Lifetime Weight Research Articles

Accuracy and reliability of self-reported weight and height in the Sister Study.

To assess the accuracy and reliability of self-reported weight and height and identify the factors associated with reporting accuracy. Analysis of self-reported and measured weight and height from participants in the Sister Study (2003-2009), a nationwide cohort of 50 884 women aged 35-74 years in the USA with a sister with breast cancer. Weight and height were reported via computer-assisted telephone interview (CATI) and self-administered questionnaires, and measured by examiners. Early enrolees in the Sister Study. There were 18 639 women available for the accuracy analyses and 13 316 for the reliability analyses. Using weighted kappa statistics, comparisons were made between CATI responses and examiner measures to assess accuracy and CATI and questionnaire responses to assess reliability. Polytomous logistic regression evaluated factors associated with over- or under-reporting. Compared with measured values, agreement was 96 % for reported height (±1 inch (±2·5 cm); weighted κ = 0·84) and 67 % for weight (±3 lb (±1·36 kg); weighted κ = 0·92). Obese women (BMI ≥ 30 kg/m2) were more likely than normal-weight women to under-report weight by ≥5 % and underweight women (BMI < 18·5 kg/m2) were more likely to over-report. Among normal-weight and overweight women (18·5 kg/m2 ≤ BMI < 30 kg/m2), weight cycling and lifetime weight difference ≥50 lb (≥22·68 kg) were associated with over-reporting. US women in the Sister Study were reasonably reliable and accurate in reporting weight and height. Women with normal-range BMI reported most accurately. Overweight and obese women and those with weight fluctuations were less accurate, but even among obese women, few under-reported their weight by >10 %.

Abstract A77: Weight gain and weight cycling and risk of endometrial cancer

Abstract Background: Obesity, as measured by BMI, is an established risk factor for endometrial cancer in postmenopausal women. However, whether weight gain and weight cycling, both which occur frequently, are associated with risk of endometrial cancer independent of BMI is not clear. Previous studies of weight gain have found mixed results, but there was considerable variation in how the potential influence of BMI on this association was accounted for. Some studies did not adjust for BMI at all while others adjusted for BMI from different points during life. Similarly, inconsistent findings have been reported from studies of weight cycling and risk of endometrial cancer. Because weight cycling has been suggested to influence fat distribution and the ability to lose weight, it may affect risk of endometrial cancer. Methods: The associations of weight gain and weight cycling with endometrial cancer risk were investigated in a large, well characterized prospective study, the American Cancer Society's Cancer Prevention Study II (CPS-II) Nutrition Cohort. Included in this analysis were 38,152 women with an intact uterus who provided information on weight history and weight cycling on the 1992 baseline questionnaire. Of these, 560 were diagnosed with endometrial cancer between 1992 and June 30, 2007. Adult weight change was calculated from the reported weight at age 18 and current weight on the 1992 baseline questionnaire. Number of lifetime weight cycles was assessed based on responses to the 1992 baseline questions asking how many times 10 or more pounds were intentionally lost and later regained. Multivariate-adjusted hazards ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression. Results: Total weight gain during adulthood was statistically significantly positively associated with risk of endometrial cancer (HR=3.93, 95% CI:2.73–5.65 for gained 61+ lbs versus stable weight, p&amp;lt;0.0001). This association was attenuated by adjustment for BMI in 1992 but remained statistically significant (HR=1.92, 95% CI:1.20–3.07, p-trend&amp;lt;0.0001). Similarly, weight cycling was associated with increased risk of endometrial cancer (HR=2.10, 95% CI:1.61–2.74 for 10+ weight cycles versus no weight cycles, p-trend&amp;lt;0.0001). However, after adjustment for BMI in 1992, this association was null (HR=1.02, 95% CI:0.75–1.39, p-trend=0.95). Weight cycling was not associated with endometrial cancer in analyses stratified by BMI or by weight change after adjustment for BMI in 1992. Conclusions: Our finding that adult weight gain is positively associated with risk of endometrial cancer even after adjustment for BMI suggests that both adult weight gain and BMI might have independent effects on the risk of endometrial cancer. The absence of association of weight cycling with endometrial cancer incidence after adjustment for BMI suggests that cycles of intentional weight loss followed by regain do not contribute to risk of this cancer. These findings underscore the importance of avoiding adult weight gain and indicate that encouraging women to try to lose weight is unlikely to increase risk of endometrial cancer even if weight is lost and subsequently regained. Citation Information: Cancer Prev Res 2011;4(10 Suppl):A77.

Body mass and DNA promoter methylation in breast tumors in the Western New York Exposures and Breast Cancer Study

The mechanism of the observed association between body mass, particularly centralized body fat, and postmenopausal breast cancer risk is not well understood. We hypothesized that body mass may affect DNA methylation through increased estrogen and chronic inflammation. The association between body mass and promoter methylation in breast tumors was investigated in a population-based, case-control study. The promoter methylation of E-cadherin, p16, and RAR-β(2) genes was assessed in breast tumor blocks from 803 pre- and postmenopausal cases by using real-time methylation-specific polymerase chain reaction. Unconditional logistic regression was used to derive the adjusted OR and 95% CI for case-case comparisons of tumors with and without promoter methylation of the genes. The frequency of promoter methylation was 20% for E-cadherin, 25.9% for p16, and 27.5% for RAR-β(2). There was no difference in the prevalence of the DNA methylation of individual genes by BMI, waist-to-hip ratio (WHR), or lifetime weight change between the age of 20 y and the present. However, in a case-case comparison of postmenopausal breast cancer, a greater WHR was associated with an increased likelihood of ≥1 of the 3 genes being methylated (OR: 1.85; 95% CI: 1.10, 3.11; P-trend < 0.02). We showed that WHR was associated with DNA promoter methylation of ≥1 of 3 genes in postmenopausal breast tumors. It may be that the association of body fat composition and postmenopausal breast cancer is related to altered DNA methylation. However, future studies in other populations and with an examination of the methylation of more genes are needed.

Persistent organic pollutants are related to lifetime weight gain

Persistent organic pollutants are related to lifetime weight gain

How Children Move: Activity Pattern Characteristics in Lean and Obese Chinese Children

Physical activity and sedentary behavior are central components of lifetime weight control; however, our understanding of dimensions of these behaviors in childhood is limited. This study investigated free-living activity pattern characteristics and the individual variability of these characteristics in 84 lean and obese Chinese children (7–9 y) during the school day and over the weekend. Activity pattern characteristics were established from triaxial accelerometry (StayHealthy RT3). Results indicated that children's free-living activity is characterized by many short-duration, low-intensity bouts of movement. Obese children take longer rest intervals between bouts and engage in fewer activity bouts both at school and at home. Intraindividual variability in activity patterns was low during school days but high for the rest intervals between bouts and number of activity bouts per day at the weekend. Finding ways to reduce the rest time between bouts of movement and increase the number of movement bouts a child experiences each day is an important next step.

Abstract PL03-04: Exercise, adiposity, and cancer

Abstract PL03-04: Exercise, adiposity, and cancer

Lifetime body mass index, other anthropometric measures of obesity and risk of knee or hip osteoarthritis in the GOAL case-control study

To examine the risk of large joint osteoarthritis (OA) in those becoming overweight during early adult life, and to assess the risks associated with high body mass index (BMI) and other anthropometric measures of obesity. BMI, waist and hip circumference were measured in the GOAL case-control study comprising hip OA cases (n=1007), knee OA cases (n=1042) and asymptomatic controls (n=1121). Retrospective estimates of lifetime weight, body shape and other risk factors were collected using an interview-lead questionnaire. Odds ratios (ORs), adjusted OR (aOR), 95% confidence intervals (CIs) and P values were calculated using logistic regression analysis. BMI was associated with knee OA (aOR 2.68, 95% CI 2.33-3.09, P-trend<0.001) and hip OA (aOR 1.65, 95% CI 1.46-1.87, P-trend<0.001). Those who became overweight earlier in adulthood showed higher risks of lower limb OA (P-trend<0.001 for knee OA and hip OA). Self-reported body shape was also associated with knee OA and hip OA, following a similar pattern to current and life-course BMI measures. Waist:hip ratio (WHR) at time of examination did not associate with OA independently of BMI, except in women-only analysis. Waist circumference was associated with lower limb OA risk. Becoming overweight earlier in adult life increased the risks of knee OA and hip OA. Different distribution patterns of adiposity may be related to OA risk in women.

Ideal Weight and Weight Satisfaction: Association With Health Practices

Evidence suggests that individuals have become more tolerant of higher body weights over time. To investigate this issue further, the authors examined cross-sectional associations among ideal weight, examination year, and obesity as well as the association of ideal weight and body weight satisfaction with health practices among 15,221 men and 4,126 women in the United States. Participants in 1987 reported higher ideal weights than participants in 2001, an effect particularly pronounced from 1987 to 2001 for younger and obese men (85.5 kg to 94.9 kg) and women (62.2 kg to 70.5 kg). For a given body mass index, higher ideal body weights were associated with greater weight satisfaction but lower intentions to lose weight. Body weight satisfaction was subsequently associated with greater walking/jogging, better diet, and lower lifetime weight loss but with less intention to change physical activity and diet or lose weight (P < 0.01). Conversely, body mass index was negatively associated with weight satisfaction (P < 0.01) and was associated with less walking/jogging, poorer diet, and greater lifetime weight loss but with greater intention to change physical activity and diet or lose weight. Although the health implications of these findings are somewhat unclear, increased weight satisfaction, in conjunction with increases in societal overweight/obesity, may result in decreased motivation to lose weight and/or adopt healthier lifestyle behaviors.

Breast cancer prevention in countries with diverse resources

Breast cancer is the most common invasive cancer in women globally, and it affects more than 1 million women worldwide each year. It is a preventable disease in part, and primary care providers and public health programs play a key role in providing cancer preventive care. There are several health behaviors that may reduce the risk of breast cancer, including prolonged lactation; regular physical activity; avoiding overweight, obesity, and lifetime weight gain; avoiding excess alcohol intake; avoiding prolonged use of exogenous hormone therapy; and avoiding excessive radiation. These behaviors, although they have not been proven in clinical trials to reduce risk, are likely to be beneficial; information on them can be provided as a prevention strategy in countries of diverse means, although the methods of information delivery and follow-up will depend on financial and personnel resources. Many of these health behaviors can reduce the risk for other chronic diseases and, thus, may be of great interest for general public health. In high resource level countries, additional prevention methods are available for high-risk women, including selective estrogen response modulators and, for women at very high risk, bilateral prophylactic mastectomy and bilateral oophorectomy. Most women can benefit from advice and preventive care for reducing their risk for breast cancer.

Weight gain in overweight and obese community dwelling old-old.

The purpose of this study was to 1) investigate lifetime weight changes in community dwelling old-old, those age 80 or older; 2) explore reasons for weight changes from their personal perspective and 3) examine ways the old-old feel they can successfully lose weight. A cross sectional design was used for this qualitative study. One county of a southeastern U.S. state. Nine community dwelling old-old. Content analysis of transcripts was used to examine the interviews. All of the old-old interviewed had reached their maximum weight after the age of 65. Average lifetime weight gain was 73 pounds. All wanted to lose weight and found ways to incorporate small changes in their everyday lives. With increasing life expectancy among older adults, health promotion targeting weight control needs to include the old-old.

Lifetime Weight History and Endometrial Cancer Risk by Type of Menopausal Hormone Use in the NIH-AARP Diet and Health Study

Obesity and menopausal estrogen therapy are established risk factors for endometrial cancer. However, the joint effects of obesity and menopausal hormone therapy on endometrial cancer risk are incompletely understood. We addressed this issue in a cohort of 103,882 women ages 50 to 71 years at baseline in 1995 to 1996. During a median of 4.6 years, which contributed to a total of 455,304 person-years of follow-up through 2000, 677 cases of endometrial cancer were ascertained. Both baseline body mass index (BMI) and adult weight gain were associated with increased endometrial cancer risk. The multivariate relative risk (RR) comparing obese with normal weight women (BMI >30 versus <25 kg/m(2)) was 3.03 [95% confidence interval (95% CI), 2.50-3.68]. Compared with women with stable weight (gained or lost <5 kg) between age 18 and baseline, women who gained >or=20 kg had a RR of 2.75 (95% CI, 1.96-3.86). Menopausal hormone therapy significantly modified the relations of BMI (P(interaction) < 0.001) and adult weight gain (P(interaction) = 0.004) to endometrial cancer risk. Compared with normal weight, the RRs for obesity were 5.41 (95% CI, 4.01-7.29) among women who never used menopausal hormone therapy, 2.53 (95% CI, 1.21-5.30) among former menopausal hormone therapy users, and 1.44 (95% CI, 1.00-2.05) among current users. Compared with a stable weight between age 18 and baseline, the RRs for weight gain of >or=20 kg among never users and ever users of menopausal hormone therapy were 5.35 (95% CI, 3.01-9.52) and 1.43 (95% CI, 0.96-2.15), respectively. We conclude that both current adiposity and adult weight gain are associated with substantial increases in the risk of endometrial cancer, with relations particularly evident among never users of menopausal hormone therapy.

Lifetime Weight Patterns in Male Physicians: The Effects of Cohort and Selective Survival

The natural history of lifetime weight change is not well understood because of conflicting evidence from cross-sectional and longitudinal studies. Cross-sectional analyses find that adult weight is highest at approximately 60 years of age and lower thereafter. Longitudinal analyses have not found this pattern. Our objective was to test whether cohort effects and selective survival may explain the differences observed between cross-sectional and longitudinal studies. We analyzed data on white men from the Johns Hopkins Precursors Study (n = 1197). Weight and height were measured at enrollment during medical school. The Precursors Study collected subsequent weight measurements by self-report and follows all participants for mortality. In preliminary analyses that ignored cohort and survival effects, average weight increased 0.16 kg/yr to age 65 (p < 0.001) and declined 0.10 kg/yr thereafter (p = 0.002). When controlling for differing rates of weight change by cohort and survival group, the apparent decline after 65 years of age was mostly explained. These data suggest that, in white men, weight increases steadily until age 65 and then plateaus. These findings emphasize the necessity of longitudinal rather than cross-sectional data to describe lifetime weight patterns.

Previous Weight Loss Experiences of Bariatric Surgery Candidates: How Much Have Patients Dieted prior to Surgery?

To describe the dieting histories of bariatric surgery candidates. One hundred seventy-seven individuals with extreme obesity who sought bariatric surgery completed the Weight and Lifestyle Inventory, a self-report instrument that assesses several variables, including weight and dieting history. Patients' dieting histories were further explored with an aided recall during a preoperative behavioral/psychological evaluation performed by a mental health professional. Participants who completed the Weight and Lifestyle Inventory reported an average of 4.7 +/- 2.9 successful dieting attempts, defined as those that resulted in a loss of 10 lbs (4.5 kg) or more. These individuals reported a mean total lifetime weight loss of 61.1 +/- 41.3 kg. Despite these efforts, their weight increased from 89.4 +/- 27.4 kg at the time of their first diet (age 21.2 +/- 10.1 years) to 144.5 +/- 30.8 kg at the time they underwent their behavioral/psychological evaluation (age 43.0 +/- 11.0 years). Results of the aided recall revealed that participants had made numerous other efforts to lose weight that were unsuccessful. Self-directed diets and commercial programs were used more frequently. Individuals who sought bariatric surgery reported an extensive history of dieting, beginning in adolescence, that was not successful in halting progressive weight gain. Thus, the recommendation often made by insurance companies that patients delay surgery to attempt more conservative treatment options may be unwarranted, particularly in the presence of significant obesity-related comorbidities. Weight loss histories should be routinely examined during a behavioral evaluation to determine whether additional attempts at non-surgical weight loss are advisable. Future studies also are needed to explore the potential relationship between dieting history and postoperative outcome.

Strength measures are related to bone mineral content and bone mineral density in postmenopausal women

Loss of estrogen during menopause causes a decline in bone mineral content (BMC) and bone mineral density (BMD), increasing the risk of osteoporosis. Physical fitness, muscle strength, and body weight protect against bone loss. We used Spearman's rho correlation analysis to determine the relationship between spine, hip, and whole body BMC and BMD (using dual-energy x-ray absorptiometry) and fitness measures in healthy non-athletic postmenopausal women (n=255). These included strength measures (hand, torso, leg), balance, BMI, maximum lifetime weight (max wt), and blood pressure (BP). Strength measurements were related to each other, but also positively to hip (p<0.002), spine (p<0.0001), and whole body (p<0.0001) BMC and spine (p<0.003) and whole body (p<0.03) BMD. As the number of menstruating years increased, strength measures decreased (P<0.05). Balance and BP were not related to BMC or BMD. Both diastolic and systolic BP were positively related (p<0.006) to max wt and BMI, but inversely related to balance (p<0.01). Based on the correlation coefficients, max wt appeared to be more highly related than BMI to BMC and BMD, illustrating the importance of historical weight on bone. Physical fitness as reflected by strength but not other measures was positively associated with BMC and BMD in postmenopausal women, indicating the importance of maintaining muscle strength to decrease the risk of osteoporosis. Supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH (AR046922 A2)

Previous weight loss experiences of bariatric surgery candidates: how much have patients dieted prior to surgery?

Objective To describe the dieting histories of bariatric surgery candidates. Research methods and procedures One hundred seventy-seven individuals with extreme obesity who sought bariatric surgery completed the Weight and Lifestyle Inventory, a self-report instrument that assesses several variables, including weight and dieting history. Patients’ dieting histories were further explored with an aided recall during a preoperative behavioral/psychological evaluation performed by a mental health professional. Results Participants who completed the Weight and Lifestyle Inventory reported an average of 4.7 ± 2.9 successful dieting attempts, defined as those that resulted in a loss of 10 lbs (4.5 kg) or more. These individuals reported a mean total lifetime weight loss of 61.1 ± 41.3 kg. Despite these efforts, their weight increased from 89.4 ± 27.4 kg at the time of their first diet (age 21.2 ± 10.1 years) to 144.5 ± 30.8 kg at the time they underwent their behavioral/psychological evaluation (age 43.0 ± 11.0 years). Results of the aided recall revealed that participants had made numerous other efforts to lose weight that were unsuccessful. Self-directed diets and commercial programs were used more frequently. Discussion Individuals who sought bariatric surgery reported an extensive history of dieting, beginning in adolescence, that was not successful in halting progressive weight gain. Thus, the recommendation often made by insurance companies that patients delay surgery to attempt more conservative treatment options may be unwarranted, particularly in the presence of significant obesity-related comorbidities. Weight loss histories should be routinely examined during a behavioral evaluation to determine whether additional attempts at non-surgical weight loss are advisable. Future studies also are needed to explore the potential relationship between dieting history and postoperative outcome.

Associations with Weight Loss and Subsequent Mortality Risk

Studies have shown a high prevalence of weight loss in older adults is associated with an increased risk of death. We investigated this in a population-based study. Persons living in Beaver Dam, Wisconsin, participated in a baseline examination between 1988 and 1990 (n=4926). A medical examination and standardized questionnaire were administered. Weight loss was defined as percent loss in body weight from highest lifetime weight to measured weight at baseline. Weight loss was associated with older age, higher rates of diseases such as diabetes, and lower baseline levels of blood pressure and serum total cholesterol. After controlling for age, medical, and lifestyle factors, both men and women had higher mortality rates over a 10+ year period for increasing categories of weight loss (hazard ratio [ 95% CI]: 1.16 [1.06, 1.27] for men and 1.23 [1.13, 1.34] for women). Increased mortality rates with increasing weight loss was shown in stratified analyses of age, body mass index (BMI) at highest weight, smoking, and disease status, but did not always reach statistical significance. Persons on weight loss diets within the year prior to baseline did not have increased mortality with increasing weight loss. The strong association between weight loss (likely involuntary) and mortality may be a useful way of estimating overall risks to longevity in populations.

Weight changes and obesity predict impaired resting and endothelium‐dependent myocardial blood flow in postmenopausal women

Obesity has been associated with impaired endothelial function, but the influence of lifetime weight patterns on endothelial function has not been studied. We hypothesized that coronary vascular reactivity would be diminished in postmenopausal women with a history of obesity and frequent weight swings. We performed dynamic N-13 ammonia positron emission tomography in 18 postmenopausal women with cardiac risk factors. Myocardial blood flow (MBF) was measured at rest, after the cold pressor test (CPT), and after adenosine infusion in order to determine baseline and endothelium-dependent and -independent flows, respectively. Myocardial blood flow was corrected for cardiac work by normalizing to the rate-pressure product. Weight history was obtained by standardized questionnaire. Normalized rest (n-rest) MBF correlated negatively with current weight (r = -0.52, p = 0.026) and weight at age 18 (r = -0.47, p = 0.047). Normalized CPT (n-CPT) MBF correlated inversely with current weight (r = -0.55, p = 0.018), weight at age 18 (r = -0.605, p = 0.008), and highest weight (r = -0.62, p = 0.006). Higher waist circumference predicted lower n-rest MBF (r = -0.52, p = 0.028) and n-CPT MBF (r = -0.48, p = 0.04). The same association was found with hip circumference (r = -0.52, p = 0.028; r = -0.49, p = 0.038, respectively), whereas higher body mass index (BMI) predicted lower n-CPT MBF (r = -0.53, p = 0.02). Women with at least four significant weight swings had lower MBF during rest, CPT, and n-CPT (0.88 vs. 1.19 ml/g/min, p = 0.008; 0.76 vs. 1.23 ml/g/min, p < 0.001; 0.74 vs. 1.10 ml/g/min, p = 0.009, respectively). Increased waist and hip circumference, weight, and frequent weight swings are associated with impaired resting and endothelium-dependent MBF in postmenopausal women. These data suggest that lifetime weight patterns may influence cardiovascular risk in women.

Weight Change and the Risk of Late-Onset Breast Cancer in the Original Framingham Cohort

: Objective: Adult weight gain has been associated with a twofold risk of postmenopausal breast cancer. Data are limited regarding whether weight gain at specific periods of marked changes in estrogen- and insulin-related hormones have different risk associations. This study assesses the relation of adult weight change overall and at specific, hormonally relevant times with diagnosis of a first breast cancer after age 55 (late onset). Methods: Framingham study data were used to assess premenopausal (25-44 yr), perimenopausal (45-55 yr), postmenopausal (after 55 yr), and adult lifetime (from 25 yr) weight change in relation to late-onset breast cancer in 2,873 women followed for up to 48 yr, with 206 late-onset breast cancers. Results: Adult lifetime weight gain was associated with an increased risk of late-onset breast cancer (P trend = 0.046). Weight gain during specific time periods was not associated with breast cancer. Data suggested a possible decreased risk of breast cancer with weight loss from ages 25 to 44 and 45 to 55 yr (relative risk = 0.4 [0.2-1.2] and 0.5 [0.3-0.9], respectively). Conclusion: These data confirm prior reports of an association between adult lifetime weight gain and increased risk of late-onset breast cancer and support current recommendations to avoid adult weight gain.

Psychological predictors of weight regain in obesity

It is a consistent finding that, among obese patients, the weight lost as a result of the most widely available treatments for obesity is almost always regained. This relapse appears to be attributable to the individual’s inability to persist with the behavioural strategies needed to maintain the new lower weight. Little research has investigated the psychological mechanisms that might account for this phenomenon. This study aimed to identify psychological factors that predict weight regain. Fifty-four women with obesity who had lost weight by attending community slimming clubs were interviewed immediately after losing 10% of their initial body weight, and then followed-up every 2 months for a period of 1 year by means of telephone interviews. The results identified two prospective predictors of weight regain: one cognitive factor (dichotomous thinking) and one historical variable (maximum lifetime weight). The finding that a specific cognitive style is a significant predictor of relapse has implications for the treatment of obesity.

Recovery from relapse among successful weight maintainers

Little is known about the natural history of weight change among persons who are successful at losing weight. This study evaluated the occurrence of weight regain and recovery among 2400 persons in the National Weight Control Registry (NWCR) who had lost an average (+/- SD) of 32.1 +/- 17.8 kg and had kept it off for 6.5 +/- 8.1 y. Participants were evaluated prospectively over 2 y. The mean reported weight change from entry into the NWCR to 2 y later was 3.8 +/- 7.6 kg. At year 2, 96.4% of the sample remained > or =10% below their maximum lifetime weight. However, small regains were common, and few persons were able to re-lose weight after any weight regain. Of the participants who gained any weight between baseline and year 1 (n = 1483; 65.7%), only 11.0% returned to their baseline weight or below at year 2. Of the participants who relapsed, which was defined as a weight regain of > or =5% at year 1 (n = 575, or 25.5% of the sample), only 4.7% returned to their baseline weight or below at year 2, and only 12.9% re-lost at least half of their year 1 gain by year 2. Logistic regression showed that recovery was related to gaining less at year 1 and to smaller increases in depressive symptoms between baseline and year 1. Although successful weight losers continued to maintain a large percentage of their weight losses over 2 y, recovery from even minor weight regain was uncommon.