meeting neither goal (n = 35; all p < 0.05). Baseline BMI (AOR = 0.87, p < 0.01), elevated glycemic status (AOR = 0.49, p < 0.05), and female sex (AOR = 0.52, p < 0.05) were inversely related to goal achievement at 6 months. Meeting either lifestyle goal at 6 months had the strongest association with meeting both goals at 12 and 18 months. Our study supports the importance of early engagement, regular attendance, self-monitoring, and self-weighing for goal achievement. Dissemination efforts should consider alternative approaches for those not meeting goals by 6 months to enhance long-term success.

The Impact of Self-Reported Impulsivity on the Course of Weight Is Mediated by Disinhibited Eating

This study investigates the impact of impulsivity and the mediating role of disinhibited eating behaviour (DEB) on weight and weight trajectories in a large data set including obese non-treatment seeking individuals (obese control, n = 138) and obese individuals who were either receiving a conventional treatment program (n = 227) or bariatric surgery (n = 123). Data was assessed one, 4 and 9 years after baseline including self-reports for impulsivity and DEB. Results suggest a significant association between impulsivity and body mass index, which is partially mediated by DEB. Longitudinally, the influence of impulsivity on the course of weight after 9 years was fully mediated by DEB in obese control but not in the treatment groups. The results indicate an interplay between impulsivity and DEB with respect to obesity. Further research is needed to clarify how the mediation works and when it exerts its effect, in order to identify those that might profit from a specific (impulsivity-reducing) training. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Weight Loss Strategies Utilized in a Men's Weight Loss Intervention

Men are underrepresented in weight loss programs and little is currently known about the weight loss strategies men prefer. This study describes the weight loss strategies used by men during a men-only weight loss program. At baseline, 3 months, and 6 months, participants reported how frequently they used 45 weight loss strategies including strategies frequently recommended by the program (i.e., mentioned during every intervention contact; e.g., daily self-weighing), strategies occasionally recommended by the program (i.e., mentioned at least once during the program; e.g., reduce calories from beverages), and strategies not included in the program (e.g., increase daily steps). At baseline participants ( N = 107, 44.2 years, body mass index = 31.4 kg/m², 76.6% White) reported regularly using 7.3 ± 6.6 ( M ± SD) strategies. The intervention group increased the number of strategies used to 19.1 ± 8.3 at 3 months and 17.1 ± 8.4 at 6 months with no changes in the waitlist group. The intervention group reported increased use of most of the strategies frequently recommended by the program (4 of 5), nearly half of the strategies occasionally recommended by the program (10 of 24), and one strategy not included in the program (of 16) at 6 months. The intervention effect at 6 months was significantly mediated by the number of strategies used at 3 months. This study adds to what is known about men's use of weight loss strategies prior to and during a formal weight loss program and will help future program developers create programs that are tailored to men.

[Analysis of clinical relevance applied to 3methods of reducing weight in overweight or obesity followed-up for one year]

OBJECTIVE

To analyse the effect of the use/implementation of 3methods to reduce weight in overweight or obese patients during one year of follow up.

MATERIAL AND METHODS

The design corresponds to a double-blind, randomised, controlled clinical trial with 3arms, and 12 months of follow-up. Patients were randomised into 3intervention groups: obesity motivational intervention, with a nurse previously trained in motivational intervention by expert psychologists (G1; n=60); lower intensity consultation, non-motivational group, with digital platform support (G2; N=61), and a third group that received recommendations for weight loss and follow-up in Primary Care Clinic (G3; n=59). Anthropometric variables (weight, height, and abdominal-waist circumference) were measured, and the percentage of patients who managed to reduce their weight ≥5% was considered as the main measurement of treatment effectiveness.

RESULTS

All groups significantly decreased body weight at the end of the study, with a reduction in G1 (-5.6kg) followed by G2 (-4.3kg), and G3 (-1.7kg), with an overall mean: -3.9kg. The indicators of clinical relevance were in G1/G3: relative risk (RR): 4.99 (95% CI: from 2.71 to 9.18); relative risk reduction (RRR): 399.1% (171.3 to 818.0); Absolute risk reduction (RAR): 65.3% (from 51.5 to 79.1) and NNT: 2 (from 2 to 2). In the G2/G3 groups: RR: 3.01 (from 1.57 to 5.76); RRR: 200.5% (from 57.0 to 475.5); RAR: 32.8% (from 16.9 to 48.7) and NNT: 4 (from 3 to 6). In the G1/G2 groups: RR: 1.66 (from 1.25 to 2.20); RRR: 66.1% (from 25.3 to 120.1); RAR: 32.5% (from 16.6 to 48.4) and NNT: 4 (from 3 to 7).

CONCLUSIONS

All 3groups were able to reduce weight. Although the group with motivational intervention achieved the greatest decrease, as well as the most favourable clinical relevance indicators.

The role of bariatric surgery in nonalcoholic fatty liver disease and nonalcoholic steatohepatitis

Nonalcoholic fatty liver disease (NAFLD) affects between 25% and 33% of the population, is more common in obese individuals, and is the most common cause of chronic liver disease in the United States. However, despite rising prevalence, effective treatments remain limited. Areas covered: We performed a literature search across multiple databases (Pubmed, Medline, etc.) to identify significant original research and review articles to provide an up-to-date and concise overview of disease pathogenesis and diagnostic evaluation and to expand on available treatment options with a specific focus on the potential role of bariatric surgery. Here we provide the most comprehensive review of bariatric surgery for the management of NAFLD, noting benefits from different procedures and multiple reports showing improvements in steatosis, inflammation and fibrosis over the duration of follow-up. Expert commentary: The morbidity of NAFLD is significant as it may become the most common indication for liver transplantation within the next 5 years. In addition to known benefits of weight loss and diabetes resolution, bariatric surgery has the potential to halt and reverse disease progression and future controlled trials should be performed to further define its benefit in the treatment of NAFLD in morbidly obese patients.

Behavioral weight-loss treatment plus motivational interviewing versus attention control: lessons learned from a randomized controlled trial

BACKGROUND

Studies evaluating the benefit of adding motivational interviewing (MI) to behavioral weight-loss programs (BWLPs) have yielded mixed findings.

METHODS

The aims of this randomized controlled trial were to: (1) assess the efficacy of adding MI to a BWLP on weight loss and adherence among 135 individuals with overweight and obesity (77.8% female; mean BMI = 33.6 kg/m2) enrolled in a 12-week BWLP and (2) explore levels of importance, confidence, and readiness for change ratings.

RESULTS

Participants, who were randomized to receive two MI sessions or two attention control sessions, were assessed at baseline, the end of the BWLP, and 6 months post BWLP. Both groups decreased their weight from baseline to the end of the BWLP; however, there was no weight change in either group when measured between baseline and 6 months post BWLP. We observed no group differences in importance, confidence, and readiness for change after each session.

CONCLUSIONS

We highlight some important lessons learned from the present trial that can be applied to MI + BWLP research. Participants may not have benefited from MI because they were already highly motivated to change, which highlights the importance of pretreatment assessment. Findings also suggest that treatment monitoring may help to enhance MI + BWLP efficacy by guiding a stepped-care approach that identifies individuals for whom additional MI sessions are needed, and when. A focus on refining elements of treatment remains an important direction.

TRIAL REGISTRATION

ClinicalTrials.gov, Identifier: NCT02649634 . Retrospectively registered on 5 January 2016.

Effect on the lipid parameters of an intervention to reduce weight in overweight and obese patients

OBJECTIVE

To assess the effect on lipid parameters most associated with excess weight (triglycerides [TG], cholesterol, and high density lipoprotein [HDL-C]) of an intervention to reduce weight in overweight and obese patients.

METHODS

A randomised, controlled, double blind clinical trial, with three groups, and a follow-up of 12 months. Patients included in the study were randomised into three intervention groups: Obesity motivational intervention group with previously trained nurse (G1), lower intensity consultation, non-motivational group, with digital platform support (G2), and a third group that received a recommendation to lose weight and usual follow-up (G3). The anthropometric variables measured were height, weight, and abdominal/waist circumference, and laboratory results, total cholesterol, TG and HDL cholesterol).

RESULTS

The study include 176 patients, of whom 60 were randomised to G1, 61 to G2, and 59 to G3. All groups significantly decreased body weight at the end of the study, with a decrease in G1 (-5.6kg), followed by G2 (-4.3kg), and G3 (-1.7kg), with an overall mean loss of -3.9kg. There was a also significant decrease (P<.05) in total cholesterol and TG, and an increased HDL-C. These changes were more marked in the G1 group (the group that lost more weight). The clinical relevance indicators that were significant were: in the case of TG: G1/G3: relative risk: 1.42 (95% CI: 1.11-1.80); relative risk reduction: 41.7% (11.4-80.2); absolute risk reduction: 25% (9.2-40.8) and NNT: 5 (3-11). In the case of G1/G2 HDL-C: relative risk: 1.32 (1.07-1.63); relative risk reduction: 32.2% (7.4-62.6); absolute risk reduction: 21.1% (6.4-35.8) and NNT: 5 (3-16).

CONCLUSIONS

Weight reduction is accompanied by favorable changes in the lipid parameters related to overweight and obesity, being more intense the greater the weight loss.

State of the Art Reviews: Relationship Between Diet/ Physical Activity and Health

Obesity and 4 of the leading causes of death—heart disease, cancer, stroke, and type 2 diabetes mellitus—are related to lifestyle. The combination of a healthy weight, prudent diet, and daily physical activity clearly plays a role in primary, secondary, and tertiary prevention of these and other chronic diseases. Because nearly 65% of the adult population is overweight or obese, weight loss and maintenance are central to this review article. Improved lipid profiles, blood pressure, insulin sensitivity, and euglycemia are associated with weight loss or a normal body weight; thus, maintaining a healthy weight is a universal recommendation for health. The methods for improving lifestyle described in the section on obesity include assessing nutritional status and stages of change of the client, setting realistic goals, eating a diet high in fruits and vegetables with low-fat sources of dairy and protein, and achieving appropriate physical activity levels. The importance of physicians discussing weight with clients and vice versa is stressed. The common features of lifestyle-related diseases make them amenable to similar lifestyle interventions.

Windows of Opportunity for Lifestyle Interventions to Prevent Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is linked with several acute maternal health risks and long-term development of type 2 diabetes, metabolic syndrome, and cardiovascular disease. Intrauterine exposure to GDM similarly increases offspring risk of early-life health complications and later disease. GDM recurrence is common, affecting 40 to 73% of women, and augments associated maternal/fetal/child health risks. Modifiable and independent risk factors for GDM include maternal excessive gestational weight gain and prepregnancy overweight and obesity. Lifestyle interventions that target diet, activity, and behavioral strategies can effectively modify body weight. Randomized clinical trials testing the effects of lifestyle interventions during pregnancy to reduce excessive gestational weight gain have generally shown mixed effects on reducing GDM incidence. Trials testing the effects of postpartum lifestyle interventions among women with a history of GDM have shown reduced incidence of diabetes and improved cardiovascular disease risk factors. However, the long-term effects of interpregnancy or prepregnancy lifestyle interventions on subsequent GDM remain unknown. Future adequately powered and well-controlled clinical trials are needed to determine the effects of lifestyle interventions to prevent GDM and identify pathways to effectively reach reproductive-aged women across all levels of society, before, during, and after pregnancy.

Mindfulness as a Weight Loss Treatment for Veterans

Despite substantial evidence for their effectiveness in treating disordered eating and obesity, mindfulness-based treatments have not been broadly implemented among Veterans. A number of reviews have reported mindfulness to be beneficial in promoting healthy eating behaviors and weight loss among non-Veteran samples. We discuss this approach in the context of the Veterans Affairs system, the largest integrated healthcare provider in the U.S. and in the context of Veterans, among whom obesity is at epidemic proportions. In this article, we discuss what is known about treating obesity using a mindfulness approach, mindfulness interventions for Veterans, a new pilot mindfulness-based weight loss program designed for Veterans, and future directions for this type of obesity treatment in Veterans. We conclude that this population may be uniquely poised to benefit from mindfulness-based treatments.

Setting targets leads to greater long-term weight losses and 'unrealistic' targets increase the effect in a large community-based commercial weight management group

Background

Setting personal targets is an important behavioural component in weight management programmes. Normal practice is to encourage ‘realistic’ weight loss, although the underlying evidence base for this is limited and controversial. The present study investigates the effect of number and size of weight‐loss targets on long‐term weight loss in a large community sample of adults.

Methods

Weight change, attendance and target weight data for all new UK members, joining from January to March 2012, were extracted from a commercial slimming organisation's electronic database.

Results

Of the 35 380 members who had weight data available at 12 months after joining, 69.1% (n = 24 447) had a starting body mass index (BMI) ≥30 kg m^–2. Their mean (SD) weight loss was 12.9% (7.8%) and, for both sexes, weight loss at 12 months was greater for those who set targets (P < 0.001). Those that set ≥4 targets achieved the greatest loss (P < 0.001). The odds ratio for weight loss ≥10% at 12 months was 10.3 (95% confidence interval = 9.7–11.1, P < 0.001) where targets had been set compared to none. At the highest quintile of target size, the size of the first target explained 47.2% (P < 0.001) of the variance in weight loss achieved at 12 months. The mean (SD) BMI reduction in those with a target >25% was 7.6 (4.0) kg m^–2. A higher percentage of obese members did not set targets (P < 0.001) compared to those with a BMI <30 kg m^–2.

Conclusions

Much of the variance in weight loss achieved in this population was explained by the number of targets set and the size of the first target. Although obese people were less likely to set targets, doing so increased the likelihood of achieving clinically significant weight loss and, for some ‘unrealistic’ targets, improved the results.

Relevant Aspects of Nutritional and Dietary Interventions in Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is the main cause of liver disease worldwide. NAFLD is linked to circumstances such as type 2 diabetes, insulin resistance, obesity, hyperlipidemia, and hypertension. Since the obesity figures and related comorbidities are increasing, NAFLD has turned into a liver problem that has become progressively more common. Currently, there is no effective drug therapy for NAFLD; therefore, interventions in lifestyles remain the first line of treatment. Bearing in mind that adherence rates to this type of treatment are poor, great efforts are currently focused on finding novel therapeutic agents for the prevention in the development of hepatic steatosis and its progression to nonalcoholic steatohepatitis and cirrhosis. This review presents a compilation of the scientific evidence found in the last years showing the results of interventions in lifestyle, diet, and behavioral therapies and research results in human, animal and cell models. Possible therapeutic agents ranging from supplementation with vitamins, amino acids, prebiotics, probiotics, symbiotics, polyunsaturated fatty acids and polyphenols to interventions with medicinal plants are analyzed.

Mobile phone intervention and weight loss among overweight and obese adults: a meta-analysis of randomized controlled trials

We conducted a meta-analysis of randomized controlled trials to examine the association of mobile phone intervention with net change in weight-related measures among overweight and obese adults. We searched electronic databases and conducted a bibliography review to identify articles published between the inception date of each database and March 27, 2014. Fourteen trials (including 1,337 participants in total) that met the eligibility criteria were included. Two investigators independently abstracted information on study characteristics and study outcomes. Net change estimates comparing the intervention group with the control group were pooled across trials using random-effects models. Compared with the control group, mobile phone intervention was associated with significant changes in body weight and body mass index (weight (kg)/height (m)(2)) of -1.44 kg (95% confidence interval (CI): -2.12, -0.76) and -0.24 units (95% CI: -0.40, -0.08), respectively. Subgroup analyses revealed that the associations were consistent across study-duration and intervention-type subgroups. For example, net body weight changes were -0.92 kg (95% CI: -1.58, -0.25) and -1.85 kg (95% CI: -2.99, -0.71) in trials of shorter (<6 months) and longer (≥6 months) duration, respectively. These findings provide evidence that mobile phone intervention may be a useful tool for promoting weight loss among overweight and obese adults.

A new look at the science of weight control: how acceptance and commitment strategies can address the challenge of self-regulation

The current manuscript proposes an acceptance-based, self-regulation framework for understanding the challenge of weight maintenance and describes how this framework can be integrated into the behavioral treatment of obesity. According to this framework, intrinsic drives to consume palatable, high-calorie food interact with a modern environment in which high calorie foods are easily accessible. This combination produces a chronic desire to eat unhealthy foods that exists in opposition to individuals' weight control goals. Similarly, low energy expenditure requirements reduce physical activity. We suggest that individuals vary in their responsivity to cues that motivate overeating and sedentary behavior, and that those higher in responsivity need specialized self-regulatory skills to maintain healthy eating and exercise behaviors. These skills include an ability to tolerate uncomfortable internal reactions to triggers and a reduction of pleasure, behavioral commitment to clearly-defined values, and metacognitive awareness of decision-making processes. So-called "acceptance-based" interventions based on these skills have so far proven efficacious for weight control, especially for those who are the most susceptible to eating in response to internal and external cues (as predicted by the model). Despite the current empirical support for the postulated model, much remains to be learned including whether acceptance-based interventions will prove efficacious in the longer-term.

All roads bring to Rome: a different way for predicting success in the therapy of obesity through psychological features

PURPOSE

Obesity treatment based on lifestyle modifications is characterized by a high proportion of treatment failures. The study of predictors of success could be useful for a better definition of therapeutic needs in individual patients. Few studies have attempted a comprehensive assessment of psychological factors related with treatment response. Aim of the study is the identification of psychological and psychopathological features associated with a good treatment response in patients referring for obesity.

METHODS

This prospective observational study was conducted on a consecutive series of 270 obese patients and a six-month follow-up was performed. At enrollment, a complete medical history was collected and, psychopathology and psychological features were assessed with: General psychopathology: Symptom Checklist 90-revised, Eating Disorder Examination-Questionnaire, Obesity Related well-being and Treatment, Motivation and Readiness test.

RESULTS

Among the 231 patients evaluated at follow-up, the mean weight loss was 3.2% of initial body weight and 68 patients (29.4%) reached the pre-defined therapeutic target of 5% weight loss. Higher psychopathology was associated with a worse outcome in women only; whereas motivation was higher in patients achieving therapeutic targets among men, but not in women.

CONCLUSIONS

Mean weight loss obtained with lifestyle interventions is confirmed to be rather small and a more accurate selection of patients to be enrolled in lifestyle intervention programs is needed. The present study provides some intriguing information on predictors of weight loss, which could be useful for the identification of patients with a higher chance of succeeding with lifestyle programs for the treatment of obesity.

[Outcome of a one-year behavior therapy weight loss program]

INTRODUCTION

Treatment of obesity has become one of the most challenging issues.

AIM

The aims of the authors were to present the results of standard behavior therapy weight loss program combined with self-help and the results of one-year follow-up.

METHOD

The 24-week program involved 41 participants of which 33 subjects participated in the follow-up. Anthropometric data were obtained and the participants were asked to fill questionnaires (the 21 items Three Factor Eating Questionnair Revised 21 items; Physical Exercise: Steps of change [Short Form].

RESULTS

87.8% of participants achieved a minimum weight loss of 5% which is the rate expected in professional therapies for obesity. Significant changes in maladaptive eating pattern and an increase in the rate of regular exercise were observed. Significant association was found between the increase of cognitive restraint and the rate of weight loss during treatment. At one-year follow-up the majority of participants (75.8%) did keep their minimum weight loss of 5% and they showed significant change in eating pattern.

CONCLUSIONS

The results suggest that standard behavior therapy extended with self-help elements may be a cost-effective treatment of obesity.

Associations between intakes of individual nutrients or whole food groups and non-alcoholic fatty liver disease among Korean adults

BACKGROUND AND AIM

Dietary factors are closely associated with the risk of non-alcoholic fatty liver disease (NAFLD). Asian and Western diets differ in energy-nutrient composition, fatty-acid composition, and main nutritional sources; therefore, the implications would be limited if the Western-oriented study results were applied to Asian patients. We aimed to identify the nutrient and food group intakes of a typical Asian diet and assess their effects on NAFLD risk.

METHODS

In total, 348 subjects were recruited from 5 participating hospitals. Information on sociodemographic characteristics and health-related behaviors were obtained through face-to-face interviews. NAFLD was diagnosed by ultrasound. Dietary intakes were assessed with a 24-h recall applying a multiple-pass approach and 4-day food records that included 1 or 2 weekend days.

RESULTS

There were no significant differences in health-related behaviors between the cases and controls except for smoking behavior. The cases had elevated triacylglycerol, fasting glucose, and low-density lipoprotein cholesterol levels compared with the controls. In men, after adjusting for variables, low intakes of vitamin C (odds ratio [OR], 4.23), vitamin K (OR, 3.93), folate (OR, 3.37), omega-3 fatty acids (OR, 2.16), and nuts and seeds (OR, 3.66) were associated with a significantly higher risk for developing NAFLD. In women, vitamin K (OR, 2.54) and vegetable (OR, 4.11) intakes showed a significant beneficial effect for lowering NAFLD risk.

CONCLUSIONS

Adequate intakes of vitamin C, vitamin K, folate, omega-3 fatty acids, nuts and seeds, and vegetables may help in preventing NAFLD in Korean adults.

Influence of dietary macronutrient composition on eating behaviour and self-perception in young women undergoing weight management

The control of eating behaviours such as hunger and disinhibition is problematic for women during weight management. Higher-protein (HP) diets have been shown to promote greater weight reduction than higher-carbohydrate (HC) diets, but their impact on eating behaviours is relatively unexplored. This study compared two iso-energetically restricted (5,600 kJ/day) diets differing in protein (HP: 32%, HC: 20%) and carbohydrate (HP: 41%, HC: 58%) on appetite ratings, restraint, disinhibition, perceived hunger and binge eating in 36 (HP: n = 21, HC: n = 15) young (18-25 years), healthy women with BMI ≥27.5 kg/m(2) who completed a 12-month clinical weight management trial. Dietary compliance and self-worth were also assessed. Results showed that both diets induced improvements in restraint and disinhibition from baseline (p < 0.01), with HP participants losing a non-significantly greater amount of weight than HC participants (HP: 9.6 ± 2.6, HC: 4.1 ± 1.4 kg, p = 0.07). Despite reasonable compliance, no significant appetite and eating behaviour differences were observed between the diets. Reduction in disinhibition (regardless of diet) significantly predicted weight loss (β = 0.574, p < 0.001) and self-worth improvement (β = -0.463, p = 0.002), while HP intake predicted greater self-worth change (β = -0.371, p = 0.011). This study demonstrates that young women can improve restraint and disinhibition on a weight management programme, with the reduction in disinhibition shown to be a key predictor of weight loss. HP intake may offer some advantage for increasing self-worth but not eating behaviours. As HP diets are popular, these findings warrant confirmation in a larger sample.

Twenty-four hour total and dietary fat oxidation in lean, obese and reduced-obese adults with and without a bout of exercise

Background

It has been hypothesized that obese and reduced-obese individuals have decreased oxidative capacity, which contributes to weight gain and regain. Recent data have challenged this concept.

Objective

To determine (1) whether total and dietary fat oxidation are decreased in obese and reduced-obese adults compared to lean but increase in response to an acute exercise bout and (2) whether regular physical activity attenuates these metabolic alterations.

Design

We measured 24-hr total (whole-room calorimetry) and dietary fat (¹⁴C-oleate) oxidation in Sedentary Lean (BMI = 21.5±1.6; n = 10), Sedentary Obese (BMI = 33.6±2.5; n = 9), Sedentary Reduced-Obese (RED-SED; BMI = 26.9±3.7; n = 7) and in Physically Active Reduced-Obese (RED-EX; BMI = 27.3±2.8; n = 12) men and women with or without an acute exercise bout where energy expended during exercise was not replaced.

Results

Although Red-SED and Red-EX had a similar level of fatness, aerobic capacity and metabolic profiles were better in Red-EX only compared to Obese subjects. No significant between-group differences were seen in 24-hr respiratory quotient (RQ, Lean: 0.831±0.044, Obese: 0.852±0.023, Red-SED: 0.864±0.037, Red-EX: 0.842±0.039), total and dietary fat oxidation. A single bout of exercise increased total (+27.8%, p<0.0001) and dietary (+6.6%, p = 0.048) fat oxidation across groups. Although exercise did not impact RQ during the day, it decreased RQ during sleep (p = 0.01) in all groups. Red-EX oxidized more fat overnight than Red-SED subjects under both resting (p = 0.036) and negative energy balance (p = 0.003) conditions, even after adjustment for fat-free mass.

Conclusion

Obese and reduced-obese individuals oxidize as much fat as lean both under eucaloric and negative energy balance conditions, which does not support the hypothesis of reduced oxidative capacity in these groups. Reduced-obese individuals who exercise regularly have markers of metabolic health similar to those seen in lean adults. Both the acute and chronic effects of exercise were primarily observed at night suggesting an important role of sleep in the regulation of lipid metabolism.

Aspiration therapy leads to weight loss in obese subjects: a pilot study

BACKGROUND & AIMS

Obese patients rarely achieve long-term weight loss with only lifestyle interventions. We evaluated the use of endoscopic aspiration therapy for obesity. Aspiration therapy involves endoscopic placement of a gastrostomy tube (A-Tube) and the AspireAssist siphon assembly (Aspire Bariatrics, King of Prussia, PA) to aspirate gastric contents 20 minutes after meal consumption.

METHODS

We performed a pilot study of 18 obese subjects who were randomly assigned (2:1) to groups that underwent aspiration therapy for 1 year plus lifestyle therapy (n = 11; mean body mass index, 42.6 ± 1.4 kg/m(2)) or lifestyle therapy only (n = 7; mean body mass index, 43.4 ± 2.0 kg/m(2)). Lifestyle intervention comprised a 15-session diet and behavioral education program.

RESULTS

Ten of the 11 subjects who underwent aspiration therapy and 4 of the 7 subjects who underwent lifestyle therapy completed the first year of the study. After 1 year, subjects in the aspiration therapy group lost 18.6% ± 2.3% of their body weight (49.0% ± 7.7% of excess weight loss [EWL]) and those in the lifestyle therapy group lost 5.9% ± 5.0% (14.9% ± 12.2% of EWL) (P < .04). Seven of the 10 subjects in the aspiration therapy group completed an additional year of therapy and maintained a 20.1% ± 3.5% body weight loss (54.6% ± 12.0% of EWL). There were no adverse effects of aspiration therapy on eating behavior and no evidence of compensation for aspirated calories with increased food intake. No episodes of binge eating in the aspiration therapy group or serious adverse were reported.

CONCLUSIONS

In a pilot study, aspiration therapy appears to be a safe and effective long-term weight loss therapy for obesity.

Lifestyle modification in the management of obesity: achievements and challenges

Lifestyle modification therapy for overweight and obese patients combines specific recommendations on diet and exercise with behavioral and cognitive procedures and strategies. In completers it produces a mean weight loss of 8-10 % in about 30 weeks of treatment. However, two main issues still to be resolved are how to improve dissemination of this approach, and how to help patients maintain the healthy behavioral changes and avoid weight gain in the long term. In recent years, several strategies for promoting and maintaining lifestyle modification have been evaluated, and promising results have been achieved by individualising the treatment, delivering the intervention by phone and internet or in a community setting, and combining lifestyle modification programs with residential treatment and bariatric surgery. These new strategies raise optimistic expectations for the effective management of obesity through lifestyle modification.

Major factors for facilitating change in behavioral strategies to reduce obesity

It is very unlikely that our obesity-promoting environment will change in the near future. It is therefore mandatory to improve our knowledge of the main factors associated with successful adoption of obesity-reducing behaviors. This may help design more powerful procedures and strategies to facilitate the adoption of healthy lifestyles in a "toxic" environment favoring the development of a positive energy balance. The aim of this review is to describe the main factors associated with successful adoption of obesity-reducing behaviors and to describe the most recent development, limits, and outcomes of lifestyle modification programs. The evidence regarding predictors of weight loss and weight loss maintenance remains largely incomplete. It is necessary to develop strategies matching treatments to patients' needs to improve successful weight loss and its maintenance. How to detect and how to address these needs is a continuous, challenging, research problem.

Psychopathology in a sample of candidate patients for bariatric surgery

BACKGROUND

The prevalence of morbid obesity and the popularity of bariatric surgery have grown in recent years. Many surgical protocols require that the candidates undergo a pre-operative psychological evaluation. We describe the psychopathological characteristics of both clinical syndromes (Axis I of the DSM-IV), as well as personality disorders (Axis II of the DSM-IV), in a sample of morbidly obese patients accepted as bariatric surgery candidates and who participate in a specific surgery preparatory programme, and we analyze its relationship with personality clusters.

METHODS

The Millon Clinical Multiaxial Inventory-III (MCMI-III) scores from 50 patients attending for bariatric surgery were cluster analyzed in hopes of identifying clinical subgroups corresponding to typical personality profiles.

RESULTS

With regard to personality disorders, the highest prevalence was found in the histrionic disorder, followed by obsessive- compulsive disorder. Cluster analysis revealed three personality profiles, which were validated by examining demographics, morphological variables, scores on anxiety and depression psychometric scales, and MCMI-III clinical scales scores. Groups were different in virtually all the MCMI-III clinical scores, as well as in depression and trait anxiety, with Cluster 3 presenting the worst scores.

CONCLUSIONS

These findings suggest that morbidly obese patients are heterogeneous in their psychological profiles, highlighting Cluster C disorders.

The Use of Lifestyle and Behavioral Modification Approaches in Obesity Interventions for Black Women: A Literature Review

The alarming obesity prevalence in Black women is well documented yet poorly understood. Obesity interventions for Black women have failed to produce long-term reductions in weight. Recommendations to incorporate a lifestyle and behavioral modification approach have been made to address obesity in this population. The purpose of this article was to provide a comprehensive review of the literature to identify lifestyle and behavioral modification obesity intervention studies for Black women. We included articles published between February 1992 and January 2013. This search identified 28 articles from the PsycInfo, MEDLINE, CINAHL, and SPORTDiscus databases. Results of these studies were summarized primarily into six categories. The importance of modest improvements in health outcomes that result from adapting healthier behaviors was highlighted. Future research is required for identifying the most salient intervention component or combination of components that lead to the best outcomes for ensuring intervention success and minimizing weight regain postintervention.

Higher protein diet for weight management in young overweight women: a 12-month randomized controlled trial

Clinical research on weight management in young women is limited. This randomized controlled trial compared the efficacy of two iso-energetically restricted (5600 kJ) diets [higher protein (HP): 32% protein, 41% carbohydrate, 25% fat or higher carbohydrate (HC): 20, 58, 21%, respectively] in 71 (HP: n = 36; HC: n = 35) young healthy women (18-25 years; body mass index ≥ 27.5 kg/m2) for weight (kg; percent weight loss), body composition, metabolic and iron changes assessed at baseline, 6 and 12 months.

DATA

mean (95% CI). In HP completers at 6 months, percent weight loss was higher [HP: 9.3 (5.6-13.1); HC: 5.1 (2.3-7.9)%; p = 0.06]; although, this did not reach statistical significance. Absolute weight [HP: 8.9 (5.3-12.5); HC: 4.6 (2.2-7.0) kg; p = 0.034] and fat loss [HP: 8.0 (4.4-11.5); HC: 3.4 (1.3-5.6) kg; p = 0.022] were significantly greater. No significant between-diet differences were observed at 12 months. Biochemistry remained within normal ranges with HP showing superior preservation of ferritin at 6 months [HP: 53 (40-66); HC: 46 (30-61) µg/l; p = 0.029]. Both diets supported clinically meaningful weight loss with HP tending to be more effective in the medium-term.

Weight loss maintenance in African American women: a systematic review of the behavioral lifestyle intervention literature

We performed a systematic review of the behavioral lifestyle intervention trials conducted in the United States published between 1990 and 2011 that included a maintenance phase of at least six months, to identify intervention features that promote weight loss maintenance in African American women. Seventeen studies met the inclusion criteria. Generally, African American women lost less weight during the intensive weight loss phase and maintained a lower % of their weight loss compared to Caucasian women. The majority of studies failed to describe the specific strategies used in the delivery of the maintenance intervention, adherence to those strategies, and did not incorporate a maintenance phase process evaluation making it difficult to identify intervention characteristics associated with better weight loss maintenance. However, the inclusion of cultural adaptations, particularly in studies with a mixed ethnicity/race sample, resulted in less % weight regain for African American women. Studies with a formal maintenance intervention and weight management as the primary intervention focus reported more positive weight maintenance outcomes for African American women. Nonetheless, our results present both the difficulty in weight loss and maintenance experienced by African American women in behavioral lifestyle interventions.

Comparison of acceptance-based and standard cognitive-based coping strategies for craving sweets in overweight and obese women

Existing strategies for coping with food cravings are of unknown efficacy and rely on principles that have been shown to have paradoxical effects. The present study evaluated novel, acceptance-based strategies for coping with craving by randomly assigning 48 overweight women to either an experimental psychological acceptance-oriented intervention or a standard cognitive reappraisal/distraction intervention. Participants were required to carry a box of sweets on their person for 72 h while abstaining from any consumption of sweets. Results suggested that the acceptance-based coping strategies resulted in lower cravings and reduced consumption, particularly for those who demonstrate greater susceptibility to the presence of food and report a tendency to engage in emotional eating.

A Randomized Controlled Trial of a Commercial Internet Weight Loss Program

OBJECTIVE

To assess, in a 1-year randomized controlled trial, the efficacy of eDiets.com (a commercial Internet weight loss program) in improving weight, cardiovascular health, and quality of life.

RESEARCH METHODS AND PROCEDURES

Participants were 47 women with a mean age of 43.7 +/- 10.2 (SD) years and a mean BMI of 33.5 +/- 3.1 kg/m2. They were randomly assigned to either: 1) eDiets.com, a commercial Internet-based program available to the public; or 2) a weight loss manual (i.e., LEARN Program for Weight Control 2000). At baseline, participants in both groups met briefly with a psychologist who instructed them to follow the components of their program as closely as possible. Additional brief visits were provided at weeks 8, 16, 26, and 52 to review their progress. Change in weight was the main outcome measure.

RESULTS

At week 16, participants in eDiets.com lost 0.9 +/- 3.2% of initial weight compared with 3.6 +/- 4.0% for women assigned to the weight loss manual. At week 52, losses increased to 1.1 +/- 4.0% and 4.0 +/- 5.1%, respectively. Results of a last-observation-carried-forward analysis found that women in the manual group lost significantly (p < 0.05) more weight (at both times) than those treated by eDiets.com. (Results, however, of baseline-carried-forward and completers analyses did not reach statistical significance.) There were no significant differences between groups in changes in cardiovascular risk factors or quality of life.

DISCUSSION

This study provides consumers with important information about the probable benefits they can expect from participating in a popular Internet-based weight loss program.

Randomized trial of Tapas Acupressure Technique for weight loss maintenance

Background

Obesity is an urgent public health problem, yet only a few clinical trials have systematically tested the efficacy of long-term weight-loss maintenance interventions. This randomized clinical trial tested the efficacy of a novel mind and body technique for weight-loss maintenance.

Methods

Participants were obese adults who had completed a six-month behavioral weight-loss program prior to randomization. Those who successfully lost weight were randomized into either an experimental weight-loss maintenance intervention, Tapas Acupressure Technique (TAT^®), or a control intervention comprised of social-support group meetings (SS) led by professional facilitators. TAT combines self-applied light pressure to specific acupressure points accompanied by a prescribed sequence of mental steps. Participants in both maintenance conditions attended eight group sessions over six months of active weight loss maintenance intervention, followed by an additional 6 months of no intervention. The main outcome measure was change in weight from the beginning of the weight loss maintenance intervention to 12 months later. Secondary outcomes were change in depression, stress, insomnia, and quality of life. We used analysis of covariance as the primary analysis method. Missing values were replaced using multiple imputation.

Results

Among 285 randomized participants, 79% were female, mean age was 56 (standard deviation (sd) = 11), mean BMI at randomization was 34 (sd = 5), and mean initial weight loss was 9.8 kg (sd = 5). In the primary outcome model, there was no significant difference in weight regain between the two arms (1.72 kg (se 0.85) weight regain for TAT and 2.96 kg (se 0.96) weight regain for SS, p < 0.097) Tests of between- arm differences for secondary outcomes were also not significant. A secondary analysis showed a significant interaction between treatment and initial weight loss (p < .036), with exploratory post hoc tests showing that greater initial weight loss was associated with more weight regain for SS but less weight regain for TAT.

Conclusions

The primary analysis showed no significant difference in weight regain between TAT and SS, while secondary and post hoc analyses indicate direction for future research.

Trial Registration

ClinicalTrials.gov: NCT00526565

Effects of dietary weight loss on obstructive sleep apnea: a meta-analysis

PURPOSE

Clinical and epidemiologic investigations suggest a strong association between obesity and obstructive sleep apnea (OSA). The purpose of this study is to evaluate the currently available literature reporting on the effectiveness of dietary weight loss in treating OSA among obese patients.

METHODS

Relevant studies were identified by computerized searches of PubMed, EMBASE, CINAHL, Web of Science, and The Cochrane Central Register of Controlled Trials through September 2011 as well as the reference lists of all obtained articles. Information on study design, patient characteristics, pre- and post-dietary weight loss measures of OSA and body mass index (BMI), and study quality was obtained. Data were extracted by two independent analysts. Weighted averages using a random-effects model are reported with 95 % confidence intervals.

RESULTS

Nine articles representing 577 patients were selected. Dietary weight loss program resulted in a pooled mean BMI reduction of 4.8 kg/m(2) (95 % confidence interval [CI] 3.8-5.9). The random-effects pooled apnea hypopnea (AHI) indices at pre- and post-dietary intervention were 52.5 (range 10.0-91.0) and 28.3 events/h (range 5.4-64.5), respectively (p < 0.001). Compared to control, the weighted mean difference of AHI was decreased by -14.3 events/h (95 % CI -23.5 to -5.1; p = 0.002) in favor of the dietary weight loss programs.

CONCLUSIONS

Dietary weight loss programs are effective in reducing the severity of OSA but not adequate in relieving all respiratory events. Weight reduction programs should be considered as adjunct rather than curative therapy.

Reducing excessive gestational weight gain: lessons from the weight control literature and avenues for future research

Excessive gestational weight gain is a prevalent problem and an independent predictor of future obesity in both mothers and offspring. Intervention research to prevent excessive gestational weight gain is still in its infancy but results to date have been quite modest. Research in weight control outside of pregnancy over the past 30 years has been more robust and identified several key components of effective programs, including use of caloric restriction, daily diet self-monitoring, self-weighing, behavior therapy and ongoing patient-provider contact. The aim of this article is to summarize intervention components shown to be effective in promoting successful weight control outside of pregnancy and explore potential applications in pregnancy. Available evidence suggests that the strategies shown to be effective for weight control outside of pregnancy may also promote better weight control in pregnancy, but several lines for future investigation remain.