Successful Weight Loss Maintenance Research Articles

Primary care-led weight-management intervention: qualitative insights into patient experiences at two-year follow-up

ABSTRACT Purpose The prevalence of overweight and obesity is continuously increasing globally and long-term weight loss intervention outcomes remain disappointing. To determine which behavioural intervention approaches improve the probability of achieving long-term weight loss, this two-year follow-up study aimed to identify distinct factors and strategies for successful long-term weight loss maintenance. Methods A cohort of 20 participants with overweight and obesity from a primary-care led weight management programme with diverse backgrounds was interviewed at baseline, after 1 and 2 years, and asked to do quantitative self-description. This study focused on the 2-year follow-up interviews from this study series. Results We found that agile, continuous self-monitoring with personalized, sustainable lifestyle habits correlated with positive outcomes. Participants reported health benefits, maintained weight loss, and found motivation in supportive peer networks. Challenges like anxiety, disappointment, and disruptions derailed progress. Long-term success relied on a strong support system of healthcare professionals, friends, and family. Conclusions The findings of this study series highlight the intricate nature of long-term weight loss maintenance. This study corroborates the persistence of overarching themes while highlighting the individual variability in their relative importance. Findings emphasize the importance of long-term support to effectively address the diverse needs of patients trying to achieve long-term weight loss maintenance.

Metabolic profiles reflect weight loss maintenance and the composition of diet after very-low-energy diet

Diet and weight loss affect circulating metabolome. However, metabolite profiles induced by different weight loss maintenance diets and underlying longer term weight loss maintenance remain unknown. Herein, we investigated after-weight-loss metabolic signatures of two isocaloric 24-wk weight maintenance diets differing in satiety value due to dietary fibre, protein and fat contents and identified metabolite features that associated with successful weight loss maintenance. Non-targeted LC-MS metabolomics approach was used to analyse plasma metabolites of 79 women and men (mean age±SD 49.7±9.0 years; BMI 34.2±2.5kg/m2) participating in a weight management study. Participants underwent a 7-week very-low-energy diet (VLED) and were thereafter randomised into two groups for a 24-week weight maintenance phase. Higher satiety food (HSF) group consumed high-fibre, high-protein, and low-fat products, while lower satiety food (LSF) group consumed isocaloric low-fibre products with average protein and fat content as a part of their weight maintenance diets. Plasma metabolites were analysed before the VLED and before and after the weight maintenance phase. Metabolite features discriminating HSF and LSF groups were annotated. We also analysed metabolite features that discriminated participants who maintained ≥10% weight loss (HWM) and participants who maintained <10% weight loss (LWM) at the end of the study, irrespective of the diet. Finally, we assessed robust linear regression between metabolite features and anthropometric and food group variables. We annotated 126 metabolites that discriminated the HSF and LSF groups and HWM and LWM groups (p<0.05). Compared to LSF, the HSF group had lower levels of several amino acids, e.g. glutamine, arginine, and glycine, short-, medium- and long-chain acylcarnitines (CARs), odd- and even-chain lysoglycerophospholipids, and higher levels of fatty amides. Compared to LWM, the HWM group in general showed higher levels of glycerophospholipids with a saturated long-chain and a C20:4 fatty acid tail, and unsaturated free fatty acids (FFAs). Changes in several saturated odd- and even-chain LPCs and LPEs and fatty amides were associated with the intake of many food groups, particularly grain and dairy products. Increase in several (lyso)glycerophospholipids was associated with decrease in body weight and adiposity. Increased short- and medium-chain CARs were related to decreased body fat-free mass. Our results show that isocaloric weight maintenance diets differing in dietary fibre, protein, and fat content affected amino acid and lipid metabolism. Increased abundances of several phospholipid species and FFAs were related with greater weight loss maintenance. Our findings indicate common and distinct metabolites for weight and dietary related variables in the context of weight reduction and weight management. The study was registered in isrctn.org with identifier 67529475.

Increased meal-induced neurotensin response predicts successful maintenance of weight loss – Data from a randomized controlled trial

BackgroundThe gut derived anorexigenic hormone neurotensin (NT) is upregulated after bariatric surgery which may contribute to the sustained weight loss. In contrast, diet-induced weight loss is most often followed by weight regain. We therefore investigated whether diet-induced weight loss impacts levels of circulating NT in mice and humans and whether NT levels predicts body weight change after weight loss in humans. MethodsIn vivo mice study: Obese mice were fed ad-libitum or a restricted diet (40–60 % of average food intake) for 9 days to obtain similar weight loss as observed in the human study. At termination, intestinal segments, the hypothalamus and plasma were collected for histological, real time PCR, and radioimmunoassay (RIA) analysis.Clinical trial: Plasma samples from 42 participants with obesity, completing an 8-week low-calorie diet in a randomized controlled trial, were analyzed. Plasma NT was measured by RIA at fasting and during a meal test before and after diet-induced weight loss and after one year of intended weight maintenance. ResultsIn obese mice, food restriction-induced body weight loss of 14 % was associated with a 64 % reduction in fasting plasma NT (p < 0.0001). In the mouse duodenum (p = 0.07) and jejunum (p < 0.05), NT tissue concentration was decreased without tissue atrophy indicative of a physiological downregulation. In the mouse hypothalamus a downregulation of Pomc (p < 0.01) along with upregulation of Npy (p < 0.001) and Agrp (p < 0.0001) expression was found after restricted feeding in support of increased hunger after diet-induced weight loss. Therefore, we investigated the NT response in humans undergoing weight loss maintenance. In humans, similar to the mice, the low-calorie diet induced weight loss of 13 % body weight was associated with 40 % reduction in fasting plasma NT levels (p < 0.001). Meal-induced NT peak responses were greater in humans who lost additional weight during the 1 year maintenance phase compared to participants who regained weight (p < 0.05). ConclusionDiet-induced weight loss decreased fasting plasma NT levels in both humans and mice with obesity, and regulated hunger-associated hypothalamic gene expression in mice. Meal-induced NT responses were greater in humans who lost additional weight during the 1 year maintenance phase compared to participants who regained weight. This indicates that increased peak secretion of NT after weight loss may contribute to successful maintenance of weight loss.Clinical trial registration number:NCT02094183.

Perceived stress as a predictor of eating behavior during the 3-year PREVIEW lifestyle intervention

BackgroundTo better support participants to achieve long-lasting results within interventions aiming for weight loss and maintenance, more information is needed about the maintenance of behavioral changes. Therefore, we examined whether perceived stress predicts the maintenance of changes in eating behavior (flexible and rigid restraint of eating, disinhibition, and hunger).MethodsThe present study was a secondary analysis of the PREVIEW intervention including participants with overweight (BMI ≥ 25 kg/m2) at baseline and high risk of type 2 diabetes (n = 1311). Intervention included a 2-month low-energy diet phase and a 34-month subsequent weight maintenance phase. The first 6 months were considered an active behavior change stage and the remaining 2.5 years were considered a behavior maintenance stage. Eating behavior was measured using the Three Factor Eating Questionnaire and stress using the Perceived Stress Scale. The associations between stress and eating behavior were analyzed using linear mixed effects models for repeated measurements.ResultsPerceived stress measured after the active behavior change stage (at 6 months) did not predict changes in eating behavior during the behavior maintenance stage. However, frequent high stress during this period was associated with greater lapse of improved flexible restraint (p = 0.026). The mean (SD) change in flexible restraint from 6 to 36 months was −1.1 (2.1) in participants with frequent stress and −0.7 (1.8) in participants without frequent stress (Cohen’s ds (95% CI) = 0.24 (0.04–0.43)). Higher perceived stress at 6 months was associated with less flexible restraint and more disinhibition and hunger throughout the behavior maintenance stage (all p < 0.001).ConclusionsPerceived stress was associated with features of eating behavior that may impair successful weight loss maintenance. Future interventions should investigate, whether incorporating stress reduction techniques results in more effective treatment, particularly for participants experiencing a high stress level.

Locus of control and self-efficacy in relation to 12-month weight change after non-surgical weight loss treatment in adults with severe obesity – A clinical cohort study

Sustainable dietary, behavioural and lifestyle changes are necessary to accomplish weight loss. Evaluate impact of internal motivation, locus of control and self-efficacy on non-surgical weight loss treatment in patients with severe obesity. A total of 1196 patients, Body Mass Index ≥35 kg/m 2 , referred to obesity treatment were included. Visual analogue scales for motivation, locus of control and self-efficacy were completed before starting weight loss treatment. A total of 601 patients (42% drop out) completed 12-month weight loss treatment. After 12 months, 94.6% in the Very Low Energy Diet (VLED) group and 79.4% in the dietary treatment group had a weight loss of ≥5% of their body weight. No statistically significant associations were found between achieved weight loss in the VLED group, and locus of control or self-efficacy. Achieving ≥15% weight loss by dietary treatment was related to a higher score on self-efficacy compared to those who lost <5% in weight or dropped out. Self-efficacy appears to be important for weight loss when on dietary treatment without VLED. Attrition rate was higher among patients with lower score on self-efficacy at baseline. The study indicates that psychological factors associated with adherence to, and completion of weight loss treatment deserve attention. • Locus of control and self-efficacy did not predict weight loss when treated with VLED. • Extensive weight loss early in treatment with VLED predicted completion of treatment. • Self-efficacy was positively correlated to weight loss in dietary treatment. • High level of self-efficacy predicted completion of dietary treatment. This knowledge is important when developing effective weight loss treatment in order to focus on effective strategies and behaviors framing outcome, as well as awareness of factors preventing successful weight loss and weight loss maintenance.

Healthy Habits Associated with Successful Weight Loss Maintenance on a Commercial Program

ObjectivesAn online survey of real-world OPTAVIA® Coaches and Clients was conducted to understand the habits of successful weight loss maintainers. OPTAVIA (the “Program”) is a holistic commercial weight management program that includes meal replacements (MRs), support from a Coach and the OPTAVIA Community and encourages the use of a core set of healthy habits related to weight management, eating and hydration, motion, sleep, mind, and surroundings to promote a healthier lifestyle. However, it is not known what habits are most closely associated with successful maintenance in this population. Therefore, this study identified the behaviors and strategies used by Coaches and Clients who were considered successful at weight loss maintenance.MethodsCoaches and Clients who had lost ≥10% body weight on the Program, had been trying to maintain their weight loss for ≥1 year, and maintained >75% of their weight loss during that time were identified. Mean ± SD were calculated for continuous variables and categorical variables were quantified using frequencies and percents. All data were self-reported.ResultsThe analysis included 590 respondents (342 Coaches, 248 Clients; 84% female, 53 y; current BMI of 24.4 ± 4.0 kg/m2). Average weight loss was 23.7 ± 8.6% body weight; average time in maintenance was 24.5 ± 15.8 months. The most common strategies and specific tactics for maintaining their weight loss included: self-monitoring (80%); leveraging habits learned during weight loss (72%); food/diet-related strategies (69%) (drinking water 84%, using Program MRs 61%, portion control 54%); physical activity (PA) 67% (prioritize PA 66%, track PA 46%, build PA into social life 34%, increase NEAT activity 32%); establish a healthy environment (56%) and become a Coach (55%). Most (81%) reported taking action (use the Program 66% or general calorie reduction strategies 57%) within 5–10 lb of weight regain. Eighty % (80%) reported weighing themselves at least weekly.ConclusionsSuccessful Coaches and Clients use behaviors consistent with the scientific literature combined with several unique to the Program, such as those centered on the Program's core healthy habits, for weight loss maintenance.Funding SourcesMedifast, Inc.

Examination of three-factor eating questionnaire subscale scores on weight loss and weight loss maintenance in a clinical intervention

BackgroundThe purpose of this study is to examine three-factor eating questionnaire (TFEQ) scores at baseline and post-intervention (6 months) on successful weight loss and weight maintenance in an 18-month behavioral weight management intervention for adults with overweight and obesity.MethodsTFEQ and weight were assessed at baseline, 6, and 18 months. Logistic regression models were used to examine scores at baseline on disinhibition, restraint, and perceived hunger factors in the TFEQ on 5% body weight loss at 6 months and 6-month scores to predict 5% weight maintenance at 18 months while controlling for age, sex, and baseline weight.ResultsParticipants (n = 287; age = 43.8 ± 10.36 years; female = 64.1%; weight = 222.5 ± 39.02 pounds; BMI = 34.73 ± 4.56) were included for analysis. Dietary restraint at baseline was the only significant predictor of 5% weight loss at 6 months. None of the TFEQ subscale scores at 6 months predicted 5% weight maintenance at 18 months. The model examining weight loss at 6 months accounted for 7% of the variance of the outcome and 11% of the variance of weight maintenance at 18 months.ConclusionDietary restraint is a unique eating behavior associated with weight loss at 6 months beyond other eating behaviors measured by the TFEQ in an adult sample enrolled in a weight loss intervention. No other subscale scores were significant at 6 months or at 18 months. Future research should consider how to promote flexible control and discourage adoption of rigid restraint behaviors since the latter is associated with disordered eating patterns.

Healthy Habits Associated with Successful Weight Loss Maintenance on a Commercial Program: Learnings from a Research Survey

Healthy Habits Associated with Successful Weight Loss Maintenance on a Commercial Program: Learnings from a Research Survey

Ghrelin, glucagon-like peptide-1, and peptide YY secretion in patients with and without weight regain during long-term follow-up after bariatric surgery: a cross-sectional study.

IntroductionWeight loss after bariatric surgery is attributed, at least in part, to the altered gastrointestinal (GI) hormone secretion, which is thought to be responsible for a number of beneficial metabolic effects.Material and methodsWe conducted a cross-sectional study. Twelve patients who underwent laparoscopic sleeve gastrectomy (SG) and 20 patients who underwent a variant of biliopancreatic diversion with Roux-en-Y gastric bypass and long limbs (BPD/RYGB-LL) were evaluated ≥ 7 years postoperatively. Ghrelin, glucagon-like peptide-1 (GLP-1), and peptide YY (PYY) secretion were compared between patients with successful weight loss maintenance (WM group) and patients with weight regain (WR group).ResultsIn both types of surgery, standard liquid mixed meal (SLMM) ingestion did not result in significant changes in fasting GI hormone levels. Fasting ghrelin levels did not differ between the WM group and the WR group in both types of surgery. In SG patients, SLMM ingestion elicited greater suppression of ghrelin levels in the WM group (p = 0.032). No difference in GLP-1 secretion was observed between the 2 groups of patients in both types of surgery. When patients were examined, regardless of the type of bariatric surgery they had undergone, postprandial PYY levels were lower in the WM group (p < 0.05), while fasting and postprandial PYY levels were correlated positively with an increase in body mass index (BMI) in the evaluation (Spearman’s rho ≥ 0.395, p < 0.03).ConclusionsOur data do not support the hypothesis that long-term weight regain after bariatric surgery is associated with an unfavourable GI hormone secretion pattern.

Weight Gain and Lymphedema After Breast Cancer Treatment: Avoiding the Catch-22?

Background: Overweight and obesity are strongly implicated in breast cancer (BC) development and are also a risk factor for BC-related lymphedema (BCRL). Methods and Results: An online cross-sectional survey was conducted between November 2017 and January 2018. Analyses were restricted to women with localized BC, who provided information about BCRL (n = 238). Most women were not experiencing BCRL (55.46%). Mean self-reported weight at diagnosis was 68.55 kg for women without BCRL and 74.43 kg for women with BCRL (p = 0.0021). In this study, 50.9% with BCRL were overweight/obese at diagnosis (body mass index [BMI] ≥25) compared with 36.4% of women without BCRL (p = 0.003). For women without BCRL, 12.12% were classified as obese (BMI ≥30) versus 20.75% with BCRL. Women with BCRL were more likely to have gained >5% of body weight (p = 0.03), be currently overweight or obese (p = 0.004), and less active (48.11%) than they were at diagnosis than women without BCRL (33.33%) (p = 0.042). Having a structured exercise program, following a prescribed diet, and being accountable to someone else were identified as the main facilitators to successful weight loss and weight maintenance. Conclusions: Clinicians should consider obesity when personalizing axillary treatment and encourage lifestyle interventions and lymphedema screening after BC treatment.

Frequency of Self-Weighing and Weight Change: Cohort Study With 10,000 Smart Scale Users.

BackgroundFrequent self-weighing is associated with successful weight loss and weight maintenance during and after weight loss interventions. Less is known about self-weighing behaviors and associated weight change in free-living settings.ObjectiveThis study aimed to investigate the association between the frequency of self-weighing and changes in body weight in a large international cohort of smart scale users.MethodsThis was an observational cohort study with 10,000 randomly selected smart scale users who had used the scale for at least 1 year. Longitudinal weight measurement data were analyzed. The association between the frequency of self-weighing and weight change over the follow-up was investigated among normal weight, overweight, and obese users using Pearson’s correlation coefficient and linear models. The association between the frequency of self-weighing and temporal weight change was analyzed using linear mixed effects models.ResultsThe eligible sample consisted of 9768 participants (6515/9768, 66.7% men; mean age 41.5 years; mean BMI 26.8 kg/m2). Of the participants, 4003 (4003/9768, 41.0%), 3748 (3748/9768, 38.4%), and 2017 (2017/9768, 20.6%) were normal weight, overweight, and obese, respectively. During the mean follow-up time of 1085 days, the mean weight change was –0.59 kg, and the mean percentage of days with a self-weigh was 39.98%, which equals 2.8 self-weighs per week. The percentage of self-weighing days correlated inversely with weight change, r=–0.111 (P<.001). Among normal weight, overweight, and obese individuals, the correlations were r=–0.100 (P<.001), r=–0.125 (P<.001), and r=–0.148 (P<.001), respectively. Of all participants, 72.5% (7085/9768) had at least one period of ≥30 days without weight measurements. During the break, weight increased, and weight gains were more pronounced among overweight and obese individuals: 0.58 kg in the normal weight group, 0.93 kg in the overweight group, and 1.37 kg in the obese group (P<.001).ConclusionsFrequent self-weighing was associated with favorable weight loss outcomes also in an uncontrolled, free-living setting, regardless of specific weight loss interventions. The beneficial associations of regular self-weighing were more pronounced for overweight or obese individuals.

Fast Food Chains and Obesity in Oman: Commentary Article

Introduction: Fast food chains are a global phenomenon, and they have been associated with less successful weight loss maintenance, undesirable weight gain, a higher Body Mass Index (BMI). Some have defined fast food as pre packed meals or ready to eat convenience food, and others have described fast food as food purchased from a major franchised chain. Higher rates of fast food consumption have been connected with increasing rates of obesity. Materials and methods: Colorectal Cancer (CRC) patients treated at Royal Hospital were identified from Royal Hospital medical records and from Oman’s cancer registry between 2000 and 2013. Results: The total number of patients diagnosed with CRC was 492, and the BMI information of 351 patients was available. In Oman, most fast food restaurants are situated in the Muscat region (40 restaurants) followed by Sohar (seven restaurants), Salalah (four restaurants), and Nizwa (two restaurants). The obesity, BMI, and CRC malignancy rates were higher in the areas with fast food chains (with the exception of Sohar). The CRC age standardized rate was lower in the areas with no fast food outlets, and the incidence of obesity and CRC were also lower. In our study, the proportion of those who were overweight or obese was 65.2% in Muscat, 81.5% in Salalah, 62.5% in Sohar, and 50% in Buraimi. In other regions with no available fast food outlets, the rate of obesity ranged from 33.3% to 47.4%. Conclusion: There was a strong association between obesity, fast food chain availability and CRC. High fish intake might have a protective effect on the development of CRC. Although Sohar had a high obesity rate and a good number of fast food chains, the region had a low CRC incidence possibly attributable to high fish intake.

Factors Associated with Weight Loss Maintenance and Weight Regain Among African American and White Adults Initially Successful at Weight Loss.

Providing ongoing treatment through extended care programs can improve weight loss maintenance (WLM), but the effectiveness of these programs for African Americans (AA) are mixed and may be due to unique cultural factors. To identify, prioritize, and organize factors associated with WLM as experienced by AA and White adults initially successful with weight loss. Adults identified their greatest amount of lifetime weight loss, and those achieving ≥5% weight loss were classified as maintainers (continued >5% weight reduction for ≥1 year) or regainers (≤5% weight reduction) based on current weight. The nominal group technique was conducted to identify and rank WLM facilitators and barriers. Online card sorting tasks and hierarchical clustering were performed to illustrate conceptual relationships between facilitators (maintainers only) and barriers (regainers only). Participants (maintainers, n = 46; regainers, n = 58; 81.7% women, 48.1% AA) identified known factors associated with successful weight management (daily weighing, self-monitoring, regular physical activity, mindful eating). However, the perceived importance of these factors differed between groups (maintainer vs. regainers; AA vs. Whites). Unique factors affecting WLM were also identified (refresher groups recommended by White maintainers and regainers; self-accountability identified by AA maintainers). Salient facilitators and barriers were best represented in 2-3 clusters; each group had ≥1 unique cluster(s) revealing group-specific higher-order domains associated with successful WLM. As lifestyle interventions for WLM (particularly for AA) are developed, attention to the preferences, and lived experiences of these groups is recommended. Strategies targeting physical activity maintenance and autonomy-supportive approaches may improve WLM among AA.

Understanding children and young people's experiences pursuing weight loss maintenance using the Socio-ecological Model: A qualitative systematic literature review.

Developing a broader understanding of children and young people's experiences of long-term attempts of weight management may provide insight into both enablers and barriers to successful weight loss maintenance. This review aims to explore children and young people's perceptions of long-term attempts of weight management. Six databases were searched for qualitative studies describing young participants (<25 years, previously or currently above a healthy weight) experiences of weight management for >6 months following intentional weight loss. A thematic synthesis was undertaken. Themes were interpreted using the Socio-ecological Model. Factors supporting attempts to maintain weight loss included having clear motivation for change; developing personal skills to manage the challenges of change; family support/dynamics that encourage healthy lifestyles; and health-promoting cultures in schools/workplaces, communities, and the broader living environment. Conversely, ambivalence, difficulty coping with changes, peer pressure, challenging family dynamics, limited professional support, and unhealthy living environments were barriers to maintaining behavior change. These facilitators and barriers at each level of the Socio-ecological Model informed a model of weight loss maintenance for children and young people. Supporting children, young people, and families to develop the skills to manage the individual, social, and environmental challenges that shape attempts of long-term weight management will help to support their ability to manage their weight long term.

Identifying Persuasive Design Principles and Behavior Change Techniques Supporting End User Values and Needs in eHealth Interventions for Long-Term Weight Loss Maintenance: Qualitative Study.

BackgroundAn increasing number of eHealth interventions aim to support healthy behaviors that facilitate weight loss. However, there is limited evidence of the effectiveness of the interventions and little focus on weight loss maintenance. Knowledge about end user values and needs is essential to create meaningful and effective eHealth interventions, and to identify persuasive system design (PSD) principles and behavior change techniques (BCTs) that may contribute to the behavior change required for successful long-term weight loss maintenance.ObjectiveThis study aimed to provide insight into the design of eHealth interventions supporting behavior change for long-term weight maintenance. The study sought to identify the values and needs of people with obesity aiming to maintain weight after weight loss, and to identify PSD principles, BCTs, and design requirements that potentially enable an eHealth intervention to meet end user values and needs.MethodsThis study presents the concept of integrating PSD principles and BCTs into the design process of eHealth interventions to meet user values and needs. In this study, individual interviews and focus groups were conducted with people with obesity (n=23) and other key stakeholders (n=27) to explore end user values and needs related to weight loss maintenance. Design thinking methods were applied during the focus group sessions to identify design elements and to explore how eHealth solutions can support the needs to achieve sustainable weight loss maintenance. The PSD model and behavior change taxonomy by Michie were used to identify PSD principles and BCT clusters to meet end user values and needs.ResultsA total of 8 key end user values were identified, reflecting user needs for weight loss maintenance support: self-management, personalized care, autonomy, feel supported, positive self-image, motivation, happiness, and health. Goals and planning, feedback and monitoring, repetition and substitution, shaping knowledge, social support, identity, and self-belief were some of the BCT clusters identified to address these concepts, together with PSD principles such as personalization, tailoring, self-monitoring, praise, and suggestions.ConclusionsThe process of translating end user values and needs into design elements or features of eHealth technologies is an important part of the design process. To our knowledge, this is the first study to explore how PSD principles and BCTs can be integrated when designing eHealth self-management interventions for long-term weight loss maintenance. End users and other key stakeholders highlighted important factors to be considered in the design of eHealth interventions supporting sustained behavior change. The PSD principles and BCTs identified provide insights and suggestions about design elements and features to include for supporting weight loss maintenance. The findings indicate that a combination of BCTs and PSD principles may be needed in evidence-based eHealth interventions to stimulate motivation and adherence to support healthy behaviors and sustained weight loss maintenance.Trial RegistrationClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988

Frequency and Consistency of Self-Weighing to Promote Weight-Loss Maintenance.

This study aimed to investigate the roles of frequency and consistency of self-weighing in promoting weight-loss maintenance. Participants were 74 adults who completed a 3-month internet-based weight-loss program followed by a 9-month no-intervention maintenance period. Frequency of self-weighing was defined as the number of days that participants self-weighed during the maintenance period via a study-provided smart scale. Consistency was defined as the number of weeks that participants self-weighed at a certain frequency, with multiple minimum thresholds examined. Hierarchical regression analyses were used to assess associations among frequency, consistency, and weight change during the maintenance period. Greater consistency was significantly associated with less weight regain when defined as the number of weeks that participants self-weighed on ≥6 d/wk or 7 d/wk (P values < 0.05). Contrary to hypotheses, frequency was not associated with weight change (P = 0.141), and there was not a significant interaction between frequency and consistency. Results demonstrate that consistency of self-weighing may be more important than total frequency for preventing weight regain after the end of a weight-loss program. Further, results suggest that a high level of consistency (self-weighing for ≥6 d/wk or 7 d/wk) may be necessary to promote successful weight-loss maintenance.

Beyond weight loss: Impact of a weight management programme for mid-older Australians in private health insurance.

Weight-loss maintenance and lifestyle behaviour necessary to manage weight are undisputedly challenging. We evaluated a secondary prevention weight-loss maintenance programme for participants (n = 490) with weight-related chronic disease in the Australian private health insurance setting. This study investigated the impact of the maintenance programme on anthropometric and lifestyle risk behaviour changes after 6 and 12 months, and trends in weight-loss maintenance after 1 year. Using a pre- and post-test design, data were analysed with generalized linear mixed models for repeated measures to determine the effect of the programme on weight loss and lifestyle behaviour outcomes. After initially losing a clinically significant amount of weight (mean 9.1 kg), maintenance-programme participants maintained clinically significant weight loss (mean 7.6 kg) at 12 months. Rates of discontinuation in the programme were high (47% at 6 months and 73% at 12 months). Weight-loss maintenance was achieved by 76% of participants at 3 months and 62% at 6 months, stabilizing at 55% and 56% at 9 and 12 months, respectively. Greater initial weight loss was associated with weight-loss maintenance at 12 months. Participants <55 years demonstrated consistent weight-loss maintenance over this time but the odds for successful weight-loss maintenance for those ≥55 years continued to decrease over time. At maintenance-baseline, 68.3% of participants had sufficient physical activity for health; 61.4% and 19.8% met recommended fruit and vegetable consumption, respectively. All lifestyle risk behaviours were maintained at 12 months. A programme extending support strategies for maintaining weight-related behaviour shows promise to successfully support these changes over 12 months. There is a potentially important opportunity for targeted intervention at 6 to 9 months.

Successful weight loss maintenance: A systematic review of weight control registries

Weight loss maintenance is a major challenge for obesity treatment. Weight control registries can be useful in identifying psychological and behavioural factors that could contribute to better long-term success. The objective of this study is to describe the existing weight control registries and their participants and identify correlates of weight loss maintenance. A comprehensive search of peer-reviewed articles published until November 2018 was conducted in PubMed, Web of Science, and Scopus. Studies that reported results from weight control registries were considered. Fifty-two articles, corresponding to five registries (the United States, Portugal, Germany, Finland, and Greece), were included. Registries differed in inclusion criteria and procedures. Of 51 identified weight loss and maintenance strategies, grouped in 14 domains of the Oxford Food and Activity Behaviors taxonomy, the following were the most frequently reported: having healthy foods available at home, regular breakfast intake, increasing vegetable consumption, decreasing sugary and fatty foods, limiting certain foods, and reducing fat in meals. Increased physical activity was the most consistent positive correlate of weight loss maintenance. To our knowledge, this is the first systematic review of information about successful weight loss maintenance obtained from weight control registries. Key common influential characteristics of success were identified, which can inform future prospective studies and weight management initiatives.

Can a Nordic diet be implemented as a new strategy for successful long-term weight loss maintenance in subjects with obesity?

AbstractIntroductionA key problem in all weight-loss programs to fight obesity is the extent to which the body weight is maintained on a long-term basis. The study examines whether the 1-year consumption of healthy Nordic foods can result in better sustainable weight control compared to a control diet.Material and methodsAfter a successful 6-week VLCD period in obese subjects (n = 80, 52 ± 10y, BMI 34.4 ± 3.1 kg/m2, 69% female; 93% completers, -10.9 ± 3.0 kg, p &lt; 0.001), the subjects were randomized to a new Nordic diet (NND) and a traditional Nordic diet (TND) group. The following 1-year period was a body weight maintenance period where the diets were implemented ad libitum. Weight, BMI, waist circumference and sagittal abdominal diameter were measured at 0 (immediately after VLCD), 6 and 12 months. Results are reported as mean ± SEM. Differences in the anthropometric parameters between the diets at different time points compared to the start of the dietary intervention were statistically evaluated using a general linear model (GLM-ANOVA, Minitab Inc.).ResultsForty-three subjects were randomized to NND and 37 to TND. In the NND group, 31 subjects completed the 6-month visit and 30 subjects 12-month visit. In the TND group, 24 and 21 completed 6-month and 12-month visit, respectively. We observed a non-significant difference in weight change at 6 months between NND (0.04 ± 0.87kg) and TND (2.65 ± 1.08kg). At 12 months, the weight change was significantly different between the diets (NND 1.94 ± 0.99 kg and TND 5.69 ± 1.41 kg, p = 0.029, R2 = 9.39). Change in the BMI at 12 months was significantly lower for NND (0.65 ± 0.33 kg/m2) compared to TND (1.87 ± 0.46 kg/m2, p = 0.034, R2 = 8.87) but not at 6 months (0.01 ± 0.30 kg/m2 for NND and 0.84 ± 0.36 kg/m2 for TND). Differences in waist circumference (at 6 months 0.26 ± 0.93 cm for NND and 3.30 ± 1.45 cm for TND; at 12 months 1.04 ± 1.01 cm for NND and 3.85 ± 1.79 cm for TND) were not statistically different. The sagittal abdominal diameter was borderline statistically different at 6 months (NND -0.28 ± 0.29 cm and TND 0.49 ± 0.22 cm, p = 0.049, R2 = 7.09) but not at 12 months (NND 0.41 ± 0.38 cm and TND 1.23 ± + 0.42cm).ConclusionResults show a tendency that the type of diet has an impact on successful weight maintenance, with a benefit for the NND. Further statistical analyses including dietary compliance and biomarkers are needed and will be performed. Moreover, the study is ongoing with a total of 2-year follow-up.

Delineating the psychological and behavioural factors of successful weight loss maintenance

Overweight and obesity present alarming global health problems including detrimental health risks that call for effective interventions. Considerable research has examined behavioural and psychological factors associated with weight loss to advance the field of obesity and overweight. In line with the literature, this study aimed to develop a behavioural and psychological profile based on factors of personality, eating behaviours, emotional functioning, physical well-being, and psychopathology. The sample consisted of 105 community participants who had reduced their bodyweight by at least 10% and had either successfully maintained their weight loss for a minimum 12-month period (n = 41) or had regained their weight loss within 12 months (n = 64). Participants completed an online survey comprising demographic items and four empirical measures (Mini Marker Personality Scale, Patient Health Questionnaire, Three-Factor Eating Questionnaire-Revised, and a food screening tool). Based on significant bivariate correlations results, four factors (fat intake, restrained eating, uncontrolled eating, and emotional eating) were entered into a binary logistic regression. Restrained eating was the only factor that significantly increased the likelihood of predicting successful long-term weight loss. Findings have implications for overweight and obesity future research, which may guide the direction of obesity and overweight treatments.