Behavioral Weight Loss Research Articles

Pragmatic online obesity treatment in primary care: a hybrid randomized clinical trial of implementation strategies

Online behavioral weight loss (BWL) in primary care is effective and disseminable. This trial compared two implementation approaches on program uptake, use, and weight loss via a pragmatic hybrid type 2 implementation-effectiveness design to evaluate online BWL implementation (Rx Weight Loss [RxWL]) and effectiveness. This manuscript presents the implementation results. RxWL was implemented across a state-wide network of primary care clinics using lower- and higher-intensity implementation strategies (Basic [base program] and Enhanced [base plus enhanced training and dashboard], respectively) between 2018 and 2022. Nurse care managers (NCMs; N = 23) were recruited and block-randomized to implementation condition. Adult primary care patients (body mass index [BMI] > 25 kg/m2, internet-connected device access) were referred and enrolled by their NCMs. Outcomes were the proportion of eligible patients who enrolled in and completed RxWL by NCM condition, initial weight loss and regain over 12 and 24 months by NCM condition, and clinician acceptability and feasibility. NCMs (N = 12 Enhanced, N = 11 Basic) in Enhanced enrolled more patients (N = 490) than in Basic (N = 164). Although the proportion of patients who completed RxWL and mean weight loss did not differ by condition, different enrollment rates resulted in the Enhanced condition engaging more patients. NCMs rated RxWL as acceptable and feasible with no difference by condition. Findings support connecting primary care patients with technology-based health behavior change programs. Clinical trial registration number: ClinicalTrials.Gov identifier NCT03488212: https://clinicaltrials.gov/ct2/show/NCT03488212. Trial registration: clinicaltrials.gov Identifier: https://clinicaltrials.gov/study/NCT03488212.

The impact of weight self-stigma on weight-loss treatment engagement and outcome.

Individuals with overweight or obesity often endure significant weight-based prejudice and discrimination in various settings. Experiencing weight-related stigma is linked to many adverse psychosocial outcomes. Weight self-stigma is when an individual internalizes and identifies with negative attributes ascribed to people with larger bodies and has self-devaluing thoughts because of their weight and is associated with poorer health outcomes. This study explored how weight self-stigma may impact weight management efforts and outcomes for adults participating in an onlight weight-loss intervention. 508 adults (86.2% female, 84.6% White) with overweight or obesity participated in an asynchronous 12-week online weight-loss intervention with computer-generated feedback. Weight and weight self-stigma were measured at baseline and 3 months later. Thirty-one point five percent of the sample reported high levels of stigma, which was associated with greater program dropout than those who did not report high stigma (32.5% vs. 21.6%). Program completers reporting high self-stigma showed better treatment engagement (77.0% vs. 69.7% lessons viewed) and weight loss (M = -6.31% vs. -5.08%); these differences were not observed when using intent-to-treat assumptions. When analyzed as a continuous variable, weight self-stigma showed no association with treatment engagement and outcome. These findings highlight the complexity of understanding how self-stigma affects treatment engagement and outcome in behavioral weight loss and the need for more targeted research in this understudied area. Results suggest that weight self-stigma plays a role in weight management during an online weight-loss intervention, affecting engagement and outcomes.

Considering Sufficient Weight Loss as a Prerequisite for Development of Anorexia Nervosa and Atypical Anorexia Nervosa.

Because premorbid BMI strongly predicts the amount of weight loss in anorexia nervosa (AN)/atypical AN, we hypothesize that weight loss triggers both disorders by inducing the endocrine adaptation to starvation. We propose research to capture the onset of AN/atypical AN following intentional, otherwise behaviorally motivated, or unintentional weight loss in relationship to premorbid weight. We propose retrospective and prospective studies to examine the temporal development of symptoms in AN/atypical AN. Given a greater frequency of weight loss behaviors in individuals with high BMIs, patients with intentionally driven weight loss should demonstrate a higher mean weight loss and greater premorbid weight and shape concerns. Practice guidelines necessitateweight gain for AN recovery, yet how weight gain induces improvements is unspecified and warrants systematic elucidation. Finally, we highlight implications for the current conceptualization of genetic and environmental contributors of AN/atypical AN in twin and molecular genetic studies. We propose separating the starvation-induced mechanisms relevant for AN/atypical AN development from the reasons/mechanisms inherent to weight loss.

Severity levels of anorexia nervosa and atypical anorexia nervosa in a Korean cohort.

Despite its potential for informing tailored treatments, the severity of eating disorders (EDs) lacks clear conceptualisation. The present retrospective cohort study examined the clinical validity and utility of severity specifiers for anorexia nervosa (AN) and atypical AN in a Korean population. Data from 696 Korean outpatients with AN or atypical AN were analysed. Severity criteria for AN from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the Medical Emergencies in Eating Disorders (MEED) guidance were used. Severity criteria applied for atypical AN were the frequency of intermittent fasting (ED Diagnostic Scale item 17), Eating Disorder Examination Questionnaire global scores, and the degree of weight suppression. Prevalence of extreme cases of AN in our cohort was higher than in Western populations in previous studies. MEED guidance further subclassified extreme AN, revealing distinct psychopathological profiles across severity levels. The proposed severity classification for atypical AN based on the weight loss behaviour of intermittent fasting showed merit. These findings suggest a potential need for a more nuanced AN severity classification that better represents severe medical aspects and encompasses cultural and ethnic diversities. In atypical AN, there is a need to examine severity indices measuring pathological behaviours.

Additive vs. redundant properties of theory in the advancement of weight-control behaviors within community-based obesity treatments in lower- to lower-middle income women

BackgroundObesity is a growing epidemic with non-surgical/non-pharmacological interventions having only nominal and transient effects on excess weight. Those persistent shortcomings are associated with minimal understandings of impacts of treatment-associated changes in psychological variables and their relationships. Women of lower incomes have high rates of obesity and might have increased difficulties accessing evidence-based programs.MethodsWomen with obesity of lower- to lower-middle incomes participated in 6-month community-based treatments in the United States emphasizing either self-regulatory skills development (behavioral methods group: n = 63) or typical education in exercise and healthy dietary practices (education group: n = 48).ResultsThere were significant 6-month improvements in self-regulation, self-efficacy, mood, physical activity/exercise, dietary behaviors, and weight in both groups. All improvements were significantly greater in the behavioral group. Based on the incorporation of multiple behavioral theories, separate multiple regression models were fit for prediction of the weight-loss behavior changes. Stepwise entry of changes in self-regulation, self-efficacy, and mood each significantly contributed to the explained variance in physical activity/exercise change. Change in self-efficacy was most relevant in the prediction of change in dietary behaviors. Change in physical activity/exercise was significantly related to change in dietary behaviors; however, a regression analysis indicated that only physical activity/exercise change was a significant independent contributor to the overall accounted-for variance in lost weight.ConclusionBy incorporating key tenets of social cognitive theory, self-efficacy theory, self-regulation theory, coaction theory, and the mood-behavior model in an additive manner, suggestions and emphases for addressing psychological variables for improved weight-loss behaviors within scalable obesity treatments were advanced.

Effect of stress mitigation measures on the aggressive behaviour and body weight loss of Large White Yorkshire crossbred pigs during transportation

This study examined the impact of stress mitigation measures on the live body weight loss and skin lesion scores of Large White Yorkshire pigs after a 200 km transportation by road. Twenty-four LWY pigs were randomly allotted into four groups of six each: control group (T1 ), pigs injected with vitamin E and selenium (T2 ), pigs administered hydrogen rich water (T3 ), and pigs exposed to monochromatic blue light (T4 ). Hydrogen-rich water administration (T3 ) resulted in the highest live body weight loss, while exposure to monochromatic blue light (T4 ) induced the lowest. Shrinkage during transport mirrored the live body weight loss trend. Significant differences emerged in skin lesion scores, notably in the hindquarter and tail regions. Monochromatic blue light exposure (T4 ) correlated with reduced aggressive behaviour, evidenced by lower hindquarter skin lesion scores. Conversely, hydrogen-rich water administration (T3 ) resulted in higher tail region skin lesion scores. The findings suggest that exposure to monochromatic blue light may have a calming effect during transport and can be recommended as a stress mitigation strategy to enhance overall animal welfare during transportation Keywords: Transportation stress, body weight loss, shrinkage, aggressive behaviour

The prognostic role of food addiction for weight loss treatment outcomes in individuals with overweight and obesity: A systematic review and meta-analysis.

Food addiction (FA) could be a potential prognostic factor of weight loss intervention outcomes. This systematic review with meta-analysis aimed to (1) estimate this prognostic effect of FA diagnosis and symptom count in individuals with overweight or obesity and (2) explore potential sources of heterogeneity based on properties of the weight loss intervention, study, and sample (e.g., age, gender, ethnicity). We searched PubMed, PsycINFO, and Web of Science for studies reporting on associations between pre-intervention FA (assessed with the Yale Food Addiction Scale) and weight outcomes after weight loss intervention in individuals with overweight or obesity without a medically diagnosed eating disorder. Twenty-five studies met inclusion criteria, including 4904 individuals (71% women, Mage = 41 years, BMI = 40.82 kg/m2), k = 18 correlations of weight loss with FA symptom count, and k = 21 mean differences between FA diagnosis groups. Pooled estimates of random-effects meta-analyses found limited support for a detrimental effect of FA symptom count and diagnosis on weight loss intervention outcomes. Negative associations with FA increased for behavioral weight loss interventions and among more ethnically diverse samples. More research on the interaction of FA with pre-existing mental health problems and environmental factors is needed.

A randomized controlled trial of a “Small Changes” behavioral weight loss treatment delivered in cardiac rehabilitation for patients with atrial fibrillation and obesity: study protocol for the BE-WEL in CR-AF study

BackgroundAtrial fibrillation (AF) represents a global epidemic. Although international AF practice guidelines indicate weight loss for patients with AF and comorbid obesity (BMI ≥ 30 kg/m2) to alleviate symptom burden and improve prognosis, few cardiac rehabilitation (CR) programs include targeted weight loss treatment.AimsThis RCT protocol will evaluate the efficacy of a “Small Changes” behavioral weight loss treatment (BWLT) to produce clinically relevant (≥ 10%) weight loss among patients with AF and obesity undergoing CR, relative to CR alone. Secondary aims are to establish efficacy of CR + BWLT for improving AF symptoms, AF risk factors, and health-related quality of life.MethodsAdults (18 +) with AF and obesity will be recruited and randomized to receive CR + BWLT (intervention) or CR-only (control). Controls will receive CR consisting of supervised exercise and risk factor self-management for 12 weeks. The intervention group will receive CR plus BWLT (12 weekly, group-based virtual sessions, followed by 12 weeks of follow-up support). Weight and AF-risk factors will be assessed at pre-randomization, 12 weeks, 24 weeks, and 52 weeks. AF burden will be assessed using 30-s ECGs recorded bidaily and with AF symptoms. The primary endpoint of weight loss will be calculated from baseline to 52 weeks as a percentage of starting weight. Intention-to-treat analyses will compare the proportion in each group achieving ≥ 10% weight loss. Assuming success rates of 5% and 30% among controls and intervention groups, respectively, and a 30% loss to follow-up, 120 patients (60 per group) will provide 80% power to detect a difference using a two-sided independent test of proportions (alpha = 5%).ImpactThis clinical trial will be the first to demonstrate that adding BWLT to CR promotes clinically meaningful weight loss among patients with AF and comorbid obesity. Findings will inform design and execution of a large efficacy trial of long-term (e.g., 5-year) clinical endpoints (e.g., AF severity, mortality). Implementing weight control interventions designed to target the AF substrate in CR could dramatically reduce morbidity and enhance quality of life among patients living with AF in Canada.Trial registrationClinicalTrials.gov registration number: NCT05600829. Registered October 31, 2022.

Coach access to digital self-monitoring data: an experimental test of short-term effects in behavioral weight-loss treatment.

This study experimentally tested whether coach access to participants' digital self-monitoring data improved behavioral weight-loss outcomes. Participants (N = 322) received 12 weeks of group-based behavioral weight-loss sessions via videoconference and were instructed to engage in daily self-monitoring of weight, physical activity (PA), and dietary intake. For participants who were randomly assigned to Coach Share ON (n = 161), coaches regularly accessed a web-based portal that displayed data from the participants' scale, PA sensor, and food record. Weight loss at 12 weeks was significantly greater in Coach Share ON versus OFF (6.2% vs. 5.3%; p = 0.04). Self-monitoring of PA (98.70% vs. 97.40% of days; p = 0.006) and eating (98.05% vs. 93.51% of days; p = 0.007) was more frequent in Coach Share ON versus OFF. There were no significant differences by condition in PA (p = 0.57), attendance (p = 0.42), working alliance (p = 0.62), or self-monitoring of weight (p = 0.12). Perceived supportive accountability was significantly greater in Coach Share ON versus OFF (p < 0.001). The short-term efficacy of behavioral weight loss was greater when coaches had direct access to self-monitoring device data. Notably, there also was no evidence of iatrogenic effects of data sharing.

Self-regulatory and self-efficacy mechanisms of weight loss in women within a community-based behavioral obesity treatment.

Given the traditional methods of treating obesity through education on controlling eating and increasing exercise have largely failed beyond the very short term, a more intensive focus on psychosocial correlates of those weight-loss behaviors has been suggested. Multiple behavioral theories incorporate self-regulation, self-efficacy, and mood; however, their interrelations and effects over both the short and long term within cognitive-behavioral obesity treatments remain unclear. Within a novel community-based program with women with obesity who had either low (n = 29) or high (n = 71) mood disturbance scores, there were significant improvements in exercise- and eating-related self-regulation and eating-related self-efficacy-primary targets of that intervention-with no significant difference in those changes by mood disturbance grouping. Changes in the summed exercise- and eating-related self-regulation scores significantly mediated relationships between changes in eating-related self-efficacy and weight (over both 6 and 12months). There were similar results with mediation assessed via the extent exercise-related self-regulation carried over to eating-related self-regulation. In both of those models a reciprocal relationship between self-regulation and self-efficacy changes was indicated. In serial multiple mediation equations, paths of changes in exercise-related self-regulation → eating-related self-regulation → eating-related self-efficacy → weight were significant. However, paths were not significant when change in self-efficacy was entered as the predictor (initial) variable. Findings suggest viability in first focusing on exercise-related self-regulation, then eating-related self-regulation, in the course of increasing self-efficacy and probabilities for inducing enough sustained weight loss to improve obesity-associated health risks. Benefits of field-based research findings generalizing to weight-management applications were suggested.

Theory-Driven Behavioral Obesity Treatment and Carry-Over of Exercise-Related, to Eating-Related, Self-Regulation: Effects on Short- and Long-Term Weight/Waist Circumference Reductions.

The predominant method for treating obesity has been suggesting and providing information on a controlled diet and, to a lesser extent, increased exercise. That approach has largely failed beyond the short term for many decades as obesity rates continue to rise. Therefore, leveraging improvements in psychosocial correlates of weight-loss behaviors has sometimes been suggested instead. The aim of this study was evaluation of targeted improvements in self-regulation and self-efficacy within a theoretically derived weight-loss program. Women with obesity (N = 103) participated in a year-long community-based program emphasizing self-regulatory skills development to counter lifestyle barriers/challenges to first exercise, then controlled eating. Within a structured treatment protocol administered by community facility employees-and based on tenets of social cognitive theory, self-regulation theory, self-efficacy theory, and coaction theory-self-regulatory skills were initially developed to foster adherence to exercise. Those skills were then adapted to promote eating-behavior changes, emphasizing fruit and vegetable intake. Improvements in measures of exercise self-regulation, eating self-regulation, and self-efficacy for controlling eating, their corresponding behaviors, and weight and waist circumference were significant. Greater within-participant carry-over of changes in exercise self-regulation to eating self-regulation was significantly associated with more weight and waist circumference reductions over both 6 and 12 months. Change in eating-related self-efficacy significantly mediated those relationships. The mean weight reduction of approximately 6% indicated positive effects on obesity-related health risks. The community-based setting indicated potentials for large-scale dissemination of theory- and evidence-driven behavioral obesity treatments focused primarily on self-regulatory skills development.

The association between weight loss behaviors and body weight perception in Chinese adolescents: 2007–2022

BackgroundWeight misperceptions are common in children and adolescents, which is related to the engagement of weight loss behaviors. The aim of this study was to investigate the association between body weight perception and weight loss behaviors of lower-calorie diets and increased levels of physical activity (PA).MethodsThe Ningbo Youth Risk Behavior Survey was conducted from 2007 to 2022. A multistage, stratified cluster sampling procedure was utilized to draw target adolescents aged 12 to 18 years participating in each survey wave (2007, 2012, 2017, 2022). Data of anthropometry, weight perception, and weight loss behaviors were collected through self-administered questionnaires. A binary generalized linear model was used to examine associations between body weight perception and weight loss behaviors of lower calorie diets and increased levels of PA.ResultsThe sample sizes for each survey wave were 777, 885, 1588 and 2638. The prevalence of overweight (OW)/obesity (OB), self-perception of OW/OB and overestimated perception increased from 7.6%, 27.0% and 29.1% in 2007 to 16.3%, 39.9% and 41.4% in 2022, respectively. Adolescents that perceived themselves as OW/OB had higher odds of lower-calorie diets (OR: 4.2, 3.3–5.4) and increased level of PA (OR: 3.8, 2.9-5.0), whereas adolescents that perceived themselves as underweight had lower odds of lower-calorie diets (OR: 0.371, 0.253–0.542) and increased levels of PA (OR: 0.381, 0.295–0.559).ConclusionOW, self-perception of OW/OB and overestimated perception were prevalent in Chinese adolescents. Self-perception of OW/OB was positively associated with lower-calorie diets and increased levels of PA. The results can support public health specialists to promote health education of body perception and improve self-esteem in Chinese children and adolescents.

Analysis of the diet, weight-loss behavior, and nutritional knowledge of athletes and coaches in weightclass sports: influence of a coach's nutritional knowledge on athletes.

This study was conducted to investigate the nutritional knowledge of elite athletes undergoing weight loss and to identify differences in weight-loss strategies according to nutritional knowledge. The participants included 22 coaches and 88 elite athletes registered under the same affiliation. The survey involved translating the General Nutrition Knowledge Questionnaire (GNKQ), and interviews were used to confirm the diet and weight loss patterns of the athletes. The coaches and athletes were divided into high-rank (12 coaches and 57 athletes) and low-rank (10 coaches and 31 athletes) groups based on GNKQ scores. Paired t-tests, correlation analysis, and logistic regression analysis were performed. GNKQ results showed significant differences between high-ranking and low-ranking coaches (p < 0.001). Furthermore, a significant difference in nutrition knowledge scores was also noticed between athletes with high-ranking and low-ranking coaches (p < 0.001). A strong correlation was observed between the GNKQ scores of coaches and athletes (r = 0.369; p < 0.001). The nutritional knowledge of coaches was also correlated with weight-loss strategies (weight loss attempt frequency; r = -0.235; p = 0.027; weight loss duration; r = -0.268; p = 0.012). Additionally, differences were observed in the intake of all nutrients (carbohydrates, proteins, and fat) in the diets of athletes (p < 0.001). Our study suggests that the nutritional knowledge of coaches indirectly affects athletes. Coaches have significant influence over athletes and possess experience with diet and weight-loss patterns. This insight should be effectively utilized to enhance the training and performance of athletes and coaches.

Family functioning and the implications for adult weight management.

Strong support for family-based interventions in child and adolescent weight management exists. However, family-based interventions have not been as well documented in adult populations. Given that many adults operate within family systems that could influence their weight management behaviors, research is needed to establish possible family-level variables as intervention targets for adult weight loss programs. This study tested the relationship between family functioning (defined as support and bonding), chaos (defined as disorder in the home), and weight loss in adults with overweight or obesity participating in a behavioral weight-loss program. Participants (N = 118; baseline mean body mass index 33.8 ± 3.7; 69.5% female; 97.5% White; 67.8% with a combined annual income of $75k or above; 90.7% completed some college or above) were from a randomized controlled trial examining weight loss ripple effects (Gorin et al., 2018) in individuals assigned to either 6 months of WW (formerly Weight Watchers) or a self-guided approach. Higher family support and bonding at baseline were associated with greater percent weight loss at 6 months. Family support and bonding at baseline were associated with lower chaos in the home at 6 months. However, this was moderated by condition such that this association was significant in the WW but not the self-guided group. Results provide theoretical support that targeting family dynamics may improve weight loss outcomes in behavioral weight loss programs for adults. Future research should test whether family support, bonding, chaos, or other related variables such as family cohesion and adaptability-focused interventions improve weight loss outcomes for adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring Dietary Restraint as a Mediator of Behavioral andCognitive-Behavioral Treatments on Outcomes for Patients With Binge-Eating Disorder With Obesity.

To explore dietary-restraint as a mediator of binge eating and weight-loss outcomes within a randomized controlled trial comparing cognitive-behavioral therapy (CBT) and behavioral weight loss (BWL) for binge-eating disorder (BED) with obesity. Ninety participants were randomly assigned to CBT or BWL and assessed by evaluators blinded to conditions at pretreatment, throughout-, and post-treatment (6 months). Three dietary-restraint measures (Eating Disorder Examination-Questionnaire [EDE-Q]-Restraint, Three-Factor Flexible-Restraint and Rigid-Restraint) were administered at pretreatment and after 2 months of treatment. Regression models examined whether changes at 2-months in the restraint scales mediated the effects of treatment (CBT versus BWL) on binge eating and weight-loss outcomes at post-treatment. CBT and BWL had similar binge-eating outcomes and similar changes in EDE-Q-restraint and flexible-restraint. BWL had greater 2-month increases in rigid-restraint and greater weight-loss at posttreatment than CBT, with results suggesting 2-month changes in rigid-restraint mediated the greater difference (>7 pounds) in weight-loss. The observed mediation effect of 2.92 suggests 39% of total treatment-effect on weight-loss was mediated through 2-month increases in rigid-restraint. This secondary analysis within a trial comparing CBT and BWL for BED suggests early-change in rigid-restraint has a mediating effect of BWL on weight-loss. Findings indicate that BWL improves binge eating and challenge views that dietary-restraint might exacerbate binge eating in BED with obesity. Findings require confirmation using hypothesis-testing in future trials. Clinicaltrials.gov: NCT00537758 ("Treatment for Obesity and Binge Eating Disorder").

Weight Management Package Based on Knowledge, Attitude, Behavior, and Barriers of Obese Youth in China

This study explored the knowledge, attitudes, behaviors and barriers of obese adolescents in Erqi District, Zhengzhou City, China, in terms of weight loss management. The study adopted a cross-sectional design, collected data through a questionnaire survey, and used statistical analysis methods to explore the relationship between these factors and their association with socio-demographic characteristics. The study found that participants generally had misconceptions about health knowledge, had a negative attitude towards weight, rarely adopted weight-loss behaviors, and faced some barriers to health management. The study revealed a negative correlation between health knowledge and attitudes, a finding that challenges traditional ideas and suggests that simply increasing health knowledge may not be sufficient to change attitudes and behaviors. In addition, the study found that economic factors had a small effect on health-related dimensions, while BMI had a significant effect on knowledge and behavior dimensions. These findings highlight the need to consider the interaction of multiple factors when designing interventions for adolescent obesity, and to fully consider the local socio-cultural context. The results of the study provide a new perspective on understanding the problem of adolescent obesity in China, and also raise questions about current health education and intervention strategies. Future research can further explore the underlying reasons behind these findings, providing a scientific basis for the development of more effective strategies for the prevention and management of adolescent obesity.

Successful Weight Loss in Adolescents with Overweight or Obesity Using a Swallowable Intragastric Balloon and Nutritional Oversight

PurposeMedical devices benefit patients living with overweight or obesity, but studies in the adolescent population are lacking. The goal of this study was to collect information on the performance and safety of a swallowable intragastric balloon program (SGBP) in adolescent patients.Materials and MethodsData were collected retrospectively on patients aged 15 to 17 years with body mass index (BMI) ≥ 27 kg/m2 who received the swallowable intragastric balloon (SGB) and associated lifestyle and nutritional change program. Patients had not responded to previous dietary and behavioral modification weight loss treatments and elected to undergo SGBP. The SGB was swallowed and filled with 550 mL of distilled water in an outpatient setting, and a multidisciplinary team delivered a lifestyle/nutritional change program. Mean % total body weight loss (%TBWL) was calculated for each patient compared with baseline.ResultsA total of 91 patients, 69 (75.8%) female and 22 (24.2%) male, underwent SGBP and completed follow-up through SGB passage at 4 months. Baseline mean ± SD age, weight, and BMI were 16.4 ± 0.77, 99.70 ± 21.33 kg, and 35.60 ± 5.59 kg/m2, respectively. After 4 months, mean weight and BMI were 86.37 ± 18.83 kg and 30.86 ± 5.16 kg/m2 respectively; %TBWL was 13.05 ± 7.64 (1-sided t-test, p < 0.0001). Most (80, 87.9%) reported no adverse events; 11/91 (12.1%) experienced an adverse event. Of these, 9/91 (9.9%) experienced nausea and/or vomiting; 1/91 (1.1%) reported abdominal pain only; 1/91 (1.1%) reported flatulence only. There were no serious adverse events or premature device removals.ConclusionThe SGBP provides safe and effective short-term weight loss in adolescents living with overweight and obesity.Graphical

Anti-cancer and visible-light-driven photocatalyst activities of graphene oxide nanosheets against A549 lung cancer cells and organic dyes

The use of graphene oxide (GO) nanosheets (NSs) in cancer cell treatment is a promising and innovative approach to eradicate lung cancer cells and to adsorb and photodegrade organic dyes in water. XRD results revealed that the produced GO NSs have a high crystallinity and a d-spacing value of 0.87 nm. The FTIR spectrum showed that several oxygen-containing functional groups were introduced at the graphite surface from the exfoliation process. The TGA curve result supported the synthesis of GO NSs from the characteristic weight loss behavior. The wrinkled and fold surface morphology of the synthesized GO NSs was confirmed using FE-SEM and TEM. Subsequently, the assessment of their in vitro anti-oxidant and hydroxyl radical scavenging characteristics revealed that the synthesized GO NSs possessed effective antioxidant properties. The viability of A549 lung cancer cells against GO NSs was found to decrease in a dose-dependent manner and their morphology and nuclear damages was assessed by AO/EB and DAPI staining assays. The increased oxidative stress resulted in greater apoptotic cell death, loss of nuclear integrity, and mitochondrial membrane damage against A549 lung cancer cells. The increasing caspase-3 and caspase-9 activation resulted in more apoptotic cell death and cell cycle arrest as determined by flow cytometry. Further, GO NSs demonstrated moderate photocatalytic activity under visible light irradiation, degrading methylene blue (MB) and bromothymol blue (BTB) dye molecules by 44 and 53.5 %, respectively, after 120 min irradiation. Finally, the present study demonstrated that GO NSs possess excellent anti-cancer and moderate photocatalyst activities.

The Mood-Behavior Model: Assessing Mood-Related Mobilization of Self-Regulation of Weight-Loss Behaviors Within Community-Based Obesity Treatments

Increasing understanding of self-regulation processes within behavioral obesity treatments is required to improve consistently inadequate outcomes. The mood-behavior model proposes that, under conditions of goal striving and mood awareness, enhanced mood will mobilize self-regulation resources. That was tested within community-based obesity treatments where increased exercise might enhance mood, and increased self-regulation could improve weight-loss behaviors. Women with obesity participating in treatments focusing on either moderate exercise and self-regulation (Exercise/Self-Regulation [Exercise/SR] group, n = 42) or education on healthy eating and (to a lesser extent) exercise (Usual Care group, n = 48) were assessed on psychological and behavioral changes over 6 months. Significant overall improvements in negative mood, self-regulation for exercise and controlling eating, exercise, and fruit/vegetable intake were significantly greater in the Exercise/SR group. Using aggregated data ( N = 90), at baseline, negative mood did not significantly predict self-regulation. However, at months 3 and 6, negative mood significantly predicted both self-regulation for exercise and self-regulation for controlling eating. The addition of the group as a predictor significantly increased the explained variances. Increase in self-regulation for exercise significantly mediated the prediction of increased exercise via earlier reduction in negative mood. When group was entered into that model, it significantly moderated the mood-self-regulation and mood-exercise relationships. Increase in self-regulation for controlling eating significantly mediated the prediction of increase in fruit/vegetable intake via reduction in negative mood. Group marginally moderated the mood-self-regulation relationship only. Findings supported viability of the mood-behavior model in a field-based setting and suggested a need to facilitate improved mood to increase participants’ self-regulatory skill usage within obesity treatments.

Longitudinal associations of internalized weight stigma with physical activity and weight loss.

Cross-sectional research has demonstrated that internalized weight stigma (IWS) is associated with less engagement in weight management behaviors, including physical activity. However, limited research has explored longitudinal relationships among IWS, physical activity, and weight loss. This study examined longitudinal associations of changes in IWS, physical activity, and weight and tested whether physical activity mediated the relationship between IWS and weight change. Individuals with obesity and high IWS (N=105) participated in a 72-week behavioral weight loss intervention, with or without a weight stigma intervention. Measures of IWS (Weight Self-Stigma Questionnaire), physical activity (accelerometry and self-report), and weight were collected at baseline and weeks 20, 46 and 72. Correlations examined relationships among changes in variables from baseline to all timepoints, controlling for treatment condition. Mediation, controlling for treatment condition, tested whether IWS reductions during the first 20weeks predicted greater weight loss at weeks 46 and 72 via increased physical activity between weeks 20 and 46 or 72. Decreases in IWS at week 20 were associated with greater week-20 weight loss (r=0.265, p=0.012). Physical activity was not a significant mediator, but greater reductions in IWS at week 20 predicted greater week-46 weight loss with or without controlling for physical activity (WSSQ: b=0.30, confidence interval: 0.12, 0.54). Significant associations were not found at week 72. Initial reductions in IWS were associated with greater week-46 weight loss. Further research should investigate whether reducing IWS early in obesity treatment enhances long-term outcomes. ClinicalTrials.gov (NCT03704064).