6-month Weight Loss Research Articles

Abstract P3-08-02: Comparison of strategies for weight loss maintenance among rural breast cancer survivors: The rural women connecting for better health randomized controlled trial

Abstract Background: Breast cancer survivors who reside in rural areas represent one of the largest medically underserved populations of breast cancer survivors in the nation and have higher obesity prevalence compared to their urban counterparts. Given the evidence linking obesity with poor breast cancer prognosis, trials are needed to demonstrate ability to produce long-term weight loss maintenance in this hard-to-reach group. Group phone-based counseling via conference calls is a low-technology approach with excellent reach to rural areas. This treatment delivery approach capitalizes on the support benefits of in-person groups by allowing participants to interact in real time while also diminishing costs. Methods: In this 2 phase trial, overweight and obese (BMI 27 to 45 kg/m2) rural breast cancer survivors (with initial stage 0-III disease) were randomized to one of two extended care interventions for weight loss maintenance (Phase 2) subsequent to an initial 6-month weekly group phone-based behavioral weight loss intervention (Phase 1). To be eligible for randomization for maintenance, participants must have lost ≥ 5% of their baseline weight during Phase 1. In Phase 2, participants were randomized to continued group phone-based counseling reduced in frequency to every other week during maintenance vs every other week mailed newsletters that followed the same content. Results: 210 breast cancer survivors with a mean time since treatment of 3.5 years ± 2.4 years, mean age of 58.1 ± 9.9 years, and mean BMI of 33.9 ± 4.4 kg/m2 residing in a three state region of the rural Midwest were entered in the 6-month weight loss phase. Retention from baseline to 6 months (Phase 1) was 91%. Mean percent weight loss at 6 months for the total sample was 12.9% with 82% of enrolled participants ≥ 5% below baseline weight. 172 participants with a mean initial loss of 14.0% of baseline weight (12.8 ± 4.9 kg) were randomized to a maintenance intervention. Retention from 6 to 18 months (Phase 2) was 92%. Intent-to-treat analyses with imputation of missing data revealed participants in the group phone condition regained less weight (3.3 ± 4.8 kg) compared to participants in the newsletter condition (4.9 ± 4.8 kg; p = 0.03). Mean percent weight loss from baseline to 18 months did not significantly differ between the group phone condition (10.2 ± 7.5%) and the newsletter condition (9.2 ± 7.9%). However, at 18 months 75.3% of participants in the group phone condition remained ≥ 5% below baseline weight compared to 57.8% in the newsletter condition (p = .02). Discussion: The initial group phone-based weight loss intervention exceeded typical weight losses reported in the literature with over 80% of enrolled participants achieving clinically meaningful weight loss. Continued group phone counseling was modestly better in sustaining weight loss at 18 months than a mailed newsletter. However, for both maintenance approaches, the majority of participants maintained a weight at 18 months that was 5% or more below baseline. Citation Format: Befort CA, Klemp JR, Sullivan DK, Diaz FJ, Schmitz KH, Perri MG, Fabian CJ. Comparison of strategies for weight loss maintenance among rural breast cancer survivors: The rural women connecting for better health randomized controlled trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-08-02.

Effect of weight history on ability to lose weight after a 6-month randomized controlled weight loss trial in overweight breast cancer survivors: The Lifestyle, Exercise and Nutrition (LEAN) study.

174 Background: Because obesity portends a higher risk of breast cancer mortality, achieving a healthy weight is recommended for breast cancer survivors. The impact of weight history on the ability to lose weight is unclear. We previously reported a 6.2 + 0.7% vs. 2.1 + 0.9% weight loss (p = .0003) in 100 breast cancer survivors randomized to a 6-month weight loss intervention vs. usual care. We examined whether weight history modified the effect of the intervention on body weight changes. Methods: Breast cancer survivors with a BMI > 25 kg/m2were randomized to usual care or 6-month, 11-session diet and exercise-counseling intervention. Baseline and 6 month weight and height were measured; weight at ages 18 and 35, 5 years and 1 year before and at diagnosis were self-reported. We defined weight history as: 1) change in weight between each time point and baseline; and 2) duration of obesity (i.e., number of years of having a BMI > 30 between age 18 and baseline). Generalized linear models were used to evaluate mean changes at 6 months between the intervention and usual care groups, adjusted and stratified by weight history variables. Results: Mean age and time since diagnosis were 59 + 7 years and 2.9 + 2.1 years, respectively. BMI increased over time (age 18 BMI = 21.8 + 2.9; baseline BMI = 32.4 + 6.5). Number of years being obese was 5.3 + 8.2 years (range 0-40 years). BMI at baseline, change in BMI from various time points to baseline, and years of obesity did not modify weight loss results. After adjusting for weight history, women randomized to intervention vs. usual care lost 6.1 + 0.7% vs. 2.0 + 0.9%, p = .0006, respectively. Conclusions: Participants reported a history of steady weight gain over time. The duration of obesity did not modify weight loss results. Weight history did not hinder survivors’ ability to lose clinically meaningful weight via a structured intervention.

The PILI@Work Program: a translation of the diabetes prevention program to Native Hawaiian-serving worksites in Hawai'i.

A previously translated Diabetes Prevention Program Lifestyle Intervention (DPP-LI) was adapted for delivery as a worksite-based intervention, called PILI@Work, to address obesity disparities in Native Hawaiians/Pacific Islanders. This study examined the effectiveness of PILI@Work and factors associated with weight loss at post-intervention. Overweight/obese employees of 15 Native Hawaiian-serving organizations received the 3-month component of PILI@Work. Assessments included weight, systolic/diastolic blood pressure, physical activity and functioning, fat intake, locus of weight control, social support, and self-efficacy. Weight, systolic/diastolic blood pressure, physical functioning, physical activity frequency, fat intake, family support, and eating self-efficacy improved from pre- to post-intervention. Regression analysis indicated that worksite type, decreased diastolic blood pressure, increased physical activity, and more internalized locus of weight control were significantly associated with 3-month weight loss. PILI@Work initiated weight loss in Native Hawaiians/Pacific Islanders. DPP-LI translated to worksite settings and tailored for specific populations can be effective for addressing obesity.

Improved Function With Enhanced Protein Intake per Meal: A Pilot Study of Weight Reduction in Frail, Obese Older Adults.

Background:Obesity is a significant cause of functional limitations in older adults; yet, concerns that weight reduction could diminish muscle along with fat mass have impeded progress toward an intervention. Meal-based enhancement of protein intake could protect function and/or lean mass but has not been studied during geriatric obesity reduction.Methods:In this 6-month randomized controlled trial, 67 obese (body mass index ≥30kg/m2) older (≥60 years) adults with a Short Physical Performance Battery score of 4–10 were randomly assigned to a traditional (Control) weight loss regimen or one with higher protein intake (>30g) at each meal (Protein). All participants were prescribed a hypo-caloric diet, and weighed and provided dietary guidance weekly. Physical function (Short Physical Performance Battery) and lean mass (BOD POD), along with secondary measures, were assessed at 0, 3, and 6 months.Results:At the 6-month endpoint, there was significant (p < .001) weight loss in both the Control (−7.5±6.2kg) and Protein (−8.7±7.4kg) groups. Both groups also improved function but the increase in the Protein (+2.4±1.7 units; p < .001) was greater than in the Control (+0.9±1.7 units; p < .01) group (p = .02).Conclusion:Obese, functionally limited older adults undergoing a 6-month weight loss intervention with a meal-based enhancement of protein quantity and quality lost similar amounts of weight but had greater functional improvements relative to the Control group. If confirmed, this dietary approach could have important implications for improving the functional status of this vulnerable population (ClinicalTrials.gov identifier: NCT01715753).

Postoperative Follow-up After Bariatric Surgery: Effect on Weight Loss.

While adherence to long-term follow-up after bariatric surgery is a mandate for center of excellence certification, the effect of attrition on weight loss is not well understood. The aim of this study was to assess the effect of postoperative follow-up on 12-month weight loss using the Bariatric Outcomes Longitudinal Database (BOLD) dataset. Patients with complete follow-up (3, 6, and 12 months) were compared to patients who had one or more prior missed visits. There were 51,081 patients with 12-month follow-up data available. After controlling for baseline characteristics, complete follow-up was independently associated with excess weight loss ≥50%, and total weight loss ≥30%. Adherence to postoperative follow-up is independently associated with improved 12-month weight loss after bariatric surgery. Bariatric programs should strive to achieve complete follow-up for all patients.

Low fat dairy foods improve lipid profile and proinflammatory markers in overweight/obese early postmenopausal women after a 6-month weight loss intervention

W previously showed that consumption of low fat dairy foods (4-5 servings/day), resulted in better body composition (lean and fat tissue) outcomes compared to calcium (Ca) supplement or control group in postmenopausal women after a 6-month weight loss intervention. Here we report the effect of dairy foods and/or Ca supplementation on lipid profile and proinflammatory markers in the same population. A total of n=97 overweight/obese early postmenopausal women completed the 6 months follow up and had complete datasets. They were divided into 3 groups: Supplement (pills containing 630 mg Ca+400 IU of vitamin D/day); Dairy (low fat dairy consumption, 4-5 servings/day) and Control (placebo pills). Each group included moderate energy restriction (~85% of energy needs). Glucose, insulin, lipid profile (cholesterol, triglycerides, LDL, HDL) as well as Apo A1, Apo B and CRP were analyzed in fasting blood samples by commercially available Enzyme Linked Immunosorbent Assay (ELISA) kits. There was improvement in each measured parameter, probably due to weight loss, except in glucose, HDL and Apo B which remained the same. Dairy group showed the highest % decrease in total cholesterol and LDL, 6.1% and 7.7%, respectively, compared to Supplement (3.2% and 3.4%) and Control (3.8% and 1.7%) groups. Additionally, Apo A decreased in Dairy group while it increased in Supplement and Dairy groups. In conclusion, the intervention with low fat dairy foods complemented with hypo caloric diet resulted in the best outcomes for lipid profile and highest reduction in Apo A. Increasing the low fat dairy foods to 4-5 servings/day may be beneficial for metabolic profile in postmenopausal women during weight loss.

A matched cohort analysis of single anastomosis loop duodenal switch versus Roux-en-Y gastric bypass with 18-month follow-up.

The Roux-en-Y gastric bypass (GBP) has been considered the gold standard for many years. The loop duodenal switch (LDS) is a relatively new procedure that simplifies the complexity of the duodenal switch (BPDDS) by making it a single anastomosis procedure while at the same time giving it more intestinal absorption to reduce the rates of malnutrition associated with traditional BPDDS. This paper seeks to compare the 18-month weight loss outcomes and complications of the more standard GBP with the newer LDS in a single US center. A retrospective matched cohort was analyzed on 108 patients who had either GBP (54 patients) or LDS (54 patients). Regression analysis was used to compare weight loss outcomes as measured by BMI and weight loss percentages. Complications gathered included bleeds, reoperations, diagnostic or therapeutic endoscopy (EGD), ulcers and chronic nausea. GBP and LDS have statistically similar weight loss at 18months (39.6 vs 41% weight loss, respectively). However, there were significantly more nausea complaints (26 vs 5), diagnostic endoscopies (EGD) (21 vs 3) and ulcers (6 vs 0) with the GBP than the LDS. LDS has comparable weight loss results to GBP. However, LDS has fewer 30-day and 18-month complications and patients suffer from less nausea postoperatively.

Daño hepático crónico como manifestación de pericarditis constrictiva. Reporte de un caso

Constrictive pericarditis (CP) is an uncommon condition which clinical presentation becomes very unspecific, making its diagnosis a hard challenge. It has multiple and varied causes, all of them determine pericardium inflammation and progressive fibrosis that restricts heart filling and develops diastolic dysfunction, expressing mainly as right heart failure. Symptoms of this last condition allow posing different diagnosis as they can appear in many other diseases, including chronic liver disease as happens in the following clinical case. A 27 year-old male patient with a history of progressive edema on his extremities, increased abdominal volume, a 3-month body weight loss, and dyspnea; is firstly diagnosed as CLD after medical evaluation. However, etiological studies for CLD appear negative and the patient does not respond to general approaches, motivating his hospitalization for further studies. Cardiologic tests reveal pulmonary hypertension, which is studied by MRI showing a thickened pericardium suggesting constriction that is confirmed by cardiac catheterization. The patient undergoes surgery without incidents and a favorable post-operatory period, being completely asymptomatic 3 months later. This clinical case reflects how difficult can become diagnosing CP; as well as presenting the right way to study these patients in order to confirm this alternative diagnosis, the treatment of choice, and the excellent results that surgery can achieve. Finally, CP is a rare condition that must be included within differential diagnosis of patients with clinical manifestations of RHF.

Longitudinal Weight Loss Patterns and their Behavioral and Demographic Associations.

Identification of weight change patterns may allow tailored interventions to improve long-term weight loss. To identify patterns of weight change over 18 months, and assess participant characteristics and intervention adherence factors associated with weight change patterns in a sample of 359 overweight/obese adults. Weight loss (0-6 months) was achieved with reduced energy intake and increased physical activity (PA). Maintenance (7-18 months) provided adequate energy to maintain weight and continued PA. Latent profile analysis identified three weight change profiles. During weight loss/maintenance, participants in profiles 2 and 3 (18-month weight loss ∼14 %) attended more behavioral sessions and performed more PA compared with profile 1 (18-month weight loss <1 %). Self-efficacy for both weight management and exercise barriers were higher in profiles 2 and 3 compared with profile 1 following weight loss and during maintenance. Weight change patterns can be identified and are associated with both participant characteristics and intervention adherence.

Improving diabetes outcomes through lifestyle change – A randomized controlled trial

To compare a diabetes group lifestyle intervention (GLI) with dietitian referral for medical nutrition therapy (RD) for weight loss in the usual care setting. Randomized clinical trial was conducted with 57 primary care patients with type 2 diabetes and body mass index (BMI) >25 kg/m(2) who received either a dietitian-led 19-week GLI adapted from the Look AHEAD study or RD. Outcome measures include 6-month and 1-year weight loss, changes in medications, glycemic control, cardiac risk factors, and cost analysis. Patients were mean age 61, 59% male, and 32% non-white, and they weighed 97 kg with mean HbA1c 8.2%. At 6 months, 46% of GLI vs. 21% of RD lost ≥5% body weight (P = 0.04), with mean weight loss 6.6 (SD 7.0) kg with GLI and 2.1 (3.5) kg in RD (P = 0.004). HbA1c improved by 0.70 (1.13) vs. 0.39 (1.51) in GLI vs. RD (P = 0.4), respectively, and 82% vs. 38% stopped or reduced diabetes medications (P < 0.001). Weight loss remained significantly greater in GLI compared to RD at 1 year. GLI program cost was $578 per participant. An affordable GLI achieved significantly more weight loss and medication reduction than RD in primary care patients with type 2 diabetes.

Effects of a weight loss program on body composition and the metabolic profile in obese postmenopausal women displaying various obesity phenotypes: a MONET group study.

Obesity is a heterogeneous condition, since the metabolic profile may differ greatly from one individual to another. The objective of this study was to compare the effect of a 6-month diet-induced weight loss program on body composition and the metabolic profile in obese individuals displaying different obesity phenotypes. Secondary analyses were done on 129 obese (% body fat: 46% ± 4%) postmenopausal women (age: 57 ± 4 years). Outcome measures included body composition, body fat distribution, glucose homeostasis, fasting lipids, and blood pressure. Obesity phenotypes were determined based on lean body mass (LBM) index (LBMI = LBM/height(2)) and visceral fat (VF) accumulation, as follows: 1, lower VF and lower LBMI (n = 35); 2, lower VF and higher LBMI (n = 19); 3, higher VF and lower LBMI (n = 14); and 4, higher VF and higher LBMI (n = 61). All groups had significantly improved measures of body composition after the intervention (P < 0.0001). Greater decreases in LBM and LBMI were observed in the higher LBMI groups than in the lower LBMI groups (P < 0.0001). Similarly, decreases in VF were greater in the higher VF groups than in the lower VF groups (P < 0.05). Overall, fasting insulin levels and glucose disposal improved following the intervention, with higher LBMI groups showing a trend for greater improvements (P = 0.06 and 0.07, respectively). Overall, no difference was observed among the different obesity phenotypes regarding improvements in the metabolic profile in response to weight loss. Individuals displaying higher VF or higher LBMI at baseline experienced significantly greater decreases for these variables after the intervention.

The safety and efficacy of early‐initiation exercise training after acute venous thromboembolism: a randomized clinical trial

Exercise training after myocardial infarction is the standard of care within a cardiac rehabilitation setting. However, there is scant evidence regarding the safety and efficacy of early exercise training following a venous thromboembolism (VTE). Eligible consenting participants were randomly allocated, on an individual basis, to either a 3-month exercise and behavioral weight loss intervention group or a control group. The primary clinical outcomes were change in health behavior (body weight and physical activity) and objectively measured fitness (Vo2peak ). From 2013 to 2014, 239 patients presented to a community-based specialty clinic after an acute VTE; 43 (18%) of these met the eligibility criteria for inclusion in the study. Of these, 19 (44%) consented to participate (nine in the intervention group; 10 in the control group). There were no adverse events in either group over a 3-month period. The mean difference in body weight between the intervention and control groups was -4.6kg (95% confidence interval [CI]-11.4 to 2.2) in favor of the intervention. The mean difference in duration of physical activity from baseline to 3months between the intervention and control groups was 133min (95%CI7-248) in favor of the intervention. There was a significant change in fitness over a 3-month period for the intervention group (baseline Vo2peak , 26.1±5.4mLO2 kg(-1) min(-1) ; postintervention Vo2peak , 29.8±5.4mLO2 kg(-1) min(-1) ). Early initiation of exercise training resulted in improvements in physical activity and fitness, and did not result in adverse events while individuals were receiving therapeutic anticoagulation. These are the first data on initiation of an exercise training and behavioral weight loss program in the early post-VTE setting.

Bone turnover markers and bone mineral density after 12-month weight loss therapy in obese children

Bone turnover markers and bone mineral density after 12-month weight loss therapy in obese children

Time-based physical activity interventions for weight loss: a randomized trial.

This study aims to examine whether enhancing standard behavioral weight loss interventions (standard behavioral weight loss program (SBWP)) with additional strategies at the initiation of intervention (ADOPT) or providing the additional strategies at predetermined times over the intervention period (MAINTAIN) enhances 18-month weight loss. This was a clinical trial of participants (N = 195; mean ± SEM: age, 43.2 ± 8.6 yr; body mass index, 33.0 ± 3.4 kg·m) randomized to SBWP, ADOPT, or MAINTAIN. All participants were prescribed an energy-restricted diet and physical activity, with group intervention sessions delivered over 18 months. ADOPT participants received additional phone contact (months 1-3), supervised exercise (months 1-6), and behavior campaigns (months 4-9). MAINTAIN participants received additional phone contact (months 4-6), supervised exercise (months 7-12), and behavior campaigns (months 13-18). There was a significant group-time interaction for weight loss (P = 0.0032). SBWP participants lost 9.3 ± 0.9, 7.8 ± 1.1, and 5.9 ± 1.2 kg at 6, 12, and 18 months, respectively. ADOPT participants lost 8.9 ± 0.9, 7.6 ± 1.2, and 5.8 ± 1.2 kg, whereas MAINTAIN participants lost 9.7 ± 0.9, 11.0 ± 1.2, and 9.0 ± 1.2 kg at 6, 12, and 18 months, respectively. The group-time interactions for SBWP versus MAINTAIN (P = 0.0033) and for ADOPT versus MAINTAIN (P = 0.0075) were significant. There was a significant group-time interaction for change in fitness (P = 0.0060). The group-time interaction for MAINTAIN versus ADOPT (P = 0.0018) was significant, with a trend for MAINTAIN versus SBWP (P = 0.0525). MAINTAIN improves 18-month weight loss compared with SBWP and ADOPT, with statistical trends indicating that MAINTAIN results in greater improvements in fitness. These results suggest that time-based strategies emphasizing physical activity confer greater benefits when delivered later and over the full course of intervention. This provides valuable information for the implementation of time-based strategies for improving long-term weight loss and fitness in overweight and obese adults.

Fruit and Vegetable Consumption and Diet Quality in Response to a Behavioral Weight Loss Intervention

PURPOSE: Fruit and vegetable consumption has been recommended as part of a healthy diet. The purpose of this analysis is to examine the change in fruit and vegetable consumption and measures of diet quality within the context of a 12 month behavioral weight loss intervention. METHODS: Participants were 151 women classified as overweight or obese (age=38.0±5.5 years; BMI=32.6±4.2 kg/m2) who completed a 12-month behavioral weight loss intervention. Participants received weekly contact that included a combination of group sessions and brief telephone calls, prescribed calorie-restricted diet, and physical activity. The calorie-restricted diet was prescribed at 1200 or 1500 calories per day, with no specific recommendations related to fruit and vegetable intake. Assessments were conducted at baseline, 6, and 12 months. Daily servings of fruits and vegetables were assessed using a food frequency questionnaire. Calories consumed per serving of fruits and vegetables was computed as a measure of diet quality. RESULTS: Weight loss was 8.4±4.7 kg at 6 months and 8.1±6.9 kg at 12 months (p<0.001). Total daily energy intake decreased at 6 (-626±1011 kcal/d) and 12 months (-656±1015 kcal/d) (p<0.001). Median [25th, 75th percentile] fruit and vegetable intake increased from 3.6 [2.5, 5.2] servings at baseline to 5.1 [3.3, 7.3] and 4.4 [2.7, 6.2] (p<0.001) at 6 and 12 months, respectively. Median calories per serving of fruit and vegetables decreased from 577.9 [405.0, 775.8] at baseline to 288.2 [202.4, 417.4] and 332.4 [227.3, 490.4] (p<0.001) at 6 and 12 months, respectively. Servings of and calories per fruits and vegetables, were not significantly correlated with weight change at either 6 or 12 months. CONCLUSIONS: Within the context of a behavioral weight loss program, a prescribed energy-restricted diet also resulted in an increase in fruit and vegetable consumption and diet quality. However, fruit and vegetable consumption and diet quality were not associated with weight loss. While these components of diet may not improve weight loss, adults with obesity may realize other health benefits from the change in diet that warrant investigation.

Measuring Dietary Restraint Status: Comparisons between the Dietary Intent Scale and the Restraint Scale.

The measurement of young women’s self-reported dietary restraint status is complex. Compared to Herman and Polivy’s commonly utilized Restraint Scale (RS), Stice’s Dietary Intent Scale (DIS) is less understood. Because the DIS is becoming a popular research tool, it is important to understand how this scale compares to more traditional measures of restraint. We conducted two correlational studies (Study 1 N = 110; Study 2 N = 216) to ascertain the similarities and the differences between the DIS and – as a comparison measure – the well-researched RS. We explored how the two scales were related to several body image variables (e.g., thin-ideal internalization); with a range of self-regulatory variables (e.g., dispositional self-control); with observed food intake during a taste test; and with 18-month weight change (Study 2 only). Participants were female University students and were not selected for dieting or disordered eating. Unlike RS scores, DIS scores were not significantly correlated with the majority of variables tapping into unsuccessful self-regulation. However, our data also highlighted similarities between the two restraint scales (e.g., association with 18-month weight-loss) and demonstrated that not only were participants’ DIS scores un-related to unsuccessful self-regulatory variables, neither were they related to the variables tapping into successful self-regulation.

Baseline characteristics associated with different BMI trajectories in weight loss trials: a case for better targeting of interventions.

Dietary weight loss interventions have heterogeneous outcomes in long-term studies, with many participants regaining part or all of the lost weight. Growth mixture modelling is a novel analytic approach that can be used to identify different trajectories of weight change during a trial rather than focussing on the total amount of weight lost. Data were pooled from two 12-month dietary weight loss studies where no significant difference was detected between the treatment and control arms, thus allowing analysis independent of treatment. The data set included 231 subjects (74.5% female), with a mean weight loss of 6.40 kg (4.96). Growth mixture models were used to identify participants with similar trajectories of change in body mass index (BMI). Three subgroups were identified. A rapid and continuing BMI loss over the study period (rapid, n=53), a rapid initial weight loss in the first 3 months with a slowing rate over the remaining 9 months (maintainers, n=146) and those with an initial loss trajectory, which slowed and began to increase at 9 months (recidivists, n=53). Age (s.d.) and BMI (s.d.) were significantly different between the three groups (rapid 53 years (7), 28.99 kg/m(2) (3.30); maintainers 47 years (9), 30.90 kg/m(2) (2.95); recidivists 44 years (7), 34.84 kg/m(2) (1.92), both P<0.001). Older subjects with lower BMIs were more likely to have a rapid and continuing weight loss in a 1-year dietary-based weight loss intervention. Different interventional approaches may be necessary for different ages and baseline BMIs and stratification prior to randomisation may be necessary to prevent confounding in weight loss trials.

Effect of 1 year of alternate day fasting versus daily calorie restriction on type 2 diabetes risk

Alternate day fasting (ADF) is effective for weight loss and cardio‐protection, but its effect on type 2 diabetes (T2D) risk remains unclear. Moreover, whether ADF produces greater reductions in T2D risk versus daily calorie restriction (CR) is also unknown. Accordingly, this study compared the effect ADF versus CR on T2D risk indicators. Obese subjects (n = 48) were randomized to: 1) ADF (75% restriction fast day alternated with ad libitum feed day), or 2) CR (25% restriction everyday), for a 6‐month weight loss period followed by a 6‐month weight maintenance period. Body weight, fat mass, and visceral fat mass decreased similarly (P &lt; 0.01) in the ADF (7 ± 1 kg; 5 ± 1 kg; 0.4 ± 0.1 kg) and CR group (7 ± 1 kg; 5 ± 1 kg; 0.4 ± 0.1 kg) during the weight loss period, and remained stable during the weight maintenance period. Fat free mass did not change throughout the study. Glucose remained unchanged. Insulin decreased (P &lt; 0.05) by ADF only (7 ± 4 uIU/ml) with weight loss, and was sustained with weight maintenance. HOMA‐IR remained unchanged in both groups. Resistin, an adipokine involved in insulin resistance, decreased (P &lt; 0.05) by ADF (2 ± 2 ng/ml) and CR (4 ± 1 ng/ml) with weight loss, and was sustained with weight maintenance. Thus, ADF and CR produce mild but comparable reductions in T2D risk, which are sustained with weight maintenance.

Impact of a male‐only weight loss maintenance programme on social–cognitive determinants of physical activity and healthy eating: A randomized controlled trial

To examine the effect of a gender-tailored, Social Cognitive Theory (SCT)-based weight loss maintenance (WLM) intervention on men's physical activity and healthy eating cognitions and behaviours in the 12 months after completing a weight loss programme. A two-phase, assessor-blinded, randomized controlled trial. Ninety-two overweight/obese men (mean [SD] age: 49.2 years [10.1], BMI: 30.7 [3.3] kg/m(2) ) who lost at least 4 kg after completing the 3-month SCT-based SHED-IT Weight Loss Program were randomly allocated to receive (1) the SCT-based SHED-IT WLM Program; or (2) no additional resources (self-help control group). The 6-month gender-tailored SHED-IT WLM Program was completely self-administered and operationalized SCT behaviour change principles to assist men to increase moderate-to-vigorous physical activity (MVPA) and decrease energy-dense, nutrient-poor (discretionary) food consumption after initial weight loss. After randomization (WLM baseline), men were reassessed at 6 months (WLM post-test) and 12 months (6-month WLM follow-up). SCT cognitions (e.g., self-efficacy, goal setting), MVPA, and discretionary food consumption were assessed with validated measures. Following significant improvements in cognitions, MVPA and discretionary food consumption during the weight loss phase, intention-to-treat, linear mixed models revealed no significant group-by-time differences in cognitions or behaviours during the WLM phase. Initial improvements in MVPA and some cognitions (e.g., goal setting, planning, and social support) were largely maintained by both groups at the end of the study. Dietary effects were not as strongly maintained, with the intervention and control groups maintaining 57% and 75% of the Phase I improvements in discretionary food intake, respectively. An additional SCT-based WLM programme did not elicit further improvements over a self-help control in the cognitions or behaviours for MVPA or discretionary food intake of men who had lost weight with a SCT-based weight loss programme. Statement of contribution What is already known on this subject?Weight regain after weight loss (WL) is common. As successful weight loss maintenance (WLM) requires sustained improvements in cognitions and behaviours, health psychology can contribute to intervention development. However, little research has examined the utility of psychological theory in the context of a WLM randomised controlled trial. What does this study add? A theory-based WL program improved men's physical activity and dietary behaviours and cognitions. Men who also received a theory-based WLM program did not show further improvements in physical activity or dietary cognitions and behaviours compared to those that did not.

Racial Differences in Weight Loss Among Adults in a Behavioral Weight Loss Intervention: Role of Diet and Physical Activity.

African-Americans lose less weight during a behavioral intervention compared with Whites, which may be from differences in dietary intake or physical activity. Subjects (30% African American, 70% White; n = 346; 42.4 ± 9.0 yrs.; BMI = 33.0 ± 3.7 kg/m2) in an 18-month weight loss intervention were randomized to a standard behavioral (SBWI) or a stepped-care (STEP) intervention. Weight, dietary intake, self-report and objective physical activity, and fitness were assessed at 0, 6, 12, and 18 months. Weight loss at 18 months was greater in Whites (-8.74 kg with 95% CI [-10.10, -7.35]) compared with African Americans (-5.62 kg with 95% CI [-7.86, -3.37]) (P = .03) in the SBWI group and the STEP group (White: -7.48 kg with 95% CI [-8.80, -6.17] vs. African American: -4.41kg with 95% CI [-6.41, -2.42]) (P = .01). Patterns of change in dietary intake were not different between groups. Objective physical activity (PA) changed over time (P < .0001) and was higher in Whites when compared with African Americans (P = .01). Whites lost more weight (3.10 kg) than African American adults. Although there were no differences in dietary intake, Whites had higher levels of objective PA and fitness. Thus, the discrepancy in weight loss may be due to differences in PA rather than dietary intake. However, the precise role of these factors warrants further investigation.