Behavioral Weight Loss Research Articles

Soluble Receptor for Advanced Glycation End Products (sRAGE) Isoforms Predict Changes in Resting Energy Expenditure in Adults with Obesity during Weight Loss

BackgroundAccruing evidence indicates that accumulation of advanced glycation end products (AGEs) and activation of the receptor for AGEs (RAGE) play a significant role in obesity and type 2 diabetes. The concentrations of circulating RAGE isoforms, such as soluble RAGE (sRAGE), cleaved RAGE (cRAGE), and endogenous secretory RAGE (esRAGE), collectively sRAGE isoforms, may be implicit in weight loss and energy compensation resulting from caloric restriction. ObjectivesWe aimed to evaluate whether baseline concentrations of sRAGE isoforms predicted changes (∆) in body composition [fat mass (FM), fat-free mass (FFM)], resting energy expenditure (REE), and adaptive thermogenesis (AT) during weight loss. MethodsData were collected during a behavioral weight loss intervention in adults with obesity. At baseline and 3 mo, participants were assessed for body composition (bioelectrical impedance analysis) and REE (indirect calorimetry), and plasma was assayed for concentrations of sRAGE isoforms (sRAGE, esRAGE, cRAGE). AT was calculated using various mathematical models that included measured and predicted REE. A linear regression model that adjusted for age, sex, glycated hemoglobin (HbA1c), and randomization arm was used to test the associations between sRAGE isoforms and metabolic outcomes. ResultsParticipants (n = 41; 70% female; mean ± SD age: 57 ± 11 y; BMI: 38.7 ± 3.4 kg/m2) experienced modest and variable weight loss over 3 mo. Although baseline sRAGE isoforms did not predict changes in ∆FM or ∆FFM, all baseline sRAGE isoforms were positively associated with ∆REE at 3 mo. Baseline esRAGE was positively associated with AT in some, but not all, AT models. The association between sRAGE isoforms and energy expenditure was independent of HbA1c, suggesting that the relation was unrelated to glycemia. ConclusionsThis study demonstrates a novel link between RAGE and energy expenditure in human participants undergoing weight loss.This trial was registered at clinicaltrials.gov as NCT03336411.

The Multi-Caregiver Role and Its Relationship to Behavioral Adherence and Weight Among Treatment Engaged Black Women.

To examine the relationship between the multiple caregiver role and its perceived barriers to self-care on behavioral adherence in a weight loss intervention. A secondary analysis of data from a behavioral weight loss intervention. The study was conducted in two cohorts from March 2016 to February 2017 at the University of North Carolina at Chapel Hill. Eighty-one Black women with overweight/obesity (age = 48.4 ± 10.9 years [M ± SD], BMI = 36.4 ± 4.5kg/m2 [M ± SD]). Identification with the multiple caregiver role and barriers was assessed with the Multiple Caregiving Measurement Instrument. Weight was measured with a digital scale and height with a stadiometer. The Block food frequency questionnaire evaluated dietary intake. Moderate-to-vigorous physical activity (MVPA) was measured objectively with an accelerometer. Study adherence was measured by session attendance, self-weighing, and self-monitoring (diet and physical activity) frequency. Generalized linear models were used to examine the relationship between the multiple caregiver scales and the outcomes of interest, controlling for study arm, cohort, and income. Chi-square tests tested correlations. Greater identification with the multiple caregiver role was associated with decreased session attendance (β = -.56 [SE = .27], P < .05) and a trend towards weight gain (β = .36, [SE = .19], P = .07). Greater multiple caregiver barriers score predicted a decrease in fruit/vegetable intake (β = -.17 [SE = .07], P < .05). All regression results are unstandardized. Negative correlations between multiple caregiver barriers and MVPA (r = -.24, P = .06) and daily self-weighing (r = -.19, P = .10) approached significance. Participants' identification with multiple caregiving role and barriers can reduce adherence, behavior and weight change. Interventions to address Black women's multiple roles and barriers during weight loss are needed to maximize outcomes.

Parents of minor children lose less weight during a behavioral weight loss intervention: Findings from the Rural LEAP trial.

The transition to parenthood is associated with worsening health behaviors, yet the impact of parental status on successful weight loss has rarely been examined. The purpose of this study was to examine the effect of parental status of minor children on weight loss and behavioral adherence in a rural community-based weight loss intervention. Five hundred and twenty-eight adults (age 21-75years, body mass index [BMI] 30-45kg/m2) were enrolled in a group-based weight loss intervention consisting of 16 weekly sessions delivered in face-to-face group sessions at Cooperative Extension Service (CES) offices. Participants who were parents with at least one minor child (≤18 years old) in the home were compared to participants with no minor children in the home. Measures included percent weight loss, session attendance, adherence to self-monitoring, and achieving calorie and physical activity goals. Compared to participants without minor children, parents with minor children lost significantly less weight (7.5% vs. 6.2%, respectively; p=0.01), and were less likely to lose ≥5% of baseline weight (59.2% vs. 70.2%, respectively; p=0.02). In addition, parents with minor children attended significantly fewer sessions, had lower adherence to self-monitoring, and met calorie and step goals less often (all ps<0.001). The association between parental status and percent weight loss was not significantly moderated by gender of the parent. Parents of minor children had greater difficulty adhering to intervention goals and lost less weight than participants without minor children. Future research should investigate whether tailoring intervention to meet the unique needs of parents can enhance outcomes, especially given the large segment of the population represented by this group.

Personalized Self-Monitoring of Energy Balance through Integration in a Web-Application of Dietary, Anthropometric, and Physical Activity Data

Self-monitoring of weight, diet and physical activity is a valuable component of behavioral weight loss treatment. The validation and user-friendliness of this approach is not optimal since users are selected from homogeneous pools and rely on different applications, increasing the burden and achieving partial, generic and/or unrelated information about their metabolic state. Moreover, studies establishing type, time, duration, and adherence criteria for self-monitoring are lacking. In this study, we developed a digital web-based application (ArmOnIA), which integrates dietary, anthropometric, and physical activity data and provides a personalized estimation of energy balance. Moreover, we determined type, time, duration, and adherence criteria for self-monitoring to achieve significant weight loss in a highly heterogeneous group. A single-arm, uncontrolled prospective study on self-monitored voluntary adults for 7 months was performed. Hierarchical clustering of adherence parameters yielded three behavioral approaches: high (HA), low (LA), and medium (MA) adherence. Average BMI decrease is statistically significant between LA and HA. Moreover, we defined thresholds for the minimum frequencies and duration of dietary and weight self-monitoring. This approach can provide the correct clues to empower citizens with scientific knowledge, augmenting their self-awareness with the aim of achieving long-lasting results when pursuing a healthy lifestyle.

390 Adaptation and Evaluation of Guideline-Based Family-Based Behavioral Treatment for Overweight and Obesity in Childhood Survivors of Acute Lymphoblastic Leukemia (ALL)

OBJECTIVES/GOALS: Childhood survivors of ALL are at considerable risk for late effects which are exacerbated by excess weight. The proposed study involves the adaption and evaluation of the first empirically supported intervention for childhood survivors of ALL that is consistent with all national recommendations for the treatment of childhood obesity. METHODS/STUDY POPULATION: The proposed intervention will be adapted from family-based behavioral weight loss treatment (FBT) a multicomponent intervention which targets diet, activity, behavioral skills, parenting, and social facilitation among children and their parents. The Framework for Reporting Adaptations and Modifications-Enhanced structure (FRAME), a dissemination and implementation framework, will guide the adaptation, allowing for the incorporation of feedback previously gathered from key stakeholders. A single-arm, non-randomized trial of the adapted intervention will then be conducted to evaluate its acceptability, feasibility, and preliminary indications of efficacy including measures of relative weight change and associated health-related behaviors among 40 childhood ALL survivors and their families. RESULTS/ANTICIPATED RESULTS: Self-reported feedback from families at the end of treatment (EoT) is anticipated to demonstrate that this intervention will be regarded as both acceptable and feasible. Other measures of feasibility will include attendance and retention rates, which are expected to reflect to those of previous FBT trials (92% and 85%, respectively). Preliminary indications of the efficacy of the adapted intervention will be investigated through the comparison of a series of measurements taken at both baseline and EoT. Changes in relative weight will be assessed and are expected to meet a previously established range of clinically meaningful reduction in child percent overweight of 9 units or more. Improvements in dietary intake, physical activity, and health related quality of life are also anticipated. DISCUSSION/SIGNIFICANCE: Knowledge gained from the implementation of the first evidence-based intervention adapted for childhood survivors of ALL will be critical to the justification of a larger-scale, randomized controlled trial and holds promise to effectively modify the risk for chronic disease among a vulnerable population.

Acceptability and feasibility of an acceptance and commitment therapy-based guided self-help intervention for weight loss maintenance in adults who have previously completed a behavioural weight loss programme: the SWiM feasibility study protocol

IntroductionThe cost-effectiveness and long-term health impact of behavioural weight management programmes depends on post-treatment weight-loss maintenance. Growing evidence suggests that interventions using acceptance and commitment therapy (ACT) could improve long-term...

511 Automation of Home Food Inventory Scoring to Standardize Reporting, Enhance Clinical Utility, and Operationalize Delivery of Personalized Behavioral Targets

OBJECTIVES/GOALS: The Fulkerson Home Food Inventory (HFI) is widely used to assess the home food environment, a key target of behavioral weight loss trials. However, no standardized report is available. We created publicly available procedures to automate and standardize HFI reporting, yielding a personalized report to enhance this measures clinical utility. METHODS/STUDY POPULATION: Parents in the TEENS adolescent behavioral weight loss trial complete the HFI at 0-, 2-, 4-, 8-, and 12m and receive personalized reports at each timepoint. In REDCap, participants identify foods available in their home. HFI syntax is applied to calculate the obesogenic home food availability score. Categories of foods found are identified, with specific guidance provided to enhance their home food environment. Prior to automation, procedures were time intensive and error prone. To address this, HFI data are exported into Excel by a PowerShell (v7.2) command-line script using Python (v3.10) with the REDCap API. Results are calculated with F# (v6.0) using Microsoft Excel Interop API and inserted into a report template with F# using the Microsoft Publisher Interop API. This process is repeated at each timepoint. RESULTS/ANTICIPATED RESULTS: The new automated procedures significantly reduce time to generate reports and enhance accuracy. Procedures yield a 2-page individualized report that includes the obesogenic home food environment score and identifies categories of healthy items found (e.g., fruits, vegetables, whole grains) as well as areas of improvement (e.g., high-fat dairy products, processed meats). Specific items found in each category are identified. The report identifies food found in the home (e.g., chicken nuggets) with suggested healthier substitutions (e.g., lean chicken breast). This syntax and commands will be made publicly available for use in the scientific and clinical community. DISCUSSION/SIGNIFICANCE: These publicly available procedures optimize, automate, and standardize reporting for the HFI. Procedures improve efficiency within large-scale clinical trials and yield a personalized report to enhance the clinical utility of this measure and empower participants to make informed decisions about their health behaviors.

Determinants of Weight Loss and Obesity Control Behaviors Among Women Based on the Pender’s Health Promotion Model

Background: Lifestyle changes, advertising, and access to high-calorie, low-value foods have led to an increase in the prevalence of obesity and overweight, and women are at greater risk in this regard. The aim of the present study was to identify the determinants of weight loss and obesity control behaviors based on Pender’s health promotion model (HPM) among women referring to the healthcare centers of Shahrekord, Iran. Methods: This descriptive-analytical study was performed on 500 women aged 18-49 years with a body mass index (BMI)≥25 in 2019. The cluster sampling method was performed on the healthcare centers, and women were selected using simple random sampling. The data collection instrument included a researcher-made questionnaire, the reliability and validity of which were approved, and finally, data were analyzed using analytical tests in SPSS 22 and Stata14. Results: The mean (±standard deviation) of the women’s age was 34.33±8.2 years. A total of 57.8% of women had no history of weight loss and obesity control behaviors. Variables such as age, education level, and marital status were statistically significantly related to weight loss and obesity control behaviors (P≤0.05). Moreover, the constructs of prior related behaviors, interpersonal influences, and commitment to a plan of action were among the predictors of weight loss and obesity control behaviors and predicted 6.6% of behavioral changes (R2 : 6.6, P&lt;0.05). Conclusion: Overall, prior related behaviors, interpersonal influences, and commitment to a plan of action are predictors of weight loss and obesity control behaviors, and thus it is suggested to place more on these constructs while designing relevant health-promotion interventions.

Parent-adolescent dyadic associations among weight misperceptions, weight change behaviors, and dietary intakes

Prior research has shown that larger differences between individuals' actual and perceived bodily states are associated with their engagement in weight change behaviors. However, it remains unknown whether these intrapersonal associations extend to the parent-adolescent dyadic level. To address this research gap, the present study examined associations between parents' and adolescents' weight misperceptions (discrepancies between individuals' self-reported body mass indices and perceived weight statuses) relative to participants' own and their dyadic partners' weight change behaviors and dietary intakes. Participants included a large community sample of parent-adolescent dyads (N = 1,606 dyads) who completed the National Cancer Institute's FLASHE Study. Actor-partner interdependence models examined dyadic associations among participants' weight misperceptions (over- and under-perceptions) relative to their own and their dyadic partners' general weight change behaviors (current weight loss and gain behaviors), and low nutrient (e.g., processed foods) and nutrient-dense (e.g., fruits/vegetables) dietary intakes. Multiple intrapersonal and cross-dyad member associations were identified that varied based on the direction of weight misperceptions, the weight control behavior type, and whether the dyadic member was a parent or adolescent. For example, adolescents' weight under-perception was associated with a lower likelihood of their own, but not their parents', current weight loss behavior use, whereas parents who exhibited weight under-perception were less likely to report weight loss behaviors at the intrapersonal level and were less likely to have adolescents who reported weight loss behaviors. These results suggest that associations among weight misperceptions and weight control behaviors within the parent-adolescent dyadic context are complex, and that both inter- and intra-individual processes are implicated in these associations. The impact of these perceptual influences on parent-adolescent dyads' use of both healthy and disordered eating behaviors warrants further exploration in future research.

A systematic review of inequalities in the uptake of, adherence to, and effectiveness of behavioral weight management interventions in adults.

SummaryThe extent to which behavioral weight management interventions affect health inequalities is uncertain, as is whether trials of these interventions directly consider inequalities. We conducted a systematic review, synthesizing evidence on how different aspects of inequality impact uptake, adherence, and effectiveness in trials of behavioral weight management interventions. We included (cluster‐) randomized controlled trials of primary care‐applicable behavioral weight management interventions in adults with overweight or obesity published prior to March 2020. Data about trial uptake, intervention adherence, attrition, and weight change by PROGRESS‐Plus criteria (place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, plus other discriminating factors) were extracted. Data were synthesized narratively and summarized in harvest plots. We identified 91 behavioral weight loss interventions and 12 behavioral weight loss maintenance interventions. Fifty‐six of the 103 trials considered inequalities in relation to at least one of intervention or trial uptake (n = 15), intervention adherence (n = 15), trial attrition (n = 32), or weight outcome (n = 34). Most trials found no inequalities gradient. If a gradient was observed for trial uptake, intervention adherence, and trial attrition, those considered “more advantaged” did best. Alternative methods of data synthesis that enable data to be pooled and increase statistical power may enhance understanding of inequalities in behavioral weight management interventions.

Abstract P115: Association Of Circulating And Fecal Butyrate And Other Short Chain Fatty Acids With Blood Pressure And Hypertension: Results From The SPIRIT Trial

Background: Short chain fatty acids (SCFAs) are the microbially-derived end products of dietary fiber fermentation. The SCFA butyrate is a signaling molecule shown to influence blood pressure (BP) in mouse models. The association of butyrate and other SCFAs on BP in humans is unclear, due in part to predominantly cross-sectional analyses and to differences in which biospecimens (blood vs. fecal) SCFAs were measured. Longitudinal studies including both circulating and fecal SCFAs are lacking. Objective: Investigate the cross-sectional and longitudinal associations of fecal and serum SCFAs with hypertension and changes in BP. Methods: We leveraged existing data from the SPIRIT trial, which randomized 121 adult cancer survivors with overweight/obesity to a behavioral weight loss intervention, metformin, or self-directed weight loss. Of participants with serum and fecal SCFAs measured at baseline (N=111), a subset also had serum (N=93) and fecal (N=89) SCFA measurements 12 months later. We used Poisson regression with robust error variance to estimate associations of serum or fecal SCFAs with hypertension at baseline (adjusting for age, sex, BMI, and fiber intake). In longitudinal analyses, we assessed the percent change in serum or fecal SCFAs from baseline with corresponding 12-month changes in BP (covariates listed in Table ). Results: Participants were aged 60.2±8.9 years, 78.4% female, and 46.9% identified as White. Higher baseline fecal butyrate was inversely associated with prevalent hypertension (standardized PR [95%CI]: 0.71 [0.54, 0.92]). In longitudinal analyses ( Table ), a 10% increase in fecal butyrate from baseline levels was significantly and inversely associated with systolic BP, and a 10% increase in serum butyrate was significantly and inversely associated with systolic and diastolic BPs. Associations of butyrate with BP were not modified by sex or race. Conclusion: Increased serum or fecal butyrate is associated with lowered BP. Butyrate may be a target for SCFA-centered BP-lowering interventions.

Abstract 007: The Impact Of A Personalized Weight Loss Diet On Dietary Measures In Adults With Prediabetes And Early-stage Type 2 Diabetes

Introduction: There is limited research examining dietary changes in adults with prediabetes who are following a diet personalized to predict postprandial glycemic response (PPGR). Objective: We compared dietary changes in subjects randomized to a low-fat, one-size-fits-all diet ( Standardized ) or to a diet personalized to minimize PPGR ( Personalized ). Methods: Dietary data collected to-date were analyzed from the Personal Diet study, a clinical trial to compare two behavioral weight loss interventions in adults with prediabetes or early-stage type 2 diabetes. All subjects had resting energy expenditure (REE) measured at baseline using indirect calorimetry. Both arms were instructed to restrict energy intake (-500 kcal/day, based on REE and a physical activity factor of 1.4), log daily dietary intake with a smartphone app, and attend scheduled behavioral counseling sessions. The Standardized arm received app feedback about energy and fat intake, while the Personalized arm received app feedback about energy intake and meal specific predicted PPGR determined from a gut microbiome-based machine learning algorithm. At baseline, 3 months, and 6 months, subjects completed one 24-hour dietary recall using the Automated Self-Administered 24-hour Dietary Assessment Tool. Total energy, total carbohydrate, total sugars, fiber, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, and protein were measured using the USDA Food and Nutrient Database for Dietary Studies 2011-2012. Macronutrient intakes were analyzed as percentage of energy (%E). Linear mixed modelling, with random intercepts and slopes and an unstructured covariance pattern, was used to analyze dietary changes within- and between-arms from baseline to 3 and 6 months. Fixed effects were included for study arm, time period, and interaction of study arm and time period. A random effect was included for subjects. Models were adjusted for age and sex. Results: Dietary assessments were completed at baseline (n=66 Personalized ; n=65 Standardized ), 3 months (n=50 Personalized ; n=36 Standardized ), and 6 months (n=47 Personalized ; n=39 Standardized ). The Personalized arm had a greater reduction than the Standardized arm in energy (β: -342 kcal; 95% CI: -672, -12) and %E from carbohydrate (β: -6.2; 95% CI: -11.7, -0.6) and sugars (β: -4.9; 95% CI: -8.8, -1.0) from baseline to 3 months, but there were no between-arm differences in dietary measures at 6 months. Within-arm, Personalized had decreases in energy (β: -327 kcal; 95% CI: -546, -108) and %E from carbohydrate (β: -4.6; 95% CI: -8.2, -0.9) from baseline to 3 months. In the Standardized arm, %E from sugars increased from baseline to 3 months (β: 3.0; 95% CI: 0.02, 5.9). Conclusions: Personalized had greater reductions than Standardized in energy and %E from carbohydrate and sugars over the first 3 months of the intervention, but dietary changes were similar by 6 months.

Abstract P215: A Qualitative Exploration Of Barriers And Facilitators To A Cardiac Rehabilitation-based Weight Loss Program For Patients With Atrial Fibrillation And Obesity.

Background: Cardiac rehabilitation (CR) programs are ideal treatment settings for atrial fibrillation (AF) risk factor management, yet few CR curricula include a behavioral weight loss treatment (BWLT) component for patients with comorbid obesity (BMI ≥ 30 kg/m 2 ). Aim: To identify perceived barriers, facilitators, and preferences regarding CR with added BWLT among patients with AF and obesity using a qualitative descriptive approach. Methods: Patients (18+) with paroxysmal or persistent AF and obesity were recruited from a Canadian AF clinic. Patients completed questionnaires assessing socio-demographic variables and participated in semi-structured interviews to elicit their potential barriers, facilitators, and preferences regarding a proposed 12-week CR+BWLT program (i.e., twice-weekly supervised exercise, risk factor management, and weekly group-based cognitive-behavioral weight management support). Interviews were recorded and transcribed. Conventional content analysis was used to derive themes from qualitative data. Results: Twenty patients (9 women; 63±12 years; BMI=35.50±6.00 kg/m 2 ) participated. Data were categorized to describe patients' barriers, facilitators, and preferences/perspectives (Figure 1). Four overarching themes emerged from the categories: 1) frustration with weight management; 2) AF symptoms are manageable; 3) AF information needs; and 4) desire for program flexibility. Conclusion &amp; Future Directions: The proposal to offer BWLT alongside CR was acceptable to patients with AF and obesity, with most reporting few barriers to participating. The results will inform AF-specific adaptations to an established BWLT (e.g., modules on AF pathophysiology and exercise recommendations). The AF-adapted BWLT will be piloted in the target population prior to testing the full intervention package in a randomized controlled trial. The novel combination of CR+BWLT, tailored to an AF population, has potential to improve AF management and outcomes for patients with comorbid obesity.

Steps toward behavioural weight loss and maintenance: a daily practice

Obesity is an increased fat accumulation to the levels that affect health and wellbeing. Body mass index (BMI) categorizes people as normal, overweight or obese depending on arithmetic equations. Obesity is a global epidemiological problem, affecting more than 30% of the world population. The main hazard is that the obesity prevalence still escalating. Human behavior plays a major role in the causes of obesity. In addition, other factors are also contributing to bodyweight increase such as, genetic, endocrine and metabolic factors. Nevertheless, obesity can be controlled and ideal weight can be achieved. Some measures and practices were suggested in this mini-review through which a one-day human life cycle was set up as a model that can be followed to ensure proper weight and maintain it thereafter. These measures include regular sleep/wake-up pattern, strict timing of meals, practicing exercise, drinking at least 2.5 liters of water and early going to bed. However, the fundamental mechanisms of weight loss and increase were not addressed in this mini-review.

Home Food Environment Changes and Dietary Intake during an Adolescent Behavioral Weight Loss Intervention Differ by Food Security Status.

Behavioral weight loss (BWL) for pediatric obesity includes guidance on improving the home food environment and dietary quality; yet food insecurity presents barriers to making these changes. This study examined if home food environment, dietary quality, energy intake, and body weight changes during adolescent obesity treatment differed by food security status, and if changes in the home food environment were associated with changes in dietary quality and energy intake by food security status. Adolescents (n = 82; 13.7 ± 1.2 years) with obesity participated in a 4-month BWL treatment. Food insecurity, home food environment (Home Food Inventory [HFI]), dietary quality (Healthy Eating Index [HEI]), energy intake, and body mass index (BMI) were assessed at baseline and post-treatment. A reduced obesogenic home food environment and improved dietary quality were observed for food secure (ps < 0.01), but not insecure households (ps > 0.05) (mean difference, HFI: −6.6 ± 6.4 vs. −2.4 ± 7.4; HEI: 5.1 ± 14.4 vs. 2.7 ± 17.7). Energy intake and BMI decreased for adolescents in food secure and insecure households (ps < 0.03) (mean difference; energy intake: −287 ± 417 vs. −309 ± 434 kcal/day; BMI: −1.0 ± 1.4 vs. −0.7 ± 1.4). BWL yielded similar reductions in energy intake and body weight yet did not offer the same benefits for improved dietary quality and the home food environment for adolescents with food insecurity.

Prepare randomized clinical trial: Acceptability, engagement, and lifestyle effects of a weight loss intervention beginning in pre-pregnancy.

BackgroundHealthier lifestyles in early pregnancy are associated with lower rates of pregnancy complications, childhood adiposity, and maternal and child cardiovascular risks. However, it is not known whether lifestyle coaching initiated prior to pregnancy can affect behavior and attitudes during pregnancy.MethodsThree hundred and twenty six women planning pregnancy within 2 years with BMI ≥27 kg/m2 were randomized to a behavioral weight loss intervention or to usual care. Analyses reported here examined the intervention’s impact on mid‐pregnancy diet quality and activity levels; program acceptability; and effects of pregnancy on intervention engagement.ResultsOne hundred and sixty eight participants experienced pregnancy during the study (intervention: 91; usual care: 77). From randomization to mid‐pregnancy, participants who received the intervention had larger increases in fruit intake than usual care participants (+0.67 vs. +0.06 cups; p = 0.02) and engaged in more vigorous‐intensity activity (3.9 [5.5] vs. 1.2 [3.0] Met‐hr/week p = 0.002) and sports/exercise (17.0 [14.1] vs. 11.0 [9.5] Met‐hr/week; p = 0.03); the groups also differed in changes in sedentary time (−4.9 [15.0] vs. +0.5 [7.6] Met‐hr/week; p = 0.02). Intervention satisfaction was high (>80%), and experiencing pregnancy during the intervention was associated with higher engagement.ConclusionA coaching‐based intervention beginning in pre‐pregnancy successfully helped women attain healthier diet and exercise habits in mid‐pregnancy.Clinical trials registrationRegistered with ClinicalTrials.gov, NCT02346162, first registered on January 26, 2015, before date of initial participant enrollment (May 2015), https://clinicaltrials.gov/ct2/show/NCT02346162.

Responding to Health Disparities in Behavioral Weight Loss Interventions and COVID-19 in Black Adults: Recommendations for Health Equity.

COVID-19 has disproportionately impacted Black adults with high prevalence and mortality rates. Obesity is a central factor in the severity of COVID-19 and related treatment. Behavioral weight loss interventions are an efficacious treatment for obesity, but consistently, Black men and women are minimally represented, and weight loss outcomes are less than clinically significant thresholds. This commentary draws parallels between COVID-19 racial disparities, disparate obesity rates, weight loss treatment outcomes, and underlying systemic racial context. This paper also indicates paths forward to address racialized societal norms in obesity treatment to advance health equity in obesity and reduce acute disease vulnerability. Recommendations for behavioral medicine practice and policy include (1) expanding the research lens to prioritize Black scholars and institutions to generate innovative research questions, (2) creating trustworthy relationships with Black community members to bolster recruitment and retention, (3) employing qualitative methods to facilitate better intervention design and uncover influences of racialized social context, (4) centering Black adults in weight loss interventions, and (5) using multilevel approaches that integrate policy into interventions. Moving forward, this commentary aims to make plain the multilayered form and function of racism, its impact on COVID-19 and obesity, and offer pathways to improve behavioral weight loss interventions that can produce more equitable outcomes.

Travel burden in a rural primary care behavioral weight loss randomized trial: Impact on visit attendance and weight loss.

Rural residents have higher obesity rates and need access to treatment. Travel burden may limit use and effectiveness of clinic-based behavioral weight loss treatment, which includes frequent visits. This paper examines the impact of travel distance and time on visit attendance and weight loss during a 2-year cluster randomized trial. Thirty-six primary care practices were randomized to 1 of 3 methods of providing behavioral weight loss counseling: individual clinic visits, group clinic visits, or group phone visits. Participants in the clinic visit conditions were included in this secondary analysis (n = 875). Travel distance and time was measured using ArcGIS and categorized as <15 miles (and minutes) or ≥15 miles (and minutes). Percent visit attendance and percent weight loss were measured 6 and 24 months. Participants traveling ≥15 miles (n = 211) had lower attendance than those traveling <15 miles (n = 664) for individual clinic visits, both in the first 6 months (81.4% vs 89.1%, respectively; P = .005) and between 7 and 24 months (52.8% vs 61.6%, respectively; P = .02). Travel time revealed similar findings. Neither travel distance nor time had an effect on attendance to group clinic visits. Travel distance and time were not significantly associated with weight loss for either individual or group visits. Travel burden to clinics was associated with visit attendance for individual visits but not for group visits and was not significantly associated with weight loss. Assessment of travel burden as a potential barrier to clinic-based weight loss interventions should be based on local empirical data.

Experienced weight stigma, internalized weight bias, and clinical attrition in a medical weight loss patient sample.

BackgroundLimited research has explored the relationship between weight bias and clinical attrition, despite weight bias being associated with negative health outcomes.Participants/methodExperienced weight stigma (EWS), internalized weight bias (IWB), and clinical attrition were studied in a Medical Weight Loss clinic, which combines pharmacological and behavioral weight loss. Patient sociodemographic, medical, and psychological (depression) variables were measured at consultation, and clinic follow-ups were monitored for 6 months. IWB was assessed with the Weight Bias Internalization Scale Modified (WBIS-M).ResultsTwo-thirds (66%) of study participants returned for follow-up appointments during the 6-month period (“continuers”), while 34% did not return after the initial consultation (“dropouts”). Clinic “dropouts” had higher WBIS-M scores at initial consultation than “continuers,” (χ2(1) = 4.56; p < 0.05). No other variables were related to clinical attrition. Average WBIS-M scores (4.57) were similar to other bariatric patient studies, and were associated with younger age (t = −2.27, p < 0.05), higher depression (t = 2.65, p < 0.01), and history of EWS (t = 2.14, p < 0.05).ConclusionStudy findings indicate that IWB has significant associations with clinical attrition. Additional research is warranted to further explore the relationships between EWS, IWB, and medical clinic engagement.

Using health economic modelling to inform the design and development of an intervention: estimating the justifiable cost of weight loss maintenance in the UK

BackgroundThere is a need to develop cost-effective weight loss maintenance interventions to prolong the positive impact of weight loss on health outcomes. Conducting pre-trial health economic modelling is recommended to inform the design and development of behavioural interventions. We aimed to use health economic modelling to estimate the maximum cost per-person (justifiable cost) of a cost-effective behavioural weight loss maintenance intervention, given an estimated intervention effect for individuals with: i) a Body Mass Index (BMI) of 28 kg/m2 or above without diabetes and ii) a diagnosis of type 2 diabetes prescribed a single non-insulin diabetes medication.MethodsThe School for Public Health Research Diabetes prevention model was used to estimate the lifetime Quality-adjusted life year (QALY) gains, healthcare costs, and maximum justifiable cost associated with a weight loss maintenance intervention. Based on a meta-analysis, the estimated effect of a weight loss maintenance intervention following a 9 kg weight loss, was a regain of 1.33 kg and 4.38 kg in years one and two respectively compared to greater regain of 2.84 kg and 5.6 kg in the control group. Sensitivity analysis was conducted around the rate of regain, duration of effect and initial weight loss.ResultsThe justifiable cost for a weight loss maintenance intervention at an ICER of £20,000 per QALY was £104.64 for an individual with a BMI of 28 or over and £88.14 for an individual with type 2 diabetes. Within sensitivity analysis, this varied from £36.42 to £203.77 for the former, and between £29.98 and £173.05 for the latter.ConclusionsResearchers developing a weight loss maintenance intervention should consider these maximum justifiable cost estimates and the potential impact of the duration of effect and initial weight loss when designing intervention content and deciding target populations. Future research should consider using the methods demonstrated in this study to use health economic modelling to inform the design and budgetary decisions in the development of a behavioural interventions.