Weight Loss Intervention Research Articles

Beyond the Physical: Weight Stigma and the Bariatric Patient Journey

Background: Obesity represents a global epidemic associated with significant health risks, including diabetes, cardiovascular disease, and certain cancers. Management strategies have evolved from focusing solely on weight reduction to emphasizing overall health improvements and mitigating associated risks. Methods: This narrative review analyzed the existing peer-reviewed literature across databases such as PubMed, Scopus, EMBASE, the Cochrane Library, and Google Scholar to examine the outcomes of bariatric surgery and its interplay with weight stigma. The review incorporated data from clinical studies, systematic reviews, and meta-analyses, focusing on bariatric surgery and its psychological impact, as well as approaches to mitigate stigma in bariatric care. Results: Bariatric surgery has emerged as the most effective intervention for sustained weight loss and the resolution of obesity-related comorbidities. However, individuals undergoing surgery frequently encounter weight stigma, both pre- and postoperatively, which manifests through discriminatory healthcare interactions, societal biases, and internalized self-criticism. These factors contribute to anxiety, depression, diminished healthcare engagement, and weight regain, ultimately affecting the long-term surgical outcomes. Conclusions: Addressing weight stigma in bariatric care is critical to optimizing outcomes. Interventions such as preoperative counseling, postoperative psychological support, and multidisciplinary care can mitigate the psychological and societal burdens of stigma. This review explores the intricate relationships between obesity, bariatric surgery outcomes, weight stigma, and the health-related quality of life (HRQOL).

Impact of Genetic Variants on Vitamin E Levels in an Italian Cohort of Bariatric Surgery Patients: A Focus on SNPs Involved with Transport and Bioavailability

Obesity is a global epidemic associated with chronic inflammation, oxidative stress, and metabolic disorders. Bariatric surgery is a highly effective intervention for sustained weight loss and the improvement of obesity-related comorbidities. However, post-surgery nutritional deficiencies, including vitamin E, remain a concern. This study investigates the role of single-nucleotide polymorphisms (SNPs) in genes related to vitamin E transport and bioavailability in determining vitamin E levels post bariatric surgery. A cohort of 140 patients with obesity undergoing bariatric surgery was analyzed. Serum vitamin E levels were measured before and one year after surgery, and SNPs in genes associated with vitamin E transport and metabolism were genotyped using PCR, DHPLC, and sequencing methods. Associations between SNPs, haplotypes, and vitamin E levels were statistically evaluated. Significant associations were observed between the APOE rs7412 SNP and serum vitamin E levels. The rare T allele was linked to lower vitamin E levels post surgery, with an increased frequency in patients with severe deficiency (<11.6 μmol/L). Haplotype analysis of APOE revealed that the ε2 haplotype (T-T) was strongly associated with vitamin E deficiency. Other SNPs, including CD36 rs1761667, SCARB1 rs4238001, and ABCA1 rs4149314, were also linked to changes in vitamin E levels, suggesting that an impaired bioavailability and transport can be the reason for low vitamin E levels post surgery. Genetic polymorphisms in APOE, CD36, SCARB1, and ABCA1 significantly influence vitamin E status after bariatric surgery. These findings highlight the importance of personalized supplementation strategies considering patients’ genetic profiles to mitigate the risk of vitamin E deficiency and related complications.

Effects of Anti-obesity Strategies on Bone Mineral Density: A Comprehensive Meta-analysis of Randomized Controlled Trials.

Although an appropriate weight management strategy is essential for obese individuals, weight loss can have adverse effects on bone mineral density (BMD). We conducted a systematic review of randomized controlled trials to evaluate changes in BMD after the implementation of various weight loss strategies. The PubMed, Embase, Web of Science, and Cochrane Library databases were searched to find articles published from database inception until June 2023. Randomized controlled trials of various treatments for obese patients that reported changes in BMD were selected. The primary outcome was BMD of the whole body, lumbar spine, and total hip, measured using dual X-ray absorptiometry. Eighteen randomized controlled trials involving 2,510 participants with obesity were included in the analysis. At follow-up examination, the BMD of the lumbar spine decreased significantly after metabolic surgery (mean difference [MD]=-0.40 g/cm2; 95% confidence interval [CI], -0.73 to -0.07; I2=0%); lifestyle and pharmacological interventions did not result in a significant decrease in BMD at any location. Metabolic surgery also produced the most substantial difference in weight, with an MD of -3.14 (95% CI, -3.82 to -2.47). This meta-analysis is the first to examine the effects of all categories of anti-obesity strategies, including the use of anti-obesity medications, on BMD. Bariatric metabolic surgery can have adverse effects on BMD. Moreover, medications can be used as a treatment for weight loss without compromising bone quality.

The Association of SLC16A1 (MCT1) Gene Polymorphism with Body Composition Changes during Weight Loss Interventions: A Randomized Trial with Sex-Dependent Analysis.

Monocarboxylates, transported by monocarboxylate transporters (MCTs), have been proposed to influence energy homeostasis and exhibit altered metabolism during exercise. This study investigated the association between the Asp490Glu (T1470A) (rs1049434) polymorphism of the SLC16A1 (MCT1) gene and changes in body composition in males and females with overweight or obesity. The 173 participants (56.6% females) completed a 6-month randomized controlled trial, being assigned to the Supervised exercise group (strength, endurance, or strength plus endurance training) or the Physical Activity (PA) Recommendations group. Participants were genotypically categorized as Asp/Asp (TT), Asp/Glu (TA), or Glu/Glu (AA). ANCOVA analysis showed main effects for genotype and interaction genotype x group (p<0.05) for several variables, especially in females. Asp/Asp (TT) females showed greater reductions in total fat mass (-29.30±8.75% change), percentage of body fat (-17.50±8.06% change), and body weight (-13.90±2.62% change) compared with Glu/Glu (AA) (p≤0.020; d≥0.18) and Asp/Glu (TA) (p≤0.050; d≥0.16) females, but only within the PA Recommendations group. Data indicated higher decreases in lean body mass of the Asp/Asp (TT) compared to Glu/Glu (AA) in females (p=0.067, η2p=0.067) and to Asp/Glu (TA) in males (p=0.026; η2p=0.101). Our investigation suggests an association of the SNP with body composition changes especially in females following exercise recommendations, highlighting the importance of supervised training to offset genetic predisposition for different weight loss. Differences in males only appeared for lean body mass, suggesting sex differences for this genetic association. The study underscores the potential influence of MCT1 functionality on human adaptations to weight loss interventions. ClinicalTrials.gov registration number, NCT01116856.

Nutrient Intake Among Lactating Women With Overweight and Obesity in Norway: A Comparison With the Nordic Nutrition Recommendations 2023.

During lactation, maternal requirements for many nutrients increase due to the physiological demands of breast milk production, reflected in dietary recommendations. BMI is negatively associated with dietary quality postpartum, and 40% of women in Norway have pre-pregnancy overweight and obesity. Currently, there is limited data on dietary intake among lactating women in Norway and whether they meet nutritional requirements. We aimed to evaluate the nutrient intake in a study sample of lactating women with overweight and obesity, compared with the Nordic Nutrition Recommendations (NNR 2023). In this cross-sectional analysis, we included baseline data from 112 lactating women with a pre-pregnancy BMI of 25-35 kg/m2, participating in a weight loss and breastfeeding promotion intervention trial in Oslo, Norway. Data were collected at 2 weeks postpartum (subject characteristics, anthropometry and dietary supplement use), at 7 weeks postpartum (dietary assessment) and post-weaning (retrospective dietary supplement use). Dietary data were obtained from a 4-day dietary record before randomisation to dietary treatment for weight loss. Nutrient intake was compared to the dietary reference values for lactating women in NNR 2023. Increased risk of inadequate intake of micronutrients was assessed as the proportion of women with intakes below the average requirement (AR), with and without dietary supplements. Mean ± SD BMI at 2 weeks postpartum was 30.7 ± 2.5 kg/m2. At 7 weeks postpartum the women reported a mean energy intake of 9.2 ± 2.0 MJ/day, with a higher intake of saturated fat and a lower intake of carbohydrate, dietary fibre and docosahexaenoic acid than recommended. The majority had an increased risk of inadequate intake of vitamin A (92%), folate (92%), vitamin D (84%), selenium (87%) and iodine (71%) from the diet alone. When dietary supplements were taken into account, ≥ 50% of the women still had an increased risk of inadequate intake of vitamin A, folate and selenium. The high proportion of lactating women with overweight and obesity failing to meet the newly updated Nordic Nutrition Recommendations highlights the need to raise awareness among new mothers and healthcare professionals about the increased maternal nutritional demands during lactation and hence, the importance of nutrient-dense diets.

Emotional Eating Interventions for Adults Living With Overweight and Obesity: A Systematic Review and Meta-Analysis of Behaviour Change Techniques.

Emotional eating (EE) is a barrier to the long-term success of weight loss interventions. Psychological interventions targeting EE have been shown to reduce EE scores and weight (kg), though the mechanisms remain unclear. This review and meta-analysis aimed to identify the specific behaviour change techniques (BCTs) associated with improved outcomes. This is a review update and extension, with new studies extracted from searches of CINAHL, PsycINFO, MEDLINE and EMBASE 1 January 2022 to 31 April 2023. EE interventions for adults with BMI > 25 kg/m2 were considered for inclusion. Paper screening, extraction, BCT-coding and risk of bias were completed using the Template for Intervention Description and Replication (TIDieR) checklist, Behaviour Change Taxonomy v1 (BCTTv1) and Risk of Bias2 (RoB2)/Risk of Bias In Non-randomised Studies (ROBINS-I) tool. Narrative syntheses and random effects multi-level meta-analyses were conducted. In total, 6729 participants were included across 47 studies (13 identified in the update). Forty-two studies contributed to the pooled estimate for the impact of interventions on EE (SMD = -0.99 [95% CI: -0.73 to -1.25], p < 0.001). Thirty-two studies contributed to the pooled estimate for the impact of interventions on weight (-4.09 kg [95% CI: -2.76 to -5.43 kg], p < 0.001). Five BCTs related to identity, values and self-regulation were associated with notable improvements to both weight and EE ('incompatible beliefs', 'goal setting outcome'. 'review outcome goals', 'feedback on behaviour' and 'pros/cons'). Implementation and evaluation of the highlighted BCTs are required. Weight management services should consider screening patients for EE to tailor interventions to individual needs.

Maintaining Fat-Free Mass and Muscle Mass during obesity therapy with Incretin-Mimetic Drugs

Obesity is one of the major public health challenges of the 21st century. In recent years, incretin mimetic drugs (IMDs), primarily liraglutide, semaglutide, and tirzepatide, have gained popularity due to their ability to help patients lose 10%-20% of their body weight. However, it has been observed that during treatment with these medications, patients also lose fat-free mass (FFM) and muscle mass (MM). Available scientific knowledge provides limited information regarding preventing FFM and MM loss associated with IMDs treatment. This study aims to analyze current information about strategies that minimize the loss of FFM and MM and muscle function and consider using methods to prevent muscle atrophy in patients treated for obesity with other methods, such as diet, exercise, and bariatric surgery, to form a holistic approach for patients treated with IMDs. This review was conducted by searching scientific publications on PubMed, Google Scholar, and Clinicaltrials.gov databases. The analysis included articles concerning FFM and MM loss in the most common obesity treatment therapies and articles that provided information about the impact of exercise and nutrition combined with IMDs in obesity treatment and proper weight maintenance. The research findings indicate that two primary factors significantly influence the preservation of FFM and muscle mass MM during weight loss therapy: proper nutrition and physical activity. During weight loss interventions, diets should consist of adequate high-quality protein, which contributes to reducing MM loss. Furthermore, physical activity, particularly resistance training, demonstrates a markedly positive effect on the maintenance of MM. All patients undergoing obesity treatment with IMDs must participate in comprehensive programs that offer an appropriate dietary regimen and individually tailored physical exercise plans.

Examining adverse life experiences, disordered eating behaviors and cognitions and weight loss treatment in Peru

ObjectiveStudies conducted in the US indicate that exposure to trauma, and stigma related to weight are environmental factors associated with the development of disordered eating. Few studies have explored psychosocial and contextual factors surrounding disordered eating in Latin American populations. This study examined everyday discrimination, verbal weight-related abuse, adverse childhood experiences, and disordered eating across individuals seeking versus not seeking weight loss treatment in Peru. MethodParticipants (N = 420) were recruited via social media and a weight management clinic in Peru. Participants completed disordered eating, everyday discrimination, verbal weight-related abuse, and adverse childhood experiences measures. ResultsThe weight loss treatment seeking group showed greater disordered eating behaviors (dietary restraint) and cognitions (body dissatisfaction, overvaluation of shape/weight) compared to the non-weight loss treatment seeking group. Increased experiences of everyday discrimination, adverse childhood experiences, and verbal weight-related abuse were associated with greater levels of disordered eating behaviors and cognitions in both samples. Weight loss treatment seeking status was not a moderator of the relationships among disordered eating behaviors and cognitions, and everyday discrimination. DiscussionResults suggest discrimination, adverse childhood experiences, and verbal weight-related abuse are associated with eating pathology, and more disordered eating and behaviors are seen in individuals seeking or engaged in weight loss treatment. Findings highlight the importance of evaluating eating pathology for individuals reporting, or at high risk for discrimination, childhood trauma or weight-related abuse.

Optimizing a mobile just-in-time adaptive intervention (JITAI) for weight loss in young adults: Rationale and design of the AGILE factorial randomized trial

Optimizing a mobile just-in-time adaptive intervention (JITAI) for weight loss in young adults: Rationale and design of the AGILE factorial randomized trial

Appetite Regulation in Response to Acute Exercise among Weight-Loss Treatment Responders vs Nonresponders: A Pilot Study

ABSTRACT Introduction The reason for weight-loss heterogeneity in response to lifestyle interventions is not clear. Important regulators of food intake and energy expenditure include peripheral hormonal signals from insulin, glucagon-like peptide 1 (GLP-1), leptin, and ghrelin. Herein, we examine the hormonal regulators of appetite and satiety following a high-volume bout of moderate-to-vigorous intensity exercise in responders and nonresponders to a 6-month, digitally delivered, weight-loss lifestyle intervention. Methods Young adults (27.7 ± 3.7 yr; 11 female, 1 male) characterized as responders (n = 7; lost 3% of their initial body weight) and nonresponders (n = 5) participated in a 60-min treadmill exercise challenge, consisting of three 15-min intervals at 80% of peak oxygen consumption (V̇O2peak), with 5 min of walking at 50% V̇O2peak between intervals. Blood samples were obtained prior to and immediately after exercise and 30 and 60 min after exercise during seated recovery for determination of plasma glucose, insulin, GLP-1active, leptin, and acylated ghrelin. Univariate analyses (mean ± standard deviation) and Cohen’s d described between-group differences in hormone responses to exercise. Results Glucose and leptin responses during the exercise challenge and recovery were similar for nonresponders and responders; however, nonresponders had higher insulin concentrations post-exercise compared to responders (9.8 ± 3.5 μU·mL−1 vs 6.2 ± 2.2 μU·mL−1 at 30 min (d = 1.23); 9.4 ± 1.8 μU·mL−1 vs 6.3 ± 2.1 μU·mL−1 at 60 min (d = 1.54)). Concentrations of GLP-1active also appeared higher in nonresponders compared to responders following exercise (12.2 ± 2.8 pmol·L−1 vs 9.3 ± 1.1 pmol·L−1 (d = 1.36)), but this difference disappeared after 30 min of recovery. Ghrelin levels were lower in the nonresponders following exercise (308 ± 27 pg·mL−1 vs 494 ± 98 pg·mL−1 (d = −2.58)) and remained so over the recovery period (287.4 ± 12.3 pg·mL−1 vs 392.1 ± 47.2 pg·mL−1 at 30 min (d = −3.08); 313.0 ± 39.8 pg·mL−1 vs 393.9 ± 60.8 pg·mL−1 at 60 min (d = −1.21)). Conclusions These findings support potential appetite hormonal differences in the heterogenous weight-loss response to lifestyle therapy. A better understanding of how exercise affects appetite regulation in young adults with overweight and obesity could help with precision care.

The Etiology of Reduced Muscle Mass with Surgical and Pharmacological Weight Loss and the Identification of Potential Countermeasures.

Obesity represents a major health crisis in the United States, significantly increasing risks for chronic diseases and generating substantial economic costs. While bariatric surgery and pharmacological interventions such as GLP-1 receptor agonists have been proven effective in achieving substantial weight loss and improving comorbid conditions, they also raise concerns about the unintended loss of fat-free mass, particularly muscle. This loss of muscle mass compromises physical functionality, quality of life, and long-term metabolic health, particularly in individuals with sarcopenic obesity or those at risk of frailty. To sustain strength, mobility, and metabolic function during weight loss interventions, the preservation of muscle mass is essential. However, current weight-loss strategies often fail to adequately address the need to maintain fat-free mass. This review explores the physiological mechanisms governing muscle mass, the impact of obesity and rapid weight loss on muscle protein turnover, and nutritional and age-based strategies that may help protect muscle during intentional weight reduction. By focusing on these critical countermeasures, this review aims to inform future clinical practice and research initiatives with the long-term goal of achieving effective weight loss through reduction in fat tissue while preserving skeletal muscle mass, enhancing health outcomes, and long-term functionality in patients undergoing significant weight reduction.

Spotlight on the Mechanism of Action of Semaglutide.

Initially intended to control blood glucose levels in patients with type 2 diabetes, semaglutide, a potent glucagon-like peptide 1 analogue, has been established as an effective weight loss treatment by controlling appetite. Integrating the latest clinical trials, semaglutide in patients with or without diabetes presents significant therapeutic efficacy in ameliorating cardiometabolic risk factors and physical functioning, independent of body weight reduction. Semaglutide may modulate adipose tissue browning, which enhances human metabolism and exhibits possible benefits in skeletal muscle degeneration, accelerated by obesity and ageing. This may be attributed to anti-inflammatory, mitochondrial biogenesis, antioxidant and autophagy-regulating effects. However, most of the supporting evidence on the mechanistic actions of semaglutide is preclinical, demonstrated in rodents and not actually confirmed in humans, therefore warranting caution in the interpretation. This article aims to explore potential innovative molecular mechanisms of semaglutide action in restoring the balance of several interlinking aspects of metabolism, pointing to distinct functions in inflammation and oxidative stress in insulin-sensitive musculoskeletal and adipose tissues. Moreover, possible applications in protection from infections and anti-aging properties are discussed. Semaglutide enhancement of the core molecular mechanisms involved in the progress of obesity and diabetes, although mostly preclinical, may provide a framework for future research applications in human diseases overall.

The metabolome of male and female individuals with knee osteoarthritis is influenced by 18-months of weight loss intervention: the IDEA trial

BackgroundThe Intensive Diet and Exercise for Arthritis (IDEA) trial was a randomized trial conducted to evaluate the effects of diet and exercise on osteoarthritis (OA), the most prevalent form of arthritis. Various risk factors, including obesity and sex, contribute to OA’s debilitating nature. While diet and exercise are known to improve OA symptoms, cellular and molecular mechanisms underlying these interventions, as well as effects of participant sex, remain elusive.MethodsSerum was obtained at three timepoints from IDEA participants assigned to groups of diet, exercise, or combined diet and exercise (n = 10 per group). A randomly selected subset of serum samples were extracted and analyzed via liquid chromatography-mass spectrometry combined with metabolomic profiling to unveil mechanisms associated with types of intervention and disease. Extracted serum was pooled and fragmentation patterns were analyzed to identify metabolites that statistically differentially regulated between groups.ResultsChanges in metabolism across male and female IDEA participants after 18-months of diet, exercise, and combined diet and exercise intervention mapped to lipid, amino acid, carbohydrate, vitamin, and matrix metabolism. The diverse metabolic landscape detected across IDEA participants shows that intervention type differentially impacts the serum metabolome of OA individuals. Moreover, dissimilarities in the serum metabolome corresponded with participant sex.ConclusionsThese findings suggest that intensive weight loss among males and females offers potential metabolic benefits for individuals with knee OA. This study provides a deeper understanding of dysregulation occurring during OA development in parallel with various interventions, potentially paving the way for improved interventions, treatments, and quality of life of those impacted by OA.Trial Registrationclinicaltrials.gov Identifier NCT00381290, Registered, 9/25/2006.

The Influence of Bariatric Surgery on Matrix Metalloproteinase Plasma Levels in Patients with Type 2 Diabetes Mellitus.

Bariatric surgery is a safe and effective procedure for treating obesity and metabolic conditions such as type 2 diabetes mellitus (T2DM). Remodeling of the extracellular matrix (ECM) supports adipose tissue expansion and its metabolic activity, where matrix metalloproteinases (MMPs) play a key role in ECM regulation. The MMPs, particularly MMP-2 and MMP-9, are elevated in patients with morbid obesity, metabolic syndrome, and T2DM. To evaluate the effect of weight loss in bariatric surgery patients using oxidative stress markers and to compare MMP levels in patients undergoing bariatric surgery. This was a prospective, controlled study including 45 morbidly obese patients with T2DM (BMI > 35 kg/m2) who underwent RYGB (n = 24) or VG (n = 21). Weight loss was assessed through anthropometric measurements (weight, height, BMI). MMP-2 and MMP-9 levels were measured preoperatively and at 3 and 12 months postoperatively. Significant and sustained weight loss was observed after surgery in both groups, with reductions in BMI. MMP-2 and MMP-9 levels decreased significantly after one year of follow-up. Bariatric surgery is an effective long-term intervention for weight loss and associated comorbidities, including T2DM. MMP-2 and MMP-9 proved to be effective markers of extracellular matrix remodeling, with significant reductions following surgery.

The Greater the Number of Altered Eating Behaviors in Obesity, the More Severe the Psychopathology.

Background: Altered eating behaviors (AEBs) are not only associated with eating disorders but also play a role in obesity. This study assessed AEBs in individuals with obesity and their association with general and eating psychopathology, using the "Eating Behaviors Assessment for Obesity" (EBA-O). The hypothesis posited that a higher frequency of pathological eating behaviors would correlate with more severe psychopathology. Methods: Participants seeking weight loss treatment answered the EBA-O and other measures of eating and general psychopathology. The analysis employed MANOVA to estimate psychopathological variance based on AEBs and a cluster analysis to identify patient clusters by AEB type and number. Results: Out of the 244 participants, approximately two-thirds reported clinically relevant AEBs, with almost half exhibiting more than two AEBs. Predominant AEBs included sweet eating, binge eating, and hyperphagia. A significant impact of the numbers of AEBs on both eating and general psychopathology severity (p < 0.001; η2 = 0.167) was evident. Three clusters emerged, with Cluster 3 showing the highest AEB frequency and greater psychopathological impairment. Conclusions: The present findings confirm the correlation between the frequency of AEBs and the severity of general and eating psychopathology in individuals with obesity. AEBs deserve clinical attention, and their screening might aid their clinical characterization and foster more tailored treatments.

Time to act? Is the new era of gut hormone-based pharmacotherapy an opportunity to rethink the tier-based UK obesity care model?

Obesity, like type 2 diabetes, is a complex, often life limiting disease influenced by genetics and modern environment. However, unlike diabetes, the provision of integrated, holistic care for people with obesity in the UK remains underdeveloped, despite the growing prevalence of obesity and increasing availability of effective treatments for weight loss. The current tier-based approach to obesity management, although based around a multidisciplinary model, can be fragmented with significant geographical variations in care. The recent approval of new pharmacotherapies by the National Institute for Health and Care Excellence offers an opportunity to rethink and reshape the approach to obesity management. This article provides a review of the current tier-based system for obesity care in UK and proposes alternative models aimed at improving efficiency, promoting equity, and enhancing person-centred outcomes.

Urinary Metabolite Profiles of Participants with Overweight and Obesity Prescribed a Weight Loss High Fruit and Vegetable Diet: A Single Arm Intervention Study.

Thus far, no studies have examined the relationship between fruit and vegetable (F and V) intake, urinary metabolite quantities, and weight change. Therefore, the aim of the current study was to explore changes in urinary metabolomic profiles during and after a 10-week weight loss intervention where participants were prescribed a high F and V diet (7 servings daily). Adults with overweight and obesity (n = 34) received medical nutrition therapy counselling to increase their F and V intakes to national targets (7 servings a day). Data collection included weight, dietary intake, and urine samples at baseline at week 2 and week 10. Urinary metabolite profiles were quantified using 1H NMR spectroscopy. Machine learning statistical approaches were employed to identify novel urine-based metabolite biomarkers associated with high F and V diet patterns at weeks 2 and 10. Metabolic changes appearing in urine in response to diet were quantified using Metabolite Set Enrichment Analysis (MSEA). Energy intake was significantly lower (p = 0.02) at week 10 compared with baseline. Total F and V intake was significantly higher at week 2 and week 10 (p < 0.05). In total, 123 urinary metabolites were quantified. At week 10, 21 metabolites showed significant changes relative to baseline. Of these, 11 metabolites also significantly changed at week 2. These overlapping metabolites were acetic acid, dimethylamine, choline, fumaric acid, glutamic acid, L-tyrosine, histidine, succinic acid, uracil, histamine, and 2-hydroxyglutarate. Ridge Classifier and Linear Discriminant Analysis provided best prediction accuracy values of 0.96 when metabolite level of baseline was compared to week 10. Urinary metabolites quantified represent potential candidate biomarkers of high F and V intake, associated with a reduction in energy intake. Further studies are needed to validate these findings in larger population studies.

Yes I can! Exploring the impact of self-efficacy in a digital weight loss intervention.

Self-efficacy is a modifiable intervention target in behavioral weight loss interventions. However, its role in the context of digital interventions is less clear. To determine change in self-efficacy in a digital weight loss intervention, and whether self-efficacy is associated with engagement in self-monitoring diet or weight loss. This is a secondary analysis of the GoalTracker study among 100 adults with overweight or obesity enrolled in a 12-week standalone digital weight loss intervention emphasizing daily self-monitoring. At baseline, 1 month, and 3 months, we assessed self-efficacy for controlling eating (via the Weight Efficacy Lifestyle Questionnaire; WELQ) and self-efficacy for tracking diet. Dietary self-monitoring engagement data were collected from the MyFitnessPal app. Weight was collected in person on a calibrated scale. Analyses included participants with complete data (N range: 72-99). Positive change from baseline to 1 month in self-efficacy for controlling eating was associated with higher dietary self-monitoring engagement (r = 0.21, P = .008) but not with 3-month weight change (r = -0.20, P = .052). Meanwhile, positive change from baseline to 1 month in self-efficacy for tracking diet was associated in a beneficial direction with both outcomes (r = 0.57, P < .001; r = -0.35, P < .001, respectively). However, on average, self-efficacy for controlling eating did not change over time while self-efficacy for tracking diet decreased (P < .001). Improvements in self-efficacy-particularly for tracking diet-early on in a digital weight loss intervention served as a mechanism of greater engagement and weight loss, highlighting the need for strengthening intervention strategies that promote early self-efficacy within a digital context.

Behavioral Weight Loss Treatment Promotes Weight Loss by Increasing Eating Disorder Symptoms: A Response to Grilo & Pittman (2024).

We provide commentary on the Grilo and Pittman (2024). Exploring Dietary Restraint as a Mediator of Behavioral and Cognitive-Behavioral Treatments on Outcomes for Patients With Binge-Eating Disorder With Obesity article published in the International Journal of Eating Disorders. Grilo and Pittman show that weight loss in the Behavioral Weight Loss Treatment condition is mediated by an increase in rigid restraint, whereas binge eating is not mediated by rigid restraint. They conclude that this result is a positive outcome for patients with binge-eating disorder and shows that BWL is not harmful in this population. We argue that increasing rigid restraint equates to increasing eating disorder symptoms and is harmful in any population, but specifically in those with an already diagnosed eating disorder. In addition, we point out the major limitations of no follow-up data in the mediation report, no measurement of additional eating disorder symptoms that could represent diagnostic migration, and lack of inclusion of weight stigma as additional problems with the stated conclusions. We recommend that the field moves away from measurement of weight loss as an outcome in those with eating disorders and carefully consider what it means to increase restraint/restriction in eating disorder populations.

Sonographic Analysis of Non-Alcoholic Fatty Liver Disease (NAFLD) and Its Correlation with Obesity

Background: NAFLD is strongly associated with obesity and metabolic syndrome, arguably the most common liver disorders worldwide. To provide early diagnosis and prevention, we need to understand its predictors. Objectives: This study aimed to identify the clinical, biochemical and sonographic predictors for NAFLD in a cohort of patients with multivariate analysis. Methods: In our study, 537 patients: 340 with NAFLD as diagnosed by sonography. Clinical parameters (BMI and waist circumference) and biochemical markers (ALT, triglycerides, HDL cholesterol) were compared with demographic characteristics (age, gender and marital status). Sonographic findings involved evaluation of liver echogenicity, hepatomegaly, and steatosis. Multivariate logistic regression was used to identify odds ratios (OR) and 95% confidence intervals (CI) of NAFLD predictors. Results: All three measures (BMI, OR = 3.21, 95% CI: 1.8–5.3; waist circumference, OR = 4.02, 95% CI: 2.5–6.0; and waist/hip ratio, OR = 2.09, 95% CI: 1.3–3.3) were significantly associated with NAFLD. Elevated ALT (OR = 2.55, 95% CI: 1. The associations between NAFLD and 9–3.8), triglycerides (OR = 1.45, 95% CI: 1.2–1.9), and HDL cholesterol (OR = 0.35, 95% CI: 0.18–0.63) were lower. Sonographically, increased liver echogenicity (OR = 3.50, 95% CI: 2. Prevalence of NAFLD patients was 8–4.8 and (OR = 4.85, 95% CI: 3.2–7.1) for steatosis. Conclusion: Strong association exists between NAFLD and obesity, metabolic dysfunction, and characteristic sonographic features. Preventing disease progression requires early detection, via ultrasound, with weight loss and metabolic control interventions.