Deliver Weight Loss Research Articles

Weight control efforts and practices and health professional advice: a cross-sectional national survey in England

ObjectivesThere is evidence that general practitioners (GPs) can increase the uptake of weight management programmes that enhance weight loss compared with self-directed efforts, but the rate at which they do...

Supporting Weight Loss Among Parents of Children With a Disability: Lessons Learned From a Single-Arm Pilot Study.

This study assessed weight change in the parents of children with disabilities following a 12-week, remotely delivered weight loss program focused on lifestyle modifications and found a significant median weight reduction of 3 kg from baseline to week 12.

Searching for the Scale-Able Weight Loss Intervention: Can One Size Fit All? Lessons to Be Learned from the EQUAL Trial.

Overweight and obesity affect 71.2% of adults in the United States, with cancer survivors not far behind at 70.3%. Subgroups such as those diagnosed with acute lymphoblastic leukemia (ALL) face even greater challenges. The Exercise and Quality Diet after Leukemia (EQUAL) trial sought to address weight management issues among ALL survivors by implementing a remotely delivered weight loss intervention, leveraging the previously proven Practice-based Opportunities for Weight Reduction (POWER) program. Despite a strong foundation and design, the EQUAL trial yielded null results. Key differences in study populations and intervention contexts between the EQUAL and POWER trials, such as the lack of primary care physician involvement in EQUAL, contributed to these outcomes. EQUAL's failure to meet its accrual target and poor adherence among participants highlighted challenges in engaging this unique population. Contrary to EQUAL's conclusions, evidence from other studies supports the efficacy of remote interventions for weight loss among cancer survivors. The lack of qualitative assessment among ALL survivors and key integration to inform intervention adaptations undermined EQUAL's impact. However, EQUAL's impressive retention rate offers valuable insights. Lessons from EQUAL underscore the need for well-fitted, remotely delivered interventions and the importance of thoughtfully adapted and tailored approaches to specific survivor populations. See related article by Fiedmann et al., p. 1158.

Optimising a digitally delivered behavioural weight loss programme: study protocol for a factorial cluster randomised controlled trial

BackgroundDigitally delivered weight loss programmes can provide a convenient, potentially cheaper, and scalable treatment option for people who may need to lose weight. However, outcomes are often inferior to in-person interventions in the long-term. This trial will use principles from the Multiphase Optimisation Strategy (MOST) framework to test whether it can enhance the effectiveness of a commercial digital behavioural weight loss programme. This trial aims to identify an optimised combination of four intervention components to enhance weight loss over a 24-week period. We will also explore which components contribute to improvements in participant retention and engagement with the programme.MethodsApproximately 1400 adults with a BMI > 21 kg/m2 will be enrolled and randomised to one of 16 experimental conditions in a 24 factorial cluster design. The trial will test four intervention components: an introductory video call with the health coach, drop-in webchat sessions with the health coach, goal setting statements, and food diary review and feedback. All participants will receive the core digital behavioural weight loss programme and up to four new intervention components. Participation in the trial will last for 24 weeks. The primary outcome will be weight change at 16 weeks. Other outcomes, measured at 4, 16, and 24 weeks, include programme drop-out and engagement (number of interactions with the three main app functions). Fidelity and acceptability will be assessed using data on component adherence and self-report questionnaires. Decision-making for the enhanced programme will be based on components that contribute to at least a minimal improvement in weight loss, defined as ≥ 0.75kg, alone or in combination with other components.DiscussionThe factorial design is an efficient way to test the efficacy of behavioural components alone, or in combination, to improve the effectiveness of digital weight loss programmes. This trial will test the implementation of the MOST framework in an industry setting, using routinely collected data, which may provide a better way to refine and evaluate these types of interventions in a model of continuous service improvement.Trial registrationTrial registration: ISRCTN, ISRCTN14407868. Registered 5 January 2024, 10.1186/ISRCTN14407868.

Episodic future thinking: A behavioral intervention to promote weight loss in breast cancer survivors.

e22541 Background: Digital behavioral interventions are a scalable method to increase healthy lifestyle engagement. Episodic future thinking (EFT) is a behavior change method where participants mentally simulate positive, detailed, personal, and future-oriented events. EFT targets delay discounting (DD), a behavioral economic principle that measures valuation of long-term, future rewards. Higher DD correlates with bias of immediate gratification and maladaptive health behaviors. EFT can decrease impulsivity and improve body weight (BW) in those with obesity. However, EFT may impact cancer survivors differently. We report results from a phase II trial evaluating the feasibility of 12 week (wk) EFT in overweight/obese BC survivors. Methods: Eligibility included women with non-metastatic BC, BMI ≥ 25 kg/m2 and completion of BC treatment apart from endocrine therapy. All patients (pts) received lifestyle counseling, referral to nutritionist, and logged exercise/diet in MyFitnessPal. Pts were stratified by baseline DD and randomized 1:1 to 12-wk EFT vs control (Episodic Recent Thinking; ERT) in which pts imagine events in the past. Pts received text cues 3x/day during meals. The primary endpoint was adherence to EFT (percentage of smartphone prompts opened and attended to over 12 wk). Secondary endpoints were 12 wk change in BW and DD. A one-sample t-test evaluated adherence in pts regardless of drop-out and compared to an 80% target. A linear mixed effects model was used for secondary endpoints. Results: Pts were recruited from November 2021 - August 2023 (Table 1, n = 46) at The Ohio State University. In total, 17 (74%) in EFT and 19 (83%) in ERT completed the intervention. The average adherence was consistent with the 80% target (EFT 77%, 95% CI = 0.69 - 0.85; ERT 82%; 95% CI = 0.78 - 0.86). BW at 12 wk was available in 17 (74%) EFT and 19 (83%) ERT pts. There was a significant 12 wk change in BW in all pts (-4.0 lbs, 95% CI -6.08 - -1.79, p < 0.001; -2.03%, 95% CI -3.15 - -0.91, p < 0.001) but no significant difference between groups (lbs: -2.28 EFT vs -5.42 ERT, 95% CI -7.41 - 1.14, p = 0.1; %: -1.07 EFT vs -5.20 ERT, 95% CI -4.01 - 0.37, p = 0.1). There was no significant difference in 12 wk change in DD rate between EFT and ERT (ratio 1.56, 95% CI 0.19 - 12.95, p = 0.7). Conclusions: The high adherence supports the feasibility of implementing EFT and engaging digital health for remotely delivered weight loss in BC survivors. BW loss was globally observed, despite low baseline DD in the majority. Further investigation of EFT in combination with lifestyle intervention is needed to formally assess efficacy in this population. Clinical trial information: NCT05012176 . [Table: see text]

Abstract 17793: Remotely Delivered Weight Loss and Exercise Intervention to Improve Cardiovascular Risk in Older Patients With Rheumatoid Arthritis

Background: Persons with rheumatoid arthritis (RA) face two-fold increases in CVD, due to traditional risk factors - e.g., hypertension, dyslipidemia, obesity, and physical inactivity - and RA systemic inflammation. Despite improvements in pharmacologic management of inflammatory disease activity, the increased prevalence of RA CVD persists. Thus, developing innovative, non-pharmacologic interventions to improve clinical care is critical. The goal of the SWET-RA trial was to identify the effects of a 16-wk remotely supervised weight loss and exercise training (SWET) intervention on metabolic syndrome in older persons (60-80 years) with RA and overweight/obesity (BMI 28-40 kg/m 2 ). Methods: Participants were randomized to SWET (n =10) or a counseling health as treatment (CHAT) control group (n=10). Using video conference and mobile applications, the SWET group completed aerobic training (150 min/wk moderate-to-vigorous), resistance training (2 days/wk), and a hypocaloric diet (7% weight loss goal). The CHAT group completed two counseling visits for diet and exercise followed by monthly check-ins. Metabolic syndrome z -scores (MSSc) were derived from fasting glucose, triglycerides (TG), HDL-cholesterol (HDL-C), waist circumference (WC), and mean arterial pressure. Within groups, Wilcoxon signed rank tests assessed significance of post- minus pre-intervention change scores (p<0.05). Between group comparisons were assessed using regression modeling controlling for baseline. Results: Following the intervention, the SWET group significantly improved TG and WC, yet reduced HDL-C; the CHAT group did not improve individual score components. Both groups significantly improved MSSc, with no between group differences. Conclusion: Results from this trial support the use of a remotely delivered program for older persons with RA and overweight/obesity. Both SWET and CHAT elicited improvements in a composite measure of CVD risk. Although SWET exceeded CHAT for reductions in TG and WC, HDL-C was reduced in SWET - possibly due to the hypocaloric diet - and increased in CHAT, likely accounting for the lack of MSSc group difference. More research is needed to distinguish the specific effects of exercise versus diet and weight loss for improving RA CVD risk.

The metabolomic signature of weight loss and remission in the Diabetes Remission Clinical Trial (DiRECT)

Aims/hypothesisHigh-throughput metabolomics technologies in a variety of study designs have demonstrated a consistent metabolomic signature of overweight and type 2 diabetes. However, the extent to which these metabolomic patterns can be reversed with weight loss and diabetes remission has been weakly investigated. We aimed to characterise the metabolomic consequences of a weight-loss intervention in individuals with type 2 diabetes.MethodsWe analysed 574 fasted serum samples collected within an existing RCT (the Diabetes Remission Clinical Trial [DiRECT]) (N=298). In the trial, participating primary care practices were randomly assigned (1:1) to provide either a weight management programme (intervention) or best-practice care by guidelines (control) treatment to individuals with type 2 diabetes. Here, metabolomics analysis was performed on samples collected at baseline and 12 months using both untargeted MS and targeted 1H-NMR spectroscopy. Multivariable regression models were fitted to evaluate the effect of the intervention on metabolite levels.ResultsDecreases in branched-chain amino acids, sugars and LDL triglycerides, and increases in sphingolipids, plasmalogens and metabolites related to fatty acid metabolism were associated with the intervention (Holm-corrected p<0.05). In individuals who lost more than 9 kg between baseline and 12 months, those who achieved diabetes remission saw greater reductions in glucose, fructose and mannose, compared with those who did not achieve remission.Conclusions/interpretationWe have characterised the metabolomic effects of an integrated weight management programme previously shown to deliver weight loss and diabetes remission. A large proportion of the metabolome appears to be modifiable. Patterns of change were largely and strikingly opposite to perturbances previously documented with the development of type 2 diabetes.Data availabilityThe data used for analysis are available on a research data repository (https://researchdata.gla.ac.uk/) with access given to researchers subject to appropriate data sharing agreements. Metabolite data preparation, data pre-processing, statistical analyses and figure generation were performed in R Studio v.1.0.143 using R v.4.0.2. The R code for this study has been made publicly available on GitHub at: https://github.com/lauracorbin/metabolomics_of_direct.Graphical

ASSOCIATION BETWEEN OBESITY STATUS CHANGE AND HYPERTENSION ONSET: A COMMUNITY-BASED LONGITUDINAL COHORT STUDY IN NORTH CHINA

Objective: Our study aimed to investigate the association between obesity status change and hypertension onset based on a longitudinal community-based cohort study in north China. Design and method: A total of 2618 individuals free of hypertension at baseline were collected from the longitudinal cohort study from 2011 to 2019. The correlation between the obesity status change and the hypertension onset was analyzed by inter groups differences analysis, an adjusted Cox regression model, and Kaplan-Meier survival analysis. Furthermore, the forest plot was used to visualize the subgroups analysis results including age, gender, and the differences of BMI and blood pressure between the baseline and the follow-up. Results: Over nearly 7 years follow-up, a total of 811 (31%) were found to develop future hypertension. The new-onset hypertension was mostly observed in participants who were keeping obese all the time (P for trend &lt; 0.01). In the fully adjusted Cox regression model, keeping obese all the time would result in a 30.10% elevated risk of hypertension. The Kaplan-Meier survival analysis revealed the change in obesity status as an important feature to predict the occurrence of hypertension. What's more, we found the female gender and age over 60 years old were the important risks for people with different degree of BMI to have future hypertension. Conclusions: This study suggested maintaining obesity status was significantly associated with the risk of hypertension onset among Chinese adults based on a community-based longitudinal cohort. Even if people delivered weight loss after obesity, their hypertension level could not return to normal in a short time.

Abstract P442: An Innovative, Remotely Delivered Weight Loss and Exercise Intervention to Improve Rheumatoid Arthritis Cardiovascular Risk

Introduction: Despite improvements in pharmacologic management of rheumatoid arthritis (RA), patients with RA continue to have an increased risk for CVD - the leading cause of death in this population. RA CVD results from a combination of traditional risk factors - such as hypertension, dyslipidemia, physical inactivity, and obesity - and RA-related systemic inflammation. Although weight loss and physical activity are promising means for improving both traditional and inflammatory risk factors, evidence is lacking for lifestyle interventions targeting these health behaviors in RA. Hypothesis: In the SWET-RA trial, we hypothesized that, as compared to standard of care, a 16-week remotely delivered weight loss and exercise intervention would improve CVD risk factors in older persons with RA and obesity. Methods: Twenty-four patients (age 60-80 years; BMI 28-40 kg/m 2 ) were randomized to one of two groups: 1) supervised weight loss and exercise training (SWET); or 2) counseling health as treatment (CHAT). The SWET intervention - delivered via video conference, the study YouTube channel, and mobile applications - consists of a) dietitian-led caloric restriction diet (7% weight loss goal) with weekly weigh-ins and group support sessions; and b) exercise physiologist-led aerobic (150 min moderate-to-vigorous exercise) and resistance training (twice weekly). CHAT provides initial clinical counseling on healthy diets and physical activity followed by monthly check-ins. Outcomes include body mass; body composition via Air Displacement Plethysmography; peak oxygen consumption [VO 2 (mL/kg/min)] via maximal cardiopulmonary exercise testing; and mean arterial blood pressure (MAP). Within-groups, paired t-tests assessed whether post- minus pre-intervention change scores (mean ± standard deviation) were significant (p&lt;0.05). Results: To date, 13 patients (61.5% White; 84.6% female) have completed the study; 8 additional patients are expected to complete the study by February 2023. Following the intervention, the CHAT group (n=5) had mean changes in body mass, fat mass, and lean mass of -2.4 ± 4.0%, -3.3 ± 4.3 kg, and 1.0 ± 1.0 kg (all p&gt;0.05). Those randomized to SWET (n=8) had significant improvements in body mass (-5.0 ± 2.9%; p=0.002) and fat mass (-4.3 ± 2.8 kg; p=0.004), and no change in lean mass (0.4 ± 1.2 kg; p=0.36). The CHAT group had a 1.1 ± 6.7% change in peak VO 2 (p=0.81), while the SWET group exhibited a 10.6 ± 16.7% change (p=0.13). There were minimal changes in MAP for both groups (CHAT: -1.0 ± 1.0 mmHg; SWET: -0.4 ± 1.2 mmHg). Conclusions: Preliminary findings indicate that, as compared to CHAT, the SWET intervention elicits beneficial changes in body mass, fat mass, and cardiorespiratory fitness. As the SWET-RA trial is pioneering a remotely delivered program, results from this study will help guide lifestyle intervention implementation to improve CVD risk in larger groups of patients with RA.

Abstract P139: Behavioral Weight Loss Programs for Cancer Survivors: A Non-Randomized Clinical Trial

Background: Clinical trials for weight loss in cancer survivors have been shown to be safe and effective. Pragmatic approaches are needed to facilitate broader adoption. The ASPIRE study evaluates real-world, lifestyle weight loss programs in Maryland on reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) outcomes. Here we report 6-month data on weight change. Methods: Participants were adults with overweight or obesity, who had a history of solid malignant tumors and completed curative intent treatment. The exclusion criteria were minimized to increase generalizability. Participants self-selected 1 of 3 programs: the Self-Directed (SD) Program provided evidence-based, written materials; the App-Directed (AD) Program additionally provided a commercially available, free smartphone app and weekly diet and exercise tips; and the Coach-Directed (CD) Program additionally included 1-on-1 telephonic coaching. SD and AD had versions with and without weight tracking; CD required weight tracking. Weights were transmitted to the study team using cellular technology with the scales provided and collected at baseline, 3, 6, and 12 months. Results: 5,644 cancer survivors were invited, mostly via electronic health records; 9% expressed interest. Of these, 67% enrolled (total n=340; n=240 in weight tracking programs; 54% black, 74% women.) Participants in CD were younger, more likely to be women, less likely to have bachelor’s degree, and weighed more than those in SD. At 6m, weights were obtained from 97.5% of participants. Within-program weight reduction was most significant in CD. In the adjusted mixed-effects models, compared with SD participants, CD participants achieved significant weight reduction (see Table) Conclusion: Remotely delivered weight loss programs are desirable and can be broad- reach. Intervention with remote coaching was effective. While selected by many participants, app-directed program with weight tracking but without coaching led to small weight reduction.

Randomised controlled trial of breast cancer and multiple disease prevention weight loss programmes vs written advice amongst women attending a breast cancer family history clinic

BackgroundOverweight and obesity are common amongst women attending breast cancer Family History, Risk and Prevention Clinics (FHRPCs). Overweight increases risk of breast cancer (BC) and conditions including1 cardiovascular disease (CVD) and type-2 diabetes (T2D). Clinics provide written health behaviour advice with is likely to have minimal effects. We assessed efficacy of two remotely delivered weight loss programmes vs. written advice.Method210 women with overweight or obesity attending three UK FHRPCs were randomised to either a BC prevention programme (BCPP) framed to reduce risk of BC (n = 86), a multiple disease prevention programme (MDPP) framed to reduce risk of BC, CVD and T2D (n = 87), or written advice (n = 37). Change in weight and health behaviours were assessed at 12-months.ResultsWeight loss at 12 months was −6.3% (−8.2, −4.5) in BCPP, −6.0% (−7.9, −4.2) in MDPP and −3.3% (−6.2, −0.5) in the written group (p = 0.451 across groups). The percentage losing ≥10% weight in these groups were respectively 34%, 23% and 14% (p = 0.038 across groups).DiscussionBCPP and MDPP programmes resulted in more women achieving ≥10% weight loss, but no evidence of additional benefits of MDPP. A multicentre RCT to test the BCPP across UK FHRPCs is warranted.Clinical Trial Registration ISRCTN16431108.

The impact of a group based, remotely delivered weight loss intervention in women with polycystic ovary syndrome on ovulation, quality of life and body composition.

BackgroundObesity and visceral adiposity are associated with anovulation. The most common cause of anovulatory infertility in women of reproductive age is polycystic ovary syndrome (PCOS). We conducted this formative study to examine the effects of a remotely delivered, group-based lifestyle program for women with overweight/obesity and PCOS on ovulation, PCOS related quality of life (PCOSQ) and body composition.MethodsWomen with anovulatory infertility caused by PCOS (N = 12) were enrolled in a 6-month high-intensity weight management intervention. Participants were asked to attend 45 min., group behavioral lifestyle sessions, delivered remotely by a registered dietitian weekly across the 6-mo. study and comply with a reduced energy diet, increased physical activity (225 min/wk.), and self-monitoring of weight, physical activity and diet. Diets consisted of five portion-controlled meals (three shakes + two entrees), at least five servings of fruits/vegetables, and ad libitum non-caloric beverages daily. Wilcoxon signed-rank tests were used to assess changes in outcomes across the intervention.ResultsTwelve women received the weight loss intervention (mean age = 32.7 ± 4.2 yrs., BMI = 36.8 ± 4.5 kg/m2, 92% college educated), and 8 completed the intervention. Eight (67%) women reported ovulating during the intervention with an average time to ovulation of 57 ± 45 days. Women lost an average of 3.85 ± 5.94 kg (p = 0.02), decreased their BMI (−1.61 ± 1.09 kg/m2; p = 0.04), and waist circumference (−4.54 ± 3.03 cm; p = 0.04) over the 6-mo. intervention. Additionally, self-reported menstrual problems measured by PCOSQ significantly improved over the study (p = 0.03).ConclusionA multicomponent group-based, remotely delivered, lifestyle intervention delivered remotely is a feasible and potentially scalable option to achieve clinically relevant (>3%) weight loss in women with PCOS.Clinical trial registrationwww.clinicaltrials.gov, identifier: NCT03677362.

Digital Therapeutics Care Utilizing Genetic and Gut Microbiome Signals for the Management of Functional Gastrointestinal Disorders: Results From a Preliminary Retrospective Study.

Diet and lifestyle-related illnesses including functional gastrointestinal disorders (FGIDs) and obesity are rapidly emerging health issues worldwide. Research has focused on addressing FGIDs via in-person cognitive-behavioral therapies, diet modulation and pharmaceutical intervention. Yet, there is paucity of research reporting on digital therapeutics care delivering weight loss and reduction of FGID symptom severity, and on modeling FGID status and symptom severity reduction including personalized genomic SNPs and gut microbiome signals. Our aim for this study was to assess how effective a digital therapeutics intervention personalized on genomic SNPs and gut microbiome signals was at reducing symptomatology of FGIDs on individuals that successfully lost body weight. We also aimed at modeling FGID status and FGID symptom severity reduction using demographics, genomic SNPs, and gut microbiome variables. This study sought to train a logistic regression model to differentiate the FGID status of subjects enrolled in a digital therapeutics care program using demographic, genetic, and baseline microbiome data. We also trained linear regression models to ascertain changes in FGID symptom severity of subjects at the time of achieving 5% or more of body weight loss compared to baseline. For this we utilized a cohort of 177 adults who reached 5% or more weight loss on the Digbi Health personalized digital care program, who were retrospectively surveyed about changes in symptom severity of their FGIDs and other comorbidities before and after the program. Gut microbiome taxa and demographics were the strongest predictors of FGID status. The digital therapeutics program implemented, reduced the summative severity of symptoms for 89.42% (93/104) of users who reported FGIDs. Reduction in summative FGID symptom severity and IBS symptom severity were best modeled by a mixture of genomic and microbiome predictors, whereas reduction in diarrhea and constipation symptom severity were best modeled by microbiome predictors only. This preliminary retrospective study generated diagnostic models for FGID status as well as therapeutic models for reduction of FGID symptom severity. Moreover, these therapeutic models generate testable hypotheses for associations of a number of biomarkers in the prognosis of FGIDs symptomatology.

Dietary and Physical Activity Changes and Adherence to WCRF/AICR Cancer Prevention Recommendations following a Remotely Delivered Weight Loss Intervention for Female Breast Cancer Survivors: The Living Well after Breast Cancer Randomized Controlled Trial

BackgroundDiet, exercise, and weight management are key in improving outcomes for breast cancer survivors, with international recommendations for cancer survivors relating to these behaviors. However, few behavioral interventions have reported outcomes aligned specifically with these recommendations. ObjectiveTo evaluate a remotely delivered weight loss intervention vs usual care for female breast cancer survivors, on changes in multiple diet and physical activity behaviors. DesignA randomized controlled trial with assessments at study baseline, 6-, 12-, and 18 months (ie, mid-intervention, post-intervention, and non-contact follow-up). Participants/settingParticipants were recruited between October 2012 and December 2014 through hospitals in Brisbane, Australia, and the state-based cancer registry. Eligible participants (women aged 18 to 75 years with body mass index 25 to 45 kg/m2 who were diagnosed with stage I through III breast cancer during previous 2 years) were randomly allocated to intervention (n = 79) or usual care (n = 80). InterventionParticipants randomized to the intervention group received 22 counseling telephone calls targeting diet and physical activity aimed at achieving 5% to 10% weight loss, and optional text messages, over 12 months. Usual care participants received their standard medical care and brief feedback following each assessment, which was similar to that provided to intervention participants with the exception that usual care participants’ results were not compared with national and study recommendations. Main outcome measuresDietary intake (24-hour recalls), physical activity (hip-worn GT3X+ accelerometer [Actigraph]), sitting time (thigh-worn activPAL3 [PAL Technologies Limited), and adherence to World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations for cancer survivors (0 to 7 score) were measured at each assessment, with data collected between November 2012 and October 2016. Statistical analyses performedIntervention effects were assessed by linear mixed models, accounting for repeated measures and baseline values. Significance was set at P < 0.05. ResultsAt baseline, participants were aged 55 ± 9 years, with a body mass index of 31.4 ± 5.0 kg/m2, 10.7 ± 5.0 months postdiagnosis, and primarily non-minority. At baseline, only 8% (n = 12) of participants met ≥5 out of seven WCRF/AICR recommendations (WCRF/AICR adherence score = 3.8 ± 1.0). At 12 months, significant intervention effects were observed in walking/running (+21 minutes/week; 95% CI 4 to 38) and WCRF/AICR adherence scores (+0.3 points; 95% CI 0.0 to 0.6) only. At 18 months, significant intervention effects were observed for energy intake (–229 kcal/day energy; 95% CI –373 to –84), total fat (–10 g/day; 95% CI –18 to –2), and saturated fat (–5 g/day; 95% CI –9 to –1), and were sustained for WCRF/AICR adherence scores (+0.5 points; 95% CI 0.2 to 0.8). ConclusionsThis remotely delivered weight loss intervention led to sustained improvements in WCRF/AICR adherence scores, and some improvements in diet and physical activity. These findings provide support for the health benefit of programs targeting lifestyle behaviors in line with cancer survivor recommendations, and the potential for dissemination of such programs for women following treatment for early-stage breast cancer.

Effect of a Remotely Delivered Weight Loss Intervention in Early-Stage Breast Cancer: Randomized Controlled Trial.

Limited evidence exists on the effects of weight loss on chronic disease risk and patient-reported outcomes in breast cancer survivors. Breast cancer survivors (stage I–III; body mass index 25–45 kg/m2) were randomized to a 12-month, remotely delivered (22 telephone calls, mailed material, optional text messages) weight loss (diet and physical activity) intervention (n = 79) or usual care (n = 80). Weight loss (primary outcome), body composition, metabolic syndrome risk score and components, quality of life, fatigue, musculoskeletal pain, menopausal symptoms, fear of recurrence, and body image were assessed at baseline, 6 months, 12 months (primary endpoint), and 18 months. Participants were 55 ± 9 years and 10.7 ± 5.0 months post-diagnosis; retention was 81.8% (12 months) and 80.5% (18 months). At 12-months, intervention participants had significantly greater improvements in weight (−4.5% [95%CI: −6.5, −2.5]; p < 0.001), fat mass (−3.3 kg [−4.8, −1.9]; p < 0.001), metabolic syndrome risk score (−0.19 [−0.32, −0.05]; p = 0.006), waist circumference (−3.2 cm [−5.5, −0.9]; p = 0.007), fasting plasma glucose (−0.23 mmol/L [−0.44, −0.02]; p = 0.032), physical quality of life (2.7 [0.7, 4.6]; p = 0.007; Cohen’s effect size (d) = 0.40), musculoskeletal pain (−0.5 [−0.8, −0.2]; p = 0.003; d = 0.49), and body image (−0.2 [−0.4, −0.0]; p = 0.030; d = 0.31) than usual care. At 18 months, effects on weight, adiposity, and metabolic syndrome risk scores were sustained; however, significant reductions in lean mass were observed (−1.1 kg [−1.7, −0.4]; p < 0.001). This intervention led to sustained improvements in adiposity and metabolic syndrome risk.

Examining community mental health providers'delivery of structured weight loss intervention to youth with serious emotional disturbance: An application of the theory of planned behaviour.

Rates of overweight and obesity are disproportionately high among youth with serious emotional disturbance (SED). Little is known about community mental health providers' delivery of weight loss interventions to this vulnerable population. This study examined attitudinal predictors of their providers' intentions to deliver weight loss interventions to youth with SED using the theory of planned behaviour. This study used a cross-sectional, single-time-point design to examine the relationship of the theory of planned behaviour constructs with behavioural intention. Community mental health providers (n = 101) serving youth with SED in the United States completed online clinical practice and theory of planned behaviour surveys. We examined the relationship of direct attitude constructs (i.e., attitude towards the behaviour, social norms and perceived behavioural control), role beliefs and moral norms with behavioural intention. Analyses included a confirmatory factor analysis and two-step linear regression. The structure of the model and the reliability of the questionnaire were supported. Direct attitude constructs, role beliefs and moral norms predicted behavioural intention to deliver weight loss interventions. While there is debate about the usefulness of the theory of planned behaviour, our results showed that traditional and newer attitudinal constructs appear to influence provider intentions to deliver weight loss interventions to youth with SED. Findings suggest preliminary strategies to increase provider intentions. This study was designed and the results were interpreted as part of a larger, community-based participatory research effort that included input from youth, families, providers, administrators and researchers. Collaborative discussions with community mental health providers and administrators particularly contributed to the study question asked as well as interpretation of results.

Is Burden Always Bad? Emerging Low-Burden Approaches to Mobile Dietary Self-monitoring and the Role Burden Plays with Engagement

The goal of this paper is to provide an overview of the emerging lower-burden mobile dietary self-monitoring approaches and provide a case study highlighting the role that habit formation (regularly logging meals) and burden played in two weight loss interventions examining three different methods of dietary self-monitoring: two lower-burden (wearable device and photo-based) and one higher-burden (standard database app). A review of the literature of current methods for dietary self-monitoring was conducted. In addition, a case study using data from two different remotely delivered weight loss interventions is presented. Participants (n = 100) were randomly assigned to one of the three mobile diet tracking methods. At 6 weeks, participants were asked seven questions on a Likert scale (1 completely disagree; 7 completely agree) assessing factors such as habit formation (e.g., remembering to use the device). Several emerging methods of dietary self-monitoring are presented. For the case study, the wearable device (5.0 ± 1.81) and photo-based app (4.0 ± 2.24) participants found it more difficult to remember to use their device than did the standard database app (2.35 ± 1.79; p < 0.001) participants, indicating that habit formation was stronger in the Standard App condition than the approaches that were aimed to be of lower burden. Gaining a better understanding of the current and innovative approaches to dietary self-monitoring, as well as considering how burden and habit formation may be influencing sustained engagement could help inform future effective dietary interventions.

What a weight loss programme should contain if people with obesity were asked - a qualitative analysis within the DO:IT study

BackgroundCurrently 1.9 billion adults worldwide are estimated to be overweight or obese. In Denmark the municipalities hold the responsibility to deliver weight loss programmes to overweight and obese citizens. There is a tendency to assume that weight loss programmes that show positive effects in specialized hospital settings are directly transferrable to municipal settings. However, municipality-based weight loss programmes have not produced clinically significant reductions in body weight. One reason for this may be that much research evidence regarding obesity programming neglects the perspectives of people with obesity. The first step in developing a weight loss programme designed for municipal settings is to understand what people with obesity want and need from a programme. The aim of this study was to examine what people with obesity find important in a weight loss programme for weight loss and weight maintenance.MethodsWe used a qualitative, explorative, descriptive design with individual interviews. We included men and women age 17 and older with a BMI ≥ 25 kg/m2. Participants were recruited from the wait lists of 13 municipality programmes and through Facebook posts. Data were analyzed using content analysis.ResultsThirty-four participants with overweight or obesity were individually interviewed (ages between 19 and 74). Findings suggest that weight loss programmes should; a) support participants in structuring days; b) consider the use of replacement activities to reduce cognitive and emotional burden; c) aide individuals to increase self-efficacy and; d) include family and friends as well as health professionals and peers in the weight loss process. Diet and exercise, while important, should be balanced with other meaningful activities in everyday life.ConclusionParticipants in this study wished to balance weight loss related activities with overall everyday life as well as finding the believe in their ability to lose weight in social relations.

Obesity Treatment in African American Churches: Current Treatment Targets and Preferences among Parishioners.

Obesity is prevalent among African Americans, and church-based weight management programs may help address this public health issue. To develop more effective interventions, a survey was administered to members of a large, African American faith-based organization that assessed weight management intervention targets and preferences. Respondents (N = 1,439) represented the Midwestern and Southern United States. Mean body mass index was 30.8 ± 9.2 kg/m2, and 82.5% of respondents were overweight/obese. The majority (65.0%) wanted a weight management intervention conducted with the church and preferred an in-person (69.0%), group-based (68.0%) program that meets weekly for one hour or less (72%) and addresses identified barriers including access to healthy foods, childcare, and physical activity support. Church support was linked to better dietary quality and higher physical activity among parishioners (p's ≤ 0.02), suggesting church support may be important for healthy eating and exercise. This study provides a clear path forward for developing and delivering weight loss interventions within African American churches.

The Effects of a Remote-based Weight Loss Program on Adipocytokines, Metabolic Markers, and Telomere Length in Breast Cancer Survivors: the POWER-Remote Trial.

We initiated a clinical trial to determine the proportion of breast cancer survivors achieving ≥5% weight loss using a remotely delivered weight loss intervention (POWER-remote) or a self-directed approach, and to determine the effects of the intervention on biomarkers of cancer risk including metabolism, inflammation, and telomere length. Women with stage 0-III breast cancer, who completed local therapy and chemotherapy, with a body mass index ≥25 kg/m2 were randomized to a 12-month intervention (POWER-remote) versus a self-directed approach. The primary objective was to determine the number of women who achieved at least 5% weight loss at 6 months. We assessed baseline and 6-month change in a panel of adipocytokines (adiponectin, leptin, resistin, HGF, NGF, PAI1, TNFα, MCP1, IL1β, IL6, and IL8), metabolic factors (insulin, glucose, lipids, hs-CRP), and telomere length in peripheral blood mononuclear cells. From 2013 to 2015, 96 women were enrolled, and 87 were evaluable for the primary analysis; 45 to POWER-remote and 42 to self-directed. At 6 months, 51% of women randomized to POWER-remote lost ≥5% of their baseline body weight, compared with 12% in the self-directed arm [OR, 7.9; 95% confidence interval (CI), 2.6-23.9; P = 0.0003]; proportion were similar at 12 months (51% vs 17%, respectively, P = 0.003). Weight loss correlated with significant decreases in leptin, and favorable modulation of inflammatory cytokines and lipid profiles. There was no significant change in telomere length at 6 months. A remotely delivered weight loss intervention resulted in significant weight loss in breast cancer survivors, and favorable effects on several biomarkers.