Behavioral Weight Loss Intervention Research Articles

Abstract PO4-11-07: Early response to Adaptive Nutrition and Exercise Weight loss (A-NEW) Study for Breast Cancer Survivors with Overweight or Obesity

Abstract BACKGROUND: Obesity is associated with inferior survival and increased risk of recurrence in breast cancer (BC) survivors. In the Look AHEAD trial, 45% of patients attained ≥5% weight loss at 2 months, and those who lost 3-6% of weight at 2 months had higher odds of >5% weight loss at 1 year. Behavioral weight loss (BWL) studies consistently demonstrate that only half of BC survivors lose >5% weight, emphasizing the need for new approaches to aid those not benefiting from BWL alone. We hypothesized that early weight loss could identify BC survivors with excess body weight who may not benefit from BWL alone, and my benefit from the addition of a FDA-approved anti-obesity pharmaceutical agent. METHODS: Women with stage 0-III BC and BMI >27 kg/m2 who completed recommended local therapy and chemotherapy were enrolled in a 6-month BWL program consisting of remote coaching, an online curriculum, and tracking of diet, activity and weight. Patients completed demographic surveys and were weighed in clinic at baseline and 2 months. We used an adaptive design utilizing weight loss at 2 months to identify those with greater likelihood of weight loss at 6 months with BWL alone. Patients with and without ≥5% weight loss at 2 months were stratified as FAST-BWL and SLOW-BWL, respectively. Those in FAST-BWL continued BWL alone for 4 months, while those in SLOW-BWL also receive anti-obesity medication (Contrave®) until end of study. We anticipate 55% of 55 subjects enrolled will be in the SLOW-BWL group, resulting in a sample size of approximately 30 SLOW-BWL women and 25 FAST-BWL women. Simon's two-stage minimax design was used for the SLOW-BWL group. The null hypothesis that the true rate of attaining ≥5% weight loss is 10.9%, which is chosen based on the rate of women attaining ≥5% weight loss in the self-directed arm in the previously conducted POWER-remote study. The null hypothesis will be rejected if 7 or more women are observed in the 30 patients who attain ≥5% weight loss. This design yields a power of 80% at type I error rate of 5% when the true rate of attaining ≥5% weight loss of the baseline weight for the SLOW-BWL women is 29%, a clinical meaningful rate for the SLOW-BWL women group. We performed a descriptive analysis and evaluated outcomes at 2 months. RESULTS: Total enrollment is complete, and at time of presentation, 54 of 55 participants will be at end of study. Mean age at enrollment was 56 [30 -73], and majority were white (73%), postmenopausal (84%), had an ECOG of 0 (77%) and were employed (69%). The median time from diagnosis to enrollment was 3.9 years [0.6-10.0]. Over half received chemotherapy (54%), radiation (73%), and current endocrine therapy (75%); only 13% received prior antiHER2 therapy. Mean baseline weight was 213 (SD 30) pounds and baseline BMI was 35.5 (4.7). Mean HbA1c, total cholesterol, LDL, and triglycerides were 5.6% (0.4), 203 (29), 120 (26), and 135 (64), respectively. After 2 months of the BWL intervention, 14 (27%) attained ≥5% weight loss (FAST-BWL) and 38 (73%) did not (SLOW-BWL). CONCLUSIONS: We have successfully enrolled to this novel adaptive design and will present full data at the conference. Understanding predictors of successful weight loss inform populations that may benefit from anti-obesity medication, and design future studies that allow more patients to achieve significant weight loss. Citation Format: Jennifer Sheng, Amanda Montanari, Jennifer Trost, Mengyang Lu, Justin Mahosky, Sheetal Parida, Amanda Blackford, Dipali Sharma, Marci Laudenslager, Kimberly Gudzune, Janelle Coughlin, Vered Stearns. Early response to Adaptive Nutrition and Exercise Weight loss (A-NEW) Study for Breast Cancer Survivors with Overweight or Obesity [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-11-07.

Weight Loss Trajectories and Short-Term Prediction in an Online Weight Management Program.

The extent to which early weight loss in behavioral weight control interventions predicts long-term success remains unclear. In this study, we developed an algorithm aimed at classifying weight change trajectories and examined its ability to predict long-term weight loss based on weight early change. We utilized data from 667 de-identified individuals who participated in a commercial weight loss program (Instinct Health Science), comprising 69,363 weight records. Sequential polynomial regression models were employed to classify participants into distinct weight trajectory patterns based on key model parameters. Next, we applied multinomial logistic models to evaluate if early weight loss in the first 14 days and prolonged duration of participation were significantly associated with long-term weight loss patterns. The mean percentage of weight loss was 7.9 ± 5.1% over 133 ± 69 days. Our analysis revealed four main weight loss trajectory patterns: a steady decrease over time (30.6%), a decrease to a plateau with subsequent decline (15.8%), a decrease to a plateau with subsequent increase (46.9%), and no substantial decrease (6.7%). Early weight change rate and total participating duration emerged as significant factors in differentiating long-term weight loss patterns. These findings contribute to support the provision of tailored advice in the early phase of behavioral interventions for weight loss.

Racial differences in physical activity engagement, barriers, and enjoyment during weight loss.

Aiming to identify potential intervention targets to achieve more equitable outcomes from behavioral weight loss (BWL) programs, the current study examined whether Black and White individuals experienced similar increases in physical activity (PA) engagement, perceived PA barriers, and PA enjoyment during an 18-month BWL program. Adults (N = 290) enrolled in an 18-month BWL program from 2014 to 2016 completed accelerometer-based measurements of moderate-to-vigorous PA and self-reported measures of PA barriers and enjoyment at months 0, 6, 12, and 18. Black participants had significantly fewer minutes of PA than White participants at baseline, 6, 12, and 18 months. Black participants reported fewer barriers to PA than White participants at 0 and 6 months but not at 12 or 18 months. They also reported higher PA enjoyment than White participants at 0 and 6 months but not at 12 or 18 months. Furthermore, whereas White participants had a significant reduction in PA barriers and an increase in PA behavior overtime, Black participants did not. There was no interaction between race and time on PA enjoyment. Traditional BWL interventions may be ineffective for promoting PA among Black participants and may not appropriately address the unique PA barriers that Black participants experience. An improved understanding of differences in PA behaviors during BWL among Black and White individuals could help delineate why Black participants do not appear to benefit as much as White participants from traditional BWL programs and inform intervention strategies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pragmatic Implementation of Online Obesity Treatment and Maintenance Interventions in Primary Care

Behavioral weight loss interventions have achieved success in primary care; however, to our knowledge, pragmatic implementation of a fully automated treatment that requires little researcher oversight has not been tested. Moreover, weight loss maintenance remains a challenge. To evaluate the long-term effectiveness of an automated, online, behavioral obesity treatment program (Rx Weight Loss [RxWL]) at 12 months (primary end point) and 24 months when delivered pragmatically in primary care and to compare the effectiveness of 3 weight loss maintenance approaches. This randomized clinical trial of RxWL, an online weight loss program, recruited patients from a Rhode Island primary care network with approximately 60 practices and 100 physicians. Eligible participants were primary care patients aged 18 to 75 years with overweight or obesity who were referred by their nurse care manager and enrolled between 2018 and 2020. All participants were included in the intention-to-treat analysis, whereas only those who engaged with maintenance intervention were included in the per-protocol analysis. Data were analyzed from August 2022 to September 2023. All participants were offered the same 3-month weight loss program, with randomization to one of three 9-month maintenance programs: control intervention (monthly online newsletters), monthly intervention (9 monthly video lessons and 1 week of self-monitoring per month), or refresher intervention (an introductory session and two 4-week periods of lessons and self-monitoring at 7 and 10 months). The primary outcome was weight change at 12 months using height and weight data collected from electronic medical records through 24 months. Among the 540 participants (mean [SD] age, 52.8 [13.4] years; 384 females [71.1%]) in the intention-to-treat analysis, mean estimated 3-month weight loss was 3.60 (95% CI, -4.32 to -2.88) kg. At the 12-month primary end point, the amount of weight regained in the monthly (0.37 [95% CI, -0.06 to 0.81] kg) and refresher (0.45 [95% CI, 0.27 to 0.87] kg) maintenance groups was significantly less than that in the newsletter control maintenance group (1.28 [95% CI, 0.85 to 1.71] kg; P = .004). The difference in weight regain between the monthly and refresher maintenance groups was not statistically significant. This pattern persisted at 24 months. In the per-protocol analysis of 253 participants, mean weight loss at the end of the initial 3-month intervention was 6.19 (95% CI, -7.25 to -5.13) kg. Similarly, at 12 months there was less weight regain in the monthly (0.61 kg) and refresher (0.96 kg) maintenance groups than in the newsletter control maintenance group (1.86 kg). Results of this randomized clinical trial indicate that pragmatic implementation of a 12-month automated, online, behavioral obesity treatment that includes 9 months of active maintenance produces clinically significant weight loss over 2 years in primary care patients with overweight or obesity. These findings underscore the importance of providing ongoing maintenance intervention to prevent weight regain. ClinicalTrials.gov Identifier: NCT03488212.

Behavioral Lifestyle Interventions for Weight Loss in Overweight or Obese Patients with Type 2 Diabetes: A Systematic Review of the Literature.

Around 80-90% of patients with type 2 diabetes mellitus (T2DM) are overweight or obese, presenting a greater risk for serious health complications and mortality. Thus, weight loss represents a main goalfor T2DMmanagement. Although behavioral lifestyle interventions (BLIs) could help promoting weight loss in T2DM patients with overweight or obesity, their effectiveness is still controversial. This systematic review offers an updated and comprehensive picture of BLIs according to Michie's classification in T2DM patients with overweight or obesity and identifies possible factors (related to both patients and interventions) associated with weight loss. The PRISMA guidelines were followed. The literature search till March 2023 indicated 31 studies involving 42 different BLIs. Our findings suggest that structured BLIs, characterized by frequent feedback and support, can lead to a clinically meaningful 5% weight loss, regardless of specific behavioral, diet, and physical activity components. Further research should address methodological issues and heterogeneity of interventions, also considering the effect of pharmacological therapies on weight reduction. Lastly, more attention should be paid to the long-term effectiveness of behavioral lifestyle interventions and to the relationship between weight loss and diabetes.

Psychological and behavioral responses to daily weight gain during behavioral weight loss treatment

Self-weighing is consistently associated with more effective weight control. However, patterns show that participants disengage from their weight control behaviors following weight gain. Women with BMIs in the overweight/obese range (N = 50) enrolled in a long-term behavioral weight loss program completed ecological momentary assessment (EMA) surveys immediately after their daily weigh-ins. Nightly EMA surveys and self-monitoring data through Fitbit measured their weight control behavior that day. On days when participants gained weight (vs. lost or maintained), they reported more negative mood, more guilt/shame, and lower confidence in weight control. Motivation following daily weight gain depended on participants’ overall satisfaction with their weight loss so far: more satisfied participants had marginally higher, but less satisfied participants had marginally lower motivation in response to daily weight gain. Greater guilt/shame and lower motivation after the weigh-in predicted less effective weight control behavior that day (e.g., lower likelihood of calorie tracking, fewer minutes of physical activity). Results demonstrate that even small weight gain is distressing and demoralizing for women in BWL programs, which can lead to goal disengagement. These findings have implications for future BWL interventions, including the potential utility of just-in-time adaptive interventions to promote more adaptive responses in the moments after weigh-ins.

Characterization of Early Non-responders within Behavioral Weight Loss Treatment

Objectives: Given that low early (4 weeks) weight loss (WL) predicts longer-term WL, the purpose of this study was to identify factors associated with poor early WL. Methods: We had 438 adults with overweight/obesity participating in an Internet-delivered behavioral WL program provide weights at baseline and 4 weeks. Participants were stratified by percent WL at 4 weeks: LOW: < 2% WL, MEDIUM: 2 to < 4% WL, HIGH: ≥ 4% WL and groups were compared on baseline variables (demographics, physical activity, and psychosocial measures) and 4-week intervention adherence. Results: Respectively, 37.4%, 40.9%, and 21.7% of participants had LOW, MEDIUM, and HIGH early WL. LOW was more likely to be female compared to HIGH and less likely to be non-Hispanic white compared to MEDIUM and HIGH (p's<0.05). After controlling for demographic differences, LOW had lower baseline physical activity compared to HIGH and watched fewer video lessons, self-monitored calorie intake and weight on fewer days, and were less likely to achieve the exercise goal compared to MEDIUM and HIGH (ps < .05). Conclusion: Findings can inform future adaptive interventions that tailor treatment based upon early WL to improve WL outcomes for more individuals.

Impact of polygenic score for BMI on weight loss effectiveness and genome-wide association analysis.

While environmental factors play an important role in weight loss effectiveness, genetics may also influence its success. We examined whether a genome-wide polygenic score for BMI was associated with weight loss effectiveness and aimed to identify common genetic variants associated with weight loss. Participants in the ONTIME study (n = 1210) followed a uniform, multimodal behavioral weight-loss intervention. We first tested associations between a genome-wide polygenic score for higher BMI and weight loss effectiveness (total weight loss, rate of weight loss, and attrition). We then conducted a genome-wide association study (GWAS) for weight loss in the ONTIME study and performed the largest weight loss meta-analysis with earlier studies (n = 3056). Lastly, we ran exploratory GWAS in the ONTIME study for other weight loss outcomes and related factors. We found that each standard deviation increment in the polygenic score was associated with a decrease in the rate of weight loss Beta (95% CI) = -0.04 (-0.06, -0.01; P = 3.7×10-03) and with higher attrition after adjusting by treatment duration. No associations reached genome-wide significance in meta-analysis with previous GWAS studies for weight loss. However, associations in the ONTIME study showed effects consistent with published studies for rs545936 (MIR486/NKX6.3/ANK1), a previously noted weight loss locus. In the meta-analysis, each copy of the minor A allele was associated with 0.12 (0.03) kg/m2 higher BMI at week five of treatment (P = 3.9 × 10-06). In the ONTIME study, we also identified two genome-wide significant (P < 5×10-08) loci for the rate of weight loss near genes implicated in lipolysis, body weight, and metabolic regulation: rs146905606 near NFIP1/SPRY4/FGF1; and rs151313458 near LSAMP. Our findings are expected to help in developing personalized weight loss approaches based on genetics. Obesity, Nutrigenetics, Timing, and Mediterranean (ONTIME; clinicaltrials.gov: NCT02829619) study.

Conventional weight loss therapy in morbid obesity during COVID-19 pandemic: degree of burdens at baseline and treatment efficacy.

COVID-19 affected global physical and psychological health. The purpose of this study was to explore the pandemics impact on health-related quality of life (HRQoL), mental health (anxiety, depression, and perceived stress) and eating behavior in people with severe obesity participating in a multimodal conservative behavioral weight loss (BWL) program conducted via videoconferencing. Additionally, the efficacy of the six-month BWL program in a virtual video-based setting during the pandemic was examined. 297 participants of a face-to-face multimodal behavioral weight loss program prior to the pandemic (PrePAN, May 2014-September 2019) and 146 participants of the in terms of content same intervention in a videoconference-based setting during the pandemic (PAN, July 2020-April 2022) were questioned and compared using standardized questionnaires for HRQoL, symptoms of depressive and anxiety disorders, perceived stress, and eating behavior at baseline and at the end of treatment. Symptoms for anxiety, depression and perceived stress were similar between PrePAN and PAN at baseline. In addition, PAN tended to show lower disinhibition of eating behavior and feelings of hunger than PrePAN. During the pandemic, the BWL intervention resulted in body weight loss (67%) or stabilization (16%) in most of the participants. It also contributed by improving physical HRQoL, lower worries, and improved eating behaviors compared to baseline. During the COVID-19 pandemic, baseline mental health of people with morbid obesity was not worse than before the pandemic. Additionally, the BWL intervention in the virtual video-based setting stabilized and improved physical and mental health during the COVID-19 pandemic.

The relationship between sleep quantity, sleep quality and weight loss in adults: A scoping review.

Sleep is hypothesized to interact with weight gain and loss; however, modelling this relationship remains elusive. Poor sleep perpetuates a cascade of cardiovascular and metabolic consequences that may not only increase risk of adiposity, but also confound weight loss efforts. We conducted a scoping review to assess the research on sleep and weight loss interventions. We searched six databases for studies of behavioural weight loss interventions that included assessments of sleep in the general, non-clinical adult human population. Our synthesis focused on dimensions of Population, Intervention, Control, and Outcomes (PICO) to identify research and knowledge gaps. We identified 35 studies that fell into one of four categories: (a) sleep at baseline as a predictor of subsequent weight loss during an intervention, (b) sleep assessments after a history of successful weight loss, (c) concomitant changes in sleep associated with weight loss and (d) experimental manipulation of sleep and resulting weight loss. There was some evidence of improvements in sleep in response to weight-loss interventions; however, randomized controlled trials of weight loss interventions tended not to report improvements in sleep when compared to controls. We conclude that baseline sleep characteristics may predict weight loss in studies of dietary interventions and that sleep does not improve because of weight loss alone. Future studies should enrol large and diverse, normal, overweight and obese short sleepers in trials to assess the efficacy of sleep as a behavioural weight loss treatment.

Black Feminism and Womanism: A Narrative Review of the Weight Loss Literature

Objective Black Feminism and Womanism offers an interdisciplinary lens and practice to center Black women’s health, engage relevant health, and create Black women–informed solutions to address obesity. The purpose of this review article is to employ Black Feminism and Womanism to examine approaches and results of Black women–centered behavioral weight loss interventions. Methods A narrative review of Black women–centered behavioral weight loss interventions was conducted. To be included, articles met the following criteria: published between 2012 and 2022, standard behavioral treatment for weight loss, randomized design, weight loss outcomes stratified by race and gender, sample size of at least 75 individuals, adults at least 18 years of age, and at least 51% Black women in the sample. Results Eight studies met the inclusion criteria for a Black women–centered behavioral weight loss intervention and were evaluated. Findings indicate that weight loss among Black women was mostly low, below the clinical target of 5 to 10% weight loss. Intervention designs ranged widely in their approach to respond to the context of Black women’s lives, with little consistency between designs. Conclusions To make meaningful improvement in the effectiveness of behavioral weight loss interventions for Black women, new approaches are critical. Approaches grounded in Black Feminism and Womanism can provide the essential foundation to generate new knowledge, novel hypotheses, and intervention designs that fully attend to the lived context of Black women, including consideration of the potential health effects of gendered racism.

Modifying diet and exercise in multiple sclerosis (MoDEMS): A randomized controlled trial for behavioral weight loss in adults with multiple sclerosis and obesity

Background: Obesity is a risk factor for developing multiple sclerosis (MS) and MS-related disability. The efficacy of behavioral weight loss interventions among people with MS (pwMS) remains largely unknown. Objective: Examine whether a group-based telehealth weight loss intervention produces clinically significant weight loss in pwMS and obesity. Methods: Seventy-one pwMS were randomized to the weight loss intervention or treatment-as-usual (TAU). The 6-month program promoted established guidelines for calorie reduction and increased physical activity. Anthropometric measurements, mobility tasks, self-report questionnaires, and accelerometry were used to assess changes at follow-up. Results: Mean percent weight loss in the treatment group was 8.6% compared to 0.7% in the TAU group (p < .001). Sixty-five percent of participants in the intervention achieved clinically meaningful weight loss (⩾ 5%). Participants in the treatment group engaged in 46.2 minutes/week more moderate-to-vigorous physical activity than TAU participants (p = .017) and showed improvements in quality of life (p = .012). Weight loss was associated with improved mobility (p = .003) and reduced fatiguability (p = .008). Conclusion: Findings demonstrate the efficacy of a behavioral intervention for pwMS and obesity, with clinically significant weight loss for two-thirds of participants in the treatment condition. Weight loss may also lead to improved mobility and quality of life.

Automated Messaging Delivered Alongside Behavioral Treatment for Weight Loss: Qualitative Study.

Mobile health interventions for weight loss frequently use automated messaging. However, this intervention modality appears to have limited weight loss efficacy. Furthermore, data on users' subjective experiences while receiving automated messaging-based interventions for weight loss are scarce, especially for more advanced messaging systems providing users with individually tailored, data-informed feedback. The purpose of this study was to characterize the experiences of individuals with overweight or obesity who received automated messages for 6-12 months as part of a behavioral weight loss trial. Participants (n=40) provided Likert-scale ratings of messaging acceptability and completed a structured qualitative interview (n=39) focused on their experiences with the messaging system and generating suggestions for improvement. Interview data were analyzed using thematic analysis. Participants found the messages most useful for summarizing goal progress and least useful for suggesting new behavioral strategies. Overall message acceptability was moderate (2.67 out of 5). From the interviews, 2 meta-themes emerged. Participants indicated that although the messages provided useful reminders of intervention goals and skills, they did not adequately capture their lived experiences while losing weight. Many participants found the automated messages insufficiently tailored to their personal weight loss experiences. Future studies should explore alternative methods for message tailoring (eg, allowing for a higher degree of participant input and interactivity) that may boost treatment engagement and efficacy. ClinicalTrials.gov NCT05231824; https://clinicaltrials.gov/study/NCT05231824.

What matters for weight loss in behavioral trials in the Latinx community: Learnings from three randomized controlled trials

BackgroundNearly half of Latinx adults in the US are obese, making effective weight loss interventions crucial to prevent associated chronic conditions. ObjectiveTo identify factors associated with increased session attendance and clinically significant weight loss among Latinx adults. ParticipantsLatinx participants from the Vivamos Activos (n = 207), Vida Sana (n = 191), and HOMBRE (n = 424 Latinx men) randomized clinical trials. DesignPost-hoc analysis of randomized controlled trial data. InterventionCulturally-adapted behavioral weight loss interventions based on the Diabetes Prevention Program among Latinx adults over 12 months. Main outcome measureDemographic, clinical, and psychosocial predictors of session attendance and 5% weight loss at 12-months. Statistical analysis performedBi-variable associations between baseline characteristics and outcomes were tested with chi-square and t-tests. Those with p-value< 0.15 were then included in stepwise logistic regressions. ResultsParticipants (N = 822) were middle age with diverse socioeconomic backgrounds. Older age in the Vivamos Activos and Vida Sana trials, and lower acculturation in the HOMBRE trial were significant predictors of increased session attendance. Factors associated with 5% weight loss varied by trials. These included younger age (OR 0.96 95% CI 0.92, 0.99) in Vivamos Activos, higher acculturation (OR 1.88 95% CI 1.05, 3.37) in Vida Sana, and higher education (OR 3.20 95% CI 1.3, 7.03) and greater body image dissatisfaction (OR 1.29, 95% CI 1.04, 1.6), and lower acculturation (0.69 95% CI 0.5, 0.96) in HOMBRE. ConclusionsFew and conflicting baseline characteristics were associated with session attendance and clinically significant weight loss, suggesting that alternative approaches to optimizing interventions are needed.

Behavioral Weight Loss Interventions for Overweight and Obese Cardiac Rehabilitation Patients: A Systematic Review.

The purpose of this systematic review was to identify evidence pertaining to the effectiveness of behavioral weight loss interventions for overweight and obese cardiac rehabilitation participants. A database search of PUBMED, CINAHL, PsycINFO, and PROSPERO yielded 10 eligible studies. Quantitative studies implementing behavioral weight loss interventions for overweight and obese adult cardiac rehabilitation participants were reviewed. Evidence supported the usefulness and effectiveness of behavioral weight loss interventions for overweight cardiac rehabilitation participants. With the limited number of studies and inclusion of quasi-experimental studies with comparative groups, it was not possible to determine the relative power of behavioral weight loss interventions across studies. In conclusion, behavioral weight loss interventions can be incorporated into cardiac rehabilitation or offered following cardiac rehabilitation to improve weight loss of overweight and obese cardiac rehabilitation participants. Findings reinforce national guidelines emphasizing the role of cardiac rehabilitation to address secondary cardiovascular disease risk factor modification, including integrating behavioral weight loss programs in cardiac rehabilitation, or referring overweight patients to weight management programs following completion of cardiac rehabilitation.

Factors associated with weight loss and health gains in a structured lifestyle modification programme for adults with severe obesity: a prospective cohort study.

Individual responses to behavioural weight loss interventions can vary significantly, and a better understanding of the factors associated with successful treatment might help to target interventions for those who will benefit the most. We sought to identify demographic and clinical characteristics that predicted intervention "success" (defined as ≥5% weight loss) and other health gains in patients with severe obesity attending a ten-week structured lifestyle modification programme. We conducted a prospective cohort study of all 1122 patients (751 (66.9%) female, mean age 47.3 ± 11.9 years, mean body mass index (BMI) 46.7 ± 7.8 kgm-2) referred from our hospital-based obesity clinic, who started the structured lifestyle programme between 2012-2019. We compared routine clinical measures such as weight, fitness, blood pressure, lipids and HbA1c at baseline and follow-up. We also used validated questionnaires to quantify anxiety, depression and health-related quality of life. Of 1122 patients who started, 877 (78.2%) completed the programme and attended for follow up. Of these, 12.8% lost ≥5% body weight. The amount of weight lost was a strong and consistent predictor of improvements in metabolic, cardiovascular, and mental health, even after adjusting for age, sex, programme attendance and baseline fitness. Older age, male sex, being physically active and having lower anxiety and depression scores at baseline predicted greater weight loss. Younger age, depression and longer wait time to start the intervention were associated with drop-out. In adults with severe obesity completing a structured lifestyle modification programme, older age and good mental health were associated with programme completion and attaining ≥5% weight loss. The magnitude of weight lost was a strong predictor of improvements in cardiovascular, metabolic and mental health associated with programme completion.

Accumulated physical activity and the association with obesity, fitness, and cardiometabolic risk factors in healthy adults.

This study examined the prevalence of ≥150 min/wk of moderate-to-vigorous physical activity (MVPA) using different criteria for bout length and to examine associations with measures of obesity, cardiorespiratory fitness, and cardiometabolic risk factors in healthy adults with overweight or obesity. Baseline data from healthy adults (N = 375; age [mean ± SD] = 45.2 ± 7.7 years; BMI = 32.3 ± 3.8 kg/m2 ) enrolled in a behavioral weight-loss intervention were examined cross-sectionally. Categorization was by objectively measured MVPA as follows: 1) LOW-MVPA: <150 min/wk (n = 122, 32.5%); 2) MVPA-NON-BOUTED: ≥150 min/wk in bouts < 10 min (n = 72, 19.2%); 3) MVPA-COMBINED: ≥150 min/wk with a combination of bouts < 10 and ≥10 min (n = 50, 13.3%); and 4) MVPA-BOUTED: ≥150 min/wk with bouts ≥ 10 min (n = 131, 34.9%). Weight, BMI, and waist circumference were higher in the LOW-MVPA category versus the other categories. Body fatness was significantly lower in the MVPA-BOUTED category compared with the LOW-MVPA category (p < 0.05). Differences by category for cardiorespiratory fitness and cardiometabolic risk factors were limited. Some adults with overweight or obesity may be more active than they perceived themselves to be, and accumulation of ≥150 min/wk of MVPA may have favorable effects on weight and adiposity status. Findings may influence physical activity recommendations, and confirmation with prospective and randomized studies is needed.

Association of weight and shape concern with weight change and weight-related behaviors in behavioral weight loss treatment.

Weight and shape concern (WSC) is a facet of negative body image that is common among individuals with overweight/obesity seeking behavioral weight loss treatment (BWL), but remains understudied. This secondary analysis evaluates associations between WSC, weight change, and weight-related behaviors among individuals in a 24-week BWL. Adults (n = 32) with body mass index 25-50kg/m2 completed a baseline WSC questionnaire, measured weight at 12 and 24 weeks, measured physical activity via accelerometer, and completed 24-hour dietary recalls. Adherence to self-monitoring dietary intake and weight were assessed. A series of linear mixed models were used to evaluate associations between baseline WSC and weight change, as well as weight-related behaviors. Results revealed no significant effect of WSC on weight change. There were significant WSC x time interactions, such that those rating WSC "very important" decreased self-weighing and the "low importance" group decreased their caloric intake during treatment. The "pretty important" group had greater minutes of activity than the "low importance" group. Findings indicated that WSC may impact weight-related behaviors that contribute to BWL success. This trial was pre-registered on ClinicalTrials.gov (NCT03739151).

Early and slow weight loss responders’ perceptions of an adaptive diabetes prevention trial: A qualitative perspective

Objective: Behavioural weight loss interventions demonstrate success on average, yet participants who respond more slowly may benefit from an augmented, tailored approach. Thus, an augmented intervention for early, slow weight loss responders was implemented. This qualitative analysis explored participants’ perceptions of and experiences of the 12-month weight loss programme to inform future intervention development and implementation. Design: Individual interviews were conducted post-treatment. In-person, in-depth interviews were offered prior to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic; videoconferencing interviews were offered following the pandemic onset. Setting: A Midwestern US university workplace. Method: Adults ⩾ 21 years old with overweight or obesity and prediabetes ( n = 39) were recruited and volunteered to participate in a semi-structured interview. Results: Content analysis identified recurring themes among early and early slow weight loss responders. Social support received during weekly group sessions was a critical intervention component. Some early slow responders expressed difficulty with self-regulatory strategies such as setting specific yet attainable goals, and requested additional contact prior to the maintenance study phase – treatment randomisation at month 5 disrupted group dynamics. Early slow responders who received the intervention via videoconferencing believed the format interfered with their ability to establish friendships with other participants and gain insight and support from others’ lived experiences. Conclusion: Weight loss interventions may be more efficacious when considering participant heterogeneity during implementation of behavioural strategies. Findings suggest early slow weight loss responders may benefit from greater emphasis on goal setting and striving, agentic thinking, and social support. Future research is needed to examine the implications of these insights on intervention outcomes.

Mental Health Variables Impact Weight Loss, Especially in Patients with Obesity and Binge Eating: A Mediation Model on the Role of Eating Disorder Pathology.

Various mental health and eating behavior variables have been independently associated with predicting weight loss in individuals with obesity. This study aims to investigate a mediation model that assesses the distinct contributions of these variables in predicting weight changes in patients with obesity following an outpatient behavioral weight loss intervention (BWLI). General mental health (depression, anxiety, stress, impulsivity), eating behavior (cognitive restraint, disinhibition, hunger), eating disorder pathology, and body mass index (BMI) were assessed in a group of 297 patients with obesity at the admission of a BWLI program. BMI was re-evaluated during the final treatment session. A mediation model was employed to examine whether mental health and eating behavior variables predicted BMI changes, with eating disorder pathology serving as a mediator. The model was tested both overall and within two patient subgroups: those with regular binge eating (≥four episodes/month) and those without. In the overall sample (n = 238), the relationships between depression, impulsivity, and cognitive restraint with BMI change were mediated by eating disorder pathology. In the subgroup with regular binge eating (n = 99, 41.6%), the associations between stress and disinhibition with BMI change were additionally mediated by eating disorder pathology. In the subgroup without regular binge eating, eating disorder pathology showed no mediating effect. Multiple mental health and eating behavior variables assessed at admission predicted BMI changes, particularly when mediated by eating disorder pathology in patients with regular binge eating. A comprehensive psychopathological assessment prior to starting BWLI may help identify multiple factors affecting prognosis and treatment outcomes. Long-term follow-up studies in this field are required.