Strategies For Weight Loss Maintenance Research Articles

Addressing the psychology of weight loss and maintenance: A feasibility study of the Skills for weight loss and Maintenance weight management programme.

Building on prior theory, we aimed to evaluate the feasibility and acceptability of integrating novel, weight loss maintenance strategies into existing weight management programmes. We also piloted recruitment and data collection procedures for future research. Two phases of action research nested within a single-arm feasibility study. The intervention was refined between phases using feedback from intervention fidelity analysis and qualitative exploration of patient and provider experiences. Changes in outcomes were assessed up to 18 months post-baseline. One hundred adults with a mean body mass index of 37 kg/m2 were offered the Skills for weight loss and Maintenance (SkiM) intervention. This included existing weight management programme content and additional weight loss maintenance techniques delivered fortnightly for 6 months in local community centres to groups of 11-15 people. Of the 100 participants, 65%, 58% and 56% provided data at 7, 12 and 18 months. Across both phases, the mean initial weight loss was 4.2 kg (95% CI: 2.4-5.9) and 3.1 kg at 18 months (95% CI: .8-5.5). In Phase 2, we observed better weight loss maintenance (.5 kg [13.2%] regain from 7 to 18 months, vs. 1.7 kg [36.2%] in Phase 1). Variation in outcomes, high early dropout rates and qualitative feedback indicated that, although delivery of the intervention and trial procedures was feasible and acceptable, there was scope to refine the intervention to engage a wider range of participants. Intervention fidelity was acceptable, particularly in Phase 2. The SkiM intervention seems promising, but more research is needed to improve recruitment and retention prior to further evaluation.

Chronic pain and weight regain in a lifestyle modification trial.

ObjectiveObesity and chronic pain often co‐occur and exert bidirectional influences on one another. How patients with obesity and chronic pain respond to weight loss treatments, however, remains unclear. This study evaluated body weight, physical activity, and diet outcomes in participants with and without chronic pain in a 2‐year behavioral weight loss trial.MethodsAn analytical cohort of 397 adults was assembled from a Midwestern healthcare system that participated in the larger trial. Participants with chronic pain 1 year prior to, or during, the trial were identified using a validated medical records algorithm. Mixed models were used to estimate changes in outcomes over 24 months.ResultsOne‐third of participants (n = 130) had chronic pain. After adjustment for age, sex, body mass index, and trial arm, weight loss was similar in both groups at 6‐months (−7.0 ± 0.8 kg with chronic pain vs. −7.7 ± 0.6 kg without). Participants with chronic pain had significantly less weight loss at 24‐months relative to those without (−3.6 ± 0.5 vs. −5.2 ± 0.4 kg; p = 0.007). Physical activity, screen time, dietary fat, fruit/vegetable consumption, and sugar‐sweetened beverage intake improved similarly in both groups over time.ConclusionsParticipants with chronic pain lost ∼33% less weight over 2 years, which was driven by greater weight regain after the first 6 months. Future research should test tailored weight loss maintenance strategies for individuals with chronic pain.

Weight change among repeat participants of an Aboriginal community-based weight loss program

BackgroundCommunity-based weight loss programs may have potential to address overweight and obesity at the population level. However, participation patterns and individual outcomes from these programs are understudied. This study examined repeat participation patterns and participant weight change between contests over seven years of an Aboriginal Australian team-based program in order to identify (1) predictors of repeat participation and (2) associations with weight change between contests.MethodsData for the 12 contests from 2012 to 2018 were merged, with probabilistic record matching. A total of 7510 enrolments were registered for the 12 contests, representing 4438 unique people. Contest lengths varied from 10 to 16 weeks in duration. Non-repeat participants were those who only competed once in the program by the end of 2018, and repeaters were those who competed in at least two contests. Associations between repeat participation and participant baseline (i.e., first participation occasion) characteristics, change in diet and physical activity and percent change in weight during the first participation occasion were examined using crossed random effects (for person and team) regression adjusted for exposure to the program. Weight percentage change between contests was calculated for consecutive participation occasions occurring at least three months apart, converted to percent change per month. Weight change was regressed on number of repeat participation occasions adjusted for age, gender, baseline weight at first participation occasion, and weight percent change in the immediately preceding contest.ResultsOne-third of the 4433 participants participated more than once, with women more likely than men to repeat. A 1% reduction in weight during a competition was associated with an increase in weight of 0.05% per month between competition end and subsequent participation. Regain was smaller the heavier participants were at their first participation.ConclusionsWhile individuals benefit from weight loss through program participation, strengthening strategies for weight loss maintenance within or following the program could improve long-term weight outcomes and reduce weight cycling.

Compensatory eating behaviors in male and female rats in response to exercise training.

Exercise is often used as a strategy for weight loss maintenance. In preclinical models, we have shown that exercise may be beneficial because it counters the biological drive to regain weight. However, our studies have demonstrated sex differences in the response to exercise in this context. In the present study, we sought to better understand why females and males exhibit different compensatory food eating behaviors in response to regular exercise. Using a forced treadmill exercise paradigm, we measured weight gain, energy expenditure, food intake in real time, and the anorectic effects of leptin. The 4-wk exercise training resulted in reduced weight gain in males and sustained weight gain in females. In male rats, exercise decreased intake, whereas it increased food intake in females. Our results suggest that the anorectic effects of leptin were not responsible for these sex differences in appetite in response to exercise. If these results translate to the human condition, they may reveal important information for the use and application of regular exercise programs.

Dietary Strategies for Weight Loss Maintenance.

Weight regain after a successful weight loss intervention is very common. Most studies show that, on average, the weight loss attained during a weight loss intervention period is not or is not fully maintained during follow-up. We review what is currently known about dietary strategies for weight loss maintenance, focusing on nutrient composition by means of a systematic review and meta-analysis of studies and discuss other potential strategies that have not been studied so far. Twenty-one studies with 2875 participants who were overweight or obese are included in this systematic review and meta-analysis. Studies investigate increased protein intake (12 studies), lower dietary glycemic index (four studies), green tea (three studies), conjugated linoleic acid (three studies), higher fibre intake (three studies), and other miscellaneous interventions (six studies). The meta-analysis shows a significant beneficial effect of higher protein intake on the prevention of weight regain (SMD (standardized mean difference) −0.17 (95% CI −0.29, −0.05), z = 2.80, p = 0.005), without evidence for heterogeneity among the included studies. No significant effect of the other strategies is detected. Diets that combine higher protein intake with different other potentially beneficial strategies, such as anti-inflammatory or anti-insulinemic diets, may have more robust effects, but these have not been tested in randomized clinical trials yet.

Exercise is the Key to Keeping Weight Off, but What is the Key to Consistently Exercising?

In this issue of Obesity, Ostendorf et al. (1) employs modern measurement techniques and a creative cross-sectional design to expand findings from the landmark National Weight Control Registry study (2). Utilizing doubly labeled water, calorimetry, and physical activity monitoring devices, the authors examined the relative contributions of metabolism, physical activity, and caloric intake in long-term weight loss maintenance. To our knowledge, there are no available randomized studies that have a priori examined the contribution of physical activity in weight loss maintenance, leaving us with cross-sectional and nonrandomized study designs. The available data are consistent, however, in suggesting that physical activity plays a critical role in successful weight loss maintenance. Ostendorf et al. went one step further in attempting to determine the amount of activity required to maintain weight loss. They reported that successful weight loss maintainers achieve more than 12,000 steps per day and 800 kcal of total physical activity per day, and that they have a physical activity level (PAL) of 1.75 compared with approximately 9,000 steps per day, 600 kcal per day expended in activity, and a PAL of 1.6 in normal weight controls. The level of activity achieved by the weight loss maintainers is associated with 60 to 90 minutes of moderate-intensity physical activity or 30 to 40 minutes of vigorous-intensity activity. Regardless of the way it is quantified, the physical activity dose associated with weight loss maintenance is large and daunting. In addition and critically, the Ostendorf results are striking in that the weight loss maintainers did not appear to maintain their weight loss via continuous calorie restriction. Rather, the weight loss maintainers ate approximately the same number of calories per day as the control participants with overweight/obesity but had much higher energy burn from exercise. These findings beg the question, who are these individuals who can achieve large amounts of exercise on a consistent basis and what drives this behavior? Is their psychology or physiology different, or both? Does the energy flux or high amount of energy in and energy out affect their bodies in unique ways? Achieving the activity level observed in the weight loss maintainers is a significant time commitment; therefore, it is logical to conclude that this group of people may have tremendous discipline or willpower (e.g., type A exercisers), or they are driven to exercise for reasons other than weight management and weight loss maintenance is essentially a by-product of exercise. For example, we consistently hear people convey that they “exercise for their head, not the scale,” and it is well documented that regular exercise can lower stress, moderate anxiety, and improve overall quality of life (3) but with great individual variation in magnitude of response. Are the individuals who stick with their exercise program the same ones who receive substantial psychological benefit from exercising, and could this be a benefit that they become dependent on? The time required to maintain such high doses of exercise also suggests that these individuals may benefit from a supportive environment, which could include a supportive family and workplace, access to facilities/programs and available time to dedicate to them, and peers who support exercise and/or are exercise partners. The extent to which such environmental factors contribute to the success of these individuals is unclear, however, and it is also unclear to what extent these factors are malleable. This highlights the need for further research to identify the physiological, psychological, and environmental factors that help people successfully maintain weight loss through large amounts of exercise, as such research will help shape future weight loss maintenance strategies.

Aggressive clinical approach to obesity improves metabolic and clinical outcomes and can prevent bariatric surgery: a single center experience.

BackgroundThe number of bariatric procedures has exponentially increased in the past decade, as a result of the lack of successful clinical weight-loss interventions. The main reasons for the failure of clinical obesity management are: (1) anti-obesity medications are administered as monotherapies (or pre-combined drugs); (2) lack of combination between pharmacotherapy and non-pharmacological modalities; (3) short duration of pharmacotherapy for obesity; (4) lack of weight-loss maintenance strategies; (5) misunderstanding of the complex pathophysiology of obesity; and (6) underprescription of anti-obesity medications. We developed a protocol that can potentially overcome the drawbacks that may lead to the failure of clinical therapy for obesity. The aim of this study is therefore to report the clinical and metabolic effects of our proposed obesity-management protocol over a 2-year period, and to determine whether this more intensive approach to obesity management is feasible and a possible alternative to bariatric surgery in patients with moderate-to-severe obesity.MethodsThis retrospective study involved 43 patients in whom bariatric surgery was indicated. Patients underwent an intensive anti-obesity protocol that included pharmacotherapy with multiple drugs; intense surveillance with monthly body analysis by air-displacement plethysmography, electrical bioimpedance, and 3D body scans; weekly psychotherapy; diet planning with a dietician every 2 months; and exercises at least 3 times a week with exercises prescribed by a personal trainer at least once a month. Body weight (BW), total weight excess (TWE), obesity class, body mass index, fat weight, muscle weight, waist circumference, and visceral fat were analyzed. Markers of lipid and glucose metabolism, liver function, and inflammation were also evaluated. Therapeutic success was defined as >20% BW loss or >50% decrease in TWE after 1 year.ResultsSignificant improvements were observed in all clinical and metabolic parameters. Thirty-eight (88.4%) patients achieved 10% BW loss, and 32 (74.4%) achieved 20% BW loss. TWE decreased by >50% in 35 (81.4%) patients. Forty (93.0%) patients were able to avoid bariatric surgery.ConclusionAn intensive clinical approach to obesity management can be an effective alternative to bariatric surgery, although further randomized controlled studies are necessary to validate our findings.

Three-Year Follow-Up of Participants from a Self-Weighing Randomized Controlled Trial.

Frequent self-weighing is associated with weight loss maintenance. Several years ago, we investigated frequent self-weighing's effect on weight loss and found the participants lost a significant amount of weight. Three years after this trial's end, participants were contacted for an update on their weight and self-weighing frequency. Weight change and self-weighing frequency since the end of the study were assessed. We hypothesized that participants who maintained frequent self-weighing behavior would have maintained their weight loss. Out of 98 participants enrolled in the RCT, 37% (n = 36) participated in this follow-up study. Total weight loss during the trial for the follow-up participants was 12.7 ± 19.4 lbs (p < 0.001). Three years after intervention, participants regained 0.9 ± 4.34 lbs, a value that was not statistically different from zero (p = 0.75). This did not differ by gender (p = 0.655). Over 75% of these participants continued to weigh themselves at least once a week. Frequent self-weighing may be an effective, low-cost strategy for weight loss maintenance. Future research should further investigate the role of self-weighing in long-term weight gain prevention.

Weight loss maintenance strategies among rural breast cancer survivors: The rural women connecting for better health trial.

Obesity is a risk factor for breast cancer recurrence. Rural women have higher obesity rates compared with urban women and are in need of distance-based interventions that promote long-term weight loss. In this two-phase trial, rural breast cancer survivors who lost >5% of their starting weight during a 6-month lifestyle intervention (delivered through weekly group conference calls) were randomized to one of two 12-month interventions for weight loss maintenance: continued biweekly phone-based group counseling or mailed newsletters. The primary outcome was weight regain from 6 to 18 months. Secondary outcomes included dichotomous measures of weight change and costs. Mean weight loss at 6 months was 14.0 ± 5.1%. Participants in the group phone condition regained less weight (3.3 ± 4.8 kg) compared with participants in the newsletter condition (4.9 ± 4.8 kg; P = 0.03). At 18 months, 75.3% of participants in the group phone condition remained ≥5% below baseline weight compared with 57.8% in the newsletter condition (P = 0.02). Incremental cost-effectiveness ratios were $882 to keep one more person ≥5% below baseline weight. A lifestyle intervention incorporating group phone-based support improved the magnitude of weight loss maintained and increased the proportion of survivors who maintained clinically significant reductions.

Abstract P3-08-02: Comparison of strategies for weight loss maintenance among rural breast cancer survivors: The rural women connecting for better health randomized controlled trial

Abstract Background: Breast cancer survivors who reside in rural areas represent one of the largest medically underserved populations of breast cancer survivors in the nation and have higher obesity prevalence compared to their urban counterparts. Given the evidence linking obesity with poor breast cancer prognosis, trials are needed to demonstrate ability to produce long-term weight loss maintenance in this hard-to-reach group. Group phone-based counseling via conference calls is a low-technology approach with excellent reach to rural areas. This treatment delivery approach capitalizes on the support benefits of in-person groups by allowing participants to interact in real time while also diminishing costs. Methods: In this 2 phase trial, overweight and obese (BMI 27 to 45 kg/m2) rural breast cancer survivors (with initial stage 0-III disease) were randomized to one of two extended care interventions for weight loss maintenance (Phase 2) subsequent to an initial 6-month weekly group phone-based behavioral weight loss intervention (Phase 1). To be eligible for randomization for maintenance, participants must have lost ≥ 5% of their baseline weight during Phase 1. In Phase 2, participants were randomized to continued group phone-based counseling reduced in frequency to every other week during maintenance vs every other week mailed newsletters that followed the same content. Results: 210 breast cancer survivors with a mean time since treatment of 3.5 years ± 2.4 years, mean age of 58.1 ± 9.9 years, and mean BMI of 33.9 ± 4.4 kg/m2 residing in a three state region of the rural Midwest were entered in the 6-month weight loss phase. Retention from baseline to 6 months (Phase 1) was 91%. Mean percent weight loss at 6 months for the total sample was 12.9% with 82% of enrolled participants ≥ 5% below baseline weight. 172 participants with a mean initial loss of 14.0% of baseline weight (12.8 ± 4.9 kg) were randomized to a maintenance intervention. Retention from 6 to 18 months (Phase 2) was 92%. Intent-to-treat analyses with imputation of missing data revealed participants in the group phone condition regained less weight (3.3 ± 4.8 kg) compared to participants in the newsletter condition (4.9 ± 4.8 kg; p = 0.03). Mean percent weight loss from baseline to 18 months did not significantly differ between the group phone condition (10.2 ± 7.5%) and the newsletter condition (9.2 ± 7.9%). However, at 18 months 75.3% of participants in the group phone condition remained ≥ 5% below baseline weight compared to 57.8% in the newsletter condition (p = .02). Discussion: The initial group phone-based weight loss intervention exceeded typical weight losses reported in the literature with over 80% of enrolled participants achieving clinically meaningful weight loss. Continued group phone counseling was modestly better in sustaining weight loss at 18 months than a mailed newsletter. However, for both maintenance approaches, the majority of participants maintained a weight at 18 months that was 5% or more below baseline. Citation Format: Befort CA, Klemp JR, Sullivan DK, Diaz FJ, Schmitz KH, Perri MG, Fabian CJ. Comparison of strategies for weight loss maintenance among rural breast cancer survivors: The rural women connecting for better health randomized controlled trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-08-02.

Impact of carbohydrates on weight regain.

Research on obesity treatment has shifted its focus from weight loss to weight-loss maintenance strategies. The conventional approach of a low-fat diet is challenged by insights from glycemic effects of carbohydrates on body weight regulation. Metabolic and endocrine adaptations to weight loss that contribute to weight regain involve reduced energy expenditure, increased insulin sensitivity, and enhanced orexigenic signals. This review summarizes the impact of carbohydrates on energetic efficiency, partitioning of weight regain as fat and lean mass, and appetite control. Both the amount and frequency of postprandial glycemia add to body weight regulation after weight loss and strengthen the concept of glycemic index and glycemic load. In addition, dietary fiber and slowly or poorly absorbable functional sugars modify gastrointestinal peptides involved in appetite and metabolic regulation and exert prebiotic effects. Current evidence suggests that a low-glycemic load diet with a preference for low-glycemic index foods and integration of slowly digestible, poorly absorbable carbohydrates may improve weight-loss maintenance. Future studies should investigate the health benefits of low glycemic functional sweeteners (e.g., isomaltulose and tagatose).

A qualitative study of successful adolescent and young adult weight losers: implications for weight control intervention.

Our study aims to provide an in-depth analysis of behavioral strategies, psychological factors, and social contributors to adolescent weight loss and weight loss maintenance among participants in the Adolescent Weight Control Registry (AWCR). Qualitative analyses were conducted using semi-structured interview data from 40 participants from the AWCR who successfully lost ≥10 lbs and maintained their weight loss for at least one year. In contrast to existing literature, our findings suggest that primary motivating factors for adolescent weight loss may be intrinsic (e.g., desire for better health, desire to improve self-worth) rather than extrinsic. In addition, life transitions (e.g., transition to high school) were identified as substantial motivators for weight-related behavior change. Peer and parental encouragement and instrumental support were widely endorsed as central to success. The most commonly endorsed weight loss maintenance strategies included attending to dietary intake and physical activity levels, and making self-corrections when necessary. Results from this study highlight considerations for future adolescent weight control treatment development.

Effects of anti-obesity drugs, diet, and exercise on weight-loss maintenance after a very-low-calorie diet or low-calorie diet: a systematic review and meta-analysis of randomized controlled trials

Background: Weight-loss maintenance remains a major challenge in obesity treatment.Objective: The objective was to evaluate the effects of anti-obesity drugs, diet, or exercise on weight-loss maintenance after an initial very-low-calorie diet (VLCD)/low-calorie diet (LCD) period (<1000 kcal/d).Design: We conducted a systematic review by using MEDLINE, the Cochrane Controlled Trial Register, and EMBASE from January 1981 to February 2013. We included randomized controlled trials that evaluated weight-loss maintenance strategies after a VLCD/LCD period. Two authors performed independent data extraction by using a predefined data template. All pooled analyses were based on random-effects models.Results: Twenty studies with a total of 27 intervention arms and 3017 participants were included with the following treatment categories: anti-obesity drugs (3 arms; n = 658), meal replacements (4 arms; n = 322), high-protein diets (6 arms; n = 865), dietary supplements (6 arms; n = 261), other diets (3 arms; n = 564), and exercise (5 arms; n = 347). During the VLCD/LCD period, the pooled mean weight change was −12.3 kg (median duration: 8 wk; range 3–16 wk). Compared with controls, anti-obesity drugs improved weight-loss maintenance by 3.5 kg [95% CI: 1.5, 5.5 kg; median duration: 18 mo (12–36 mo)], meal replacements by 3.9 kg [95% CI: 2.8, 5.0 kg; median duration: 12 mo (10–26 mo)], and high-protein diets by 1.5 kg [95% CI: 0.8, 2.1 kg; median duration: 5 mo (3–12 mo)]. Exercise [0.8 kg; 95% CI: −1.2, 2.8 kg; median duration: 10 mo (6–12 mo)] and dietary supplements [0.0 kg; 95% CI: −1.4, 1.4 kg; median duration: 3 mo (3–14 mo)] did not significantly improve weight-loss maintenance compared with control.Conclusion: Anti-obesity drugs, meal replacements, and high-protein diets were associated with improved weight-loss maintenance after a VLCD/LCD period, whereas no significant improvements were seen for dietary supplements and exercise.

Dietary Habits and Weight Maintenance Success in High Versus Low Exercisers in the National Weight Control Registry

The National Weight Control Registry (NWCR) was established to examine characteristics of successful weight loss maintainers. This study compares the diet and behavioral characteristics and weight regain trajectories of NWCR members with differing physical activity (PA) levels at baseline. Participants (n = 3591) were divided into 4 levels of self-reported PA at registry entry (< 1000, 1000 to < 2250, 2250 to < 3500, and ≥ 3500 kcals/week). We compared self-reported energy intake (EI), macronutrient composition, eating behaviors (dietary restraint, hunger, and disinhibition), weight loss maintenance strategies, and 3 year weight regain between these 4 activity groups. Those with the highest PA at registry entry had lost the most weight, and reported lower fat intake, more dietary restraint, and greater reliance on several specific dietary strategies to maintain weight loss. Those in the lowest PA category maintained weight loss despite low levels of PA and without greater reliance on dietary strategies. There were no differences in odds of weight regain at year 3 between PA groups. These findings suggest that there is not a "one size fits all strategy" for successful weight loss maintenance and that weight loss maintenance may require the use of more strategies by some individuals than others.

Impact of 5-year weight change on blood pressure: results from the Weight Loss Maintenance trial.

In this secondary analysis of the Weight Loss Maintenance trial, the authors assessed the relationship between blood pressure (BP) change and weight change in overweight and obese adults with hypertension and/or dyslipidemia who were randomized to 1 of 3 weight loss maintenance strategies for 5years. The participants were grouped (N=741) based on weight change from randomization to 60months as: (1) weight loss, (2) weight stable, or (3) weight gain. A significant positive correlation between weight change and systolic BP (SBP) change at 12, 30, and 60 months and between weight change and diastolic BP (DBP) change at 30months was observed. From randomization to 60months, mean SBP increased to a similar degree for the weight gain group (4.2±standard error=0.6mmHg; P<.001) and weight stable group (4.6±1.1mmHg; P<.001), but SBP did not rise in the weight loss group (1.0±1.7mmHg, P=.53). DBP was unchanged for all groups at 60months. Although aging may have contributed to rise in BP at 60months, it does not appear to fully account for observed BP changes. These results suggest that continued modest weight loss may be sufficient for long-term BP lowering.

Sucesso na manutenção do peso perdido em Portugal e nos Estados Unidos: comparação de 2 Registos Nacionais de Controlo do Peso

The aim of this work is to compare participant characteristics and weight loss and weight loss maintenance strategies adopted by an initial cohort of the Portuguese Weight Control Registry (PWCR) with published results from the National Weight Control Registry's (NWCR).Sample includes 198 adults (age: 39.7±11.1 yr; BMI: 26.0±3.9kg/m2), 59% women, who voluntarily registered to the PWCR and completed one initial questionnaire including demographics, methods and strategies used to lose weight and/or to maintain weight, and a laboratory assessment. Individuals meeting inclusion criteria reported a weight loss of 17.4kg, maintained for an average of 29 months. The PWCR sample is younger, heavier, and more gender-balanced than the NWCR sample.Modifying both dietary intake and physical activity (PA) levels was the most common weight loss strategy in Portuguese individuals (82%), while 89% reported it in NWCR. To lose weight, 43% of all PWCR participants started to use stairs, 91% started to eat breakfast every day, 79% chose “better foods”, 74% reported “limiting food quantities”, and 86% frequently limit fat intake. To keep weight loss, PWCR individuals engaged weekly in 250minutes of moderate and vigorous physical activity and a weekly physical activity energy expenditure of 3422kcal (NWCR: 2621kcal). Other strategies were used: 69% chose “better foods” (NWCR: 92%), 87% frequently limiting fat intake (NWCR: 38%), 63% reported “limiting food quantities” (NWCR: 49%), 98% ate breakfast every day (NWCR: 78%), and 65% weighed themselves at least once a week (NWCR: 75%).Data from the first PWCR cohort show similarities with the larger US sample of successful maintainers but also some differences. This work discusses these differences.

Orlistat after initial dietary/behavioural treatment: changes in body weight and dietary maintenance in subjects with sleep related breathing disorders

BackgroundSleep related breathing disorders (SRBD) are associated with increased morbidity and mortality and weight loss is recommended to overweight or obese patients with SRBD. However, maintenance of weight loss is difficult to achieve and strategies for weight loss maintenance is needed. Orlistat is a pharmacological agent that reduces the intestinal absorption of fat and may favour long-term weight maintenance.ObjectiveTo examine the change in body weight and dietary intake during a 1-year treatment with orlistat after an initial weight loss in obese subjects with SRBD. Furthermore, to explore the dietary determinants of weight maintenance during treatment with orlistat.MethodsMen and women with SRBD aged 32-62 years (n = 63) participated in a 3-month dietary intervention to increase intake of vegetables and fruit. After an initial weight loss of 3.4 kg they achieved a mean body mass index of 34.3 ± 4.7 kg/m2. Subsequently they were treated with orlistat for 1 year. During this year, dietary and behavioural interventions to attain weight loss were provided in the course of 14 group sessions. Dietary intake, energy density and food choices were assessed with a food frequency questionnaire before and after orlistat treatment.ResultsWith orlistat, body weight decreased by a mean of 3.5 kg (95% CI 1.5, 5.5). The dietary E% from saturated fat, intake of fatty dairy products and energy density increased after 1 year while intakes of oils, fish and vegetables decreased (all P < 0.05). After multivariate adjustments, weight loss was associated with E% protein (R2adj = 0.19 [95% CI 0.10, 0.46]), and inversely associated with E% saturated fat (R2adj = 0.20 [95% CI 0.12, 0.47]) and fatty dairy products (R2adj = 0.23 [95% CI 0.12, 0.49]).ConclusionsOrlistat induced further weight loss, but dietary compliance declined with time. Increasing dietary protein and restricting saturated fat and fatty dairy products may facilitate weight loss with orlistat.

A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial

Objective to examine the effect of individual counselling on diet and physical activity from pregnancy to six months post partum, or from birth to six months post partum, on weight retention among Taiwanese women. Design a randomised controlled trial assigned participants to two experimental groups [from pregnancy to six months post partum (EP) and from birth to six months post partum (EPP)] and one comparison group. Setting a 3900-bed medical centre in northern Taiwan with around 3000 births annually. Participants a sample of 189 women who had regular check-ups during pregnancy and gave birth at the medical centre. Interventions the comparison group received the routine outpatient department obstetric educational programme. The EP group attended regularly scheduled clinic visits with individualised dietary and physical activity education plans from 16 gestational weeks to six months post partum, and received on brochure. The EPP group received the same educational intervention as the EP group from 24–48 hours after birth to six months post partum. Measurements body weight, body mass index, health-promoting behaviour and psycho-social variables (self-efficacy, body image, depression and social support). Findings average gestational weight gain was 14.02, 15.27 and 16.22 kg in the three EP, EPP and comparison groups respectively, and average weight retention at six months post partum was 2.34, 4.06 and 5.08 kg in the three groups, respectively. Key conclusions a diet and physical activity intervention from pregnancy is effective for reducing post-pregnancy weight retention. Implications for practice the findings of the present study should be taken into consideration when incorporating significant others and weight-loss maintenance strategies with interventions for a healthier family lifestyle.

Weight Loss Programs for Urban-based, Postpartum African-American Women: Perceived Barriers and Preferred Components

There are currently 1.85 million reproductive-aged women in the United States with diabetes or glucose intolerance. While it is known that postpartum weight retention can lead to obesity and diabetes, particularly among African-American women, little is known about African-American women's preferences for postpartum weight loss programs. Our objective was to explore urban-based African-American women's attitudes toward weight gain, perceived barriers to postpartum weight loss, and preferences for weight intervention strategies. Focus groups of pregnant African-American women (n = 22) were conducted by a race-concordant moderator. Open-ended questions were posed to stimulate discussions which were audio taped and transcribed verbatim. Transcriptions were independently reviewed by two investigators who extracted quotations and coded each statement to identify major themes. The median age of participants was 26 years. Median pre-pregnancy or first trimester body-mass index was 31 kg/m(2). Fifty-seven percent of the women were multiparous and 68% were Medicaid recipients. We identified 16 themes with the majority of participant comments focused on: (1) effect of postpartum depression on motivation to lose weight; (2) strong desire to lose weight; (3) knowledge of adverse effects of obesity; (4) costs of weight loss programs; (5) negative impact of media coverage of successful celebrity postpartum weight loss; (6) limitations of childcare on ability to exercise; and (7) family-centered lifestyle behaviors that promote unhealthy eating. Weight loss interventions for African-American women with postpartum obesity should address psychological effects of childbearing, affordability, and perceptions of body image. Interventions should incorporate family-centered approaches and weight loss maintenance strategies.

A comparison of acceptance- and control-based strategies for coping with food cravings: An analog study

The present study utilized an analog paradigm to investigate the effectiveness of two strategies for coping with food cravings, which was theorized to be critical to the maintenance of weight loss. Ninety-eight undergraduate students were given transparent boxes of chocolate Hershey's Kisses and instructed to keep the chocolates with them, but not to eat them, for 48 h. Before receiving the Kisses, participants were randomized to receive either (a) no intervention, (b) instruction in control-based coping strategies such as distraction and cognitive restructuring, or (c) instruction in acceptance-based strategies such as experiential acceptance and defusion techniques. Measures included the Power of Food Scale (PFS; a measure of psychological sensitivity to the food environment), self-report ratings of chocolate cravings and surreptitiously recorded chocolate consumption. Results suggested that the effect of the intervention depended on baseline PFS levels, such that acceptance-based strategies were associated with better outcomes (cravings, consumption) among those reporting the highest susceptibility to the presence of food, but greater cravings among those who scored lowest on the PFS. It was observed that craving self-report measures predicted chocolate consumption, and baseline PFS levels predicted both cravings and consumption. Results are discussed in terms of the implications for weight loss maintenance strategies.