Predictors Of Weight Loss Research Articles

Predicting Early Weight Loss Failure Using a Bariatric Surgery Outcomes Calculator and Weight Loss Curves.

Weight loss after bariatric surgery can be accurately predicted using an outcomes calculator; however, outliers exist that do not meet the 1year post-surgery weight projections. Our goal was to determine how soon after surgery these outliers can be identified. We conducted a retrospective cohort study. Using a bariatric surgery outcomes calculator formulated by the Michigan Bariatric Surgery Collaborative (MBSC), predicted weight loss at 1year post-surgery was calculated on all patients who underwent primary bariatric surgery at a single-center academic institution between 2006 and 2015 who also had a documented 1-year follow-up weight (n = 1050). Weight loss curves were compared between high, low, and non-outliers as defined by their observed-to-expected (O:E) weight loss ratio based on total body weight loss (TBWL) %. Mean predicted weight loss for the study group was 39.1 ± 9.9kg, while mean actual weight loss was 39.7 ± 17.1kg resulting in a mean O:E 1.01 (± 0.35). Based on analysis of the O:E ratios at 1year post-surgery, the study group was sub-classified. Low outliers (n = 188, O:E 0.51) had significantly lower weight loss at 2months (13.1% vs 15.6% and 16.5% TBWL, p < 0. 001) and at 6months (19% vs 26% and 30% TBWL, p < 0.001) when compared to non-outliers (n = 638, O:E 1.00) and high outliers (n = 224, O:E 1.46), respectively. Weight loss curves based on individually calculated outcomes can help identify low outliers for additional interventions as early as 2months after bariatric surgery.

Developing the "Choosing Health" Digital Weight Loss and Maintenance Intervention: Intervention Mapping Study.

Digital health promotion programs tailored to the individual are a potential cost-effective and scalable solution to enable self-management and provide support to people with excess body weight. However, solutions that are widely accessible, personalized, and theory- and evidence-based are still limited. This study aimed to develop a digital behavior change program, Choosing Health, that could identify modifiable predictors of weight loss and maintenance for each individual and use these to provide tailored support. We applied an Intervention Mapping protocol to design the program. This systematic approach to develop theory- and evidence-based health promotion programs consisted of 6 steps: development of a logic model of the problem, a model of change, intervention design and intervention production, the implementation plan, and the evaluation plan. The decisions made during the Intervention Mapping process were guided by theory, existing evidence, and our own research-including 4 focus groups (n=40), expert consultations (n=12), and interviews (n=11). The stakeholders included researchers, public representatives (including individuals with overweight and obesity), and experts from a variety of relevant backgrounds (including nutrition, physical activity, and the health care sector). Following a structured process, we developed a tailored intervention that has the potential to reduce excess body weight and support behavior changes in people with overweight and obesity. The Choosing Health intervention consists of tailored, personalized text messages and email support that correspond with theoretical domains potentially predictive of weight outcomes for each participant. The intervention content includes behavior change techniques to support motivation maintenance, self-regulation, habit formation, environmental restructuring, social support, and addressing physical and psychological resources. The use of an Intervention Mapping protocol enabled the systematic development of the Choosing Health intervention and guided the implementation and evaluation of the program. Through the involvement of different stakeholders, including representatives of the general public, we were able to map out program facilitators and barriers while increasing the ecological validity of the program to ensure that we build an intervention that is useful, user-friendly, and informative. We also summarized the lessons learned for the Choosing Health intervention development and for other health promotion programs. RR2-10.1136/bmjopen-2020-040183.

Sustained weight loss after duodenal-jejunal bypass liner treatment in patients with body mass index below, but not above 35 kg/m2 : A retrospective cohort study.

Previous data from short term studies have shown an efficacy of the duodenal-jejunal bypass liner (DJBL) for weight loss. However, less data is available regarding weight change after device removal and possible predictors for weight loss. This is a retrospective chart review of all patients who had DJBL inserted at the University Hospital Zurich between December 2012 and June 2015. A total of 27 patients had DJBL insertion. The median BMI at baseline was 38.5 (34.0-42.2)kg/m2 . In the 24 patients with DJBL treatment >3months (failed implantation or early removal due to side effects in 3 patients), the mean duration of implantation was 42.9 ± 13.1 weeks. During the treatment, the mean total body weight loss (%TBWL) was 15.0 ± 8.3%. Fifteen patients had long-term follow-up data available (mean duration of follow-up 4.0 ± 0.9 years). The mean weight change was 12.7 ± 12.8kg, corresponding with a mean % weight regain of 13.3 ± 13.3%. Five patients (33.3%) subsequently underwent bariatric surgery. In patients with class I obesity (BMI <35 kg/m2 at baseline), 4 out of 6 (66.7%) had a stable weight or only a weight regain <7%. In contrast, no patient with BMI >35 kg/m2 at baseline was able to keep weight regain below 7%. DJBL is an effective treatment for obesity, but substantial weight regain occurs during long-term follow up after the device removal, in particular in patients with BMI > 35 kg/m2 .

Retention, Fasting Patterns, and Weight Loss With an Intermittent Fasting App: Large-Scale, 52-Week Observational Study

BackgroundIntermittent fasting (IF) is an increasingly popular approach to dietary control that focuses on the timing of eating rather than the quantity and content of caloric intake. IF practitioners typically seek to improve their weight and other health factors. Millions of practitioners have turned to purpose-built mobile apps to help them track and adhere to their fasts and monitor changes in their weight and other biometrics.ObjectiveThis study aimed to quantify user retention, fasting patterns, and weight loss by users of 2 IF mobile apps. We also sought to describe and model starting BMI, amount of fasting, frequency of weight tracking, and other demographics as correlates of retention and weight change.MethodsWe assembled height, weight, fasting, and demographic data of adult users (ages 18-100 years) of the LIFE Fasting Tracker and LIFE Extend apps from 2018 to 2020. Retention for up to 52 weeks was quantified based on recorded fasts and correlated with user demographics. Users who provided height and at least 2 readings of weight and whose first fast and weight records were contemporaneous were included in the weight loss analysis. Fasting was quantified as extended fasting hours (EFH; hours beyond 12 in a fast) averaged per day (EFH per day). Retention was modeled using a Cox proportional hazards regression. Weight loss was analyzed using linear regression.ResultsA total of 792,692 users were followed for retention based on 26 million recorded fasts. Of these, 132,775 (16.7%) users were retained at 13 weeks, 54,881 (6.9%) at 26 weeks, and 16,478 (2.1%) at 52 weeks, allowing 4 consecutive weeks of inactivity. The survival analysis using Cox regression indicated that retention was positively associated with age and exercise and negatively associated with stress and smoking. Weight loss in the qualifying cohort (n=161,346) was strongly correlated with starting BMI and EFH per day, which displayed a positive interaction. Users with a BMI ≥40 kg/m2 lost 13.9% of their starting weight by 52 weeks versus a slight weight gain on average for users with starting BMI <23 kg/m2. EFH per day was an approximately linear predictor of weight loss. By week 26, users lost over 1% of their starting weight per EFH per day on average. The regression analysis using all variables was highly predictive of weight change at 26 weeks (R2=0.334) with starting BMI and EFH per day as the most significant predictors.ConclusionsIF with LIFE mobile apps appears to be a sustainable approach to weight reduction in the overweight and obese population. Healthy weight and underweight individuals do not lose much weight on average, even with extensive fasting. Users who are obese lose substantial weight over time, with more weight loss in those who fast more.

Effects of meeting steps-based and minutes-based physical activity goals on weight loss in online behavioral weight control: seemingly unrelated regression analysis

ABSTRACT Background Behavioral weight loss programs often prescribe physical activity (PA) goals in terms of minutes/week of moderate-to-vigorous PA (MVPA) and steps/day. However, the impact of meeting each type of goal prescription on weight loss is unclear, particularly in digitally-based (eHealth/mHealth) programs. This secondary analysis of a randomized trial examined the effects of meeting steps-based and minutes-based goals on weight loss in an eHealth behavioral weight control program. Methods Adults in the control arm received a 6-month online behavioral weight loss intervention with prescribed weekly goals for daily steps and minutes of MVPA. The number of weeks steps-based and minutes-based goals were met (≥100% and ≥75% thresholds) based on self-reported PA were examined as predictors of 6-month weight loss among those providing weight outcomes (n = 172; 81% of control arm) using a systems regression approach. Results Participants (BMI 35.6 kg/m2; 90.1% female; 48.7 years of age) met weekly goals for MVPA (7.1 ± 6.4 weeks) more often than steps (3.5 ± 5.5 weeks, P < .001). Meeting the steps goals (β = .24, P < .001) and MVPA goals (β = .20, P < .001) were each statistically significant predictors of weight loss at the 100% threshold; their total effects were not statistically different from one another (χ 2 = 1.12, P = .29). Similarly, at the 75% threshold for steps goals (β = .19, P < .001) and MVPA goals (β = .19, P < .001), each independently predicted weight loss; no differences were detected in their total effects (χ2 = .01, P = .92). The probability of reaching ≥5% weight loss was comparable between meeting the steps goals and MVPA goals at both adherence thresholds. Conclusions Greater attainment of PA goals prescribed as steps and minutes of MVPA independently contribute to similar weight loss outcomes in a 6-month online behavioral weight loss intervention. Future research should determine whether promoting adherence to combined steps-based and minutes-based goals produces better weight loss than utilizing either goal alone and identify strategies that improve adherence.

Factores preoperatorios correlacionados con la pérdida de peso post-cirugía bariátrica

Whether preoperative parameters can predict weight loss following bariatric surgery is a matter of debate. We conducted a longitudinal and prospective pilot study on 35 patients that underwent bariatric surgery, with a 12-month follow-up. In the preoperative period, a high HOMA-beta index, lower fasting blood glucose, and lower HbA1c were correlated with a lower BMI at 12 months. Traditional preoperative factors, such as weight and BMI, were correlated with the post-operative BMI values. The presence of well-controlled diabetes may influence weight loss after surgery.

Preoperative factors correlated with post-bariatric surgery weight loss

Whether preoperative parameters can predict weight loss following bariatric surgery is a matter of debate. We conducted a longitudinal and prospective pilot study on 35 patients that underwent bariatric surgery, with a 12-month follow-up. In the preoperative period, a high HOMA-beta index, lower fasting blood glucose, and lower HbA1c were correlated with a lower BMI at 12 months. Traditional preoperative factors, such as weight and BMI, were correlated with the postoperative BMI values. The presence of well-controlled diabetes may influence weight loss after surgery.

S1453 Weight Loss in Bariatric Surgery Patients Treated at a Novel Clinic Incorporating Obesity Medicine for Treatment of Nonalcoholic Fatty Liver Disease

Introduction: The Yale Fatty Liver Disease Program (YFLDP) is a patient care model incorporating weight management with standard hepatology care for targeted treatment of nonalcoholic fatty liver disease (NAFLD). Weight management is the mainstay treatment for NAFLD, with 10% total body weight loss (TBWL) leading to disease improvement. Bariatric surgery is an effective treatment for obesity and associated metabolic diseases, though only an estimated 1% of eligible patients receive referral nationwide. We studied YFLDP patient referral rates to bariatric surgery, clinical and surgical characteristics, and weight loss outcomes. Methods: We retrospectively extracted demographic, surgical, and weight loss outcome data of adult YFLDP patients from 10/2015 to 5/2022. Standard eligibility criteria included body mass index (BMI) >40 kg/m2 or >35 kg/m2 with an obesity-associated comorbidity. Actual 1-year weight loss outcomes were compared to predicted weight-loss outcomes calculated using the MBSAQIP Bariatric Surgical Risk/Benefit Calculator and assessed with a 2-tailed t-test. Results: There were 1,166 patients, of whom 596 (51.1%) were eligible for bariatric surgery (Table). Of these, 150 (25.3%) received referral, 32 patients (21.3%) underwent surgery (22 received sleeve gastrectomy (SG) and 10 had a Roux-en-Y gastric bypass [RYGB]). Patients who received surgery were more likely female and upper class compared to those who continued with lifestyle/medication management. Patients receiving SG and RYGB had mean TBWL 21.5% and 20.0%, respectively, while patients who continued medication/lifestyle management had TBWL of 3%. There was no significant difference comparing actual vs predicted final BMI (P=0.12), actual vs predicted weight loss (P=0.13), and actual vs predicted TBWL (P=0.13) post-bariatric surgery for all procedures (Figure). Conclusion: Integration of weight management with hepatology medical care is an effective model for NAFLD weight loss treatment. Patients receive referral for bariatric surgical evaluation at a rate 25 times greater than the national average, and those that receive surgery have comparable weight loss to that predicted in all patients receiving these surgeries, and on average exceeded the treatment threshold expected to treat NAFLD. Further study to identify patients who would most benefit from bariatric surgery would help to inform better patient selection and proactive referral efforts.Figure 1.: Predicted vs actual bariatric surgical outcomes in patients referred for surgery. (A) Actual vs Predicted Final Body Mass Index (BMI) post Bariatric Surgery: Comparison between YFLDP (Yale Fatty Liver Disease Program) patients’ actual BMI post bariatric surgery vs predicted BMI post bariatric surgery using the MBSAQIP Bariatric Surgical Risk/Benefit Calculator. There was no statistically significant difference between actual and predicted BMI (P=0.12). (B) Total Body Weight Loss (TBWL) in Patients given Bariatric Surgery Referral: Comparison between YFDLP patients’ total body weight % reduction in patients given a bariatric surgery referral who either underwent a gastric bypass or sleeve gastrectomy or did not have surgery and continued with lifestyle/medication management. Patients who underwent surgery had a statistically significant percent reduction in TBWL compared to patients managed with only lifestyle/medications. Error bars represent standard error. ***P< 0.001 Table 1. - Demographic and surgical characteristics of Yale Fatty Liver Disease Program patients who were referred for bariatric surgery Patient Characteristics Referred, Underwent Bariatric Surgery (+)(n=32) Referred, Did Not Undergo Bariatric Surgery (-)(n=118) P Sex n (%) Male 6 (19) 35 (30) 0.22 Female 26 (81) 83 (70) Age years (SD) 49 (10.3) 51 (12.98) 0.60 Medicare Qualifying n (%) 2 (6) 19 (12.98) 0.15 Race n (%) White 22 (69) 86 (73) 0.29 Black 4 (13) 15 (13) Asian 1 (3) 0 (0) Other/Declined 5 (15) 17 (14) Ethnicity n (%) Hispanic 6 (19) 27 (23) 0.62 Non-Hispanic 26 (81) 91 (77) Insurance Status n (%) Uninsured 0 (0) 0 (0) 0.045 Medicaid 14 (44) 31 (26) Medicare 2 (6) 27 (23) Private 16 (50) 60 (51) Median House Income by Zip Code n (%) < $50k 7 (22) 29 (25) 0.48 $50k-100k 19 (59) 75 (63) >$100k 6 (19) 14 (12) Anti-Obesity Medications n (%) Lifetime 16 (47) 38 (32) 0.78 Since YFLDP 10 (31) 29 (25) BMI Reduction mean (SD) RYGB (n=10) 8.3 (5.4) Predicted 1.3 (3.9) < 0.001 SG (n=22) 9.4 (6.1) < 0.001 TBWL % (SE) RYGB (n=10) 20.5 (3.5) Predicted 3 (0.8) < 0.001 SG (n=22) 21 (2.73) < 0.001 (+) Surgery denotes patients who underwent bariatric surgery after referral. (-) Surgery denotes patients who did not undergo bariatric surgery after referral. Patients who underwent bariatric surgery had statistically significant greater reduction in mean BMI compared to patients who did not have surgery. SD is standard deviation, SE is standard error, BMI is body mass index (kg/m2), RYGB is Roux-en-Y gastric bypass, SG is sleeve gastrectomy, TBWL is total body weight loss.

Effectiveness of Combined Exercise and Nutritional-Behavioral Intervention on Health Outcomes among Patients with Bariatric Surgery

Context: Many bariatric surgery patients experience suboptimal long-term weight outcomes, including weight regain. Weight regaining threatens the benefits initially achieved from surgery, including improved health outcomes, and patients still require hard work and lifelong behavioral change to lose and maintain weight successfully.&#x0D; Aim: This study aimed to evaluate the effectiveness of combined exercise and nutritional-behavioral intervention on health outcomes among patients with bariatric surgery.&#x0D; Methods: A quasi-experimental (study/control group) design was utilized in the present study that was conducted at surgical departments and outpatient clinics in the Benha University Hospital, Qualubia Governorate, from January 2021 until April 2022. A convenience sample of 85 patients ended with 60 patients who completed the study (Intervention group 30 &amp; control group 30). They were recruited according to to sample size equation based on the patient admitted to the study setting in 2020. Two tools were utilized for data collection; the patient structured interviewing questionnaire and the patient’s health outcomes questionnaires that included anthropometric measures, eating behavior and food frequency questionnaire, international physical activity questionnaire, and the Moorehead-Ardelt quality of life questionnaire.&#x0D; Results: The findings revealed a mean sample age of 35.53±4.06 for the intervention group and 34.47±4.11 for the control group. The intervention and control groups revealed a highly statistically significant difference regarding all knowledge elements and the total knowledge score. Besides, a statistically significant improvement in the intervention group's knowledge throughout the study phases. A highly statistically significant difference was revealed in the percentage of weight loss (%wt L) among the intervention group throughout the following study periods (first month, six months, and one year of intervention), with statistically significant differences between the intervention and control group after one and six months, and after one year of intervention regarding their weight, % wt L, BMI, and excess BMI loss percentage. Eating habit scores revealed statistically significant differences between the intervention and control group regarding eating behaviors and food frequency at one and six months and one year of intervention. Residence (p=0.01), total patient knowledge (p=0.002), food frequency (p=0.000), and physical activity (p=0.001) level predicted weight loss in the intervention group, while age was the only predictor in the control group (p=0.02).&#x0D; Conclusion: Implementing the combined exercise and nutritional-behavioral intervention post bariatric surgery significantly improved patients' health outcomes in terms of improved patient knowledge, weight loss percentage, eating habits, physical activity, and quality of life levels among the intervention group compared to the control group. There is a need to raise knowledge of bariatric surgery patients regarding the value of living a healthy lifestyle for improving surgical outcomes and maintaining weight loss.

Acute Exercise Increases Attentional Bias Towards Food Cues

Although exercise is a common weight loss strategy, the amount of weight loss resulting from exercise training is often less than expected. This is often attributed to exercise promoting greater energy intake, resisting the exercise-induced negative energy balance required for weight loss. Prior research on how exercise can influence hormonal mediators of appetite offer conflicting results, with some demonstrating longitudinal exercise increases the satiety response to a meal and changes in hunger hormones do not predict weight loss. Research on other underlying mechanisms working to promote energy intake during exercise is scarce. PURPOSE: To determine if acute exercise influences attentional bias towards food cues. METHODS: Thirty (30) participants (BMI ≥ 25, aged 18-50 years) completed the Dot-Probe task before and 15 minutes after a bout of aerobic exercise where they expended an estimated 500 kcal and before and after a 60-minute bout of television watching (sedentary condition) on separate sessions. Sessions were separate by one week and order was counterbalanced across participants. The Dot-Probe task uses an eye-tracking device to measure the amount of time (ms) participants spent fixated on image pairs projected on a computer screen. Images included either highly appealing food (critical task stimuli) or neutral (non-food) images. Images were presented for 3,000 ms. A yellow dot appeared on either side of the screen in place of one of the previously presented images. Participants responded as quickly as possible to indicate which side the probe appeared by pressing a corresponding computer key. Mean fixation time (amount of time looking at each image) was recorded in ms. RESULTS: A condition (exercise vs sedentary) by time (pre vs post) interaction (p = 0.001) was observed where the percent of time fixated on food cues increased from 48.3% pre to 56.6% post-exercise while fixation percent changed from 50.6% pre to 49.7% post-sedentary. CONCLUSION: Acute aerobic exercise increases the environmental salience of food cues, which may increase the motivational drive to eat and resist an exercise-induced energy deficit. Attentional bias training has been successfully used to change eating behaviors and may represent a novel adjunct therapy to increase the success of an exercise for weight loss intervention.

Efficacy and Safety of a Long-Term Multidisciplinary Weight Loss Intervention under Hospitalization in Aging Patients with Obesity: An Open Label Study.

The effects of the hypocaloric diet under hospitalization on blood biochemical parameters (lipid, glycaemic, thyroid and liver profiles) were not reported in literature. This study aims to evaluate the efficacy and safety of a hypocaloric diet under hospitalisation in obese patients. A total of 151 obese subjects (49 males and 102 females, aged 69.38 ± 14.1 years, BMI 41.78 ± 7.1) were enrolled in this study. Participants were treated with an hypocaloric diet for a maximum period of 3 months. Outcomes were assessed at the beginning and at the end of the recovery period. The average duration of the hospitalisation was 47.5 days ± 1.3. The effect of the diet on all the outcomes was evaluated using the Analysis of Covariance (ANCOVA) and the predictors of weight loss were identified using linear regression. The diet induced a reduction in the anthropometric (BMI decrease of −2.713 points) and DXA body measurements in addition to serum lipids, glucose, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and C-reactive protein (CRP) levels without affecting the muscle mass, liver and thyroid profiles. During the intervention, there was a positive shift in body composition favouring fat free mass (FFM). Lower insulin but higher serum calcium and potassium levels were predictors of weight loss.

Effects of short-video use on undergraduates’ weight- loss intention: a regulatory mediation model

This research intends to explore the effects of short video use on college students’ weight loss intentions, and its intrinsic mechanism of action, based on the responses of 1268 students from three universities in southwest China to questionnaires with the instruments of a sports participation scale, body image scale, self-esteem scale and weight loss intention scale. The findings are listed as follows: 1) Short video use can significantly and positively predict weight loss intention; 2) Body image mediates the relationship between short video usage and weight loss intentions; 3) Self-esteem plays a regulatory effect as the direct path between short video use and weight loss intention as well as partial mediation effect of body image. The direct effect of short video use on weight loss intentions and the mediating effect of body image gradually increased with the decrease of self-esteem. The results of the study suggest that short video use can affect the weight loss intentions of college students through either a direct or indirect path created by the mediating role of body image. Meanwhile, the influence of self-esteem on weight loss intention can’t be ignored, which is another key factor that affects college students’ weight loss intentions beyond short video use and body image.

Predictors for weight loss after Roux-en-Y gastric bypass: the trend and associated factors for weight loss

BackgroundHistorically, Roux-en-Y gastric bypass (RYGB) has been considered the gold standard of bariatric surgery (BS). This procedure acts as a mixed restrictive and malabsorptive operation.Methods This retrospective cohort study included 410 morbidly obese patients (BMI > 40 kg/m2 or BMI > 35 kg/m2 along with at least one major comorbidity) who underwent primary laparoscopic RYGB surgery from 2009 to 2015 by a single surgery team. The patients were 18 years and older with at least 12 months of follow-up. Total weight loss (%TWL) and comorbidity resolution were compared in short-term (12 months) and mid-term (12–60 months) follow-ups. The primary and secondary outcomes were evaluating the effect of Roux-en-Y on weight loss and control of comorbidities, respectively.Results The mean ± SD age, weight, and BMI at surgery were 40.1 ± 10.58 years, 123.32 ± 19.88 kg, and 45.78 ± 5.54 kg/m2, respectively, and 329 (80%) were female, and 62 (15%) had T2DM. %TWL was significantly higher in T2DM patients 9 months postoperatively and after that. Patients with lower BMI (< 50 kg/m2) at surgery and non-diabetic patients had a significantly lower %TWL over a short- and long-term follow-up (P < 0.001).ConclusionsBS remains the most efficacious and durable weight loss treatment. However, a proportion of patients will experience insufficient weight loss following BS.

Exercise training enhances muscle mitochondrial metabolism in diet-resistant obesity.

SummaryBackgroundCurrent paradigms for predicting weight loss in response to energy restriction have general validity but a subset of individuals fail to respond adequately despite documented diet adherence. Patients in the bottom 20% for rate of weight loss following a hypocaloric diet (diet-resistant) have been found to have less type I muscle fibres and lower skeletal muscle mitochondrial function, leading to the hypothesis that physical exercise may be an effective treatment when diet alone is inadequate. In this study, we aimed to assess the efficacy of exercise training on mitochondrial function in women with obesity with a documented history of minimal diet-induced weight loss.MethodsFrom over 5000 patient records, 228 files were reviewed to identify baseline characteristics of weight loss response from women with obesity who were previously classified in the top or bottom 20% quintiles based on rate of weight loss in the first 6 weeks during which a 900 kcal/day meal replacement was consumed. A subset of 20 women with obesity were identified based on diet-resistance (n=10) and diet sensitivity (n=10) to undergo a 6-week supervised, progressive, combined aerobic and resistance exercise intervention.FindingsDiet-sensitive women had lower baseline adiposity, higher fasting insulin and triglycerides, and a greater number of ATP-III criteria for metabolic syndrome. Conversely in diet-resistant women, the exercise intervention improved body composition, skeletal muscle mitochondrial content and metabolism, with minimal effects in diet-sensitive women. In-depth analyses of muscle metabolomes revealed distinct group- and intervention- differences, including lower serine-associated sphingolipid synthesis in diet-resistant women following exercise training.InterpretationExercise preferentially enhances skeletal muscle metabolism and improves body composition in women with a history of minimal diet-induced weight loss. These clinical and metabolic mechanism insights move the field towards better personalised approaches for the treatment of distinct obesity phenotypes.FundingCanadian Institutes of Health Research (CIHR-INMD and FDN-143278; CAN-163902; CIHR PJT-148634).

Does Gastric Expansibility Affect Weight Loss Success After Laparoscopic Sleeve Gastrectomy?

Reduced excess weight loss (EWL) or regain is a worrying problem after metabolic surgery. Factors attainable from the resected specimen that can predict this outcome are investigated. We retrospectively analyzed 64 patients who had undergone laparoscopic sleeve gastrectomy. We collected demographic data, preoperative gastric emptying measurements, volume, expansion capacity, and 6-dimensional measurements of sleeve gastrectomy specimens. Correlations between EWL, body mass index levels, and gastric specimen measurements related to gastric remnant dimensions were also scrutinized. We found a significant correlation between the gastric specimen and remnant gastric volume, the resection line length in the gastric specimen, and 12th-month EWL%. Antrum expansibility was significantly increased in patients with weight regain. There was also a negative correlation between weight loss and age at postoperative first and third years. Sleeve resection line measurement and resected antrum diameter measurements can be used to predict weight loss, especially in the first year postoperatively.

Change in craving and frequency of consuming palatable foods for non-homeostatic motives after a gut-cued eating intervention

IntroductionLittle is known regarding consumption of palatable foods (PFs) for non-homeostatic reasons after weight-loss interventions and if baseline or change in frequency of this kind of eating can predict weight-loss outcomes. Little is also known of the relationship between PF eating for non-homeostatic motives and PF craving. Addressing these gaps is important because cravings and habitual consumption of PFs in the absence of homeostatic need contribute to obesity. MethodsN = 30 adults with a mean 34.8 BMI completed a seven-response choice version of the PEMS (PEMS-7) before and after Gut-Cued Eating (GCE), an intervention that did not ban PFs but instructed them to eat only when stomach-hungry and stop eating before feeling too full. Photos of PFs were also rated pre- and post-GCE. ResultsFrequency of eating PFs for social, reward enhancement, and coping, but not conformity motives, decreased after GCE. The decreases predicted amount of weight loss independent of initial weight and demographics. PF craving also decreased and, while correlated with decreasing PF intake, it did not predict weight loss. DiscussionThe study is preliminary because GCE was uncontrolled. However, results warrant a controlled investigation. That craving and frequency of consuming PFs for non-homeostatic motives declined with an intervention that did not ban PFs suggests a method that may voluntarily decrease one's intake of PFs. This should facilitate weight-loss and healthy-weight maintenance. Finally, decreased eating for non-homeostatic motives suggests that individuals were no longer using PFs to cope, socialize, and enhance reward, a change with benefits beyond weight loss.

What Intervention Elements Drive Weight Loss in Blended-Care Behavior Change Interventions? A Real-World Data Analysis with 25,706 Patients.

Background: Blended-care behavior change interventions (BBCI) are a combination of digital care and coaching by health care professionals (HCP), which are proven effective for weight loss. However, it remains unclear what specific elements of BBCI drive weight loss. Objectives: This study aims to identify the distinct impact of HCP-elements (coaching) and digital elements (self-monitoring, self-management, and education) for weight loss in BBCI. Methods: Long-term data from 25,706 patients treated at a digital behavior change provider were analyzed retrospectively using a ridge regression model to predict weight loss at 3, 6, and 12 months. Results: Overall relative weight loss was −1.63 kg at 1 month, −3.61 kg at 3 months, −5.28 kg at 6 months, and −6.55 kg at 12 months. The four factors of BBCI analyzed here (coaching, self-monitoring, self-management, and education) predict weight loss with varying accuracy and degree. Coaching, self-monitoring, and self-management are positively correlated with weight losses at 3 and 6 months. Learn time (i.e., self-guided education) is clearly associated with a higher degree of weight loss. Number of appointments outside of app coaching with a dietitian (coach) was negatively associated with weight loss. Conclusions: The results testify to the efficacy of BBCI for weight loss-with particular positive associations per time point-and add to a growing body of research that characterizes the distinct impact of intervention elements in real-world settings, aiming to inform the design of future interventions for weight management.

Early Postoperative Weight Loss Predicts Weight Loss up to 5 Years After Roux-En-Y Gastric Bypass, Banded Roux-En-Y Gastric Bypass, and Sleeve Gastrectomy

PurposePrevious studies showed that patients with lower weight loss after bariatric surgery could be identified based on early postoperative weight loss. However, these studies had only 12–36-month follow-up. This study aimed to explore whether patients in the lowest weight loss quartile at 3 months had lower weight loss trajectories up to 5 years after Roux-en-Y gastric bypass (RYGB), banded Roux-en-Y gastric bypass (BRYGB), and sleeve gastrectomy (SG) surgery.MethodsWeight was assessed preoperatively, and 3, 6, 9, 12, 24, 36, 48, and 60 months postoperatively. Patients were grouped into four categories based on quartiles of percentage total weight loss (%TWL) at 3-month follow-up. Results were compared between the lowest %TWL quartile group and other quartile groups.ResultsPatients underwent either RYGB (n=13,106; 72%), SG (n=3585; 20%), or BRYGB (n=1391, 8%) surgery. Weight loss trajectories of patients in the lowest %TWL quartile group remained lower than that of other quartile groups throughout a 5-year follow-up, for all three types of surgery. Patients in the lowest %TWL quartile group had higher age at surgery, higher baseline BMI, and were more likely to be male (in the SG group), and to suffer from diabetes, hypertension, dyslipidemia, and osteoarthritis.ConclusionThis study showed a positive association between weight loss at 3 and 12 to 60 months after bariatric surgery. Weight loss at 3 months after surgery could be used to identify patients whose anticipated weight loss trajectories are below average, to potentially improve their outcomes through early behavioral or medical interventions.Graphical

Weight Loss and Its Predictors During Participation in Cardiac Rehabilitation

We aimed to assess the prevalence and magnitude of clinically meaningful weight loss among cardiac rehabilitation (CR) participants who were overweight or obese and identify its predictors. We analyzed subjects with body mass index (BMI) ≥25 who were enrolled in a 12-week CR outpatient program from January 1, 2015, to December 31, 2019, and had paired pre- and post-CR weight data. Patients who lost 3% or more of their body weight by the end of the program were compared with the remaining participants. Multivariable logistic regression was used to determine predictors of weight loss. Overall, 129 of 485 subjects (27%) with overweight or obesity reduced their weight by at least 3% (average percent weight change: -5.0% ± 1.8% vs -0.02% ± 2.2%, average weight change: -10.9 ± 5.0 vs -0.1 ± 4.4 pounds, and average BMI change: -1.7 ± 0.7 vs -0.02 ± 0.7 kg/m²). Compared with the remaining 356 patients, those who achieved the defined weight loss were younger (p=0.016) and had higher baseline weight (p=0.002) and BMI (p &lt;0.001). The weight loss group tended to be enrolled more likely for an acute myocardial infarction or percutaneous coronary intervention (p &lt;0.001) and less likely for coronary artery bypass grafting (p=0.001) or a heart valve procedure (p=0.05). By the end of the CR program, the weight loss group demonstrated a greater increase in Rate Your Plate - Heart score (7 [3, 11] vs 4 [1, 8]; p &lt;0.001) and a greater decrease in triglycerides (-20 ± 45 vs -7 ± 55 mg/dL; p=0.026) and glycated hemoglobin (-0.1 [-0.5, 0.1] vs 0.1 [-0.3, 0.4] %; p=0.05, among patients with diabetes or prediabetes). In a multivariable logistic regression model, baseline predictors of clinically meaningful weight loss included higher BMI and not being enrolled for a surgical CR indication (p=0.001). In conclusion, throughout 12 weeks of CR participation, 129 of 485 subjects (27%) with BMI ≥25 had a 3% or more reduction in body weight. Patients with higher baseline BMI and participants without a surgical enrollment diagnosis were more likely to achieve the defined weight loss. Efforts to improve CR referral and enrollment for eligible patients with overweight and obesity should be encouraged, and suitable and efficient weight reduction interventions in CR settings need to be further studied.

Follow-up after bariatric surgery: is it time to tailor it? Analysis of early predictive factors of 3-year weight loss predictors of unsuccess in bariatric patients

Bariatric surgery (BS) is the most effective treatment strategy for obesity. Nevertheless, a subset of patients does not reach a successful weight loss or experience long-term weight regain. Conflicting evidence exists regarding predictors of BS outcomes. We aimed to define the early factors linked to 3 year unsuccessful weight loss in order to promote a tailored close follow-up. We enrolled 443 patients who underwent BS from January 2014 to December 2018 with a 3 year follow-up. An unsuccessful BS outcome was defined as a percentage of total weight loss (%TWL) < 20. We compared the characteristics between successful and unsuccessful patients in order to identify predictor factors of unsuccess after surgery. We found that the proportion of patients with unsuccessful weight loss progressively increased from one to three years after BS. In a multiple regression model, only 1 month %TWL and sleeve gastrectomy (SG) were significantly associated with 3 year unsuccessful weight loss. We stratified our cohort in four groups according to the risk of BS unsuccess, in terms of 1 month %TWL and type of surgery (SG vs gastric bypass). Interestingly, groups showed a significant difference in terms of %TWL at each follow-up point. Patients submitted to SG with lower 1 month %TWL must be considered at higher risk of future weight regain; consequently, they require a tailored and closer follow-up.Graphical abstract