Weight Management Recommendations Research Articles

Facilitators and Barriers to Weight Loss Among Patients With Idiopathic Intracranial Hypertension.

Little is known about motivation for weight loss and barriers to weight loss among patients with idiopathic intracranial hypertension (IIH). Such information is crucial for developing tailored weight management recommendations and novel interventions. We administered a survey to patients with IIH presenting to neuro-ophthalmology clinics at The University of Michigan Kellogg Eye Center (Michigan, USA) and St. Thomas' Hospital (London, England). Participants rated importance and motivation to lose weight (1-10 scale; 10 = extremely important/motivated). Facilitators and barriers to weight loss were assessed using open-ended survey questions informed by motivational interviewing methodology. Open-ended responses were coded by 2 team members independently using a modified grounded theory approach. Demographic data were extracted from medical records. Descriptive statistics were used to analyze quantitative responses. Of the 221 (43 Michigan and 178 London) patients with IIH (Table 1), most were female (n = 40 [93.0%] Michigan and n = 167 [94.9%] London). The majority of patients in the United States were White (n = 35 [81.4%] Michigan), and the plurality were Black in the United Kingdom (n = 67 [37.6%] London]) with a mean (SD) BMI of 38.9 kg/m2 (10.6 kg/m2) Michigan and 37.5 kg/m2 (7.7 kg/m2) London. Participants' mean (SD) level of importance to lose weight was 8.5 (2.2) (8.1 [2.3] Michigan and 8.8 [2.1] London), but their mean (SD) level of motivation to lose weight was 7.2 (2.2) (6.8 [2.4] Michigan and 7.4 [2.1] London). Nine themes emerged from the 992 open-ended coded survey responses grouped into 3 actionable categories: self-efficacy, professional resources (weight loss tools, diet, physical activity level, mental health, and physical health), and external factors (physical/environmental conditions, social influences, and time constraints). Most responses (55.6%; n = 551) were about barriers to weight loss. Lack of self-efficacy was the most discussed single barrier (N = 126; 22.9% total, 28.9% Michigan, and 20.4% London) and facilitator (N = 77; 17.5% total, 15.9% Michigan, and 18.7% London) to weight loss. Other common barriers were related to physical activity level (N = 79; 14.3% total, 13.2% Michigan, and 14.8% London) and diet (N = 79; 14.3% total, 9.4% Michigan, and 16.3% London). Commonly reported facilitators included improvements in physical activity level (N = 73; 16.6% total, 18.5% Michigan, and 15.1% London) and dietary changes (N = 76; 17.2% total, 16.4% Michigan, and 17.9% London). Patients with IIH believe weight loss is important. Self-efficacy was the single most mentioned important patient-identified barrier or facilitator of weight loss, but professional resource needs and external factors vary widely at the individual level. These factors should be assessed to guide selection of weight loss interventions that are tailored to individual patients with IIH.

A study protocol for a pilot randomized controlled trial to evaluate the effectiveness of a gene-based nutrition and lifestyle recommendation for weight management among adults: the MyGeneMyDiet® study.

Managing nutrition and lifestyle practices, nutrition phenotypes, and the genome forms the foundation of precision nutrition. Precision nutrition focuses on metabolic variability among individuals, and one approach to achieving its goals is to integrate gene-based nutrition and lifestyle recommendations in nutrition practice. However, scientific evidence proving the effectiveness of such recommendations is limited. This study will examine whether providing nutrition and lifestyle recommendations based on individual genotype can lead to better weight loss, along with reduction in body mass index (BMI), waist circumference, and body fat percentage among overweight and obese adults. A parallel group, single-blind, randomized controlled trial will be conducted. Sixty-two overweight/obese individuals aged 19-59 years old will be recruited. Participants will be randomly allocated to either the intervention (n = 31) or the control arm (n = 31). Participants in the intervention group will receive the MyGeneMyDiet® Recommendation for Weight Management, a gene-based nutrition and lifestyle recommendation that was developed based on existing evidence of the effects of FTO rs9939609 on body weight, BMI, and physical activity; UCP1 rs1800592 on calorie intake; and TCF7L2 rs7903146 on dietary fat intake. Participants in the control group will receive the standard recommendations for weight management. The primary outcomes will be the differences in weight, BMI, waist circumference, and body fat percentage between arms in both the active phase (6 months) and inactive phase (last 6 months) of the trial. Participants in both arms will be evaluated at baseline and in months 3, 6, 9, and 12. To the best of our knowledge, this will be the first gene-based intervention that will adopt a phase of intensive nutrition counseling, followed by a simulation of a free-living state to determine adherence to a gene-based recommendation. This study will contribute to the future implementation of precision nutrition interventions by providing evidence on the effectiveness of a gene-based nutrition and lifestyle recommendation for weight loss. clinicaltrials.gov, identifier [NCT05098899].

Why do some people with osteoarthritis and obesity awaiting hip or knee arthroplasty achieve successful weight management? A qualitative study.

To explore perceived barriers and enablers to weight management among people with obesity awaiting total knee or hip arthroplasty. A nested qualitative study within a multi-centre, quasi-experimental pilot study comparing usual care weight management to a dietitian-led weight-loss diet. Semi-structured individual interviews were conducted with adults with end-stage osteoarthritis and a body mass index ≥30 kg/m2 waitlisted for primary total knee or hip arthroplasty. Participants with diverse sociodemographic characteristics and varied success with weight management in the pilot study were purposively sampled. Interviews were analysed using inductive thematic analysis, underpinned by constructivist-interpretivist epistemology. The Patient Activation Measure and Health Literacy Questionnaire were used for context when interpreting the findings. Twenty-five participant interviews were conducted with a sociodemographically varied sample (aged 44-80 years, 9 born in Australia, 6 in paid employment and 11 lost ≥5% of their baseline weight). Four identified themes underpinned successful weight management: beliefs, adaptability, navigating healthcare and sociocultural context. Beliefs about whether weight was perceived as a problem, the expectation of weight loss and treatment-related beliefs influenced participants' perspectives towards weight loss. Adaptability, the ability to overcome barriers to weight loss, comprised three subthemes; readiness to act, degree of independence and problem-solving skills. Approaches towards navigating healthcare influenced uptake and adherence to weight management recommendations. Importantly, these themes were dependent on social and environmental circumstances, which influenced the type of barriers experienced and resources available to the individual. Differences in a person's beliefs, their ability to adapt and navigate healthcare and sociocultural context appear to explain successful weight management among people with end-stage arthritis. Clinicians should allow for individualisation cognisant of the identified themes when providing advice and treatment to promote adherence to weight management interventions. This study explored perceived barriers and enablers to weight management among people with obesity awaiting total knee or hip arthroplasty. Four identified themes underpinned successful weight management: beliefs, adaptability, navigating healthcare and sociocultural context. Beliefs about whether weight was perceived as a problem, the expectation of weight loss and treatment-related beliefs influenced participants' perspectives towards weight loss. Understanding and assessing the contribution of each factor may guide weight management from clinicians treating patients with obesity and osteoarthritis. The data are reported using the COREQ guidelines. Patients contributed to the data collected.

Weight management recommendations for youth with Down syndrome: Expert recommendations.

Youth with Down syndrome (DS) have a higher prevalence of overweight and obesity compared to the general youth population. Due to physiological and cognitive differences observed in youth with DS, weight management recommendations developed for the general population, may not be suitable for youth with DS. However, there are no recent recommendations for weight management in youth with DS. A workgroup of clinicians and researchers with extensive experience working with youth with DS came together to give clinicians and families guidance for weight management in youth with DS. Recommendations were developed by the workgroup via a methodical, deliberative process. After the initial development of the recommendations, they were shared with an expert review panel and caregivers who rated the strength of the recommendation and strength of the evidence. The workgroup moved forward the recommendations which the review panels rated as strong. Eight recommendations were developed which focused on screening for overweight and obesity, screening for health conditions that may impact dietary intake and physical activity, screening for feeding difficulties, setting appropriate recommendations for dietary intake and physical activity, and well as prevention and treatment of overweight and obesity using evidence-based strategies. These recommendations can be implemented by clinicians working with youth with Down syndrome as well as the family, school, and other relevant entities.

Barriers to Implementing Weight Management Recommendations

Dietitians are responsible for using evidence-based practice to mitigate the effects of obesity; however, it is unclear how dietitians use research to guide weight management interventions. The aim of this pilot study was to identify the barriers of research utilization and implementation of evidence-based practice in adult weight management. A survey was disseminated to dietitians working at least part-time with people with obesity. Dietitians seem to value research and evidence-based practice; however, implementation may be an issue. The pilot study found that workplace setting may provide a barrier to research utilization, but dietitian opinion of current screening and referral guidelines may also be a significant barrier to implementing best practices in adult weight management.

Recommendations for weight management in osteoarthritis: A systematic review of clinical practice guidelines

ObjectiveWhile targeting obesity is central to osteoarthritis management, recent meta-analyses demonstrate only modest effects of weight loss on symptoms, and little on structure. The World Health Organisation recommends that effective management of obesity include prevention of weight gain, weight maintenance and weight loss. Therefore, we systematically reviewed the recommendations and approaches for management of obesity in clinical practice guidelines (CPGs) for osteoarthritis. DesignNine databases were searched (01.01.2010–15.03.2022) to identify guidelines informing the non-pharmacological management of osteoarthritis. Three reviewers appraised guidelines according to the AGREE II instrument, and independently extracted data on their characteristics. One author extracted and summarised guideline recommendations on weight management. This systematic review is registered on PROSPERO (CRD42021274195). ResultsOf the included fifteen CPGs (median AGREE II domain score 78.7%), weight loss was recommended for knee (12 of 13) and hip (10 of 11) but not hand (0 of 4) osteoarthritis. Combination approaches of diet and/or exercise were recommended for overweight or obese individuals in knee (8 of 12) and hip (4 of 10) osteoarthritis. Two guidelines specified ≥5% weight loss. One guideline specified strategies for maintenance of lost weight; none specifically recommended preventing weight gain. There was discordance between strength of recommendation for weight loss and level of evidence (3 of 15). ConclusionMost CPGs for knee and hip osteoarthritis recommend weight loss to manage obesity in osteoarthritis. As steady weight accumulation is common in adults, preventing weight gain should also be considered as it is a missed opportunity to improve outcomes in osteoarthritis.

The association between sexual orientation, BMI, obesity diagnosis, and provider recommendation for weight management

BackgroundNational data show that lesbian and bisexual women are more likely to be obese compared to straight women. However little is known about whether provider recommendation for weight management varies across these populations. Furthermore, health care providers have explicit and implicit preferences for straight people in comparison to lesbian or gay people. There is little research that exists depicting how this preference affects quality of patient care. The purpose of the study is: to compare, among lesbian, bisexual, and straight females with BMIs ≥ 30: (1) the average Body Mass Index (BMI); (2) receipt of a diagnostic code for obesity; and (3) receipt of a provider recommendation for weight management.MethodsWe performed a cross-sectional study of 534 patient records from four outpatient academic internal medicine practices at the University of Pennsylvania between January 1, 2019 to December 31, 2019 to determine variations in average BMI, proportion of International Classification of Diseases (ICD)-10 codes for obesity, and proportion of weight management recommendations offered by providers among lesbian, bisexual and straight females with BMIs ≥ 30. We classified provider recommendations as definite, possible, and absent. Multivariable median (BMI outcome only) or logistic regression was used to evaluate the associations between sexual orientation and each of the following outcomes: BMI, receipt of obesity diagnosis, and weight management recommendations.ResultsThere were no significant differences in BMI, receipt of obesity diagnoses, or weight management recommendations between lesbian, bisexual, and straight females with BMIs ≥ 30. However, only about half the patients with BMIs ≥ 30, regardless of sexual orientation, received a weight management recommendation as recommended by the United States Preventive Services Task Force (USPSTF) guidelines.ConclusionWe did not observe disparities in BMI, receipt of obesity diagnoses, or receipt of weight management recommendations between sexual orientation minority and heterosexual females among this sample from an urban population of patients receiving care in a university medical system. However, provider recommendation for weight management was suboptimal in all the groups.

A qualitative exploration of the priorities and experiences of children with Duchenne muscular dystrophy, their parents, and healthcare professionals around weight management

Purpose The quality and length of life for boys with Duchenne muscular dystrophy (DMD) has improved due to medical advancements, but obesity has emerged as and may pose a risk to their physical health. Clinical guidelines recommend attention to weight management, but healthcare professionals (HCPs) find implementing them in clinical care challenging. Little information is available about the perspectives of children with DMD and their families around weight management. This study explored the key priorities of children with DMD, their parents, and HCPs who treat them, around weight management. Methods Qualitative, individual, semi-structured interviews were conducted and analyzed using a qualitative descriptive approach. Results Participants included parents of children with DMD (n = 13), children with DMD (n = 10), and HCPs (n = 14). Theme one: “Competing priorities between healthcare providers, parents, and boys” contained two sub-themes: (i) Body mechanics and function; and (ii) Psychosocial well-being. Theme two: “The realities of living with Duchenne’s Muscular Dystrophy,” with subthemes: (i) Striving for normality; (ii) The trajectory of DMD; (iii) The labour associated with DMD. Conclusion HCPs, parents, and boys have diverging worldviews around weight management, highlighting the importance of integrating the priorities of families into care, even when not aligned with guideline recommendations. IMPLICATIONS FOR REHABILITATION HCPs must understand the competing priorities in the lives of children with DMD and their families when discussing weight, weight management, and lifestyle changes. Quality of life and living a “normal” life are prioritized by children and families over the surveillance and time demands of lifestyle routines recommended by clinicians for weight management. Weight management recommendations should be based upon the individual needs and priorities of the family.

Obesity and long-term outcomes after incident stroke: a prospective population-based cohort study.

BackgroundThe association between obesity, major adverse cardiovascular events (MACE), and mortality in patients with incident stroke is not well established. We assessed the relationship between body mass index (BMI) and MACE in patients with incident stroke.MethodsThe population‐based cohort study identified 30 702 individuals from the Clinical Practice Research Datalink (CPRD GOLD) and Hospital Episode Statistics (HES) databases from the United Kingdom. Individuals were aged ≥18 years with incident stroke between 1‐1‐1998 and 31‐12‐2017, a BMI recorded within 24 months before incident stroke, and no prior history of MACE. BMI was categorized as underweight (<18.5 kg/m2), normal (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), obesity class I (30.0–34.9 kg/m2), class II (35.0–39.9 kg/m2) and class III (≥40 kg/m2). MACE was defined as a composite of incident coronary heart disease, recurrent stroke, peripheral vascular disease (PVD), heart failure, and cardiovascular‐related mortality. Multivariable Cox regression was used to assess differences in MACE risk between BMI categories.ResultsAt baseline, 1217 (4.0%) were underweight, 10 783 (35.1%) had a normal BMI, 10 979 (35.8%) had overweight, 5206 (17.0%) had obesity Class I, 1749 (5.7%) Class II, and 768 (2.5%) Class III. In multivariable analysis, higher BMI were associated with lower risk of subsequent MACE [overweight: HR 0.96, 95% CI 0.93–0.99)]; PVD [overweight: 0.65 (0.49–0.85); obesity Class III: 0.19 (0.50–0.77)]; cardiovascular‐related death [overweight: 0.80 (0.74–0.86); obesity Class I: 0.79 (0.71–0.88); Class II: 0.80 (0.67–0.96)]; and all‐cause mortality [overweight: 0.75 (0.71–0.79); obesity Class I: 0.75 (0.70–0.81); Class II: 0.77 (0.68–0.86)] when compared to those with normal BMI. The results were similar irrespective of sex, diabetes mellitus, smoking or cancer at time of incident stroke.ConclusionsIn patients with incident stroke, overweight or obesity were associated with a more favourable prognosis for subsequent MACE, PVD, and mortality, irrespective of sex, diabetes mellitus, smoking, or cancer at baseline. As with other cohort studies, our study demonstrates an association. Randomized control trials should be considered to robustly evaluate the impact of weight management recommendations on subsequent cardiovascular outcomes in stroke survivors.

Weight management across preconception, pregnancy, and postpartum: A systematic review and quality appraisal of international clinical practice guidelines.

This systematic review and quality appraisal evaluated clinical practice guidelines (CPGs) for weight management and weight-related behaviors across preconception, pregnancy, and postpartum. CPGs published in English were identified from research and guideline-specific databases between 2010 and 2019. Recommendations were categorized into weight (body mass index screening, weight loss, weight gain prevention, and gestational weight gain), diet, food safety, physical activity, and behavioral strategies. Three independent appraisers assessed CPG quality using the Appraisal of Guidelines Research and Evaluation II instrument. Twenty-two CPGs were included across preconception (n= 2), pregnancy (n=8), postpartum (n=2), or a combination (n=10). Overall, 45% of CPGs were appraised as poor quality, 32% as moderate, and 23% as high. Evaluation of body mass index and supplementation recommendations were most common across CPGs, alongside secondary weight management recommendations for women with obesity in fewer CPGs. Accompanying recommendations for diet, physical activity, and behavior were highly variable between guidelines. We report significant ambiguity in existing guidance and an absence of important considerations, including targeting weight gain prevention and limiting excess gestational weight gain. Results emphasize the need for development of robust, comprehensive, and high quality guidelines on healthy lifestyle and weight management across these formative reproductive life stages.

Colorectal Cancer Survivors: How Gastroenterology Nurses Can Help Them Thrive.

Overall cancer death rates have fallen since a peak in 1991 due to declining death rates for lung, colorectal, breast, and prostate cancers. A "cancer survivor" is defined as anyone with a cancer diagnosis. Their numbers are increasing for several reasons including better screening, earlier detection, and improved treatments. The American Cancer Society's projections for colorectal cancer in 2020 are 147,950 new cases and 53,200 deaths. By 2024, there will be an estimated 1.71 million colorectal cancer survivors (17% of all cancer survivors) and many will experience long-term consequences. These problems may be the result of one or more treatment options: surgical resection, systemic chemotherapy, and radiation therapy. Problems include issues with bowel, ostomy, bladder, sexual health, peripheral neuropathy, and mental health. Colorectal cancer survivors are especially receptive to making lifestyle changes to improve their long-term health. Gastroenterology nurses can utilize evidence-based recommendations for weight management, diet, physical activity, and lifestyle with the goal of preventing recurrence and a second primary cancer and promoting overall long-term health.

Temporal patterns of physical activity in successful weight loss maintainers.

Individuals successful at weight loss maintenance engage in high amounts of physical activity (PA). Understanding how and when weight loss maintainers accumulate PA within a day and across the week may inform PA promotion strategies and recommendations for weight management. We compared patterns of PA in a cohort of weight loss maintainers (WLM, n = 28, maintaining ≥13.6 kg weight loss for ≥1 year, BMI 23.6 ± 2.3 kg/m2), controls without obesity (NC, n = 30, BMI similar to current BMI of WLM, BMI 22.8 ± 1.9 kg/m2), and controls with overweight/obesity (OC, n = 26, BMI similar to pre-weight loss BMI of WLM, 33.6 ± 5.1 kg/m2). PA was assessed during 7 consecutive days using the activPALTM activity monitor. The following variables were quantified; sleep duration, sedentary time (SED), light-intensity PA (LPA), moderate-to-vigorous intensity PA (MVPA), and steps. Data were examined to determine differences in patterns of PA across the week and across the day using mixed effect models. Across the week, WLM engaged in ≥60 min of MVPA on 73% of days, significantly more than OC (36%, p < 0.001) and similar to NC (59%, p = 0.10). Across the day, WLM accumulated more MVPA in the morning (i.e., within 3 h of waking) compared to both NC and OC (p < 0.01). WLM engaged in significantly more MVPA accumulated in bouts ≥10 min compared to NC and OC (p < 0.05). Specifically, WLM engaged in more MVPA accumulated in bouts of ≥60 min compared to NC and OC (p < 0.05). WLM engage in high amounts of MVPA (≥60 min/d) on more days of the week, accumulate more MVPA in sustained bouts, and accumulate more MVPA in the morning compared to controls. Future research should investigate if these distinct patterns of PA help to promote weight loss maintenance.

Racial/ethnic variations in weight management among patients with overweight and obesity status who are served by health centres.

This study sought to examine racial/ethnic variations in receipt of provider recommendations on weight loss, patient adherence, perception of weight, attempts at weight loss and actual weight loss among patients with overweight/obesity status at Health Resources and Services Administration-funded health centres (HC). We used a 2014 nationally representative survey of adult HC patients with overweight/obesity status (PwOW/OB) last year and reported the HC was their usual source of care (n = 3517). We used logistic regression models to assess the interaction of race/ethnicity and having obesity in (1) provider recommendations of diet or (2) exercise, (3) patient adherence to diet or (4) exercise, (5) perceptions of weight and (6) weight loss attempts. We used a multinomial regression model to examine (7) weight loss or gain vs no change and a linear regression model to evaluate (8) percent weight change. We found Black PwOW/OB (OR = 1.65) experienced greater odds of receiving diet recommendations than Whites. We found limited racial/ethnic disparities in adherence. Black (OR = 0.41), Hispanic/Latino (OR = 0.45), and American Indian/Alaska Native (OR = 0.41) PwOW/OB had lower odds of perceiving themselves as overweight. Black (OR = 1.68) and Hispanic (OR = 1.98) PwOW/OB had a greater odds of reporting weight gain, and Asian PwOW/OB (OR = 0.42) had lower odds of reporting weight loss than Whites. Disparities in provider diet recommendations among Blacks and Hispanics indicated the importance of personalized weight management recommendations. Understanding underlying reasons for discordance between self-perception and observed weight among different groups is needed. Overall increase in weight, despite current interventions, should be addressed through targeted racially/ethnically appropriate approaches.

A Scientific Perspective of Personalised Gene-Based Dietary Recommendations for Weight Management.

Various studies showed that a “one size fits all” dietary recommendation for weight management is questionable. For this reason, the focus increasingly falls on personalised nutrition. Although there is no precise and uniform definition of personalised nutrition, the inclusion of genetic variants for personalised dietary recommendations is more and more favoured, whereas scientific evidence for gene-based dietary recommendations is rather limited. The purpose of this article is to provide a science-based viewpoint on gene-based personalised nutrition and weight management. Most of the studies showed no clinical evidence for gene-based personalised nutrition. The Food4Me study, e.g., investigated four different groups of personalised dietary recommendations based on dietary guidelines, and physiological, clinical, or genetic parameters, and resulted in no difference in weight loss between the levels of personalisation. Furthermore, genetic direct-to-consumer (DTC) tests are widely spread by companies. Scientific organisations clearly point out that, to date, genetic DTC tests are without scientific evidence. To date, gene-based personalised nutrition is not yet applicable for the treatment of obesity. Nevertheless, personalised dietary recommendations on the genetic landscape of a person are an innovative and promising approach for the prevention and treatment of obesity. In the future, human intervention studies are necessary to prove the clinical evidence of gene-based dietary recommendations.

The use of whole body calorimetry to compare measured versus predicted energy expenditure in postpartum women

Accurate assessment of energy expenditure may support weight-management recommendations. Measuring energy expenditure for each postpartum woman is unfeasible; therefore, accurate predictive equations are needed. This study compared measured with predicted resting energy expenditure (REE) and total energy expenditure (TEE) in postpartum women. This was a longitudinal observational study. REE was measured at 3 mo postpartum (n=52) and 9 mo postpartum (n=49), whereas TEE was measured once at 9 mo postpartum (n=43) by whole body calorimetry (WBC). Measured REE (REEWBC) was compared with 17 predictive equations; measured TEE plus breast milk energy output (ERWBC) was compared with the estimated energy requirements/Dietary Reference Intakes equation (EERDRI). Fat and fat-free mass were measured by dual-energy X-ray absorptiometry. Group-level agreement was assessed by the Pearson correlation, paired t test, and Bland-Altman (bias) analyses. Individual-level accuracy was assessed with the use of Bland-Altman limits of agreement, and by the percentage of women with predicted energy expenditure within 10% of measured values ("accuracy"). The cohort was primarily Caucasian (90%). At a group level, the best equation predicting REEWBC was the DRI at 3 mo postpartum (-7 kcal, -0.1%; absolute and percentage bias, respectively), and the Harris-Benedict at 9 mo postpartum (-17 kcal, -0.5%). At an individual level, the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU) height and weight equation was the most accurate at 3 mo postpartum (100% accuracy) and 9 mo postpartum (98% accuracy), with the smallest limits of agreement. Equations including body composition variables were not more accurate. Compared with ERWBC, EERDRI bias was -36 kcal, with inaccurate predictions in 33% of women. Many REE predictive equations were accurate for group assessment, with the FAO/WHO/UNU height and weight equation having the highest accuracy for individuals. EERDRI performed well at a group level, but inaccurately for 33% of women. A greater understanding of the physiology driving energy expenditure in the postpartum period is needed to better predict TEE and ultimately guide effective weight-management recommendations.

Obesity in Type 1 Diabetes: Pathophysiology, Clinical Impact, and Mechanisms.

There has been an alarming increase in the prevalence of obesity in people with type 1 diabetes in recent years. Although obesity has long been recognized as a major risk factor for the development of type 2 diabetes and a catalyst for complications, much less is known about the role of obesity in the initiation and pathogenesis of type 1 diabetes. Emerging evidence suggests that obesity contributes to insulin resistance, dyslipidemia, and cardiometabolic complications in type 1 diabetes. Unique therapeutic strategies may be required to address these comorbidities within the context of intensive insulin therapy, which promotes weight gain. There is an urgent need for clinical guidelines for the prevention and management of obesity in type 1 diabetes. The development of these recommendations will require a transdisciplinary research strategy addressing metabolism, molecular mechanisms, lifestyle, neuropsychology, and novel therapeutics. In this review, the prevalence, clinical impact, energy balance physiology, and potential mechanisms of obesity in type 1 diabetes are described, with a special focus on the substantial gaps in knowledge in this field. Our goal is to provide a framework for the evidence base needed to develop type 1 diabetes-specific weight management recommendations that account for the competing outcomes of glycemic control and weight management.

Body mass index and the risk of mortality among Chinese adults with Type 2 diabetes.

To examine the associations between BMI and the risks of all-cause, cardiovascular disease (CVD)-specific and cancer-specific mortality among people with Type 2 diabetes, and thus provide recommendations for weight management in the population. This retrospective cohort study was conducted among 52 763 people with newly diagnosed Type 2 diabetes between 1 January 2004 and 31 December 2014 in Shanghai, China. All cases of death were identified by linking to the Shanghai Vital Statistics. Some 52 488 people were included in the analysis. Survival curves for people with different BMI categories were plotted using the Kaplan-Meier method. Cox proportional hazard models within or without restricted cubic spline functions were applied to examine the potential non-linear or linear relationship between BMI and the risk of mortalities respectively. A total of 4777 deaths were identified during an average of 6-year follow-up. An L-shaped association was observed between BMI and all-cause mortality in men (P for overall association < 0.001 and P for non-linearity < 0.001) while a U-shaped association was found in women (P for overall association < 0.001 and P for non-linearity< 0.001). In men, no significant association was observed for BMI with cancer-specific and CVD-specific mortality. In women, an increased risk of cancer-specific mortality was observed with increasing BMI, whereas decreasing BMI was associated with the increased CVD-specific mortality rate. The increased all-cause mortality in men with low BMI and in women with either low or high BMI indicate the importance of keeping BMI in a normal range for Chinese adults with Type 2 diabetes.

Predictors of Long-Term Adherence to Multiple Health Behavior Recommendations for Weight Management.

We have demonstrated previously that patterns of behavioral adherence in the first 6 months of behavioral lifestyle interventions were associated with significant weight loss at 18 months. In this article, we extend this work to examine patterns of behavioral adherence over 18 months and to explore baseline demographic and psychosocial predictors. Latent class analysis was applied separately to the Weight Loss Maintenance and PREMIER trials data to examine patterns of adherence to the following recommendations: (1) consuming ≥9 servings of fruits and vegetables per day, (2) ≤25% of energy from total fat, (3) ≤7% energy from saturated fat, and (4) ≥180 minutes of moderate-to-vigorous physical activity per week. Multinomial logistic regression was used to test demographic and psychosocial predictors of latent class membership. Four distinct subgroups with common patterns of behavioral adherence were identified in each trial including, Behavioral Maintainers, who maintained adherence to all behavioral recommendations for 1 year, Nonresponders, who did not adhere to the recommendations at any time point, and latent classes that reflected patterns of adherence to one or two behaviors or behavioral relapse. A significantly higher proportion of Behavioral Maintainers sustained ≥5% weight loss for 1 year compared with Nonresponders. Participants with higher vitality scores at baseline were more likely to belong to a latent class with long-term adherence to one or more recommendations than the Nonresponders class. Regular assessment of health behaviors and psychosocial measures such as vitality may help identify nonresponders and inform treatment tailoring to improve long-term behavioral and weight outcomes.

Factors Associated With Documentation of Obesity in the Inpatient Setting.

Childhood obesity is rarely identified in hospitalized pediatric patients despite the high prevalence of obesity and potential for associated morbidity. The purpose of this study was to identify specific patient characteristics associated with the documentation of obesity and related weight management recommendations in the inpatient setting. Retrospective chart review was conducted on all pediatric patients ages 2 to 18 years old and discharged between January 1, 2012, and December 31, 2014, to determine the following: (1) if obesity was noted in the clinical documentation of those with a BMI ≥95th percentile; and (2) if those with documented obesity had evidence of an obesity-specific management plan. Using χ2 and multivariable logistic regression, we determined patient characteristics associated with the documentation of obesity and presence of a management plan. Only 26% (214 of 809) of inpatients with obesity had documentation of weight status. The odds of obesity documentation were higher in patients with comorbid cholelithiasis, severe obesity, and older age. Of those with obesity documentation, 23% (49 of 214) had an obesity management plan. Comorbid sleep apnea and admission to a surgical service with a pediatric hospital medicine consult were significantly associated with the presence of an obesity management plan. Increased efforts are necessary to improve obesity diagnosis and management in younger children who have not yet developed comorbidities. Additionally, the role of pediatric hospitalists as consultants for surgical patients should be further explored as a tool for addressing obesity during inpatient hospitalization.

Cognitive Function Predicts Risk for Clinically Significant Weight Gain in Adults With Heart Failure.

Few investigators have examined whether cognitive deficits predict poorer self-care of weight management recommendations and weight gain in adults with heart failure. The purposes of this study were (1) to examine whether cognition is associated with adherence to daily weighing and weight gain incidence and (2) to explore self-reported symptom perception and management when a weight increase occurs. In this observational study, participants completed neuropsychological testing, were given an electronic scale, and were instructed to record their weight for 21 days. Data for 301 participants were collected at baseline and 3 weeks after weight monitoring. At baseline, only 35% of the enrolled respondents knew when to call their physician for increased weight gain, and 37% of the analyzed sample (n = 110/301) experienced a clinically significant weight gain. Regressions tested whether baseline attention, executive function, or memory predicted adherence to daily weighing and the likelihood of weight gain incidence. In unadjusted and adjusted covariate analyses, none of the cognitive domains predicted adherence to daily weighing (P ≥ .375); however, all 3 cognitive domains predicted an increased risk of a clinically significant weight gain (P ≤ .05). Importantly, 65% of participants with a weight gain did not identify this symptom on self-report questions. Although cognitive deficits are not associated with adherence to daily weighing, adults with cognitive deficits may be at an increased risk for experiencing a clinically significant weight gain, and most do not perceive symptoms. Adults with heart failure require more than directions on self-care related to weight monitoring.