Successful Weight Loss Outcomes Research Articles

Stronger control of eating 3 months after sleeve gastrectomy predicts successful weight loss outcomes at one year

BackgroundWeight loss response to sleeve gastrectomy (SG) is variable and predicting the effectiveness of surgery is challenging and elusive. The aim of our study was to assess and quantify the association between eating control and weight loss outcomes and identify the control of eating (CoE) attributes during the early postoperative period that might predict good vs. poor response to SG at one year. MethodsA prospective longitudinal cohort study using the Control of Eating Questionnaire (CoEQ) was designed as a series before and at 3-, 6-, and 12-months post-SG. Primary outcomes were changes in CoE attributes and percent of total weight loss (%TWL) 12-months post-surgery. Subjects were categorized based on %TWL as good (GR, ≥25 %) or poor responders (PR, <25 %). A receiver operating characteristic and logistic regression analyses were performed. ResultsWe included 41 participants (80.5% females, 51.2% Hispanic, mean age 41.7±10.6, median baseline body mass index (BMI) 43.6 kg/m2 [range 35.2–66.3]) who completed the CoEQ at all four timepoints. The “Difficulty to control eating” score at 3 months revealed the highest area under the curve (AUC) (AUC 0.711; 95%CI 0.524–0.898; p=0.032). In a trade-off between a high Youden index and high sensitivity, the “Difficulty to control eating” score of 7 at 3 months was identified as the optimal cut-off for distinguishing between GRs and PRs. Score ≤7 at 3 months was strongly independently associated with a successful weight loss target of 25%TWL at one-year post-SG (Relative Risk 4.43; 95%CI 1.06–18.54; p=0.042). Conclusion“Difficulty to control eating” score at 3 months post-SG is an independent early predictor of optimal response (achieving a successful TWL target of ≥25 % at one-year post-SG). Our results support the utility of this easy-to-administer validated tool for predicting the effectiveness of SG and may assist in identifying individuals with suboptimal response early and helping them with interventions to attain optimal weight loss targets.

An Increase in Prominent Probiotics Represents the Major Change in the Gut Microbiota in Morbidly Obese Female Patients upon Bariatric Surgery

The global increase in obesity carries inherent health implications, with an increased BMI being a known risk factor for diseases such as type 2 diabetes, cardiovascular diseases, or different cancer types. The long-term effectiveness of diet therapy in addressing morbid obesity is extremely limited, with no adequate pharmaceutical agents available as treatment options, resulting in bariatric surgery being the only viable option to achieve and maintain significant long-term weight loss. Something that plays an important role in overall human health is the gut microbiome and its complex composition, which is usually altered and reduced in complexity/diversity in severely obese patients. In this study, the influence of bariatric surgery and the resulting weight loss on the gut microbiome composition of twelve morbidly obese (BMI ≥ 40) adult female central European patients was investigated by comparing the relative abundances of the major microbial phyla Actinobacteria, Bacteroidetes, Firmicutes, and Proteobacteria pre- and post-surgery. We also aimed to give insight into the major changes in individual prominent and promising future probiotic bacteria characterized by an overall increase in abundance accompanied by a switch of enterotypes. Identifying specific microbial alterations associated with successful weight-loss outcomes may contribute to the development of future therapeutic interventions by supplementation with next-generation probiotics.

The Result of Different Kinds of Weight Loss Surgeries in Obese Patients at Kirkuk City

Objective: Our study aimed to evaluate the outcomes of obese patients undergoing weight loss surgeries in Kirkuk City. Background: We can define Obesity as a common factor in the contemporary world. Obesity is a major factor in cardiovascular disease, diabetes, and renal disease. It was also linked to various comorbidities. Weight loss surgery has beneficial effects on both Obesity and comorbidities. Patients and methods: This paper examines weight loss surgeries for obese patients using data collected from Baghdad, Iraq, between 16 January 2019 and 15 December 2022. By studying the outcomes of 122 patients, including 89 women (73%) and 33 men (27%), we developed the methodology to assess outcomes; each patient underwent one of several weight-reduction procedures. Results and discussion: Obesity is a severe health problem, and according to Epidemiological studies, Obesity affects approximately 400 million people worldwide. Females outnumbered males in all categories, possibly because women are more susceptible to psychological difficulties and more concerned about the aesthetic implications of Obesity. As a result, our study detected that women have more Obesity than males, where women were 89 and males had 33 cases of 122. Laparoscopic sleeve surgery is considered the most common surgery in the world (LGS), which is well-established in the treatment of morbid Obesity and has a significant impact on weight loss and the risk of comorbidities. This technique resulted in significant weight reduction. Previous studies indicated that having a high BMI increases the risk of operational mortality and complications. Due to that, the Ur study found that laparoscopic gastric sleeve (LGS) got the most cases with 75 of 122 patients. Also, our outcomes found that infections were the highest score of 11 patients who had complications, where there may be an increased risk of site infections. Conclusion: A range of weight loss procedures was employed in Kirkuk City to address morbid Obesity, with all procedures resulting in successful weight loss outcomes. However, LMGB patients showed the most significant benefits.

Toward Precision Weight-Loss Dietary Interventions: Findings from the POUNDS Lost Trial.

The POUNDS Lost trial is a 2-year clinical trial testing the effects of dietary interventions on weight loss. This study included 811 adults with overweight or obesity who were randomized to one of four diets that contained either 15% or 25% protein and 20% or 40% fat in a 2 × 2 factorial design. By 2 years, participants on average lost from 2.9 to 3.6 kg in body weight in the four intervention arms, while no significant difference was observed across the intervention arms. In POUNDS Lost, we performed a series of ancillary studies to detect intrinsic factors particular to genomic, epigenomic, and metabolomic markers that may modulate changes in weight and other cardiometabolic traits in response to the weight-loss dietary interventions. Genomic variants identified from genome-wide association studies (GWASs) on obesity, type 2 diabetes, glucose and lipid metabolisms, gut microbiome, and dietary intakes have been found to interact with dietary macronutrients (fat, protein, and carbohydrates) in relation to weight loss and changes of body composition and cardiometabolic traits. In addition, we recently investigated epigenomic modifications, particularly blood DNA methylation and circulating microRNAs (miRNAs). We reported DNA methylation levels at NFATC2IP, CPT1A, TXNIP, and LINC00319 were related to weight loss or changes of glucose, lipids, and blood pressure; we also reported thrifty miRNA expression as a significant epigenomic marker related to changes in insulin sensitivity and adiposity. Our studies have also highlighted the importance of temporal changes in novel metabolomic signatures for gut microbiota, bile acids, and amino acids as predictors for achievement of successful weight loss outcomes. Moreover, our studies indicate that biochemical, behavioral, and psychosocial factors such as physical activity, sleep disturbance, and appetite may also modulate metabolic changes during dietary interventions. This review summarized our major findings in the POUNDS Lost trial, which provided preliminary evidence supporting the development of precision diet interventions for obesity management.

Diagnostic challenge: A pediatric patient with severe obesity and complications of imminent death

BackgroundA 15-year-old patient suffering from severe obesity (400 pounds, BMI 71.6 kg/m2) with a clinical phenotype suggestive of syndromic obesity was hospitalized for severe heart failure and cardiogenic shock. The hospital admission prompted a palliative care and heart transplant consultation given end-stage-disease and poor prognosis. It further necessitated a pediatric inpatient obesity consult, which was complicated by several significant hurdles including lack of insurance coverage, FDA approvals, availability of medications, and inadequate knowledge among the medical community. MethodsInnovative treatment, proactive, persistent advocacy, anti-obesity medication combination strategies modeled after diabetes and hypertension treatment algorithms, and latest evidence in obesity management were utilized to effectively and expeditiously overcome major challenges to care and the medical emergency. ResultsThe patient was stabilized and ultimately discharged home, after −25.2% weight loss over 4 months (weight down to 299 pounds, BMI 49.9 kg/m2) through collaborative medical obesity intervention. ConclusionThe typical delay in care sought by patients suffering from obesity, often due to stigma and lack of disease awareness, results in missed opportunities to prevent serious obesity-related complications. Skilled specialist expertise, fund of obesity-specific knowledge, and constant advocacy can be crucial in surmounting regulatory barriers to obesity care and in generating successful weight loss outcomes.

Post-surgical cannabis use is associated with weight loss among individuals up to 4years after bariatric surgery.

Although cannabis is known to stimulate appetite, it is not clear whether cannabis use may impact weight loss outcomes following bariatric surgery. Although some work has suggested that pre-surgical cannabis use is not associated with post-surgical weight loss, the role of post-surgical cannabis use has not yet been examined. The purpose of this study was to measure pre- and post-surgical cannabis use and determine whether cannabis use was associated with weight loss outcomes following bariatric surgery. Patients who underwent bariatric surgery over a 4-year period at a single health care system were invited to complete a survey regarding pre- and post-surgical cannabis use and report their current weight. Pre-surgical weight and BMI were extracted from medical records to calculate change in BMI (ΔBMI), percent total weight loss (%TWL), percent excess weight loss (%EWL), whether participants experienced a successful weight loss outcome, and whether participants had weight recurrence. Among all participants (N = 759), 10.7% and 14.5% engaged in pre- and post-surgical cannabis use, respectively. Pre-surgical cannabis use was not associated with any weight loss outcomes (p > 0.05). Any post-surgical cannabis use was associated with lower %EWL (p = 0.04) and greater likelihood of weight recurrence (p = 0.04). Weekly cannabis use was associated with lower %EWL (p = 0.003), lower %TWL (p = 0.04), and a lower likelihood of having a successful weight loss outcome (p = 0.02). Although pre-surgical cannabis use may not predict weight loss outcomes, post-surgical cannabis was associated with poorer weight loss outcomes. Frequent use (i.e., weekly) may be especially problematic. Providers should consider screening patients for cannabis use and educate them about the potential impact of postoperative cannabis use on weight loss following bariatric surgery.

Validation of Tools to Assess Predictors of Successful Weight Loss Outcome in Individuals With Overweight and Obesity

ObjectiveTo develop and validate questionnaires to assess the behavioral, psychosocial, and environmental predictors of successful weight loss outcomes. DesignMixed method study. Questionnaires were developed using 5 steps: item generation by literature review and preexisting questionnaires, expert evaluation, pilot testing, factor analysis, and internal consistency. SettingAdults with obesity recruited via web-based survey hyperlink. ParticipantsOne hundred participants with a mean body mass index of 28.7 ± 4.4 kg/m2. Variables MeasuredThe questionnaires were generated using 221 items. Establishing content, face and construct validity, and internal consistency. AnalysisContent validity was analyzed using content validity index and content validity ratio, internal consistency through Cronbach α (CA), and structural validity by factor analysis via principal varimax rotation. ResultsAll three questionnaires had good content validity. The Behavioral Predictor Questionnaire had good internal consistency (CA, 0.7) and excellent structural validity (69.7%). Psychosocial Predictors Questionnaire (CA, 0.8, 67.5%) and Environmental Predictors Questionnaire (CA: 0.8, 72.2%) had excellent internal consistency and structural validity. Conclusion and ImplicationQuestionnaires seem to be practical, valid, and reliable tools for baseline assessment of individual-specific factors related to weight loss success.

Monitoring Your Weight-Loss Process Online: The Impacts of Prior Experiences and Online Social Support on Subsequent Weight-Loss Outcome

ABSTRACT Online weight-loss communities (OWCs) have become increasingly popular for weight management; they enable individuals to monitor (i.e. self-monitoring) and discuss (i.e. social interaction) their weight-loss experiences. This study investigates the relationship between prior weight-loss experiences (success and failure), online social support, and subsequent weight-loss outcome in the context of OWCs and based on self-determination theory. We collected the data of 1465 users from one popular OWC and deployed two logit regression models to estimate the effects of prior weight-loss experiences on subsequent weight-loss success as well as the moderating role of social support. The results revealed that prior successful weight-loss experiences were positively related to subsequent weight-loss outcome, while the relationship between prior failed weight-loss experiences and subsequent weight-loss outcome was negative. Meanwhile, online social support can not only be positively related to subsequent weight-loss outcome, but also buffer the negative role of prior failed weight-loss experiences. Nevertheless, social support had no significant moderating role in the relationship between prior successful weight-loss experiences and subsequent weight-loss outcome. This study contributes to the literature on prior experiences and online social support in the context of OWCs and provides valuable insights to improve participants’ engagement and their weight-loss success.

Abstract 041: Effect Of Personalized Feedback Messages On Adherence To The Dietary, Physical Activity And Weight Loss Goals- The Smarter RCT

Background: A core component of standard behavior treatment for weight loss is establishing goals for caloric restriction and weekly minutes of physical activity (PA). Adherence to these behavior change goals is essential for successful weight loss outcomes. The aim of this paper is to examine adherence to the behavior change goals in the two treatment conditions: Self-Monitoring plus personalized Feedback (SM+FB) or SM alone. Methods: We conducted a single-site, two-arm randomized controlled trial from August 2018 to March 2021. Adults (N=502) 18 years of age or over with body mass index (BMI) 27-43 kg/m 2 were randomized with equal allocation to SM+FB (n=251) or SM (n=251). Feedback messages were sent daily for diet and every other day for PA. Adherence to the dietary and PA goals were defined as: 1) for diet the number of days one was adherent to the calorie goal (i.e., between 80% and 120% with the wide range due to the lack of precision in self-reported food intake) and 2) for PA the percentage of minutes of fairly and very active minutes per week meeting the PA goal of at least 150 minutes for fairly and very active minutes based on the Fitbit Charge 2™. Associations between treatment assignment and adherence to the dietary and PA goals were examined using linear mixed modeling with intention-to-treat method. Results: The sample (N=502) was mostly white (84%, 423 of 502), female (79%, 399 of 502) and on average 45.0±14.4 years of age and BMI of 33.7±4.0 kg/m 2 . Study retention at 12 months was 79%. The trajectory of change in adherence to the dietary goal was non-linear over 12 months (b=-.18, 95% CI [-.20, -.17]; b 2 =.006, 95% CI [.005, .007]; b 3 =-.0001, 95% CI [-.00007, -.00006], all P&lt;.0001). The rate of decline over time in adherence to the diet goal was nonlinear and different by treatment (b trt*time = .03, 95% CI [.01, .06]; b trt*time*time = -.002, 95% CI [-.003, -.001]; b trt*time*time*time = .00003, 95% CI [.00002, .00004], all P&lt;.05) Notably, the effect of treatment (b= .41, 95% CI [.10, .72], P=.009) on adherence to the dietary goal was significant. Additionally, the effects of time with polynomial contrasts showed declining curvilinear trajectories of change in the PA goal over 12 months (b=-1.75, 95% CI [-2.57, -0.92], b 2 =.08, 95% CI [.04, .11], b 3 =-.001, 95% CI [-.002, -.001], all P&lt;.0001). The rate of decline over time in adherence to the PA goal was non-linear and different by treatment (b trt*time = -.80, 95% CI [-1.40, -.20]; b trt*time*time = .02, 95% CI [.004, -.03], all P&lt;.05); the effect of treatment on adherence to the PA goal was not significant (b= 19.07, 95% CI [-3.86, 42.01], P = .103). Conclusions: In this study, adherence to the dietary and PA goals was associated with daily FB, which may be related to the frequency of the feedback messages. Further studies are needed to determine the best dose of tailored feedback messages to achieve sustained adherence to the prescribed behavior change goals.

Precision Medicine and Obesity.

Obesity is a chronic, relapsing, and multifactorial disease, with a rising prevalence and an associated high economic burden. Achieving successful and sustained weight loss outcomes with current interventions is challenging. This is due, at least in part, to the disease's heterogenous pathophysiology that is yet to be completely understood. Technological advances and greater capabilities for the extraction and storage of information have facilitated the application of precision medicine. Several precision medicine initiatives have been proposed to improve obesity outcomes. Most of these initiatives are based on -omics technologies. Although the data generated from these technologies have led to developing hypotheses that may explain the underpinnings of obesity, their applicability to the clinical practice is yet to be determined. There are other initiatives that have identified quantitative or qualitative physiologic traits that can be targeted and that could have a more immediate clinical impact. This review aims to provide a perspective of current initiatives for precision medicine for obesity.

Nightly Variation in Sleep Influences Self-efficacy for Adhering to a Healthy Lifestyle: A Prospective Study.

Self-efficacy, or the perceived capability to engage in a behavior, has been shown to play an important role in adhering to weight loss treatment. Given that adherence is extremely important for successful weight loss outcomes and that sleep and self-efficacy are modifiable factors in this relationship, we examined the association between sleep and self-efficacy for adhering to the daily plan. Investigators examined whether various dimensions of sleep were associated with self-efficacy for adhering to the daily recommended lifestyle plan among participants (N = 150) in a 12-month weight loss study. This study was a secondary analysis of data from a 12-month prospective observational study that included a standard behavioral weight loss intervention. Daily assessments at the beginning of day (BOD) of self-efficacy and the previous night's sleep were collected in real-time using ecological momentary assessment. The analysis included 44,613 BOD assessments. On average, participants reported sleeping for 6.93 ± 1.28h, reported 1.56 ± 3.54 awakenings, and gave low ratings for trouble sleeping (3.11 ± 2.58; 0: no trouble; 10: a lot of trouble) and mid-high ratings for sleep quality (6.45 ± 2.09; 0: poor; 10: excellent). Participants woke up feeling tired 41.7% of the time. Using linear mixed effects modeling, a better rating in each sleep dimension was associated with higher self-efficacy the following day (all p values < .001). Ourfindings supported the hypothesis that better sleep would be associated with higher levels of reported self-efficacy for adhering to the healthy lifestyle plan.

Perceived and Preferred Social Support in Patients Experiencing Weight Regain After Bariatric Surgery\u2014a Qualitative Study

PurposeWhile bariatric surgery generally shows successful weight loss outcomes in patients with obesity, weight regain exists. The aim of this qualitative study was to improve understanding of how patients with substantial weight regain after bariatric surgery experienced the support from family, friends, and healthcare providers, and what kind of support they had preferred.Materials and MethodsQualitative data were collected from semi-structured interviews with 16 participants. Mean weight regain from surgery to interview was 36%. The transcribed interviews were analyzed with thematic analysis.ResultsTwo main themes and seven sub-themes were formulated. The theme, A lonely struggle, illustrates patients’ feelings of abandonment and struggle during weight regain due to lack of support or unfavorable treatment. Participants commonly blamed themselves for re-gaining weight, and shame made them reluctant to engage in social activities or seek medical care. The theme, Others as sources of compassion and control, covers what support they desired, as well as had perceived to be helpful. Exercising or eating healthy with others was appreciated and felt supportive. Pro-active healthcare support and access to dietitians, physiotherapists, and psychological support were desired.ConclusionTo optimize the effect of bariatric surgery, support may need to be individualized and lifelong. Since shame and self-blame in patients with weight regain may hinder seeking professional help, care providers may need to initiate follow-up visits. Empathetic and non-judgmental support, access to multidisciplinary healthcare team, as well as peer-support groups may be beneficial to counteract weight regain post-bariatric surgery.

Predictors of successful weight loss outcomes amongst individuals with obesity undergoing lifestyle interventions: A systematic review.

Understanding the predictors of weight loss with lifestyle interventions can help to ascertain the probable outcomes of individuals with obesity who undergo such interventions. This systematic review assessed the evidence of predictors of successful weight loss among individuals who are overweight or with obesity undergoing lifestyle interventions. Four electronic databases (PubMed, Cochrane Reviews, PsychInfo and Wiley) were searched to find relevant literature published in the past 20years. A total of 1351 titles were identified in the initial search, of which 23 studies were finally included. Predictors were synthesized in the domains of socio-demographic factors, anthropometric parameters, psychological and behavioural factors and intervention-based factors. The overall quality of evidence on predictors was then appraised using an adapted GRADE approach. Patient-specific factors such as being male, older in age, having existing cardiometabolic comorbidities and limited fat intake were significantly associated with weight loss success. Amongst intervention specific predictors, greater initial weight loss and higher adherence to lifestyle advice were associated with greater weight loss success. In this review, initial weight loss came out to be as the most important predictor of successful weight loss outcome.

Committed To Weightloss: An IPA Analysis into the Experiences of Individuals Who Lost Weight Through Nutritional Intervention

One of the challenges faced by healthcare professionals working with individuals seeking to lose weight is the issue of adherence. Individuals often fail to stick to long term dietary changes, which can impact on weight loss success. The aim of this study is to identify factors which influence adherence to nutritional intervention for weight loss, from the experiences of a purposively sampled group of individuals who had successful weight loss outcomes whilst working with a nutritional practitioner. Four participants who met the inclusion criteria took part in a semi-structured interview. They were asked to discuss their experiences of working with a nutritional practitioner, their motivation for seeking nutritional support, their experiences of working with the practitioner and the subsequent nutritional intervention and what they believed encouraged them to adhere to the intervention in the longer term. The interviews were audio-recorded, transcribed and analysed for themes using Interpretative Phenomenological Analysis (IPA). Nine themes were identified within the four transcripts. The themes were grouped and labelled as follows; (1) professional (what they do and what they know), (2) in-depth and thorough, (3) can’t argue with the results, (4) someone genuinely cares, (5) I am an important part of this process, (6) empowered by knowledge, (7) shift in focus towards health, (8) my motivation, and (9) this is who I am and what I need to do. These themes were then grouped them into three superordinate themes; I trust this process, I feel valued, and understanding of self. The findings suggest practitioners may have opportunities to influence adherence to nutritional interventions for weight loss. These opportunities can be grouped into four categories, which are: enhancing professionalism, enhancing their relationship with the client, providing coaching and providing education.

Expected benefits and motivation to weight loss in relation to treatment outcomes in group-based cognitive-behavior therapy of obesity.

We aimed to determine cognitive drivers, expected to play a role in target reach and/or attrition in obesity programs. We recorded the expected benefits of weight loss, weight targets, primary motivation for weight loss, perceived treatment needs, readiness and self-confidence to be successful and a battery of psychopathology questionnaires in 793 subjects with obesity (68% women; mean age 48.7; 46% obesity class III) enrolled into a group-based cognitive-behavioral treatment program. Their relevance on attrition and successful weight loss outcome were tested by logistic regression analysis. The expected benefits of weight loss scored very high in all physical, psychological and social areas, with differences between genders. Attrition rate was 24, 41 and 65% at 6-, 12-, and 24-month follow-up. Average weight loss was 5.8 ± 7.1kg (- 4.8%) at 6months, with 17% of cases (32% of continuers) maintaining weight loss > 10% at 24months. After adjustment for confounders, attrition was reduced by concern for present health, motivation/consciousness of the importance of physical activity and need for support; treatment discontinuation was favored by concern for body image, by expectations for drug treatment or bariatric surgery, and by high-challenging weight loss targets. Male gender, higher BMI and concern for present health predicted weight loss > 10%, whereas concern for body appearance was associated with lower probability of attaining the desired weight loss targets. A more precise definition of needs and expectations might help tailor treatment to individual patients, but attrition rates and target reach remain difficult to predict. Level V, descriptive studies.

Correlates of Dietary Adherence and Maladaptive Eating Patterns Following Roux-en-Y Bariatric Surgery.

Self-reported poor dietary adherence following bariatric surgery is associated with less successful weight loss outcomes. Poor dietary adherence is a global construct lacking specificity regarding its underlying, clinically targetable, maladaptive eating behaviors. Comprehensive online survey data were obtained from a sample of 274 adults who underwent Roux-en-Y surgery in the prior 1-12years. Correlations between dietary adherence and six eating-related behaviors were calculated, with the frequency of each behavior reported on a 7-point scale. Linear regression modeling was applied. All six maladaptive eating behaviors were highly correlated with dietary adherence (Pearson's r>0.5): grazing (r=-0.565), mindless eating (r=-0.572), loss of control eating (r=-0.517), eating "more than is best" after dinner (r=-0.518), eating foods off of one's plan (r=-0.557), and "when I eat something off-plan, I feel like I have blown it and I give up and eat more" (r=-0.574). The estimated regression coefficients in the linear model was statistically significant, [F(5, 261)=60.006, p<0.001] and accounted for approximately 54% of the variance of global dietary adherence (R 2=0.535, adjusted R 2=0.526). Six maladaptive eating behaviors accounted for a highly significant portion of post-Roux-en-Y patients' poor self- reported dietary adherence. Prospective studies are needed to investigate the relationship between targetable maladaptive eating behaviors and bariatric surgery outcomes.

Heterozygosity for the rs696217 SNP in the Preproghrelin Gene Predicts Weight Loss After Bariatric Surgery in Severely Obese Individuals.

Several patients encompass a scarce weight loss after Roux-en-Y gastric bypass (RYGB). As such event is not related to surgical complications, finding markers able to identify "well responders" and to predict weight loss outcome is clinically relevant. Ghrelin regulates appetite and energy balance. Common single nucleotide polymorphisms (SNPs) in its encoding genes have been associated with body weight regulation. Other peptides involved in satiety modulation, like the CD40/CD40L complex, are less explored. One hundred, otherwise healthy, obese subjects (aged 45±11years, 65 females, BMI 48.0±0.7kg/m2) were sequentially enrolled in years 2014-2015. SNPs rs2241766 for adiponectin gene, rs490683 for ghrelin receptor, rs696217 and rs27647 for the preproghrelin/ghrelin gene, and rs1126535 for the CD40L gene were determined on DNA extracted from circulating lymphomonocytes. Patients were reevaluated at 6 (n=100), 26 (n=91), and 52weeks (n=79) after RYGB. Subjects carrying the rs696217 T allele encompassed a significantly greater reduction in BMI 52weeks after surgery (GG vs GT 30.5±1.1 vs 38.1±2.1%; p<0.001). Carrying the rs1126535 C allele in the CD40L gene was associated with a significantly lower BMI reduction at week 52 (TT vs CT 33.2±1.1 vs 28.1±2.3%, p=0.049). rs490683 and rs27647 SNPs of ghrelin and rs2241766 for adiponectin gene did not show any difference between carriers and non-carriers of the mutant allele. Carrying a G to T substitution in rs696217 (preproghrelin gene) seems to mark a successful weight loss outcome; we also report for the first time that the rs1126535 C allele (CD40L gene) may predict a worse response to bariatric surgery.

Quantified-self for obesity: Physical activity behaviour sensing to improve health outcomes

Event Abstract Back to Event Quantified-self for obesity: Physical activity behaviour sensing to improve health outcomes Jennifer Murphy1*, David Taylor1, Mian Ahmad1, Suzanne I. Alsters2, Sanjay Purkayastha1, Samantha Scholtz3, Ramin Ramezani4, Ivo Vlaev5, Ahmed R. Ahmed6, Harvinder Chahal6, Alexandra I. Blakemore*2 and Ara Darzi*1 1 Imperial College London, Department of Surgery, Cancer and Investigative Medicine, United Kingdom 2 Imperial College London, Section of Investigative Medicine, Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, United Kingdom 3 Imperial College London, Department of Investigative Medicine, United Kingdom 4 University of California, Los Angeles, Wireless Health Institute, United States 5 University of Warwick, Behavioural Science Group, Warwick Business School, United Kingdom 6 Imperial College Healthcare NHS Trust, St. Mary’s Hospital, Imperial Weight Centre, United Kingdom Background Physical activity is effective for long-term weight loss maintenance following calorie restriction diets; however, there is a lack of research on its effects on weight loss following bariatric surgery1. Previous studies objectively measuring physical activity have shown that while there is a wide range of activity levels in bariatric patients, the majority achieve significantly less than the recommended 30min/day moderate-to-vigorous physical activity (MVPA) guidelines for health-related benefits2-5. It is important to gain a better understanding of physical activity profiles in this heterogeneous group over time and to ascertain whether increased physical activity is associated with better weight loss outcomes, improved quality of life and resolution of comorbid conditions. Aims The primary aim of this study is to assess the feasibility of continuously monitoring physical activity via a smartphone app with minimal user interaction required, and to characterise the physical activity profiles of bariatric surgery patients. Method 255 patients aged 18-65years with a BMI >35kg/m2 and who were either awaiting or had previously underwent bariatric surgery were recruited from the Imperial Weight Centre. Physical activity [i.e. step count, walk time (mins) and distance walked (km)] was recorded using the free, commercial ‘Moves’ app (Protogeo), with an adjunct app recording weight, mood and wakefulness data. Physical activity data tracked by the Moves app for at least 8 hours per day between the hours of 6am-10pm was categorised as follows: 1) Average walking time (mins) of light, moderate and vigorous intensity per day, 2) ‘Moderate to Vigorous physical activity (MVPA)’; average daily walking time with >80steps/min; 3) average light and MVPA in bouts of 10 minutes per day, and 4) average MVPA in 10 minute bouts of activity per day. Results Data from 147 participants (mean age 42.95, SD±11.50; 70.7% female) met inclusion criteria for data analysis. The average BMI of patients awaiting surgery (n=52) was 47.1kg/m2 (SD±9.53) and average weight loss percentage for post-surgery patients (n=95) at the time of recruitment was 14.62% (SD±10.71) encompassing a post-surgery period from 10 days to >2 years. Participants were tracked for a median of 26 days each (range 1-139 days, partly depending on when they were recruited). 61% of participants (n=89) achieved an average of at least 30 minutes of light and MVPA per day. 57% (n=84) achieved one or more bouts of light and MVPA for a minimum of 10 minutes per day but only averaging 15.31 minutes (SD±2.89). 66% of participants (n=97) walked at a moderate-to-vigorous pace at >80 steps/min, but only for an average of 6 minutes (SD±2.83) per day. 54% (n=80) performed MVPA in bouts of 10 minutes, but only averaging at 15 minutes (SD±3.26). Conclusions We have shown that it is possible to passively monitor physical activity in a large patient population in a cost-effective way. The results demonstrate that while two thirds of bariatric patients achieved an average of 30 minutes walking per day, this was not of sufficient intensity to gain health-related benefits. Further analysis will examine whether increased activity is associated with successful weight loss outcomes, improved mood and psychological functioning, and increased quality of life. We will also employ machine-learning techniques to identify the factors that are critical for a successful outcome following bariatric surgery. Recruitment will continue to the end of the project (April 2016) and tracking will continue into 2017.

Preoperative factors and 3-year weight change in the Longitudinal Assessment of Bariatric Surgery (LABS) consortium

BackgroundLimited data guide the prediction of weight loss success or failure after bariatric surgery according to presurgery factors. There is significant variation in weight change after bariatric surgery and much interest in identifying preoperative factors that may contribute to these differences. This report evaluates the associations of a comprehensive set of baseline factors and 3-year weight change. Setting: Ten hospitals in 6 geographically diverse clinical centers in the United States. MethodsAdults undergoing a first bariatric surgical procedure as part of clinical care by participating surgeons were recruited between 2006 and 2009. Participants completed research assessments utilizing standardized and detailed data collection on over 100 preoperative and operative parameters for individuals undergoing Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB). Weight was measured 3 years after surgery. Percent weight change for RYGB or LAGB from baseline to 3 years was analyzed as both a continuous and dichotomous outcome with cut points at 25% for RYGB and 10% for LAGB. Multivariable linear and logistic regression models were used to identify independent baseline predictors of the continuous and categorical outcomes, respectively. ResultsThe median weight loss 3 years after surgery for RYGB (n = 1513) participants was 31.5% (IQR: 24.6%–38.4%; range, 59.2% loss to .9% gain) of baseline weight and 16.0% (IQR: 8.1%–23.1%; range, 56.1% loss to 12.5% gain) for LAGB (n = 509) participants. The median age was 46 years for RYGB and 48 years for LAGB; 80% of RYGB participants and 75% of LAGB participants were female; and the median baseline body mass index (BMI) was 46 kg/m2 for RYGB and 44 kg/m2 for LAGB. For RYGB, black participants lost 2.7% less weight compared with whites and participants with diabetes at baseline had 3.7% less weight loss at year 3 than those without diabetes at baseline. There were small but statistically significant differences in weight change for RYGB in those with abnormal kidney function and current or recent smoking. For LAGB participants, those with a large band circumference had 75% greater odds of experiencing less than 10% weight loss after adjusting for BMI and sex. ConclusionsFew baseline variables were associated with 3-year weight change and the effects were small. These results indicate that baseline variables have limited predictive value for an individual’s chance of a successful weight loss outcome after bariatric surgery.Trial registration: NCT00465829, ClinicalTrials.gov.

Exploring weight management recommendations across Australian community pharmacies using case vignettes.

With the increase in the overweight and obese population, it is critical that pharmacy staff are able to provide weight management advice to women at different stages of their life. This study utilized case vignettes to identify pharmacists' and pharmacy assistants' current weight management recommendations to women of different ages, life stages and co-morbidities. A total of 537 pharmacist and 403 pharmacy assistant responses were received. In the case of the pre-pregnancy vignette, only 57% (46/80) of pharmacy assistants were able to correctly identify a woman's weight category based on her body mass index, which was significantly fewer than 86% (86/108) of pharmacists (P < 0.001). In the pregnancy vignette, both pharmacists and pharmacy assistants were able to identify the risks of using a herbal weight loss medication in pregnancy. The need for a 'multi-disciplinary team approach' was seen in the menopause case vignette with pharmacists, highlighting the need for the involvement of other health care professionals for successful weight loss outcomes. Australian pharmacists and pharmacy assistants are currently providing weight management services to their consumers, however, not all of their recommendations are evidence-based. There is a need for pharmacy weight management educational resources to be developed and implemented across community pharmacies.