Maintain Weight Loss Research Articles

The Aussie-FIT process evaluation: feasibility and acceptability of a weight loss intervention for men, delivered in Australian Football League settings

Objective This process evaluation aimed to evaluate the feasibility and acceptability of Aussie-FIT, a group-based weight loss intervention for men with overweight and obesity in Australia. Design Process data and data collected from: (1) six-participant focus groups (n= 24), (2) coach interviews (n = 4), (3) audio recordings of Aussie-FIT sessions and (4) post-program participant surveys (n= 93) were analysed. Main Outcome Measures We explored the feasibility and acceptability of program setting and context, recruitment strategies, factors impacting implementation and mechanisms of impact. Results Recruitment via Australian Football League (AFL) clubs was highly effective; 426 men expressed interest within 3 days of advertising, 130 men took part. Program attendance was not consistently recorded by coaches. Coach interviews indicated a ‘core group of men’ participated in each session (typically 10–12 of 15 men). Program delivery proved feasible in the AFL context. Program acceptability and satisfaction were high. Internalisation of autonomous motives was identified as driving behaviour change. Behaviour change to support maintained weight loss was facilitated through habit formation, goal setting and effective management of multiple goals. Conclusion Aussie-FIT sets a blueprint for future weight loss interventions that utilise behaviour change strategies and principles of self-determined motivation to support men to lose weight. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12617000515392. © 2021 Informa UK Limited, trading as Taylor & Francis Group

Motivations to exercise in young men following a residential weight loss programme conducted in National Service - a mixed methods study

BackgroundPhysical activity is a critical component of lifestyle interventions to reduce body weight and maintain weight loss. The goal of this study was to examine the motivations to exercise in young men following a 5-month residential weight loss programme conducted in the Singapore military as part of National Service.MethodsWe conducted a sequential mixed methods study starting with three focus groups comprising 21 programme instructors. Fifteen former programme participants aged 20.8 years (±1.4) with an average body mass index (BMI) of 29.3 kg/m2 (±4.6) were interviewed in-depth over a total duration of 9 h. Another 487 current programme participants aged 20.8 years (±1.1), BMI 27.1 kg/m2 (±2.6), completed a survey on weight loss, physical fitness, and motivations to exercise using the Behaviours Regulating Exercise Questionnaire (BREQ-3). Qualitative data was coded thematically using the six constructs of exercise motivation described by self-determination theory: amotivation, external, introjected, identified and integrated regulation and intrinsic motivation. Quotes from interviewees were cross-tabulated according to their weight maintenance trajectories. BREQ-3 responses were analysed according to initial body mass index (BMI), percentage weight loss and fitness.ResultsOver the course of the residential programme interview and survey participants experienced an average weight loss of 15.6 kg (±6.5) and 13.0 kg (±5.4) respectively. Among the fifteen interviewees seven had gained no more than 34% of initial weight loss 6 months after completing the programme while another eight had gained more than 51%. We elicited three key themes from the data: (1) Barriers to exercise; (2) diminishing extrinsic motivation; and (3) unidentified exercise benefits. The integration of findings uncovered reinforcing motivational patterns in the areas of health, fitness, camaraderie and identified regulation. Narratives of self-acceptance and shift-work environments gave rise to potentially deleterious motivational patterns. Our findings suggest that successful transition from a residential programme to independent weight management requires a more deliberate pivot from predominantly extrinsic to intrinsic motivational approaches.ConclusionResidential programmes such as the one investigated here, should develop a deliberate transition strategy, replace weight loss targets with physical performance goals and promote sports that are appropriate for young men affected by overweight and obesity.

15. Trends in Medicare Reimbursement for Body Contouring Surgeries from 2009-2018: What Does This Mean for the Massive Weight Loss Population?

Body: Background: In the setting of the obesity epidemic, there is an increasing number of bariatric surgeries. These patients undergo massive weight loss (MWL) and often have excess skin resulting in physiological and psychological symptoms. Recent studies demonstrate that post-bariatric patients who undergo body contour surgery (BCS) are more likely to maintain weight loss and demonstrate higher scores for psychological wellbeing and quality of life. The most common BCS desired and performed for MWL addresses excess abdominal skin. Given these benefits of BCS, we aimed to determine whether Medicare reimbursement for bariatric surgeries and BCS has changed from 2009 to 2018. Methods: Using CPT Professional 2019, 6 bariatric codes and 14 BCS plastic surgery codes were identified. Data for each code was abstracted from the CMS Part B National Summary Data Files (2009-2018). Payments per procedure and number of procedures were analyzed via linear regression. Payments were adjusted for inflation to 2018 prices. Results: From 2009 to 2018, Medicare’s reimbursement per gastric procedure increased by 9% and the number of reimbursed gastric procedures decreased by 61%. Medicare reimbursement per procedure decreased for panniculectomy from $811 to $768 (-5%), abdominoplasty from $301 to $275 (-9%), and trunk liposuction from $446 to $314 (-29%). For other BCS, there was an increase in reimbursement per lower leg lipectomy (+12%), forearm lipectomy (+19%), chin lift (+5%), hip lipectomy (+93%), thighplasty (+42%), brachioplasty (+53%) and decrease for butt lifts (-6%). With linear regression analysis, the change in reimbursement was found to be significant (p<0.05) for abdominoplasties, thighplasty, brachioplasty, and hip lipectomies. For the number of procedures, there was an increase in the number of reimbursed panniculectomies from 2003 to 2749 (+37%), abdominoplasties from 318 to 438 (+38%), and trunk liposuctions from 25 to 46 (+84%). There was a decrease in lower leg lipectomies (-18%), hip lipectomies (-57%), butt lifts (-24%), chin lifts (-31%), thighplasties (-26%), brachioplasties (-28%), and forearm lipectomies (-25%). Conclusion: Medicare coverage from 2009 to 2018 for BCS demonstrates a decrease in reimbursed payment of BCS for the abdomen and an increase in reimbursed payment of BCS for certain other areas.

Patient motivation to lose weight: Importance of healthcare professional support, goals and self-efficacy

BackgroundPeople with obesity (PwO) often struggle to achieve and maintain weight loss. This can perpetuate and/or be influenced by feelings of low motivation. This analysis from ACTION-IO data identified factors associated with PwO motivation to lose weight. MethodsPwO completed an online survey in 11 countries. Exploratory multinomial logistic regression analyses identified independent variables associated with self-report of feeling motivated versus not motivated to lose weight. ResultsData from 10,854 PwO were included (5,369 motivated; 3,312 neutral; 2,173 not motivated). Variables associated with feeling motivated versus not motivated included (odds ratio [95% confidence interval]): acknowledgement of healthcare professional (HCP) responsibility to contribute to weight loss (2.32 [1.86–2.88]), comfort in talking to their HCP about weight (1.46 [1.24–1.72), agreement that it is easy to lose weight (1.73 [1.30–2.31]), and a goal of reducing risks from excess weight (1.45 [1.22–1.73]). Conversely, if PwO considered obesity less important than other diseases they were less likely to report feeling motivated (0.49 [0.41–0.58]). PwO who reported being motivated to lose weight were more likely to exercise ≥5 times a week versus <1 time a week (2.77 [2.09–3.68]) than those who reported they were not motivated. ConclusionsPositive interactions with HCPs, self-efficacy, setting goals and knowledge of the importance of weight management, in addition to regular exercising, may increase PwO motivation for weight loss. Appropriate HCP support may help PwO who are ready to engage in weight management. Clinical trial registration: NCT03584191.

Motives for weight loss and weight loss maintenance: results from the MedWeight study.

The relationship of weight loss motives with long-term outcomes is equivocal. We aimed to examine differences in weight loss motives of maintainers and regainers, as well as explore associations between motives and successful maintenance. The study sample includes 607 adults, with a history of overweight/obesity and self-reported ≥10% voluntary weight loss, 12months before study entry. Participants were classified as maintainers (weighing ≤90% maximum weight) or regainers. Volunteers identified possible motives for weight loss and maintenance (maintainers only), from a specific list. Both maintainers and regainers were predominantly motivated by physical appearance (38.6% versus 39.9%, P>0.05) and self-esteem (26.8% versus 32.0%, P>0.05) for weight loss. Compared to regainers, more maintainers reported weight reduction driven by social purposes (16.6% versus 9.4%, P=0.022) and less were prompted by friends/family to lose weight (21.1% versus 31.7%, P=0.005). In maintainers, shifts in motives from weight loss to maintenance phase were found, including an increased prevalence of health motives (6.4% versus 9.6%, P<0.001) and decreased physical appearance motives (38.6% versus 30.3%, P<0.001). Reporting physical appearance as main maintenance motive was inversely associated with maintained weight loss, after adjusting for age, sex and years of education (B=-3.49 [1.07], P=0.001); maintainers reporting physical appearance as the main motive maintained 3.5% less weight loss compared to those who did not (P=0.001). The present study has highlighted motivational influences associated with weight loss outcomes. Future studies should explore the ability of people with overweight/obesity to act upon motives for long-term weight management, as well as the impact of shifting through motives on the magnitude of maintenance.

The Role of Life Style Modifications in Comprehensive Non-Alcoholic Fatty Liver Disease Treatment.

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Demonstration and Promotion of Hermetic Bag Storage for The Management of Maize Weevil in Mid- Altitude Agroecologyandrsquo;s of Ethiopia

The experiment was conducted for two years in 2018 to 2019 cropping seasons to demonstrate and promote hermetic bag storage for the management of maize weevil and to disseminate/scale-out possible knowledge of maize storage. The experiment was replicated 3 × 5 in randomized complete block designs. Three farmers from each selected kebele’s are used as replication 3 × 5 from five agroecology’s of Bako, Ambo, Hawassa, Jimma and Bure. From each kebele’s in each agroecology’s nine household farmers were selected where a total of 270 samples were collected. All the data the collected were analyzed using analysis of variance (ANOVA) and difference among means were separated by the least significant difference (LSD). The correlation between parameters were examined using Pearson‘s correlation coefficient using PROC CORR procedure of the SAS software. The result revealed that hermetic bag storage structures was significant different (P < 0.05) form the two storage and caused 100% mortality of the weevils. Significant (P < 0.05) high mean values 9.22 and 9.66% of grain damage and weight losses was observed in the untreated sack from this research, it can be concluded that hermetic bag storage showed better result in reducing insect-damage, maintaining weight loss, germination percentage and grain quality than chemically treated sack in each location. This is due to the biochemical analysis between the grains and insect respiration which reduces oxygen in the storage and increases carbon dioxide and cause of lack of oxygen resulted in insect’s mortality. Therefore, it is concluded that hermetic bag better than using insecticides in reducing of weevils, grains damage and weight losses and maintaining grain quality as well as germination percentage.

Endobariatric procedures for obesity: clinical indications and available options.

Obesity remains a growing public health epidemic that has increased healthcare costs and related comorbidities. Current treatment guidelines encourage a multidisciplinary approach starting from patient selection, interventions, and long-term follow-up to maintain weight loss. However, these conservative interventions are largely ineffective at reducing body weight due to low adherence to the treatment regimen. Recently, endoscopic bariatric therapies have become an attractive alternative to traditional invasive bariatric surgeries due to their improved efficacy, safety, and cost-effectiveness. Endoscopic bariatric therapies include intragastric balloon placement, endoscopic sleeve gastroplasty, gastric bypass revision, and aspiration therapy. These procedures fall into two separate categories depending on the primary mechanism involved: restrictive or malabsorptive. Restrictive methods, such as the Orbera® and ReShape™ intragastric balloons, increase satiation and delay gastric emptying while decreasing the amount of food that can be ingested. In contrast, malabsorptive devices, such as the EndoBarrier®, interfere with the small intestine’s ability to absorb food while restoring normal gastrointestinal hormone levels regulating satiation. Together, these techniques provide useful alternatives for patients in whom pharmacological or lifestyle modifications have proven ineffective. Despite these advantages, the long-term effects of these procedures on metabolic changes remain to be studied. Furthermore, the management of complications from these procedures continues to evolve. In this review, we aim to elaborate on the clinical indications and efficacy of the endobariatric procedures, together with various types of available endoscopic bariatric therapy procedures.

Association of weight loss and weight loss maintenance following diabetes diagnosis by screening and incidence of cardiovascular disease and all-cause mortality: An observational analysis of the ADDITION-Europe trial.

Short-term weight loss may lead to remission of type 2 diabetes but the effect of maintained weight loss on cardiovascular disease (CVD) is unknown. We quantified the associations between changes in weight 5 years following a diagnosis of diabetes, and incident CVD events and mortality up to 10 years after diagnosis. Observational analysis of the ADDITION-Europe trial of 2730 adults with screen-detected type 2 diabetes from the UK, Denmark and the Netherlands. We defined weight change based on the maintenance at 5 years of weight loss achieved during the year after diabetes diagnosis, and as 5-year overall change in weight. Incident CVD events (n = 229) and all-cause mortality (n = 225) from 5 to 10 years follow-up were ascertained from medical records. Gaining >2% weight during the year after diabetes diagnosis was associated with higher hazard of all-cause mortality versus maintaining weight [hazard ratio (95% confidence interval): 3.18 (1.30-7.82)]. Losing ≥5% weight 1 year after diagnosis was also associated with mortality, whether or not weight loss was maintained at 5 years: 2.47 (0.99-6.21) and 2.72 (1.17-6.30), respectively. Losing ≥10% weight over 5 years was associated with mortality among those with body mass index <30 kg/m2 [4.62 (1.87-11.42)]. Associations with CVD incidence were inconclusive. Both weight loss and weight gain after screen-detected diabetes diagnosis were associated with higher mortality, but not CVD events, particularly among participants without obesity. The clinical implications of weight loss following a diagnosis of diabetes probably depend on its magnitude and timing, and may differ by body mass index status. Personalization of weight loss advice and support may be warranted.

Understanding children and young people's experiences pursuing weight loss maintenance using the Socio-ecological Model: A qualitative systematic literature review.

Developing a broader understanding of children and young people's experiences of long-term attempts of weight management may provide insight into both enablers and barriers to successful weight loss maintenance. This review aims to explore children and young people's perceptions of long-term attempts of weight management. Six databases were searched for qualitative studies describing young participants (<25 years, previously or currently above a healthy weight) experiences of weight management for >6 months following intentional weight loss. A thematic synthesis was undertaken. Themes were interpreted using the Socio-ecological Model. Factors supporting attempts to maintain weight loss included having clear motivation for change; developing personal skills to manage the challenges of change; family support/dynamics that encourage healthy lifestyles; and health-promoting cultures in schools/workplaces, communities, and the broader living environment. Conversely, ambivalence, difficulty coping with changes, peer pressure, challenging family dynamics, limited professional support, and unhealthy living environments were barriers to maintaining behavior change. These facilitators and barriers at each level of the Socio-ecological Model informed a model of weight loss maintenance for children and young people. Supporting children, young people, and families to develop the skills to manage the individual, social, and environmental challenges that shape attempts of long-term weight management will help to support their ability to manage their weight long term.

Simulating the impact of health behavior interventions in the SNAP-Ed population.

In 2020, the US invested $441 million dollars in the Supplement Nutrition Assistance Program Education (SNAP-Ed), a program that encourages a healthy diet and promotes physical activity. Understanding the long-term health outcomes associated with promoting physical activity versus weight loss among the low-income population it serves could help guide the direction of future program efforts. We used the Future Americans Model (FAM), a microsimulation, to model over 10years the impacts of changes in Body Mass Index (BMI) and exercise interventions on future health outcomes among adults aged 25 and older that could potentially accrue from SNAP-Ed interventions. We applied data from the Panel Study of Income Dynamics and data collected from 2,323 SNAP-Ed eligible adults in Los Angeles County in 2019. By 2029 interventions that increased vigorous physical activity by 20% would reduce the prevalence of difficulties with activities of daily living (ADL) by 4.72%. Interventions that would reduce BMI by 0.5 could decrease the prevalence of diabetes and heart disease by 5.34% and 0.66%, respectively. Helping people maintain weight loss, even as little as 3-4lb, results in significant future health benefits. Given continued increases in weight at the population level, weight maintenance should be a focus of future interventions.

Physical Activity Recommendations for Adults in Yemen

Background: Physical inactivity is one of the most crucial global problems in spite of the approved impact of physical activity in enhancing health and preventing NCDs, osteoporosis and many other diseases. Thus, WHO encouraged the countries to set their own physical activity guidelines based on the international physical activity recommendations, however, many countries do not have their national Physical activity recommendations such as Yemen in Eastern Mediterranean Region.Objectives: To suggest proper physical activity recommendations for adults in Yemen based on physical activity recommendations in different countries in WHO regions particularly the Eastern Mediterranean Region.Discussion: Prevalence of national physical activity guidelines and physical activity factors vary among WHO regions. The absence of physical activity recommendations and statistical data in Yemen is obvious and surveillance using validated tools should be done to assess the recent PA and related factors. However, although Yemen has its own issues such as Khat chewing habit and conflict, it shares many factors with other Eastern Mediterranean Region countries in general and Qatar in particular such as unsupportive physical activity environment and limited outdoor activities for women. Conclusion: Qatar national physical activity guidelines can be suggested as applicable and affordable guidelines for adults in Yemen. According to Qatar guidelines, adults should do (30–60) min of moderate exercise ≥ 5 days per week or (20–60) min of vigorous exercise for ≥3 days per week and in case of promoting or maintaining weight loss, they should do (50-60) minutes daily exercise. Many studies should be done to assess recent physical activity and related barriers to draw evidence-based physical activity guidelines for adults in Yemen.Background: Physical inactivity is one of the most crucial global problems in spite of the approved impact of physical activity in enhancing health and preventing NCDs, osteoporosis and many other diseases. Thus, WHO encouraged the countries to set their own physical activity guidelines based on the international physical activity recommendations, however, many countries do not have their national Physical activity recommendations such as Yemen in Eastern Mediterranean Region.Objectives: To suggest proper physical activity recommendations for adults in Yemen based on physical activity recommendations in different countries in WHO regions particularly the Eastern Mediterranean Region.Discussion: Prevalence of national physical activity guidelines and physical activity factors vary among WHO regions. The absence of physical activity recommendations and statistical data in Yemen is obvious and surveillance using validated tools should be done to assess the recent PA and related factors. However, although Yemen has its own issues such as Khat chewing habit and conflict, it shares many factors with other Eastern Mediterranean Region countries in general and Qatar in particular such as unsupportive physical activity environment and limited outdoor activities for women. Conclusion: Qatar national physical activity guidelines can be suggested as applicable and affordable guidelines for adults in Yemen. According to Qatar guidelines, adults should do (30–60) min of moderate exercise ≥ 5 days per week or (20–60) min of vigorous exercise for ≥3 days per week and in case of promoting or maintaining weight loss, they should do (50-60) minutes daily exercise. Many studies should be done to assess recent physical activity and related barriers to draw evidence-based physical activity guidelines for adults in Yemen.

Cognitive Behavioral Therapy Versus Usual Care Before Bariatric Surgery: One-Year Follow-Up Results of a Randomized Controlled Trial

BackgroundAlthough early results of bariatric surgery are beneficial for most patients, some patients regain weight later. Cognitive behavioral therapy (CBT) has been suggested as a way to improve patients’ psychological health and maintaining weight loss in the longer term. The added value of preoperative CBT to bariatric surgery was examined. Pre- and posttreatment and 1-year follow-up data are presented.MethodsIn a multi-center randomized controlled trial, CBT was compared to a treatment-as-usual (TAU) control group. Measurements were conducted pre- and posttreatment/pre-surgery (T0 and T1) and at 1-year post-surgery (T2). Patients in the intervention group received 10 individual, weekly sessions of preoperative CBT focused on modifying thoughts and behaviors regarding eating behavior, physical exercise, and postoperative life style. Outcome measures included weight change, eating behavior, eating disorders, depression, quality of life, and overall psychological health.ResultsThough no significant differences between conditions were found per time point, in the CBT, condition scores on external eating, emotional eating, depressive symptoms, and psychological distress decreased significantly more over time between pre- (T0) and posttreatment (T1) pre-surgery compared to TAU. No significant time x condition differences were found at 1-year post-surgery (T2).ConclusionsCompared to TAU, preoperative CBT showed beneficial effects on eating behavior and psychological symptoms only from pretreatment to posttreatment/pre-surgery, but not from pre-surgery to 1-year post-surgery. Preoperative CBT does not seem to contribute to better long-term outcomes post-surgery. Recent studies suggest that the optimal time to initiate psychological treatment may be early in the postoperative period, before significant weight regain has occurred.Trial Registrationhttps://www.trialregister.nl Identifier: Trial NL3960.

A qualitative study of men's behavioural changes during weight loss maintenance.

Aim:This study aims to understand the behaviour changes men who attended a weight loss programme engage in during weight maintenance. Understanding the needs of men in the context of weight loss maintenance is important, as they are underrepresented in this body of literature.Method:Given its focus on personal experience, this study adopted a qualitative design. Semi-structured interviews supported by participant-generated photo-elicitation techniques to explore the behavioural changes 12 men engaged in 6 months after attending a men-only weight loss programme. Data analysis was undertaken through thematic analysis and Gleeson’s polytextual thematic analysis.Results:This study suggests that the key behaviours men engaged in to maintain weight loss can be classified into four categories: (1) ‘Small’ changes, (2) Informed decisions, (3) Monitoring of behaviours, and (4) Dealing with ambivalence.Conclusion:This study makes an original contribution to knowledge and can have important implications for practice in the area of men’s health, particularly with regard to the long-term impact of weight loss interventions.

Counselor Surveillance of Digital Self-Monitoring Data: A Pilot Randomized Controlled Trial.

This pilot study tested counselor access to participants' digital self-monitoring (SM) data as a means of improving long-term lifestyle modification (LM) outcomes. After 12 weeks of weight-loss treatment, participants (N = 77) were randomized to LM or LM+SHARE for weeks 13 to 52. All participants received monthly phone calls and weekly text messages from weeks 13 to 52 and were instructed to engage in daily digital SM of weight, eating, and exercise. In LM+SHARE, but not LM, counselors had access to SM device data. Assessments were conducted as weeks 0, 13, 26, and 52. Retention, engagement, and treatment satisfaction were excellent. LM+SHARE participants, compared with LM, had more frequent SM of weight and eating. Weight loss continued at a similar rate in both conditions from weeks 13 to 26. From weeks 26 to 52, those in LM regained approximately 2 kg, whereas those in LM+SHARE maintained weight loss, a significant difference. Nonetheless, total weight loss did not significantly differ by condition. Engagement in dietary SM mediated the effect of condition on weight. Counselor access to SM data is feasible and acceptable. Additional research is warranted to determine whether it can meaningfully improve outcomes.

'I have been all in, I have been all out and I have been everything in-between': A 2-year longitudinal qualitative study of weight loss maintenance.

Qualitative studies investigating weight management experiences are usually cross-sectional or of short duration, which limits understanding of the long-term challenges. Eleven women [mean (SD) age 44.9(9.8)years; body mass index 40.3(4.0)kg m-2 ] participated in this longitudinal qualitative study, which included up to 20weeks of total diet replacement (825-853kcal day-1 ) and ongoing support for weight loss maintenance (WLM), to 2years. Semi-structured interviews were conducted at baseline and programme end, as well as at key intervals during the intervention. Questions examined five theoretical themes: motivation, self-regulation, habits, psychological resources and social/environmental influences. Data were coded and analysed in nvivo (https://qsrinternational.com/nvivo) using the framework method. In total, 64 interviews were completed (median, n=6 per participant). Mean (SD) weight loss was 15.7(9.6)kg (14.6% body weight) at 6months and 9.6(9.9)kg (8.8% body weight) at 2years. The prespecified theoretical model offered a useful framework to capture the variability of experiences. Negative aspects of obesity were strong motivations for weight loss and maintenance. Perceiving new routines as sustainable and developing a 'maintenance mindset' was characteristic of 'Maintainers', whereas meeting emotional needs at the expense of WLM goals during periods of stress and negative mood states was reported more often by 'Regainers'. Optimistic beliefs about maintaining weight losses appeared to interfere with barrier identification and coping planning for most participants. People tended to be very optimistic about WLM without acknowledging barriers and this may undermine longer-term outcomes. The potential for regain remained over time, mainly as a result of emotion-triggered eating to alleviate stress and negative feelings. More active self-regulation during these circumstances may improve WLM, and these situations represent important targets for intervention.

Determinants favoring weight regain after weight-loss therapy among postmenopausal women

Little is known about the factors affecting body weight-loss maintenance among postmenopausal women. We thus performed an analysis to identify some sociodemographic, physiological, and behavioral predictors of weight regain in a targeted subpopulation of women who had lost weight 1 year earlier. We also measured how eating behaviors and habits as well as physical activity pattern differ among successful and unsuccessful weight-loss maintainers over the trial. Sixty-four postmenopausal women were followed up for a year after dieting, and the successful and unsuccessful maintainers were identified. The regainers had regained an average of 4.9 kg of their lost body weight, while the maintainers had regained only 1.5 kg. Regainers had fewer years of education and lower initial body weight loss than maintainers. They also showed poor dietary adherence during dieting, and had unhealthy patterns of eating involving the avoidance of breakfast and a lower intake of nuts, seeds, and pulses, and a higher intake of sweets, biscuits, cakes, and pastries over time (excluding the dieting period). All the significant sociodemographic, physiological and behavioral variables differentiating regainers and maintainers before and after dieting were then examined as independent variables in a logistic regression model. The model showed that less weight reduction during dieting, higher disinhibition scores after dieting, and avoidance of breakfast before dieting were significant predictors of body weight regain in postmenopausal women. From a practical point of view, early identification of postmenopausal women who are at risk of regaining lost weight can allow health professionals to create behavioral and dietary supports to help prevent this. A regular schedule of follow-ups over at least the first year should be considered for them—including psychological and dietary intervention, if necessary. Since this sample study included only postmenopausal women, our findings are not generalizable to other populations.

Rural breast cancer survivors are able to maintain diet quality improvements during a weight loss maintenance intervention.

Obesity and poor diet quality (DQ) are associated with increased risk of morbidity/mortality among breast cancer survivors. This study explored DQ changes during a weight loss maintenance intervention in a cohort of rural female breast cancer survivors (n = 131) who lost ≥ 5% body weight in a weight loss intervention. Previous analyses demonstrated significant DQ improvements during weight loss. DQ was calculated using the alternate Healthy Eating Index (aHEI)-2010. Differences in scores across time for the cohort and between those that maintained weight loss within 5% (low regainers) and those that regained > 5% (high regainers) were analyzed by linear mixed models. Significant improvements in aHEI total score were observed from baseline (M = 52.3 ± 11) to 6months (M = 60.7 ± 8; p < 0.001); these improvements were sustained from 6 to 18months (M = 58.4 ± 11; p = 0.16). Total aHEI-2010 score at 18months was higher in low regainers, compared with high regainers (60.7 vs. 56.0, p = 0.03), with healthier component scores for red meat (p = 0.01) and fruit (p = 0.04), and a trend for a healthier score for sugar-sweetened beverages (p = 0.08). Overall DQ improvements made during a weight loss intervention for rural breast cancer survivors were sustained during a weight loss maintenance intervention; this intervention was effective in helping low regainers maintain healthier scores in fruit, red meat, and sugar-sweetened beverage components. Maintaining higher DQ may help breast cancer survivors maintain weight loss, thereby reducing risk of breast cancer recurrence and premature death from comorbidities.

Dietary Quality Changes According to the Preceding Maximum Weight: A Longitudinal Analysis in the PREDIMED-Plus Randomized Trial.

One-year dietary quality change according to the preceding maximum weight in a lifestyle intervention program (PREDIMED-Plus trial, 55–75-year-old overweight or obese adults; n = 5695) was assessed. A validated food frequency questionnaire was used to assess dietary intake. A total of 3 groups were made according to the difference between baseline measured weight and lifetime maximum reported weight: (a) participants entering the study at their maximum weight, (b) moderate weight loss maintainers (WLM), and (c) large WLM. Data were analyzed by General Linear Model. All participants improved average lifestyle. Participants entering the study at their maximum weight were the most susceptible to improve significantly their dietary quality, assessed by adherence to Mediterranean diet, DII and both healthful and unhealthful provegetarian patterns. People at maximum weight are the most benefitted in the short term by a weight management program. Long term weight loss efforts may also reduce the effect of a weight management program.

The Influence of Health Literacy and Health Numeracy on Weight Loss Outcomes Following Bariatric Surgery.

Although cognitive functioning and health literacy are related to weight loss 1year following bariatric surgery, the influence of health numeracy (i.e., health-related mathematical abilities) is unknown. In addition, further research is needed to examine the impact of all these factors on longer-term weight loss outcomes to determine if they influence the ability to maintain weight loss. Single bariatric center. Patients (N = 567) who underwent bariatric surgery from 2014-2017 completed a brief survey including current weight. Retrospective chart reviews were conducted to gather information from the presurgical evaluation including weight, body mass index (BMI), health literacy, health numeracy and score on a cognitive screener. Among participants in the weight loss period (< 2 years postsurgery), health literacy, health numeracy and cognitive functioning were not related to change in BMI (ΔBMI), percent total weight loss (%TWL) or percent excess weight loss (%EWL). However, for participants in the weight maintenance period (2-4 years postsurgery), higher health literacy scores were related to greater change in ΔBMI, and higher health numeracy scores were related to greater ΔBMI, %TWL, and %EWL. Although health literacy and health numeracy did not predict weight loss outcomes for those in the initial weight loss period, they were related to weight outcomes for participants in the weight maintenance period. This suggests that health literacy and health numeracy may play a role in facilitating longer-term weight maintenance among patients who undergo bariatric surgery. Clinicians conducting presurgical psychosocial evaluations should consider routinely screening for health literacy and health numeracy.