Improve Weight Loss Maintenance Research Articles

Incretin-Based Weight Loss Pharmacotherapy: Can Resistance Exercise Optimize Changes in Body Composition?

This narrative review highlights the degree to which new antiobesity medications based on gut-derived nutrient-stimulated hormones (incretins) cause loss of lean mass, and the importance of resistance exercise to preserve muscle. Glucagon-like peptide 1 receptor agonists (GLP-1RA) induce substantial weight loss in randomized trials, effects that may be enhanced in combination with glucose-dependent insulinotropic polypeptide (GIP) receptor agonists. Liraglutide and semaglutide (GLP-1RA), tirzepatide (GLP-1 and GIP receptor dual agonist), and retatrutide (GLP-1, GIP, and glucagon receptor triple agonist) are peptides with incretin agonist activity that induce ∼15-24% weight loss in adults with overweight and obesity, alongside beneficial impacts on blood pressure, cholesterol, blood glucose, and insulin. However, these agents also cause rapid and significant loss of lean mass (∼10% or ∼6 kg), comparable to a decade or more of aging. Maintaining muscle mass and function as humans age is crucial to avoiding sarcopenia and frailty, which are strongly linked to morbidity and mortality. Studies indicate that supervised resistance exercise training interventions with a duration >10 weeks can elicit large increases in lean mass (∼3 kg) and strength (∼25%) in men and women. After a low-calorie diet, combining aerobic exercise with liraglutide improved weight loss maintenance compared with either alone. Retaining lean mass during incretin therapy could blunt body weight (and fat) regain on cessation of weight loss pharmacotherapy. We propose that tailored resistance exercise training be recommended as an adjunct to incretin therapy to optimize changes in body composition by preserving lean mass while achieving fat loss.

Protocol for a multicentre, parallel, randomised, controlled trial on the effect of sweeteners and sweetness enhancers on health, obesity and safety in overweight adults and children: the SWEET project

IntroductionThe aim of this randomised controlled trial (RCT) is to investigate whether prolonged consumption of sweeteners and sweetness enhancers (S&SEs) within a healthy diet will improve weight loss maintenance and...

Sex-specific differences in metabolic outcomes after sleeve gastrectomy and intermittent fasting in obese middle-aged mice.

Despite the high prevalence of obesity among middle-aged subjects, it is unclear if sex differences in middle age affect the metabolic outcomes of obesity therapies. Accordingly, in this study, middle-aged obese female and male mice were randomized to one of three groups: sleeve gastrectomy (SG), sham surgery ad libitum (SH-AL), or sham surgery with weight matching to SG through intermittent fasting with calorie restriction (SH-IF). Comprehensive measures of energy and glucose homeostasis, including energy intake, body weight, energy expenditure, glucose and insulin tolerance, and interscapular brown adipose tissue (iBAT) sympathetic innervation density were obtained. At the end of 8 wk, SG and SH-IF females had better metabolic outcomes than their male counterparts. SG females had improved weight loss maintenance, preservation of fat-free mass (FFM), higher total energy expenditure (TEE), normal locomotor activity, and reduced plasma insulin and white adipose tissue (WAT) inflammatory markers. SH-IF females also had lower plasma insulin and WAT inflammatory markers, and higher TEE than SH-IF males, despite their lower FFM. In addition, SH-IF females had higher iBAT sympathetic nerve density than SG and SH-AL females, whereas there were no differences among males. Notably, SH-IF mice of both sexes had the most improved glucose tolerance, highlighting the benefits of fasting, irrespective of weight loss. Results from this study demonstrate that in middle-aged obese mice, female sex is associated with better metabolic outcomes after SG or IF with calorie restriction. Clinical studies are needed to determine if sex differences should guide the choice of obesity therapies.NEW & NOTEWORTHY SG or IF with calorie restriction produces better metabolic outcomes in females than in males. IF with calorie restriction prevents metabolic adaptation, even in the face of fat-free mass loss. IF with calorie restriction in females only, is associated with increased iBAT sympathetic innervation, which possibly mitigates reductions in energy expenditure secondary to fat-free mass loss. Lastly, IF leads to better glucose homeostasis than SG, irrespective of sex.

Factors Related to Weight Loss Maintenance in the Medium-Long Term after Bariatric Surgery: A Review.

Despite bariatric surgery being the most effective treatment for obesity, some individuals do not respond adequately, especially in the long term. Identifying the predictors of correct weight maintenance in the medium (from 1 to 3 years after surgery) and long term (from 3 years and above) is of vital importance to reduce failure after bariatric surgery; therefore, we summarize the evidence about certain factors, among which we highlight surgical technique, psychological factors, physical activity, adherence to diet, gastrointestinal hormones or neurological factors related to appetite control. We conducted a search in PubMed focused on the last five years (2015–2021). Main findings are as follows: despite Roux-en-Y gastric bypass being more effective in the long term, sleeve gastrectomy shows a more beneficial effectiveness–complications balance; pre-surgical psychological and behavioral evaluation along with post-surgical treatment improve long-term surgical outcomes; physical activity programs after bariatric surgery, in addition to continuous and comprehensive care interventions regarding diet habits, improve weight loss maintenance, but it is necessary to improve adherence; the impact of bariatric surgery on the gut–brain axis seems to influence weight maintenance. In conclusion, although interesting findings exist, the evidence is contradictory in some places, and long-term clinical trials are necessary to draw more robust conclusions.

Factors Associated with Weight Loss Maintenance and Weight Regain Among African American and White Adults Initially Successful at Weight Loss.

Providing ongoing treatment through extended care programs can improve weight loss maintenance (WLM), but the effectiveness of these programs for African Americans (AA) are mixed and may be due to unique cultural factors. To identify, prioritize, and organize factors associated with WLM as experienced by AA and White adults initially successful with weight loss. Adults identified their greatest amount of lifetime weight loss, and those achieving ≥5% weight loss were classified as maintainers (continued >5% weight reduction for ≥1 year) or regainers (≤5% weight reduction) based on current weight. The nominal group technique was conducted to identify and rank WLM facilitators and barriers. Online card sorting tasks and hierarchical clustering were performed to illustrate conceptual relationships between facilitators (maintainers only) and barriers (regainers only). Participants (maintainers, n = 46; regainers, n = 58; 81.7% women, 48.1% AA) identified known factors associated with successful weight management (daily weighing, self-monitoring, regular physical activity, mindful eating). However, the perceived importance of these factors differed between groups (maintainer vs. regainers; AA vs. Whites). Unique factors affecting WLM were also identified (refresher groups recommended by White maintainers and regainers; self-accountability identified by AA maintainers). Salient facilitators and barriers were best represented in 2-3 clusters; each group had ≥1 unique cluster(s) revealing group-specific higher-order domains associated with successful WLM. As lifestyle interventions for WLM (particularly for AA) are developed, attention to the preferences, and lived experiences of these groups is recommended. Strategies targeting physical activity maintenance and autonomy-supportive approaches may improve WLM among AA.

Diet and exercise in the prevention and treatment of type 2 diabetes mellitus.

Evidence from observational studies and randomized trials suggests that prediabetes and type 2 diabetes mellitus (T2DM) can develop in genetically susceptible individuals in parallel with weight (that is, fat) gain. Accordingly, studies show that weight loss can produce remission of T2DM in a dose-dependent manner. A weight loss of ~15 kg, achieved by calorie restriction as part of an intensive management programme, can lead to remission of T2DM in ~80% of patients with obesity and T2DM. However, long-term weight loss maintenance is challenging. Obesity and T2DM are associated with diminished glucose uptake in the brain that impairs the satiating effect of dietary carbohydrate; therefore, carbohydrate restriction might help maintain weight loss and maximize metabolic benefits. Likewise, increases in physical activity and fitness are an important contributor to T2DM remission when combined with calorie restriction and weight loss. Preliminary studies suggest that a precision dietary management approach that uses pretreatment glycaemic status to stratify patients can help optimize dietary recommendations with respect to carbohydrate, fat and dietary fibre. This approach might lead to improved weight loss maintenance and glycaemic control. Future research should focus on better understanding the individual response to dietary treatment and translating these findings into clinical practice.

Protein-Rich Diets for Weight Loss Maintenance.

High-protein diets in the management of obesity have been around for many years and have been rigorously tested for their ability to induce weight loss. Comparably less is known about their effects on the maintenance of lost weight. Several small and a few large randomized trials have evaluated the efficacy of high-protein diets (20-35% of calories from protein; 1.2-1.9g/kg∙day) compared with normal-protein diets (10-20% of calories from protein; 0.8-1.3g/kg∙day), consumed mostly ad libitum during weight loss maintenance, i.e., after clinically significant weight loss. Most of these studies indicate that weight regain in the short term (3-12months) is lower by 1-2kg with high-protein diets than low-protein diets. This effect is attenuated with longer periods of observation, likely because of decreasing dietary compliance. In line with findings during the active weight loss phase, studies assessing the efficacy of protein-rich diets to improve weight loss maintenance report beneficial effects in the short term, which nevertheless dissipate over time.

Emotion regulation training in the treatment of obesity in young adolescents: protocol for a randomized controlled trial

BackgroundThe prevalence rates of childhood obesity are increasing. The current multidisciplinary treatments for (childhood) obesity are effective but only moderately and in the short term. A possible explanation for the onset and maintenance of childhood obesity is that it reflects a maladaptive mechanism for regulating high levels of stress and emotions. Therefore, the current RCT study aims to test the effectiveness of adding an emotion regulation training to care as usual (multidisciplinary obesity treatment) in young inpatients (10–14) involved in an obesity treatment program compared to care as usual alone.The research model for this RCT study states that when high levels of stress are regulated in a maladaptive way, this can contribute to the development of obesity.MethodsThe current study will recruit 140 youngsters (10–14 years) who are involved in an inpatient multidisciplinary obesity treatment (MOT) program. After giving consent to participate in the study, youngsters will be randomly assigned, during consecutive waves, to one of two conditions: care as usual (receiving MOT) or intervention (receiving MOT in addition to emotion regulation training). The training itself consists of 12 weekly sessions, followed by a booster session after 3 and 5 months. The participants will be tested pretraining, post-training, and at 6 months’ follow-up. We hypothesize that, compared to the control condition, youngsters in the intervention condition will (1) use more adaptive emotion regulation strategies and (2) report less emotional eating, both primary outcome measures. Moreover, on the level of secondary outcome measures, we hypothesize that youngsters in the intervention condition, compared with the control condition, will (3) report better sleep quality, (4) undergo improved weight loss and weight loss maintenance, and (5) experience better long-term (6-months) psychological well-being.DiscussionThis study will add to both the scientific and clinical literature on the role of emotion regulation in the development and maintenance of different psychopathologies, as emotion regulation is a transdiagnostic factor.Trial registrationThe RCT study protocol is registered at ISRCTN Registry, with study ID “ISRCTN 83822934.” Registered on 13 December 2017.

No effects on appetite or body weight in weight-reduced individuals of foods containing components previously shown to reduce appetite - Results from the SATIN (Satiety Innovation) study

AimsThe aim was to investigate the acute and sustained effects of foods previously shown to reduce appetite on appetite and weight loss maintenance. MethodsFollowing an 8-week weight loss phase achieving ≥ 8% weight loss and 7–10 days of weight-stabilization, participants underwent a double-blinded, randomized, parallel 12-week weight loss maintenance period with either one of three intervention products previously shown to reduce appetite or matching controls. Appetite probe days were completed at baseline, at the start of the weight loss maintenance (acute effects), and after the weight loss maintenance (sustained effects) along with body weight measurements. ResultsIn total, 197 participants entered the weight loss maintenance period and were included in intention-to-treat analyses. No differences in acute or sustained effects on appetite were observed between the intervention and control groups for any of the three products (24-h energy intake: all P ≥ 0.63; overall appetite suppression score assessed by visual analogue scales: all P ≥ 0.14). Also, no difference in body weight was observed (all P ≥ 0.62). ConclusionsExposure to specific foods previously shown to reduce appetite was not found to reduce appetite acute or sustained or to improve weight loss maintenance as compared to control products in weight-reduced individuals.

Effects of Exercise during Weight Loss Maintenance on Appetite Regulation in Women.

Exercise is accepted as a method to improve weight loss maintenance; however, the mechanisms by which this occurs have yet to be elucidated. In this pilot study, 13 women with obesity underwent a structured weight loss program (goal 8%-10% weight loss) and were then randomized to either a 12-wk diet (n = 7) or an aerobic exercise training (n = 6) intervention aimed at maintaining weight loss. At baseline, post-weight loss, and following the weight loss maintenance interventions, measurements of appetite (hunger and satiety) and appetite-regulating hormones (leptin, ghrelin, peptide tyrosine tyrosine, and glucagon-like peptide 1) were obtained after an overnight fast and for 3 h after a standardized test meal. Ad libitum energy intake was measured at a lunch meal. During the weight loss phase, participants lost 9.1% ± 1.1% of baseline body weight. Participants in both groups maintained weight loss during the 12-wk weight loss maintenance intervention. No differences in fasting leptin (P = 0.68) or in ghrelin (P = 0.30), peptide tyrosine tyrosine (P = 0.93), and glucagon-like peptide 1 (P = 0.98) area under the curve were detected between groups. Similarly, ratings of hunger (P = 0.99) and satiety (P = 0.65) area under the curve after the standardized test meal also did not differ between the groups nor did ad libitum energy intake at lunch. In summary, the 12-wk diet and exercise interventions were equally effective at maintaining weight loss in women, and no differences in measures of appetite regulation and food intake were found.

The Influence of Body Contouring Surgery on Weight Control and Comorbidities in Patients After Bariatric Surgery

IntroductionA considerable number of patients experience some long-term weight regain after bariatric surgery. Body contouring surgery (BCS) is thought to strengthen post-bariatric surgery patients in their weight control and maintenance of achieved improvements in comorbidities.ObjectivesTo examine the impact of BCS on long-term weight control and comorbidities after bariatric surgery.MethodsWe performed a retrospective study in a prospective database. All patients who underwent primary Roux-en-Y gastric bypass (RYGB) and presented for preoperative consultation of BCS in the same hospital were included in the study. Linear and logistic mixed-effect model analyses were used to evaluate the longitudinal relationships between patients who were accepted or rejected for BCS and their weight loss outcomes or changes in comorbidities.ResultsOf the 1150 patients who underwent primary RYGB between January 2010 and December 2014, 258 patients (22.4%) presented for preoperative consultation of BCS. Of these patients, 126 patients eventually underwent BCS (48.8%). Patients who were accepted for BCS demonstrated significant better ∆body mass index (BMI) on average over time (− 1.31 kg/m2/year, 95% confidence interval (CI) −2.52 − −0.10, p = 0.034) and percent total weight loss (%TWL) was significantly different at 36 months (5.79, 95%CI 1.22 – 10.37, p = 0.013) and 48 months (6.78, 95%CI 0.93 – 12.63, p = 0.023) after body contouring consultation. Patients who were accepted or rejected did not differ significantly in the maintenance of achieved improvements in comorbidities.ConclusionBCS could not be associated with the maintenance of achieved improvements in comorbidities after bariatric surgery, whereas it could be associated with improved weight loss maintenance at 36 and 48 months after body contouring consultation. This association should be further explored in a large longitudinal study.

Effects of cognitive behavioral therapy on weight maintenance after successful weight loss in women; a randomized clinical trial.

Weight regain after weight loss is a main challenge in obesity management. Cognitive behavioral therapy (CBT) has been introduced as an option for achieving weight loss but not tested for weight maintenance. The aim of this study was to evaluate the effects of CBT on weight maintenance after successful weight loss. Female adults [n = 113, BMI = 23-30 kg/m²; age = 18-45 years], who had lost at least 10% of their body weight by using a weight loss program, were randomly allocated to either CBT or control group for a further 24-week weight-maintenance period. Compared with control group, CBT treatment improved weight loss maintenance (mean difference, -2.2 kg [95% CI, -3.50, -0.94]; P = 0.001), BMI (mean difference, -0.77 kg/m²; [95% CI, -1.25, -0.28]; P = 0.002), and waist circumference (mean difference, -2.08 cm; [95% CI, -3.31, -0.844]; P = 0.001) at the end of the 24-week period intervention. Estimated energy intake showed a significant reduction over time in CBT group, while it increased in control group (P < 0.001). There was also a significant group × time interaction for mean daily steps over the 24-week period with CBT having a higher level (P < 0.001). However, changes in lipid profiles and carbohydrate metabolism were not significantly different between the groups. Cognitive behavioral therapy is an effective tool for weight maintenance over a 24-week period in successful weight losers, with corresponding maintenance of a reduced energy intake and doing more physical activity which may helpful for weight maintenance in the long term.

Is reduction in appetite beneficial for body weight management in the context of overweight and obesity? Yes, according to the SATIN (Satiety Innovation) study.

New dietary-based concepts are needed for treatment and effective prevention of overweight and obesity. The primary objective was to investigate if reduction in appetite is associated with improved weight loss maintenance. This cohort study was nested within the European Commission project Satiety Innovation (SATIN). Participants achieving ≥8% weight loss during an initial 8-week low-energy formula diet were included in a 12-week randomised double-blind parallel weight loss maintenance intervention. The intervention included food products designed to reduce appetite or matching controls along with instructions to follow national dietary guidelines. Appetite was assessed by ad libitum energy intake and self-reported appetite evaluations using visual analogue scales during standardised appetite probe days. These were evaluated at the first day of the maintenance period compared with baseline (acute effects after a single exposure of intervention products) and post-maintenance compared with baseline (sustained effects after repeated exposures of intervention products) regardless of randomisation. A total of 181 participants (forty-seven men and 134 women) completed the study. Sustained reduction in 24-h energy intake was associated with improved weight loss maintenance (R 0·37; P = 0·001), whereas the association was not found acutely (P = 0·91). Suppression in self-reported appetite was associated with improved weight loss maintenance both acutely (R -0·32; P = 0·033) and sustained (R -0·33; P = 0·042). Reduction in appetite seems to be associated with improved body weight management, making appetite-reducing food products an interesting strategy for dietary-based concepts.

A one-year resistance training program following weight loss has no significant impact on body composition and energy expenditure in postmenopausal women living with overweight and obesity

Resistance training (RT) has been shown to decrease fat mass (FM), and increase fat-free mass (FFM), which can be a useful for weight loss maintenance. ObjectiveTo examine the effects of a 1-year RT intervention on weight loss maintenance following a 6-month dietary weight loss intervention. DesignFollowing a 6-month dietary weight loss intervention (−6% ± 5.8; 5.05 kg ± 4.45), 70 postmenopausal women living with overweight or obesity were randomized to a control group (n = 34) or a RT group (n = 36) (3×/week first 6 months, 2×/week last 6 months, 70–80% of 1-repetition maximum). Body composition (DXA), abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) (CT scan), resting energy expenditure (EE) (indirect calorimetry), physical activity EE and total daily EE were measured (doubly-labelled water). ResultsA total of 54 participants completed the study (control group n = 29; RT group n = 25) and compliance to the RT program was on average 64%. Significant regains were noted for body weight 0.98 (3.71) kg vs. 1.33 (3.94) kg and FM regain 1.32 (2.69) kg vs. 0.81 (3.26) kg in control and RT groups after the 1-year weight maintenance phase. No group differences were noted. Resting EE and total daily EE did not change after the weight maintenance phase, and no differences were observed between groups. Both groups had significantly greater than predicted decrease in resting EE after the 6-month dietary intervention and at the end of the 1-year weight-loss maintenance phase. ConclusionsOur results suggest that a 1-year RT intervention following a 6-month dietary weight loss intervention does not improve weight loss maintenance, body composition or EE in post-menopausal women living with overweight or obesity.

Dietary Intake of Protein from Different Sources and Weight Regain, Changes in Body Composition and Cardiometabolic Risk Factors after Weight Loss: The DIOGenes Study.

An increase in dietary protein intake has been shown to improve weight loss maintenance in the DIOGenes trial. Here, we analysed whether the source of the dietary proteins influenced changes in body weight, body composition, and cardiometabolic risk factors during the weight maintenance period while following an energy-restricted diet. 489 overweight or obese participants of the DIOGenes trial from eight European countries were included. They successfully lost >8% of body weight and subsequently completed a six month weight maintenance period, in which they consumed an ad libitum diet varying in protein content and glycemic index. Dietary intake was estimated from three-day food diaries. A higher plant protein intake with a proportional decrease in animal protein intake did not affect body weight maintenance or cardiometabolic risk factors. A higher plant protein intake from non-cereal products instead of cereal products was associated with benefits for body weight maintenance and blood pressure. Substituting meat protein for protein from other animal sources increased insulin and HOMA-IR (homeostasis model assessment of insulin resistance). This analysis suggests that not only the amount of dietary proteins, but also the source may be important for weight and cardiometabolic risk management. However, randomized trials are needed to test the causality of these associations.

Comparison of an alternative schedule of extended care contacts to a self-directed control: a randomized trial of weight loss maintenance

BackgroundBehavioral interventions for obesity produce clinically meaningful weight loss, but weight regain following treatment is common. Extended care programs attenuate weight regain and improve weight loss maintenance. However, less is known about the most effective ways to deliver extended care, including contact schedules.MethodsWe compared the 12-month weight regain of an extended care program utilizing a non-conventional, clustered campaign treatment schedule and a self-directed program among individuals who previously achieved ≥5% weight reductions. Participants (N = 108; mean age = 51.6 years; mean weight = 92.6 kg; 52% African American; 95% female) who achieved ≥5% weight loss during an initial 16-week behavioral obesity treatment were randomized into a 2-arm, 12-month extended care trial. A clustered campaign condition included 12 group-based visits delivered in three, 4-week clusters. A self-directed condition included provision of the same printed intervention materials but no additional treatment visits. The study was conducted in a U.S. academic medical center from 2011 to 2015.ResultsPrior to randomization, participants lost an average of −7.55 ± 3.04 kg. Participants randomized to the 12-month clustered campaign program regained significantly less weight (0.35 ± 4.62 kg) than self-directed participants (2.40 ± 3.99 kg), which represented a significant between-group difference of 2.28 kg (p = 0.0154) after covariate adjustments. This corresponded to maintaining 87% and 64% of lost weight in the clustered campaign and self-directed conditions, respectively, which was a significant between-group difference of 29% maintenance of lost weight after covariate adjustments, p = 0.0396.ConclusionsIn this initial test of a clustered campaign treatment schedule, this novel approach effectively promoted 12-month maintenance of lost weight. Future trials should directly compare the clustered campaigns with conventional (e.g., monthly) extended care schedules.Trial registrationClinicaltrials.gov NCT02487121. Registered 06/26/2015 (retrospectively registered)

Exploring process variables through which acceptance-based behavioral interventions may improve weight loss maintenance

ObjectiveA previously published randomized trial with individuals reporting high internal disinhibition showed significant differences in post-treatment weight change favoring Acceptance-Based Behavioral Intervention (ABBI) when compared to standard behavioral treatment (SBT). This paper examines process variables that might contribute to the observed differences in weight change. MethodsParticipants were 162 adults with overweight or obesity (mean BMI 37.6) randomly assigned to ABBI or SBT. Both interventions provided the same calorie intake target, exercise goal, and self-monitoring skills training. SBT incorporated current best practice interventions for addressing problematic thoughts and emotions. ABBI utilized acceptance-based techniques based on Acceptance and Commitment Therapy. ABBI and SBT were compared on process measures hypothesized to be related to outcome in ABBI and SBT and their association with weight loss outcomes using linear and non-linear mixed models methods and exploratory correlational analyses. ResultsBoth the SBT and the ABBI groups showed significant changes over time on all process variables. The only significant between group difference was for values consistent behavior, with the ABBI group improving more as compared to SBT (t=2.45, p=0.016); however, changes in values consistent behavior did not mediate weight change. Exploratory analyses suggest the possibility that changes in process variables were less associated with weight change in ABBI than in SBT after treatment was discontinued. ConclusionsBoth conditions produced significant changes in process variables, however there was little difference between groups. Thus, the results do not provide an adequate process account for the observed weight change differences between ABBI and SBT, leaving important questions that need to be addressed by future research.

Post-surgery support and the long-term success of bariatric surgery

Obesity was perceived as a symbol of wealth, power and health in times of food shortages, but now, in a time of abundance, it is a serious public health concern and is responsible for a number of diseases and deaths. As obesity becomes more prevalent, feasible solutions for weight loss and weight loss maintenance are urgently needed. Surgical interventions such as bariatric surgery have resulted in significant weight loss and the resolution of various co-morbidities. Long-term weight loss maintenance can be challenging, and the success of post-bariatric surgery requires significant lifestyle changes, which can be difficult to make without educational and emotional support. The studies described in this review look at the effect of different types of support, such as nutrition support, cognitive behavioural therapy, motivational support, family support, dietary education and support for depression; the studies show a significant correlation between the support of family members and attendance of support groups, and greater weight loss and improved weight loss maintenance.

Circulating ACE is a predictor of weight loss maintenance not only in overweight and obese women, but also in men

Circulating angiotensin-converting enzyme (ACE) was identified as a predictor of weight loss maintenance in overweight/obese women of the Diogenes project. To investigate whether ACE acted also as a predictor in men of the Diogenes study and to compare it with that in women. Subjects, who lost ≥ 8% of body weight induced by low-caloric diet in an 8-week weight loss period, were assigned to weight loss maintenance with dietary intervention for 6 months. 125 overweight/obese healthy men from eight European countries who completed whole intervention. Concentrations and activity of serum ACE at baseline and after the 8-week weight loss, in addition to anthropometric and physiological parameters. Serum ACE concentration decreased by 11.3 ± 10.6% during the weight loss period in men. A greater reduction is associated with less body weight regain during the maintenance period (r=0.227, P=0.012). ACE change was able to predict a weight regain ≤ 20% after 6 months, with an odds ratio of 1.59 (95% confidence interval (CI): 1.09-2.33, P=0.016) for every 10% reduction, which was independent of body mass index and weight loss. The prediction power was weaker in men than in women, but without a significant sex difference (P=0.137). In pooled subjects (N=218), the odds ratio was 1.96 (95% CI: 1.46-2.64, P<0.001). A greater reduction of ACE during weight loss is favorable for weight maintenance in both men and women. This can offer useful information for personalized advice to improve weight loss maintenance. It also confirms the role of ACE in the metabolic pathways of weight regulation.

Treatment Modalities of Obesity

The prevalence of obesity is increasing in both developed and developing countries, with rates reaching approximately 10-35% among adults in the Euro-American region. Obesity is associated with increased risks of cardiovascular diseases, type 2 diabetes, arthritis, and some type of cancers. Obesity significantly affects the quality of life and reduces the average life expectancy. The effective treatment of obesity should address both the medical and the social burden of this disease. Obesity needs to be treated within the health care system as any other complex disease, with empathy and without prejudice. Both health care providers and patients should know that the obesity treatment is a lifelong task. They should also set realistic goals before starting the treatment, whereas keeping in mind that even a modest weight loss of 5-15% significantly reduces obesity-related health risks. Essential treatment of obesity includes low-calorie low-fat diets, increased physical activity, and strategies contributing to the modification of lifestyle. Anti-obesity drugs facilitate weight loss and contribute to further amelioration of obesity-related health risks. A short-term weight loss, up to 6 months, is usually achieved easily. However, the long-term weight management is often associated with a lack of compliance, failures, and a high dropout rate. Regular physical activity, cognitive behavioral modification of lifestyle, and administration of anti-obesity drugs improve weight loss maintenance. Bariatric surgery is an effective strategy to treat severely obese patients. Bariatric surgery leads to a substantial improvement of comorbidities as well as to a reduction in overall mortality by 25-50% during the long-term follow-up. Obesity treatment should be individually tailored and the following factors should be taken into account: sex, the degree of obesity, individual health risks, psychobehavioral and metabolic characteristics, and the outcome of previous weight loss attempts. In the future, an evaluation of hormonal and genetic determinants of weight loss could also contribute to a better choice of individual therapy for a particular obese patient. A multilevel obesity management network of mutually collaborating facilities should be established to provide individually tailored treatment. Centers of excellence in obesity management represented by multidisciplinary teams should provide comprehensive programs for the treatment of obesity derived from evidence-based medicine.