Maintain Weight Loss Research Articles

Supplemental Material for Conscientiousness in Weight Loss Maintainers and Regainers

Supplemental Material for Conscientiousness in Weight Loss Maintainers and Regainers

Sociodemographic and health risk profile associated with participation in a private health insurance weight loss maintenance and chronic disease management program.

Objective Identifying who participates in chronic disease management programs yields insights into program reach and appeal. This study investigated sustained participation in a remotely delivered weight loss maintenance program offered to Australian private health insurance members. Methods All participants completing an initial 18-week weight loss program were eligible for a maintenance phase. A pre-post test design was used and sociodemographic and anthropometric characteristics of those who did and did not opt in to the maintenance phase were compared using binary logistic regression. Results Maintenance phase participants lost more weight during the initial weight loss program (-2.2kg (P<0.001); body mass index -0.8kg/m2 (P<0.001)) than those who did not opt in. Participants who were obese (v. overweight) upon completion of the initial weight loss program were less likely to opt in to the maintenance phase (adjusted odds ratio (aOR) 1.76, 95% confidence interval (CI) 1.35-2.30, P<0.001) and participants aged ≥55 years were more likely to opt in (aOR 0.59, 95% CI 0.44-0.80, P<0.001) than those aged <55 years. Conclusions Understanding why health insurance members opt in to maintenance programs can assist the development of strategies to improve program reach. Younger participants and those who remain obese following a weight loss program may be targeted by private health insurers and service providers to increase weight loss maintenance program participation. What is known about the topic? Australian private health insurers offer chronic disease management programs to support members to manage obesity-related chronic disease. An 18-week weight loss and lifestyle modification program was extended to assist participants maintain weight loss and health benefits resulting from the initial program. This weight loss maintenance phase is novel in the private health insurance setting and is thought to be important to sustained health improvement. Although program reach is important to benefit those most in need, little is known about who sustains the use (or does not) of such programs. What does this paper add? This study provides an insight to the characteristics of participants more likely to opt in to a weight loss maintenance program. It highlights the sociodemographic and anthropometric characteristics associated with maintenance program uptake, identifying the subgroups less likely to opt in. These study findings are novel because they report on participation in a chronic disease management program with a focus on maintenance of weight loss. What are the implications for practitioners? These results will benefit private health insurers and service providers implementing maintenance programs for weight loss, providing an awareness of which participant groups to target to increase maintenance and reach. In addition, they offer avenues for future exploration, such as the generalisability and sustainability of chronic disease management programs. Although those not opting in are a difficult-to-access group, a qualitative study of reasons for not opting in to such a program would provide further information for program design, recruitment and retention.

Associations of Objectively Measured Physical Activity and Sleep with Weight Loss Maintenance: A Preliminary Study of Japanese Adults.

Maintaining weight loss is considerably more challenging than losing weight. Most previous studies on weight loss maintenance have been conducted in Western countries and have assessed physical activity and sleep with the use of questionnaires. This preliminary study investigated the associations of objectively measured physical activity and sleep with weight loss maintenance among 25 Japanese adults who had intentionally lost ≥ 10% of their original weight. Participants wore tri-axial accelerometers on their waists and sleep monitors on their wrists for two weeks to measure their physical activity and sleep, respectively. A linear regression adjusted for sex, age, maximum weight, and time since losing weight was performed to investigate these associations. Participants had a mean body mass index of 23.4 kg/m2 and a median weight loss of 12.5%. Compared to those who maintained < 12.5% weight loss, those who maintained ≥ 12.5% weight loss slept longer (adjusted mean difference: 66.1 min/night, 95% confidence interval (CI): −14.0, 146.3 min/night, p = 0.10) and performed less moderate-to-vigorous physical activity (adjusted mean difference: −21.7 min/day, 95% CI: −58.0, 14.5 min/day, p = 0.22). Though statistical power was limited, sleep behavior may be an important modifiable factor that facilitates weight loss maintenance. Our findings can be used to establish a well-designed study to confirm this association.

Diet Quality and Micronutrient Intake among Long-Term Weight Loss Maintainers.

Inadequate vitamin and mineral intake is documented among individuals with obesity, but is unknown among long-term weight loss maintainers (WLM). This study examined dietary quality and micronutrient adequacy among WLMs in a commercial weight management program. Participants were 1207 WLM in Weight Watchers (WW) who had maintained a 9.1 kg or greater weight loss (29.7 kg on average) for 3.4 years and had a body mass index (BMI) of 28.3 kg/m2. A control group of weight stable adults with obesity (controls; N = 102) had a BMI of 41.1 kg/m2. Measures included the Diet History Questionnaire-II, Healthy Eating Index-2015 (HEI), and Dietary References Intakes. WLM versus controls had a 10.1 point higher HEI score (70.2 (69.7–70.7) vs. 60.1 (58.4–61.8); p = 0.0001) and greater odds of meeting recommendations for copper (OR = 5.8 (2.6–13.1)), magnesium (OR = 2.9 (1.8–4.7)), potassium (OR = 4.7 (1.4–16.5)), vitamin A (OR = 2.8 (1.7–4.8)), vitamin B6 (OR = 2.9 (1.6–5.2)), and vitamin C (OR = 5.0 (2.8–8.8)). WLM, compared to controls, also reported higher percentages of calories from carbohydrates (50.3% (49.7–50.8) vs. 46.7% (44.8–48.7); p = 0.0001) and protein (18.2% (18.0–18.5) vs. 15.9% (15.1–16.6); p = 0.0001) and lower calories from fat (32.3% (31.9–32.8) vs. 37.4% (35.8–38.9); p = 0.0001). Long-term weight loss maintenance in a widely used commercial program was associated with a healthier diet pattern, including consuming foods with higher micronutrient density.

Building a Patient-Centered Weight Management Program: A Mixed Methods Project to Obtain Patients' Information Needs and Ideas for Program Structure.

Achieving and maintaining weight loss for large segments of the population remains elusive, despite evidence demonstrating the value of many weight management programs. This study aimed to gather patients’ perceptions on weight management education needs, and ideas for the structure of a weight management program to be delivered in community pharmacies. This was an exploratory mixed methods study combining qualitative focus group interviews with a cross-sectional survey. Three focus group interviews were conducted, along with a brief survey based on focus groups findings and sent to all eligible participants. The survey allowed for individual responses on the program components and narrowing down of focus group findings. Nearly half of the respondents (45.9%) wanted further education on limiting carbohydrate and sugar intake. Participants were most interested in identifying different exercises appropriate for those with physical limitations (48.6%). Most participants preferred 1 h meetings (70.3%) that contain a mix of one-on-one and group meeting formats (67.6%). The results of the study suggest a three-month weight management program, with a combination of group and individual in-person meetings occurring twice per month, would be of most interest to patients.

Assessing the feasibility and acceptability of Changing Health for the management of prediabetes: protocol for a pilot study of a digital behavioural intervention

BackgroundThe prevalence of prediabetes is rapidly rising in the UK, largely associated with an increase in obesity. Lifestyle programmes that provide support to make and sustain dietary and physical activity behavioural changes are necessary to initiate and maintain weight loss. However, these programmes are often intensive and time consuming. Given the magnitude of the problem, there is a need for behavioural interventions that can be delivered at scale. Digital interventions can address some of the aforementioned issues. The primary aim of the present study is to assess the feasibility and acceptability of a digital intervention called Changing Health that provides structured education and lifestyle behaviour change support to adults with prediabetes.MethodsA single-group pilot study will be undertaken. We aim to recruit 40 participants with prediabetes defined by HbA1c or fasting plasma glucose (FPG), aged between 18 and 75 years with a BMI ≥ 25. Participants will receive the digital intervention (a mobile phone app incorporating structured education and behavioural tools to support lifestyle behaviour change) with the aim of losing and maintaining 5–6% of their baseline body weight. Each participant will receive 100 min of lifestyle coaching over the 9-month intervention period and will have continued access to the digital intervention. Clinical outcome measures will be collected during four visits to our clinical research facility: two visits at baseline, one visit at month 3, and one visit at month 9. These secondary outcome measures will include diet, physical activity, sleep, metabolic control, body composition, cardiorespiratory fitness, and cardiovascular function. To measure primary outcomes, an embedded qualitative study will be conducted to obtain data on feasibility and acceptability of the intervention.DiscussionThis pilot study will establish whether Changing Health is feasible and acceptable to adults with prediabetes. Clinical outcome measures will provide estimates of variability to inform sample size calculations, and qualitative data generated will inform any necessary refinements to the intervention. This will provide a platform for a larger evaluation to assess the effectiveness of Changing Health for changing diet and physical activity to initiate and maintain weight loss in adults with prediabetes.Trial registrationISRCTN Registry: ISRCTN69270299.

Effect of Electronic Health Record-Based Coaching on Weight Maintenance: A Randomized Trial.

Weight regain after intentional loss is common. Most evidence-based weight management programs focus on short-term loss rather than long-term maintenance. To evaluate the benefit of coaching in an electronic health record (EHR)-based weight maintenance intervention. Randomized controlled trial. (ClinicalTrials.gov: NCT01946191). Practices affiliated with an academic medical center. Adult outpatients with body mass index (BMI) of 25 kg/m2 or higher, intentional weight loss of at least 5% in the previous 2 years, and no bariatric procedures in the previous 5 years. Participants were randomly assigned to EHR tools (tracking group) versus EHR tools plus coaching (coaching group). The EHR tools included weight, diet, and physical activity tracking flow sheets; standardized surveys; and reminders. The coaching group received 24 months of personalized coaching through the EHR patient portal, with 24 scheduled contacts. The primary outcome was weight change at 24 months. Secondary outcomes included 5% weight loss maintenance and changes in BMI, waist circumference, number of steps per day, health-related quality of life, physical function, blood pressure, and satisfaction. Among 194 randomly assigned participants (mean age, 53.4 years [SD, 12.2]; 143 [74%] women; 171 [88%] white), 157 (81%) completed the trial. Mean baseline weight and BMI were 85.8 kg (SD, 19.1) and 30.4 kg/m2 (SD, 5.9). At 24 months, mean weight regain (±SE) was 2.1±0.62 kg and 4.9±0.63 kg in the coaching and tracking groups, respectively. The between-group difference in weight change at 24 months was significant (-2.86 kg [95% CI, -4.60 to -1.11 kg]) in the linear mixed model. At 24 months, 65% of participants in the coaching group and 50% in the tracking group maintained weight loss of at least 5%. Single-site trial, which limits generalizability. Among adults with intentional weight loss of at least 5%, use of EHR tools plus coaching resulted in less weight regain than EHR tools alone. Agency for Healthcare Research and Quality and National Institutes of Health.

The challenge of keeping it off, a descriptive systematic review of high-quality, follow-up studies of obesity treatments.

The aim of this systematic review is to answer the question: Is substantial, stable, and long-term weight loss a viable goal for adults with obesity? To answer this question, we conducted a broad systematic search of non-surgical and non-pharmacological obesity treatment studies with the following strict criteria: (a) minimum 3-year follow-up, (b) 5% body mass lost, (c) no continued interventions in the follow-up-period, (d) prospective design, and (e) less than 30% attrition from the start of the follow-up period. While the search revealed a very large number of published articles, only eight studies met the inclusion criteria. Several of the nonincluded studies report a majority of participants achieving satisfactory weight loss and little regain, especially among studies with continued interventions during the follow-up period. In contrast, the eight high-quality studies included in this study demonstrate a trend of weight regain towards pretreatment baseline. This review concludes that the majority of high-quality follow-up treatment studies of individuals with obesity are not successful in maintaining weight loss over time. The results suggest that excess weight can be lost but is likely regained over time, for the majority of participants.

Psychological factors influencing weight regain after bariatric surgery

Background Approximately 15 to 40% of bariatric patients regain a significant percentage of their weight lost after surgery. Among psychological variables, control and self-efficacy loci are associated with behaviors related to weight loss. Also, family support can be a risk or protection factor for the maintenance of weight loss. Aim To evaluate the association between psychological variables with weight maintenance or regain after bariatric surgery. Material and Methods We evaluated 97 patients at 4.1 ± 3.4 years after their bariatric surgery. They answered questionnaires about self-efficacy to lose weight, locus of weight control and family functioning style. Regain after surgery was also calculated, through self-report. Results Seventeen percent of patients gained weight. Locus of control (Z = -3.09, p < 0.01), family identity (Z = -3.71, p < 0.01) and self-efficacy (Z = -2.44, p = 0.01), differentiated patients who maintained weight loss from those who re-gained at least 15% of their lost weight. An inverse and significant relationship was observed between the percentage of weight regain and locus of control (r = -0.42, p < 0.01), family identity (r = -0.36, p < 0.01) and self-efficacy (r = -0.34, p <0.01). Conclusions The psychological variables "locus of weight control" and "family identity" are inversely and moderately associated with weight regain in patients subjected to bariatric surgery.

Comparison of dietary patterns, food groups, nutrients intake, cardio-metabolic biomarkers, and liver enzymes in successful and unsuccessful weight loss maintainers

PurposeCompare dietary patterns, food groups, nutrients intake, cardio-metabolic risk factors, and liver enzymes between female weight loss maintainers and regainers. MethodsThe present study was conducted using a case-control design on 263 participants. Cases and controls were matched regarding sex, ethnicity, and family history of obesity. Three 24-h dietary recalls were used to extract the usual dietary intake and major dietary patterns; the three-factor eating questionnaire was administered to evaluate the dietary habits; and blood sampling was performed to evaluate fasting blood sugar, lipid profile, and liver enzymes. ResultsIn total, three major dietary patterns were identified: Mediterranean-like dietary pattern, high-fat-high-carbohydrate (HFHC) dietary pattern, and Iranian traditional dietary pattern. Higher adherence to the Mediterranean-like and Iranian traditional dietary patterns increased the odds of success in weight loss maintenance (P-value<0.001 and p < 0.001, respectively). The HFHC dietary pattern was associated with lower success in weight loss (P-value<0.001). Maintainers had lower daily energy and carbohydrate intake (P-value<0.001), but not lower fiber, calcium and folate (P-value >0.05); even in the maintainers the calories percent from protein was higher than regainers (P-value <0.001). Longer duration of weight loss period (P-value<0.001), and combination of diet and exercise method in weight loss (P-value = 0.028) were more frequent and attempts for weight loss (P-value<0.001) was less frequent among maintainers compared to regainers. Participants with successful weight loss had significantly lower fasting blood sugar and gamma-glutamyltransferase levels after adjusted for confounding factors (P-value<0.001 and p = 0.004, respectively). ConclusionResults indicated a higher healthy dietary patterns and lower adherence to unhealthy dietary patterns and different intake of food groups and nutrients in maintainers compared to regainers.

Understanding bariatric surgery to support patients in primary care

The relatively new field of bariatric surgery is increasingly used as an option to address issues linked to obesity. Practice nurses must understand how they can manage patients who have undergone these procedures Obesity is steadily rising, with 64% of adults in England in 2017 being classified as overweight or obese. Obesity is strongly linked to metabolic diseases such as cardiovascular disease, type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease (NAFLD), polycystic ovary syndrome (PCOS), musculoskeletal and respiratory disorders, cancer as well as psychological illness ( World Health Organization (WHO), 2018 ). Therefore every opportunity should be taken to support patients to lose weight and maintain weight loss. Practice nurses are in a unique and pivotal position to guide patients in a variety of options to assist in their weight loss. Bariatric surgery in England is relatively new, with its usage having increased dramatically in the last 10 years. Practice nurses require knowledge of bariatric surgery to undertake their role effectively. This article provides information to assist practice nurses in providing care and support to patients who have had a surgical intervention. This paper also highlights signs and symptoms of physical and psychological complications including pregnancy and excess skin and recommended action and advice including nutritional monitoring and supplementation.

2514 The Biggest Loser: A Case of Dramatic Weight Loss Achieved With an Intragastric Balloon

INTRODUCTION: The prevalence of obesity and the medical costs associated with it are steadily rising, both among the adult and adolescent populations. New procedures such as the intragastric balloon (IGB), can provide rapid improvement in overall health to help manage and maintain weight loss with few adverse events. CASE DESCRIPTION/METHODS: A 61-year-old male patient with class III-IV obesity and multiple comorbidities had been in discussion with his gastroenterologist for over a year to undergo an IGB procedure. Peak weight was 302 lbs, with BMI of 43 kg/m2. He underwent intensive lifestyle and medical therapy, was started on Liraglutide 1.8 mg daily, with 15 lbs weight loss that plateaued. On his pre-procedure visit, hemoglobin A1C was 9.4, with a weight of 275 lbs and BMI 40.7 kg/m2. An intragastric Orbera™ IGB System (Apollo Endosurgery Inc, Austin, TX, United States) was placed and inflated with 600 ml of saline. On 2-month follow-up, the patient had lost 34 pounds. A number of his chronic medications, including those for hypertension and diabetes mellitus, were held due to improvement in lab and exam findings. The IGB was removed after 6 months. The patient continued to lose weight and has maintained daily exercise and dietary guidelines. Most recently, the patient's A1C level has trended down to 6.4%, with a weight of 202 lbs and a BMI of 29.9 kg/m2. Since starting the program, he has lost a total of 101 lbs. DISCUSSION: This case highlights the dramatic weight loss after a minimally invasive weight loss procedure in conjunction with proper diet and, exercise. The patient lost 27% of his body weight (275 lbs to 202 lbs) and went from class III obesity (&gt;40 BMI), to an overweight range (25.0–29.9 BMI) with the IGB. Overall, he has lost over 100 lbs with 34.4% total weight loss, making him the “biggest loser' in our program. The effect on the patient's overall well-being has been extraordinary; over time, he has been able to start a regular exercise and dietary regimen, use less medication or experience remission of his chronic conditions. The typical weight loss expected with a gastric balloon is 10-12%. This patient's results have far exceeded the expected trajectory. Given the chronicity of obesity, and improvements in health seen with even 5-10% weight loss, a relatively safe endoscopic procedure such as the gastric balloon can significantly improve the health status of patients with obesity and should be considered before more invasive interventions.

A453 Personalized, Multi-Component Interventions for Behavioral Weight Management: Yes, but How? A Hybrid Intervention of Compulsory and Personalized Elements Based in Self-Determination Theory

Bariatric surgery is the most effective treatment for severe obesity. However, with more than 40% of postoperative bariatric patients experiencing excessive weight regain (i.e., 25%+ of total lost weight) and the majority of patients regaining some weight, there is a need for individualized behavioral interventions to promote sustained, lifelong maintenance of surgical weight loss. Given the multifactorial nature of weight regain, interventions must be multicomponent and personalized. This recommendation represents best practice; however, clinicians may lack knowledge or experience for pragmatic implementation. This session will address these issues, highlighting self-determination theory (SDT) as optimal for conceptualizing personalized treatments. Emphasis will be placed on the utility of the three components of SDT – autonomy, competence, and relatedness – to inform personalized, holistic interventions for patients who have lost or are trying to lose weight. SDT-based, personalized behavioral interventions can be tailored for both surgical and non-surgical populations with obesity, and they are ideal for preventing recidivism following weight loss. A brief overview of the BOSS intervention (Bariatric Outcomes: Sustaining Success) will be provided: this is an SDT-based, multicomponent intervention for promoting sustained weight loss and preventing recidivism. Five adult case examples will highlight how the intervention is tailored across SDT domains of autonomy, competence, and relatedness. Preliminary outcome data will also be provided: all patients are actively losing weight or maintaining weight loss. The session will demonstrate the implementation and personalization of evidence-based interventions, emphasizing the need for both compulsory and individualized elements within a multi-component program for lifelong behavioral weight management.

DAILY PHYSICAL ACTIVITY LEVEL AFTER BARIATRIC SURGERY AND A 12-WEEK SUPERVISED EXERCISE PROGRAM: ARE THEY ACTIVE ENOUGH

Following bariatric surgery, increasing physical activity (PA) level helps to maintain weight loss and has benefits on quality of life. Although, one could believe that the weight loss achieved with the surgery would ease patients to engage in more PA practices, the PA habits of these patients are not known. Evidences and objectives measures of the PA level are sparse in the literature in this population. We measured the evolution of PA level in severely obese patients who underwent bariatric surgery. Forty-seven severely obese patients from the randomized controlled trial ACTIVE were either assigned in the supervised exercise group (ExG = 32) or control group (CG = 15). Anthropometric measurements and daily PA using an accelerometer were performed before, at 3, 6 and 12 months after bariatric surgery. The ExG trained 3 times a week for 60 minutes during 12 weeks between the 3rd and 6th months. At baseline and 3 months, both groups were comparable regarding anthropometric measurements (p>0.05). After 6 months, participants in CG and ExG had lost 13.1±5.6 vs. 14.2±5.5kg; p=0.509 respectively with approximately similar changes between 6 and 12 months. Regarding PA parameters at baseline, participants in the CG were spending 11.3±2.4 hours doing sedentary behavior and averaging 5001±2525 steps per day. For the ExG, 12.0±2.1 hours were devoted to sedentary behavior with a total of 4711±2183 daily steps. Daily time spent at moderate intensity PA was 16.7±18.4 vs. 19.4±39.9min; p=0.968 for CG and ExG respectively. Between 3 and 6 months, both groups had decreased their time spent at sedentary behavior (CG = -1.5±2.3 hours and ExG = -0.3±2.4 hours; p=0.718), increased their number of daily steps (CG = 1215±2324 steps and ExG = 1303±2522 steps; p=0.717) and their time spent at moderate intensity PA (CG = 19.0±15.6 min and ExG = 8.6±24.5 min; p=0,085) with no significant difference between groups. At 12 months follow-up, no significant changes occurred in PA parameters. According to these results, anthropometric measurements and PA levels are not affected by the PA intervention. This suggests that a supervised exercise training program does not seem to play a major role in the patients’ daily PA behaviors.

Regular exercise potentiates energetically expensive hepatic de novo lipogenesis during early weight regain.

Exercise is a potent facilitator of long-term weight loss maintenance (WLM), whereby it decreases appetite and increases energy expenditure beyond the cost of the exercise bout. We have previously shown that exercise may amplify energy expenditure through energetically expensive nutrient deposition. Therefore, we investigated the effect of exercise on hepatic de novo lipogenesis (DNL) during WLM and relapse to obesity. Obese rats were calorically restricted with (EX) or without (SED) treadmill exercise (1 h/day, 6 days/wk, 15 m/min) to induce and maintain weight loss. After 6 wk of WLM, subsets of WLM-SED and WLM-EX rats were allowed ad libitum access to food for 1 day to promote relapse (REL). An energy gap-matched group of sedentary, relapsing rats (REL-GM) were provided a diet matched to the positive energy imbalance of the REL-EX rats. During relapse, exercise increased enrichment of hepatic DN-derived lipids and induced hepatic molecular adaptations favoring DNL compared with the gap-matched controls. In the liver, compared with both REL-SED and REL-GM rats, REL-EX rats had lower hepatic expression of genes required for cholesterol biosynthesis; greater hepatic expression of genes that mediate very low-density lipoprotein synthesis and secretion; and greater mRNA expression of Cyp27a1, which encodes an enzyme involved in the biosynthesis of bile acids. Altogether, these data provide compelling evidence that the liver has an active role in exercise-mediated potentiation of energy expenditure during early relapse.

Neuropathy and neural plasticity in the subcutaneous white adipose depot.

The difficulty in obtaining as well as maintaining weight loss, together with the impairment of metabolic control in conditions like diabetes and cardiovascular disease, may represent pathological situations of inadequate neural communication between the brain and peripheral organs and tissues. Innervation of adipose tissues by peripheral nerves provides a means of communication between the master metabolic regulator in the brain (chiefly the hypothalamus), and energy-expending and energy-storing cells in the body (primarily adipocytes). Although chemical and surgical denervation studies have clearly demonstrated how crucial adipose tissue neural innervation is for maintaining proper metabolic health, we have uncovered that adipose tissue becomes neuropathic (ie: reduction in neurites) in various conditions of metabolic dysregulation. Here, utilizing both human and mouse adipose tissues, we present evidence of adipose tissue neuropathy, or loss of proper innervation, under pathophysiological conditions such as obesity, diabetes, and aging, all of which are concomitant with insult to the adipose organ as well as metabolic dysfunction. Neuropathy is indicated by loss of nerve fiber protein expression, reduction in synaptic markers, and lower neurotrophic factor expression in adipose tissue. Aging-related adipose neuropathy particularly results in loss of innervation around the tissue vasculature, which cannot be reversed by exercise. Together with indications of neuropathy in muscle and bone, these findings underscore that peripheral neuropathy is not restricted to classic tissues like the skin of distal extremities, and that loss of innervation to adipose may trigger or exacerbate metabolic diseases. In addition, we have demonstrated stimulation of adipose tissue neural plasticity with cold exposure, which may ameliorate adipose neuropathy and be a potential therapeutic option to re-innervate adipose and restore metabolic health.

Cognitive and behavioural strategies employed to overcome 'relapse' among weight loss maintainers and regainers: a qualitative study

Cognitive and behavioural strategies employed to overcome 'relapse' among weight loss maintainers and regainers: a qualitative study

Support Required to Maintain Weight Loss after an Initial Intervention: A Mixed Methods Study of Patients' Views

Searchable abstracts of presentations at key conferences in obesity ISSN 2632-9808 (online)

Prevalence and predictors of weight loss maintenance: aretrospective population-based survey of European adults with overweight and obesity.

The prevalence of weight loss attempts has increased worldwide, although the extent to which sustained weight loss is achieved is unknown. There is insufficient research into weight loss maintenance (WLM) in individuals with overweight or obesity who have recently lost clinically significant amounts of weight (≥5%), particularly in the European general population. The present study aimed to determine the prevalence and retrospective predictors of WLM in population-based samples of European adults with overweight or obesity who had made a recently completed weight loss attempt. Participants (N=2000) in UK, Denmark and Portugal completed an online survey about loss and regain in their most recent completed weight loss attempt, features of their attempt (duration, self-weighing, lapses, strategies), as well as loss of control and binge eating. Multiple regression analysis was used to determine factors retrospectively associated with WLM in those who achieved clinically significant weight loss (n=1272). Mean (SD) self-reported weight loss was 9% (8%) and mean (SD) regain was 96.3% (9%) of participants' start weight. Twenty-three percent of the total sample had maintained weight loss of ≥5% for at least 1month. Controlling for weight loss and time since attempt, predictors of better WLM were avoidance of a temporary lapse, infrequent/absent loss of control and binge eating, and use of a greater number of dietary strategies for WLM (r2 =0.338, P<0.001). Factors associated with recent successful WLM indicate the importance of the continued use of dietary and other strategies for WLM, particularly in the face of a lapse, as well as the need to manage dysfunctional eating behaviours.

Five-year results of endoscopic gastrojejunostomy revision (transoral outlet reduction) for weight gain after gastric bypass.

The study aim is to determine if patients who have undergone endoscopic gastrojejunostomy revision (EGJR) maintain weight loss up to 5years postoperatively. This is a retrospective review of patients who underwent EGJR with a full-thickness endoscopic suturing device between April 2009 and June 2018. Percent of excess body weight loss (%EBWL) was calculated using the weight on day of EGJR consult as baseline. The paired t test and McNemar's test were used to compare weight and comorbidities between preoperative and postoperative time points. A total of 70 patients regained a mean of 42.8 ± 18.7% of the weight lost after gastric bypass. On day of EGJR consult, average was 116.1 ± 25.2kg and BMI of 42.3 ± 8.5. Weight loss and %EBWL at follow-up was as follows: 10.7 ± 11.6kg and 18.5 ± 18.2% at 6months, 8.5 ± 11.5kg and 14.9 ± 20.6% at 1year, 6.9 ± 10.7kg and 12.2 ± 19.8% at 2years, 5.3 ± 9.1kg and 8.7 ± 14.9% at 3years, 3.1 ± 12.0kg and 3.2 ± 21.6% at 4years, and 3.9 ± 13.1kg and 7.0 ± 23.8% at 5years. The percentage of patients with obstructive sleep apnea, hypertension, hyperlipidemia, and diabetes did not change over time. Patients who received a pursestring revision or had a greater percent reduction in stoma diameter had more significant %EBWL. Weight loss after EGJR is sustained up to 5years after revision with little effect on medical comorbidities. Patients with a greater reduction in stoma diameter experienced superior weight loss.