Comprehensive Weight Management Program Research Articles

139-OR: An Obesity-centric Approach With and Without Antiobesity Medications Compared with the Usual-Care Approach to Management of Patients with Obesity and Type 2 Diabetes in an Employer Setting—A Pragmatic Randomized Controlled Trial (EMPOWER-T2D)

Objective: Among patients with T2D and obesity, determine the effect of combining anti-obesity medications (AOM) with a comprehensive employer-based weight management program [obesity-centric approach (OCA) + AOM] compared with OCA alone, or usual care (UC) on weight and HbA1c. Methods: A 1-year open-label, randomized, pragmatic clinical trial was conducted at the Cleveland Clinic (CC). Participants were adults with T2D (HbA1c >7.5%) and BMI ≥ 30 kg/m2 enrolled in the CC Employee Health Plan. Participants were randomized 1:1:1 to OCA+ AOM, OCA alone, or UC. Participants in the OCA+AOM group initiated treatment with 1 of 5 US FDA-approved AOMs according to standard practice. Linear mixed effect models were conducted for analysis. Results: A total of 74 participants were randomized (24 OCA+AOM, 26 OCA, and 24 UC). Participants were predominantly female (59%), median age 53.5 (47, 60) years, 68% Caucasian, with baseline median BMI and HbA1c of 37.4 (34.2, 42.7) and 8.8% (7.9, 10.4), respectively. At 1 year, patients that received UC, OCA alone, and OCA + AOM had their mean % weight change (90% confidence interval, CI) by -4.48% (-6.52 to -2.45), -6.68% (-8.71 to -4.65), and -8.74% (-10.64 to -6.74) and mean HbA1c change (90% CI) by -1.65% (-2.09 to -1.22), -2.22% (-2.65 to -1.79), and -2.18% (-2.61 to -1.74), respectively. Only OCA + AOM treatment was found to be non-inferior (P=0.004) to UC approach in weight loss change. OCA + AOM treatment was also found to be superior to UC approach in weight loss change (P=0.022). OCA+AOM and OCA alone were non-inferior to usual-care in HbA1c change (P <0.05), but neither was superior (P>0.05). Conclusion: An OCA +AOM approach to T2D treatment was associated with additional weight loss with non-inferior A1C reductions vs. UC. Larger long-term studies evaluating obesity-focused approaches to T2D management are needed. Disclosure K.M.Pantalone: Consultant; AstraZeneca, Bayer Inc., Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk, Sanofi, Research Support; Bayer Inc., Merck & Co., Inc., Novo Nordisk, Twin Health, Speaker's Bureau; AstraZeneca, Corcept Therapeutics, Merck & Co., Inc., Novo Nordisk. B.Rogen: None. J.F.Bena: None. H.Xiao: None. G.Barnard: None. E.Borukh: None. S.Peechakara: None. M.L.Griebeler: None. B.Burguera: Research Support; Novo Nordisk.

Impact of transition from face-to-face to telehealth on behavioral obesity treatment during the COVID-19 pandemic.

This study evaluated whether the transition of a face-to-face behavioral intervention to videoconferencing-based telehealth delivery during the COVID-19 pandemic resulted in significantly smaller weight losses than those typically observed in gold-standard, face-to-face programs. Participants were 160 adults with obesity (mean [SD] age = 49.2 [11.9] years, BMI = 36.1 [4.2] kg/m2 ) enrolled in two cohorts of a 16-week comprehensive weight-management program. Cohort 1 began in person and transitioned to telehealth (Zoom) delivery during week 11 of the intervention because of COVID-19; Cohort 2 was conducted completely remotely. A noninferiority approach (using a clinically relevant noninferiority margin of 2.5%) was used to assess whether the weight losses observed were inferior to the 8% losses from baseline typically produced by gold-standard, face-to-face lifestyle interventions. From baseline to postintervention, participants lost an average of 7.4 [4.9] kg, representing a reduction of 7.2% [4.6%]. This magnitude of weight change was significantly greater than 5.5% (t[159] = 4.7, p < 0.001), and, thus, was within the proposed noninferiority margin. These findings demonstrate that the results of behavioral weight-management interventions are robust, whether delivered in person or remotely, and that individuals can achieve clinically meaningful benefits from behavioral treatment even during a global pandemic. Pragmatic "lessons learned," including modified trial recruitment techniques, are discussed.

Hunger Training as a Self-regulation Strategy in a Comprehensive Weight Loss Program for Breast Cancer Prevention: A Randomized Feasibility Study.

This study found that it was feasible to add a short glucose-guided eating intervention to a comprehensive weight management program targeting postmenopausal women at high risk of breast cancer. However, further development of this novel intervention as a cancer prevention strategy is needed.

Abstract MP31: Telehealth Versus Self-directed Lifestyle Intervention To Promote Healthy Blood Pressure: A Randomized Controlled Trial

Introduction: Telehealth and web-based applications are increasingly available to promote healthy lifestyle behavior change. However, evidence that these approaches lower blood pressure is limited. Methods: We conducted a randomized controlled trial to compare the efficacy of a self-directed vs. a telehealth-delivered dietitian approach using web-based applications in 187 participants (mean age 54.6 y, 52% female) with 24-hour systolic blood pressure (BP) 120-160 mmHg. Participants were recruited in the Geisinger Health System from 1/2019 to 3/2021. Both study arms received personalized recommendations to improve dietary quality based on web-based food frequency questionnaire, and access to an online comprehensive weight management program. The telehealth arm additionally received weekly telephone calls with a dietitian who used motivational interviewing. The primary outcome was 3-month change in 24-hour systolic BP. Secondary outcomes included changes in awake and sleep BP, self-reported physical activity, healthy eating index (HEI)-2015 score, and weight. Results: Twenty-four hour systolic BP improved in both the telehealth-dietitian arm (-6.5 mmHg, 95% CI: -8.4, -4.6) and the self-directed arm (-4.9, 95% CI: -7.0, -2.8), with no difference between arms (p=0.3). Participants in the telehealth-dietitian arm had significantly greater decreases in sleep systolic BP (mean -6.9 mmHg vs. -1.5; p=0.004) and diastolic BP (-3.3 mmHg vs. 0.7; p=0.001). The telehealth-dietitian arm tended to have greater improvements in self-reported physical activity, weight loss, and HEI-2015 score (Figure). Participant satisfaction with the intervention was higher in the telehealth-dietitian arm (p=0.004). Conclusions: Among individuals with elevated BP, the telehealth-dietitian intervention did not lower 24-hour systolic BP compared to the self-directed arm over 3 months. However, there were encouraging changes in other outcomes, including reduced sleep systolic and diastolic BP and increased physical activity.

Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative.

Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative.

Examining the feasibility and characteristics of realistic weight management support for patients: Focus groups with rural, micropolitan, and metropolitan primary care providers.

The purpose of this investigation was to understand perspectives of physicians, nurses, and staff regarding the feasibility of implementing an evidence-based weight management program to support primary care practice. An exploratory aim was to examine differences in responses based on the clinic location. Ten focus groups were conducted with primary care staff from rural, micropolitan, and metropolitan clinics. The Promoting Action on Research in Health Services (PARIHS) framework was used to inform the interview guide. Transcripts were reviewed to identify common themes among PARIHS constructs (evidence, context, and facilitation). Presence of comorbidities (e.g., diabetes, hypertension) were typical prompts for provider-led discussions about patient weight. Metropolitan clinics reported the availability of health coaching, diabetes education, or dietician consultation, but no clinic reported offering a comprehensive weight management program. Participants agreed it is possible to implement a weight management program through primary care, but cited potential facilitation challenges such as costs, clinic resources, and individual patient barriers. More enthusiasm arose for a referral program with patient tracking. Program characteristics such as proven efficacy, individual tailoring, program accessibility, and patient feedback to the providers were desired. Rural focus group participants reported unique barriers (lack of local resources) and facilitators (more flexibility in practice changes) to weight management when compared to metropolitan and micropolitan focus groups. Primary care staff are interested in weight management solutions for their patients and would prefer an evidence-based program to which they could refer patients, receive feedback on patient progress, and sustainably include as part of their regular services.

Patient and Provider Satisfaction with Telemedicine in a Comprehensive Weight Management Program.

Introduction: Telemedicine use became widespread at our weight management center in 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Objectives: The objective of this study was to determine patient and provider satisfaction with telemedicine visits at a community-based hospital in the United States. Methods: Patients and providers were electronically surveyed at the end of 2020 regarding telemedicine visit experiences. These visits took place throughout the majority of 2020 during the COVID-19 pandemic. Results: A total of 85.7% (6) of providers reported spending the same or less time on telemedicine visits compared with in-person visits. All providers were either somewhat or very satisfied with the interpersonal connections made in telemedicine visits. All providers wished to see telemedicine visits continued in the future. A total of 355 patients responded. Over 90% of participants reported feeling comfortable speaking to their provider about personal issues through telemedicine. Around 73.2% of patients were very satisfied with their telemedicine visit. Around 69.8% of patients report that they would like to use either primarily telemedicine visits or a combination of telemedicine and in-person visits when it is safe to return to in-person care. Conclusions: Patients and providers exhibited high levels of satisfaction with telemedicine use in a weight management center. They both wish to see these visit types offered in the future. Patients who saved more than 30 min of time traveling with a telemedicine visit were significantly more likely to show high levels of satisfaction. Patients who found it easier to connect with the virtual platforms also were significantly more likely to have higher satisfaction levels.

Reactions to the U.S. Preventive Services Task Force guidelines for the management of adolescent obesity: A multi-informant qualitative approach.

The U.S. Preventive Services Task Force (USPSTF) has set forth recommendations for clinicians to screen youth (6-18 years) for obesity. Those identified should be referred to comprehensive weight management programs consisting of at least 26 contact hours and focus on multiple targets of behaviour (ie, diet, physical activity, behaviour change). However, these recommendations are primarily based upon outcomes from randomized controlled trials and the feasibility of meeting these guidelines for adolescents in a clinical setting is unknown. The present study employed a multi-informant qualitative approach with adolescents, parents, and physicians, to identify and understand multiple perspectives on the feasibility and acceptability of implementing the USPSTF guidelines. In-depth interviews with seven adolescents, seven parents, and four physicians were analysed. Generally, participants viewed the guidelines positively but identified changes that may be necessary to increase the feasibility of adolescents engaging in programs that meet these guidelines. Participants also noted the importance of flexibility within programs, indicating that it would be difficult for many adolescents to participate in a program that was not tailored to their needs and resources. Future research should focus on adapting clinical weight management programs to meet both USPSTF guidelines and the needs of adolescents and their families.

Exploration of biomarkers from a pilot weight management study for men undergoing radical prostatectomy

BackgroundSeveral biologic mechanisms, including inflammation and immune changes, have been proposed to explain the role of obesity in prostate cancer (CaP) progression. Compared to men of a healthy weight, overweight and obese men are more likely to have CaP recurrence post-prostatectomy. Obesity is related to inflammation and immune dysregulation; thus, weight loss may be an avenue to reduce inflammation and reverse these immune processes. ObjectivesThis study explores the reversibility of the biological mechanisms through intentional weight loss using a comprehensive weight management program in men undergoing prostatectomy. Outcomes include blood and tissue biomarkers, microtumor environment gene expression, inflammation markers and Dietary Inflammatory Index (DII) scores. MethodsTwenty overweight men undergoing prostatectomy participated in this study. Fifteen men chose the intervention and 5 men chose the nonintervention group. The intervention consisted of a comprehensive weight loss program prior to prostatectomy and a weight maintenance program following surgery. Prostate tissue samples were obtained from diagnostic biopsies before the intervention and prostatectomy samples after weight loss. Blood samples and diet records were collected at baseline, pre-surgery after weight loss and at study end after weight maintenance. Immunohistochemistry and NanoString analysis were used to analyze the tissue samples. Flow cytometry was used to assess circulating immune markers. Inflammation markers were measured using Luminex panels. ResultsThe intervention group lost >5% body weight prior to surgery. DII scores improved during the weight loss intervention from baseline to pre-surgery (P = 0.002); and between group differences were significant (P = 0.02). DII scores were not associated with IL-6 nor hsCRP. In the intervention, CXCL12, CXCR7, and CXCR4 (C-X-C motif chemokine ligand/receptor) and Ki67 expression decreased in the prostate tissue from biopsy to surgery (P = 0.06), yet plasma CXCL12 increased during the same timeframe (P = 0.009). The downregulation of several genes (FDR<0.001) was observed in the intervention compared to the non-intervention. Changes in immune cells were not significant in either group. ConclusionThis feasibility study demonstrates that in overweight men with localized CaP, weight loss alters blood, and tissue biomarkers, as well as tumor gene expression. More research is needed to determine the biological and clinical significance of these findings.

A longitudinal study to investigate the effects of a 12-week comprehensive lifestyle weight management program on body weight and quality of life.

The majority of Americans now have overweight or obesity. With limited resources to treat all patients, group programs are emerging as an efficient method for dissemination of evidence-based lifestyle information. The objective of this study was to evaluate change in body weight, biochemical parameters, and quality of life among individuals after completion of a 12-week comprehensive group weight management program at an obesity medicine clinic. 204 patients were recruited for the study after enrolling in the Healthy Habits for Life program at the Massachusetts General Hospital Weight Center in Boston and Danvers, MA. Prior to the program, patients met individually with a dietitian and baseline data was collected. Primary outcome measures collected were weight and BMI change over the course of the program. Secondary measures collected included biochemical parameters and quality of life. Weekly group visits consisted of primary outcome collection and 1.5h of instruction on various lifestyle- and nutrition-related topics. Secondary outcome measures were reassessed at an individual visit with the dietitian after the program concluded. 142 participants were adherent to the protocol (attended 9 out of 12 classes). On average, patients lost 6.4kg (14.1 lbs.), representing a percent total body weight loss of over 5%. Average BMI decrease was significant at 5.35±4.61%. Improvements were seen in physical function, self-esteem, and sexual life; total QOL scores also improved by a significant 5.79% on average. There were also significant improvements in total cholesterol, triglycerides, and HbA1c. The Healthy Habits for Life group program was an effective treatment for obesity and related health concerns, including overall quality of life. Group programs of this style may be a more efficient was to disseminate evidence-based lifestyle information and affect change for patients with overweight or obesity.

Abstract P169: Randomized Controlled Trial Comparing a Self-guided vs. Dietitian-led Approach Using Web-based Tools to Lower Blood Pressure: Study Design and Rationale

Background: Weight loss, consumption of a Dietary Approaches to Stop Hypertension (DASH) dietary pattern, reduced sodium intake, and increased physical activity have been shown to lower systolic blood pressure (SBP). Use of website or smartphone-based tools could be potentially scalable solutions to improve lifestyle behaviors and lower SBP, but little data exists to support their use in clinical practice. Methods: In an ongoing single-center, 2-arm, randomized controlled trial, we compare the efficacy of a dietitian-guided approach vs. a self-guided approach in lowering 24-hour SBP in overweight/obese patients with 24-hour SBP 120-160 mmHg on 0-1 BP medication. As part of standard of care, participants with outpatient SBP ≥ 130 mmHg are identified using Geisinger electronic health record data and through Geisinger Health Plan’s health and wellness program and invited to complete 24-hour ambulatory BP monitoring (ABPM). Qualifying participants are then invited to a research visit to sign informed consent and for data collection, including a web-based food frequency questionnaire (Viocare®), which provides personalized recommendations to improve dietary quality. After a 2-week run-in period in which participants must regularly log data into www.bmiq.com, a comprehensive weight management program, and a smartphone app (Lose It!), participants are randomized 1:1 to a self-guided arm or a dietitian-led arm. All participants are instructed to use the website and app, and the dietitian-led arm additionally receives weekly telephone calls from registered dietitian nutritionists, trained in motivational interviewing. The primary outcome is 3-month change in 24-hour SBP. Other outcomes include changes in other ABPM measures, total healthy eating index-2015 (HEI) score, weight, waist circumference, metabolic equivalent of task-minutes per week (International Physical Activity Questionnaire short form), and study satisfaction. Results: Out of 210 patients who have thus far completed ABPM, 128 were eligible for the trial, 85 consented for the trial, and 78 were randomized after completing the run-in period. In a preplanned interim analysis of the first 34 randomized patients, 28 (82%) completed the 3-month study visit. Mean (SD) changes from baseline to 3 months were: -8.0 mmHg (9.9) for 24-hour SBP, -5.4 kg (4.5) for weight, -6.1 cm (7.4) for waist circumference, and 11.2 units (12.0) for HEI score. Conclusions: Confirmation of elevated BP using ABPM may provide an opportunity to engage patients in making lifestyle modifications, as more than 60% of eligible patients after 24-hour ABPM screening were successfully randomized into the trial. Completion of the study is expected by the end of 2020 and will determine the efficacy of a self-directed vs. dietitian-led approach to lower 24-hour SBP using web-based tools.

Change in Visceral Adiposity with a 12-Month Behavioral Weight Loss Intervention with Varying Doses of Physical Activity: The Heart Health Study

Visceral adipose tissue (VAT) is considered to have biochemical characteristics that influence several pathophysiological processes of the body and high levels are associated with increased risk for metabolic syndrome, cardiovascular disease, and certain cancers. There is data to suggest that supervised aerobic exercise may reduce VAT in the absence of caloric restriction. PURPOSE: To examine whether VAT is reduced within the context of a comprehensive weight management program, varied by prescribed levels of home-based moderate-to-vigorous physical activity (MVPA) in adults who were overweight or obese across 12 months. METHODS: Data were examined from sedentary adults (N=309; BMI: 32.3±3.8 kg/m2; age=45.1±7.9 years) enrolled in a behavioral program and randomized to a reduced calorie diet (DIET, N=107), diet plus a moderate dose of MVPA (MOD-EX, N=101), or diet plus a high dose of MVPA (HIGH-EX, N=101). All groups received weekly intervention sessions in months 1-6 followed by 2 group and 2 telephone contacts per month in months 7-12, and were prescribed a diet to reduce energy intake (1200-1800 kcal/day). MOD-EX was prescribed unsupervised MVPA that progressed to 150 min/wk, whereas HIGH-EX was progressed to 250 min/wk. Body composition and VAT were measured by DXA (GE Lunar iDXA, Corescan) along with weight at 0, 6 and 12 months. RESULTS: Weight significantly decreased in all groups at 6 months (DIET: -9.0±5.9 kg, MOD-EX: -10.2±6.4 kg, HIGH-EX: -9.4±5.3 kg; p<0.001) and 12 months (DIET: -10.0±8.3 kg, MOD-EX: -11.1±8.1 kg, HIGH-EX: -9.7±6.9 kg; p<0.001), with no significant difference between groups. A similar pattern was observed for percent body fat (Baseline: 43.3±5.5%, 6-month: 38.3±7.0%, 12-month: 37.7±7.6%; p<0.001) with no difference between groups. VAT decreased across time (Baseline: 1518±907cm3, 6-month: 1018±617cm3, 12-month: 971±648cm3; p<0.001) with no difference between groups. CONCLUSIONS: The interventions were successful at reducing body weight and improving body composition in adults with obesity. The lack of additional weight loss, reductions in body compositon and VAT with participation in MVPA at two different doses may suggest that there is a compensatory response in factors influencing energy balance that warrant further investigation. Supported by: NIH (R01 HL103646)

12 Month Behavioral Weight Loss Intervention With Varying Doses Of Physical Activity

Secondary data analysis from intervention studies has suggested that ≥250 min/wk of moderate-to-vigorous physical activity (MVPA) is associated with improved long-term weight loss within the context of a behavioral weight loss intervention; however, randomized clinical trials are needed to support these findings and to determine the feasibility of adults who are overweight or obese to achieve this recommended level of MVPA. PURPOSE: This study examined the ability of a behavioral intervention to achieve MVPA levels recommended for public health (150 min/wk) or weight control (250 min/wk). This study also examine whether weight loss, within the context of a comprehensive weight management program, varied by these prescribed levels of MVPA in adults who were overweight or obese across 12 months. METHODS: Data were examined from sedentary adults (N=230; BMI: 32.1±3.8 kg/m2; age=46.2±7.7 years) enrolled in a behavioral program and randomized to a reduced calorie diet (DIET, N=71), diet plus a moderate dose of MVPA (MOD-EX, N=82), or diet plus a high dose of MVPA (HIGH-EX, N=77). All groups received weekly intervention sessions in months 1–6 followed by 2 group and 2 telephone contacts per month in months 7–12, and were prescribed a diet to reduce energy intake (1200–1800 kcal/day). MOD-EX was prescribed unsupervised MVPA that progressed to 150 min/wk, whereas HIGH-EX was progressed to 250 min/wk. MVPA and weight were assessed at 0, 6, and 12 months. RESULTS: MVPA at 0, 6, and 12 months was 52.3±60.5, 82.3±93.4, and 85.7±110.6 min/wk in DIET; 53.8±78.7, 173.1±112.1, and 185.8±134.5 min/wk in MOD-EX, and 73.2±92.2, 254.1±127.8, and 236.0±154.9 min/wk in HIGH-EX (Group X Time p-value <0.001). Weight significantly decrease in all groups at 6 months (DIET: −9.2±5.8 kg, MOD-EX: −10.2±6.4 kg, HIGH-EX: −9.5±5.4 kg; p<0.001) and 12 months (DIET: −9.7±7.5 kg, MOD-EX: −11.0±8.2 kg, HIGH-EX: −9.7±7.1 kg; p<0.001), with no significant difference between groups. CONCLUSIONS: The MOD-EX and HIGH-EX interventions were successful at achieving the prescribed dose of MVPA in adults with obesity. The lack of additional weight loss with participation in higher amounts of MVPA may suggest that there is a compensatory response in factors influencing energy balance that warrant further investigation. Supported by: NIH (R01 HL103646)

Moving Beyond BMI: Improvement in Cardiovascular Risk and Fatty Liver Markers in Children Attending a Comprehensive Weight Management Program

Moving Beyond BMI: Improvement in Cardiovascular Risk and Fatty Liver Markers in Children Attending a Comprehensive Weight Management Program

Weight loss endoscopy: Development, applications, and current status.

Obesity and its comorbidities - including diabetes and obstructive sleep apnea - have taken a large and increasing toll on the United States and the rest of the world. The availability of commercial, clinical, and operative therapies for weight management have not been effective at a societal level. Endoscopic bariatric therapy is gaining acceptance as more effective than diet and lifestyle measures, and less invasive than bariatric surgery. Various endoscopic therapies are analogues of the restrictive or bypass components of bariatric surgery, utilizing gastric remodeling or intestinal anastomosis to achieve proven weight loss and metabolic benefits. Others, such as aspiration therapy, employ novel mechanisms of action. Intragastric balloons have recently been approved by the United States Food and Drug Administration, and a number of other technologies have completed large multicenter trials (such as AspireAssist aspiration therapy and Primary Obesity Surgery Endolumenal). Endoscopic sleeve gastroplasty and transoral outlet reduction for endoscopic revision of gastric bypass have proven safe and effective in a number of studies. As devices are approved for use, data will continue to accumulate for safety, effectiveness, and cost effectiveness. Bariatric endoscopists should be prepared to appropriately target and apply various endoscopic bariatric therapies in the context of a comprehensive long-term weight management program.

Barriers and facilitators to providing primary care-based weight management services in a patient centered medical home for Veterans: a qualitative study.

BackgroundObesity is highly prevalent among Veterans. In the United States, the Veterans Health Administration (VHA) offers a comprehensive weight management program called MOVE!. Yet, fewer than 10 % of eligible patients ever attend one MOVE! visit. The VHA has a patient-centered medical home (PCMH) model of primary care (PC) called Patient-Aligned Care Teams (PACT) at all Veterans Affairs (VA) Medical Centers. PACT teamlets conduct obesity screening, weight management counseling, and refer to MOVE!. As part of a needs assessment to improve delivery of weight management services, the purpose of this study was to assess PACT teamlet and MOVE! staff: 1) current attitudes and perceptions regarding obesity care; 2) obesity-related counseling practices 3) experiences with the MOVE! program; and 4) targets for interventions to improve implementation of obesity care in the PC setting.MethodsWe recruited 25 PACT teamlet members from a single VA study site—11 PC physicians, 5 registered nurses, 5 licensed practical nurses, 1 clerical assistant, and 3 MOVE! staff (2 dietitians, 1 psychologist)—for individual interviews using a combination of convenience and snowball sampling. Audio recorded interviews were professionally transcribed and iteratively coded by two independent reviewers. The analytic process was guided by discourse analysis in order to discover how the participants perceived and provided weight management care and what specific attitudes affected their practices, all as bounded within the organization.ResultsEmerging themes included: 1) role perceptions, 2) anticipated outcomes of weight management counseling and programs, and 3) communication and information dissemination. Perceived role among PCPs was influenced by training, whereas personal experience with their own weight management impacted role perception among LPNs/RNs. Attitudes about whether or not they could impact patients’ weight outcomes via counseling or referral to MOVE! varied. System-level communication about VHA priorities through electronic health records and time allocation influenced teams to prioritize referral to MOVE! over weight management counseling.ConclusionWe found a diversity of attitudes, and practices within PACT, and identified factors that can enhance the MOVE! program and inform interventions to improve weight management within primary care. Although findings are site-specific, many are supported in the literature and applicable to other VA and non-VA sites with PCMH models of care.

Increased frequency of dietitian visits is associated with improved body mass index outcomes in obese youth participating in a comprehensive pediatric weight management program.

Comprehensive weight management (CWM) interventions are most effective for obese youth when they include multiple components, such as nutrition, physical activity, and behavioral strategies. However, effectiveness of different approaches to delivering the nutrition component is unknown. Our aim was to evaluate two dietary approaches and extent of registered dietitian (RD) involvement on outcomes of obese youth participating in a CWM program. A retrospective review of CWM patients was conducted before and after redesign of the nutrition component. The earlier clinical model (CM1) introduced a portion-controlled diet at an RD visit after the initial medical visit, whereas the later clinical model (CM2) introduced a reduced glycemic load diet at the initial medical visit. CWM patients were included if they had at least one RD visit and an initial and 3- to 6-month medical follow-up visit during CM1 or CM2. Differences between CM1 and CM2 groups regarding changes in BMI and programmatic success (BMI change ≤0) were evaluated. Median BMI change during follow-up did not differ between CM1 (n=41) and CM2 (n=51) groups (p=0.41). In a multiple logistic regression model combining study groups, each additional RD visit was associated with a 28% increased odds of success (odds ratio [95% confidence interval]: 1.28 [1.00, 1.64]; p=0.05). The probability of success exceeded 78% with ≥1 RD visit/month versus 43% with minimal RD exposure. Increased frequency of RD visits is associated with improved BMI outcomes in obese youth participating in a CWM program regardless of dietary intervention implemented.

Effects of a Pediatric Weight Management Program With and Without Active Video Games

Active video games may offer an effective strategy to increase physical activity in overweight and obese children. However, the specific effects of active gaming when delivered within the context of a pediatric weight management program are unknown. To evaluate the effects of active video gaming on physical activity and weight loss in children participating in an evidence-based weight management program delivered in the community. Group-randomized clinical trial conducted during a 16-week period in YMCAs and schools located in Massachusetts, Rhode Island, and Texas. Seventy-five overweight or obese children (41 girls [55%], 34 whites [45%], 20 Hispanics [27%], and 17 blacks [23%]) enrolled in a community-based pediatric weight management program. Mean (SD) age of the participants was 10.0 (1.7) years; body mass index (BMI) z score, 2.15 (0.40); and percentage overweight from the median BMI for age and sex, 64.3% (19.9%). All participants received a comprehensive family-based pediatric weight management program (JOIN for ME). Participants in the program and active gaming group received hardware consisting of a game console and motion capture device and 1 active game at their second treatment session and a second game in week 9 of the program. Participants in the program-only group were given the hardware and 2 games at the completion of the 16-week program. Objectively measured daily moderate-to-vigorous and vigorous physical activity, percentage overweight, and BMI z score. Participants in the program and active gaming group exhibited significant increases in moderate-to-vigorous (mean [SD], 7.4 [2.7] min/d) and vigorous (2.8 [0.9] min/d) physical activity at week 16 (P < .05). In the program-only group, a decline or no change was observed in the moderate-to-vigorous (mean [SD] net difference, 8.0 [3.8] min/d; P = .04) and vigorous (3.1 [1.3] min/d; P = .02) physical activity. Participants in both groups exhibited significant reductions in percentage overweight and BMI z scores at week 16. However, the program and active gaming group exhibited significantly greater reductions in percentage overweight (mean [SD], -10.9%[1.6%] vs -5.5%[1.5%]; P = .02) and BMI z score (-0.25 [0.03] vs -0.11 [0.03]; P < .001). CONCLUSIONS AND RELEVANCE Incorporating active video gaming into an evidence-based pediatric weight management program has positive effects on physical activity and relative weight. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01757925.

Practical Application of a Comprehensive Weight Management Program in Patients with and without Metabolic Syndrome

This paper examines weight loss outcomes and their impact on risk factors associated with metabolic syndrome following participation in OPTIFAST®, a comprehensive weight-management program. A multicenter, retrospective chart review of 153 patients enrolled in the OPTIFAST program was conducted. Change in weight, body mass index, percent weight loss and cardiometabolic risk factors were compared between patients with and without metabolic syndrome. Patients with metabolic syndrome at baseline lost 21.6 ± 10.0 kg compared to 20.4 ± 9.2 kg for patients without metabolic syndrome (p > 0.05). Mean reduction in body mass index was 7.3 ± 3.1 kg/m2 and 7.1 ± 3.0 kg/ m2, and mean percent weight loss was 16.7 ± 6.9% and 17.6 ± 6.9%, respectively (p > 0.05). Metabolic syndrome patients had significantly greater reductions in triglycerides (p < 0.0001) and diastolic blood pressure (p < 0.01). The proportion of metabolic syndrome patients at program completion (41/87 (47%)) was significantly less than the proportion of metabolic syndrome patients at baseline (51/87 (59%); p < 0.0001). Patients with and without metabolic syndrome achieved significant weight loss and similar declines in body weight, body mass index and percent weight change. Significant improvements in cardiometabolic risk factors, including meaningful reductions in the prevalence of metabolic syndrome within the study population were observed.

Clinical experience of weight loss surgery in morbidly obese Korean adolescents.

PurposeComprehensive multidisciplinary weight management programs encompassing various conservative measures have shown only modest weight loss results in obese children and adolescents; therefore, bariatric surgery for this population has become a matter of discussion. This study aimed to present our experience with and outcomes for laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in morbidly obese Korean adolescents.Materials and MethodsThe prospectively established database of all patients undergoing bariatric surgery at Soonchunhyang University Seoul Hospital, Korea between January 2011 and January 2013 was retrospectively reviewed. Adolescents aged 14 to 20 years were included in the present analyses.ResultsTwenty-two adolescents underwent bariatric surgery during the study period; 14 underwent LSG and 8, LRYGB. Of these, 17 were female and 5 were male. The mean age was 19 years. Their mean body weight and body mass index (BMI) before surgery were 115 kg and 40.1 kg/m2. The only postoperative complication was intraluminal bleeding in 1 patient, which was managed conservatively. The mean BMI decreased to 29.1 kg/m2 after a mean follow-up of 10 months. The percent excess weight loss (%EWL) at 1, 3, 6, and 12 months postoperatively were 19.6, 39.9, 52.6, and 74.2%, respectively. Only 1 patient showed %EWL less than 30% at 12 months after surgery. All patients with diabetes and sleep apnea were cured of their disease, and other comorbidities also improved or resolved after surgery.ConclusionBariatric surgery leads to significant short-term weight loss along with resolution of obesity-related comorbidities in obese children and adolescents.