Weight Loss Progress Research Articles

Successful Implementation of a Multidisciplinary Weight Loss Program Including GLP1 Receptor Agonists for Liver Transplant Candidates With High Body Mass Index.

Body mass index (BMI) >40 is considered a relative contraindication to liver transplant. However, there is little research regarding best practices for weight loss in this population. We hypothesized that providing multidisciplinary support, including the use of glucagon-like protein 1 receptor agonists would facilitate patients' achievement of weight loss necessary for transplant eligibility. Patients 18 y or older were referred to the Henry Ford Health Liver Metabolic Clinic from August 2019 to September 2023, with either BMI >40 or >35 with abdominal adiposity that would complicate surgery. Patients were provided individualized support from hepatologists, dieticians, and counselors, as well as prescribed antiobesity medication and monitored closely for weight loss progress. Among 19 patients referred to the Liver Metabolic Clinic, median baseline BMI was 42 (range, 34.6-48.8) with median goal weight loss of 14.1 kg (range, 4.1-31.4). Sixteen patients (84%) had metabolic dysfunction-associated steatohepatitis and 3 patients had alcohol-associated liver disease. Seven had comorbid hepatocellular carcinoma. Median Model for End-stage Liver Disease score was 14 (range, 7-22). Fifteen patients were treated with a glucagon-like peptide 1 receptor agonist (6 patients received liraglutide, 8 received semaglutide, and 1 received tirzepatide) and 4 received phentermine. Median weight loss was 11.7 kg for all 19 patients (range, 0-33). Eight patients received a transplant and 4 more patients were waitlisted. Time from baseline to waitlisting was ~5.5 mo (median 166 d; range, 68-840). Three patients remained on treatment, whereas 4 were deceased due to progressive liver disease or infection. Providing high BMI patients with individualized dietary and medical support can facilitate weight loss necessary to achieve liver transplant eligibility.

Collaborative Prescribing Practice in Managing Patients Post-Bariatric Surgery in a Tertiary Centre in Singapore.

Background: A collaborative prescribing (CP) practice model, established by the endocrinologists, pharmacists, and advanced practice nurses, aims to provide for the postoperative monitoring and medical and nutritional management of stable patients after bariatric surgery. Method: Under the CP agreement, endocrinologists refer patients who have undergone bariatric surgery with stable medical conditions to CP practitioners, comprising senior pharmacists and advanced practice nurses. CP practitioners review the patient's weight loss progress, blood test results and vitals, the sufficiency of micronutrient repletion, adherence to supplements and medications, and chronic disease control. CP practitioners can prescribe and adjust the medications and supplements, in accordance with a clinical evaluation and standard guidance. Patients who require immediate attention due to complications or red flags are referred to the primary endocrinologist for further management. Results: From 5 May 2020 to 30 September 2023, CP practitioners provided 672 consultations. At least 68% and 80% of patients achieved appropriate weight loss post-surgery during the acute and maintenance phases, respectively. Less than 10% of the patients presented with anaemia and iron deficiency, and vitamin B12, folate and vitamin D deficiency. More than 80% of patients achieved a HbA1c of less than 7%. Conclusions: The CP practice framework provides a sustainable and viable model to facilitate optimal outcomes after bariatric surgery.

Behavioral change readiness among obese adolescents in Jakarta, Indonesia

BACKGROUND Prochaska’s transtheoretical model of behavioral change process, consisting of stages and processes of change, should be monitored to evaluate obesity management, particularly in adolescents. Two of four processes of change are supporting relationships, which promote behavioral change, and weight management actions, which are activities that push individuals to a particular direction in patients’ weight loss progress. This study aimed to determine the participants’ current stages of change, nutritional status, and their relationship with the processes of change.
 METHODS This cross-sectional study used secondary data collected in 2018 from 115 obese adolescents aged 15–21 years in Jakarta, Indonesia, using an Indonesian-translated and validated questionnaire adapted from Andrés et al’s study. The questionnaire evaluated participants’ processes of change, focusing on scores of supporting relationships (5 items) and weight management actions (10 items).
 RESULTS Of the participants, 71.3% were classified as obese grade I, and 28.7% were obese grade II. Most participants were in the contemplation (31.3%) and action (31.3%) stages. The mean supporting relationships and weight management actions scores were different between participants with obese I and obese II (66.67 versus 80, p = 0.004; 64.17 versus 70, p = 0.008, respectively). Meanwhile, no differences were identified in supporting relationships and weight management actions scores in all stages of change.
 CONCLUSIONS Adolescents with obesity and higher BMI (based on the obesity grading of the WHO Asia Pacific) tended to have significantly higher scores for supporting relationships and weight management actions, indicating that external reinforcement and immediate weight loss actions played pivotal roles in readiness for behavioral change.

Retroypective Comparative Study between Sleeve Gastrectomy and Mini Gastric Bypass Regarding Postoperative Skin Redundancy

Abstract Background Obesity has reached epidemic levels worldwide affecting more than 30% of adults. Mortality rates in patients with morbid obesity are 6-12 times higher in men aged 25 — 44 versus men with healthy weight of the same age. Surgical treatment of comorbidities appears to be cost effective by eliminating use of medications in patients who were previously morbidly obese. Aim of the Work to determine and evaluate the impact of sleeve gastrectomy and minigastric bypass procedure on weight loss and post operative skin redundancy. Patients and Methods The study included 50 morbidly obese patients that were assigned to two equal groups as regards to the operation they underwent either Laparoscopic MGB or Laparoscopic SG. The primary outcome measured was change in weight and BMI. The secondary outcome was skin redundancy after operation. Patients were followed up to 1 2 months after operation. Results After retrospectively comparing the two procedures for a year, almost both procedures have near same effect on loss of weight and MGB has slightly more skin redundancy after operation. The statistical differences observed as regards to BMI and skin redundancy Conclusion So this study was carried out to compare the effect on 50 patients undergone laparoscopic sleeve gastrectomy and laparoscopic mini gasteric bypass see if there was effect on weight loss and skin redundancy progress among those patients, 25 patients performed laparoscopic sleeve gasterectomy and 25 patients performed laparoscopic mini-gasteric bypass.

Romantic partner undermining of weight loss: Links between overweight individuals' weight management efforts and perceptions of their partner's undermining motivations and behaviors.

This study investigated romantic partners' undermining of weight management (i.e. hindrance of weight loss efforts) and how perceived motivations behind undermining were associated with weight loss progress. Data from 241 overweight individuals currently cohabiting with a romantic partner and trying to lose weight revealed two overarching undermining factors (i.e. verbal criticism/complaint, behavioral interference) and six perceived motivations (e.g. partner believed weight loss was unnecessary, partner relational fears, weight loss was an imposition on partner). Path modeling showed both undermining behaviors were negatively associated with weight management. Yet, only certain motivations (e.g. imposition on partner, weight loss was unnecessary) were linked to weight management, either directly or indirectly, through undermining. Specifically, whereas criticism/complaint mediated the associations between these motivations and weight management, interference only mediated the association between imposition and weight management. Findings are discussed in terms of the theoretical and practical value of distinguishing undermining behaviors and their underlying motivations.

Patient-provided e-support in reduced intensity obesity treatment: The INSPIRE randomized controlled trial.

There are two types of patient supporters, peers (two individuals initiating health behavior change who support one another) and mentors (a previously successful patient who supports incoming patients). Social comparison theory suggests that peers and mentors may elicit social comparison processes (patients may compare their progress to that of their peer/mentor), and these social comparisons could impact treatment outcomes. This randomized controlled trial is the first to examine the differential impact of peers and mentors on obesity treatment outcomes and social comparison processes when added to reduced intensity treatment. Participants (N = 278) were randomly assigned to reduced intensity behavioral weight loss treatment alone (rBWL), rBWL plus peer e-support (rBWL + Peer), or rBWL plus mentor e-support (rBWL + Mentor). rBWL involved periodic group sessions that decreased over time; when group sessions decreased, intensity of peer/mentor e-support increased. Weight and social comparison processes were assessed throughout the 12-month intervention. There was a significant treatment effect; when group sessions became less frequent and peer/mentor e-support became more frequent, rBWL + Peer had significantly greater weight loss than rBWL alone, and rBWL + Mentor was not significantly different from the other two. Social comparison processes differed by treatment arm; rBWL + Peer participants tended to report more lateral social comparisons ("my weight loss progress is 'similar' to my peer's"), whereas rBWL + Mentor participants reported more upward comparisons ("my weight loss progress is 'worse than' my mentor's"). Upward comparisons were associated with poorer weight loss outcomes. Peer e-support may be an effective, low-cost, sustainable method for improving longer-term weight loss outcomes in reduced intensity obesity treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Características clínicas y epidemiológicas de los pacientes VIH/SIDA diagnosticados con tuberculosis en el Servicio de Atención Integral del Hospital Infantil Dr. Robert Reid Cabral durante el periodo 2010-2016

Introducción: el diagnóstico de TB puede ser particularmente difícil en niños infectados con VIH porque es común la superposición clínica con otra enfermedad relacionada con el VIH, lo que dificulta y retrasa un correcto diagnóstico.
 Objetivo: conocer las características clínicas y epidemiológicas de los pacientes VIH/SIDA diagnosticados con tuberculosis en el Hospital Infantil Dr. Robert Reid Cabral durante el periodo 2010- 2016.
 Métodos: se realizó un estudio descriptivo, la información se obtuvo de los expedientes de los pacientes VIH/SIDA diagnosticados con tuberculosis en el Hospital Infantil Dr. Robert Reid Cabral durante el periodo 2010-2016. Las variables de estudio se recolectaron en un instrumento diseñado para estos fines. Los datos se procesaron mediante el paquete estadístico SPSS 2007 y en el análisis se usó estadística descriptiva.
 Resultados: el 13.2 % de los pacientes con VIH desarrollaron TB, 72.3 % presentaba una inmunosupresión grave al momento del diagnóstico de TB, 45 % refería el antecedente de contacto TB y el 90.5 % era intradomiciliario. 53 % no estaba recibiendo TARV antes de establecer el diagnóstico TB. Tos (65.9 %), fiebre (61.7 %) y pérdida o mal progreso de peso (40.4 %), fueron las principales manifestaciones clínicas. 76.6 % completó 6 meses de tratamiento, 17 % se perdió durante el seguimiento y 4.3 % falleció durante el tratamiento.
 Conclusión: 13.2 % de los pacientes con VIH desarrollaron tuberculosis, con un importante deterioro de su inmunidad al momento de hacer este diagnóstico, más de la mitad no recibía terapia antiretroviral; un alto porcentaje de estos pacientes tenían antecedente de contacto intradomiciliario con un caso TB, 17 % abandono tratamiento antituberculosis luego de iniciado.

Diabetes and Diet: A Patient and Dietitian's Perspective.

This article has been co-authored by a patient with type 2 diabetes and a specialist dietitian. Here they discuss the patient’s experience and difficulties with controlling weight and strategies that can help a patient in this situation. The patient discusses how stress and her corresponding comfort eating dampened weight loss progress, and how adopting a lifestyle change aided through group support helped to deal with this. The physician discusses the importance of recognizing the mental and physical challenges faced by patients in this situation.

Strategies in Context: How Perceptions of Romantic Partner Support for Weight Loss Vary by the Relational Context

ABSTRACTBecause romantic partners can be a strong influence on individuals’ weight loss efforts and progress, the current study assessed the relational context of weight loss—dynamics within the relationship that pertain to weight loss. Three relational characteristics were examined: whether the weight loss was a team effort, how much partners had opposing approaches to weight loss, and individuals’ difficulty in balancing their weight loss goals within their relationship goals. Findings showed that the relational characteristics were associated with both the perceived frequency and effectiveness of partner strategies (i.e., instrumental influence, encouragement, and coercion). Team effort was associated with perceiving all three strategies as more frequent and effective; opposing approaches were negatively associated with encouragement but positively associated with coercion for both frequency and effectiveness; and balance struggle was positively associated with coercion frequency and effectiveness. Additionally, a cluster analysis of the three relational characteristics yielded four relational climates: synchronized (high team effort, low relational strains), contentious cooperatives (moderate in all three relational characteristics), autonomous (low in all relational characteristics), and lone battlers (low team effort, high relational strains). The groups varied in the strategies they perceived as effective. All of these findings emerged beyond the variance explained by general relationship satisfaction. Overall, these results better explicate relationship characteristics that can be incorporated into a larger, ecological model on health behavior change.

Good Intentions, Bad Outcomes: The Effects of Mismatches between Social Support and Health Outcomes in an Online Weight Loss Community

The United States has the highest rate of obesity in the world. To help address this problem, social support is gaining credibility as a powerful tool to facilitate weight loss because it can affect people's behavior. Although social support has long been recognized for its effectiveness in promoting health, we argue, in this study, that social support may not always lead to good outcomes. Specifically, we differentiate between support providers and support seekers, and examine whether providing and receiving support affect individuals’ weight‐loss outcomes differently. By analyzing a group of individuals participating in an online weight‐loss community, we show that providing and receiving support does affect weight‐loss outcomes in different ways. First, the influences are dynamic. Second, while providing support is positively associated with weight‐loss progress, receiving support could hinder weight‐loss outcome for a person with high self‐efficacy in weight‐loss progress. Third, by categorizing social support into different types, we find evidence suggesting that the match between needed and received social support type also influences individuals’ performance in the weight‐loss process. Furthermore, mismatches of social support could negatively affect weight‐loss outcomes. These findings have implications for maximizing the usefulness of social support for participants in the online environment as well as for clinicians who refer individuals to online weight‐loss communities and for those who design them.

The Exchange of Social Support on Online Bariatric Surgery Discussion Forums: A Mixed-Methods Content Analysis

ABSTRACTBariatric surgery patients often experience physical and psychosocial stressors, and difficulty adjusting to significant lifestyle changes. As a result, social support groups that provide patients with support, coping skills, and nutritional information are valuable components of bariatric care. Support group attendance at bariatric centers is associated with greater post-surgery weight loss; however, several barriers hinder attendance at in-person support groups (e.g., travel distance to bariatric centers). Consequently, online support forums are an increasingly utilized resource for patients both before and after surgery. This study examined and described the type and frequency of social support provided on a large online bariatric surgery forum. A total of 1,412 messages in the pre- (n = 822) and post-surgery (n = 590) sections of the forum were coded using qualitative content analysis according to Cutrona and Suhr’s (1992) Social Support Behavior Code model (i.e., including informational, tangible, esteem, network, and emotional support types). The majority of messages provided informational and emotional support regarding: a) factual information about the bariatric procedure and nutrition; b) advice for coping with the surgery preparation process, and physical symptoms; and c) encouragement regarding adherence to surgical guidelines, and weight loss progress. Network, esteem, and tangible support types were less frequent than informational and emotional support types. The results inform healthcare providers about the types of social support available to bariatric patients on online support forums and, thus, encourage appropriate referrals to this resource.

Weighing Every Day Matters: Daily Weighing Improves Weight Loss and Adoption of Weight Control Behaviors

BackgroundDaily weighing is emerging as the recommended self-weighing frequency for weight loss. This is likely because it improves adoption of weight control behaviors. ObjectiveTo examine whether weighing every day is associated with greater adoption of weight control behaviors compared with less frequent weighing. DesignLongitudinal analysis of a previously conducted 6-month randomized controlled trial. Participants/settingOverweight men and women in Chapel Hill, NC, participated in the intervention arm (N=47). InterventionThe intervention focused on daily weighing for weight loss using an e-scale that transmitted weights to a study website, along with weekly e-mailed lessons and tailored feedback on daily weighing adherence and weight loss progress. Main outcome measuresWe gathered objective data on self-weighing frequency from the e-scales. At baseline and 6 months, weight change was measured in the clinic and weight control behaviors (total items=37), dietary strategies, and calorie expenditure from physical activity were assessed via questionnaires. Calorie intake was assessed using an online 24-hour recall tool. Statistical analysesWe used χ2 tests to examine variation in discrete weight control behaviors and linear regression models to examine differences in weight, dietary strategies, and calorie intake and expenditure by self-weighing frequency. ResultsFifty-one percent of participants weighed every day (n=24) over 6 months. The average self-weighing frequency among those weighing less than daily (n=23) was 5.4±1.2 days per week. Daily weighers lost significantly more weight compared with those weighing less than daily (mean difference=–6.1 kg; 95% CI –10.2 to –2.1; P=0.004). The total number of weight control behaviors adopted was greater among daily weighers (17.6±7.6 vs 11.2±6.4; P=0.004). There were no differences by self-weighing frequency in dietary strategies, calorie intake, or calorie expenditure. ConclusionsWeighing every day led to greater adoption of weight control behaviors and produced greater weight loss compared with weighing most days of the week. This further implicates daily weighing as an effective weight loss tool.

Early-treatment weight loss predicts 6-month weight loss in women with obesity and depression: Implications for stepped care

ObjectiveSome adults with comorbid depression and obesity respond well to lifestyle interventions while others have poor outcomes. The objective of this study was to evaluate whether early-treatment weight loss progress predicts clinically significant 6-month weight loss among women with obesity and depression. MethodsWe conducted a secondary analysis of data from 75 women with obesity and depression who received a standard lifestyle intervention. Relative risks (RRs) and 95% confidence intervals (CIs) for achieving ≥5% weight loss by 6months were calculated based on whether they achieved ≥1lb/week weight loss in weeks 2–8. Among those on target at week 3, we examined potential subsequent time points at which weight loss progress might identify additional individuals at risk for treatment failure. ResultsAt week 2, women who averaged ≥1lb/week loss were twice as likely to achieve 5% weight loss by 6months than those who did not (RR=2.40; 95% CI: 2.32–4.29); weight loss at weeks 3–8 was similarly predictive (RRs=2.02–3.20). Examining weight loss progress at week 3 and subsequently at a time point during weeks 4–8, 52–67% of participants were not on target with their weight loss, and those on target were 2–3 times as likely to achieve 5% weight loss by 6months (RRs=1.82–2.92). ConclusionWeight loss progress as early as week 2 of treatment predicts weight loss outcomes for women with comorbid obesity and depression, which supports the feasibility of developing stepped care interventions that adjust treatment intensity based on early progress in this population.

Daily Self-Weighing and Adverse Psychological Outcomes

Despite evidence that daily self-weighing is an effective strategy for weight control, concerns remain regarding the potential for negative psychological consequences. The goal of the study was to examine the impact of a daily self-weighing weight-loss intervention on relevant psychological constructs. A 6-month RCT. The study sample (N=91) included overweight men and women in the Chapel Hill NC area. Between February and August 2011, participants were randomly assigned to a daily self-weighing intervention or delayed-intervention control group. The 6-month intervention included daily self-weighing for self-regulation of diet and exercise behaviors using an e-scale that transmitted weights to a study website. Weekly e-mailed lessons and tailored feedback on daily self-weighing adherence and weight-loss progress were provided. Self-weighing frequency was measured throughout the study using e-scales. Weight was measured in-clinic at baseline, 3 months, and 6 months. Psychological outcomes were assessed via self-report at the same time points. In 2012, using linear mixed models and generalized estimating equation models, there were no significant differences between groups in depressive symptoms, anorectic cognitions, disinhibition, susceptibility to hunger, and binge eating. At 6 months, there was a significant group X time interaction for body dissatisfaction (p=0.007) and dietary restraint (p<0.001), with the intervention group reporting lower body dissatisfaction and greater dietary restraint compared to controls. Results indicate that a weight-loss intervention that focuses on daily self-weighing does not cause adverse psychological outcomes. This suggests that daily self-weighing is an effective and safe weight-control strategy among overweight adults attempting to lose weight. This study is registered at clinicaltrials.gov NCT01369004.

G98 Multidisciplinary Assessment For Bariatric Surgery in Adolescents: A Pilot Project from a National Referral Service

IntroductionObesity has medical, social, psychological, familial and dietary underpinnings. We report the results of multidisciplinary assessments in adolescent bariatric surgery patients in the UK.Aim1. Multidisciplinary assessment of patients prior to...

Matching the Graphical Display of Data to Avoidance Versus Approach Motivation Increases Outcome Expectancies

ABSTRACT This study is the first demonstration of the effect of motivational focus (approach vs. avoidance) on the interpretation of graphical view of personal data, specifically, weight loss progress. In two experiments, participants were randomly assigned to see the bogus weight loss data charted against either a goal or a baseline reference line. In the first experiment, we accessed participants' chronic motivational focus. In the second study, we primed motivation by exposing the participants to either a gain- or loss-focused health message. The results demonstrate that participants with either chronic or manipulated approach motivation predicted higher future weight loss in the goal reference line condition than in the baseline reference line condition. The opposite pattern was observed for participants with either chronic or manipulated avoidance motivation. The potential of matching graphical data display to personality characteristics to promote effective health management is discussed.

Associations between Snacking and Weight Loss and Nutrient Intake among Postmenopausal Overweight to Obese Women in a Dietary Weight-Loss Intervention

Snacking may play a role in weight control. The associations of timing and frequency of snacking with observed weight change and nutrient intake were assessed in an ancillary study to a 12-month randomized controlled trial in Seattle, WA. Overweight-to-obese postmenopausal women (n=123) enrolled in the two dietary weight-loss arms from 2007 to 2008 with complete data at 12 months were included in these analyses. Generalized linear models were used to test the associations between snacking and weight loss (percent) and nutrient intake at the 12-month time point. Participants were, on average, 58 years old and mainly non-Hispanic white (84%). Ninety-seven percent reported one or more snacks per day. Weight loss (percent) was significantly lower among mid-morning (10:30 am to 11:29 am) snackers (7.0%, 95% confidence interval: 4.3 to 9.7) compared to non–mid-morning snackers (11.4%, 95% confidence interval: 10.2 to 12.6; P=0.005). A higher proportion of mid-morning snackers reported more than one snack per day (95.7%), compared to afternoon (82.8%) and evening (80.6%) snackers, although differences were not statistically significant ( P>0.005). Women who reported two or more snacks per day vs one or no snacks per day had higher fiber intake ( P=0.027). Afternoon snackers had higher fruit and vegetable intake compared to non–afternoon-snackers ( P=0.035). These results suggest that snack meals can be a source for additional fruits, vegetables, and fiber-rich foods; however, snacking patterns might also reflect unhealthy eating habits and impede weight-loss progress. Future dietary weight-loss interventions should evaluate the effects of timing, frequency, and quality of snacks on weight loss.

Thyroid Function and Insulin Sensitivity Before and After Bilio-pancreatic Diversion

Bilio-pancreatic diversion (BPD) induces permanent weight loss in previously severe obese patients through a malabsorptive mechanism. The aim of the study was to evaluate the modifications of circulating thyroid hormones after BPD, a surgical procedure which interferes with the entero-hepatic circulation of biliary metabolites. Forty-five patients were studied before and 2 years after BPD. Thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), anti-thyroid antibodies, iodine urinary excretion, lipid profile, insulin and glucose plasma levels were assessed. The insulin-resistance HOMA IR index was calculated, and colour Doppler ultrasonography of the neck was performed. The subjects (23%) had subclinical hypothyroidism prior to BPD (TSH levels above the normal range with normal fT3 and fT4 levels). After 2 years 40.42% of the population showed subclinical hypothyroidism, while 6.3% became frankly hypothyroid, all of them with no evidence of auto-immune thyroiditis. Most of the patients, who became sub-clinically hypothyroid only following BPD, had already thyroid alterations at the sonogram (multi-nodular euthyroid goiter and thyroidal cysts) prior to surgery. BPD increases the prevalence of subclinical or even frank hypothyroidism, without causing a defect in thyroid function itself, through several integrated mechanisms. (1) It induces iodine malabsorption, which is partially compensated by iodine excretion contraction. (2) The entero-hepatic open circulation determines fT3 loss, which induces subclinical or frank hypothyroidism in patients with pre-existing thyroid alterations, interfering also with the weight loss progress. Iodine supplementation should be recommended in those patients reporting thyroid alterations at the sonogram prior to BPD, LT4 therapy should be strictly monitored in patients suffering of subclinical hypopthiroidism and T3 therapy should eventually be considered for patients diagnosed with frank hypothyroidism prior to BPD.

‘I’ve put weight on cos I’ve bin inactive, cos I’ve ’ad me knee done’: moral work in the obesity clinic

As governments and healthcare systems grow increasingly concerned with the current obesity 'epidemic', sociological interest in the condition has also increased. Despite the emergence of work discussing obesity as a social phenomenon, the sociological dimensions of medical weight-loss treatments for obesity remain underexplored. This paper reports on a conversation analytic (CA) study and describes how moral issues surrounding weight and patienthood become visible when doctors and patients discuss obesity. Consultations in two UK National Health Service clinics were video-recorded and analysed to identify recurring patterns of interaction. This paper describes how patients answer opening questions: questions which begin the consultation, enabling patients to report their medical status. Analysis reveals that when producing their answers, patients typically imply either 'success' or 'lack of success' in their weight-loss progress. Whilst doing so, they construct their personal agency in different ways, crediting themselves for implied successes and resisting responsibility for lack of success. Through interaction the doctor and patient collaboratively construct obesity as a moral issue. The moral obligations invoked share similarities with certain perceived normative dynamics surrounding obesity and the responsibilities of patienthood. These findings have relevance to healthcare practice and add to sociological understanding of the modern obesity 'crisis'.

A Satisfaction Enhancement Intervention for Long‐Term Weight Loss

To compare the effects of two satisfaction enhancement interventions for weight control on behavioral and weight changes among individuals in a 15-month weight loss program. The primary hypothesis was that long-term weight loss would be improved by an intervention that enhances perceived satisfaction with achieved outcomes. Men and women (331) were randomized to weight control programs comprised of diet and exercise counseling and a cognitive intervention that emphasized either comparing experienced outcomes with expectation of ideal outcomes or comparing experienced outcomes with pretreatment status. The latter was expected to cause greater satisfaction with weight loss progress. The intervention manipulation was not successful in influencing cognitions, satisfaction, or weight change. The potential for intervening on satisfaction per se for the purpose of achieving greater or more sustained weight loss remains to be demonstrated.