6-month Weight Loss Research Articles

Deep sedation versus orotracheal intubation for endoscopic sleeve gastroplasty (ESG): preliminary experience.

Endoscopic sleeve gastroplasty (ESG) is an emerging bariatric procedure currently performed under general anaesthesia with orotracheal intubation (OTI). Several studies have shown the feasibility of advanced endoscopic procedures under deep sedation (DS) without impacting patient outcomes or adverse event rates. Our goal was to perform an initial comparative analysis of ESG in DS with ESG under OTI. A prospective institutional registry was reviewed for ESG patients between 12/2016 and 1/2021. Patients were stratified into OTI or DS cohorts, and the 1st 50 cases performed in each cohort were included for comparability. Univariate analysis was performed on demographics, intraoperative, and postoperative outcomes (up to 90days). Multivariate analyses evaluated the relationship between anesthesia type, preclinical and clinical variables. Of the 50DS patients, 21(42%) underwent primary and 29 (58%) revisional surgery. There was no significant differences in Mallampati score across groups. No DS patient required intubation. DS patients were younger (p = 0.006) and lower BMI (p = 0.002) than OTI. As expected, DS patients overall and in the primary subgroup had shorter operative time (p ≤ 0.001 and p = 0.003, respectively) and higher rates (84% DS vs. 20% OTI, p ≤ 0.001) of ambulatory procedures. There were no significant differences in the sutures used between groups (p = 0.616). DS patients required less postoperative opioids (p ≤ 0.001) and antiemetics (p = 0.006) than OTI. There were no significant differences in 3-month postoperative weight loss across cohorts. There was no rehospitalization in either group. In primary ESG cases, we found DS patients were more likely younger (p = 0.006), female (p = 0.001), and had a lower BMI (p = 0.0027). ESG under DS is safe and feasible in select patients. We found DS safely increased rates of outpatient care, reduced use of opioids and antiemetics, and provided the same results of postoperative weight loss. Patient selection for DS may be more clearer for durable weight loss.

The effects of a 6-month weight loss intervention on physical function and serum biomarkers in older adults with and without osteoarthritis

ObjectiveTo examine the effects of a 6-month weight loss intervention on physical function, inflammatory biomarkers, and metabolic biomarkers in both those with and without osteoarthritis (OA). Design59 individuals ≥60 years old with obesity and a functional impairment were enrolled into this IRB approved clinical trial and randomized into one of two 6-month weight loss arms: a higher protein hypocaloric diet or a standard protein hypocaloric diet. All participants were prescribed individualized 500-kcal daily-deficit diets, with a goal of 10% weight loss. Additionally, participants participated in three, low-intensity, exercise sessions per week. Physical function, serum biomarkers and body composition data were assessed at the baseline and 6-month timepoints. Statistical analyses assessed the relationships between biomarkers, physical function, body composition, and OA status as a result of the intervention. ResultsNo group effects of dietary intervention were detected on any outcome measures (multiple p ​> ​0.05). During the 6-month trial, participants lost 6.2 ​± ​4.0% of their bodyweight (p ​< ​0.0001) and experienced improved physical function on the Short-Performance-Physical-Battery (p ​< ​0.0001), 8-foot-up-and-go (p ​< ​0.0001), and time to complete 10-chair-stands (p ​< ​0.0001). Adiponectin concentrations (p ​= ​0.0480) were elevated, and cartilage oligomeric matrix protein (COMP) concentrations (p ​< ​0.0001) were reduced; further analysis revealed that reductions in serum COMP concentrations were greater in OA-negative individuals. ConclusionsThese results suggest that weight loss in older adults with and without OA may provide a protective effect to cartilage and OA. In particular, OA-negative individuals may be able to mitigate changes associated with OA through weight loss.

Study protocol: BRInging the Diabetes prevention program to GEriatric Populations.

In the Diabetes Prevention Program (DPP) randomized, controlled clinical trial, participants who were ≥ 60 years of age in the intensive lifestyle (diet and physical activity) intervention had a 71% reduction in incident diabetes over the 3-year trial. However, few of the 26.4 million American adults age ≥65 years with prediabetes are participating in the National DPP. The BRInging the Diabetes prevention program to GEriatric Populations (BRIDGE) randomized trial compares an in-person DPP program Tailored for Older AdulTs (DPP-TOAT) to a DPP-TOAT delivered via group virtual sessions (V-DPP-TOAT) in a randomized, controlled trial design (N = 230). Eligible patients are recruited through electronic health records (EHRs) and randomized to the DPP-TOAT or V-DPP-TOAT arm. The primary effectiveness outcome is 6-month weight loss and the primary implementation outcome is intervention session attendance with a non-inferiority design. Findings will inform best practices in the delivery of an evidence-based intervention.

Efficacy of Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair versus Sleeve-Fundoplication on Gastroesophageal Reflux Disease Resolution: Systematic Review and Meta-Analysis.

(1) Background: There is still disagreement over how sleeve gastrectomy (SG) affects gastroesophageal reflux disease (GERD). The debate regarding the best option for patients undergoing bariatric surgery who are also affected by GERD and/or hiatal hernia continues to divide the community of bariatric surgeons. While concomitant hiatal hernia repair (SG + HHR) has been proposed as a means of reducing the risk of GERD following SG with varying degrees of success, the addition of a fundoplication (SG + FP) has been suggested in recent years as a way to improve the lower esophageal sphincter's competency. The aim of this study is to systematically review and meta-analyze the efficacy of SG + HHR versus SG + FP on GERD remission in patients with obesity. (2) Methods: A systematic review of the literature was conducted, and studies analyzing the effects of SG + HHR versus SG + FP on postoperative GERD were included. The methodological quality of included trials was evaluated. The primary outcome was postoperative GERD rate, erosive esophagitis, and 12-month weight loss. Secondary outcomes included postoperative complications and mortality. The PRISMA guidelines were used to carry out the present systematic review (PROSPERO Registration Number: CRD42023405600). (3) Results: Fifteen articles with a total of 1164 patients were included in the meta-analysis; 554 patients underwent SG + HHR while 610 underwent SG + FP. In the SG + HHR group, 58.5 ± 28.9% of subjects presented clinical GERD symptoms compared to 20.4 ± 17.5% postoperatively (p < 0.001). In the SG + FP group, 64.8 ± 39.4% were affected by GERD preoperatively compared to only 5 ± 8.1% postoperatively (p < 0.001). SG + FP patients had a significantly greater GERD remission compared to SG + HHR (p < 0.001). Weight loss was similar between groups (p = 0.125). The rate of leaks was 0.18% and 0.33% in the SG + HHR and SG + FP, respectively (p = 0.657), while perforations were significantly higher after SG + FP compared to the SG + HHR group (3.1% versus 0%, p = 0.002). The mortality rate was significantly greater in the SG + FP group (0.5% versus 0%, p = 0.002). (4) Conclusions: This study revealed that both SG with concomitant HHR and sleeve-fundoplication are effective in terms of reflux resolution and weight outcomes, with superiority of SG + FP in terms of GERD control, despite a greater overall complication rate. Both strategies can therefore be suggested as a suitable alternative variant to a conventional SG in subjects with obesity and concomitant hiatal hernia and/or GERD. Studies with extended follow-up and direct comparisons of these surgical approaches to conventional SG are warranted.

‘The fact that I know I can do it is quite a motivator now’: a qualitative study exploring experiences maintaining weight loss 6 months after completing a weight loss programme for knee osteoarthritis

ObjectiveTo explore experiences maintaining weight loss 6 months after completing a multicomponent weight loss programme for knee osteoarthritis.DesignQualitative study based on an interpretivist paradigm and a phenomenological approach that was...

Delivering a Postpartum Weight Loss Intervention via Facebook or In-Person Groups: Results From a Randomized Pilot Feasibility Trial.

Postpartum weight retention contributes to weight gain and obesity. Remotely delivered lifestyle interventions may be able to overcome barriers to attending in-person programs during this life phase. This study aimed to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups. Feasibility outcomes were recruitment, sustained participation, contamination, retention, and feasibility of study procedures. Percent weight loss at 6 and 12 months were exploratory outcomes. Women with overweight or obesity who were 8 weeks to 12 months post partum were randomized to receive a 6-month behavioral weight loss intervention based on the Diabetes Prevention Program lifestyle intervention via Facebook or in-person groups. Participants completed assessments at baseline, 6 months, and 12 months. Sustained participation was defined by intervention meeting attendance or visible engagement in the Facebook group. We calculated percent weight change for participants who provided weight at each follow-up. Among individuals not interested in the study, 68.6% (72/105) were not interested in or could not attend in-person meetings and 2.9% (3/105) were not interested in the Facebook condition. Among individuals excluded at screening, 18.5% (36/195) were ineligible owing to reasons related to the in-person condition, 12.3% (24/195) related to the Facebook condition, and 2.6% (5/195) were unwilling to be randomized. Randomized participants (n=62) were a median of 6.1 (IQR 3.1-8.3) months post partum, with a median BMI of 31.7 (IQR 28.2-37.4) kg/m2. Retention was 92% (57/62) at 6 months and 94% (58/62) at 12 months. The majority (21/30, 70%) of Facebook and 31% (10/32) of in-person participants participated in the last intervention module. Half (13/26, 50%) of Facebook and 58% (15/26) of in-person participants would be likely or very likely to participate again if they had another baby, and 54% (14/26) and 70% (19/27), respectively, would be likely or very likely to recommend the program to a friend. In total, 96% (25/26) of Facebook participants reported that it was convenient or very convenient to log into the Facebook group daily compared with 7% (2/27) of in-person participants who said it was convenient or very convenient to attend group meetings each week. Average weight loss was 3.0% (SD 7.2%) in the Facebook condition and 5.4% (SD 6.8%) in the in-person condition at 6 months, and 2.8% (SD 7.4%) in the Facebook condition and 4.8% (SD 7.6%) in the in-person condition at 12 months. Barriers to attending in-person meetings hampered recruitment efforts and intervention participation. Although women found the Facebook group convenient and stayed engaged in the group, weight loss appeared lower. Research is needed to further develop care models for postpartum weight loss that balance accessibility with efficacy. ClinicalTrials.gov, NCT03700736; https://clinicaltrials.gov/ct2/show/NCT03700736.

Impact of Minimally Invasive Approach to Radical Cystectomy in Bladder Cancer Patients with Malnutrition

Malnutrition is associated with higher rates of complications following radical cystectomy (RC) for the treatment of muscle-invasive bladder cancer. The newer robotic approach to RC has yet to be analyzed against the open approach in malnourished patients with respect to perioperative complications. A retrospective cohort analysis of RC patients with a postoperative diagnosis of bladder cancer and non-disseminated disease was performed. Malnourishment was defined as either low serum albumin (<3.5 g/dL), >10% 6-month preoperative weight loss, or BMI <18.5 kg/m2). Multivariable and generalized logistic regression were used for categorical and continuous outcomes respectively. Malnourishment was associated with greater systemic sepsis, bleeding transfusions, 30-day mortality, postoperative C. difficile infection, and days from operation to discharge (DOD) (all P < 0.05). In malnourished patients, robotic approach was associated with lower adjusted odds of bleeding transfusions (aOR = 0.51, P < 0.05) and fewer adjusted days from operation to discharge (β[SE]= −5.2[1.1], P < 0.05) compared to open. Typical benefits seen with minimally-invasive robotic surgery translate to malnourished patients, although they were still prone to longer hospital stay than their adequately nourished counterparts. Robotic approach to RC may help mitigate the increased need for transfusions and longer DOD seen in malnourishment and may be preferable for patients with preoperative nutritional deficits.

Sustainable dietary weight loss intervention and its effects on cardiometabolic parameters and greenhouse gas emissions: study protocol of a randomised controlled trial with overweight and obese adults in Ouagadougou, Burkina Faso

IntroductionThe global obesity epidemic and its adverse health effects have reached sub-Saharan Africa. In some urban settings, like Burkina Faso’s capital Ouagadougou, up to 43% of the adult population are...

Overlapping and distinct relationships between hedonic hunger, uncontrolled eating, food craving, and the obesogenic home food environment during and after a 12-month behavioral weight loss program

Hedonic hunger, reward-driven eating outside of biological need, is a newer construct in eating behavior research. During behavioral weight loss (BWL), greater improvements in hedonic hunger are associated with higher weight loss, but it remains unclear if hedonic hunger predicts weight loss independent of more well-established, similar constructs (uncontrolled eating and food craving). Research also is needed to understand how hedonic hunger interacts with contextual factors (e.g., obesogenic food environment) during weight loss. Adults (N = 283) in a 12-month randomized controlled trial of BWL were weighed at 0, 12, and 24 months, and completed questionnaires assessing hedonic hunger, food craving, uncontrolled eating, and the home food environment. All variables improved at 12 and 24 months. Decreases in hedonic hunger at 12 months were associated with higher concurrent weight loss, but not when accounting for improvements in craving and uncontrolled eating. At 24 months, reduction in craving was a stronger predictor of weight loss than hedonic hunger, but improvement in hedonic hunger was a stronger predictor of weight loss than change in uncontrolled eating. Changes to the obesogenic home food environment failed to predict weight loss, regardless of levels of hedonic hunger. This study adds novel information on the individual and contextual factors associated with short- and long-term weight control, which can help refine conceptual models and treatment strategies.

Impact of COVID-19 on a worksite weight loss program for employees with overweight and obesity.

The COVID-19 pandemic has been shown to be negatively associated with physical activity engagement, adherence to healthy diet, and weight management among people with obesity. The current study examined COVID-19-related changes in weight, physical activity (PA), and diet among employees with obesity or overweight who participated in Vibrant Lives (VL), a worksite weight loss program. School district employees participated in the 6-month VL weight loss program and were categorized into non-COVID-era participants and COVID-era participants. Participants completed questionnaires about PA and dietary intake at baseline and follow-up. COVID-era participants reported the effects of pandemic on their behaviors. Changes in weight, PA, and diet were compared between groups using multilevel linear mixed models and logistic regression models. A total of 266 participants (non-COVID, n=173; COVID, n=93) were included. Significant weight loss (non-COVID, -2.3 kg vs. COVID, -1.3 kg) and increases in moderate-to-vigorous PA minutes (non-COVID, 48.7 min vs. COVID, 61.5 min) were observed associated with the program, but no significant differences in changes between the groups were found. Compared to non-COVID participants, COVID participants decreased fast food consumption (P=.008) and increased sugar-sweetened beverage intake (P=.016). Higher frequency of snacking and overeating were reported as barriers to a healthy diet. The COVID-19 pandemic was negatively associated with healthful dietary behaviors. The information obtained from participants regarding the reasons for their pandemic-related changes in diet may help identify strategies to encourage healthier behaviors and weight management among people who have been negatively affected by the COVID-19 pandemic.This article is protected by copyright. All rights reserved.

Abstract 51: Better Sleep Health is Associated With Greater Adherence to Lifestyle Modification During a 12-month Behavioral Weight Loss Intervention

Introduction: Consistent evidence suggests that poor sleep may impede weight loss efforts; however, the impact of poor sleep on lifestyle modification during attempted weight loss is unclear. Purpose: To examine the relationship between sleep health and measures of lifestyle modification in a sample of adults who participated in a 12-month behavioral weight loss intervention. Methods: Adults (N=125) with overweight or obesity (50.3±10.6 years, 91% female, 81% White) participated in a 12-month behavioral weight loss intervention. Assessments occurred at baseline, 6 months, and 12 months. Six dimensions of sleep were included in our operationalization of sleep health: regularity, satisfaction, alertness, timing, efficiency, and duration. Sleep dimensions were assessed using validated questionnaires and actigraphy, with values dichotomized into ‘good’ and ‘poor’ sleep. A composite sleep health score was calculated based upon the count of the ‘good’ individual dimensions (range: 0-6), with higher scores indicating better sleep health. Measures of lifestyle modification included attendance at group intervention sessions, daily adherence to caloric intake goals (% of days), and change in average daily moderate-vigorous physical activity (MVPA). Linear mixed modeling was used to examine the relationship between baseline and 6-month sleep health and lifestyle modification during the subsequent 6-month interval with adjustment for age, gender, bed partner, and race. The composite sleep health score and individual sleep health dimensions were evaluated in separate models. Results: Mean sleep health was 4.5±1.1 (mean±standard deviation) at baseline and 4.5±1.2 at 6 months; from 0-6 months and 6-12 months, participants attended 79.4±15.0% and 62.3±32.3% of the group intervention sessions, adhered to caloric intake goals on 35.6±23.3% and 21.1±23.3% of the days, and changed MVPA by 8.7±13.6 min/day and -3.7±13.6 min/day. Better sleep health was associated with higher rates of attendance at group intervention sessions (b=2.71, SE=1.29; P=.038), greater adherence to caloric intake goals (b=4.60, SE=1.34; P&lt;.001), and a trend for greater change in MVPA (b=1.41, SE=0.82; P=.088). Associations with lifestyle modification outcomes were observed with the following individual sleep dimensions (each P&lt;.05): regularity with attendance and caloric intake, satisfaction with caloric intake, and duration with MVPA. Conclusions: Better sleep health was associated with greater adherence to lifestyle modification during a 12-month behavioral weight loss intervention. Whether improving sleep health prior to or during a weight loss intervention facilitates better lifestyle modification outcomes merits examination. Support: NIH R01HL107370.

Abstract P235: The Association Between Neighborhood Walkability and Physical Activity in a Behavioral Weight Loss Trial Testing the Addition of Remotely Delivered Feedback Messages to Self-Monitoring

Background: Adding feedback messages (FB) to self-monitoring (SM) may reinforce behavior change. However, socio-environmental conditions (e.g., limited access to parks and low walkability) may limit one’s ability to respond to FB focused on physical activity (PA). Hypothesis: Residents of high walkability neighborhoods will achieve higher PA levels at 12 months than those in low walkability neighborhoods regardless of whether FB was randomly assigned. Methods: This is a secondary analysis of a 12-month behavioral weight loss trial, where adults with overweight or obesity were randomized to SM+FB (n=251) or SM alone (n=251). The SM+FB group received a smartphone pop-up message every other day tailored to their PA data. Assessment included neighborhood walkability via Smart Walk Score (low [&lt;50] vs. high [≥50]), moderate to vigorous PA (MVPA) minutes and step count via Fitbit Charge 2™, and weight via digital smart scales. We report adjusted regression coefficients (b) with 95% confidence intervals from linear mixed modeling. To normalize the residual distribution, we applied a natural log transformation (ln) to MVPA. Results: Participants (N=502) were primarily white (82.5%), female (79.5%), well-educated (16.4±2.8 years), mean age of 45±14.4 years with a body mass index (BMI) of 33.10±3.93 kg/m 2 . Compared to those from neighborhoods with high walkability, participants from neighborhoods with low walkability were more likely to be White (75.3% vs. 87.8%, P ==.0003) and older (41.4±14.7 vs. 47.7±13.6 years, P &lt;.0001) at baseline. After adjusting for these characteristics, baseline BMI and exercise self-efficacy, neighborhood walkability did not moderate the effect of treatment assignment on lnMVPA (b±SE=-0.20±0.15, P =.170) or steps (b±SE=-816.48±484.83, P =.092) over 12 months. lnMVPA (b±SE=0.12±0.10, P =.244) and steps (b±SE=415.05±344.50, P =.228) were on average similar between walkability groups. Both lnMVPA (b 6mo ±SE=0.003±0.07, P =.968; b 12mo ±SE=-0.23±0.08, P =.009) and steps (b 6mo ±SE=-416.18±195.68, P =.034; b 12mo ±SE=-1443.75±227.49, P &lt;.0001) declined over time. On average, the SM+FB group had greater lnMVPA (b±SE=0.23±0.12, P =.047) and marginally greater number of steps (b±SE=674.84±392.91, P =.086) than SM group. There were no significant interactions for group and time or group, time, and walkability ( P ≥.05). Conclusion: On average, FB had a small but significant positive impact on PA over 12 months, but neighborhood walkability did not moderate the treatment effect of FB on PA. The small effect of FB on PA may have limited our ability to detect moderation of neighborhood walkability on the treatment effects of FB on PA. Future studies need to replicate this analysis in a trial with larger treatment effects and a more diverse sample.

Delivering a Post-Partum Weight Loss Intervention via Facebook or In-Person Groups: Results from a Randomized Pilot Feasibility Trial

Background Postpartum weight retention contributes to weight gain and obesity. Remote lifestyle interventions may overcome barriers to attending in-person programs during this phase. Objective We aimed to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups. Feasibility outcomes were recruitment, sustained participation, contamination, retention, and feasibility of study procedures; percent weight loss at 6 and 12 months, exploratory outcomes. Methods Women with overweight or obesity who were 8 weeks to 12 months post partum were randomized to receive a 6-month behavioral weight loss intervention based on the Diabetes Prevention Program lifestyle intervention via Facebook or in-person groups. Participants completed assessments at baseline, 6 months, and 12 months. Sustained participation was defined with intervention meeting attendance or visible engagement in the Facebook group. Retention was defined as completing follow-up assessments (providing weight or completing the survey). We calculated the percent weight change for participants who provided weight at each follow-up. Results Among uninterested individuals, 69% (72/105) were not interested in or could not attend in-person meetings and 3% (3/105) were not interested in the Facebook condition. Among individuals excluded at screening, 18% (36/195) were ineligible due to reasons related to the in-person condition, 12% (24/195) related to Facebook and 3% (5/195) were unwilling to be randomized (all preferred Facebook). Randomized participants (n=62) were a median of 6.1 (IQR 3.1-8.3) months post partum with a median BMI of 31.7 (IQR 28.2-37.4) kg/m2. Retention was 92% (57/62) at 6 months and 94% (58/62) at 12 months. Overall, 70% (21/30) of Facebook participants and 31% (10/32) of in-person participants attended the last intervention module. Further, 50% (13/26) of Facebook participants and 58% (15/26) of in-person participants would be likely or very likely to participate again if they had another baby, and 54% (14/26) and 70% (19/27), respectively, would be likely or very likely to recommend the program to a friend. Moreover, 96% (25/26) of Facebook participants reported that it was convenient or very convenient to log into the Facebook group daily versus 7% (2/27) of in-person participants who said it was convenient or very convenient to attend group meetings each week. Contamination was low, and study procedures were feasible. Average weight loss was 3.0% (SD 7.2%) in the Facebook condition and 5.4% (SD 6.8%) in the in-person condition at 6 months and 2.8% (SD 7.4%) and 4.8% (SD 7.6%) at 12 months, respectively. Conclusions Barriers to attending in-person meetings hampered recruitment efforts and intervention participation. While women found web-based groups convenient and stayed engaged in the group, weight loss may be lower. Research is needed to further develop care models for postpartum weight loss that balance accessibility with efficacy. Conflicts of Interest None declared. Trial Registration ClinicalTrials.gov NCT03700736; https://clinicaltrials.gov/ct2/show/NCT03700736

Pre–post intervention exploring cognitive function and relationships with weight loss, intervention adherence and dropout

ABSTRACT Objective: To evaluate the association between baseline cognitive function, intervention dropout, adherence and 3-month weight loss (WL) when controlling for confounding demographic variables. Methods: 107 (Mage = 40.9 yrs.), BMI in the overweight and obese range (BMI = 35.6 kg/m2), men (N = 17) and women (N = 90) completed a 3-month WL intervention. Participants attended weekly behavioral sessions, comply with a reduced calorie diet, and complete 100 min of physical activity (PA)/wk. Cognitive function tasks at baseline included Flanker (attention), Stroop (executive control) and working memory, demographics, body weight and cardiovascular fitness were assessed at baseline. Session attendance, adherence to PA and diet were recorded weekly. Results: Baseline attention was positively correlated with age (p < .05), education (p < .05), attendance (p < .05), diet (p < .05) and PA (p < .05). Baseline executive control (p < .05) and working memory (p < .05) were each associated with % WL. Baseline executive control (p < .01) and working memory (p < .001) were also each associated with education. ANOVA indicated that baseline attention (p < .01) was associated with WL, specifically for comparing those who achieved 5–10% WL (p < .01) and those who achieved greater than 10% WL (p < .01) to those who dropped. Significance: Results suggest that stronger baseline attention is associated with completion of a 3-mo. WL intervention. Executive control and working memory are associated with amount of WL achieved. NCT registration: US NIH Clinical Trials, NCT01664715

Esophageal necrosis secondary to thoracic aortic aneurysm: a rare case of dysphagia aortica.

We present the case of a 78-year-old man with dyslipidemia with ongoing treatment with statins. He was admitted for a history of 3-month dysphagia and weight loss. The physical exam was unremarkable. Blood tests revealed anemia (hemoglobin 11,5 g/dL). Gastroscopy showed a partially stenotic bulging ulcer in the middle esophagus, with a fibrinous base and residual clot Histopathology ruled out any malignancy and confirmed the presence of transmural necrosis with infiltration of inflammatory cells. Computed tomography (CT) revealed a 11x11x12 cm thoracic aortic aneurysm, with an intramural 4 cm thrombus in the anterolateral wall. The patient was referred for urgent Vascular Surgery, but unfortunately, he presented massive hematemesis with cardiorespiratory arrest, and despite cardiopulmonary resuscitation, he died.

Identifying Predictors of Adherence to the Physical Activity Goal: A Secondary Analysis of the SMARTER Weight Loss Trial.

Research is needed to inform tailoring supportive strategies for promoting physical activity (PA) in the context of behavioral treatment of obesity. We aimed to identify baseline participant characteristics and short-term intervention response predictors associated with adherence to the study-defined PA goal in a mobile health (mHealth) weight loss trial. A secondary analysis was conducted of a 12-month weight loss trial (SMARTER) that randomized 502 adults with overweight or obesity to either self-monitoring of diet, PA, and weight with tailored feedback messages ( n = 251) or self-monitoring alone ( n = 251). The primary outcome was average adherence to the PA goal of ≥150 min·wk -1 of moderate- and vigorous-intensity aerobic activities (MVPA) from Fitbit Charge 2™ trackers over 52 wk. Twenty-five explanatory variables were considered. Machine learning methods and linear regression were used to identify predictors of adherence to the PA goal. The sample ( N = 502) was mostly female (80%), White (82%) with the average age of 45 ± 14.4 yr and body mass index of 33.7 ± 4.0 kg·m -2 . Machine learning methods identified PA goal adherence for the first week as the most important predictor of long-term PA goal adherence. In the parsimonious linear regression model, higher PA goal adherence for the first week, greater PA FB messages opened, older age, being male, higher education, being single and not having obstructive sleep apnea were associated with higher long-term PA goal adherence. To our knowledge, this is the first study using machine learning approaches to identify predictors of long-term PA goal adherence in a mHealth weight loss trial. Future studies focusing on facilitators or barriers to PA among young and middle-age adults and women with low PA goal adherence are warranted.

Detailed Versus Simplified Dietary Self-monitoring in a Digital Weight Loss Intervention Among Racial and Ethnic Minority Adults: Fully Remote, Randomized Pilot Study.

Detailed self-monitoring (or tracking) of dietary intake is a popular and effective weight loss approach that can be delivered via digital tools, although engagement declines over time. Simplifying the experience of self-monitoring diet may counteract this decline in engagement. Testing these strategies among racial and ethnic minority groups is important as these groups are often disproportionately affected by obesity yet underrepresented in behavioral obesity treatment. In this 2-arm pilot study, we aimed to evaluate the feasibility and acceptability of a digital weight loss intervention with either detailed or simplified dietary self-monitoring. We recruited racial and ethnic minority adults aged ≥21 years with a BMI of 25 kg/m2 to 45 kg/m2 and living in the United States. The Pacific time zone was selected for a fully remote study. Participants received a 3-month stand-alone digital weight loss intervention and were randomized 1:1 to either the detailed arm that was instructed to self-monitor all foods and drinks consumed each day using the Fitbit mobile app or to the simplified arm that was instructed to self-monitor only red zone foods (foods that are highly caloric and of limited nutritional value) each day via a web-based checklist. All participants were instructed to self-monitor both steps and body weight daily. Each week, participants were emailed behavioral lessons, action plans, and personalized feedback. In total, 12 a priori benchmarks were set to establish feasibility, including outcomes related to reach, retention, and self-monitoring engagement (assessed objectively via digital tools). Acceptability was assessed using a questionnaire. Weight change was assessed using scales shipped to the participants' homes and reported descriptively. The eligibility screen was completed by 248 individuals, of whom 38 (15.3%) were randomized, 18 to detailed and 20 to simplified. At baseline, participants had a mean age of 47.4 (SD 14.0) years and BMI of 31.2 (SD 4.8) kg/m2. More than half (22/38, 58%) were identified as Hispanic of any race. The study retention rate was 92% (35/38) at 3 months. The detailed arm met 9 of 12 feasibility benchmarks, while the simplified arm met all 12. Self-monitoring engagement was moderate to high (self-monitoring diet: median of 49% of days for detailed, 97% for simplified; self-monitoring steps: 99% for detailed, 100% for simplified; self-monitoring weight: 67% for detailed, 80% for simplified). Participants in both arms reported high satisfaction, with 89% indicating that they would recommend the intervention. Weight change was -3.4 (95% CI -4.6 to -2.2) kg for detailed and -3.3 (95% CI -4.4 to -2.2) kg for simplified. A digital weight loss intervention that incorporated either detailed or simplified dietary self-monitoring was feasible, with high retention and engagement, and acceptable to racial and ethnic minority adults. ASPREDICTED #66674; https://aspredicted.org/ka478.pdf.

Gamification and neurotraining to engage men in behavioral weight loss: Protocol for a factorial randomized controlled trial

Over 70% of men are overweight, and most desire weight loss; however, men are profoundly underrepresented in weight loss programs. Gamification represents a novel approach to engaging men and may enhance efficacy through two means: (1) game-based elements (e.g., streaks, badges, team-based competition) to motivate weight control behaviors and (2) arcade-style “neurotraining” to enhance neurocognitive capacities to resist the temptation of unhealthy foods and more automatically select healthy foods. This study will use a 2 × 2 factorial design to examine the independent and combinatory efficacy of gamification and inhibitory control training (ICT). Men with overweight/obesity (N = 228) will receive a 12-month mobile weight loss program that incorporates behavioral weight loss strategies (e.g., self-monitoring, goal setting, stimulus control). Men will be randomly assigned to a non-gamified or gamified version, and an active or sham ICT. A game design company will create the program, with input from a male advisory panel. Aims of the project are to test whether a gamified (versus non-gamified) weight loss program and/or ICT (versus sham) promotes greater improvements in weight, diet, and physical activity; whether these treatment factors have combinatory or synergistic effects; to test whether postulated mechanisms of action (increased engagement, for gamification, and inhibitory control, for ICT) mediate treatment effects; and whether baseline gameplay frequency and implicit preferences for ICT-targeted foods moderate effects. It is hoped this study will contribute to improved mHealth programs for men and enhance our understanding of the impact of gamified elements and neurocognitive training on weight control.

Circulating Anti-Müllerian hormone in a cohort-study of women with severe obesity with and without polycystic ovary syndrome and the effect of a one-year weight loss intervention

BackgroundWomen with polycystic ovary syndrome (PCOS) have high circulating anti-Müllerian hormone (AMH) levels which is correlated with antral follicle count and polycystic ovarian morphology and negatively correlated with body mass index (BMI). Moreover, diet-induced weight loss in women with PCOS and overweight or obesity, reduce or normalize AMH-levels. There is, however, no previous study investigating the circulating AMH levels in women with severe obesity and how a structured diet-induced weight loss program affects circulating AMH levels in these women. Therefore, this study aims to investigate circulating AMH levels in a population of women with severe obesity (BMI ≥ 35 kg/m2) with and without PCOS, as diagnosed by the NIH-criteria, and to investigate the effect of a one-year weight loss program with a very low-energy diet (VLED) on circulating levels of AMH.MethodsIn a prospective cohort-study, were 246 women with severe obesity were screened for PCOS diagnosis with the NIH-criteria, circulating AMH and anthropometry were measured at baseline and after a 12-month weight loss intervention with very low-energy diet (VLED).ResultsMean BMI was 39.9 ± 4.7 (PCOS), 39.6 ± 4.3 (non-PCOS) P = 0.960. Circulating AMH was higher in women with PCOS (5.47 ± 4.89 µg/L) compared with non-PCOS (2.66 ± 3.71 µg/L) P < 0.001 and was positively correlated with circulating total testosterone in both groups. Next, we performed ROC-analyses, and show that circulating AMH could not discriminate women with PCOS and severe obesity from non-PCOS women with severe obesity. Finally, a one-year weight reduction program does not affect circulating AMH levels despite significant weight loss neither in women with PCOS, nor without PCOS and severe obesity.ConclusionWomen with severe obesity and PCOS have elevated levels of circulating AMH compared to women without the syndrome. AMH-levels could not discriminate women with PCOS from non-PCOS because of low sensitivity and specificity. Significant weight loss was not associated with changes in circulating AMH levels, neither in women with, nor without PCOS and severe obesity. These results imply that in women with severe obesity, a greater weight loss may be needed to improve reproductive features, independent of PCOS diagnosis.Trial registration number:Clinical trial.gov: NCT01319162.

Effects of meeting steps-based and minutes-based physical activity goals on weight loss in online behavioral weight control: seemingly unrelated regression analysis

ABSTRACT Background Behavioral weight loss programs often prescribe physical activity (PA) goals in terms of minutes/week of moderate-to-vigorous PA (MVPA) and steps/day. However, the impact of meeting each type of goal prescription on weight loss is unclear, particularly in digitally-based (eHealth/mHealth) programs. This secondary analysis of a randomized trial examined the effects of meeting steps-based and minutes-based goals on weight loss in an eHealth behavioral weight control program. Methods Adults in the control arm received a 6-month online behavioral weight loss intervention with prescribed weekly goals for daily steps and minutes of MVPA. The number of weeks steps-based and minutes-based goals were met (≥100% and ≥75% thresholds) based on self-reported PA were examined as predictors of 6-month weight loss among those providing weight outcomes (n = 172; 81% of control arm) using a systems regression approach. Results Participants (BMI 35.6 kg/m2; 90.1% female; 48.7 years of age) met weekly goals for MVPA (7.1 ± 6.4 weeks) more often than steps (3.5 ± 5.5 weeks, P < .001). Meeting the steps goals (β = .24, P < .001) and MVPA goals (β = .20, P < .001) were each statistically significant predictors of weight loss at the 100% threshold; their total effects were not statistically different from one another (χ 2 = 1.12, P = .29). Similarly, at the 75% threshold for steps goals (β = .19, P < .001) and MVPA goals (β = .19, P < .001), each independently predicted weight loss; no differences were detected in their total effects (χ2 = .01, P = .92). The probability of reaching ≥5% weight loss was comparable between meeting the steps goals and MVPA goals at both adherence thresholds. Conclusions Greater attainment of PA goals prescribed as steps and minutes of MVPA independently contribute to similar weight loss outcomes in a 6-month online behavioral weight loss intervention. Future research should determine whether promoting adherence to combined steps-based and minutes-based goals produces better weight loss than utilizing either goal alone and identify strategies that improve adherence.