Facilitate Weight Loss Research Articles

Effects on physiologic measures of appetite from intragastric balloon and endoscopic sleeve gastroplasty: results of a prospective study.

Background:Endoscopic bariatric therapies can help address widening management gaps in obesity. Their ability to facilitate weight loss is largely tied to influences on appetite through perturbations of gastric emptying and accommodation. As these tools gain traction in obesity therapy, their physiologic underpinnings require exploration, which may enhance efficacy, tolerance, and patient-tailored care.Methods:We prospectively assessed consecutive subjects with fluid-filled intragastric balloons (IGBs) (n = 18) placed between October 2016 and June 2017 or underwent endoscopic sleeve gastroplasty (ESG) (n = 23) from March 2018 to June 2018. Patients underwent physiologic appraisal at 3 months with 13C-spirulina-based gastric emptying breath test to determine time to half emptying (T50), as well as maximum tolerated volume (MTV) of a standard nutrient drink test. Changes in T50 and MTV at 3 months were compared with percent total body weight loss (%TBWL) at 3 and 6 months using best-fit linear regression.Results:The change in T50 at 3 months correlated with %TBWL at 3 months for IGB (P = 0.01) and ESG (P = 0.01) but with greater impact on %TBWL in IGB compared to ESG (R2 = 0.42 vs. 0.26). Change in T50 at 3 months was predictive of weight loss at 6 months for IGB (P = 0.01) but not ESG (P = 0.11). ESG was associated with greater decrease in MTV compared to IGB (340.25 ± 297.97 mL vs. 183.00 ± 217.13 mL, P = 0.08), indicting an enhanced effect on satiation through decreased gastric accommodation. Changes in MTV at 3 months did not correlate with %TBWL for either IGB (P = 0.26) or ESG (P = 0.49) but trended toward significance for predicting %TBWL at 6 months for ESG (P = 0.06) but not IGB (P = 0.19).Conclusion:IGB and ESG both induce weight loss but likely through distinct gastric motor function phenotypes, and gastric emptying may predict future weight loss in patients with IGB.

Male and Female Mice Respond Differently to Short‐term Ketogenic Diet

The ketogenic diet (KD) is a high‐fat, low‐carbohydrate diet that results in the elevation of ketone bodies in the blood, known as ketosis. This metabolic consequence has been suggested as a method for treating neurological conditions, improving exercise performance, and facilitating weight loss. Since most research studies primarily use male populations, less information is available regarding potential sex differences in response to various interventions. Therefore, the purpose of this study was to explore the sex differences in physical, metabolic, and motor performance in mice fed the KD. Male (n=29) and female (n=26) C57BL/6 were randomly assigned to KD (90% fat, 1% carbohydrate) or chow (13% fat, 60% carbohydrate) group for 6 weeks. Body weight and food intake were tracked weekly. At baseline and every 2 weeks, the Rotarod performance test assessed motor coordination and activity levels in all mice. After 6 weeks, adipose tissue, quadriceps, and heart were weighed to observe changes in organ mass. Triglyceride (TG) was measured in the heart, liver, and quadriceps. Blood was drawn to measure changes in serum metabolite levels. Final body weights in Male‐KD were similar to Male‐chow; however, Female‐KD mice were significantly higher relative to Female‐chow. Although adipose tissue mass increased significantly in both KD groups, the increase was ~40% higher in Female‐KD. Quadriceps mass was lower in Male‐KD compared to Male‐chow (188±6 vs.169±5 mg, P<0.05) while not statistically different in Female‐KD relative to Female‐chow. In contrast, heart weight to tibia length ratios (HW:TL) were increased in Female‐KD compared to Female‐chow (5.08±0.06 vs.5.58±0.12, P<0.05) with no significant change in Male‐KD. The KD resulted in similar measures of ketosis, glucose intolerance, and hyperlipidemia in Male‐KD and Female‐KD. While cardiac TG content tended to increase in Male‐KD and Female‐KD to a similar extent (P<0.10), the increase in hepatic TG content was ~30% lower in Female‐KD (P<0.05 vs. Male‐KD). Although Rotarod performance was higher in Female‐KD compared to Male‐KD at week 2 (28.6±3.1 vs.15.2±1.6 sec, P<0.05), performance decreased in Female‐KD and increased in Male‐KD over the remaining weeks and was similar at week 6 (25.7±2.0 vs.20.7±2.0 sec). In summary, these data show sex specific differences in weight gain, adiposity, and muscle (i.e., cardiac and skeletal) mass changes in response to a short‐term KD. Moreover, the data suggest that male and female mice on the KD differ in time sensitive adaptation to ketosis and motor activity. Since both males and females increase adiposity, develop glucose intolerance, and hyperlipidemia, this study questions the viability of the KD as a potential tool for weight loss, and importantly, highlights sex differences in the adaptation to the KD.

Successful correction of hyperglycemia is critical for weight loss and a decrease in cardiovascular risk in obese patients

Weight loss is recommended for obese patients with cardiovascular risk; however, it remains questionable how hyperglycemia affects this process. To address this problem, we aimed to determine the association between weight loss, lipid profile, and body mass parameters in obese normoglycemic and hyperglycemic patients. Obese (body mass index30 kg/m2) normoglycemic and hyperglycemic volunteers were placed on a weight reduction program that included a balanced, low-calorie diet and moderate exercise for 6 months. Participants were assessed for serum glucose, β-cell functions, insulin resistance, lipid metabolism, lipoprotein profile, and body mass parameters. This weight reduction program fully normalized serum glucose levels only in a subpopulation of patients. These individuals also exhibited a significant reduction in body weight, and significant improvement in serum lipid profile and insulin resistance. In contrast, the patients that remained hyperglycemic were characterized by persistent insulin resistance, increased levels of atherogenic fractions of LDL and HDL lipoproteins, and elevated values of a modified Atherogenic Index of Plasma. Correlation analysis indicated a strong positive association between the modified Atherogenic Index of Plasma with atherogenic lipid profile, insulin resistance, and body mass parameters, indicating its usefulness in clinical studies in obese patients. Overall, our data indicate that successful treatment of hyperglycemia facilitates weight loss and improves the composition of blood lipids, while persisting hyperglycemia negatively affects the weight loss process and maintains an atherogenic lipid profile. Because hyperglycemia predisposes to cardiovascular disorders, its correction should be the primary goal during weight reduction therapy.

Use and perceived effectiveness of complementary medicines for weight loss in adult women

Objectives: Complementary medicines (CMs) that are formulated to facilitate weight loss are a popular and widely available treatment option, particularly among women. There is limited research regarding their use in the South African context. The aim of this study was to gather information on the use and perceived effectiveness of CMs for weight loss among adult women. Design: A quantitative, descriptive survey design was used. Setting: Johannesburg, South Africa. Subjects: A purposive sample of women over the age of 18 years who had used CMs for weight loss within the past five years were recruited from health stores and a university campus healthcare centre. Outcome measures: Data were obtained through a self-administered 29-item, paper-and-pen questionnaire. Responses were descriptively analysed using cross-tabulation, multiple response analysis and frequency tables. Results: Data from 160 questionnaires were analysed and the results demonstrated that a wide variety of CM products are used for weight loss, with branded combination products, green tea, Garcinia cambogia and conjugated linoleic acid being the most popular. Most participants also adopted lifestyle interventions such as exercise and calorie restriction during their weight loss attempt. While minor side effects were experienced by over half of the participants, the majority were satisfied with their product choice as well as the amount of weight that they lost. Conclusion: Most participants perceived their CM weight loss product of choice to be effective. However, other concomitant weight-loss strategies that were employed may have been responsible for these results. Despite their popularity, there is only very limited research surrounding the safety and efficacy of these weight-loss products, with most studies being conducted on single constituents rather than whole formulations as sold on the market. Healthcare providers should encourage the disclosure of the use of CM weight-loss products to ensure safe and effective patient care and mitigate the potential risks associated with their inappropriate use.

Transcutaneous auricular vagus nerve stimulation augments postprandial inhibition of ghrelin.

Vagus nerve stimulation (VNS) facilitates weight loss in animals and patients treated with VNS for depression or epilepsy. Likewise, chronic transcutaneous auricular VNS (taVNS) reduces weight gain and improves glucose tolerance in Zucker diabetic fatty rats. If these metabolic effects of taVNS observed in rats translate to humans is unknown. Therefore, the hypothesis of this study was that acute application of taVNS affects glucotropic and orexigenic hormones which could potentially facilitate weight loss and improve glucose tolerance if taVNS were applied chronically. In two single‐blinded randomized cross‐over protocols, blood glucose levels, plasma concentrations of insulin, C‐peptide, glucagon, leptin, and ghrelin, together with heart rate variability and baroreceptor‐heart rate reflex sensitivity were determined before and after taVNS (left ear, 10 Hz, 300 µs, 2.0–2.5 mA, 30 min) or sham‐taVNS (electrode attached to ear with the stimulator turned off). In a first protocol, subjects (n = 16) were fasted throughout the protocol and in a second protocol, subjects (n = 10) received a high‐calorie beverage (220 kCal) after the first blood sample, just before initiation of taVNS or sham‐taVNS. No significant effects of taVNS on heart rate variability and baroreceptor‐heart rate reflex sensitivity and only minor effects on glucotropic hormones were observed. However, in the second protocol taVNS significantly lowered postprandial plasma ghrelin levels (taVNS: −115.5 ± 28.3 pg/ml vs. sham‐taVNS: −51.2 ± 30.6 pg/ml, p < 0.05). This finding provides a rationale for follow‐up studies testing the hypothesis that chronic application of taVNS may reduce food intake through inhibition of ghrelin and, therefore, may indirectly improve glucose tolerance through weight loss.

Probiotic Strains Isolated from an Olympic Woman's Weightlifting Gold Medalist Increase Weight Loss and Exercise Performance in a Mouse Model.

Obesity is a worldwide health problem. Calorie-restricted diets constitute a common intervention for treating obesity. However, an improper calorie-restricted diet can lead to malnutrition, fatigue, poor concretion, muscle loss, and reduced exercise performance. Probiotics have been introduced as an alternative treatment for obesity. In the present study, we tested the weight loss and exercise performance enhancement effectiveness of probiotic strains of different origins, including four isolated from an Olympic weightlifting gold medalist (Bifidobacterium longum subsp. longum OLP-01, Lactobacillus plantarum PL-02, Lactobacillus salivarius subsp. salicinius SA-03, and Lactococcus lactis subsp. lactis LY-66). A high-fat diet (HFD) was used to induce obesity in 16 groups of mice (n = 8/group). The mice were administered probiotic supplements at a dosage of 4.1 × 109 CFU/kg/day for 10 weeks. All probiotic supplementation groups showed a significant reduction in body weight and fat mass compared with the HFD group. TYCA06, CS-773, BLI-02, PL-02, bv-77, and OLP-01 were the most effective in facilitating weight loss and fat reduction, which may be due to fatty-acid absorbing activity. PL-02, LY-66, TYCA06, CS-773, and OLP-01 elevated the animals’ grip strength and exhaustive running duration. PL-02, LY-66, and OLP-01 increased tissue glycogen (liver and muscle) levels and muscle capillary density and reduced blood lactate production levels after exercise. In conclusion, OLP-01, PL-02, LY-66, TYCA06, and CS-773 were highly effective in enhancing weight loss and exercise performance. This study should be repeated on humans in the future to further confirm the findings.

Dialectical Behavior Therapy for Emotional and Mindless Eating After Bariatric Surgery: a Prospective Exploratory Cohort Study.

To assess the effect of dialectical behavior therapy (DBT) on emotional and mindless eating and, consequently, body mass index (BMI) loss, in patients who have undergone bariatric surgery. A prospective exploratory cohort study was conducted with two groups of patients who had undergone bariatric surgery: the DBT group received DBT group skills training sessions, while the control group received no intervention. Outcome measurements included BMI and scores of the Emotional Eating Scale (EES) and Mindful Eating Questionnaire (MEQ). The study included 36 women: 18 in each group. In the DBT group, the interval from surgery was 11.17 ± 7.12months, and in the control group 10.89 ± 5.74. Laparoscopic sleeve gastrectomy was done in 88.9% and 83.3% of patients in the DBT and control groups respectively. The rest underwent Roux-en-Y gastric bypass. The DBT group showed significant changes in overall and subscale scores of the EES and MEQ and BMI in kg/m2 after 6months of follow-up. BMI in kg/m2 changed from mean ± SD 35.45 ± 6.17 to 28.47 ± 4.28 in the DBT group, in control 35.88 ± 5.07 to 31.56 ± 3.71. The excess weight loss percentage (EWL%) in the DBT was mean ± SD 75.3 ± 17.9 and in the control was 63.6 ± 14.5. In the DBT group, the EES score and MEQ score changed from mean ± SD 45.06 ± 20.19 to 20.50 ± 13.40 and 11.52 ± 2.02 to 15.87 ± 1.92, respectively. The control group showed no significant change in scores. DBT skills training can reduce emotional eating, increase mindful eating, and facilitate weight loss after bariatric surgery.

Delay Discounting as a Potential Therapeutic Target for Weight Loss in Breast Cancer Survivors.

Simple SummaryObesity is a rising health epidemic in breast cancer survivors and associated with multiple negative health sequalae and increased mortality. Delay Discounting (DD) is a behavioral economic measure of an individual’s valuation of future outcomes. While higher DD correlates with obesity in the general adult population, valuation of the future may impact cancer survivors differently due to their unique experiences. We assessed cross-sectional associations between DD, BMI, and healthy lifestyle behaviors in an exploratory analysis of 89 women with hormone receptor positive non-metastatic breast cancer. We found higher DD to be associated with obesity and decreased frequency of vegetable consumption. Future studies should investigate DD as a therapeutic target for novel behavioral interventions in breast cancer survivors affected by obesity. This may improve valuation of the future, increase healthy lifestyle behaviors, and facilitate weight loss to promote overall health and longevity in this population.Obesity in breast cancer (BC) survivors is associated with increased mortality. Delay discounting (DD) is a behavioral economic measure of how individuals value future outcomes. Higher DD correlates with obesity in the general population. Valuation of the future may be associated with obesity differently in cancer survivors. This study evaluated the relationship between DD and obesity in BC survivors. We report an exploratory analysis assessing cross-sectional associations between DD, BMI, and lifestyle behaviors (vegetable and fruit consumption, exercise) related to obesity in 89 women with hormone receptor positive non-metastatic BC. Multivariate linear regression analysis examined demographic and lifestyle behavior variables associated with both BMI and DD. Greater willingness to wait for larger, delayed rewards (lower DD) was significantly associated with lower BMI (standardized beta = −0.32; p < 0.01), independent of age, race, income, time since diagnosis, and menopausal status. There was no significant association between DD and fruit consumption or exercise frequency. Vegetable consumption was significantly associated with lower DD (standardized beta = 0.24; p < 0.05). Higher DD is associated with obesity and decreased frequency of vegetable consumption in BC survivors. Future studies should investigate DD as a therapeutic target for behavioral interventions to facilitate weight loss and promote longevity in this population.

Does hypnosis result in greater weight loss compared to conventional approach?

ABSTRACT Hypnosis has been increasingly used in recent years as an alternative treatment to maintain well-being. Yet, limited evidence is available regarding its role in weight management, especially in Malaysia. Hence, this quasi-experimental study was conducted to evaluate the effectiveness of hypnosis on weight loss and body composition (body mass index, waist circumference and body fat percentage) among staff and students of a public university in Terengganu, Malaysia. Participants with body mass index (BMI) ≥ 25.0 kg/m2 were randomly assigned to either intervention group (IG = 53) or control group (CG = 54), for 12 weeks. All participants received health education (diet + exercise + behavioral recommendations) with those in IG had additional three hypnotherapy sessions, once a month. Body weight was measured at week 1, 7, and 12 while body compositions were measured at weeks 1 and 12. Descriptive, univariate, and repeated-measures analysis of covariance (ANCOVA) were utilized. A total of 104 participants completed the trial (mean age = 26.28 ± 8.01; female = 82.2%; BMI = 31.39 ± 4.89). A significant weight loss was observed in the intervention (−4.61%) and control (−3.04%) groups (mean difference = −1.57; 95%CI: −2.59, −0.54; p = .003) after 12 weeks. Participants that frequently practiced self-hypnosis lost more weight (−6.27%; t(50) = −5.331, p < .001). Body fat percentage and waist circumference did not significantly change from baseline in both groups. Essentially, the positive outcomes indicated the promising potential of hypnosis as an alternative tool in facilitating weight loss efforts for those in need.

Impact of Laparoscopic Sleeve Gastrectomy on Cardiovascular Pharmacotherapy in Left Ventricular Assist Device Patients.

Left ventricular assist device (LVAD) implantation is increasingly utilized in patients with advanced heart failure and morbid obesity. Laparoscopic sleeve gastrectomy (LSG) can facilitate weight loss in this population and can ultimately change the pharmacokinetics of heart failure therapeutics. In this study, we aimed to explore the changes in cardiovascular pharmacotherapy post LSG intervention. We conducted a retrospective observational cohort study of morbidly obese LVAD patients between 2013 and 2019 at the University of Florida with available pharmacotherapeutic data at 1 and 6 months. Thirteen post-LSG patients and 13 control subjects were included in the final analysis. In the post-LSG group, the mean body mass index decreased significantly (44 ± 5 vs. 34 ± 4.9, P < 0.001), and 7 patients were successfully bridged to cardiac transplantation. Only 3 patients required adjustment of their LVAD speed. Mean return to flow decreased by 8 mm Hg, despite a 45% reduction in the mean number of vasodilators per patient (1.2 vs. 0.7, P = 0.03). Mean weekly warfarin dose decreased by 35% after 6 months (32.9 ± 20.9 vs. 50.7 ± 26.6, P = 0.01). The use of diuretics, vasodilators, and beta-blockers was significantly reduced by 50%, 45%, and 35%, respectively. None of these changes were observed in the control group at 6-month follow-up post LVAD. In this single-center experience, weight loss post LSG is associated with decreased vasodilator, diuretic, and anticoagulant medication requirements in LVAD patients.

Why exercise by itself is often ineffective for weight loss but crucial for weight management

The prevalence of obesity is increasing worldwide, and excess body weight is associated with a substantially increased risk of adverse health conditions. Exercise supports the prevention and management of obesity; however, when used for weight loss, exercise (even at high volumes) is usually relatively ineffective, frequently producing less weight loss than expected based on measured energy expenditure. The difference between observed and expected weight loss is called compensation and it is primarily caused by increases in energy intake in response to exercise (compensatory eating). On the other hand, it has been shown that energy balance and body weight are better regulated in individuals with moderate to high levels of physical activity (i.e., energy intake = energy expenditure) compared to those with a sedentary lifestyle (energy expenditure &lt; energy intake), demonstrating that physical activity and exercise are crucial for long-term maintenance of a healthy weight. Weight loss approaches should combine dietary components (calorie restriction) and physical activity for increased success. Calorie restriction facilitates weight loss while physical activity can support the conservation of fat-free mass to avoid a state of increased hunger, often occurring following calorie restriction interventions due to the associated loss in fat-free mass, which ultimately encourages weight regain.

Weight loss in a digital app-based diabetes prevention program powered by artificial intelligence.

ObjectiveThe National Diabetes Prevention Program (DPP) reduces diabetes incidence and associated medical costs but is typically staffing-intensive, limiting scalability. We evaluated an alternative delivery method with 3933 members of a program powered by conversational Artificial Intelligence (AI) called Lark DPP that has full recognition from the Centers for Disease Control and Prevention (CDC).MethodsWe compared weight loss maintenance at 12 months between two groups: 1) CDC qualifiers who completed ≥4 educational lessons over 9 months (n = 191) and 2) non-qualifiers who did not complete the required CDC lessons but provided weigh-ins at 12 months (n = 223). For a secondary aim, we removed the requirement for a 12-month weight and used logistic regression to investigate predictors of weight nadir in 3148 members.ResultsCDC qualifiers maintained greater weight loss at 12 months than non-qualifiers (M = 5.3%, SE = .8 vs. M = 3.3%, SE = .8; p = .015), with 40% achieving ≥5%. The weight nadir of 3148 members was 4.2% (SE = .1), with 35% achieving ≥5%. Male sex (β = .11; P = .009), weeks with ≥2 weigh-ins (β = .68; P < .0001), and days with an AI-powered coaching exchange (β = .43; P < .0001) were associated with a greater likelihood of achieving ≥5% weight loss.ConclusionsAn AI-powered DPP facilitated weight loss and maintenance commensurate with outcomes of other digital and in-person programs not powered by AI. Beyond CDC lesson completion, engaging with AI coaching and frequent weighing increased the likelihood of achieving ≥5% weight loss. An AI-powered program is an effective method to deliver the DPP in a scalable, resource-efficient manner to keep pace with the prediabetes epidemic.

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.

Pilot study of food-specific go/no-go training for overweight individuals: brain imaging data suggest inhibition shapes food evaluation.

Food-specific go/no-go training might reduce overeating and facilitate weight loss. In this pilot study, we examined whether a food-specific go/no-go training over five weeks, as compared to a non-food-specific training, could produce changes in behavioral and neural responses to food images and body weight. Here, we used a sample of 51 overweight participants divided into training and control groups whose brain activity and food evaluation were measured before and after the training. Compared with the control group, in the training group we found significant reductions in high-calorie food evaluation. We also found lower activations in inhibitory control- and reward-related brain regions in response to high-calorie food images. Further, activation change of the mid-insula in response to the high-calorie food images was positively associated with change in the evaluation of those images. However, we found no evidence for a significant effect of food-specific go/no-go training on body weight change. Our findings highlight that food-specific go/no-go training in overweight individuals can reduce high-calorie food evaluation, but also neural activations in inhibitory control- and reward- related brain regions.

Predictors of Weight Loss and Weight Gain in Weight Management Patients during the COVID-19 Pandemic.

Objective To examine the associations between patient struggles, health, and weight management changes during the COVID-19 pandemic. Methods 585 patients attending a publicly funded clinical weight management program responded to an electronic survey. Results Over half of the patients reported worsened overall health, mental health, physical activity, or diet during the pandemic. Approximately 30% of patients lost ≥3% of their body weight and 21% gained ≥3% of their body weight between March and July of the pandemic. Reports of social isolation was associated with increased odds for weight loss in women (OR = 2.0, 1.2–3.3), while low motivation (OR = 1.9, 1.0–3.7), depression (OR = 2.5, 1.0–6.3), and struggles with carbohydrate intake (OR = 2.1, 1.0–4.3) were associated with weight gain. Cooking more at home/eating less take out was associated with increased likelihood of weight loss (OR = 2.1, 1.1–3.9) and lower odds for weight gain (OR = 0.2, 0.1 to 0.97). Working from home was not associated with weight loss or weight gain (P > 0.6). Conclusion The COVID-19 pandemic is associated with certain factors that may facilitate weight loss and other factors that promote weight gain. Thus, depending on the patient experience during the pandemic, prevention of weight gain may be more appropriate than weight loss.

Efficacy of Interventions That Incorporate Mobile Apps in Facilitating Weight Loss and Health Behavior Change in the Asian Population: Systematic Review and Meta-analysis.

BackgroundSmartphone apps have shown potential in enhancing weight management in Western populations in the short to medium term. With a rapidly growing obesity burden in Asian populations, researchers are turning to apps as a service delivery platform to reach a larger target audience to efficiently address the problem.ObjectiveThis systematic review and meta-analysis aims to determine the efficacy of interventions that incorporate apps in facilitating weight loss and health behavior change in the Asian population.MethodsA total of 6 databases were searched in June 2020. The eligible studies included controlled trials in which an app was used in the intervention. The participants were aged 18 years or older and were of Asian ethnicity. A meta-analysis to test intervention efficacy, subgroup analyses, and post hoc analyses was conducted to determine the effects of adding an app to usual care and study duration. The primary outcome was absolute or percentage weight change, whereas the secondary outcomes were changes to lifestyle behaviors.ResultsA total of 21 studies were included in this review, and 17 (81%) were selected for the meta-analysis. The pooled effect size across 82% (14/17) of the randomized controlled trials for weight change was small to moderate (Hedges g=–0.26; 95% CI –0.41 to –0.11), indicating slightly greater weight loss achieved in the intervention group; however, this may not be representative of long-term studies (lasting for more than a year). Supplementing multicomponent usual care with an app led to greater weight loss (Hedges g=–0.28; 95% CI –0.47 to –0.09). Asian apps were largely culturally adapted and multifunctional, with the most common app features being communication with health professionals and self-monitoring of behaviors and outcomes.ConclusionsMore evidence is required to determine the efficacy of apps in the long term and address the low uptake of apps to maximize the potential of the intervention. Future research should determine the efficacy of each component of the multicomponent intervention to facilitate the designing of studies that are most effective and cost-efficient for weight management.Trial RegistrationPROSPERO CRD42020165240; https://tinyurl.com/2db4tvn6

Adjustable intragastric balloon for treatment of obesity: a multicentre, open-label, randomised clinical trial

Intragastric balloons are anatomy-preserving, minimally invasive obesity therapies. Enhanced tolerance and durability could help broaden clinical adoption. We investigated the safety and efficacy of an adjustable intragastric balloon (aIGB) in adults with obesity. In this prospective, multicentre, open-label, randomised clinical trial done at seven US sites, adults aged 22-65 years with obesity were randomly assigned (2:1) to aIGB with lifestyle intervention or lifestyle intervention alone (control) for 32 weeks. Balloon volume could be increased to facilitate weight loss or decreased for tolerability. Coprimary endpoints included mean percentage total bodyweight loss and responder rate (≥5% total bodyweight loss) at 32 weeks. We used a multiple imputed intention-to-treat population analysis. This study was registered with ClinicalTrials.gov, NCT02812160. Between Aug 9, 2016, and Dec 7, 2018, we randomly assigned 288 patients to aIGB (n=187 [65%]) or control (n=101 [35%]) groups. Mean total bodyweight loss at 32 weeks was 15·0% (95% CI 13·9-16·1) in the aIGB group versus 3·3% (2·0-4·6) in the control group (p<0·0001). Clinical response was observed in 171 (92%) patients in the aIGB group. Adjustments to the aIGB occurred in 145 (80%) patients for weight loss plateau or intolerance. Upward volume adjustment facilitated an additional mean 5·2% (4·5-5·8) total bodyweight loss. Downward volume adjustment allowed 21 (75%) patients in the aIGB group to complete the full duration of therapy. Intolerance caused early removal of the device in 31 (17%) patients. No micronutrient deficiencies were observed in the aIGB cohort. Device-related serious adverse events were observed in seven (4%) patients, without any deaths. When aIGB was combined with lifestyle modification, significant weight loss was achieved and maintained for 6 months following removal. Balloon volume adjustability permitted individualised therapy, maximising weight loss and tolerance. Spatz Medical.

Participant experiences in the Diabetes REmission Clinical Trial (DiRECT).

The Diabetes REmission Clinical Trial (DiRECT) has shown that sustained remission of type 2 diabetes in primary care is achievable through weight loss using total diet replacement (TDR) with continued behavioural support. Understanding participants' experiences can help optimise the intervention, support implementation into healthcare, and understand the process of behaviour change. Thirty-four DiRECT participants were recruited into this embedded qualitative evaluation study. In-person and telephone interviews were conducted before the TDR; at week 6-8 of the TDR; 2weeks into food reintroduction (FR); and at 1year, to learn about participant experiences with the programme. Transcribed narratives were analysed thematically, and we used interpretation to develop overarching themes. Initiation of the TDR and transition to FR were challenging and required increased behavioural support. In general, adhering to TDR proved easier than the participants had anticipated. Some participants chose the optional extension of TDR. Rapid weight loss and changes in diabetes markers provided ongoing motivation. Further weight loss, behavioural support and occasional use of TDR facilitated weight loss maintenance (WLM). A process of behaviour adaptation to change following regime disruption was identified in three stages: (1) expectations of the new, (2) overcoming difficulties with adherence, and (3) acceptance of continuous effort and establishment of routines. The DiRECT intervention was acceptable and regularity, continuity, and tailoring of behavioural support was instrumental in its implementation in primary care. The adaptation process accounts for some of the individual variability of experiences with the intervention and highlights the need for programme flexibility.

Genetic preferences for food

Genetic preferences for food

Tirzepatide: a new low for bodyweight and blood glucose

The normal incretin effect—an enhanced prandial insulin response—is mediated mostly by meal-stimulated release of the intestinal hormones GLP-1 and glucose-dependent insulinotropic peptide (GIP). 1 Drucker DJ Nauck M The incretin system: glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes. Lancet. 2006; 368: 1696-1705 Summary Full Text Full Text PDF PubMed Scopus (2945) Google Scholar Analogues of GLP-1 that act as GLP-1 receptor agonists are established glucose-lowering agents that potentiate insulin release and suppress glucagon in a glucose-dependent manner. GLP-1 receptor agonists also facilitate weight loss via reduced food intake, by creating a feeling of fullness through delayed gastric emptying and by modulating central hunger-satiety controls. GIP probably makes a greater contribution to the normal prandial insulin response than does GLP-1, but GIP was disregarded for therapeutic purposes because its insulinotropic activity is greatly reduced in type 2 diabetes. 2 Gasbjerg LS Helsted MM Hartmann B et al. Separate and combined glucometabolic effects of endogenous glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 in healthy individuals. Diabetes. 2019; 68: 906-917 Crossref PubMed Scopus (69) Google Scholar However, subsequent studies noted that the insulinotropic potency of GIP is restored in individuals with type 2 diabetes if the hyperglycaemia is first reduced by another agent such as insulin. This discovery has brought GIP back into therapeutic consideration, and a new incretin mimetic, tirzepatide, combines GIP receptor agonism with GLP-1 receptor agonism in a single chimeric peptide. 3 Coskun T Sloop KW Loghin C et al. LY3298176, a novel dual GIP and GLP-1 receptor agonist for the treatment of type 2 diabetes mellitus: From discovery to clinical proof of concept. Molecular Metabolism. 2018; 18: 3-14 Crossref PubMed Scopus (160) Google Scholar