Participation In Weight Loss Programs Research Articles

A Novel Intervention Including Personalized Nutrition and Exercise Recommendations Lowers Haemoglobin A1c, Weight, Waist Circumference, and Medication use in Diabetes and Obesity

Background: The prevalence of diabetes and obesity has increased globally, but population-level health outcomes have not improved significantly. Diabetes medications are often associated with weight gain, hypoglycaemia, and cardiovascular risks. People with diabetes and obesity often receive generic “eat less, exercise more” guidelines that do not lead to sustainable outcomes. Objective: Evaluate the effectiveness of a personalized intervention focused on Plant-Based Whole Foods (PBWF), Time Restricted Eating (TRE), and Fractionized Exercise (FE) in reducing blood glucose, weight, waist circumference, and medication use. Methods: A retrospective study was conducted on a non-randomized group of 41 participants. Adults with diabetes or prediabetes (68%) or obesity (32%) (mean age: 47 years; SD: 13 years; 76% male) received personalized coaching remotely and digitally for 3 to 6 months, depending on their health and motivation baseline. A total of 35 participants completed their intervention. The primary measures were changes in HbA1c, fasting and postprandial glucose levels, weight, waist circumference, and medication use. Results: The intervention yielded significant improvements in various health parameters among the Diabetic/Prediabetic and Weight loss program participants. Specifically, a reduction was observed from baseline to completion in HbA1c by 1.64 percent points, fasting glucose by 24 percent, postprandial glucose by 27 percent, weight by 3.4 percent, and waist circumference by 3.2 percent in the Diabetic/Prediabetic program participants. In the Weight loss program participants, there was a reduction in weight by 7.5 percent and waist circumference by 6.8 percent. Participants with diabetes who were on insulin injections prior to the start of the intervention reduced their insulin doses by 67 percent by the end of their personalized program. Participants onnon-insulin, oral hypo-glycaemic agents at baseline reduced such medication categories by 27 percent. Conclusions: The findings suggest that a personalized program combining PBWF, TRE, and FE can significantly improve the biomarkers of metabolic health in individuals with diabetes and obesity while reducing the need for medications.

Motivating Weight Loss Among Black Adults in Relationships: Recommendations for Weight Loss Interventions.

Black men and women have the highest rates of obesity in the United States. Behavioral weight loss programs incorporating intimate partners may be effective in combating obesity among this population. Yet, current participation in these programs is low. Identifying motivations and triggers to weight loss may provide insight in designing programs to increase participation. To determine triggers and motivations for weight loss among Black men and women in committed relationships to inform development of weight loss interventions. Twenty semi-structured interviews, based on an integrated theoretical framework of interdependence and communal coping and the social cognitive theory, were conducted among Black heterosexual couples where one or both individuals intentionally lost ≥5% of their body weight in the last 6 months in a metropolitan region in a southern state. Interviews were transcribed and coded. Themes were identified following multi-rater coding and direct and conventional content analysis. Recommendations were developed from emergent themes. Among individuals with recent weight loss, personal relevancy and awareness (health awareness and self-awareness) were identified as personal triggers for weight loss initiation. Health concerns and appearance were general motivations among the total sample. Emphasizing the impact of weight on daily functioning and quality of life, and increasing awareness of personal weight status and health consequences, may increase weight loss initiation and participation in weight loss programs among Black men and women in committed relationships. Findings also highlight strategies to improve recruitment and retention and guide intervention development and implementation for this population.

A qualitative investigation of the need for and feasibility of weight loss programs on university campuses

BackgroundDespite the public health significance of overweight and obesity, weight management has remained a low priority for health-related programming on university campuses. ObjectiveInvestigate the need for and feasibility of implementing university-based weight loss programs. MethodsThe Practical, Robust Implementation and Sustainability Model (PRISM) was used as a framework. Semi-structured individual interviews were conducted with fifteen university staff and students from two large U.S. universities in the Northeast and Mid-Atlantic. Interviews aimed to assess readiness, preferences, characteristics, barriers and facilitators in each of the four adapted PRISM domains: (1) Organizational and Recipient (Student) Perspectives on the Intervention, (2) Recipient (Student) Characteristics, (3) Internal Environment (organizational characteristics and infrastructure), and (4) External Environment. Verbatim transcriptions were analyzed using inductive and deductive thematic analyses. Themes were extracted as outlined by Consensual Qualitative Research. ResultsParticipants supported university-based weight loss programs, but recognized barriers of resources, coordination across entities, and competing health issues taking priority for school programming. Campus built environment and students’ busy schedules were identified as barriers to maintaining healthy weight and participation in weight loss programs. Recommendations included designing weight loss programming with a positive and holistic approach, minimizing weight-stigma, ensuring support from university leaders and students, and securing external funding. ConclusionsThe identified themes provide recommendations for universities looking to develop and implement weight loss programming.

Evaluation of the Success of Weight Loss Programs Using the Fit for Performance Curriculum.

Overweight and obesity rates continue to rise among U.S. Army soldiers, which impacts their overall readiness status and puts them at greater risk for musculoskeletal injury and development of chronic disease. To address the concern with obesity and ensure that Soldiers are meeting body composition standards, the Army offers Fit for Performance-Weight Loss Strategies curriculum, a program of standardized material on nutrition and physical activity presented over six 1-hour sessions. This study aimed to evaluate the success and attrition of weight loss programs using the Fit for Performance curriculum in an Army setting among TRICARE regions. This retrospective cohort study consolidated data on participants in weight loss programs using the Fit for Performance curriculum. It examines attrition rates, weight loss, change in body mass index (BMI), factors influencing weight loss, and attrition based on geographical location. Statistical analysis was completed using R Core Team software, version 3.6.1, for t-tests, linear regression, and analysis of variance. Significance was set at P ≤ .05. This study was determined to be exempt by the Walter Reed National Military Hospital Institutional Review Board. In total, 8,336 U.S. Army soldiers (80% male, mean age = 26.2 ± 6.9 years) participated in the program. Attrition rates were high (96.4%). Those who attended 4-6 sessions lost significantly more weight than those who attended 1-3 sessions (0.72 kg [1.60lbs], P<.001); however, weight lost was not clinically significant. Sex, age, and number of sessions attended influenced to the amount of weight lost, but only accounted for 4% of the variation. Among TRICARE regions there was a significant difference in attrition rates, with those in the Western (1.2 sessions, P < .001) and Overseas (1.6 sessions, P<.001) regions attending statistically fewer sessions than those in the Eastern region. Consistent attendance in a weight loss program promotes changes in BMI, which may improve the health of the force. However, the factors influencing these changes are unclear. The results indicate opportunities to re-examine current processes and the program elements to encourage increased or complete participation and determine if program element changes are warranted for the Fit for Performance-Weight Loss Strategies Program. Attrition rates were high, indicating opportunities to research reasons for attendance and attrition in the future. Finally, these findings highlight an opportunity for educating the military leadership on the increased success with increased attendance.

Postpartum Weight Retention: A Retrospective Data Analysis Measuring Weight Loss and Program Engagement with a Mobile Health Program.

Background: Mobile health (mHealth) technology can circumvent barriers to participation in weight loss programs faced by new mothers. The objective of this study was to assess weight change and program engagement in postpartum women (n = 130) participating in a 24-week behavior change mHealth weight-loss intervention. Materials and Methods: Participants were recruited through a program offered on a commercial mHealth application that provided evidence-based lifestyle interventions. To meet inclusion criteria, women had to be 18-45 years of age, and given birth within 2 years before the start of the study. Participants signed up for the Noom Healthy Weight program between January and March of 2019 and were offered the program free of charge. Linear mixed models were conducted; the primary outcome was weight change from baseline at 16 and 24 weeks. Secondary outcomes were program engagement and their relationship with completion status. Results: Results showed that time was a significant predictor of weight at week 16 [t(-3.94) = -9.40; p < 0.001] and week 24 [t(-4.08) = -9.74; p < 0.001]; users lost 3.94 kgs at week 16 and 4.08 kgs at week 24, compared with baseline. In addition, body mass index significantly decreased at week 24 [t(112) = 7.33, p < 0.0001] with the majority of participants (80%) experiencing reductions by more than 2 units. On average, subjects who completed the program (completers) lost more weight compared with those who did not complete the program [t(-5.09) = -2.94; p = 0.004], losing 5.09 kgs (95% CI -8.48 to -1.69) throughout the 24 weeks. Conclusion: This cohort study shows that a uniquely mobile, behavior change intervention for weight management is effective at producing significant weight loss with potential to address postpartum weight retention.

Body composition outcomes and visceral fat reduction in weight loss program participants taking antidepressant medication

ObjectiveAntidepressants are one of the most commonly prescribed therapeutic drug classes in the United States. Studies support a bidirectional link between major depressive disorder and obesity. As such, it is critical to understand how these medications may impact weight loss. In this study, we assessed changes in body composition in participants taking versus not taking antidepressant medications during a comprehensive weight loss program focused on reduction of visceral adipose tissue. MethodsData was analyzed from 2200 subjects completing a commercially available expert supervised very low calorie diet (VLCD)-based program. Overall, 23% of the subjects reported taking at least one antidepressant medication. Endpoints assessed include weight, BMI, body fat, body water, and visceral adiposity. ResultsOur data show participants taking prescription antidepressants did not negatively impact improvement in any outcome, we found both groups achieved clinically relevant progress. Improvements from baseline were statistically significant and clinically relevant for all outcome measures in both groups. ConclusionInterestingly, while antidepressants may be linked to weight gain and inhibition of one's ability to lose weight, our data show subjects currently taking at least one antidepressant achieved clinically relevant improvements in body composition outcomes on par with those not taking medications in a VLCD-based weight loss and metabolic health program.

The effect of monetary incentives on promoting weight loss in individuals with obesity

Objectives: This study evaluated the effect of a cash reward program on promoting weight loss and whether this effect will last after 1 year of follow-up. Materials and Methods: This is a retrospective analysis of a 4-month program that provides cash reward for losing weight. The study individuals were weight loss program participants, aged 18–65 years, reached after 1 year (n = 162). Participants were categorized according to their main reason for joining the program as follows: those for whom incentive was the primary reason to enroll (incentive-motivated) and those who participated mainly to lose weight regardless of the incentive (self-motivated). Results: There was a significant weight loss in all participants at the end of the 4-month program compared with that at baseline (89.49 ± 18.86 vs. 96.09 ± 20.38 kg,P

OnTrack: development and feasibility of a smartphone app designed to predict and prevent dietary lapses.

Given that the overarching goal of weight loss programs is to remain adherent to a dietary prescription, specific moments of nonadherence known as "dietary lapses" can threaten weight control via the excess energy intake they represent and by provoking future lapses. Just-in-time adaptive interventions could be particularly useful in preventing dietary lapses because they use real-time data to generate interventions that are tailored and delivered at a moment computed to be of high risk for a lapse. To this end, we developed a smartphone application (app) called OnTrack that utilizes machine learning to predict dietary lapses and deliver a targeted intervention designed to prevent the lapse from occurring. This study evaluated the feasibility, acceptability, and preliminary effectiveness of OnTrack among weight loss program participants. An open trial was conducted to investigate subjective satisfaction, objective usage, algorithm performance, and changes in lapse frequency and weight loss among individuals (N = 43; 86% female; body mass index = 35.6 kg/m2) attempting to follow a structured online weight management plan for 8 weeks. Participants were adherent with app prompts to submit data, engaged with interventions, and reported high levels of satisfaction. Over the course of the study, participants averaged a 3.13% weight loss and experienced a reduction in unplanned lapses. OnTrack, the first Just-in-time adaptive intervention for dietary lapses was shown to be feasible and acceptable, and OnTrack users experienced weight loss and lapse reduction over the study period. These data provide the basis for further development and evaluation.

Parent-Reported Deficits in Executive Function and Sleep-Disordered Breathing in Adolescent Behavioral Weight Loss Program Participants

Children and adolescents with obesity are at increased risk for developing sleep-disordered breathing (SDB), and SDB has been associated with cognitive deficits including executive dysfunction. The aim of this study was to examine the relationship between executive functioning and SDB among adolescents participating in a behavioral weight loss intervention. Adolescents (n = 37) and their caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF). Sleep was characterized by the Pediatric Sleep Questionnaire (PSQ). The Sleep-Related Breathing Disorder scale on the PSQ was used to classify participants as at risk or not at risk for SDB. The Pediatric Daytime Sleepiness Scale (PDSS) was also administered. Significant correlations were found between SDB and executive functioning (r = 0.75; p 0.05). The PSQ was predictive of the PDSS as well as the composite BRIEF score while the inhibition scale of the BRIEF predicted weight loss at 1 year. Overweight or obese adolescents participating in a behavioral weight loss program that were at increased risk for SDB were rated by caregivers as demonstrating clinically significant executive dysfunction. Furthermore, ratings of inhibitory control predicted weight loss at 1 year.

Identifying Financial Incentive Designs to Enhance Participation in Weight Loss Programs

Background: Financial incentives are routinely recommended to attract participants to weight loss programs; however there is a paucity of research that uses a systematic approach to determine incentive packages that may be most beneficial in increasing program reach or participation. Methods: The purpose of this study was to determine monetary incentive designs (in terms of magnitude, form, and timing of payment) that could increase the likelihood of participation in weight loss programs. Participants (n=863) completed surveys to collect stated preferences regarding to the magnitude, timing, and form of monetary incentives as well as willingness to participate in a weight loss program. Results: The results of our model show that, as expected, higher values of monetary incentive will increase the participation. Additionally, more flexible forms of payments (cash or grocery card as compared to gym pass or copay waiver) and more immediate payments (monthly as compared to quarterly payments) will enhance the participation in a weight loss program. Further, our second model, with respondent demographic interaction terms, shows significant differences between various groups of male participants (healthy, overweight, and obese males). This simply means that each group of male participants requires different incentive design to achieve a desired level of participation. The results do not show significant differences in incentive preference across women in different weight categories, which implies that the same monetary incentive design could be used for all women to achieve a given participation rate in a weight loss program. Conclusion: It is critical to carefully construct incentive packages offered in weight loss programs to enhance program reach. A one-size-fit-all weight loss program incentive design that ignores potential nuances in participation decisions are unlikely to be as successful in maximizing programs’ reach as programs that provide customized designs to attract different cohorts of people.

Location, Timing, and Social Structure Patterns Related to Physical Activity Participation in Weight Loss Programs

Less than half of the adults in the United States meet national guidelines for physical activity. Physical activity programs can induce short-term improvements in physical activity. To develop effective interventions, researchers and practitioners should consider the timing, location, and social structure patterns of participants. Using a pretest, posttest study design, 329 adults in a weight loss program completed surveys on their patterns and physical activity participation. Men preferred weight lifting, cycling, and jogging, whereas women preferred walking and aerobics. Black participants preferred being active in the home. Additionally, participating in a mix of group and individual activities compared with individual-only activities was predictive of posttest moderate-to-vigorous intensity and total physical activity. Providing a variety of activities for adults in both location and social structure may lead to sustained physical activity participation.

Dropout, nonusage attrition, and pretreatment predictors of nonusage attrition in a commercial Web-based weight loss program.

BackgroundAn understanding of the factors that predict retention and website use are critical to the development of effective Web-based weight loss interventions. However, poor retention (dropout attrition) and website utilization (nonusage attrition) are major inhibitors to the effectiveness of Web-based programs.ObjectiveThe study aimed to (1) describe the prevalence of dropout and nonusage attrition and (2) examine pretreatment predictors of nonusage attrition in a cohort of commercial Web-based weight loss program participants.MethodsParticipants enrolled in the online program, The Biggest Loser Club, Australia, from August 15, 2007, to May 31, 2008. Only those who subscribed for 12 or 52 weeks were included in this study. All data were collected by the program proprietors, SP Health Co Pty Ltd (Sydney, Australia), and provided in “deidentified” form. Data collected included responses to a pretreatment survey (sociodemographic and behavioral characteristics), subscription history (date of enrollment and subscription end), and website use (log-ins, food and exercise diary entries, weigh-ins, and forum posts). Participants were classified as a member of the program at 12 or 52 weeks if they held an active subscription plan at that point in time. Participants were classified as nonusers at 12 or 52 weeks if they had stopped using all of the website features and had not returned. Predictors of nonusage attrition were explored using Cox proportional hazards regression analysis.ResultsOf the 9599 eligible participants, 6943 (72%) subscribed to the program for 12 weeks, and 2656 (28%) subscribed for 52 weeks. Of all participants, 31% (2975/9599) were classified as overweight, 61% (5866/9599) were classified as obese, 86% (8279/9599) were female, and participants’ mean (SD) age was 35.7 (9.5) years. The 12 week and 52 week subscribers’ retention rates were 97% and 77% respectively. Of 12 week subscribers, 35% were classified as program “users” after 12 weeks, and 30% of 52 week subscribers were classified as “users” after 52 weeks. Significant predictors of nonusage attrition among 12 week subscribers included age (hazard ratio for 45 to 55 years of age = 0.83, 95% confidence interval [CI] 0.73 - 0.93, P = .001; hazard ratio for 55 to 65 years of age = 0.80, 95% CI 0.66 - 0.99, P = .04), exercise level (hazard ratio = 0.76, 95% CI 0.72 - 0.81, P < .001), emotional eating (hazard ratio = 1.11, 95% CI 1.04 - 1.18, P = .001), eating breakfast (hazard ratio = 0.88, 95% CI 0.82 - 0.95, P = .001), and skipping meals (hazard ratio = 1.12, 95% CI 1.04 -1.19, P = .001). For 52 week subscribers, eating breakfast (hazard ratio = 0.88, 95% CI 0.79 - 0.99, P = .04) and not drinking tea or coffee with sugar (hazard ratio = 1.23, 95% CI 1.11 - 1.37, P < .001) were the pretreatment characteristics that significantly decreased risk of nonusage attrition.ConclusionsThe findings demonstrate a high prevalence of nonusage attrition among a cohort of commercial Web-based weight loss program participants. Several sociodemographic and behavioral factors were shown to independently predict nonusage attrition.

Skipping meals and alcohol consumption: The regulation of energy intake and expenditure among weight loss participants

Research suggests that specific eating patterns (e.g., eating breakfast) may be related to favorable weight status. This investigation examined the relationship between eating patterns (i.e., skipping meals; consuming alcohol) and weight loss treatment outcomes (weight loss, energy intake, energy expenditure, and duration of exercise). Fifty-four overweight or obese adults (BMI≥27kg/m2) participated in a self-help or therapist-assisted weight loss program. Daily energy intake from breakfast, lunch, dinner, and alcoholic beverages, total daily energy intake, total daily energy expenditure, physical activity, and weekly weight loss were assessed. On days that breakfast or dinner was skipped, or alcoholic beverages were not consumed, less total daily energy was consumed compared to days that breakfast, dinner, or alcoholic beverages were consumed. On days that breakfast or alcohol was consumed, daily energy expenditure (breakfast only) and duration of exercise were higher compared to days that breakfast or alcohol was not consumed. Individuals who skipped dinner or lunch more often had lower energy expenditure and exercise duration than individuals who skipped dinner or lunch less often. Individuals who consumed alcohol more often had high daily energy expenditure than individuals who consumed alcohol less often. Skipping meals or consuming alcoholic beverages was not associated with weekly weight loss. In this investigation, weight loss program participants may have compensated for excess energy intake from alcoholic beverages and meals with greater daily energy expenditure and longer exercise duration.

Individual differences in food perceptions and calorie estimation: An examination of dieting status, weight, and gender

People frequently place foods into “health” or “diet” categories. This study examined whether (1) evaluations of “healthiness/unhealthiness” influence “caloric” estimation accuracy, (2) people evaluate foods for “healthiness/unhealthiness” or “weight gain/loss” differently, and (3) food evaluations differ by gender, diet status, and weight. Also, undergraduate dieters attempting to lose weight on their own were compared to obese weight loss program participants. Undergraduate students ( N=101) rated eight “healthy” and “unhealthy” foods on perceived “healthiness/unhealthiness,” “weight loss/gain capacity” and “caloric” content. Open-ended questions inquiring why a food was “healthy/unhealthy” or would “contribute to weight gain/loss” were coded into independent food categories (e.g., high fat). Results indicate that calories were systematically underestimated in healthy/weight loss foods, while they were systematically overestimated in unhealthy/weight gain foods. Dieters were more accurate at estimating “calories” of healthy foods and more attentive to the foods’ fat, “calorie”, and sugar content than non-dieters. Overweight participants commented more on fat and sugar content than normal weight participants. Undergraduate dieters used fewer categories for evaluating foods than weight loss program participants. Individual difference characteristics, such as diet-status, weight, and gender, influence people's perceptions of foods’ healthiness or capacity to influence weight, and in some instances systematically bias their estimates of the caloric content of foods.

Binge Eating Störung

In 1994 binge eating disorder (BED) was included into the DSM-IV as provisional diagnostic category requiring further study. The prevalence in the general population is 2%; BED is 1.5 times more common in women than men. Up to 30% of participants in weight loss programs meet criteria for BED. As opposed to patients with bulimia nervosa (BN), restraint or restrictive eating is not a necessary antecedent in the development of BED. Eating-related as well as general psychopathology is significantly more common in obese patients with BED compared to obese patients without BED. In treating obese patients with BED there are several potential goals of treatment, including cessation of binge eating and improvement of eating-related psychopathology (e.g. concerns about weight and shape), weight loss or prevention of further weight gain, improvement of physical health, and reduction of psychiatric co-morbidity. Contrary to expectations weight loss programs do not appear to worsen the eating disorder and successful treatment of binge eating does not automatically promote weight loss. Controlled treatment studies could demonstrate that psychotherapeutic approaches and drug treatment are successful in reducing binge eating episodes in patients with BED. Remission rates are generally high (e.g., 50% and more with CBT) and the overall prognosis is better than for patients with BN. Patients who achieve complete abstinence from binge eating lose more weight compared to patients who remain symptomatic; however the degree of weight loss after CBT targeting binge eating is modest and does not meet with the expectations of the patients. The long-term treatment success of drug treatment remains unclear. It is currently discussed if BED represents a truly distinct diagnostic entity.

Performance of a Weight-related Measure of Quality of Life in a Psychiatric Sample

The Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire has been validated previously in weight loss program participants and community volunteers. Because of the prevalence of obesity in individuals with schizophrenia and bipolar disorder, this study evaluates the psychometric performance of the IWQOL-Lite in these populations. A sample of 111 individuals with schizophrenia (mean age = 43.5; mean BMI = 32.6; 42.3% female; 59.5% Caucasian) and 100 with bipolar disorder (mean age = 42.8; mean BMI = 34.8; 66.0% female; 81.0% Caucasian) were recruited from four programs. Height and weight measurements were taken and participants completed the IWQOL-Lite, Medical Outcomes Study Short-Form-36 (SF-36), and Global Ratings of quality of life. Sixty-five participants completed the IWQOL-Lite 1-2 weeks later to determine stability of results. Sixty-four percent of schizophrenic participants and 68.0% of bipolar participants were obese. The IWQOL-Lite demonstrated excellent reliability in the current sample, with alpha coefficients ranging from 0.874 to 0.970 and test-retest coefficients ranging from 0.740 to 0.945. Correlations with collateral measures and BMI supported the construct validity of the IWQOL-Lite in this population. The IWQOL-Lite is a reliable and valid measure for assessing weight-related quality of life in individuals with schizophrenia and bipolar disorder.

The Association of Gastrointestinal Symptoms With Weight, Diet, and Exercise in Weight-Loss Program Participants

Studies on the relationship between gastrointestinal (GI) symptoms and obesity are limited. Research on the relationship between GI symptoms (including irritable bowel syndrome [IBS]), weight, and weight-related behaviors are rare. This study assessed rates of GI symptoms in a sample of obese patients in a weight-loss program and explored relationships among GI symptoms and obesity, binge eating, dieting (fat and fruit/fiber consumption), and physical activity. A total of 983 participants (70% women) had a mean body mass index (BMI) of 33.2+/-5.7 kg/m2 (range, 25.1-60.8 kg/m2) and a mean age of 52.7+/-12.4 years (range, 20.4-89.8 y). Participants completed a questionnaire about diet and physical activity and a standardized self-report Rome II questionnaire assessing IBS status and GI symptoms. In bivariate analyses BMI was associated positively with abdominal pain and diarrhea whereas healthier diet (lower fat and higher fruit/fiber intake) and higher physical activity were associated with fewer GI symptoms. In multivariate models BMI was not associated with GI symptoms; physical activity remained a protective factor. Although physiologic mechanisms still need to be explored, associations between GI symptoms and diet and exercise behaviors may have implications for the treatment of both obesity and GI symptoms.

Effect of Orlistat in Obese Patients with Binge Eating Disorder

Binge eating disorder represents a significant public health problem, with up to 50% of weight loss program participants displaying this disorder. In previous studies with orlistat, patients with binge eating disorder were excluded. The goal of this study was to assess the efficacy of orlistat in obese patients with binge eating disorder. Eighty-nine patients with clinically diagnosed binge eating disorder and a BMI > or = 30 kg/m2 were randomized in double-blind fashion to 24 weeks of treatment with 120 mg of orlistat or placebo three times daily, in combination with a mildly reduced-calorie diet. After 24 weeks, the mean weight loss from baseline for orlistat-treated patients was significantly greater than for patients receiving placebo (-7.4% vs. -2.3%; p = 0.0001) (intent-to-treat analysis). The overall Eating Disorder Inventory 2 score at week 24 was significantly lower in patients treated with orlistat than in those in the placebo group (p = 0.011). Orlistat may be considered as part of the management for patients with obesity and binge eating disorder.

Weight loss goals and treatment outcomes among overweight men and women enrolled in a weight loss trial

Participants in weight loss programs typically set unrealistically high weight loss goals that some believe are detrimental to success. This study examined outcomes associated with goal and ideal body mass index (BMI). Participants (N=1801) were enrolled in a weight loss trial comprised of low-intensity mail or telephone interventions vs usual care. Goal and ideal weight losses were assessed by asking participants how many pounds they expect to lose in the program (goal) and how much they would like to weigh (ideal). Goal and ideal weight losses were unrealistically high (men: -16 and -19%, women: -21 and -27%). For women, less realistic goals were associated with greater weight loss at 24 months. Goals were not associated with participation or weight loss for men. Results are more supportive of the idea that higher goals motivate women to lose weight than of the hypothesis that high goals undermine effort.

Changing weight-loss expectations: A randomized pilot study

Participants in weight-loss programs expect unreasonably large weight losses and believe that such reductions will produce dramatic improvements in their lives. The failure to achieve such benefits may contribute to poor maintenance of lost weight. This randomized pilot study investigated a new cognitive–behavioral intervention designed to modify unrealistic expectations regarding weight loss and its likely impact on appearance, attractiveness, and self-esteem. Twenty-eight overweight and obese young women who completed 10 sessions of standard behavioral weight-loss treatment were randomly assigned to 10 additional sessions of either standard behavioral (SB) treatment or a reformulated cognitive–behavioral (RCB) treatment. At posttreatment, the RCB intervention produced more realistic weight-loss expectations, decreased participants' motivation to lose weight as a means of improving self-confidence, and increased their overall self-esteem, compared with the SB condition (all p's<.05). The mean posttreatment weight changes achieved in the SB (−6.2±4.5 kg) and RCB (−5.5±3.6 kg) conditions were equivalent, as were the amounts of weight regained during a 6-month follow-up (SB=2.3±2.7 kg; RCB=1.5±1.7 kg). Collectively, these findings indicate that the RCB intervention was effective in changing unrealistic weight-loss expectations, but it did not produce significantly better maintenance of lost weight than did the SB intervention.