Weight Loss Goals Research Articles

Patient perception matters in weight management.

In a survey of 471 patients, we collected self-reported weight and height data and asked about self-perceptions of provider support toward weight loss and other weight management concerns. Multivariable analysis found that respondents with higher body mass index (BMI) were more likely to report that a physician had told them that they were overweight (OR=3.49, 95% CI 2.06-5.89, P<0.001). However, this conversation was less likely to change their personal view of their weight (OR=0.62 per 5 kg/m2, 95% CI 0.45-0.86, P=0.004), or motivate them to lose weight (OR=0.67 per 5 kg/m2, 95% CI 0.50-0.91, P=0.009). Higher BMI was associated with higher weight-loss goals (P<0.001), while anticipated time to achieve those goals was increased (P<0.001). Physician involvement in weight management was important, but the patients' needs and experiences differed by BMI. Approaches to addressing barriers and identifying resources for weight management should be tailored to individuals by considering BMI.

African American Adolescent-Caregiver Relationships in a Weight Loss Trial.

Successful family-based weight loss interventions for African American adolescents are rare. Parent-adolescent interactions supporting adoption of healthier nutrition and physical activity practices are not well understood. African American caregivers' and adolescents' perspectives on how they worked together to achieve weight loss need further exploration. This study describes the relationships experienced by adolescents and caregivers during the 6-month, evidence-based FIT Families weight loss trial and explores differences between families whose adolescents were successful and unsuccessful with weight loss. Exit interviews conducted with 136 adolescents (age 12–16 years; BMI percentile ≥95) and their caregivers (primarily mothers) were taped and transcribed verbatim. Content and thematic analysis was conducted to explore differences between groups stratified by weight loss. Five adolescent-caregiver relationship patterns emerged which describe dyads working together, working alone, working against each other; caregiver support and caregiver working on self. When relationship patterns were compared between groups stratified by weight loss, three themes emerged: motivation, support, and persistence. Families that achieved the greatest weight loss referred more often to working together to reach weight loss goals, attributed their success to adolescent self-motivation, with engaged caregiver support which allowed families to persist in change efforts. Family relationships involving adolescent autonomy, engaged parental support, and persistence despite challenges, clustered differently among adolescents who were successful at weight loss compared to those who were not. Interventionists trained to reinforce effective adolescent-parent interactions will advance behavioral interventions for families who have typically benefited least in prior interventions.

Bariatric Surgery Resistance: Using Preoperative Lifestyle Medicine and/or Pharmacology for Metabolic Responsiveness

Bariatric surgery is an effective and durable treatment for individuals with obesity and its associated comorbidities. However, not all patients meet weight loss and/or cardiometabolic goals following bariatric surgery, suggesting that some people are bariatric surgery resistant. The reason for this resistance is unclear, but potential factors, such as adiposity-derived inflammation, insulin resistance, hyperglycemia, and aerobic fitness prior to surgery, have been related to blunted surgery responsiveness. Exercise, diet, and/or pharmacology are effective at reducing inflammation and improving insulin action as well as physical function. Herein, we present data that supports the novel hypothesis that intervening prior to surgery can enhance disease resolution in people who are resistant to bariatric surgery.

A513 - The acceptance of prodigious risks for unrealistic weight loss goals in bariatric surgery

A513 - The acceptance of prodigious risks for unrealistic weight loss goals in bariatric surgery

Prediction Equations Overestimate the Energy Requirements More for Obesity-Susceptible Individuals.

Predictive equations to estimate resting metabolic rate (RMR) are often used in dietary counseling and by online apps to set energy intake goals for weight loss. It is critical to know whether such equations are appropriate for those susceptible to obesity. We measured RMR by indirect calorimetry after an overnight fast in 26 obesity susceptible (OSI) and 30 obesity resistant (ORI) individuals, identified using a simple 6-item screening tool. Predicted RMR was calculated using the FAO/WHO/UNU (Food and Agricultural Organisation/World Health Organisation/United Nations University), Oxford and Miflin-St Jeor equations. Absolute measured RMR did not differ significantly between OSI versus ORI (6339 vs. 5893 kJ·d−1, p = 0.313). All three prediction equations over-estimated RMR for both OSI and ORI when measured RMR was ≤5000 kJ·d−1. For measured RMR ≤7000 kJ·d−1 there was statistically significant evidence that the equations overestimate RMR to a greater extent for those classified as obesity susceptible with biases ranging between around 10% to nearly 30% depending on the equation. The use of prediction equations may overestimate RMR and energy requirements particularly in those who self-identify as being susceptible to obesity, which has implications for effective weight management.

Cost-effectiveness of Obesity Interventions: Will We Know It When We See It?

* Abbreviations: %OBMI — : percent over BMI FBT — : family-based obesity treatment IC — : information-based control intervention ICER — : incremental cost-effectiveness ratio QALY — : quality-adjusted life year DALY — : disability-adjusted life year In this issue of Pediatrics , Quattrin et al1 present the results of a cost-effectiveness analysis of a family-based obesity treatment (FBT) program relative to an information-based control intervention (IC). The IC educated parents to encourage their children to have a weight loss goal of 0.5 to 1 lb per week. Parents then attended 16 group meetings; each meeting delivered dietary and/or physical activity advice. In between meetings, a health coach telephoned the parents to remind them to attend the meetings. The FBT group attended the same number of group meetings and received the same information. They also received education on parenting techniques both at the group sessions and during brief individual sessions with a health coach, at which time the health coach would also problem solve any concerns raised. Parents in FBT were further instructed to monitor their children’s weight and their own weight twice a week and received additional dietary (1500 and 1800 kilocalories per day for mothers and fathers, respectively), physical activity, and sedentary activity recommendations. Parents were also instructed to record food intake and activity for their children and themselves in a diary by crossing off icons detailing food groups and physical and sedentary activities undertaken. The authors report that after 2 years, child percent over BMI (%OBMI) change decreased by 1.98 U in the FBT group versus an increase of 4.37 U in the IC group. Parents lost 5.95 kg in the FBT group versus 0.16 kg in the IC group. One way to consider the impact of FBT is … Address correspondence to Eric A. Finkelstein, PhD, MHA, Health Services and Systems Research Programme, Duke-NUS Medical School, 8 College Rd, Singapore 169857. E-mail: eric.finkelstein{at}duke-nus.edu.sg

Help Your Patients Set Realistic Goals for Weight Loss and Maintenance Using the Body Weight Planner from the National Institutes of Health

Help Your Patients Set Realistic Goals for Weight Loss and Maintenance Using the Body Weight Planner from the National Institutes of Health

The Look AHEAD Trial: Translating Lessons Learned Into Clinical Practice and Further Study.

IN BRIEF Although the Look AHEAD (Action for Health in Diabetes) trial, which spanned more than 8 years, did not find significant differences in cardiovascular morbidity and mortality between study groups, it did demonstrate significant differences in weight loss and maintenance. Using lessons learned from the Look AHEAD protocol, clinicians can help people with type 2 diabetes lose weight, improve glucose management, increase physical activity, alter eating patterns, and support long-term positive health outcomes. It remains important, however, to avoid assigning a higher priority to weight loss goals than to improvements in glucose management, long-term health outcomes, and quality of life.

“I deserve a treat”: Exercise motivation as a predictor of post-exercise dietary licensing beliefs and implicit associations toward unhealthy snacks

ObjectiveTo explore whether exercise motivation predicted two of the potential mechanisms that may explain why individuals engage in unhealthy compensatory snack consumption following exercise; specifically (a) post-exercise conscious licensing beliefs, and (b) post-exercise implicit attitudes toward unhealthy snacks. DesignObservational study. MethodOne hundred and nineteen healthy participants completed a 40-min session of moderate intensity stationary cycling, and subsequently completed measures of explicit licensing and implicit associations toward unhealthy snack foods and drinks. ResultsIndividuals driven by more controlled (relative to autonomous) forms of exercise motivation reported greater compensatory licensing beliefs (Est = −0.08, p < 0.001) even after accounting for a number of relevant covariates. No significant relationship emerged between exercise motivation and implicit associations toward unhealthy snacks (Est = 0.12, p = 0.81). ConclusionThe findings demonstrate that exercise motivation may predict conscious licensing beliefs toward unhealthy snack foods and drinks post-exercise. Understanding the modifiable factors – such as exercise motivation – that predict post-exercise dietary beliefs is important for supporting individuals’ weight loss and health goals.

Presurgery Weight Loss Goals, Depressive Symptoms, and Weight Loss Among Women Undergoing Bariatric Surgery.

Purpose: To determine whether preoperative weight loss goals are associated with postoperative weight loss and whether the effect is modified by preoperative depressive symptoms. Methods: Sixty-three women from an ongoing cohort study who were undergoing first-time bariatric surgery at a large, academic hospital in Pittsburgh, PA, were included in this subanalysis. They were assessed preoperatively and 12 months postoperatively in regard to anthropometric and biobehavioral factors. Multivariable linear regression models were used to estimate associations between weight loss goals, expressed as percentage excess body mass index loss (%EBMIL), and postoperative %EBMIL, as well as test effect modification by depressive symptoms. Findings: Presurgery weight loss goals were positively associated with %EBMIL 12 months after bariatric surgery (β = 1.0, p < 0.01), adjusting for preoperative body mass index, age, race, and marital status; this relationship was negatively modified by depressive symptoms (β = -0.1, p = 0.02). The association between goal %EBMIL and postoperative %EBMIL was attenuated when type of surgery was added to the model. Conclusions: This initial report suggests that weight loss goals and depressive symptoms may be associated with achieved weight loss after bariatric surgery. If confirmed in larger cohorts, these findings may indicate that more personalized approaches will be needed when discussing weight loss goals with patients.

Exploration of likely engagement with Monetary Contingency Contracts for weight loss: a questionnaire study

Monetary Contingency Contracts (MCCs) are schemes that ask individuals to pledge money that is returned contingent on behaviour change. In relation to weight loss, this study explored likely levels of engagement with MCCs, how much individuals would be willing to pay into an MCC, and how these amounts vary under different contract conditions. Fifty-six individuals with BMI above 25 who were motivated to lose weight were recruited. The majority of participants (87.5%) indicated that they would be willing to engage with weight loss MCCs, but showed more reluctance to subscribe to pair-based MCCs which offered; (a) refunds contingent on the weight loss of a weight loss partner, and (b) ‘all or nothing refunds’ in which no reward is given for any weight loss below the target weight loss goal. This study provides preliminary evidence that individuals motivated to lose weight may be willing to engage with weight loss MCCs. Further research is needed to explore reasons for reluctance to subscribe to MCCs with certain conditions, to inform the design of future experimental studies testing the efficacy of MCCs as part of an intervention for weight loss.

Applying economic incentives to increase effectiveness of an outpatient weight loss program (TRIO) – A randomized controlled trial

The prevalence of overweight and obesity has more than doubled in the past three decades, leading to rising rates of non-communicable diseases. This study tests whether adding a payment/rewards (term reward) program to an existing evidence-based weight loss program can increase weight loss and weight loss maintenance. We conducted a parallel-group randomized controlled trial from October 2012 to October 2015 with 161 overweight or obese individuals randomized to either control or reward arm in a 1:2 ratio. Control and reward arm participants received a four month weight loss program at the LIFE (Lifestyle Improvement and Fitness Enhancement) Centre at Singapore General Hospital. Those in the reward arm paid a fee of S$165.00 (1US$ = 1.35S$) to access a program that provided rewards of up to S$660 for meeting weight loss and physical activity goals. Participants could choose to receive rewards as guaranteed cash payments or a lottery ticket with a 1 in 10 chance of winning but with the same expected value. The primary outcome was weight loss at months 4, 8, and 12. 161 participants were randomized to control (n = 54) or reward (n = 107) arms. Average weight loss was more than twice as great in the reward arm compared to the control arm at month 4 when the program concluded (3.4 kg vs 1.4 kg, p < 0.01), month 8 when rewards concluded (3.3 kg vs 1.8 kg, p < 0.05), and at month 12 (2.3 kg vs 0.8 kg, p < 0.05). These results reveal that a payment/rewards program can be used to improve weight loss and weight loss maintenance when combined with an evidence-based weight loss program. Future efforts should attempt to replicate this approach and identify how to cost effectively expand these programs to maximize their reach. This study is registered at www.clinicaltrials.gov (Identifier: NCT01533454).

A National Effort to Prevent Type 2 Diabetes: Participant-Level Evaluation of CDC's National Diabetes Prevention Program.

OBJECTIVETo assess participant-level results from the first 4 years of implementation of the National Diabetes Prevention Program (National DPP), a national effort to prevent type 2 diabetes in those at risk through structured lifestyle change programs.RESEARCH DESIGN AND METHODSDescriptive analysis was performed on data from 14,747 adults enrolled in year-long type 2 diabetes prevention programs during the period February 2012 through January 2016. Data on attendance, weight, and physical activity minutes were summarized and predictors of weight loss were examined using a mixed linear model. All analyses were performed using SAS 9.3.RESULTSParticipants attended a median of 14 sessions over an average of 172 days in the program (median 134 days). Overall, 35.5% achieved the 5% weight loss goal (average weight loss 4.2%, median 3.1%). Participants reported a weekly average of 152 min of physical activity (median 128 min), with 41.8% meeting the physical activity goal of 150 min per week. For every additional session attended and every 30 min of activity reported, participants lost 0.3% of body weight (P < 0.0001).CONCLUSIONSDuring the first 4 years, the National DPP has achieved widespread implementation of the lifestyle change program to prevent type 2 diabetes, with promising early results. Greater duration and intensity of session attendance resulted in a higher percent of body weight loss overall and for subgroups. Focusing on retention may reduce disparities and improve overall program results. Further program expansion and investigation is needed to continue lowering the burden of type 2 diabetes nationally.

Facebook for Supporting a Lifestyle Intervention for People with Major Depressive Disorder, Bipolar Disorder, and Schizophrenia: an Exploratory Study.

To examine whether Facebook could support a community-based group lifestyle intervention for adults with serious mental illness. Participants with serious mental illness and obesity enrolled in a 6-month group lifestyle program were invited to join a secret Facebook group to support their weight loss and physical activity goals. Two peer co-facilitators moderated the Facebook group. The proportion of participants who achieved ≥5% weight loss or improved fitness was measured at follow-up. The relationship between this outcome and participants' interactions in the Facebook group was examined. Interactions were defined as active contributions including posts, comments, or likes. Content of participants' Facebook posts was also explored. Participants (n=25) had major depression (44%), bipolar disorder (36%), and schizophrenia (20%). Nineteen (76%) participants joined the Facebook group, and contributed 208 interactions (70 posts; 81 comments; 57 likes). Participants who achieved ≥5% weight loss or improved fitness contributed more interactions in the Facebook group (mean=19.1; SD=20.5) compared to participants who did not (mean=3.9; SD=6.7), though this relationship approached statistical significance (t=-2.1; Welch's df=13.1; p=0.06). Participants' posts containing personal sharing of successes or challenges to adopting healthy behaviors generated more interaction compared to posts containing program reminders (p<0.01), motivational messages (p<0.01), and healthy eating content (p<0.01). Facebook appears promising for supporting health behavior change among people with serious mental illness. These findings can inform social media initiatives to scale up health promotion efforts targeting this at-risk group.

Factors related to lifestyle goal achievement in a diabetes prevention program dissemination study.

The U.S. Diabetes Prevention Program (DPP) showed that lifestyle participants who achieved ≥7% weight loss and ≥150min/week physical activity experienced the greatest reduction in type 2 diabetes incidence. Demographic, clinical, and program factors that are related to achieving both these lifestyle goals have seldom been explored in community-delivered DPP programs. The purpose of this investigation is to examine factors associated with concurrent achievement of weight loss and physical activity goals in a 12-month community DPP lifestyle intervention. Adults [n=223; age=58.4 (SD=11.5); BMI=33.8 (SD=6.0)] with glucose or HbA1c values in the pre-diabetes range and/or metabolic syndrome risk factors enrolled from one worksite and three community centers in the Pittsburgh, PA metropolitan area between January 2011 and January 2014. Logistic regression analyses determined the demographic, clinical and program adherence factors related to goal achievement at 6, 12, and 18months. Participants achieving both intervention goals at 6months (n=57) were more likely to attend sessions [Adjusted Odds Ratio (AOR) =1.48], self-weigh (AOR=1.19), and self-monitor behaviors (AOR=1.18) than those meeting neither goal (n=35; all p<0.05). Baseline BMI (AOR=0.87, p<0.01), elevated glycemic status (AOR=0.49, p<0.05), and female sex (AOR=0.52, p<0.05) were inversely related to goal achievement at 6months. Meeting either lifestyle goal at 6months had the strongest association with meeting both goals at 12 and 18months. Our study supports the importance of early engagement, regular attendance, self-monitoring, and self-weighing for goal achievement. Dissemination efforts should consider alternative approaches for those not meeting goals by 6months to enhance long-term success.

The Effect of Dietary MUFA's on Resting Energy Expenditure in Individuals with Pre‐Diabetes

Research has revealed that there may be a positive association between increased monounsaturated fatty acid (MUFA) intake and increased resting energy expenditure (REE). Increases in REE could aid in weight loss, which is the most effective intervention to prevent the progression to T2DM. Results from this study will indicate whether or not increased MUFA intake is a valid dietary approach for improving REE in individuals with pre‐diabetes.In clinical practice, predictive equations are the most practical means to estimate a patient's REE. The most common equations are the Mifflin St. Joer and Harris Benedict equations, however reliability of the predictive equations remains unknown. This study aims to determine the accuracy of the REE predictive equations for the pre‐diabetic population.Study participants include adults ages 18–70, with a BMI of 25–45 kg/m2, that have been diagnosed with pre‐diabetes. Pre‐diabetic fasting blood glucose level is defined as 100–125 mg/dL. The REE was measured using the Cosmed and compared to the Mifflin St. Jeor and Harris Benedict predictive equation. This comparison will allow us to determine if the equation method provides an accurate REE estimate.Participants were split into an intervention group, who consumed 1 ½ ounces of pecans between 8am and 2pm daily for 8 weeks and a control group. The REE was measured pre and post intervention.The MUFA intervention did not significantly change REE measured via Cosmed. The mean measured REE pre MUFA intervention 1535.8 ± 386.1 and 1764.4 ± 594.2 post intervention. We found no significant correlation between Measured REE and the Mifflin St. Joer and the Harris Benedict predictive equations (r = 0.19, p = 0.29).While we did not find a significant difference, MUFA intake slightly increased REE in individuals with pre‐diabetes. A higher number of participants may yield a significant change in REE with daily MUFA intake, therefore providing an effective dietary approach to aid in weight loss of individuals with pre‐diabetes.The lack of correlation between both predictive equations and measured REE is substantial in practice. Predictive equations are used to determine caloric needs as a measure to induce weight loss. Inaccurate measurements will impede weight loss goals. Therefore, measured REE, rather than predicted REE, should be used in this population to aid in weight loss.Support or Funding InformationSummer Undergraduate Research FellowshipTexas Pecan Growers Association

Su2033 - Argon Plasma Coagulation is Effective in Roux-En-Y Gastric Bypass Patients that do not Achieve Weight Loss Goals after Sutured Transoral Outlet Reduction (TORe)

Su2033 - Argon Plasma Coagulation is Effective in Roux-En-Y Gastric Bypass Patients that do not Achieve Weight Loss Goals after Sutured Transoral Outlet Reduction (TORe)

Patient Reported Outcomes 10years After Roux-en-Y Gastric Bypass.

Following weight-loss surgery, patients who failed to achieve or sustain weight loss have nevertheless reported high satisfaction with their long-term bariatric experience. Understanding this phenomenon better will likely improve patients' experiences. The purpose of this study was to explore patients' long-term experiences following bariatric surgery. A 604-bed academic health system in the USA. Participants rated satisfaction and shared spontaneous comments regarding their gastric bypass experience. A phenomenological mode of inquiry explored participants' experiences. Transcribed phrases were categorized and themes identified. In a 2004 surgical cohort, with 55% (155/281) participation, 99% of participants rated bariatric experience satisfaction (mean score 8.4) and 74% (115/155) shared comments regarding experiences. Responses were categorized as positive (63% 72/115), neutral (25% 29/115), or negative (12% 14/115). Satisfaction, Appreciation, and Gratefulness emerged as themes from positive comments, with 8% (6/72) explicitly acknowledging amount of weight loss achieved. Twenty-five percent (18/72) spontaneously mentioned undergoing surgery again or recommending the procedure to others. Neutral comments contained the themes of Reflection, Acknowledgment, and Wistfulness. Themes of Dissatisfaction, Disappointment, and Regret emerged from negative comments. Forty-three percent (6/14) of negative comments remarked on regaining weight or not reaching goal weight. Twenty-one percent (3/14) of negative comments explicitly stated regret at having undergone surgery. Participants readily shared comments regarding their gastric bypass experience. Exploring themes provided insight into patients' satisfaction with bariatric surgery even when weight-loss goals were not met and conversely substantial dissatisfaction even when weight loss occurred. This study underscores the importance of understanding the patients' long-term experience following bariatric surgery.

Setting a weight loss or clothes size goal following laparoscopic adjustable gastric banding: Does this impact on outcomes?

Setting a weight loss or clothes size goal following laparoscopic adjustable gastric banding: Does this impact on outcomes?

Exploring the role of the romantic relationship context in weight loss

For individuals losing weight who are cohabiting with their romantic partners, weight loss is pursued within a relational context. To better understand the role of romantic partners, 44 individuals from a Southwestern city in the U.S. who were actively trying to lose weight were interviewed about the current and desired role of their partner in their weight loss. Responses were transcribed and qualitatively analyzed. Themes specifically pertinent to the romantic relationship that facilitated or hindered weight loss were identified. Three major themes emerged, each with subthemes. Factors that facilitated weight loss were having a team effort in pursuing the weight loss goals, partners being accommodating to dietary and schedule changes, and the provision of logistical help (e.g., childcare). Obstacles presented by the interdependent nature of romantic relationships included partners having opposing perspectives on weight loss, partners’ negative comments about themselves, and difficulties in balancing the weight loss goals with the needs of the relationship. Complicating support from partners, some participants gave mixed messages about the desired support from their partners as well as inconsistent reactions to partner support. The findings highlight that theory and intervention programs need to consider the complexity of losing weight in this interdependent, relational context.