Weight Change Outcomes Research Articles

To Text or Not to Text: Electronic Message Intervention to Improve Treatment Adherence Versus Matched Historical Controls.

BackgroundEnsuring treatment adherence is important for the internal validity of clinical trials. In intervention studies where touch points decrease over time, there is even more of an adherence challenge. Trials with multiple cohorts offer an opportunity to innovate on ways to increase treatment adherence without compromising the integrity of the study design, and previous cohorts can serve as historical controls. Electronically delivered nudges offer low-cost opportunities to increase treatment adherence.ObjectiveThis study aimed to evaluate the effectiveness of electronic messages (e-messages) on treatment adherence to the last cohort of a parent weight loss intervention during the second half of a year-long trial, when intervention checkpoint frequency decreases. Treatment adherence is measured by intervention class attendance and adherence to the intervention diet.MethodsAll participants in the last cohort (cohort 5, n=128) of a large randomized weight loss study were offered an e-message intervention to improve participant adherence during the last 6 months of a 1-year weight loss program. Overall, 3 to 4 electronic weekly messages asked participants about intervention diet adherence. A propensity score model was estimated using 97 participants who opted to receive e-messages and 31 who declined in cohort 5 and used to pair match cohort 5 e-message participants to a historical control group from cohorts 1 to 4. Moreover, 88 participants had complete data, yielding 176 participants in the final analyses. After matching, intervention and matched control groups were compared on (1) proportion of class attendance between the 6 and 12 month study endpoints, (2) diet adherence, as measured by total carbohydrate grams for low-carbohydrate (LC) and total fat grams for low-fat (LF) diets at 12 months, and (3) weight change from 6 to 12 months. The dose-response relationship between the proportion of text messages responded to and the 3 outcomes was also investigated.ResultsCompared with matched controls, receiving e-messages had no effect on (1) treatment adherence; class attendance after 6 months +4.6% (95% CI −4.43 to 13.68, P=.31), (2) adherence; LC −2.5 g carbohydrate, 95% CI −29.9 to 24.8, P=.85; LF +6.2 g fat, 95% CI −4.1 to 17.0, P=.26); or on (3) the secondary outcome of weight change in the last 6 months; +0.3 kg (95% CI −1.0 to 1.5, P=.68). There was a positive significant response correlation between the percentage of messages to which participants responded and class attendance (r=.45, P<.001).ConclusionsAlthough this e-message intervention did not improve treatment adherence, future studies can learn from this pilot and may incorporate more variety in the prompts and more interaction to promote more effective user engagement. Uniquely, this study demonstrated the potential for innovating within a multicohort trial using propensity score–matched historical control subjects.Trial RegistrationClinicalTrials.gov NCT01826591; https://clinicaltrials.gov/ct2/show/NCT01826591International Registered Report Identifier (IRRID)RR2-10.1016/j.cct.2016.12.021

Using Changes in Weight-for-Age z Score to Predict Effectiveness of Childhood Tuberculosis Therapy

International guidelines recommend monitoring weight as an indicator of therapeutic response in childhood tuberculosis (TB) disease. This recommendation is based on observations in adults. In the current study, we evaluated the association between weight change and treatment outcome, the accuracy of using weight change to predict regimen efficacy, and whether successfully treated children achieve catch-up weight gain. We enrolled children treated for drug-susceptible TB disease (group 1) and multidrug-resistant TB disease (group 2) in Peru. We calculated the change in weight-for-age z score (ΔWAZ) between baseline and the end of treatment months 2-5 for group 1, and between baseline and months 2-8 for group 2. We used logistic regression and generalized estimating equation models to evaluate the relationship between ΔWAZ and outcome. We plotted receiver operating characteristic curves to determine the accuracy of ΔWAZ for predicting treatment failure or death. Groups 1 and 2 included 100 and 94 children, respectively. In logistic regression, lower ΔWAZ in months 3-5 and month 7 was associated with treatment failure or death in groups 1 and 2, respectively. In generalized estimating equation models, children in both groups who experienced treatment failure or death had lower ΔWAZ than successfully treated children. The ΔWAZ predicted treatment failure or death with 60%-90% sensitivity and 60%-86% specificity in months 2-5 for group 1 and months 7-8 for group 2. All successfully treated children-except group 2 participants with unknown microbiologic confirmation status-achieved catch-up weight gain. Weight change early in therapy can predict the outcome of childhood TB treatment.

Influence of physical activity, screen time and sleep on inmates' body weight during incarceration in Canadian federal penitentiaries: a retrospective cohort study.

Recent research found that inmates experience undesirable and rapid weight gain during incarceration in Canadian federal penitentiaries. However, little is known about what factors and daily movement behaviours (e.g., physical activity, screen time, and sleep) influence weight gain during incarceration. This study examines how these 24-h movement/non-movement behaviours contribute to weight gain during incarceration. This retrospective cohort study explored how weight change outcomes during incarceration (weight change, body mass index (BMI) change, and yearly weight gain) were influenced by physical activity, screen time, and sleep in a convenience sample of 754 inmates. The outcome measures were taken twice, once from participants' medical chart at admission and again during a face-to-face follow-up interview (conducted in 2016-2017; mean follow-up time of 5.0 ± 8.3years). Physical activity, screen time, and sleep were self-reported. The statistical analysis was chi-square testing, non-parametric median comparison testing, and regression analysis to control for confounders. Inmates who engaged in at least 60min of daily physical activities gained less weight (4.5kg) compared to inmates who reported not exercising (8.3kg). Different types of exercise (cardiovascular exercises, weight lifting, and team sports) were helpful at limiting weight gain, but playing sports was the most effective. Screen time and sleep were not associated with weight gain outcomes. Among the behaviours examined, physical inactivity was significantly associated with higher weight gain during incarceration. However, even high levels of physical activity (> 60min/day) were not sufficient to eliminate weight gain during incarceration in Canada.

The prevalence of weight cycling and associations with weight change and health outcomes (over 12 years)

The prevalence of weight cycling and associations with weight change and health outcomes (over 12 years)

Leveraging the Public School System to Combat Adolescent Obesity: The Limits of Arkansas's Statewide Policy Initiative

PurposeThis study assessed the effectiveness of one of the earliest statewide policy initiatives to address obesity via schools—Arkansas's Act 1220 of 2003—on adolescent obesity. The Act required public schools in Arkansas to conduct body mass index (BMI) screening and reporting, restrict access to vending machines, and establish physical education and nutrition standards. MethodsTo determine the effect of Act 1220 as a whole, this study analyzed data representative of adolescents in grades 9–12 from the Youth Risk Behavior Survey using the quasi-experimental method of difference-in-differences. Changes in adolescents’ weight outcomes in Arkansas before (1999 and 2001) and after (2005, 2007, and 2009) the implementation of Act 1220 were compared to changes in weight outcomes for adolescents from the neighboring state of Missouri across the same time period. ResultsArkansas's Act 1220 did not significantly influence adolescents’ BMI-for-age z-scores (−.017; 95% confidence interval [CI] [−.097, .063]; p = .68). Further, the Act did not lead to significant reductions in BMI-for-age z-scores among adolescents who were either overweight (−.003; 95% CI [−.043, .036]; p = .86) or obese (−.010; 95% CI [−.070, .051]; p = .75). Results remain robust to adjustments for self-report bias in height and weight as well as a set of alternative comparison states. ConclusionsPreventing adolescent overweight and obesity is unlikely to occur through such large-scale policy initiatives alone.

Long-term weight change and health outcomes for sleeve gastrectomy (SG) and matched Roux-en-Y gastric bypass (RYGB) participants in the Longitudinal Assessment of Bariatric Surgery (LABS) study

Data from a US multicenter longitudinal study of bariatric surgery were used to compare weight change (primary outcome) and comorbidities (secondary outcome) in patients who underwent sleeve gastrectomy versus Roux-en-Y gastric bypass. This study includes participants who underwent sleeve gastrectomy and matched participants who underwent Roux-en-Y gastric bypass from the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study. Adults undergoing initial bariatric surgical procedures between 2006 and 2009 were enrolled. Participants who underwent sleeve gastrectomy were high-risk or superobese and intended to have a second-stage procedure. Mixed models were used to evaluate percent weight change from baseline through 7 years, and diabetes, dyslipidemia, and hypertension prevalence through 5 years. Fifty-seven of 59 participants who underwent sleeve gastrectomy were matched one to one. Most were female (68%) and white (81%), and had a median age of 49 (37-56) years and median body mass index of 56.4 (35.5-76.8) kg/m2 presurgery. Weight loss was significantly less 1 to 7 years after sleeve gastrectomy versus matched Roux-en-Y gastric bypass (eg, year 7 mean weight loss was 23.6% vs 30.4%, respectively; P = .001). For both surgical groups, prevalence of diabetes, low high-density lipoprotein, and hypertension were significantly (P < .05) lower 5 years postsurgery versus baseline. Higher-risk or super-obese participants after sleeve gastrectomy lost less weight than did matched Roux-en-Y gastric bypass counterparts throughout 7 years. Both groups exhibited improvements in comorbidities from presurgery through 5 years.

Interpregnancy weight change and adverse pregnancy outcomes: a systematic review and meta-analysis

ObjectivesTo evaluate the effect of interpregnancy body mass index (BMI) change on pregnancy outcomes, including large-for-gestational-age babies (LGA), small-for-gestational-age babies (SGA), macrosomia, gestational diabetes mellitus (GDM) and caesarean section (CS).DesignSystematic...

Glucose Control and Weight Change Associated with Treatment with Exenatide Compared with Basal Insulin: ARetrospective Study.

IntroductionThe aim of the study was to compare glycemic and weight change outcomes for type 2 diabetes patients treated with either exenatide once-weekly (EQW) or exenatide twice-daily (EBID) with those patients treated with basal insulin (BI).MethodsRetrospective data (2010–2014) were extracted from the Clinical Practice Research Datalink, a UK primary care database. Patients previously naïve to injectable therapy initiating EQW, EBID, or BI were extracted and matched by propensity score within two analyses (EQW vs BI and EBID vs BI). Absolute and relative change in HbA1c and weight from baseline and the proportion of patients achieving HbA1c ≤ 7.0% (53 mmol/mol) combined with weight reduction targets of (1) any weight loss or (2) ≥ 5.0% from baseline were compared at 6 and 12–24 months.ResultsA total of 485 patients initiated EQW, 3573 EBID, and 13,503 BI. In the propensity matched EQW versus BI analysis, mean HbA1c decreased with changes of − 1.33% (− 14.5 mmol/mol) and − 1.24% (− 13.5 mmol/mol) at 6 months and − 1.19% (− 13.0 mmol/mol) and − 1.17% (− 12.8 mmol/mol) at 12–24 months, respectively. Respective weight change was − 3.7 kg versus + 1.2 kg (p < 0.001) and − 3.2 kg versus + 2.5 kg (p < 0.001). Significantly more EQW patients achieved the combined HbA1c ≤ 7.0% (53 mmol/mol) and weight loss target (22.4% versus 9.9% at 6 months and 18.2% versus 8.0% at 12–24 months, respectively) and HbA1c ≤ 7.0% (53 mmol/mol) and minimum 5% weight loss (11.8% versus 3.7% at 6 months, and 8.0% versus 0.0% at 12–24 months). For EBID versus BI, similar results were found.ConclusionIn this real-world data analysis, exenatide QW and exenatide BID were associated with similar glycemic control and greater weight reduction compared with basal insulin.

Avoiding excessive pregnancy weight gain to obtain better pregnancy outcomes in Taiwan.

Pregnancy weight gain may be associated with adverse pregnancy outcomes. The article aims to explore the relationship between weight change and pregnancy outcome in the Taiwanese pregnant women.The retrospective cohort study enrolled women with vertex singleton pregnancy at University-associated Hospital between 2011 and 2014. Pregnancy weight change was separated into 3 groups, based on the Institute of Medicine (IOM) guidelines: below (n = 221); within (n = 544); and above (n = 382). Analysis of variance, χ2 tests, generalized linear models, and logistic regression models were used for statistical comparisons.Pregnant women with weight change above IOM guidelines had a significant increase in both maternal and perinatal complications compared with normal controls (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.03–1.98; P = .043; OR 1.45, 95% CI 1.01–1.87; P = .049, respectively). This finding was not found in pregnant women with weight gain below IOM guidelines. Moreover, age (OR 1.08, 95% CI 1.02–1.15; P = .0011), pre-pregnancy weight (OR 1.04, 95% CI 1.01–1.09; P = .0008), pre-pregnancy body mass index (BMI; OR 1.15, 95% CI 1.06–1.30; P < .0001), weight at the time of delivery (OR 1.05, 95% CI 1.02–1.13; P < .0001) and BMI at the time of delivery (OR 1.15, 95% CI 1.06–1.39; P < .0001), all contributed to increased maternal complications but not perinatal complications, whereas parity (OR 0.23, 95% CI 0.12–0.41; P < .0001) and gestational age (OR 0.50, 95% CI 0.35–0.62; P < .001) were associated with fewer maternal complications.Our study reconfirmed that for Taiwanese pregnant women, the approximate pregnancy weight gain recommended by IOM in 2009 was associated with the fewest maternal and perinatal complications. If approximate pregnancy weight gain cannot be attained, even less weight gain during pregnancy is still reasonable without significantly and adversely affecting maternal and perinatal outcomes in Taiwan.

Is weight cycling associated with adverse health outcomes? A cohort study

Evidence about the health effects of weight cycling is not consistent, with some studies suggesting it is harmful for health. Here we investigated whether weight cycling was associated with weight change and mental health outcomes in 10,428 participants in the mid-age cohort of The Australian Longitudinal Study of Women's Health (ALSWH) over 12years. In 1998 the women were asked how many times they had ever intentionally lost at least 5kg and how many times had they regained this amount. Women were categorised into four weight pattern groups: frequent weight cyclers (FWC, three or more weight cycles), low frequency weight cyclers (LFWC, one or two weight cycles), non-weight cyclers (NWC), and weight loss only (WL). We used generalised linear modelling to investigate relationships between weight pattern group, weight change and mental health outcomes. In 1998, 15% of the women were FWC, 24% LFWC, 46% NWC and 15% were WL. Weight change was similar across weight pattern groups in women with obesity, however healthy weight and overweight FWC gained more weight than women who did not weight cycle. We found no difference in overall mental health scores between groups, but both LFWC and FWC had higher odds of depressive symptoms (adjusted OR 1.5, 95%CI: 1.1 to 1.9 and 1.7, 95%CI: 1.1 to 2.4, respectively) than NWC. Our results suggest that, although weight cycling is not associated with greater weight gain in women with obesity, it may increase depressive symptoms.

A Feasible and Efficacious Mobile-Phone Based Lifestyle Intervention for Filipino Americans with Type 2 Diabetes: Randomized Controlled Trial.

BackgroundFilipino Americans have a high prevalence of obesity, type 2 diabetes (T2D), and cardiovascular disease compared with other Asian American subgroups and non-Hispanic whites. Mobile health (mHealth) weight loss interventions can reduce chronic disease risks, but these are untested in Filipino Americans with T2D.ObjectiveThe objective of this study was to assess feasibility and potential efficacy of a pilot, randomized controlled trial (RCT) of a culturally adapted mHealth weight loss lifestyle intervention (Pilipino Americans Go4Health [PilAm Go4Health]) for overweight Filipino Americans with T2D.MethodsThis was a 2-arm pilot RCT of the 3-month PilAm Go4Health intervention (phase 1) with an active waitlist control and 3-month follow-up (phase 2). The waitlist control received the PilAm Go4Health in phase 2, whereas the intervention group transitioned to the 3-month follow-up. PilAm Go4Health incorporated a Fitbit accelerometer, mobile app with diary for health behavior tracking (steps, food/calories, and weight), and social media (Facebook) for virtual social support, including 7 in-person monthly meetings. Filipino American adults ≥18 years with T2D were recruited from Northern California. Feasibility was measured by rates of recruitment, engagement, and retention. Multilevel regression analyses assessed within and between group differences for the secondary outcome of percent weight change and other outcomes of weight (kg), body mass index (BMI), waist circumference, fasting plasma glucose, HbA1c, and steps.ResultsA total of 45 Filipino American adults were enrolled and randomized. Mean age was 58 (SD 10) years, 62% (28/45) were women, and mean BMI was 30.1 (SD 4.6). Participant retention and study completion were 100%, with both the intervention and waitlist group achieving near-perfect attendance at all 7 intervention office visits. Groups receiving the PilAm Go4Health in phase 1 (intervention group) and phase 2 (waitlist group) had significantly greater weight loss, −2.6% (−3.9 to −1.4) and −3.3% (−1.8 to −4.8), respectively, compared with the nonintervention group, resulting in a moderate to small effect sizes (d=0.53 and 0.37, respectively). In phase 1, 18% (4/22) of the intervention group achieved a 5% weight loss, whereas 82% (18/22) maintained or lost 2% to 5% of their weight and continued to maintain this weight loss in the 3-month follow-up. Other health outcomes, including waist circumference, BMI, and step counts, improved when each arm received the PilAm Go4Health, but the fasting glucose and HbA1c outcomes were mixed.ConclusionsThe PilAm Go4Health was feasible and demonstrated potential efficacy in reducing diabetes risks in overweight Filipino Americans with T2D. This study supports the use of mHealth and other promising intervention strategies to reduce obesity and diabetes risks in Filipino Americans. Further testing in a full-scale RCT is warranted. These findings may support intervention translation to reduce diabetes risks in other at-risk diverse populations.Trial RegistrationClinicaltrials.gov NCT02290184; https://clinicaltrials.gov/ct2/show/NCT02290184 (Archived by WebCite at http://www.webcitation.org/6vDfrvIPp)

Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study

More information is needed about the durability of weight loss and health improvements after bariatric surgical procedures. To examine long-term weight change and health status following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB). The Longitudinal Assessment of Bariatric Surgery (LABS) study is a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Adults undergoing bariatric surgical procedures as part of clinical care between 2006 and 2009 were recruited and followed up until January 31, 2015. Participants completed presurgery, 6-month, and annual research assessments for up to 7 years. Percentage of weight change from baseline, diabetes, dyslipidemia, and hypertension, determined by physical measures, laboratory testing, and medication use. Of 2348 participants, 1738 underwent RYGB (74%) and 610 underwent LAGB (26%). For RYBG, the median age was 45 years (range, 19-75 years), the median body mass index (calculated as weight in kilograms divided by height in meters squared) was 47 (range, 34-81), 1389 participants (80%) were women, and 257 participants (15%) were nonwhite. For LAGB, the median age was 48 years (range, 18-78), the body mass index was 44 (range, 33-87), 465 participants (76%) were women, and 63 participants (10%) were nonwhite. Follow-up weights were obtained in 1300 of 1569 (83%) eligible for a year-7 visit. Seven years following RYGB, mean weight loss was 38.2 kg (95% CI, 36.9-39.5), or 28.4% (95% CI, 27.6-29.2) of baseline weight; between years 3 and 7 mean weight regain was 3.9% (95% CI, 3.4-4.4) of baseline weight. Seven years after LAGB, mean weight loss was 18.8 kg (95% CI, 16.3-21.3) or 14.9% (95% CI, 13.1-16.7), with 1.4% (95% CI, 0.4-2.4) regain. Six distinct weight change trajectory patterns for RYGB and 7 for LAGB were identified. Most participants followed trajectories in which weight regain from 3 to 7 years was small relative to year-3 weight loss, but patterns were variable. Compared with baseline, dyslipidemia prevalence was lower 7 years following both procedures; diabetes and hypertension prevalence were lower following RYGB only. Among those with diabetes at baseline (488 of 1723 with RYGB [28%]; 175 of 604 with LAGB [29%]), the proportion in remission at 1, 3, 5, and 7 years were 71.2% (95% CI, 67.0-75.4), 69.4% (95% CI, 65.0-73.8), 64.6% (95% CI, 60.0-69.2), and 60.2% (95% CI, 54.7-65.6), respectively, for RYGB and 30.7% (95% CI, 22.8-38.7), 29.3% (95% CI, 21.6-37.1), 29.2% (95% CI, 21.0-37.4), and 20.3% (95% CI, 9.7-30.9) for LAGB. The incidence of diabetes at all follow-up assessments was less than 1.5% for RYGB. Bariatric reoperations occurred in 14 RYGB and 160 LAGB participants. Following bariatric surgery, different weight loss patterns were observed, but most participants maintained much of their weight loss with variable fluctuations over the long term. There was some decline in diabetes remission over time, but the incidence of new cases is low following RYGB. clinicaltrials.gov Identifier: NCT00465829.

Interpregnancy weight change and adverse maternal outcomes: a retrospective cohort study

PurposeExamine associations between interpregnancy body mass index (BMI) change (difference in the pre-pregnancy BMIs of two consecutive pregnancies) and gestational diabetes mellitus (GDM), pre-eclampsia (PE), gestational hypertension (GHtn), primary cesarean delivery, and vaginal birth after cesarean delivery (VBAC). MethodsModified Poisson regression models estimated adjusted associations. ResultsEvery 1-unit increase in interpregnancy BMI increased risks of GDM (relative risk [RR]: 1.09; 95% confidence interval [CI], 1.07–1.11), PE (RR: 1.06; 95% CI, 1.04–1.09), GHtn (RR: 1.08; 95% CI, 1.06–1.10), and primary cesarean delivery (RR: 1.03; 95% CI, 1.01–1.05) and decreased the risk of a successful VBAC (RR: 0.98; 95% CI: 0.97–0.997) in the second pregnancy. A BMI increase of ≥3 units increased risks of GDM (RR: 1.71, 95% CI, 1.52–1.93), PE (RR: 1.60, 95% CI, 1.33–1.94), GHtn (RR: 1.66, 95% CI, 1.42–1.94), and primary cesarean delivery (RR: 1.29, 95% CI, 1.12–1.49) and decreased the risk of a successful VBAC (RR: 0.89; 95% CI, 0.80–0.99) compared to women with interpregnancy BMI change within −1 and +1 unit. GDM was also increased among women increasing their BMI by ≥2 but <3 units (RR: 1.40; 95% CI, 1.21–1.61) and among those gaining ≥1 but <2 units (RR: 1.23; 95% CI, 1.08–1.40). ConclusionAn interpregnancy BMI increase of ≥3 units is associated with an increased risk of all outcomes. These findings emphasize the importance of interpregnancy weight management.

Association between Weight Change, Health Outcomes, and Mortality in Older Residents in Long-Term Care.

Despite the numerous health risks associated with being overweight, the effect of weight loss on health and longevity remains controversial, particularly in older adults. We explored the association among weight changes, health outcomes, and mortality in older residents of a skilled nursing facility. A 6-year retrospective chart review of residents of a long-term care facility was conducted, collecting monthly weights in addition to the clinical and demographic data of all residents for at least 1 year. Weight changes of 5% from baseline month 1 through month 12 were classified as stable, loss, or gain. Demographics, body mass index (BMI), comorbidities, number of hospitalizations, and mortality were analyzed. The association between weight change (and other demographic and clinical variables) and mortality outcomes, as well as number of hospitalizations, was assessed using the χ2 test, the Fisher exact test, Poisson regression, or negative binomial regression, as appropriate. A total of 116 residents fit inclusion criteria; the median age was 84 years, with 71.6% being women and 88.7% white. The median length of stay was 877.5 days. Median body weight at baseline was 137.3 lb with a BMI of 23.5. More than one-third (36.2%) of residents had stable weight, 37.9% gained weight, and 25.9% lost weight during their stay. Neither weight change category nor baseline BMI was significantly associated with mortality (P = 0.056 and P = 0.518, respectively). Multivariable models showed that receiving supplementation (P = 0.04) and having hypertension (P = 0.04) were significant predictors of mortality after adjusting for the other factors. Losing >5% body weight (compared with maintaining stable weight; P = 0.0097), being a man (P = 0.0104), receiving a supplement (P = 0.0171), and being fed by tube (P = 0.0004) were associated with an increased number of hospitalizations after covariate adjustment. Weight fluctuation and baseline BMI do not appear to be associated with increased risk of death in residents in a skilled nursing facility. Weight loss was associated with an increased number of hospitalizations, however.

Definition determines weight regain outcomes after sleeve gastrectomy

BackgroundSleeve gastrectomy (SG) is one of the most commonly undertaken bariatric procedures. Weight regain after bariatric surgery, when significant, may be associated with recurrence of diabetes and deterioration in quality of life. Furthermore, it may be more common after SG than bypass procedures. Yet the understanding of the significance of weight regain is hampered by poor reporting and no consensus statements or guidelines. ObjectivesTo illustrate how the lack of a standard definition significantly alters reported SG outcomes and to contribute to the discussion of how weight regain should be defined. SettingCounties Manukau Health, a public teaching hospital that performs over 150 bariatric procedures per year. MethodsA retrospective cohort of SG patients followed up at 5 years was used to illustrate how the presence of multiple definitions in the literature significantly affects outcome reporting for weight regain. Post hoc analyses were used to explore the relationship between weight change and clinical outcomes. ResultsApplying 6 definitions of weight regain to a retrospective cohort of SG patients resulted in 6 different rates ranging from 9%–91%. Post hoc analyses revealed significant associations between weight change and the Bariatric Analysis Reporting Outcome System (BAROS) score as well as patient opinion. ConclusionThe nonuniform reporting of weight regain appears to significantly affect SG outcome reporting. Development of consensus statements and guidelines would ameliorate this problem. Ideally, research groups with access to large robust databases would aid in the development of any proposed weight regain definitions. In the interim, bariatric literature would benefit by all published series clearly reporting how weight regain is defined in the study population.

Child and youth participatory interventions for addressing lifestyle-related childhood obesity: a systematic review.

A growing number of childhood obesity interventions involve children and youth in participatory roles, but these types of interventions have not been systematically reviewed. We aimed to identify child and youth participatory interventions in the peer-reviewed literature in order to characterize the approaches and examine their impact on obesity and obesity-related lifestyle behaviours. We searched PubMed/Medline, psychINFO and ERIC for quasi-experimental and randomized trials conducted from date of database initiation through May 2015 that engaged children or youth in implementing healthy eating, physical activity or weight management strategies. Eighteen studies met our eligibility criteria. Most (n = 14) trained youth to implement pre-defined strategies targeting their peers. A few (n = 4) assisted youth to plan and implement interventions that addressed environmental changes. Thirteen studies reported at least one statistically significant weight, physical activity or dietary change outcome. Participatory approaches have potential, but variation in strategies and outcomes leave questions unanswered about the mechanisms through which child and youth engagement impact childhood obesity. Future research should compare child-delivered or youth-delivered to adult-delivered health promotion interventions and more rigorously evaluate natural experiments that engage youth to implement environmental changes. With careful attention to theoretical frameworks, process and outcome measures, these studies could strengthen the effectiveness of child and youth participatory approaches.

Bayesian Methods for Nonignorable Dropout in Joint Models in Smoking Cessation Studies

ABSTRACTInference on data with missingness can be challenging, particularly if the knowledge that a measurement was unobserved provides information about its distribution. Our work is motivated by the Commit to Quit II study, a smoking cessation trial that measured smoking status and weight change as weekly outcomes. It is expected that dropout in this study was informative and that patients with missed measurements are more likely to be smoking, even after conditioning on their observed smoking and weight history. We jointly model the categorical smoking status and continuous weight change outcomes by assuming normal latent variables for cessation and by extending the usual pattern mixture model to the bivariate case. The model includes a novel approach to sharing information across patterns through a Bayesian shrinkage framework to improve estimation stability for sparsely observed patterns. To accommodate the presumed informativeness of the missing data in a parsimonious manner, we model the unidentified components of the model under a nonfuture dependence assumption and specify departures from missing at random through sensitivity parameters, whose distributions are elicited from a subject-matter expert. Supplementary materials for this article are available online.

Early additional food and fluids for healthy breastfed full-term infants.

Early additional food and fluids for healthy breastfed full-term infants.

Impact of inter-pregnancy BMI change on perinatal outcomes: a retrospective cohort study

ObjectiveTo examine the patterns and predictors of inter-pregnancy body mass index (BMI) change and its impact on perinatal outcomes in the second pregnancy. DesignRetrospective cohort study. SettingTertiary teaching hospital in Adelaide, Australia. PopulationWomen with their first and second consecutive, singleton deliveries occurring between 2000 and 2012 (N=5371). MethodsInter-pregnancy weight change calculated based on difference between BMI at respective antenatal booking visits. Association between inter-pregnancy weight change and perinatal outcomes investigated using multivariate generalised linear models, with stratification according to initial maternal BMI category in first pregnancy. Main outcome measuresGestational diabetes (GDM); pregnancy induced hypertensive disorders; small-for-gestational age (SGA); preterm birth; large-for-gestational age (LGA) and macrosomia (>4500g). ResultsOn average, women with a normal BMI gained 1kg/m2 between first and second pregnancies, while women who were overweight or obese gained 1.37kg/m2. Among women with a normal BMI in their first pregnancy, a BMI increase of ≥4kg/m2 was associated with increased risk of developing GDM (aRR 1.97; 95% CI 1.22–3.19), a macrosomic (aRR 4.06; 95% CI 2.25–7.34) or LGA infant (aRR 1.31 0.96–1.78) in the second pregnancy, while a reduction in BMI (≤–2kg/m2) was associated with an increased risk of SGA (aRR 1.94; 1.19–3.16). Among women who were overweight or obese in their first pregnancy, a BMI increase of ≥2–4 and ≥4kg/m2 was associated with increased risks of developing GDM in the second pregnancy (aRR 1.39; 95% CI 1.01–1.91 and aRR 1.64 95% CI 1.16–2.31; ptrend<0.001), while no associations were observed for a BMI increase and risk of a macrosomic, SGA, or LGA infant. In contrast, reduction in BMI (≤–2kg/m2) was associated with a reduced risk of GDM (aRR 0.58 95% CI 0.37–0.90) and SGA (aRR 0.47; 95% CI 0.25–0.87). ConclusionIncreases in BMI between pregnancies is associated with an increased risk for perinatal complications, even in normal-weight women, while a reduction in BMI is associated with improved perinatal outcomes among women who are overweight/obese. Inter-pregnancy weight control is an important target to reduce the risk of an adverse perinatal outcome in a subsequent pregnancy.

A5169 - 15+ year weight change outcomes and complications after Roux-en-Y gastric bypass: a single-center study

A5169 - 15+ year weight change outcomes and complications after Roux-en-Y gastric bypass: a single-center study