A Pilot Feasibility Randomized Controlled Trial of Effects of Opaque Bottles on Maternal Sensitivity, Infant Intake, and Infant Weight Status

BACKGROUND

Conventional clear infant feeding bottles provide visual cues about the amount of milk consumed, which may decrease caregivers' sensitivity to infant cues, increase infant intake, and lead to greater infant weight gain.

OBJECTIVE

This study examined feasibility, adherence, acceptability, and preliminary effectiveness of an intervention in which families received clear vs opaque bottles.

DESIGN

A pilot feasibility randomized controlled trial was conducted.

PARTICIPANTS/SETTING

Participants included mothers (N = 76) with young infants (2.9 ± 1.4 months old). Data collection occurred between December 2018 and July 2022 and within San Luis Obispo and Santa Barbara Counties, California. All assessments occurred within participants' homes.

INTERVENTION

Participants were randomized to use clear (Clear group, n = 38) or opaque (Opaque group, n = 38) bottles for 12 weeks.

MAIN OUTCOME MEASURES

We assessed feasibility of recruitment and retention, participant perceptions of study bottles, participant adherence to the intervention, maternal sensitivity to cues, infant intake (mL and mL/kg), and infant weight-for-length z-scores (WLZ).

STATISTICAL ANALYSES PERFORMED

Data were analyzed using linear regression, χ2 analysis, and repeated-measures analysis of variance (ANOVA).

RESULTS

Of 842 potential participants, 295 (35%) could not be reached after initial contact, 166 (20%) declined to participate, and 305 (36%) were ineligible. Of those who declined, 16 (10%) declined because they did not want to use study bottles. No differences were observed for loss to follow-up for Clear (8 of 38; 21%) vs Opaque (5 of 38; 13%) groups (P = 0.36) or for reported use of assigned bottles for Clear (89.8% ± 24.5% of daily feedings) vs Opaque (90.1% ± 22.1%) groups (P = 0.96). No group differences were observed for sensitivity to cues (P = 0.52) or intake (mL, P = 0.53 or mL/kg, P = 0.56) at follow-up. Opaque group infants had lower WLZ at follow-up compared with Clear group infants (mean difference, 0.47; 95% confidence interval, 0.08, 0.86; ηp2 = 0.17), adjusting for baseline WLZ.

CONCLUSIONS

Relative to providing clear bottles, providing families with opaque bottles appeared feasible and acceptable, with good adherence. Although preliminary, study findings suggest the potential of opaque bottles to support healthier weight outcomes for bottle-fed infants.

Behavioral, psychological, and environmental predictors of weight regain in a group of successful weight losers in a widely available weight-management program

OBJECTIVE

The aim of this study was to identify predictors of weight regain and continued weight maintenance among individuals already successful at long-term weight loss in a widely available weight-management program.

METHODS

Participants were 2843 weight-loss maintainers in WeightWatchers who had maintained weight loss ≥9.1 kg for ≥1 year (average 25.5 kg for 3.5 years; BMI = 26.7 kg/m2 ). Validated behavioral, psychosocial, and home environmental questionnaires were administered at study entry and 1 year later. Discriminant analysis identified variables that discriminated gainers (≥2.3-kg gain) from maintainers (±2.3-kg change).

RESULTS

Over the 1 year of follow-up, 43% were gainers (mean [SD], 7.2 [5.4] kg), and 57% were maintainers (0.4 [1.2] kg). Compared with maintainers, gainers were younger and had higher initial weight, more recent weight losses, and larger initial weight losses. Standardized canonical coefficients indicated that the 1-year changes that most discriminated gainers from maintainers were greater decreases in the ability to accept uncomfortable food cravings, urges, and desires to overeat (0.232); self-monitoring (0.166); body image (0.363); and body satisfaction (0.194) and greater increases in disinhibition (0.309) and bodily pain (0.147). The canonical correlation was 0.505 (p < 0.001).

CONCLUSIONS

Future interventions to prevent regain should consider targeting overeating in response to internal and external food cues and declines in self-monitoring and body image.

Gestational Diabetes Is Characterized by Decreased Medium-Chain Acylcarnitines and Elevated Purine Degradation Metabolites across Pregnancy: A Case-Control Time-Course Analysis

Gestational Diabetes Mellitus (GDM) results in complications affecting both mothers and their offspring. Metabolomic analysis across pregnancy provides an opportunity to better understand GDM pathophysiology. The objective was to conduct a metabolomics analysis of first and third trimester plasma samples to identify metabolic differences associated with GDM development. Forty pregnant women with overweight/obesity from a multisite clinical trial of a lifestyle intervention were included. Participants who developed GDM (n = 20; GDM group) were matched with those who did not develop GDM (n = 20; Non-GDM group). Plasma samples collected at the first (10-16 weeks) and third (28-35 weeks) trimesters were analyzed with ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Cardiometabolic risk markers, dietary recalls, and physical activity metrics were also assessed. Four medium-chain acylcarnitines, lauroyl-, octanoyl-, decanoyl-, and decenoylcarnitine, significantly differed over the course of pregnancy in the GDM vs Non-GDM group in a group-by-time interaction (p < 0.05). Hypoxanthine and inosine monophosphate were elevated in the GDM group (p < 0.04). In both groups over time, bile acids and sorbitol increased while numerous acylcarnitines and α-hydroxybutyrate decreased (p < 0.05). Metabolites involved in fatty acid oxidation and purine degradation were altered across the first and third trimesters of GDM-affected pregnancies, providing insight into metabolites and metabolic pathways altered with GDM development.

Recovery from weight regain among long-term weight loss maintainers in WW

OBJECTIVE

This study sought to understand the process and strategies to recover from regain among weight loss maintainers.

METHODS

Participants in WeightWatchers (WW; n = 2457) had lost ≥9 kg for ≥1 year and were grouped based on self-reported weight change after maximum loss: sustained maintenance ("Stable"), ups and downs ("Gain-Lose"), and regain ("Gain"). The groups were compared on weight control strategies, and the Gain-Lose and Gain groups reported on attempts to reverse weight regain.

RESULTS

Mean weight loss was 28.5 kg and duration of ≥9 kg loss was 3.5 years. During this time, 48% reported weight stability, and the remaining reported some regain (Gain-Lose, 29% or Gain, 23%). Among Gain and Gain-Lose, action to lose regained weight occurred after gaining >4 kg. Compared with Gain, Gain-Lose sustained reengagement efforts longer (16 vs. 10 weeks) and had better dietary choices (3.4 vs. 3.2), self-monitoring (2.9 vs. 2.7), and psychological coping (2.5 vs. 2.4) scores. Among Gain-Lose, the most successful (< 2.3 kg vs. >2.3 kg regain) initiated weight loss efforts after less regain (2.3 vs. 4.5 kg).

CONCLUSIONS

Reengaging with weight loss after regains may be most successful if focused on diet, self-monitoring, and psychological coping and initiated with less regain.

In their own words: Topic analysis of the motivations and strategies of over 6,000 long-term weight-loss maintainers

OBJECTIVE

This study aimed to identify major themes of a large cohort experiencing long-term weight-loss maintenance who answered open-ended questions about weight-loss triggers, current motivations, strategies, and experiences.

METHODS

Machine learning and topic modeling were used to analyze responses to six open-ended questions among 6,139 WW International, Inc., (formerly Weight Watchers) members with weight-loss maintenance; inclusion criteria included ≥9.1-kg loss with weight-loss maintenance for ≥1 year.

RESULTS

Participants (mean age = 53.6 years; 94.3% White; mean BMI = 27.8 kg/m² ) had lost 24.5 kg and maintained the loss for 3.4 years. Descriptions of factors triggering weight loss coalesced into five topics: medical status, appearance, mobility, social prompts, and change needed. Factors currently motivating weight-loss maintenance yielded two topics: looking back at experiences at higher weight and health/appearance concerns. Advice for others to succeed in weight-loss maintenance coalesced on two recommendations: perseverance in the face of setbacks and consistency in tracking. Rewards for weight management included improved confidence, pain, mobility, fitness, body image, medical status, and affect. Two thematic negative consequences were clothing costs and sagging skin.

CONCLUSIONS

Future weight-maintenance research should include more diverse populations and investigate weight-loss maintenance as a journey with highs and lows, perseverance in the face of setbacks, sustained tracking, and making changes in medical status more salient during the weight-maintenance journey.

Factors associated with food choice among long-term weight loss maintainers

Background

The present study aimed to examine motivations for food choice among long‐term weight loss maintainers (WLM) in a widely used commercial weight management program.

Methods

A cross‐sectional study was employed where determinants of food choice were measured in the USA using validated scales: Food Choice Questionnaire, Consideration of Future Consequences, and Eating in the Absence of Hunger. Participants were 3806 WLM following a commercial weight management program (WW International, Inc.) who had maintained a weight loss ≥ 9.1 kg (mean 24.7 kg) for 3.3 years and had a body mass index (BMI) of 27.6 kg m². A control group of weight stable individuals with obesity (controls; n = 519) had a BMI of 38.9 kg m² and a weight change < 2.3 kg over the previous 5 years.

Results

WLM vs. controls made food decisions more based on health (18.9 vs. 16.3; η_p² = 0.052) and weight control (9.9 vs. 7.5; η_p² = 0.16) and less based on price (8.4 vs. 9.1; η_p² = 0.10). WLM also scored higher than controls with respect to considering future consequences of behaviours (44.3 vs. 38.4; η_p² = 0.060) and reported less external eating in the absence of hunger (7.1 vs. 7.5; η_p² = 0.058). Standard canonical coefficients indicated that making food choices based on weight (0.717) with less value placed on price (−0.33) and greater consideration of future consequences (0.262) contributed independently and most (overall r = 0.593; p = 0.0001) to discriminating WLM from controls.

Conclusions

In a widely used commercial weight management program, successful WLM reported food decisions based more on weight and less on price and considered future consequences of current behaviours.

Long‐term weight loss maintainers consume a diet that is low in calories and micronutrient rich, although the diverse factors that govern these food choices remain unclear.

The present study examined diverse factors associated with food choice among weight loss maintainers in a widely used commercial weight management program (WW International, Inc.) compared to weight stable individuals with obesity (“controls”).

Weight loss maintainers more than controls made food decisions based on health and weight control and less based on price. Both groups scored similarly in the role of convenience, mood, sensory appeal, natural content, familiarity and ethical concerns.

Weight loss maintainers were overall more likely to consider future consequences.

In a widely used commercial weight management program (WW International, Inc.), successful weight loss maintainers reported food decisions based more on weight and health and less on price. They also considered future consequences of current behaviours.

Metabolites involved in purine degradation, insulin resistance, and fatty acid oxidation are associated with prediction of Gestational diabetes in plasma

INTRODUCTION

Gestational diabetes mellitus (GDM) significantly increases maternal and fetal health risks, but factors predictive of GDM are poorly understood.

OBJECTIVES

Plasma metabolomics analyses were conducted in early pregnancy to identify potential metabolites associated with prediction of GDM.

METHODS

Sixty-eight pregnant women with overweight/obesity from a clinical trial of a lifestyle intervention were included. Participants who developed GDM (n = 34; GDM group) were matched on treatment group, age, body mass index, and ethnicity with those who did not develop GDM (n = 34; Non-GDM group). Blood draws were completed early in pregnancy (10-16 weeks). Plasma samples were analyzed by UPLC-MS using three metabolomics assays.

RESULTS

One hundred thirty moieties were identified. Thirteen metabolites including pyrimidine/purine derivatives involved in uric acid metabolism, carboxylic acids, fatty acylcarnitines, and sphingomyelins (SM) were different when comparing the GDM vs. the Non-GDM groups (p < 0.05). The most significant differences were elevations in the metabolites' hypoxanthine, xanthine and alpha-hydroxybutyrate (p < 0.002, adjusted p < 0.02) in GDM patients. A panel consisting of four metabolites: SM 14:0, hypoxanthine, alpha-hydroxybutyrate, and xanthine presented the highest diagnostic accuracy with an AUC = 0.833 (95% CI: 0.572686-0.893946), classifying as a "very good panel".

CONCLUSION

Plasma metabolites mainly involved in purine degradation, insulin resistance, and fatty acid oxidation, were altered in early pregnancy in connection with subsequent GDM development.

Sitting Time, Type, and Context Among Long-Term Weight-Loss Maintainers

OBJECTIVE

This study aimed to investigate sitting time, the home sedentary environment, and physical activity among weight-loss maintainers in WW (formerly Weight Watchers).

METHODS

Participants were 4,305 weight-loss maintainers who had maintained ≥9.1 kg of weight loss (24.7 kg on average) for 3.3 years and had an average current BMI of 27.6 kg/m² . A control group of weight-stable individuals with obesity (n = 619) had an average BMI of 38.9 kg/m² . The Multicontext Sitting Time Questionnaire and Paffenbarger physical activity questionnaire were administered.

RESULTS

Weight-loss maintainers versus controls spent 3 hours less per day sitting during the week (10.9 vs. 13.9; η p 2 = 0.039; P = 0.0001) and weekends (9.7 vs. 12.6; η p 2 = 0.038). Weight-loss maintainers versus controls spent 1 hour less per day in non-work-related sitting using a computer or video games during the week (1.4 vs. 2.3; η p 2 = 0.03; P = 0.0001) and weekends (1.5 vs. 2.5; η p 2 = 0.03; P = 0.0001). Weight-loss maintainers versus controls had similar numbers of sedentary-promoting devices (15.8 vs. 14.8) and expended significantly more calories per week in physical activity (1,835 vs. 785; η p 2 = 0.036; P = 0.0001).

CONCLUSIONS

Weight-loss maintainers reported less time sitting than weight-stable individuals with obesity. Future research should test the efficacy of targeting sitting time to help promote long-term weight-loss maintenance.

Effect of prenatal lifestyle intervention on maternal postpartum weight retention and child body mass index z-score at 36 months

BACKGROUND/OBJECTIVES

We previously reported results from a randomized trial showing that a behavioral intervention during pregnancy reduced excess gestational weight gain but did not impact maternal weight at 12 months. We now examine the longer-term effects of this prenatal intervention on maternal postpartum weight retention and toddler body-mass-index z scores (BMIz) over 36 months.

SUBJECTS/METHODS

Pregnant women (N = 264; 13.7 weeks' gestation; 41.6% Hispanic) with overweight or obesity were randomized into usual care or prenatal intervention. Anthropometric assessments in mothers and toddlers occurred at baseline, 35 weeks' gestation and after delivery at 6, 12, 18, 24, and 36 months.

RESULTS

At 36 months, prenatal intervention vs. usual care had no significant effect on the proportion of participants who returned to their early pregnancy weight or below (33.3% vs. 39.5%; p = 0.12) and had no effect on the magnitude of weight retained (2.8 [0.8, 4.8] vs 3.0 kg [1.0, 4.9], respectively; mean difference = 0.14 [-3.0, 2.7]). There was also no statistically significant intervention vs. usual care effect on infant BMIz or skinfold changes over time; toddler BMIz increased by 1.4 [-1.7, 1.0] units in the intervention group and 1.6 [-1.2, 1.8] units in the usual care group from delivery to 36 months (difference = 0.16 [-0.32. 0.63]). The proportion of toddlers at risk for obesity at 36 months was similar in intervention and usual care groups (28/77 [36.4%] vs 30/80 [37.5%]; p = 0.77).

CONCLUSIONS

Compared with usual care, lifestyle intervention during pregnancy resulted in similar maternal and toddler anthropometric outcomes at 36-months postpartum in a diverse US sample of women with overweight and obesity. To sustain improved maternal weight management initiated during pregnancy, continued intervention during the postpartum years may be needed.

First Trimester Metabolites Predict Gestational Diabetes Mellitus Diagnosis: A Case: Control Study (FS03-04-19)

Objectives

Gestational Diabetes Mellitus (GDM) has an overall prevalence estimated as high as 13% of overweight/obese (OW/OB) pregnant women. Since the occurrence of GDM can have a combination of adverse perinatal outcomes and long-term increased risk of health issues in the future for both the mother and child, it is important that the mechanisms involved in this disease are better understood so that better prevention strategies can be devised. We sought to identify early and late pregnancy metabolites that discriminated women who developed vs. did not develop GDM to provide insight into its etiology and help improve treatments.

Methods

Participants were 26 OW/OB women enrolled in the Healthy Beginnings Trial and completed blood draws at 13 weeks, 26 weeks, and 35 weeks gestation. Participants from the control and dietary intervention group who developed GDM (N = 12) were matched on age and study entry BMI with those who did not develop GDM (N = 14). Plasma samples were analyzed by ultra-high-performance liquid chromatography-hybrid triple‐quadrupole linear ion trap mass spectrometry (UPLC-QTRAP) using two targeted metabolomics assays for primary metabolomics and aminomics.

Results

A total of 142 metabolites were identified. Most metabolite differences were observed during the first trimester blood draw, prior to GDM diagnosis. At first trimester, metabolites related to energy metabolism that were altered included lower levels of alpha-ketoglutarate and glycerol-3-phosphate, as well as the medium-chain acylcarnitines’ lauroyl-carnitine, dodecenoyl-carnitine, and octanoyl-carnitine (P < 0.05). Interestingly, the neurotransmitters serotonin and glutamate were elevated in subjects who later developed GDM (P < 0.01). In regards to the observed elevated creatine, the lower concentrations of methionine and glycine may suggest utilization of these amino acids for its production (P < 0.03). Lastly, the gut microbiota-derived indole-3-propionate was higher in GDM cases (P < 0.05). In the third trimester of the GDM group, only levels of 4-pyridoxate (vitamin B-6) were lowered (P < 0.05).

Conclusions

Metabolic changes associated with the numerous plasma metabolites that were different between GDM case-control subjects during first trimester may predict the development of this condition.

Funding Sources

NIH, ARI.