Four main barriers to weight loss maintenance? A quantitative analysis of difficulties experienced by obese patients after successful weight reduction

Proof-of-concept testing of a brief virtual ACT workshop for emotional eating

BACKGROUND

Emotional eating, or eating in response to negative emotions, is a commonly reported short-term emotion regulation strategy but has been shown to be ineffective in the long term. Most emotional eating interventions based on Acceptance and Commitment Therapy (ACT) have been delivered in the context of weight loss trials, highlighting a need for ACT-based emotional eating interventions in weight-neutral contexts.

AIMS

This proof-of-concept study aimed to test the acceptability and efficacy potential of a brief virtual ACT workshop for emotional eating in a small sample of adults identifying as emotional eaters.

METHODS

Twenty-six adult emotional eaters completed an ACT workshop delivered in two 1.5-h sessions over two weeks. The workshop targeted awareness and acceptance of emotions and eating urges, and valued actions around eating.

RESULTS

The acceptability of the workshop was demonstrated by high participant satisfaction. Significant improvements on all outcome measures were found and maintained up to 3 months follow-up.

CONCLUSIONS

These proof-of-concept findings suggest that a brief virtual ACT workshop may improve emotional eating and associated ACT processes. Results from this study can inform a future randomized controlled trial to test the efficacy of the workshop and the role of theoretical processes of change.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04457804.

LEVEL OF EVIDENCE

Level IV, evidence obtained from multiple time series with the intervention.

Switching diets after 6-months does not result in renewed weight loss: a secondary analysis of a 12-month crossover randomized trial

Weight change trajectory from diet and lifestyle interventions typically involves rapid weight loss followed by a weight plateau after approximately 6 months. Changing from one weight-loss diet to another at the time of the plateau could instigate renewed weight loss. Therefore, our secondary analysis aimed to assess trajectory of weight loss in a 12-month, randomized, cross-over study. Forty-two adults were randomized to eat a healthy low-fat or healthy low-carbohydrate diet for 6 months then switched to the opposite diet for an additional 6 months. Regardless of diet assignment, participants experienced rapid initial weight loss, which slowed between 3 to 6 months. After switching diets at 6 months, weight modestly decreased until 9 months, but at a rate slower than the initial 3 months and slower than the rate from 3 to 6 months. This suggests that the weight loss plateau typically seen at 6 months is physiological and cannot be overcome by simply switching to a different weight-loss diet.

Research Trends in Motivation and Weight Loss: A Bibliometric-Based Review

Obesity is a complex disease that, like COVID-19, has reached pandemic proportions. Consequently, it has become a rapidly growing scientific field, represented by an extensive body of research publications. Therefore, the aim of this study was to present the research trends in the scientific literature on motivation and weight loss. Because traditional knowledge synthesis approaches are not appropriate for analyzing large corpora of research evidence, we utilized a novel knowledge synthesis approach called synthetic knowledge synthesis (SKS) to generate new holistic insights into obesity research focusing on motivation. SKS is a triangulation of bibliometric analysis, bibliometric mapping, and content analysis. Using it, we analyzed the corpus of publications retrieved from the Scopus database, using the search string TITLE-ABS-KEY((obesity or overweight) and "weight loss" and motiv*) in titles, keywords, and abstracts, without any additional inclusion or exclusion criteria. The search resulted in a corpus of 2301 publications. The United States of America, the United Kingdom, and Australia were the most productive countries. Four themes emerged, namely, weight loss and weight-loss maintenance through motivational interventions, lifestyle changes supported by smart ICT, maintaining sustainable weight with a healthier lifestyle, and weight management on the level of primary healthcare and bariatric surgery. Further, we established that the volume of research literature is growing, as is the scope of the research. However, we observed a regional concentration of research and its funding in developed countries and almost nonexistent research cooperation between developed and less-developed countries.

Approaches to addressing the rise in obesity levels

Levels of obesity and overweight are increasing globally, with affected individuals often experiencing health issues and reduced quality of life. The pathogenesis of obesity is complex and multifactorial, and effective solutions have been elusive. In this Viewpoint, experts in the fields of medical therapy, adipocyte biology, exercise and muscle, bariatric surgery, genetics, and public health give their perspectives on current and future progress in addressing the rising prevalence of obesity.

Discovering Engagement Personas in a Digital Diabetes Prevention Program

Digital health technologies are shaping the future of preventive health care. We present a quantitative approach for discovering and characterizing engagement personas: longitudinal engagement patterns in a fully digital diabetes prevention program. We used a two-step approach to discovering engagement personas among n = 1613 users: (1) A univariate clustering method using two unsupervised k-means clustering algorithms on app- and program-feature use separately and (2) A bivariate clustering method that involved comparing cluster labels for each member across app- and program-feature univariate clusters. The univariate analyses revealed five app-feature clusters and four program-feature clusters. The bivariate analysis revealed five unique combinations of these clusters, called engagement personas, which represented 76% of users. These engagement personas differed in both member demographics and weight loss. Exploring engagement personas is beneficial to inform strategies for personalizing the program experience and optimizing engagement in a variety of digital health interventions.

The association between binge eating disorder and weight management in overweight and obese adults: A systematic literature review

Aim: Weight loss is shown to improve obesity-related health problems as long as it is maintained for a long term. The purpose of this systematic review was to investigate the association between binge eating disorder and weight management in overweight and obese adults. Methods: A systematic search following the preferred reporting items for systematic reviews and meta-analyses guidelines was conducted across PubMed, Ebsco and Cochrane Library from inception through December 2020 to identify studies that assessed the association between binge eating disorder and weight management (e.g., weight loss, weight gain and weight loss maintenance) in overweight and obese adults. We included studies that examined adults (≥18 years old) being overweight and obese with and without binge eating behaviour. Two authors independently screened and evaluated studies for methodological quality. Results: Nine articles were selected, including 3685 participants. Three of the included studies were randomised control trials and the remaining were observational studies. The majority of the studies included support that people who have binge eating disorder may have an additional barrier maintaining their weight loss compared to people who do not suffer from binge eating disorder. Conclusion: Our systematic review revealed that binge eating disorder may have a negative association with weight loss maintenance. Further well-conducted prospective cohort studies and randomised clinical trials are required to investigate the possible mechanisms and whether any such mechanisms are modifiable. These will lead us to more efficient strategies targeting weight management.

Food Liking but Not Wanting Decreases after Controlled Intermittent or Continuous Energy Restriction to ≥5% Weight Loss in Women with Overweight/Obesity

Food reward (i.e., liking and wanting) has been shown to decrease after different types of weight management interventions. However, it is unknown whether specific dietary modalities (continuous (CER) vs. intermittent (IER) energy restriction) have differing effects on liking and implicit wanting after weight loss (WL) and whether these changes are sustained after 1-year of no-contact. Women with overweight or obesity (age 18–55 years) were randomly allocated to controlled-feeding CER (25% daily energy restriction) or IER (alternating ad libitum and 75% energy restriction days). Study visits were conducted at baseline, post-WL (to ≥5% WL within 12 weeks) and 1-year post-WL. The main outcomes were liking and implicit wanting for 4 categories of common food varying in fat and taste assessed by the Leeds Food Preference Questionnaire. Linear mixed models were conducted on the 30 participants achieving ≥5% WL and 15 returners. After an initial WL of −5.1 ± 0.2 kg, after 1-year 2.6 ± 0.5 kg were regained. Liking but not wanting decreased after WL. Food reward after 1-year did not differ from baseline, but the high loss to follow-up prevents generalization. IER and CER did not differ in their effects on food reward during WL or at 1-year follow-up.