Long-term Lifestyle Modification Research Articles

Semaglutide for Weight Loss: Was It Worth the Weight?

Obesity is a major public health issue with an increasing prevalence worldwide. Excess body fat is associated with various comorbidities, as well as increased overall mortality risk. The benefits of weight loss are evident by the reductions in morbidity and mortality. The foundation for most weight loss programs involves strict lifestyle modification, including dietary change and exercise. Unfortunately, many individuals struggle with weight loss and chronic weight management due to difficulty adhering to long-term lifestyle modification and the metabolic adaptations that promote weight regain. The use of adjunctive pharmacotherapy has been employed to help patients not only achieve greater weight loss than lifestyle modification alone but also to assist with long-term weight management. Historically, antiobesity drugs have produced only modest weight loss and required at least once daily administration. Glucagon-like peptide-1 (GLP-1), a hormone with significant effects on glycemic control and weight regulation, has been explored for use as adjunctive pharmacotherapy for weight loss. Semaglutide, a GLP-1 receptor agonist, was recently approved by the Food and Drug Administration for chronic weight management in adults with obesity or who are overweight. The approval came after the publication of the Semaglutide Treatment Effect in People with Obesity clinical trials. In these 68-week trials, semaglutide 2.4 mg was associated with significantly greater weight loss compared to placebo. Semaglutide differs from other GLP-1 receptor agonists by having a longer half-life and producing greater weight loss. This article provides an overview of the discovery and mechanism of action of semaglutide 2.4 mg, and the clinical trials that led to its approval.

Значення комплаєнтності пацієнтів у довготривалій модифікації стилю життя в процесі корекції маси тіла

Мета. Визначити значення реабілітаційної комплаєнтності пацієнтів у довготриваліймодифікації стилю життя в процесі корекції маси тіла в рамках програми фізичної терапії.Методи. Обстежено 288 осіб другого зрілого віку з аліментарно-екзогенним ожирінням І–ІІІ ступеня. За результатами визначення реабілітаційного комплаєнсу їх було поділено надві групи. Групу порівняння становили особи з низьким рівнем комплаєнсу, які були інфор-мовані про ризики ожиріння та принципи зменшення маси тіла. Основну групу становилиособи з високим рівнем комплаєнсу, які проходили річну програму корекції із застосуваннямзаходів для підтримки комплаєнсу, модифікації харчування, збільшення фізичної активно-сті, лімфодренажу, психокорекції. Контрольну групу становили 60 осіб з нормальною масоютіла. За допомогою анкетування визначали поширеність модифікованих факторів ризикувиникнення ожиріння у стилі життя. Після впровадження реабілітаційної програми повторновизначали їх поширеність; ефективність програми визначали за динамікою індексу маси тіла.Результати. Початкове анкетування показало значну поширеність модифікованих етіологічнихфакторів ожиріння. У пацієнтів основної групи після річного періоду спостереження за всімазапитаннями анкети визначалось значне зменшення поширеності факторів ризику ожиріння.На фоні застосування програми реабілітації із використанням заходів для утриманнякомплаєнсу на високому рівні досягнуто статистично значущого покращення індексу маситіла. Висновок. Високий рівень комплаєнсу сприяє тривалій модифікації стилю життя хворихожирінням, виконанню ними наданих рекомендацій і, як наслідок, значному зменшеннюмаси тіла. Низький рівень комплаєнсу супроводжується невиконанням рекомендацій щодомодифікації стилю життя та відсутністю зменшення маси тіла.

Participants' Views on Lifestyle Intervention Program Enhancing Long-Term Health-Related Behaviors Improvement among Prehypertension and/or Prediabetes Mellitus Older Adults: A Qualitative Study Examined in Thailand at Health Promoting Hospitals.

This study aimed to investigate the view of prediabetes and prehypertension elderly patients living around temple on long-term self-management in proficient way underneath the lifestyle intervention program based on both focus-group discussion and In-depth interview methods to fill the gap in partially successful intervention. 62 participants were selected from 220 participants of the quantitative published study by 2 researchers. The triangulation method was used to put great emphasis on the consistency and the credibility of the results. Almost all of the participants had benefited from the program regarding proper foods, suitable exercise and an inspiration of lifestyle modification. They made changes of eating behavior and exercise behavior during program attendance, however, after the program had finished, they had minimal concern to take care of themselves. Nonetheless, more than half of them demonstrated some health-related behaviors changes due to they gave the value of the suggestion in different aspects. Moreover, high-frequency program attendance was not related to blood results improvement. The knowledge obtained from program intervention together with adequate contact between the patient and the program staff, personal problems solving, personal attitude, practice and acceptable played a key role for long-term lifestyle modification and completely successful intervention.

Counselor Surveillance of Digital Self-Monitoring Data: A Pilot Randomized Controlled Trial.

This pilot study tested counselor access to participants' digital self-monitoring (SM) data as a means of improving long-term lifestyle modification (LM) outcomes. After 12 weeks of weight-loss treatment, participants (N = 77) were randomized to LM or LM+SHARE for weeks 13 to 52. All participants received monthly phone calls and weekly text messages from weeks 13 to 52 and were instructed to engage in daily digital SM of weight, eating, and exercise. In LM+SHARE, but not LM, counselors had access to SM device data. Assessments were conducted as weeks 0, 13, 26, and 52. Retention, engagement, and treatment satisfaction were excellent. LM+SHARE participants, compared with LM, had more frequent SM of weight and eating. Weight loss continued at a similar rate in both conditions from weeks 13 to 26. From weeks 26 to 52, those in LM regained approximately 2 kg, whereas those in LM+SHARE maintained weight loss, a significant difference. Nonetheless, total weight loss did not significantly differ by condition. Engagement in dietary SM mediated the effect of condition on weight. Counselor access to SM data is feasible and acceptable. Additional research is warranted to determine whether it can meaningfully improve outcomes.

Know Thy Patient: Enhancing Lifestyle Interventions with Psychological Assessment

Disease reversal and prevention interventions aim to promote substantial lifestyle changes in patients that are maintained for the long-term. The science of behavior change has identified many factors associated with initiating and maintaining lifestyle changes, many of which are psychosocial in nature. Disease reversal interventions can be significantly enhanced through the incorporation of a comprehensive psychological evaluation. The value of psychological assessment has been firmly established for the purposes of evaluating candidates for bariatric surgery and organ transplant, which necessitate strict and long-term lifestyle modification to maximize surgical outcomes. One of the first Heart Disease Reversal Programs housed within a Cardiology department, started at UC Davis in the early 1990s, included a psychologist and a psychological evaluation that led to a tailored plan for their patients. Psychologists also receive training in both applied research and program development/evaluation, making them well-suited to organize, coordinate, and direct disease reversal and prevention programs. Psychological assessment provides a way to gain a more complete picture of our patients, enabling us to better tailor treatment interventions that work.

Long-Term Weight-Loss Lifestyle Modification Programme in a Patient with Severe Lumbar Intervertebral Disc Degeneration and Obesity: A Case Report

Obesity is a growing health problem worldwide, associated with serious medical and psychosocial comorbidities that increase the risk of mortality. Strong evidence confirms lifestyle modification programmes as the cornerstone of its treatment. However, the available long-term lifestyle modification programmes for weight management delivered in Arabic-speaking countries seem to be lacking in effectiveness in terms of weight-loss maintenance and do not conform to the standard for clinical significance. Factors such as methodological weaknesses in programme transcultural adaptation and the lack of expert clinical supervision before and during implementation seem to underlie this discrepancy. In this case report, we describe for the first time an Arabic-speaking patient with obesity and severe lumbar intervertebral disc degeneration, who successfully underwent weight management by means of a new, well-adapted and well-implemented personalized cognitive behavioural programme for obesity (CBT-OB). After eighteen months, the patient displayed significant weight-loss maintenance (~16% weight-loss), improvement in total and central body fat distribution, reduced pain from disc degeneration, and an increase in high-density lipoprotein (HDL). The CBT-OB programme may be a feasible approach to managing Arab patients with obesity, producing long-lasting weight-loss maintenance improvements in the obesity-related profile.

Effects of a long-term lifestyle modification programme on peripheral neuropathy in overweight or obese adults with type 2 diabetes: the Look AHEAD study

Aims/hypothesisThe aim of this study was to evaluate the effects on diabetic peripheral neuropathy (DPN) of a long-term intensive lifestyle intervention (ILI) programme designed to achieve and maintain weight loss.MethodsBeginning in 2001, a total of 5145 overweight or obese people with type 2 diabetes, aged 45–76 years, participating in the multicentre Look AHEAD (Action for Health in Diabetes) study were randomised to ILI (n = 2570) or to a diabetes support and education (DSE) control group (n = 2575) using a web-based management system at the study coordinating centre at Wake Forest School of Medicine (Winston-Salem, NC, USA). Randomisation was stratified by clinical centre and was not revealed to the clinical staff responsible for obtaining data on study outcomes. Because of the nature of the study, patients and the local centre interventionists were not blinded to the study group assignments. In addition, the coordinating centre staff members responsible for data management and statistical analyses were not blinded to the study group assignments. The interventions were terminated in September 2012, 9–11 years after randomisation, but both groups continued to be followed for both primary and secondary outcomes. Neuropathy evaluations included the Michigan Neuropathy Screening Instrument (MNSI) questionnaire completed at baseline in 5145 participants (ILI n = 2570, DSE n = 2575) and repeated annually thereafter and the MNSI physical examination and light touch sensation testing conducted in 3775 participants (ILI n = 1905, DSE n = 1870) 1–2.3 years after discontinuation of the intervention.ResultsAt baseline, the MNSI questionnaire scores were 1.9 ± 0.04 and 1.8 ± 0.04 in the ILI and DSE groups, respectively (difference not statistically significant). After 1 year, when weight loss was maximal in the ILI group (8.6 ± 6.9%) compared with DSE (0.7 ± 4.8%), the respective MNSI scores were 1.7 ± 0.04 and 2.0 ± 0.04 (p ≤ 0.001). Subsequently, the scores increased gradually in both groups, but remained significantly lower in the ILI group for the first 3 years and at the end of follow-up. In both groups, there was a significant association between changes in the MNSI scores and changes in body weight, HbA1c and serum lipids. There were no significant between-group differences in the proportions of participants with MNSI physical examination scores ≥2.5, considered to be indicative of diabetic neuropathy. The light touch sensation measured separately in either the right or left big toes (halluces) did not differ between ILI and DSE, but when the data were combined for both toes, light touch was better preserved in the ILI group.Conclusions/interpretationILI resulted in a significant decrease in questionnaire-based DPN, which was associated with the magnitude of weight loss. In both the ILI and DSE groups, changes in the MNSI score were also related to changes in HbA1c and lipids. There were no significant effects of ILI on physical examination measures of DPN conducted 1–2.3 years after termination of the active intervention, except for light touch sensation, which was significantly better in the ILI group when measurements were combined for both toes. However, a potential limiting factor to the interpretation of the physical examination data is that no baseline studies are available for comparison.Trial registration:ClinicalTrials.gov NCT00017953.Funding:This work was funded by the National Institutes of Health through cooperative agreements with the National Institute of Diabetes and Digestive and Kidney Diseases.

The excessive caloric intake and micronutrient deficiencies related to obesity after a long-term interdisciplinary therapy.

The aim of this study was to assess the effectiveness of a long-term interdisciplinary lifestyle modification therapy on food intake, body composition, and anthropometric measurements of obese women. Seventy obese women (age 41±5.9y) attended the interdisciplinary therapy, with nutrition, physical exercise, physiotherapy, and psychological support during the course of 1y. Usual food intake was estimated by 3-d dietary record. Dual-energy x-ray absorptiometry was performed to determine body fat and fat-free mass. Waist and hip circumferences also were measured. Student's t test and Wilcoxon test were used for comparisons among categories; P<0.05 was considered significant. The assessment of dietary intake showed significant changes after interdisciplinary therapy. A reduction in intake of total calories (18.3%), carbohydrates (15.6%), and total fats (13.1%) was observed. Total micronutrient intake did not change positively after therapy, as the intake level of 16 micronutrients was still lower than recommended. The therapy was effective in reducing significantly body weight (5.9%), body mass index (6.1%), body fat (4.7%), and waist (5.2%) and hip (3.8%) circumferences. Long-term interdisciplinary therapy was effective in decreasing the intake of calories, carbohydrates, and fats. The therapy positively changed the body composition and reduced anthropometric measurements. However, the intake of some micronutrients after therapy was still significantly lower than recommended. These results demonstrated that the proposed interdisciplinary methodology can be effective in treating obesity; however, the present study reinforced the need to address the micronutrient deficiency in the target population.

Pharmacologic Therapy for Nonalcoholic Fatty Liver Disease

Weight loss via lifestyle modification remains the most efficient treatment for NAFLD. Weight loss and exercise are the cornerstones of therapy, but achieving long-term lifestyle modification is not free from difficulties. Pharmacologic therapy should be considered for patients with NAFLD unable to achieve or maintain lifestyle-induced weight loss. Unfortunately, there is no approved drug for NAFLD currently. Current treatment methods for NAFLD can be divided roughly into those methods that target components of metabolic syndrome using weight reduction and insulin sensitizers (pioglitazone) and those that use antioxidants (Vitamin E) to benefit the liver. Pioglitazone has been shown to improve steatosis, hepatocellular ballooning, and inflammation and also to reduce the risk of fibrosis progression in several randomized-controlled trials (RCTs). In a large RCT, large doses of vitamin E improved all histological lesions except for fibrosis. Compared with a placebo, Metformin lowered ALT, but did not improveliver histology. Recently, novel anti-diabetic agents (GLP-1 analogues, DPP IV inhibitors) and probiotics that alter the gutmicrobiome were shown to mildly benefit ALT and liver histology. In this report, we systemically review current pharmacologic therapies and other promising agents that were not considered in the most recent guidelines for the treatment of NAFLD. (Korean JMed 2014;86:425-431)

Nutrition and physical activity in NAFLD: an overview of the epidemiological evidence.

Nonalcoholic fatty liver disease (NAFLD) has been recognized as a major health burden. The high prevalence of NAFLD is probably due to the contemporary epidemics of obesity, unhealthy dietary pattern, and sedentary lifestyle. The efficacy and safety profile of pharmacotherapy in the treatment of NAFLD remains uncertain and obesity is strongly associated with hepatic steatosis; therefore, the first line of treatment is lifestyle modification. The usual management of NAFLD includes gradual weight reduction and increased physical activity (PA) leading to an improvement in serum liver enzymes, reduced hepatic fatty infiltration, and, in some cases, a reduced degree of hepatic inflammation and fibrosis. Nutrition has been demonstrated to be associated with NAFLD and Non-alcoholic steatohepatitis (NASH) in both animals and humans, and thus serves as a major route of prevention and treatment. However, most human studies are observational and retrospective, allowing limited inference about causal associations. Large prospective studies and clinical trials are now needed to establish a causal relationship. Based on available data, patients should optimally achieve a 5%-10% weight reduction. Setting realistic goals is essential for long-term successful lifestyle modification and more effort must be devoted to informing NAFLD patients of the health benefits of even a modest weight reduction. Furthermore, all NAFLD patients, whether obese or of normal weight, should be informed that a healthy diet has benefits beyond weight reduction. They should be advised to reduce saturated/trans fat and increase polyunsaturated fat, with special emphasize on omega-3 fatty acids. They should reduce added sugar to its minimum, try to avoid soft drinks containing sugar, including fruit juices that contain a lot of fructose, and increase their fiber intake. For the heavy meat eaters, especially those of red and processed meats, less meat and increased fish intake should be recommended. Minimizing fast food intake will also help maintain a healthy diet. PA should be integrated into behavioral therapy in NAFLD, as even small gains in PA and fitness may have significant health benefits. Potentially therapeutic dietary supplements are vitamin E and vitamin D, but both warrant further research. Unbalanced nutrition is not only strongly associated with NAFLD, but is also a risk factor that a large portion of the population is exposed to. Therefore, it is important to identify dietary patterns that will serve as modifiable risk factors for the prevention of NAFLD and its complications.

A Long-Term Lifestyle Modification Program Aimed at Preventing Type 2 Diabetes and Cardiovascular Disease Results in Weight Loss and Improvements in Lipids, Blood Glucose and Blood Pressure

A Long-Term Lifestyle Modification Program Aimed at Preventing Type 2 Diabetes and Cardiovascular Disease Results in Weight Loss and Improvements in Lipids, Blood Glucose and Blood Pressure

Measuring health literacy: moving towards a health – promotion perspective

unattended. Of course, questions on ‘how’ to measure health literacy are not independent of the more fundamental question on ‘what’ and ‘what for’ do we want to measure it. Those questions, I suppose, cannot be answered without some differentiation on the field of application, in other words, in what public health intervention areas health literacy is meant to be applied to.Usual answers to the ‘what for’ question revolve around public health objectives to improve people’s chances for good health. But then we ask: What dimensions of health do we want to improve and through what kind of interven-tion approach is health literacy supposed to contribute to that goal? Is it medically defined outcomes such as diabe-tes, hypertension and their risk factors or is it subjective wellbeing and social functioning? And, is it through medi-cal services or through lifestyle modifications that we want health literacy interventions to contribute to? In that, we need to consider that health literacy may have very differ-ent meanings and functions in contexts as divers as a short hospital stay and a long-term lifestyle modification. This clearly indicates that we need different measures of health literacy to cover the various fields of public health inter-ventions. A more differentiated look at medical services and health promotion as the two major fields of public health inter-ventions links the applied ‘how to measure’ question with theoretical considerations behind the ‘what for’ question. Applied to medical settings, the question on what we want to measure health literacy for is often answered by point-ing to an optimal utilization of medical services. The ra-tional there is that optimal or at least adequate use of medical services would depend on people’s abilities to read and understand medical information, be it in written form or conveyed in personal encounters such as doctors visits. Improving people’s understanding of what is pro-vided in the realm of medical services is seen as a major factor that contributes to increased quality of care and ad-herence to expert advice. Measurement of health literacy is needed to identify those patients that do not understand medical information or the range of services offered. Only if we know about those patients or subgroups with low de-grees of health literacy, we can adjust our services respec-tively or provide specific teaching programs for patients.Answers to the ‘how’ and ‘what for’ questions might be significantly different, if we take them on from a health promotion perspective. Health promotion approaches do not focus on illness experiences or optimal use of medical services. In health promotion the focus usually is much broader and emphasizes healthy general living conditions and people’s chances to live healthy lives. Moreover, health promotion calls for improving the resources people need in order to be active for their health, their own personal health, the health of their families and communities, in-cluding the power to change things for the better. In this perspective, health literacy refers to people’s knowl-edge about how health is maintained and improved in

Perceptions and Beliefs About Body Size, Weight, and Weight Loss Among Obese African American Women: A Qualitative Inquiry

The purpose of this qualitative study was to explore perceptions and beliefs about body size, weight, and weight loss among obese African American women in order to form a design of weight loss intervention with this target population. Six focus groups were conducted at a community health clinic. Participants were predominantly middle-aged with a mean Body Mass Index of 40.3 +/- 9.2 kg/m(2). Findings suggest that participants (a) believe that people can be attractive and healthy at larger sizes; (b) still feel dissatisfied with their weight and self-conscious about their bodies; (c) emphasize eating behavior as the primary cause for weight gain; (d) view pregnancy, motherhood, and caregiving as major precursors to weight gain; (e) view health as the most important reason to lose weight; (f) have mixed experiences and expectations for social support for weight loss; and (g) prefer treatments that incorporate long-term lifestyle modification rather than fad diets or medication.

The effects of a children's summer camp programme on weight loss, with a 10 month follow-up.

To assess the long-term effects of a multidisciplinary approach involving structured fun-type skill learning physical activities in the treatment of obese and overweight children. A longitudinal investigation incorporating repeated measurements before and after the 8 week intervention and after the 44 week follow-up period. The camp programme (Massachusetts, USA) utilised structured fun-based skill learning physical activities, moderate dietary restriction and behaviour modification. The primary aims of the intervention were to reduce body mass and promote the maintenance of the reduction in body mass using an alternative to standard exercise prescription. One-hundred and ninety-four children (64 boys and 130 girls, aged 12.6+/-2.5y) enrolled at a summer weight loss camp, of which 102 children (38 boys and 64 girls aged 13.6+/-2.4y) returned 1 y later. On commencement of the programme all children were assessed for body mass and stature. At follow-up, data was available on 102 subjects for body mass and stature. Over the 8 week intervention significant reductions (P= 0.00) in body mass were obtained. During the 44 week follow-up significant increases (P= 0.00) were noted in body mass, body mass index (BMI) and stature, but as expected there were large variations in the responses. One year after the initial measures had been taken mean body mass and BMI were lower than at the start of the intervention, BMI significantly so (week 0, 32.9 +/- 7.4 kg/m2; week 8 29.1 +/- 6.5 kg/m2; week 52, 30.05 +/- 7.04 kg/m2); (P= 0.00). Stature increased significantly (week 0, 1.58 +/- 0.12 m; week 52, 1.64 0.11 m) (P= 0.00) during this period, demonstrating a reduction in mean body mass over a 1 y period whilst subjects continued to increase in stature. When changes in BMI are analysed with the use of standard scores, there is a non-significant increase (P=0.07) in BMI during the follow-up phase and 89% of children had a lower BMI than at week 0. These findings suggest that the use of a structured fun-based skill learning programme may provide an alternative method of exercise prescription to help children prolong the effects of the 8 week intervention. Further investigations will help identify the key factors that are necessary for long-term lifestyle modification.

Cancer Prevention - Behavior Changes: The Short and the Long of It

Background. Behavioral factors play an important role in the adoption and maintenance of nutritional modifications, delivered either through chemopreventive regimens or through dietary adaptation. A body of research supports a protective role of fruits and vegetables, dietary fiber, and eating a low-fat diet in reducing cancer risk. There is only limited knowledge, however, about the cancer-preventing properties of specific micronutrients, apart from β-carotene; about optimal levels of intake of differing micronutrients; and about patterns of food intake associated with reduced cancer risk. Thus, it would seem preferable, overall, to be able to recommend cancer prevention through dietary modification rather than through the administration of individual agents. Methods. Studies of dietary adherence in cancer prevention have yielded varying success rates, but are generally quite promising. We have developed a model that encompasses the range of behavioral, psychological, social, and systemic variables thought to influence adherence to nutritional regimens. Results. The model is being utilized to influence the form and content of nutritional regimens and to promote short-term change which can then be sustained as long-term lifestyle modification. The model can also be applied to evaluate adherence to nutritional or other behavioral modifications and to determine the factors predictive of success.