Successful Weight Maintenance Research Articles

Weight history of individuals with and without physical disability in the International Weight Control Registry.

People with physical disabilities (PWD) have an increased risk of obesity and related comorbidities compared with people without physical disabilities (PWoD). Previously identified contributors to weight loss maintenance pose challenges to PWD. However, it is not known if PWD experience less success in weight management. Six hundred and nine participants in the International Weight Control Registry (IWCR) were eligible for this analysis (PWD, n=174; PWoD, n=435). Self-reported weight history metrics were compared using general linear models. Perceived weight history category was compared using Chi-squared tests. Importance of diet and physical activity strategies for weight management were compared using Wilcoxon rank-signed tests. PWD reported higher current body mass index (BMI) (36.1±0.7 vs. 31.0±0.5; p<0.0001) and more weight loss attempts (9.1±0.7 vs. 7.1±0.4; p=0.01) than PWoD. Current weight loss percentage (PWD 13.0±1.0; PWoD, 13.0±0.6; p=0.97) and weight loss category (χ 2 [3, N=609]=2.9057, p=0.41) did not differ between the groups. There were no differences in any weight strategy between PWD who were successful and those who regained. PWD and PWoD in the IWCR achieved similar levels of weight maintenance success. However, higher BMI and more weight loss attempts suggest that PWD may face challenges with weight management. More research is needed to identify strategies leading to success for PWD.

Exploratory analysis of reflective, reactive, and homeostatic eating behaviour traits on weight change during the 18-month NoHoW weight maintenance trial

Behaviour change interventions for weight management have found varied effect sizes and frequent weight re-gain after weight loss. There is interest in exploring whether differences in eating behaviour can be used to develop tailored weight management programs. This secondary analysis of an 18-month weight maintenance randomised controlled trial (RCT) aimed to investigate the association between individual variability in weight maintenance success and change in eating behaviour traits (EBT). Data was analysed from the NoHoW trial (Scott et al., 2019), which was designed to measure processes of change after weight loss of ≥5% body weight in the previous year. The sample included 1627 participants (mean age = 44.0 years, SD = 11.9, mean body mass index (BMI) = 29.7 kg/m2, SD = 5.4, gender = 68.7% women/31.3% men). Measurements of weight (kg) and 7 EBTs belonging to domains of reflective, reactive, or homeostatic eating were taken at 4 time points up to 18-months. Increases in measures of ‘reactive eating’ (binge eating, p < .001), decreases in ‘reflective eating’ (restraint, p < .001) and changes in ‘homeostatic eating’ (unlimited permission to eat, p < .001 and reliance on hunger and satiety cues, p < .05) were significantly and independently associated with concomitant weight change. Differences in EBT change were observed between participants who lost, maintained, or re-gained weight for all EBTs (p < .001) except for one subscale of intuitive eating (eating for physical reasons, p = .715). Participants who lost weight (n = 322) exhibited lower levels of reactive eating and higher levels of reflective eating than participants who re-gained weight (n = 668). EBT domains can identify individuals who need greater support to progress in weight management interventions. Increasing reflective eating and reducing reactive eating may enhance weight management success.

Fostering weight status understanding among exercise science and health students by simulating common physical activities with additional body mass.

Overweight and obesity rates continue to rise and appear unlikely to abate. While physical activity (PA) is an important contributor to health and successful weight maintenance, exercise science and health students (ESHS) often endorse negative weight status biases that could undermine PA promotion. This experiential learning activity was intended to help foster weight status understanding among ESHS. Nine ESHS completed the learning activity across two 75-minute class periods. During the initial didactic lesson, the instructor presented on psychophysiological responses to PA among normal and overweight individuals. During the second simulation lesson, the students first responded with their predictions of how the experience of four common physical activities, including shoe tying, brisk walking, running, and climbing and descending stairs, could differ with additional body mass. Next, students twice completed each of the four physical activities while first wearing a weighted vest that simulated 16 lb followed by 32 lb of additional mass. At the beginning, middle, and end of the stair climb and descent, the students provided ratings of affective valence (i.e., pleasure-displeasure). Following the PA simulations, the students wrote about their experiences and how their PA promotion strategies could be modified for overweight clients. The changes in student qualitative responses, particularly following the 32-lb simulations, suggested an increased understanding of the psychophysiological experience of PA while carrying additional mass. Learning activities like this one may be meaningful additions to ESHS curricula aiming to mitigate weight status bias and improve PA promotion among overweight clients.NEW & NOTEWORTHY Exercise science and health students (ESHS) often enter the field with the noble intention to help people become more physically active. However, many ESHS endorse negative weight status biases that could undermine health promotion efforts among overweight individuals. Experiential learning simulations that approximate the experiences of physical activity while overweight may be helpful tools to foster understanding and reduce bias. This article outlines a two-part didactic/simulation learning activity to promote weight status understanding among ESHS.

Weight loss maintenance after a digital commercial behaviorchange program (Noom Weight): Observational cross-sectional survey study.

Behavioral weight loss programs often lead to significant short-term weight loss, but long-term weight maintenance remains a challenge. Most weight maintenance data come from clinical trials, in-person programs, or general population surveys, but there is a need for better understanding of long-term weight maintenance in real-world digital programs. This observational survey study examined weight maintenance reported by individuals who had used Noom Weight, a digital commercial behavior change program, and identified factors associated with greater weight maintenance. The cross-sectional survey was completed by 840 individuals who had lost at least 10% of their body weight using Noom Weight 6-24months prior. The study found that 75% of individuals maintained at least 5% weight loss after 1year, and 49% maintained 10% weight loss. On average, 65% of initial weight loss was maintained after 1year and 57% after 2years. Habitual behaviors, such as healthy snacking and exercise, were associated with greater weight maintenance, while demographic factors were not. This study provides real-world data on the long-term weight maintenance achieved using a fully digital behavioral program. The results suggest that Noom Weight is associated with successful weight maintenance in a substantial proportion of users. Future research will use a randomized controlled trial to track weight maintenance after random assignment and at a 2year follow-up.

The Healthiest Weight: Present and Future

Successful weight loss and maintenance programs should consider the optimal timing for the brain's control of body weight. The bases for successful Weight Management Programs have been recently proposed utilizing a new BMI sub-categorization and current state-of-the-art technologies. An inverse relationship between meal frequency and body weight has also been observed and is directly related to achieving a healthy weight. Practising regular exercise has also been shown to cause a significant reduction in Heart Rate while achieving and maintaining the Healthiest Weight as well as increasing life expectancy. Thus, the implementation of healthy habits and regular aerobic exercise programs by public authorities may contribute to the reduction in all-cause mortality worldwide. Adapting WHO-defined BMI thresholds to novel calibrated thresholds has been further revalidated by incorporating recently published multi-dimensional data from large- scale worldwide studies, resulting in a new likelihood model of the health risks associated with adiposity. This latest study has great potential in personalized and preventive medicine. In addition to ongoing vaccination programs, the results of this novel approach could be used as an “alternative method of prevention” to naturally tackle the current COVID-19 pandemic, and other anticipated in the future to come. Other current and future weight management developments are also discussed.

Self-determination: the key to successful weight loss and maintenance programs

While studies show that most people are not able to keep weight loss for the long-term, probably due to the lack of motivation, recent studies show that the effective choice and implementation of motivational strategies are fundamental to building up positive-thinking and long-term motivation, as well as succeeding at habit-formation. This manuscript provides qualitative research on the effect of motivation as a factor in behavioral interventions to reduce overweight or obesity, highlighting the importance of self- determination for succeeding in long-term weight loss and maintenance programs.

Attitudes to Three Weight Maintenance Strategies: A Qualitative Study.

Weight loss maintenance can be difficult and ultimately unsuccessful, due to psychological, behavioural, social, and physiological influences. The present study investigated three strategies with the potential to improve weight maintenance success: daily weighing, missing an occasional meal, habitually changing high energy foods. The principal aim was to gain an understanding of attitudes to these strategies in participants who had recent experience of weight loss attempts, with or without maintenance. This was a qualitative study involving semi-structured interviews, with 20 participants aged 18-67 (twelve females), analysed using thematic analysis. Most participants disliked daily weighing and missing an occasional meal for long-term maintenance and were concerned about potential negative effects on mental health. All participants had experience of habitual changes to high energy foods and regarded this strategy as obvious and straightforward. Replacement of high energy foods was favoured over elimination. Participants preferred strategies that felt flexible, "normal" and intuitive and disliked those that were thought to have a negative impact on mental health. Further investigation is needed on whether concerns regarding mental health are well founded and, if not, how the strategies can be made more acceptable and useful.

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.

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.

Weight loss at six months is the surrogate of long-term treatment outcomes for obese Chinese with a BMI less than 35 kg/m2 undergoing Roux-en-Y gastric bypass

Roux-en-Y gastric bypass (RYGB) is considered the gold standard procedure for bariatric surgery that leads to sustained weight loss and amelioration of obesity-related comorbidities. To verify long-term efficacy and safety and to investigate the influence of early weight loss on post-RYGB long-term weight maintenance in obese Chinese with body mass index (BMI)<35kg/m2. All patients were followed up for evaluating the variations in their BMI, percentage of excess weight loss (%EWL), and total body percentage weight loss (%TWL). Linear regression models were applied to evaluate the effects of early weight loss on successful weight maintenance. Optimal cutoff values were analyzed via plotting the receiver operative characteristic (ROC) curve. In the current study, 143 patients were recruited. Preoperative BMI and weight were recorded as 32.24 (29.39-33.12) kg/m2, and 88.90±9.52kg, respectively. At 1, 3, and 5 years, successful weight loss i.e., greater than 25% TWL was attained by 46.85%, 37.76%, and 37.06% of patients, respectively. The obtained data revealed that %TWL at 0.5 years was considerably associated with %TWL for up to 5 years (P-value <0.001). Based on the ROC curve, %TWL of 24.39% at 0.5 years best predicted effective weight loss at 5 years (sensitivity 71.70%, specificity 82.22%). RYGB is a safe and effective approach for weight loss and %TWL at 6 months might be used for predicting weight maintenance up to 5 years post-RYGB in obese Chinese with a BMI <35kg/m2.

Evaluation of Resting Energy Expenditure in Subjects with Severe Obesity and Its Evolution After Bariatric Surgery

PurposeOne major determinant of weight loss is resting energy expenditure (REE). However, data regarding REE is scarce in patients with severe obesity (SO)—BMI>50kg/m2. Most studies used equation in order to estimate REE and not indirect calorimetry (IC) (gold standard). Additionally, there is no reliable data on the impact of bariatric surgery (BS) on REE.Objectives(a) To evaluate the REE in patients with SO; (b) to compare REE measured by IC (mREE) to that calculated by Mifflin St-Jeor equation (eREE); (c) to evaluate the impact of BS on REE and the relationship with evolution post-BS.Material and MethodsSingle-center observational study including consecutive patients with SO between January 2010 and December 2015, candidates for BS. mREE was determined at baseline, and 1 and 12 months post-BS by IC, using a Vmax metabolic monitor.ResultsThirty-nine patients were included: mean age 46.5±11.77 years, 64.1%women. Preoperative mREE was 2320.38±750.81 kcal/day. One month post-BS, the mREE significantly decreased (1537.6 ± 117.46 kcal/day, p = 0.023) and remained unchanged at 12 months (1526.00 ± 123.35 kcal/day; p =0.682). Reduction in mREE after the BS was a predictor of reaching successful weight loss (nadir) and weight regain (5 years follow-up) (AUCROC of 0.841 (95%CI [0.655–0.909], p=0.032) and AUCROC of 0.855 (95% CI [0.639–0.901]), p= 0.027, respectively). eREE was not valid to identify these changes.ConclusionIn patients with SO, a significant reduction of mREE occurs 1 month post-BS, unchanged at 12 months, representing the major conditioning of successful weight loss and maintenance post-BS.Graphical abstract

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.

Evaluation of Pharmacologic Interventions for Weight Management in a Veteran Population.

Veterans are disproportionately impacted by weight-related morbidity: 40% of veterans are categorized as obese and an additional 38.5% are overweight. Medications are recommended as an adjunct to lifestyle and dietary changes. Guidelines recommend 7 weight management medications, including orlistat, liraglutide, phentermine, phentermine/topiramate, lorcaserin, and naltrexone/bupropion. A single-center, retrospective chart review was conducted for patients who started weight management medications at Veteran Health Indiana in Indianapolis. The primary outcomes included total weight loss and weight loss as a percentage of baseline weight at 3, 6, 12, and > 12 months of therapy. Secondary outcomes included weight loss of 5% from baseline, rate of successful weight maintenance after initial weight loss of 5% from baseline, adverse drug reaction monitoring, and use of weight management medications across clinics at this site. The absolute weight difference over 12 months of weight management medication therapy was 15.8 kg. At each time point, weight loss was found to be statistically significant when compared with baseline (P < .001). Average weight change was greatest with orlistat (-25.9 kg) and naltrexone/bupropion was associated with a gain of 2.1 kg over the duration of the study. A majority of the patients analyzed lost the guideline-recommended 5 to 10% from baseline while taking weight management medication. Weight management medications in a veteran population produced initial weight loss consistent with previous studies. However, there is room for improvement in follow-up strategies to promote greater weight maintenance after initial weight loss. Considering the high health care costs, personal burden, and potential long-term complications associated with obesity, efforts to promote continued development of programs that support weight management and maintenance are imperative.

6 voces en 10 minutos: Estrategias para prevenir reganancia de peso

6 voces en 10 minutos: Estrategias para el descenso de peso en personas con diabetes mellitus tipo 2 Estrategias para prevenir reganancia de pesoEl éxito a largo plazo de los procedimientos bariátricos depende tanto de factores técnicos como de factores clínicos, motivacionales y comportamentales.Si bien la cirugía bariátrica-metabólica es una herramienta eficaz en el arsenal terapéutico de la obesidad, la diabetes y de otras enfermedades crónicas, el 20-30% de los pacientes muestran resultados subóptimos, que incluyen no alcanzar la pérdida de peso deseada o recuperar peso. El mayor desafío es adoptar los cambios requeridos en el estilo de vida. El mantenimiento exitoso del peso se asocia con un ritmo regular de comidas, incluyendo el desayuno, un estilo de vida físicamente activo y mayor autocontrol de los comportamientos.

Early Weight Loss Following Laparoscopic Sleeve Gastrectomy Is Predictive of Long-Term Weight Loss in Morbidly Obese Chinese.

Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgical approach often used to treat Chinese individuals suffering from morbid obesity. To verify the long-term safety and efficiency of LSG and to evaluate the predictive effect of initial weight loss on long-term weight maintenance after LSG in morbidly obese Chinese. Follow-up was conducted by telephone or in hospital. We measured the body mass index (BMI), percentage of total body weight loss (%TWL), and excess weight loss (%EWL), and assessed patients for the alleviation of co-morbidities. Relationships between initial weight loss and successful weight maintenance were assessed via linear regression analyses, while optimal cutoff values were determined based on receiver operative characteristic (ROC) curves. We included 384 patients in this study. Before surgery, these patients had median weight and BMI values of 110 (91.00-130.75) kg and 38.49 (32.82-44.12) kg/m2, respectively. Successful weight loss of > 50% EWL was accomplished in 91.21%, 82.69%, and 79.37% of patients at 1, 3, and 5years after surgery. In addition, the %EWL at 6months was significantly correlated with the %EWL up to 5years (P < 0.001) in morbidly obese Chinese. Based on the ROC curve, the EWL of 56.54% at 6months was the best predictor of successful weight loss at 5years (sensitivity 72.38%, specificity 82.69%) in morbidly obese Chinese. LSG has long-term safety and efficacy for morbidly obese Chinese patients. The %EWL at 6months can be used to predict weight maintenance up to 5years after LSG.

A combined healthy strategy for successful weight loss, weight maintenance and improvement of hepatic lipid metabolism

Obesity is critically related with the development of metabolic and pathophysiological alterations among which non-alcoholic fatty liver disease (NAFLD) is of especial relevance. Although there are numerous strategies to successfully treat obesity, the prevention of weight regain still remains challenging for individuals who have undergone weight loss programs. In such context, diet and physical activity are considered essential for the regulation of body weight and lipid metabolism. In this study, rats were fed a high-fat diet (HFD) to induce obesity and alterations in hepatic lipid metabolism. Obese rats were then treated with single or combined strategies of caloric restriction, physical exercise, and/or pharmacological treatment with an appetite suppressant, to lose weight, reverse the obesity-related alterations in hepatic morphology and lipid metabolism and maintain the beneficial effects of the interventions used. HFD induced excess body weight, hepatic steatosis, altered fatty acid profile, dysregulated gene expression of lipogenic and lipolytic enzymes, as well as plasma markers of liver damage, and modifications in liver antioxidant enzyme activity. Such alterations were ameliorated by caloric restriction in combination with a mixed training protocol and/or food-intake inhibitor administration during a weight loss intervention period of 3 weeks, and the beneficial effects remained after 6 weeks of weight maintenance, with some interesting interactions observed. In conclusion, weight loss strategies assayed were efficient at correcting the obesogenic action of a HFD and related alterations in hepatic functionality through different molecular mechanisms. The beneficial effects were also evident along the post-intervention maintenance period to avoid body weight regain.

Long-Term Outcomes of Group-Based Treatment for Obese Children and Adolescents

Objective: A 1-year, group-based, treatment program with parental involvement was conducted on 115 obese youths during 2006-2011. The intervention decreased obesity severity. The current study assessed the participants’ long-term weight loss and obesity-related complications.Methods: Participants were invited for a single visit. Their weights, heights, and waist circumferences were measured and compared with corresponding figures at group-based treatment program completion. Factors associated with changed percentage weight-for-height (%W/H) were assessed.Results: There were 43 subjects, including 6 participating telephonically. The median follow-up duration was 5.8 years. %W/H, BMI, and waist circumference increased significantly (p = 0.012, 0.002, and 0.003, respectively). %W/H rose for 26 participants (60.5%; failed group) but declined or stabilized for 17 (39.5%; successful group). The successful-group exercise duration and frequency were significantly higher (p = 0.006 and 0.018, respectively). Three participants had type 2 diabetes, including 1 known case, all in the failed group. Newly-found obesity-related disorders were elevated transaminases (6 participants, with 5 from the failed group), elevated blood pressure (1 failed-group participant), and dyslipidemia (one from each group).Conclusion: Only 40% of the participants maintained long-term weight reduction. Regular exercise was associated with successful weight maintenance. Obesity-related complications were common in the failed group.

Weight suppression and weight maintenance following treatment of anorexia nervosa.

The value of weight suppression (WS) in predicting the course of anorexia nervosa (AN) is uncertain. The objective of this study was to determine, using data from a previously published study, whether patients who remain weight suppressed following restoration to a minimally normal weight are at greater risk for relapse. Following weight restoration, 93 women with AN were randomly assigned to receive fluoxetine or placebo along with cognitive behavioral therapy for 1 year. WS (highest adult weight minus current weight), body mass index (BMI), and their interaction were assessed as predictors of change in weight over the first 28 days, of successful weight maintenance at 6 and 12 months, and of time to relapse. Neither WS nor its interaction with BMI predicted successful weight maintenance at 6 and 12 months, time to relapse, or weight change over the first 28 days following discharge. This study found that WS does not substantially impact the likelihood of successful weight maintenance or time to relapse following restoration to a minimally normal weight in AN.

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.

Weight Loss and Late Complications after Silastic Ring Vertical Gastroplasty. A 10 Year Follow-up.

Severe obesity is a public health care system challenge that requires bariatric surgery. Among the plethora of bariatric surgery techniques silastic ring vertical gastroplasty (SRVG) is a safe and efficient restrictive method that has been successfully used previously. However, it's performance by open approach has been abandoned and replaced by other methods using the laparoscopic method. The aim of the present study was to investigate patients with severe obesity submitted to open SRVG and to report our results over a period of 10 years in terms of weight loss, late complications and surgical re-interventions. 112 severely obese patients submitted to open SRVG between years 2008- 2009 were investigated retrospectively for body mass index (BMI), percent excess BMI loss (%EBMIL), late surgical complications and reoperations. 41.96% of the patients were followed up 10 years after SRVG. Results: The initial mean BMI was 47.38 +- 7.59 kg/m2 and dropped statistically significant (p 0.001) to 31.05 +- 6.54 kg/m2 by the first year after SRVG. The mean BMI was rather stable along the first 5 years after SRVG when it started to increase gradually, reaching 35.93 +- 7.20 kg/m2 by the 10th year of follow-up when it remained still significantly lower (p 0.001) as compared to the mean baseline value. The %EBMIL was 79% at one year after surgery and reached 51% by the 10th year of follow-up. The most frequent late complications after SRVG were stoma stenosis (8.92%), enlargement of the stoma (8.03%) and incisional hernia (3.36%). As a consequence of stoma stenosis the ring has been removed in all cases. In 2 cases, after the ring removal, the patients underwent gastric bypass. SRVG is a safe and efficient restrictive technique of bariatric surgery open to many options to be revised, leading to a successful sustained long term weight loss and maintenance. Stoma stenosis, enlargement of the stoma and incisional hernia are the most frequent late complications after SRVG requesting reoperations.