6-month Weight Loss Program Research Articles

Serum leptin and adiponectin in overweight and obese postmenopausal women after the 6-month weight loss program and their relationship with BMD

Searchable abstracts of presentations at key conferences on calcified tissues ISSN 2052-1219 (online)

Factors Related with Adiponectinemia in Obese and Normal-Weight Women and with Its Variation in Weight Loss Programs

Objective: To assess different factors influencing adiponectinemia in obese and normal-weight women; to identify factors associated with the variation (Δ) in adiponectinemia in obese women following a 6-month weight loss program, according to surgical/non-surgical interventions. Methods: We studied 100 normal-weight women and 112 obese premenopausal women; none of them was on any medical treatment. Women were characterized for anthropometrics, daily macronutrient intake, smoking status, contraceptives use, adiponectin as well as IL-6 and TNF-α serum concentrations. Results: Adiponectinemia was lower in obese women (p < 0.001), revealing an inverse association with waist-to-hip ratio (p < 0.001; r = -0.335). Normal-weight women presented lower adiponectinemia among smokers (p = 0.041); body fat, waist-to-hip ratio, TNF-α levels, carbohydrate intake, and smoking all influence adiponectinemia (r² = 0.436). After weight loss interventions, a significant modification in macronutrient intake occurs followed by anthropometrics decrease (chiefly after bariatric procedures) and adiponectinemia increase (similar after surgical and non-surgical interventions). After bariatric intervention, Δ adiponectinemia was inversely correlated to Δ waist circumference and Δ carbohydrate intake (r² = 0.706). Conclusion: Anthropometrics, diet, smoking, and TNF-α levels all influence adiponectinemia in normal-weight women, although explaining less than 50% of it. In obese women, anthropometrics modestly explain adiponectinemia. Opposite to non-surgical interventions, after bariatric surgery adiponectinemia increase is largely explained by diet composition and anthropometric changes.

Abstract P028: The Influence of Exercise Dose, Exercise Intensity, and Weight Loss on C-reactive Protein in Sedentary Overweight Women

Background: Obesity is a modifiable risk factor associated with heart disease and an increased inflammatory state. Reducing weight and increasing physical activity have been shown to decrease heart disease risk. There is increasing evidence that weight loss leads to a reduced inflammatory state; however, there is less evidence on the combined role of weight loss and different doses of exercise. Objective: The purpose of the study was to examine the effect of exercise on change in high sensitivity C-reactive protein (hs-CRP) in overweight and obese women in a 6-month behavioral weight loss program. Methods: The parent study was a randomized trial testing different doses of exercise in a behavioral weight loss program. The sample (N = 182) consisted of sedentary overweight women with a mean (SD) age of 37.5 (±5.7) years and a baseline body mass index (BMI) of 32.7 (±4.2) kg/m 2 . Participants were randomly assigned to 1 of 4 exercise groups based on energy expenditure (1000 kcal/week or 2000 kcal/week) and intensity (vigorous vs. moderate). Groups included: vigorous intensity/high dose; vigorous intensity/moderate dose; moderate intensity/moderate dose; and moderate intensity/high dose. The dietary component included an energy restricted diet of 1200 kcal/day or 1500 kcal/day based on weight at baseline; daily fat intake recommendation was 20%-30% of total energy intake. Results: There were no statistically significant differences in hs-CRP levels between dose of exercise, moderate vs. high, (F=0.330, p=0.58) or level of intensity, moderate vs. vigorous (F=0.118, p=0.731). However, there was a significant decrease in hs-CRP from baseline to 6 months (F=25.553, p&lt;0.0004). There was a significant 3 way interaction between energy expenditure, intensity, and time (baseline to 6-month) (F=4.035, p=0.035); post hoc analysis revealed a significant decrease in hs-CRP in the moderate/high (p&lt;0.0004) and vigorous/moderate groups (p=0.004). The results were unchanged after controlling for the change in body weight, body fatness, or body distribution. The change in hs-CRP was not significantly correlated with the change in body weight, percent body fat, waist circumference, or self-reported physical activity. The hs-CRP at 6 months was correlated with 6-month measures of weight, BMI, percent body fat, and fat distribution (p&lt;0.0004). Conclusions: The level of hs-CRP was reduced in overweight and obese women in response to a 6-month weight loss intervention that included a prescribed increase in energy expenditure and reduction in energy intake. We observed a significant reduction in the moderate intensity/high dose and vigorous intensity/moderate dose exercise groups, suggesting that at least a moderate level of exercise is needed to affect hs-CRP levels. Further research is needed to better determine the dose of exercise needed to reduce markers of inflammation.

Abstract P297: Reduced Fat Mass and Improved Insulin Sensitivity in Overweight Black Women after Completion of 6-month Worksite Weight Loss Program

Background: As the epidemic of obesity in the United States steadily worsens, black women are disproportionately affected. Diminished insulin sensitivity has been linked with obesity and heightened risk of subsequent type 2 diabetes (T2D) and cardiovascular disease (CVD). Hypothesis: We propose that a decrease in fat mass achievable by weight loss intervention at the worksite improves insulin sensitivity in overweight black women. Methods: Fifty-four overweight black women [age 45±10 years (mean±SD), BMI range 25.9 to 54.7 kg/m 2 ] completed a 6-month program that included web-based nutrition information and/or dietitian counseling and access to exercise rooms near their work areas. All participants were advised to reduce daily caloric intake by 500 kcal and instructed to increase daily activity by 5,000 steps, measured by pedometer, above baseline readings. The following measurements were performed: weight, total fat mass by dual-energy X-ray absorptiometry, and insulin sensitivity index (S I ) calculated from the minimal model. Repeat of all measurements was performed at 6 months. Results: Baseline S I (median 3.0 liter/mU -1 •min -1 , range 0.74 to 7.58 liter/mU -1 •min -1 , with lower values signifying insulin resistance) was negatively associated with fat mass (r= -0.584, P&lt;0.001) independent of age. Significant reductions in weight (92.6±18.1 to 91.1±18.9 kg, P&lt;0.01) and fat mass (40.8±12.4 to 39.4±12.6 kg, P&lt;0.01) were determined for subjects completing the program. Reduction in fat mass following completion of the program was associated with an increase in S I (r= -0.293, P=0.032). When analyzed by tertiles of fat mass change (Figure), compared to the tertile with net fat mass gain (far left bar), the two tertiles with net fat mass loss had significantly improved insulin sensitivity (higher S I ). Conclusions: Even modest fat mass reduction in overweight non-diabetic black women with a combination of diet and exercise can improve insulin sensitivity, which has the potential to reduce or delay the onset of T2D and CVD.

The Visceral Adiposity Index: Relationship with cardiometabolic risk factors in obese and overweight postmenopausal women – A MONET group study

A recent study suggested visceral adipose index (VAI) as an indicator of adipose tissue distribution and function associated with cardiometabolic risk. We aim to examine the association between VAI and visceral adipose tissue (VAT), insulin sensitivity, and a large panel of associated cardiometabolic risk factors, and to determine if changes in VAI after weight loss intervention will reflect changes in VAT. We performed a secondary analysis using the data of 99 overweight and postmenopausal women that completed a 6-month weight loss program (Montreal Ottawa New Emerging Team Study). VAI was calculated according to the equation by Amato et al. (2010; Diabetes Care, 33(4):920-922). At baseline, VAI was associated with VAT (r = 0.284, p < 0.01) but not with subcutaneous adipose tissue (SAT) while body mass index (BMI) and waist circumference (WC) were significantly related to both. BMI and WC demonstrated significantly stronger predictive value of VAT accumulation (area under the curve = 0.84 and 0.86, respectively) than VAI (area under the curve = 0.61; p < 0.01). However, VAT, BMI, WC, and VAI were similarly related to fasting insulin and glucose disposal rates. After a 6-month weight loss program, VAI decreased significantly and similarly in both intervention groups (p < 0.01). In addition, the percentage of change in VAI showed the significantly weakest correlation (r = 0.25) with the percentage of change in VAT than BMI (r = 0.56; p < 0.01 for r comparisons) and was not a significant predictor of interindividual percentage of change in VAT while BMI accounted for 33.7%. VAI is a weak indicator of VAT function and did not predict changes in VAT after weight loss. Furthermore, this index was not superior to BMI or WC. However, VAI is a good indicator of metabolic syndrome.

The effects of weight loss on relative bone mineral density in premenopausal women

Heavier individuals have higher bone mineral density (BMD) than individuals of lower body weight, but it is unclear whether BMD changes in proportion to body weight during weight loss. This study compared BMD relative to body weight following a ~6 months weight loss program and a one year weight maintenance phase in premenopausal women and determined whether African American (AA) and European-American (EA) women’s BMD respond similarly during weight loss. Premenopausal women (n=115, 34 ± 5 yrs.) were evaluated in an overweight state (BMI between 27–30 kg/m2), following an 800 kcal/day diet/exercise program designed to reduce BMI <25 kg/m2, and one year following weight loss. Results indicated that BMD relative to body weight (Z-scores) increased after weight loss, but decreased during the one year weight maintenance phase. All one year follow up BMD Z-scores were increased (except L1) compared to baseline measurements (P < 0.05). These sites included the hip neck (+0.088, P=0.014), total hip (+0.099, P=0.001), L2 (+0.127, P=0.013), L3 (+0.135, P=0.014), and L4 (+0.199, P=0.002). AAs had significantly higher absolute BMD at all sites (P<0.05) compared to EAs, but no time by race interactions were evident during weight loss (except in L3). These results may indicate that weight loss is safe with regard to bone health for overweight premenopausal women.

Sociodemographic, behavioral, and biological variables related to weight loss in native hawaiians and other pacific islanders

Native Hawaiians and other Pacific Islanders (NHs/PIs) have a high obesity prevalence compared to other ethnic groups. We examined socio-demographic, behavioral, and biological factors related to ≥3% weight loss in 100 overweight/obese NHs/PIs who completed a lifestyle intervention. Data were from 56 Native Hawaiians, 22 Chuukese, and 22 Other Pacific Islanders who participated in a randomized controlled trial of the Partnership for Improving Lifestyle Intervention (PILI) 'Ohana Project. All completed a 3-month weight loss program (WLP) to initiate weight loss and were then randomized into either a 6-month family/community focused WLP called the PILI Lifestyle Program (PLP; n = 49) or a standard behavior WLP (SBP; n = 51). We collected baseline, 3- and 9-month follow-up data on socio-demographics, weight (kg), a 6-min. walk test, dietary fat, exercise frequency, and blood pressure. Based on ANCOVA or logistic fit, ethnicity, sex, initial weight loss, fat in diet at baseline, change in systolic blood pressure, and intervention type were significantly associated (P ≤ .05) with ≥3% weight loss at 9-month follow-up. A logistic regression model indicated that Chuukese (OR = 6.04; CI = 1.14-32.17) and participants who had more weight loss in the first 3-months (OR = 1.47; CI = 1.22-1.86) and who were in the PLP (OR = 4.50; CI = 1.50-15.14) were more likely to achieve ≥3% weight loss [model; χ(2) (7, N = 100) = 45.50, P < .0001]. The same lifestyle intervention does not benefit all NHs/PIs equally, possibly due to differences in acculturation status and social support. The findings also point to the importance of initial weight loss to sustain motivation toward long-term weight loss maintenance.

Physical activity enhancement to a behavioral weight loss program for severely obese individuals: A preliminary investigation.

Severe obesity is characterized by low physical activity (PA) and interventions to enhance PA are needed. Participants (45.0 ± 3.9 kg/m2) were randomized to a 6-month standard behavioral weight loss program (SBWL; n = 14) or SBWL+technology (SBWL+TECH; n = 15). Both groups received identical SBWL treatment and SBWL+TECH also received a wearable PA monitor, providing “real-time” feedback, and website access to monitor energy balance. 6-month retention was similar between groups (SBWL: 12/13 versus SBWL+TECH: 11/14 completers; P = 0.19) and adherence to wearing the armband was excellent (91.3% of days). Although differences in PA between groups did not meet conventional thresholds of significance, SBWL+TECH increased their moderate-to-vigorous intensity PA by 132.9 ± 216.8 min/week, which was 3 times greater than SBWL (44.8 ± 124.3 min/week; P = 0.27; Cohen's d = 0.50). There was a trend for SBWL+TECH to self-monitor for a greater proportion of days compared to SBWL (86.2 ± 21.4% versus 71.5 ± 19.4%; P = 0.098; Cohen's d = 0.72). The difference in weight loss between groups was modest (SBWL+TECH: −10.0 ± 7.1% versus SBWL: −7.8 ± 6.7%; P = 0.46). These preliminary findings suggest that PA monitors may be one strategy for increasing PA among the severely obese. Larger, long-term trials are needed.

Comparing Costs of Telephone vs Face-to-Face Extended-Care Programs for the Management of Obesity in Rural Settings

BackgroundA major challenge after successful weight loss is continuing the behaviors required for long-term weight maintenance. This challenge can be exacerbated in rural areas with limited local support resources. ObjectiveThis study describes and compares program costs and cost effectiveness for 12-month extended-care lifestyle maintenance programs after an initial 6-month weight-loss program. DesignWe conducted a 1-year prospective randomized controlled clinical trial. Participants/settingThe study included 215 female participants age 50 years or older from rural areas who completed an initial 6-month lifestyle program for weight loss. The study was conducted from June 1, 2003 to May 31, 2007. InterventionThe intervention was delivered through local Cooperative Extension Service offices in rural Florida. Participants were randomly assigned to a 12-month extended-care program using either individual telephone counseling (n=67), group face-to-face counseling (n=74), or a mail/control group (n=74). Main outcome measuresProgram delivery costs, weight loss, and self-reported health status were directly assessed through questionnaires and program activity logs. Costs were estimated across a range of enrollment sizes to allow inferences beyond the study sample. Statistical analyses performedNonparametric and parametric tests of differences across groups for program outcomes were combined with direct program cost estimates and expected value calculations to determine which scales of operation favored alternative formats for lifestyle maintenance. ResultsMedian weight regain during the intervention year was 1.7 kg for participants in the face-to-face format, 2.1 kg for the telephone format, and 3.1 kg for the mail/control format. For a typical group size of 13 participants, the face-to-face format had higher fixed costs, which translated into higher overall program costs ($420 per participant) when compared with individual telephone counseling ($268 per participant) and control ($226 per participant) programs. Although the net weight lost after the 12-month maintenance program was higher for the face-to-face and telephone programs compared with the control group, the average cost per expected kilogram of weight lost was higher for the face-to-face program ($47/kg) compared with the other two programs (approximately $33/kg for telephone and control). ConclusionsBoth the scale of operations and local demand for programs are important considerations in selecting a delivery format for lifestyle maintenance. In this study, the telephone format had a lower cost but similar outcomes compared with the face-to-face format.

Uncoupling Protein-2 45-Base Pair Insertion/Deletion Polymorphism: Is There an Association with Severe Obesity and Weight Loss in Morbidly Obese Subjects?

Uncoupling proteins are attractive candidate genes for obesity and type 2 diabetes mellitus. Our aim was to investigate the potential association of the uncoupling protein-2 (UCP2) 45-bp insertion/deletion (ins/del) polymorphism with obesity, as well as the potential effect of this polymorphism on weight loss variability in severely obese subjects. A total of 158 severely obese subjects (94 without and 64 with metabolic syndrome) and 91 age and sex-matched lean controls were recruited. A subgroup of 124 obese patients participated in a 3-month weight loss program. Anthropometric and metabolic variables were measured. Participants were genotyped for the UCP2 ins/del polymorphism. Allelic frequency differed neither between obese subjects and controls (P=0.56), nor between obese subjects with versus without metabolic syndrome (P=0.58). At 3 months, metabolically healthy subjects carrying the insertion allele had significantly greater reduction in body mass index (P=0.029) and fat-free mass (P=0.013) and a borderline significant improvement in the homeostatic model assessment index (P=0.048). There is no association of the UCP2 ins/del polymorphism with morbid obesity in our population, but this genotype appears to be linked with a favorable response to dietary changes in metabolically healthy obese subjects.

Racial Differences in Sex Hormones with Weight Loss and Weight Loss Maintenance in Overweight and Obese Postmenopausal Women

Changes in sex hormones with weight loss might have implications for breast cancer prevention and have not been examined extensively, particularly in African‐American (AA) women. We conducted a longitudinal study of 278 overweight/obese postmenopausal women (38% AA), not taking hormone therapy, who lost at least 4 kg after a 6‐month weight‐loss program. During the next 12 months, participants attempted to sustain weight loss. We evaluated percent change in serum estrone (E1), total estradiol (E2), testosterone, androstenedione, dehydroepiandrosterone sulfate and sex hormone‐binding globulin (SHBG) across the two phases using GEE. During the weight‐loss program, mean weight loss was 7.7 kg: E1 (−5.7%, P=0.006) and E2 (−9.9%, P&lt; 0.001) decreased, SHBG (16.2%, P&lt; 0.001) increased. During weight maintenance, weight increased on average 2.2 kg: E1 (−6.4%, P=0.003) and SHBG (−8.0%, P&lt;0.0001) decreased. AA women experienced less change in estrogens (E1 0.6% vs. 1.2%, p‐interaction= 0.10, E2 1.1% vs. 1.9%, p‐interaction=0.04) and SHBG (0.9% vs. 1.6%, p‐interaction=0.006) per kg weight change than non‐AA. AA women also had significantly higher estrogen concentrations, independent of adiposity. Overweight/obese postmenopausal women who successfully lose and maintain weight have reductions in estrogens which may reduce breast cancer risk. The racial differences merit investigation.

Bariatric surgery decision making challenges: the stability of teens’ decisions and the treatment failure paradox

Criteria for adolescent bariatric surgery include failure of ≥6 months of organized weight loss attempts. We wished to explore whether adolescents, initially wanting surgery, change their mind during a 6-month weight loss program and how many meet the treatment failure criterion. A retrospective chart review of adolescents enrolled in a weight loss program between 3/2007 and 2/2009. Twenty-one (13 % of total patients) initially wanted bariatric surgery. Most were Medicaid enrollees (70 %), female (85 %), and white (60 %). The mean age was 15 years and mean BMI was 51 (range 36-71). Five did not meet BMI, comorbidity, or psychological criteria for surgery. Eight lost weight and therefore did not meet the treatment failure criterion. Of these, seven no longer wanted surgery. Eight did not lose weight and therefore met the treatment failure criterion; five of these decided against surgery due to difficulty in making recommended lifestyle changes. Most patients initially wanting bariatric surgery changed their minds. The treatment failure criterion presented a paradox, because most patients who met the criterion exhibited difficulty in making the lifestyle changes. To aid provider/patient decisions about bariatric surgery, further work should explore the criteria for surgery and stability of adolescents' decisions regarding bariatric surgery.

The Comparison of a Technology‐Based System and an In‐Person Behavioral Weight Loss Intervention

The purpose of this study was to compare a technology-based system, an in-person behavioral weight loss intervention, and a combination of both over a 6-month period in overweight adults. Fifty-one subjects (age: 44.2 ± 8.7 years, BMI: 33.7 ± 3.6kg/m(2)) participated in a 6-month behavioral weight loss program and were randomized to one of three groups: standard behavioral weight loss (SBWL), SBWL plus technology-based system (SBWL+TECH), or technology-based system only (TECH). All groups reduced caloric intake and progressively increased moderate intensity physical activity. SBWL and SBWL+TECH attended weekly meetings. SBWL+TECH also received a TECH that included an energy monitoring armband and website to monitor energy intake and expenditure. TECH used the technology system and received monthly telephone calls. Body weight and physical activity were assessed at 0 and 6 months. Retention at 6 months was significantly different (P = 0.005) between groups (SBWL: 53%, SBWL+TECH: 100%, and TECH: 77%). Intent-to-treat (ITT) analysis revealed significant weight losses at 6 months in SBWL+TECH (-8.8 ± 5.0kg, -8.7 ± 4.7%), SBWL (-3.7 ± 5.7kg, -4.1 ± 6.3%), and TECH (-5.8 ± 6.6kg, -6.3 ± 7.1%) (P < 0.001). Self-report physical activity increased significantly in SBWL (473.9 ± 800.7kcal/week), SBWL+TECH (713.9 ± 1,278.8kcal/week), and TECH (1,066.2 ± 1,371kcal/week) (P < 0.001), with no differences between groups (P = 0.25). The TECH used in conjunction with monthly telephone calls, produced similar, if not greater weight losses and changes in physical activity than the standard in-person behavioral program at 6 months. The use of this technology may provide an effective short-term clinical alternative to standard in-person behavioral weight loss interventions, with the longer term effects warranting investigation.

Prolapse Symptoms in Overweight and Obese Women Before and After Weight Loss

The objective of this study was to estimate the association between body mass index (BMI) and pelvic organ prolapse symptoms and bother among overweight and obese women with urinary incontinence before and after weight loss. Women (N = 338) were randomized to either an intensive 6-month weight loss or educational program (control); they were evaluated for prolapse symptoms at baseline and 6 months. Symptomatic prolapse was defined as a positive response to at least 1 prolapse subscale question of the Urogenital Distress Inventory. "Bother" was defined as responses of slight, moderate, or great. Women with prolapse symptoms were analyzed by baseline BMI category: overweight, obese, and severely obese at baseline and at 6 months. Proportional odds regression and χ tests for trend were used for analysis. Age mean was 53 (SD, 10) years, BMI mean was 36 (SD, 6) kg/m, and 78% were white. A higher proportion of obese women reported feeling vaginal bulging compared with overweight women (13% vs 0%, P = <0.01). At baseline, 37% (n = 124) reported bothersome "lower abdominal pressure"; 18% (n = 62), bothersome "heaviness in the pelvic area"; and 14% (n = 48), bothersome "pelvic discomfort when standing." Nine percent (n = 31) reported bothersome "feeling," and 2% (n = 6) reported bothersome "seeing a bulge" in the vagina. At 6 months, there were no significant differences in improvement of self-reported bothersome prolapse symptoms in women in the weight loss or the control group. In this study of overweight and obese women, increasing BMI was associated with only "feeling" a vaginal bulge. Weight loss did not improve bothersome prolapse symptoms.

A Losing Battle: Weight Regain Does Not Restore Weight Loss‐Induced Bone Loss in Postmenopausal Women

Previously, we reported significant bone mineral density (BMD) loss in postmenopausal women after modest weight loss. It remains unclear whether the magnitude of BMD change in response to weight loss is appropriate (i.e., proportional to weight loss) and whether BMD is recovered with weight regain. We now report changes in BMD after a 1-year follow-up. Subjects (n = 23) in this secondary analysis were postmenopausal women randomized to placebo as part of a larger trial. They completed a 6-month exercise-based weight loss program and returned for follow-up at 18 months. Dual-energy X-ray absorptiometry (DXA) was performed at baseline, 6, and 18 months. At baseline, subjects were aged 56.8 ± 5.4 years (mean ± s.d.), 10.0 ± 9.2 years postmenopausal, and BMI was 29.6 ± 4.0kg/m(2). They lost 3.9 ± 3.5kg during the weight loss intervention. During follow-up, they regained 2.9 ± 3.9kg. Six months of weight loss resulted in a significant decrease in lumbar spine (LS) (-1.7 ± 3.5%; P = 0.002) and hip (-0.04 ± 3.5%; P = 0.03) BMD that was accompanied by an increase in a biomarker of bone resorption (serum C-terminal telopeptide of type I collagen, CTX: 34 ± 54%; P = 0.08). However, weight regain was not associated with LS (0.05 ± 3.8%; P = 0.15) or hip (-0.6 ± 3.0%; P = 0.81) bone regain or decreased bone resorption (CTX: -3 ± 37%; P = 0.73). The findings suggest that BMD lost during weight reduction may not be fully recovered with weight regain in hormone-deficient, postmenopausal women. Future studies are needed to identify effective strategies to prevent bone loss during periods of weight loss.

The accuracy of weight reported in a web-based obesity treatment program.

The overall goal of the study was to understand the accuracy of self-reported weight over a 6-month Web-based obesity program. As part of a larger study, subjects (n=323; 93% female; 28% African American) were randomized to a 6-month Internet-based behavioral weight loss program with weekly group meetings delivered either: (1) entirely by online synchronous chats or (2) by a combination of online chats plus monthly in-person group sessions. Observed weights were obtained at 0 and 6 months for all participants. Self-reported weights were submitted weekly to the study Web site. Differences in Observed and Reported weights were examined by gender, race, and condition. Observed and Reported weight were significantly correlated at 0 and 6 months (r=0.996 and 0.996, ps <0.001 respectively). However, Reported weight underestimated Observed weight by 0.86 kg (p<0.001) at 6 months. Further, there was a significant weight loss effect (p<0.001) with those losing more weight more accurately estimating their Reported weight at 6 months. Additionally, 6-month Reported weight change differed from Observed weight change (difference=0.72 kg, p<0.001), with weight change using Reported weights estimating a slightly larger weight loss than Observed weights. In general, the accuracy of self-reported weight is high for individuals participating in an Internet-based weight loss treatment program. Accuracy differed slightly by amount of weight lost and was not improved with periodic in-person assessment. Importantly, weight change by self-report was comparable to observed, suggesting that it is suitable for Web-based obesity treatment.

Persistent elevation of paraoxonase-1 specific enzyme activity after weight reduction in obese non-diabetic men with metabolic syndrome

BackgroundParaoxonase-1 (PON1) is an esterase associated with the high-density lipoprotein (HDL) in serum. To date, there have been few reports about circulating PON1 protein concentration and specific activity in subjects with metabolic syndrome (MetS). More importantly, it is unknown whether weight loss could alter PON1 protein expression or specific activity in obese non-diabetic men with MetS. MethodsWe prospectively enrolled a total of 40 obese non-diabetic men with MetS. Among them, 22 subjects finished the 3-month course of weight loss program and complied for longer follow-ups post-weight loss at the 3rd, 12th, and 18th month from the beginning of the program. Twenty-six healthy volunteers served as controls. Serum circulating PON1 concentration was measured by an enzyme linked immunosorbent kit (ELISA) and PON1 activity was measured by an automated PON1 activity assay. ResultsObese non-diabetic men with MetS (n=40) had a higher PON1 protein concentration (31.0±11.3 vs. 24.8±9.7μg/ml, p=0.025) but lower specific enzyme activity (7.5±4.0 vs. 11.2±7.2mU/μg, p=0.023) than those of the controls. Multivariate regression analysis of baseline PON1 specific activity revealed that adiponectin was a significant positive predictor (p=0.044) while monocyte chemotactic protein-1 (MCP-1) was a negative predictor (p=0.031). After a 3-month weight loss program, obese MetS men (n=22) had a significant weight reduction (95.8±9.0 to 86.3±10.4kg, with a 9.9±5.4% decrease, p<0.001). PON1 protein decreased significantly after weight loss and kept declining through the 3rd month till the 18th month follow-up. PON1 specific enzyme activity (baseline 7.5±2.6mU/μg) increased significantly after weight loss and kept increasing through the 12th month till the 18th month follow-ups (11.8±6.4mU/μg, p=0.001 vs. baseline). ConclusionsWeight loss by a 3-month diet and exercise program time-sequentially increased PON1 specific enzyme activity in obese non-diabetic men with MetS.

An Exploratory Analysis of the Effects of a Weight Loss Plus Exercise Program on Cellular Quality Control Mechanisms in Older Overweight Women

Obese older adults are particularly susceptible to sarcopenia and have a higher prevalence of disability than their peers of normal weight. Interventions to improve body composition in late life are crucial to maintaining independence. The main mechanisms underlying sarcopenia have not been determined conclusively, but chronic inflammation, apoptosis, and impaired mitochondrial function are believed to play important roles. It has yet to be determined whether impaired cellular quality control mechanisms contribute to this process. The objective of this study was to assess the effects of a 6-month weight loss program combined with moderate-intensity exercise on the cellular quality control mechanisms autophagy and ubiquitin-proteasome, as well as on inflammation, apoptosis, and mitochondrial function, in the skeletal muscle of older obese women. The intervention resulted in significant weight loss (8.0 ± 3.9 % vs. 0.4 ± 3.1% of baseline weight, p = 0.002) and improvements in walking speed (reduced time to walk 400 meters, - 20.4 ± 16% vs. - 2.5 ± 12%, p = 0.03). In the intervention group, we observed a three-fold increase in messenger RNA (mRNA) levels of the autophagy regulators LC3B, Atg7, and lysosome-associated membrane protein-2 (LAMP-2) compared to controls. Changes in mRNA levels of FoxO3A and its targets MuRF1, MAFBx, and BNIP3 were on average seven-fold higher in the intervention group compared to controls, but these differences were not statistically significant. Tumor necrosis factor-α (TNF-α) mRNA levels were elevated after the intervention, but we did not detect significant changes in the downstream apoptosis markers caspase 8 and 3. Mitochondrial biogenesis markers (PGC1α and TFAm) were increased by the intervention, but this was not accompanied by significant changes in mitochondrial complex content and activity. In conclusion, although exploratory in nature, this study is among the first to report the stimulation of cellular quality control mechanisms elicited by a weight loss and exercise program in older obese women.

A Family and Community Focused Lifestyle Program Prevents Weight Regain in Pacific Islanders

Preventing weight regain after the loss of excess weight is challenging for people, especially for ethnic minorities in the United States. A 6-month weight loss maintenance intervention designed for Pacific Islanders, called the PILI Lifestyle Program (PLP), was compared with a 6-month standard behavioral weight loss maintenance program (SBP) in a pilot randomized controlled trial using a community-based participatory research approach. Adult Pacific Islanders (N = 144) were randomly assigned to either PLP (n = 72) or SBP (n = 72) after completing a 3-month weight loss program. Successful weight maintenance was defined as participants' postintervention weight change remaining ≤ 3% of their preintervention mean weight. Both PLP and SBP participants achieved significant weight loss maintenance (p ≤ .05). Among participants who completed at least half of the prescribed sessions, PLP participants were 5.1-fold (95% confidence interval = 1.06, 24; p = .02) more likely to have maintained their initial weight loss than SBP participants. The pilot PLP shows promise as a lifestyle intervention to address the obesity disparities of Pacific Islanders and thus warrants further investigation.

Effect of Weight Loss Maintenance on Arterial Compliance and Metabolic and Inflammatory Parameters: A Three-Year Follow-Up Study

Background/Aims: To evaluate the effect of long-term weight loss maintenance on arterial compliance, and metabolic and inflammatory parameters in obese patients who participated in a 6-month weight loss program featuring nutritional and exercise intervention. Methods: Sixty-seven obese subjects who participated in a 6-month weight loss program were followed for an additional 30 months. The 47 patients who fully completed the 3-year follow-up were divided into two groups according to change in BMI from the end of the weight loss program to the long-term follow-up visit. Group 1 included 22 patients whose BMI decreased or remained stable; group 2 included 25 patients whose BMI increased after program discontinuation. Arterial compliance and metabolic measures were evaluated at baseline, and at 3, 6 and 36 months of follow-up. Results: BMI changed from 35.4 ± 6.9 to 32.6 ± 6.6 after 6 months and to 33.4 ± 7.0 after 36 months. While 53% of participants regained weight after program discontinuation, the mean weight at 3 years remained lower than at entry into the study. Large artery elasticity index (LAEI) as well as small artery elasticity index (SAEI) increased during initial weight loss program in both groups. After program discontinuation, significant improvement in SAEI was observed in patients who decreased or did not change BMI, whereas SAEI decreased in subjects who gained weight. LAEI increased marginally in group 1, while it significantly decreased in group 2. Conclusions: Obese subjects who successfully completed a 6-month behavioral weight loss program and decreased or maintained weight during 30 additional months exhibited improved arterial stiffness compared to subjects who regained weight.