Weighing the evidence: benefits of regular weight monitoring for weight control

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.

The Breast Cancer Weight Loss trial (Alliance A011401): A description and evidence for the lifestyle intervention

The Breast Cancer Weight Loss (BWEL) trial is a randomized controlled trial designed to determine whether weight loss after a breast cancer diagnosis can reduce the risk of cancer recurrence in women with overweight or obesity. The BWEL trial will compare the efficacy of a telephone-based weight-loss intervention plus health education materials versus health education materials alone on invasive disease-free survival in 3,181 women with stage II or III breast cancer and BMI > 27 kg/m² . This report provides a detailed description of the goals and methods of the lifestyle intervention and the evidence supporting the intervention used in the BWEL trial. The intervention's primary goal for participants is to achieve and maintain a weight loss ≥ 10% of baseline weight through increased physical activity and caloric restriction. The evidence supporting the diet, physical activity, and behavioral components of this telephone-based weight-loss intervention, as well as strategies to promote participant engagement and retention, is described. The intervention is provided through 42 sessions delivered by trained health coaches over a 2-year period. If the BWEL lifestyle intervention is successful in improving cancer outcomes, then weight loss will be incorporated into the care of thousands of breast cancer patients.

Identifying and measuring the behavioural, dietary, and physical activity components of weight management consultations delivered by general practice nurses in routine care

Background

Many people with obesity receive weight loss consultations by general practice nurses (GPNs) in routine primary care. This exploratory study aimed to characterise the components of these consultations, including behaviour change techniques (BCTs), and dietary and physical activity recommendations.

Methods

We analysed audio recordings of weight management consultations conducted by 8 GPNs as part of the ‘usual care’ group in a randomised controlled trial (ISRCTN75092026). Consultations were coded against three taxonomies to classify BCTs, dietary recommendations, and physical activity recommendations. Associations between coded content and weight loss were assessed. Differences in the content of consultations where weight loss was < 5% or ≥ 5% from baseline weight at 6 months were explored.

Results

One hundred and fifty audio recordings were available from 53 out of 140 (38%) participants in the usual care group. Participants had on average 3 (SD = 1) recorded consultations over 3 months, lasting 14 (SD = 7) minutes each. Weight change at 3, 6, and 12 months was -3.6% (SD = 4.3), -5.5% (SD = 6.0) and -4.2% (SD = 6.5) for participants with audio recordings. GPNs used 3.9 (SD = 1.6) of 93 BCTs, 3.3 (SD = 2.7) of 30 dietary recommendations and 1.4 (SD = 1.2) of 10 physical activity recommendations per consultation. The most commonly employed BCTs were feedback on outcome of behaviour (80.0%), problem solving (38.0%), and social reward (34.3%). The most common dietary recommendations were about portion size (31.3%), nutrients (28.0%), and balanced diet (19.7%). The main physical activity recommendation was about walking (30.3%). There was no association between weight loss and the number of dietary recommendations, physical activity recommendations, or BCTs used per consultation, or per participant. Social reward was the only technique used significantly more in consultations of participants that lost ≥ 5% of their baseline weight at 6 months.

Conclusions

The study provides a new method that could be used to describe the content of weight management consultations. Specific dietary or physical activity recommendations and BCTs were used infrequently and inconsistently in this group of GPNs. Although replication is required in larger samples, this may point to a weakness in current practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01403-1.

Temporal patterns of self-weighing behavior and weight changes assessed by consumer purchased scales in the Health eHeart Study

Self-weighing may promote attainment and maintenance of healthy weight; however, the natural temporal patterns and factors associated with self-weighing behavior are unclear. The aims of this secondary analysis were to (1) identify distinct temporal patterns of self-weighing behaviors; (2) explore factors associated with temporal self-weighing patterns; and (3) examine differences in percent weight changes by patterns of self-weighing over time. We analyzed electronically collected self-weighing data from the Health eHeart Study, an ongoing longitudinal research study coordinated by the University of California, San Francisco. We selected participants with at least 12 months of data since the day of first use of a WiFi- or Bluetooth-enabled digital scale. The sample (N = 1041) was predominantly male (77.5%) and White (89.9%), with a mean age of 46.5 ± 12.3 years and a mean BMI of 28.3 ± 5.9 kg/m² at entry. Using group-based trajectory modeling, six distinct temporal patterns of self-weighing were identified: non-users (n = 120, 11.5%), weekly users (n = 189, 18.2%), rapid decliners (n = 109, 10.5%), increasing users (n = 160, 15.4%), slow decliners (n = 182, 17.5%), and persistent daily users (n = 281, 27.0%). Individuals who were older, female, or self-weighed 6-7 days/week at week 1 were more likely to follow the self-weighing pattern of persistent daily users. Predicted self-weighing trajectory group membership was significantly associated with weight change over time (p < .001). In conclusion, we identified six distinct patterns of self-weighing behavior over the 12-month period. Persistent daily users lost more weight compared with groups with less frequent patterns of scale use.

Relation of self-weighing to future weight gain and onset of disordered eating symptoms

OBJECTIVE

Frequent self-weighing is recommended in weight loss interventions and may prevent weight gain. However, concerns regarding the associations between self-weighing and eating disorders have been expressed and the relations between self-weighing and weight gain/eating pathology have not been examined prospectively. We tested whether (a) frequency of baseline self-weighing in college students with weight concerns predicted weight change over 2-year follow-up, (b) this relation was moderated by eating disorder symptoms, and (c) self-weighing predicted future eating disorder symptoms.

METHOD

Data were merged from two trials evaluating obesity/eating disorder prevention programs in 762 students (Mage = 18.7; 86% women). Participants reported how often they weighed themselves at baseline; body mass index (BMI) and eating disorder symptoms were assessed over 2-year follow-up.

RESULTS

Baseline self-weighing predicted weight gain, with more frequent weighers experiencing greater gains (i.e., +0.8 of BMI) over follow-up. This relation was moderated by the frequency of binge eating but not weight/shape concerns or compensatory behaviors; the combination of more frequent self-weighing and binge eating was associated with greatest weight gain (+1.6 of BMI). More frequent weighers also reported higher onset of compensatory behaviors, relative to non-self-weighers (odds ratio = 3.90, 95% confidence interval [1.76, 8.75]).

CONCLUSIONS

Young adults who weighed themselves more frequently had greater weight gain than those who self-weighed less frequently, especially those who engaged in binge eating, and were at risk for future unhealthy compensatory behaviors. Findings suggest that frequent self-weighing may have negative effects for some young adults, and that relations between self-weighing and weight control outcomes require further investigation. (PsycINFO Database Record

Behavioural treatment strategies improve adherence to lifestyle intervention programmes in adults with obesity: a systematic review and meta-analysis

Poor adherence to lifestyle intervention remains a key factor hindering treatment effectiveness and health outcomes for adults with obesity. The aim of this systematic review and meta-analysis is to determine if behavioural treatment strategies (e.g. goal setting, motivational interviewing, relapse prevention, cognitive restructuring etc.) improve adherence to lifestyle intervention programmes in adults with obesity. Randomized controlled trials that investigated the use of behavioural treatment strategies in obesity management were identified by systematically reviewing the literature within Medline, PsycINFO, CINAHL, SPORTDiscus and Web of Science from their inception to August 2016. This meta-analysis shows that behavioural treatment interventions have a significant positive effect on session attendance (percentage) and physical activity (total min/week) in adults with obesity (M = 17.63 (95% confidence interval (CI) = 10.77, 24.50), z =5.0337, P < 0.0001 and M = 105.98 (95% CI = 58.64, 153.32), z =4.3878, P < 0.0001, respectively). This meta-analysis of randomized controlled trials provides evidence that behavioural treatment strategies improve adherence to lifestyle intervention programmes in adults with obesity. These strategies should be routinely incorporated into lifestyle intervention, obesity management and weight loss programmes with the aim of improving engagement and adherence. If adherence were improved, treatment effectiveness, health outcomes and the ultimate burden of chronic disease could also be improved.

Personalized multistep cognitive behavioral therapy for obesity

Multistep cognitive behavioral therapy for obesity (CBT-OB) is a treatment that may be delivered at three levels of care (outpatient, day hospital, and residential). In a stepped-care approach, CBT-OB associates the traditional procedures of weight-loss lifestyle modification, ie, physical activity and dietary recommendations, with specific cognitive behavioral strategies that have been indicated by recent research to influence weight loss and maintenance by addressing specific cognitive processes. The treatment program as a whole is delivered in six modules. These are introduced according to the individual patient's needs in a flexible and personalized fashion. A recent randomized controlled trial has found that 88 patients suffering from morbid obesity treated with multistep residential CBT-OB achieved a mean weight loss of 15% after 12 months, with no tendency to regain weight between months 6 and 12. The treatment has also shown promising long-term results in the management of obesity associated with binge-eating disorder. If these encouraging findings are confirmed by the two ongoing outpatient studies (one delivered individually and one in a group setting), this will provide evidence-based support for the potential of multistep CBT-OB to provide a more effective alternative to standard weight-loss lifestyle-modification programs.

Themed Review: Lifestyle Management of Obesity

Obesity is one of the leading causes of preventable deaths in this country. Numerous approaches have been used to manage the disease without much success. The lifestyle management of obesity has been shown to be effi cacious for successful weight loss and maintenance. Diet, physical activity, and behavior modification are the key strategies used in lifestyle programs. They are combined to help obese individuals achieve a gradual reduction in weight over an extended time period. The components may be combined in a variety of ways to e fectively promote weight loss, allowing for flexibility and personal preference. Techniques and descriptions of these components are presented in this review. In addition, special populations that may benefit from this approach are reviewed. Optional treatments that may enhance the benefits of lifestyle intervention are also discussed. The authors hope to provide a resource for clinicians that will facilitate adoption of lifestyle approaches for managing the obese patient.

Tracking Myself: Assessing the Contribution of Mobile Technologies for Self-Trackers of Weight, Diet, or Exercise

For individuals trying to lose or maintain weight, self-tracking their weight, diet, or exercise is important. In the past, different tracking modes have been examined, like paper and pencil, memory, or personal digital assistants. But the recent advancement and adoption of mobile technologies could also result in easier and simpler self-tracking. However, little is known about self-trackers, their tracking modes, and the absolute or relative contribution of each tracking mode at the population level. This study fills this gap by (a) comparing self-trackers' characteristics across tracking modes and against nontrackers and (b) testing the relationship between mobile self-tracking and tracking outcomes using a representative sample of data from the Pew Internet and American Life Project from 2012. Controls in the model include demographics, technology use, and health indicators. Results suggest that mobile self-trackers are younger and more educated and that mobile self-tracking is a positive contributor and the best tracking mode.

Does measuring body weight impact subsequent response to eating behavior questions?

OBJECTIVES

If being weighed impacts perceptions of eating behavior, it is important that the order of questionnaires and weighing be considered in research and practice. A quasi-experimental study was performed to examine whether being weighed immediately prior to completing a questionnaire affects responses to eating behavior questions. It was hypothesized that being weighed would serve as a priming stimulus and increase measures of dietary restraint, disinhibition, and hunger.

METHODS

Trained researchers collected a sample of volunteers (n = 355) in 8 locations in the United States on two Saturdays in the summer of 2011. Half of the participants were weighed immediately prior to completing the Three Factor Eating Questionnaire (TFEQ), with the remaining half weighed immediately after TFEQ completion.

RESULTS

A priori hypotheses were not supported despite replicating known relationships between weight, dietary restraint and disinhibition. Results indicated that being weighed first produced a difference in differences on disinhibition scores between low restraint score (95% CI = 4.65-6.02) and high restraint score (95% CI = 6.11-7.57) compared to being weighed after questionnaire completion (p = 0.003). However, this relationship was not significant when modeling restraint as a continuous variable, questioning the use of dichotomization.

CONCLUSIONS

Being weighed is unlikely to be a strong enough prime to significantly change scores on eating behavior questionnaires for everyone, but may allow differences in restraint status to become more evident. Researchers assessing dietary restraint should be wary of the possibility of producing different results when treating restraint as continuous or dichotomous, which could lead to different interpretations.

Self-Weighing: Helpful or Harmful for Psychological Well-Being? A Review of the Literature

Conflicting views as to the helpfulness or harmfulness of self-weighing for the control of body weight have been presented in the fields of obesity and eating disorders. Because self-weighing is increasingly being considered as an intervention to promote weight loss or prevent weight gain, it is timely to consider unintended psychological outcomes and behavioral correlates of this behavior. Twenty articles from the published literature examining self-weighing and psychological outcomes or weight control behaviors were reviewed. In evaluating self-weighing and affect (ten studies), self-esteem (four studies) and body evaluation (ten studies), and eating behaviors/cognitions (13 studies), in total, most studies found a negative relationship between self-weighing and outcomes (affect: 4/10, self-esteem: 3/4, body evaluation: 4/10, eating behaviors/cognitions: 6/13). Themes that emerged included relationships between self-weighing and negative outcomes for women and younger individuals, and lack of a relationship or positive outcomes for overweight, treatment seeking individuals. Though self-weighing has shown promise in aiding weight control, the degree to which weight loss, and not self-weighing, affects psychological outcomes is not clear. Further assessment of psychological outcomes in self-weighing research may be warranted, as this review suggests the potential for adverse effects of self-weighing in some individuals.

Dissemination of the Look AHEAD intensive lifestyle intervention in the United States Air Force: study rationale, design and methods

BACKGROUND

Despite an increase in overweight and obesity similar to the civilian population, there have been few randomized controlled trials examining behavioral weight management interventions in the military settings.

PURPOSE

This paper describes the design, intervention development and analysis plan of the Fit Blue study, a randomized controlled behavioral weight loss trial taking place in the United States Air Force.

DESIGN

This study compares two adapted versions of the efficacious Look AHEAD Intensive Lifestyle Intervention (ILI), a counselor-initiated condition and a self-paced condition. Also described are the unique steps required when conducting military-based health promotion research and adaptations made to the Look AHEAD intervention to accommodate the military environment.

CONCLUSIONS

To our knowledge, this is the first translation of the Look AHEAD ILI in the military setting and one of the first translations of the ILI in general. If successful, this intervention could be disseminated to the entire U.S. Military as this project is designed to overcome the barriers and utilize the facilitators for weight loss that are unique to a military population. Programs validated in military populations can have a major public health impact given that with 1.4 million active duty personnel, the Department of Defense is the nation's largest employer. However, while this intervention is designed for a military population and there are unique aspects of the military that may enhance weight loss interventions, the diversity of the study population should help inform obesity efforts in both civilian and military settings.

Inpatient obesity intervention with postdischarge telephone follow-up: A randomized trial

BACKGROUND

Obesity-related comorbidities frequently contribute to acute illness. Obesity interventions during hospitalization are not often utilized but may be effective.

OBJECTIVE

To examine whether inpatient weight loss intervention with postdischarge follow-up results in weight loss at 6 months when compared to control.

DESIGN

Prospective, randomized controlled trial.

SETTING

Academic medical center in Chicago, Illinois.

PATIENTS

Obese adult inpatients.

INTERVENTION

Intervention subjects viewed a weight education video, underwent personalized counseling, and set specific weight loss, dietary, and fitness goals prior to discharge. All participants were followed by phone over the subsequent 6 months. The trial was unblinded to participants, physicians, and investigators.

MEASUREMENTS

Primary outcome was weight change between groups at 6 months. Weight change from baseline and waist-to-hip ratios (WHR) were also assessed.

RESULTS

For 176 participants in the intention-to-treat analysis, mean baseline weight for the intervention group was 107.7 kg (standard deviation [SD]=16.7) and 105.1 kg (SD=17.4) for controls. Mean weight loss at 6 months was 1.08 kg (SD=4.33) for intervention subjects and 1.35 kg (SD=3.65) among controls. There was no significant difference in weight loss between groups at 6 months (P=0.26). As-treated analysis yielded similar results. There were no differences in WHRs between the intervention and control at 6 months (0.04 vs 0.04, P=0.59).

CONCLUSIONS

We found no difference in weight loss between the intervention and control groups at 6 months.

Impact of an education intervention using email for the prevention of weight gain among adult workers

OBJECTIVE

To evaluate the impact of a worksite intervention to prevent weight gain among adult workers.

DESIGN

A controlled community trial was performed by dividing the workers into two groups: intervention group (IG) and control group (CG). The theoretical framework applied was Intervention Mapping Protocol and the intervention was implemented through interactive software for weight self-monitoring. To evaluate the impact of the intervention, the differences in weight, BMI and waist circumference between the IG and CG were assessed before and 6 months after the intervention by regression models. Additionally, the sustainability of the intervention was evaluated at 12 months after the intervention. Settings São Paulo, Brazil.

SUBJECTS

Four companies; 281 workers for the analysis of effectiveness and 427 for the analysis of sustainability.

RESULTS

The intervention resulted in significant reductions in weight, BMI and waist circumference in the IG compared with the CG. The impact of the intervention on IG individuals' body weight was -0·73 kg, while the weight of CG individuals increased. IG individuals with adequate initial weights did not show significant variations, while those who were overweight demonstrated a significant reduction in body weight. The intervention resulted in a reduction of 0·26 kg/m2 in BMI and 0·99 cm in waist circumference, and the sustainability analysis after 12 months showed a continued reduction in body weight (-0·72 kg).

CONCLUSIONS

The behavioural intervention was effective, resulting in weight maintenance among participants with adequate initial weight and in significant reductions among those who were overweight. More research on longer-term weight maintenance is needed.

Daily self-weighing and adverse psychological outcomes: a randomized controlled trial

BACKGROUND

Despite evidence that daily self-weighing is an effective strategy for weight control, concerns remain regarding the potential for negative psychological consequences.

PURPOSE

The goal of the study was to examine the impact of a daily self-weighing weight-loss intervention on relevant psychological constructs.

DESIGN

A 6-month RCT.

SETTING/PARTICIPANTS

The study sample (N=91) included overweight men and women in the Chapel Hill NC area.

INTERVENTION

Between February and August 2011, participants were randomly assigned to a daily self-weighing intervention or delayed-intervention control group. The 6-month intervention included daily self-weighing for self-regulation of diet and exercise behaviors using an e-scale that transmitted weights to a study website. Weekly e-mailed lessons and tailored feedback on daily self-weighing adherence and weight-loss progress were provided.

MAIN OUTCOME MEASURES

Self-weighing frequency was measured throughout the study using e-scales. Weight was measured in-clinic at baseline, 3 months, and 6 months. Psychological outcomes were assessed via self-report at the same time points.

RESULTS

In 2012, using linear mixed models and generalized estimating equation models, there were no significant differences between groups in depressive symptoms, anorectic cognitions, disinhibition, susceptibility to hunger, and binge eating. At 6 months, there was a significant group X time interaction for body dissatisfaction (p=0.007) and dietary restraint (p<0.001), with the intervention group reporting lower body dissatisfaction and greater dietary restraint compared to controls.

CONCLUSIONS

Results indicate that a weight-loss intervention that focuses on daily self-weighing does not cause adverse psychological outcomes. This suggests that daily self-weighing is an effective and safe weight-control strategy among overweight adults attempting to lose weight.

TRIAL REGISTRATION

This study is registered at clinicaltrials.gov NCT01369004.

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.

Psychological benefits of weight loss following behavioural and/or dietary weight loss interventions. A systematic research review

It is generally accepted that weight loss has significant physiological benefits, such as reduced risk of diabetes, lowered blood pressure and blood lipid levels. However, few behavioural and dietary interventions have investigated psychological benefit as the primary outcome. Hence, systematic review methodology was adopted to evaluate the psychological outcomes of weight loss following participation in a behavioural and/or dietary weight loss intervention in overweight/obese populations. 36 Studies were selected for inclusion and were reviewed. Changes in self-esteem, depressive symptoms, body image and health related quality of life (HRQoL) were evaluated and discussed. Where possible, effect sizes to indicate the magnitude of change pre- to post- intervention were calculated using Hedges' g standardised mean difference. The results demonstrated consistent improvements in psychological outcomes concurrent with and sometimes without weight loss. Improvements in body image and HRQoL (especially vitality) were closely related to changes in weight. Calculated effect sizes varied considerably and reflected the heterogeneous nature of the studies included in the review. Although the quality of the studies reviewed was generally acceptable, only 9 out of 36 studies included a suitable control/comparison group and the content, duration of intervention and measures used to assess psychological outcomes varied considerably. Further research is required to improve the quality of studies assessing the benefits of weight loss to fully elucidate the relationship between weight loss and psychological outcomes.

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.

The effect of weight monitoring and recording on control of obesity and overweight

BACKGROUND

Obesity is one of the dilemmas of the recent century and imposes huge costs related to its complications and diseases on people and societies. This study aims to investigate whether recording and monitoring weight and its changes can modify eating habits and therefore weight control.

METHODS

This is a quasi-experimental interventional study. Seventy nine of the staff of the University of Social Welfare and Rehabilitation (USWR) were randomly placed in two intervention (N=40) and control (39) groups. A standard weight scale and height meter was used to measure weight, height and body mass index (BMI). For the intervention group, weight was measured, recorded and announced to the participants twice a week for 3 months. For the control group, weight measurement and recording was done once in the beginning of the study and once at the end of the study. Data were analyzed using SPSS ver.11.5 and compared between groups.

RESULTS

There were no significant differences in the average age between the groups. Mean pre-intervention weight was 87.08±10.9 Kg and 85.83±16.44 Kg in the intervention and control groups, respectively and was not significantly different. Mean post-intervention weight was 83.5 Kg in the intervention group, which was significantly different from pre-intervention weight. Mean post-intervention weight was 86.31 Kg in the control group that was not significantly different from pre-intervention weight.

CONCLUSION

Recording and monitoring weight and its changes in overweight people can affect weight control since knowledge and insight about weight may motivate people to modify their eating habits. We therefore recommend this strategy as an adjuvant to weight control programs.

Lifestyle modification in the management of the metabolic syndrome: achievements and challenges

Lifestyle modification based on behavior therapy is the most important and effective strategy to manage the metabolic syndrome. Modern lifestyle modification therapy combines specific recommendations on diet and exercise with behavioral and cognitive strategies. The intervention may be delivered face-to-face or in groups, or in groups combined with individual sessions. The main challenge of treatment is helping patients maintain healthy behavior changes in the long term. In the last few years, several strategies have been evaluated to improve the long-term effect of lifestyle modification. Promising results have been achieved by combining lifestyle modification with pharmacotherapy, using meals replacement, setting higher physical activity goals, and long-term care. The key role of cognitive processes in the success/failure of weight loss and maintenance suggests that new cognitive procedures and strategies should be included in the traditional lifestyle modification interventions, in order to help patients build a mind-set favoring long-term lifestyle changes. These new strategies raise optimistic expectations for an effective treatment of metabolic syndrome with lifestyle modifications, provided public health programs to change the environment where patients live support them.

A community intervention on portion control aimed at weight loss in low-income Mexican American women

A pilot study was conducted to determine if a nutritional intervention aimed at portion control leads to significant weight loss in a community of low-income Mexican American women. Nineteen low-income Mexican American women were randomized to a standard care group or an intervention group in portion control. The trial was 20 weeks in length, and the intervention included four 2-hour classes. Both interventions were administered by a certified nurse-midwife (CNM) and a promotora de salud (i.e., lay health advisor). Women in the intervention group lost more weight than women in the standard care group, though this difference was not statistically significant. The mean weight loss in the intervention group was 6.57 pounds (2.9 kg) compared to a mean weight loss of 2.8 pounds (1.3 kg) in the standard care group (P = .47). Mean weight loss, regardless of group, was significantly greater when participants reported self-weighing (P = .02). This pilot study in portion control for low-income Mexican American women merits further study.

A 2-year multifactor approach of weight loss maintenance

The overarching problem in the treatment of obesity is the consistency with which weight in treatment is regained. The aim of this study is to follow-up the patient using a multifactor approach (cognitive-behavioral therapies, diet and physical activity counselling, an "on-off" prescription of orlistat) during 4 years in order to assess the efficacy of this specific long-term weight loss maintenance programme. Weight maintenance is defined as a weight change of <2.5% of the study entry body weight. Fifty obese patients having previously lost at least 10% of their weight by any weight loss programme before entering the maintenance multifactor approach were enrolled. Ninety percent of the patients maintained more than 10% weight loss after 2 years. All the physical characteristics remained similar between study entry and 2 years after the weight loss maintenance programme. Waist and hip as well as fat mass did not show any significant differences and the mean fat mass remained stable 2 years later. In addition, all the psychological parameters analysed remained stable and in a normal range. In conclusion, this multifactor approach shows promising interim results at year-2. The multifactor approach with an "on-off" prescription of orlistat seems to be appropriate for the long term weight loss maintenance. But considering the clinical and psychological diversity of the patients, this approach has to be individually adapted for patients presenting eating behavior disorders which need a particular follow-up.

Is frequent self-weighing associated with poorer body satisfaction? Findings from a phone-based weight loss trial

OBJECTIVE

To examine the effect of self-weighing frequency on weight change and body satisfaction.

DESIGN

Observational study based on findings from a 6-month randomized controlled telephone-based weight loss trial. Data collected at baseline and 6 months.

SETTING

Metropolitan community-based sample.

PARTICIPANTS

Sixty-three obese adults. Mean age 49.5 years, 82% percent white, and 79% female. Mean body mass index at baseline was 34.2 kg/m(2).

MAIN OUTCOME MEASURES

Change in weight and body satisfaction.

ANALYSIS

General linear model regression was used to assess the effect of self-weighing on outcomes of interest. Statistical significance was set at alpha level .05. Treatment group and baseline values of dependent variables included as covariates in all analyses.

RESULTS

Participants who increased their frequency of self-weighing over the 6-month period demonstrated significantly better weight loss outcomes than those who maintained or decreased their frequency of self-weighing (-6.8 kg vs -3.1 kg, F = 8.59, P = .006). There were no significant associations between self-weighing frequency and body satisfaction at 6 months (F = 0.55, P = .58).

CONCLUSIONS AND IMPLICATIONS

These findings support frequent self-weighing for weight control. There appears to be little or no effect of self-weighing on body satisfaction. Future research should replicate these findings across a larger, more diverse population of overweight adults.

Behavioral self-regulation for weight loss in young adults: a randomized controlled trial

OBJECTIVE

To determine the feasibility of recruiting and retaining young adults in a brief behavioral weight loss intervention tailored for this age group, and to assess the preliminary efficacy of an intervention that emphasizes daily self-weighing within the context of a self-regulation model.

METHODS

Forty young adults (29.1 +/- 3.9 years, range 21-35, average BMI of 33.36 +/- 3.4) were randomized to one of two brief behavioral weight loss interventions: behavioral self-regulation (BSR) or adapted standard behavioral treatment (SBT). Assessments were conducted at baseline, post-treatment (10 weeks), and follow-up (20 weeks). Intent to treat analyses were conducted using general linear modeling in SPSS version 14.0.

RESULTS

Participants in both groups attended an average of 8.7 out of 10 group meetings, and retention rates were 93% and 88% for post-treatment and follow-up assessments, respectively. Both groups achieved significant weight losses at post-treatment (BSR = -6.4 kg (4.0); SBT = -6.2 kg (4.5) and follow-up (BSR = -6.6 kg (5.5); SBT = -5.8 kg (5.2), p < .001; but the interaction of group x time was not statistically significant, p = .84. Across groups, there was a positive association between frequency of weighing at follow-up and overall weight change at follow-up (p = .01). Daily weighing was not associated with any adverse changes in psychological symptoms.

CONCLUSION

Young adults can be recruited and retained in a behavioral weight loss program tailored to their needs, and significant weight losses can be achieved and maintained through this brief intervention. Future research on the longer-term efficacy of a self-regulation approach using daily self-weighing for weight loss in this age group is warranted.

CLINICAL TRIALS REGISTRATION

# NCT00488228.

The impact of regular self-weighing on weight management: a systematic literature review

Background

Regular self-weighing has been a focus of attention recently in the obesity literature. It has received conflicting endorsement in that some researchers and practitioners recommend it as a key behavioral strategy for weight management, while others caution against its use due to its potential to cause negative psychological consequences associated with weight management failure. The evidence on frequent self-weighing, however, has not yet been synthesized. The purpose of this paper is to evaluate the evidence regarding the use of regular self-weighing for both weight loss and weight maintenance.

Methods

A systematic literature review was conducted using the MEDLINE, CINAHL, and PsycINFO online databases. Reviewed studies were broken down by sample characteristics, predictors/conditions, dependent measures, findings, and evidence grade.

Results

Twelve studies met the inclusion/exclusion criteria, but nearly half received low evidence grades in terms of methodological quality. Findings from 11 of the 12 reviewed studies indicated that more frequent self-weighing was associated with greater weight loss or weight gain prevention. Specifically, individuals who reported self-weighing weekly or daily, typically over a period of several months, held a 1 to 3 kg/m² (current) advantage over individuals who did not self-weigh frequently. The effects of self-weighing in experimental studies, especially those where self-weighing behaviors could be isolated, were less clear.

Conclusion

Based on the consistency of the evidence reviewed, frequent self-weighing, at the very least, seems to be a good predictor of moderate weight loss, less weight regain, or the avoidance of initial weight gain in adults. More targeted research is needed in this area to determine the causal role of frequent self-weighing in weight loss/weight gain prevention programs. Other open questions to be pursued include the optimal dose of self-weighing, as well as the risks posed for negative psychological consequences.

Themed Review: Lifestyle Management of Obesity

Obesity is one of the leading causes of preventable deaths in this country. Numerous approaches have been used to manage the disease without much success. The lifestyle management of obesity has been shown to be effi cacious for successful weight loss and maintenance. Diet, physical activity, and behavior modification are the key strategies used in lifestyle programs. They are combined to help obese individuals achieve a gradual reduction in weight over an extended time period. The components may be combined in a variety of ways to e fectively promote weight loss, allowing for flexibility and personal preference. Techniques and descriptions of these components are presented in this review. In addition, special populations that may benefit from this approach are reviewed. Optional treatments that may enhance the benefits of lifestyle intervention are also discussed. The authors hope to provide a resource for clinicians that will facilitate adoption of lifestyle approaches for managing the obese patient.

An investigation of obese adults? views of the outcomes of dietary treatment

BACKGROUND

Although recommendations about the treatment of obesity have been well documented, there is little research into how obese individuals view the outcomes of dietary treatment. It has been suggested that patient involvement in evaluating treatment outcomes may help target issues to assist with the ongoing improvement of dietetic services. The aim of this qualitative study was to collect patients' views on the dietetic service, the treatment outcomes in terms of lifestyle change and the impact that attending the dietetic service had on their lives in order to improve dietetic treatment, and to assist in the selection of appropriate outcome measurements in the future.

METHODS

Semi-structured interviews were conducted with 24 obese patients attending dietetic clinics in Ayrshire, West of Scotland for weight management (advice on healthy eating and physical activity to achieve an energy deficit). Patients' views were transcribed, grouped and coded using content analysis.

RESULTS

Views included the importance of attending the dietitian for support to achieve weight management and a need to 'feel accountable to someone'. Interviewees valued information provided regarding diet, physical activity, behavioural strategies and the risks of obesity. Patients described the impact of obesity on their lives and identified changes to their lifestyles and health since attending the dietitian. They also identified barriers to change, e.g. feeling frustrated and overwhelmed about the changes necessary.

CONCLUSION

This study extends the current knowledge of patients' views of their treatment outcomes, which may be important in helping dietitians devise appropriate patient-centred outcome measures. However, as this is a small sample, further long term research into a wider range of current and discharged patients' views is required.

Self-weighing in adolescents: helpful or harmful? Longitudinal associations with body weight changes and disordered eating

PURPOSE

This study addresses the question: Is frequent self-weighing related to changes in body weight and disordered eating behaviors over a 5-year period among adolescent females and males?

METHODS

Project EAT is a 5-year population-based longitudinal study. Participants completed surveys exploring factors associated with eating and weight concerns. Participants included 2516 adolescents who were transitioning from early to middle adolescence (younger cohort) and from middle to late adolescence (older cohort).

RESULTS

In the older cohort of females and in both cohorts of males, frequent self-weighing at Time 1 was not associated with weight changes at Time 2 (5 years later), after adjusting for Time 1 weight status and sociodemographic characteristics. In the younger cohort of females, Time 1 frequent self-weighing predicted weight increases at Time 2. In both cohorts of females, but not in males, Time 1 frequent self-weighing predicted higher prevalences of Time 2 disordered eating behaviors, including unhealthy weight control behaviors and binge eating, after adjusting for Time 1 behavioral outcomes, weight status, and sociodemographic characteristics.

CONCLUSIONS

Frequent self-weighing was not associated with weight change, with the exception of predicting weight increases in younger females. In females, but not males, self-weighing predicted a higher frequency of binge eating and unhealthy weight control behaviors. Although further research is needed to explore the potential merits and problems associated with regular self-weighing, the findings suggest that population-based obesity prevention strategies targeting adolescents should avoid messages likely to lead to frequent self-weighing.

A self-regulation program for maintenance of weight loss

BACKGROUND

Since many successful dieters regain the weight they lose, programs that teach maintenance skills are needed. We developed a maintenance program based on self-regulation theory and tested the efficacy of delivering the program face to face or over the Internet.

METHODS

We randomly assigned 314 participants who had lost a mean of 19.3 kg of body weight in the previous 2 years to one of three groups: a control group, which received quarterly newsletters (105 participants), a group that received face-to-face intervention (105), and a group that received Internet-based intervention (104). The content of the programs in the two intervention groups was the same, emphasizing daily self-weighing and self-regulation, as was the frequency of contact with the groups. The primary outcome was weight gain over a period of 18 months.

RESULTS

The mean (+/-SD) weight gain was 2.5+/-6.7 kg in the face-to-face group, 4.7+/-8.6 kg in the Internet group, and 4.9+/-6.5 kg in the control group, with a significant difference between the face-to-face group and the control group (2.4 kg; 95% confidence interval [CI], 0.002 to 10.8; P=0.05). The proportion of participants who regained 2.3 kg or more over the 18-month period was significantly higher in the control group (72.4%) than in the face-to-face group (45.7%; absolute difference, 27%; 95% CI, 14 to 39; P<0.001) or the Internet group (54.8%; absolute difference, 18%; 95% CI, 5 to 30; P=0.008). Daily self-weighing increased in both intervention groups and was associated with a decreased risk of regaining 2.3 kg or more (P<0.001).

CONCLUSIONS

As compared with receiving quarterly newsletters, a self-regulation program based on daily weighing improved maintenance of weight loss, particularly when delivered face to face. (ClinicalTrials.gov number, NCT00067145 [ClinicalTrials.gov].)

The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it

The Look AHEAD (Action for Health in Diabetes) study is a multicenter, randomized controlled trial designed to determine whether intentional weight loss reduces cardiovascular morbidity and mortality in overweight individuals with type 2 diabetes. The study began in 2001 and is scheduled to conclude in 2012. A total of 5145 participants have been randomly assigned to a lifestyle intervention or to an enhanced usual care condition (i.e., diabetes support and education). This article describes the lifestyle intervention and the empirical evidence to support it. The two principal intervention goals are to induce a mean loss >or = 7% of initial weight and to increase participants' moderately intense physical activity to > or =175 min/wk. For the first 6 months, participants attend one individual and three group sessions per month and are encouraged to replace two meals and one snack a day with liquid shakes and meal bars. From months 7 to 12, they attend one individual and two group meetings per month and continue to replace one meal per day (which is recommended for the study's duration). Starting at month 7, more intensive behavioral interventions and weight loss medication are available from a toolbox, designed to help participants with limited weight loss. In Years 2 to 4, treatment is provided mainly on an individual basis and includes at least one on-site visit per month and a second contact by telephone, mail, or e-mail. After Year 4, participants are offered monthly individual visits. The intervention is delivered by a multidisciplinary team that includes medical staff who monitor participants at risk of hypoglycemic episodes.