Behavioral Weight Management Research Articles

A-164 Influence of Executive Function, Partner Support, and Environmental Structure on Behavioral Weight Management Outcomes

Abstract Objective Executive functions (EF) are crucial to successful weight management, yet few studies have prospectively explored the influence of social-environmental factors on the EF-weight loss (WL) link. This study examined interactions between EF, partner support, and household structure on weight loss outcomes in a couples-based intervention, grounded in Self-Determination Theory (SDT). Method Cohabitating dyads attended weekly weight loss groups (Ncouples = 64), Mage =54.0 ± 9.5, MBMI = 34.2 ± 5.4 kg/m2, 50% female, 88.8% Caucasian). Weight was measured at baseline and 6 months. The Behavior Rating Index of Executive Functions-Adult assessed 9 EF domains; higher scores indicate greater difficulty. Partner autonomy support (AS) was measured using the Important Other Climate Questionnaire, household structure with the Confusion, Hubbub, and Order Scale (CHAOS), IQ with the WASI-II 2-subscale estimate. Results Multilevel models were specified with MIXED linear function in SPSS to account for dyadic interdependence, controlling for age, education, IQ and group. Moderators (AS and CHAOS) were grand-mean centered. High and low levels were created at +1SD and -1SD. At high levels of AS, Shifting (B = 1.50, p = .01) and Inhibition (B = 2.23, p = .01) were associated with greater 6-month WL. At low levels of AS, Working Memory was associated with greater WL (p < .01). Self-Monitoring was associated with greater WL at high chaos (B = .43, p = .01), but not low chaos (p = 0.1). Conclusions Findings suggest that context matters; recruiting specific EFs may promote more WL for individuals embedded in low support or chaotic home environments. Future interventions should address the complexity of successful weight management, targeting both individual and social-interpersonal factors.

Comparison of mindful and slow eating strategies on acute energy intake.

SummaryMindfulness and slow eating techniques are commonly recommended to achieve weight loss within behavioural weight management programmes; yet the role of these eating strategies on acute energy intake (EI) and satiety are not clear. This study investigated the effects of mindful and slow eating strategies on acute EI and satiety. Twenty‐four participants were randomized to one of three eating conditions (EAT, MIND, SLOW). For the EAT condition, participants were instructed to eat as they normally would for both test meal sessions. For the SLOW condition, participants were instructed to eat as they normally would for their first test meal session and to slow their eating for the second test meal session. For the MIND condition, participants were instructed to eat as they normally would during their first test meal session and were given brief instructions on mindful eating for their second test meal session. For each condition, participants were provided ad libitum access to a test meal, and EI was calculated based upon food consumed. Participants rated their level of satiety following each meal. There were no significant differences in EI between eating strategy conditions. There was a trend towards a decrease in energy intake in the MIND condition compared with the EAT condition and a prevention of increased intake in the SLOW condition. There were no significant differences in ratings of satiety between conditions. Although, neither mindful nor slow eating strategies significantly decreased acute EI or satiety; the results suggest that both strategies blunted the increase in EI observed in EAT that occurred across two eating episodes, which may suggest that these strategies can be important for modifying eating behaviour that may contribute to body weight regulation. Additional appropriately designed studies investigating these strategies appear warranted to confirm these findings.

Weight-related lifestyle behaviours and the COVID-19 crisis: An online survey study of UK adults during social lockdown.

SummaryBackgroundThe COVID‐19 crisis is likely to have had wide‐ranging consequences on lifestyle behaviours and may have affected weight management. The objective of the present study was to examine perceptions of how weight‐related lifestyle changed in social lockdown among UK adults compared with before the emergence of the COVID‐19 crisis.MethodsAs part of an online cross‐sectional survey conducted during social lockdown in the United Kingdom, 723 UK adults reported on the extent to which their eating (healthiness of diet, frequency of bingeing on food), physical activity, sleep and alcohol consumption had changed since the emergence of the COVID‐19 crisis and completed measures of current psychological well‐being.ResultsAlthough both improvements and declines in weight gain protective behaviours were reported, 79% of participants reported a decline in one or more weight gain protective behaviours. Both participants with a diagnosis of psychiatric illness or obesity (body mass index [BMI] ≥ 30) were most likely to report declines in weight gain protective behaviours and show an overall profile of weight management behaviours worsening. Participants experiencing high levels of stress also reported reductions in more weight gain protective behaviours.ConclusionsLifestyle behaviours associated with weight gain are likely to have been affected by the COVID‐19 crisis. Reductions to the perceived frequency by which people engage in behaviours usually associated with successful weight management appear to be common, and people living with obesity and mental health problems may be at increased risk.

Cognitive and behavioural strategies employed to overcome "lapses" and prevent "relapse" among weight-loss maintainers and regainers: A qualitative study.

While many behavioural weight management programmes are effective in the short-term, post-programme weight regain is common. Overcoming "lapses" and preventing "relapse" has been highlighted as important in weight-loss maintenance, but little is known on how this is achieved. This study aimed to compare the cognitive and behavioural strategies employed to overcome "lapses" and prevent "relapse" by people who had regained weight or maintained weight-loss after participating in a weight management programme. By investigating differences between groups, we intended to identify strategies associated with better weight-loss maintenance. Semi-structured interviews were conducted with 26 participants (58% female) recruited from the 5-year follow-up of the Weight Loss Referrals for Adults in Primary Care (WRAP) trial (evaluation of a commercial weight-loss programme). Participants who had lost ≥5% baseline weight during the active intervention were purposively sampled according to 5-year weight trajectories (n = 16 'Regainers', n = 10 'Maintainers'). Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Key differences in strategies were that Maintainers continued to pay attention to their dietary intake, anticipated and planned for potential lapses in high-risk situations, and managed impulses using distraction techniques. Regainers did not report making plans, used relaxed dietary monitoring, found distraction techniques to be ineffective and appeared to have difficulty navigating food within interpersonal relationships. This study is one of the longest qualitative follow-ups of a weight loss trial to date, offering unique insights into long-term maintenance. Future programmes should emphasize strategies focusing on self-monitoring, planning and managing interpersonal relationships to help participants successfully maintain weight-loss in the longer-term.

Barriers and facilitators of successful weight loss during participation in behavioural weight management programmes: a protocol for a systematic review

BackgroundBehavioural weight management programmes are effective in assisting people with overweight or obesity to lose excess body weight. Yet, many still struggle to attain their weight loss goals in such programmes. Little is understood about the factors which impact success in these programmes. Synthesising this data will allow for theory to be developed on how to improve success in such programmes. The main aim of this review will be to extract and synthesise the barriers and facilitators of successful weight loss during participation of behavioural weight loss programmes in adults living with overweight and obesity.MethodsA systematic search of MEDLINE, Embase, PsycINFO, The Cochrane Library and CINAHL will be performed from inception onwards. Studies will also be sought by contacting experts in the field, reference and website searching. Studies will be eligible if the participants are adults living with obesity (population) undertaking or recently completed behavioural weight loss programmes (intervention) with the primary focus of weight loss (outcome). The primary outcomes will be amount of weight lost and information on barriers and/or facilitators to success. The secondary outcomes will be reasons or factors related to attrition and adherence and behaviour change techniques used in programmes. Two reviewers will screen citations and full-text data. Reviewer 1 will screen all, and reviewer 2 will screen a random 50% of articles. Data extraction will be completed by reviewer 1, and 10% will be checked by the research team. Potential conflicts will be resolved through discussion. Data will be synthesised and described narratively to show the characteristics of each study, levels of success and barriers and facilitators during programme participation. A thematic approach will be taken, and themes will be coded against the levels of the socioecological model. Quantitative data will be extracted and categorised according to these themes and presented alongside the qualitative data.DiscussionOur findings can be used to inform how weight loss programmes can be improved to facilitate success in those at risk of failure. Results will be published in a peer-reviewed journal.Systematic review registration(PROSPERO CRD42019148158 )

The Assessment of Supportive Accountability in Adults Seeking Obesity Treatment: Psychometric Validation Study.

BackgroundTechnology-mediated obesity treatments are commonly affected by poor long-term adherence. Supportive Accountability Theory suggests that the provision of social support and oversight toward goals may help to maintain adherence in technology-mediated treatments. However, no tool exists to measure the construct of supportive accountability.ObjectiveThis study aimed to develop and psychometrically validate a supportive accountability measure (SAM) by examining its performance in technology-mediated obesity treatment.MethodsSecondary data analyses were conducted in 2 obesity treatment studies to validate the SAM (20 items). Study 1 examined reliability, criterion validity, and construct validity using an exploratory factor analysis in individuals seeking obesity treatment. Study 2 examined the construct validity of SAM in technology-mediated interventions involving different self-monitoring tools and varying amounts of phone-based interventionist support. Participants received traditional self-monitoring tools (standard, in-home self-monitoring scale [SC group]), newer, technology-based self-monitoring tools (TECH group), or these newer technology tools plus additional phone-based support (TECH+PHONE group). Given that the TECH+PHONE group involves more interventionist support, we hypothesized that this group would have greater supportive accountability than the other 2 arms.ResultsIn Study 1 (n=353), the SAM showed strong reliability (Cronbach α=.92). A factor analysis revealed a 3-factor solution (representing Support for Healthy Eating Habits, Support for Exercise Habits, and Perceptions of Accountability) that explained 69% of the variance. Convergent validity was established using items from the motivation for weight loss scale, specifically the social regulation subscale (r=0.33; P<.001) and social pressure for weight loss subscale (r=0.23; P<.001). In Study 2 (n=80), the TECH+PHONE group reported significantly higher SAM scores at 6 months compared with the SC and TECH groups (r2=0.45; P<.001). Higher SAM scores were associated with higher adherence to weight management behaviors, including higher scores on subscales representing healthy dietary choices, the use of self-monitoring strategies, and positive psychological coping with weight management challenges. The association between total SAM scores and percent weight change was in the expected direction but not statistically significant (r=−0.26; P=.06).ConclusionsThe SAM has strong reliability and validity across the 2 studies. Future studies may consider using the SAM in technology-mediated weight loss treatment to better understand whether support and accountability are adequately represented and how supportive accountability impacts treatment adherence and outcomes.Trial RegistrationClinicalTrials.gov NCT01999244; https://clinicaltrials.gov/ct2/show/NCT01999244

Preliminary Impact of an Adapted Emotion Regulation Intervention for Adolescents with Overweight and Obesity Attempting to Lose Weight.

This study examines the acceptability, feasibility, and preliminary impact of a program (HealthTRAC) combining 2 efficacious interventions (one targeting emotion regulation [TRAC] and the other a standardized behavioral weight management intervention [SBWC]) to improve weight management outcomes among a sample of adolescents with overweight and obesity. Adolescents with overweight or obesity (N = 38), ages 13 to 17 years, were enrolled and randomized into either the SBWC or HealthTRAC. Data were collected at baseline (before intervention), at the end of the 16-week intervention (postintervention), and 4 months after completing the intervention (4 months). Assessments included adolescent self-reports of intervention acceptability and reported emotion regulation (ER) abilities and caregiver report of adolescent ER skills. Body mass index (BMI) was used to examine the impact on adolescent weight outcomes. Analyses of covariance controlling for baseline values were used to evaluate study outcomes. Eighty-four percent (n = 32) of participants completed the immediate postintervention and 4-month follow-up assessments. Adolescents in both conditions reported high treatment satisfaction. Adolescents randomized to HealthTRAC demonstrated greater reductions in BMI relative to SBWC and reported greater use of emotion regulation skills. Finally, caregivers of adolescents randomized to HealthTRAC also reported greater improvements in emotion regulation abilities among their adolescents at the 4-month follow-up. Findings suggest that the HealthTRAC intervention was acceptable, feasible to deliver, and demonstrated a positive impact on BMI and emotion regulation abilities. These data suggest that ER is related to health decision-making and is relevant to most overweight/obese adolescents seeking to lose weight.

Child neurobiology impacts success in family-based behavioral treatment for children with obesity.

Background and Objectives:Family-based behavioral treatment (FBT) is the recommended treatment for children with common obesity. However, there is a large variability in short- and long-term treatment response and mechanisms for unsuccessful treatment outcomes are not fully understood. In this study, we tested if brain response to visual food cues among children with obesity before treatment predicted weight or behavioral outcomes during a 6-mo. behavioral weight management program and/or long-term relative weight maintenance over a 1-year follow-up period.Subjects and Methods:Thirty-seven children with obesity (age 9–11y, 62% male) who entered active FBT (attended 2 or more sessions) and had outcome data. Brain activation was assessed at pre-treatment by functional magnetic resonance imaging across an a priori set of appetite-processing brain regions that included the ventral and dorsal striatum, medial orbitofrontal cortex, amygdala, substantia nigra/ventral tegmental area and insula in response to viewing food images before and after a standardized meal.Results:Children with more robust reductions in brain activation to high-calorie food cue images following a meal had greater declines in BMI z-score during FBT (r= 0.42; 95% CI: 0.09, 0.66; P=0.02) and greater improvements in Healthy Eating Index scores (r= −0.41; 95% CI: −0.67, −0.06; P=0.02). In whole-brain analyses, greater activation in the ventromedial prefrontal cortex, specifically by high-calorie food cues, was predictive of better treatment outcomes (whole-brain cluster corrected P=0.02). There were no significant predictors of relative weight maintenance and initial behavioral or hormonal measures did not predict FBT outcomes.Conclusions:Children’s brain responses to a meal prior to obesity treatment were related to treatment-based weight outcomes, suggesting that neurophysiologic factors and appetitive drive, more so than initial hormone status or behavioral characteristics, limit intervention success.

The effect of referral to an open-group behavioural weight-management programme on the relative risk of normoglycaemia, non-diabetic hyperglycaemia and type 2 diabetes: Secondary analysis of the WRAP trial.

To examine the impact of open-group behavioural weight-management programmes on the risk of diabetes among those with a body mass index (BMI) of ≥28 kg/m2 and those with non-diabetic hyperglycaemia (NDH). This was a secondary analysis of data from the WRAP trial, in which participants (N = 1267; aged ≥18 years, BMI ≥ 28 kg/m2 ) were randomized to brief intervention (BI; self-help booklet), a weight-management programme (WW; formerly Weight Watchers) for 12 weeks, or WW for 52 weeks. We used multinomial logistic regression to examine the effect of intervention group on the risk of hyperglycaemia and diabetes at 12 months in all participants with glycaemic status at both time points (N = 480; 38%) and those with NDH at baseline (N = 387; 31%). We used mixed effects models and linear fixed effects models to examine the effect of intervention group on body weight and HbA1c at 12 months in people with NDH. There was a 61% relative reduction in the risk of NDH at the 12-month follow-up (12 weeks vs. BI: relative risk ratio [RRR] = 0.39 [95% CI 0.18, 0.87], P = .021; 52 weeks vs. BI: RRR = 0.38 [95% CI 0.17, 0.86], P = .020). For intervention effects on the risk of diabetes, confidence intervals were wide and overlapped 1 [12 weeks vs. BI: RRR = 0.49 [95% CI 0.12, 1.96], P = .312; 52 weeks vs. BI: RRR = 0.40 [95% CI 0.10, 1.63], P = .199). Participants with hyperglycaemia at baseline in the weight-management programme were more probable to have normoglycaemia at the 12-month follow-up [12-week programme vs. BI: RRR = 3.57 [95% CI 1.24, 10.29], P = .019; 52-week programme vs. BI: RRR = 4.14 [95% CI 1.42, 12.12], P = .009). Open-group behavioural weight-management programmes can help to prevent the development of NDH in people with overweight and obesity and to normalize glycaemia in people with NDH.

Tackling reporting issues and variation in behavioural weight management interventions: Design and piloting of the standardized reporting of adult behavioural weight management interventions to aid evaluation (STAR-LITE) template.

In the United Kingdom, the National Institute for Health and Care Excellence make recommendations to guide the local-level selection and implementation of adult behavioural weight management interventions (BWMIs) which lack specificity. The reporting of BWMIs is generally poorly detailed, resulting in difficulties when comparing effectiveness, quality and appropriateness for participants. This non-standardized reporting makes meta-analysis of intervention data impossible, resulting in vague guidance based on weak evidence, reinforcing the urgent need for consistency and detail within BWMI description. STAR-LITE - a 4-section, 119-item standardized adult BWMI reporting template - was developed and tested using a two-phase process. After initial design, the template was piloted using adult behavioural weight management RCTs and currently implemented UK BWMI mapping information to further refine the template and examine current reporting and variance. Overall, reporting quality of weight management RCTs was poor, and large variance across different components of real-world BWMIs was observed. Non-specific guidance and wide variation in adult BWMIs are likely linked to inadequate RCT reporting quality and the inability to perform reliable comparisons of data. Future use of STAR-LITE would facilitate the consistent, detailed reporting of adult BWMIs, supporting their evaluation and comparison, to ultimately inform effective policy and improve weight management practice.

Effect of Behavioral Weight Management Interventions Using Lifestyle mHealth Self-Monitoring on Weight Loss: A Systematic Review and Meta-Analysis.

Alongside an increase in obesity, society is experiencing the development of substantial technological advances. Interventions that are easily scalable, such as lifestyle (including diet and physical activity) mobile health (mHealth) self-monitoring, may be highly valuable in the prevention and treatment of excess weight. Thus, the aims of this systematic review and meta-analysis were to estimate the following: (i) the effect of behavioral weight management interventions using lifestyle mHealth self-monitoring on weight loss and (ii) the adherence to behavioral weight management interventions using lifestyle mHealth self-monitoring. MEDLINE via PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and the Web of Science databases were systematically searched. The DerSimonian and Laird method was used to estimate the effect of and adherence to behavioral weight management interventions using lifestyle mHealth self-monitoring on weight loss. Twenty studies were included in the systematic review and meta-analysis, yielding a moderate decrease in weight and higher adherence to intervention of behavioral weight management interventions using lifestyle mHealth self-monitoring, which was greater than other interventions. Subgroup analyses showed that smartphones were the most effective mHealth approach to achieve weight management and the effect of behavioral weight management interventions using lifestyle mHealth self-monitoring was more pronounced when compared to usual care and in the short-term (less than six months). Furthermore, behavioral weight management interventions using lifestyle mHealth self-monitoring showed a higher adherence than: (i) recording on paper at any time and (ii) any other intervention at six and twelve months.

Lifestyle information and access to a commercial weight management group to promote maternal postnatal weight management and positive lifestyle behaviour: the SWAN feasibility RCT

BackgroundIncreasing numbers of UK women have overweight or obese body mass index scores when they become pregnant, or gain excessive weight in pregnancy, increasing their risk of adverse outcomes. Failure to manage postnatal weight is linked to smoking, non-healthy dietary choices, lack of regular exercise and poorer longer-term health. Women living in areas of higher social deprivation are more likely to experience weight management problems postnatally.ObjectivesThe objectives were to assess the feasibility of conducting a definitive randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of lifestyle information and access to a commercial weight management group focusing on self-monitoring, goal-setting and motivation to achieve dietary change commencing 8–16 weeks postnatally to achieve and maintain weight management and positive lifestyle behaviour.DesignThe design was a randomised two-arm feasibility trial with a nested mixed-methods process evaluation.SettingThe setting was a single centre in an inner city setting in the south of England.ParticipantsParticipants were women with body mass index scores of &gt; 25 kg/m2at antenatal ‘booking’ and women with normal body mass index scores (18.0–24.9 kg/m2) at antenatal booking who developed excessive gestational weight gain as assessed at 36 weeks’ gestation.Main outcome measuresRecruitment, retention, acceptability of trial processes and identification of relevant economic data were the feasibility objectives. The proposed primary outcome was difference between groups in weight at 12 months postnatally, expressed as percentage weight change and weight loss from antenatal booking. Other proposed outcomes included assessment of diet, physical activity, smoking, alcohol consumption, body image, maternal esteem, mental health, infant feeding and NHS costs.ResultsMost objectives were achieved. A total of 193 women were recruited, 98 allocated to the intervention arm and 95 to the control arm. High follow-up rates (&gt; 80%) were achieved to 12 months. There was an 8.8% difference in weight loss at 12 months between women allocated to the intervention arm and women allocated to the control arm (13.0% vs. 4.2%, respectively;p = 0.062); 47% of women in the intervention arm attended at least one weight management session, with low risk of contamination between arms. The greatest benefit was among women who attended ≥ 10 sessions. Barriers to attending sessions included capability, opportunity and motivation issues. Data collection tools were appropriate to support economic evaluation in a definitive trial, and economic modelling is feasible to quantify resource impacts and outcomes not directly measurable within a trial.LimitationsThe trial recruited from only one site. It was not possible to recruit women with normal body mass index scores who developed excessive pregnancy weight gain.ConclusionsIt was feasible to recruit and retain women with overweight or obese body mass index scores at antenatal booking to a trial comparing postnatal weight management plus standard care with standard care only and collect relevant data to assess outcomes. Approaches to recruit women with normal body mass index scores who gain excessive gestational weight need to be considered. Commercial weight management groups could support women’s weight management as assessed at 12 months postnatally, with probable greater benefit from attending ≥ 10 sessions. Process evaluation findings highlighted the importance of providing more information about the intervention on trial allocation, extended duration of time to commence sessions following birth and extended number of sessions offered to enhance uptake and retention. Results support the conduct of a future randomised controlled trial.Trial registrationCurrent Controlled Trials ISRCTN39186148.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.

Treatment-associated Improvements in Self-regulation and Mood as Theory-based Correlates of Increased Self-efficacy for Weight-management Behaviors

Expanded understanding of the psychosocial dynamics of weight-loss treatment processes is required to improve consistently poor results. Women with obesity of ages 40–59 years participated in self-regulation-based (n = 41) and information-based (n = 46) treatments. Improvements in self-regulation and self-efficacy related to exercise and eating, mood, exercise, intake of fruits/vegetables and sweets, and weight were significant, and generally greater in the self-regulation group. Exercise- and eating-behavior changes significantly mediated the prediction of self-efficacy changes by changes in self-regulation, with mood change significantly adding to the prediction strength. Findings suggested the value in supporting exercise for its psychosocial benefits within weight-loss treatment.

Associations between effort, importance, and self-monitoring during and after a 12-week behavioural weight management program.

SummaryObjectiveSelf‐monitoring of weight and caloric intake has been associated with improved weight loss and weight loss maintenance in behavioural weight loss programs; however, participants' adherence to self‐monitoring tends to decrease over time. To identify potential barriers to self‐monitoring adherence, the current study examined week‐to‐week associations between ratings of perceived effort, relative importance of weight loss goals, and adherence to self‐monitoring of weight and caloric intake during and after a behavioural weight loss programme.MethodParticipants were 74 adults with overweight and obesity enrolled in a 12‐week, Internet‐based weight loss programme followed by a 40‐week “maintenance” period during which no additional intervention was provided. Participants self‐reported adherence to self‐monitoring and completed ratings of effort and importance on a study website weekly throughout the study period (1 year).ResultsLongitudinal multilevel models demonstrated that higher ratings of effort were associated with fewer days of self‐monitoring of weight, β = −0.100, p < .0001, and caloric intake, β = −0.300, p < .0001. Conversely, higher ratings of importance were associated with more frequent self‐monitoring of weight, β = 0.360, p < .0001, and caloric intake, β = 0.742, p < .0001. Moreover, the magnitude of these associations were stronger during the maintenance period than during initial intervention, ps < .01.ConclusionsPerceptions of effort and importance are both independently associated with adherence to self‐monitoring weight and caloric intake, and this effect appears to be stronger after the end of initial intervention. Future research should investigate whether tailoring intervention content based on these constructs can improve adherence to self‐monitoring.

Building a Viable Weight Management Program in a Patient-Centered Medical Home.

The growing prevalence of obesity in the United States and globally highlights the need for innovative strategies to provide obesity treatment in primary care settings. This report describes and evaluates the Weight Management Program (WMP), an interprofessional program in an academic family medicine clinic delivering intensive behavioral therapy (IBT) following evidenced-based guidelines. We extracted WMP participant health data from the electronic health record and evaluated retrospectively. Eligible participants completed at least four WMP visits and had a baseline weight, blood pressure, and hemoglobin A1c (HbA1c) recorded within 1 year prior to their first visit. Paired t tests were used to assess changes in, weight, HbA1c and systolic and diastolic blood pressures from baseline. WMP counseled 673 patients over 3,895 visits from September 2015 to June 2019. Of these, 186 met eligibility criteria (at least four visits), with a median of eight visits (mean=11.3, SD=8.1). Participants saw an average weight decrease during program participation of 9.7 lbs (P&lt;.001), an average decrease in HbA1c of 0.2 points (P=.004), and an average blood pressure reduction of 2.8 mmHg systolic (P=.002) and 1.9 mmHg diastolic (P=.03). One-third of participants (n=60) achieved clinically significant weight loss (&gt;5%) at 18 months. The program has become financially sustainable through billing for preventive counseling services and a $125 out-of-pocket enrollment fee. WMP provides one model for primary care practices to develop a financially sustainable and evidence-based behavioral therapy weight management program for their patients with obesity. Future work will include assessment of longer-term program benefits, quality metrics, and health care costs.

Body image, weight management behavior, and women’s interest in cosmetic surgery

ABSTRACT In the current study, we examined body image and weight management behavior as potential factors associated with young women’s interest in obtaining cosmetic surgery. Research focusing on objectification theory, problem behavior syndrome, and positive body image provide support for considering these factors as predictors of interest in cosmetic surgery. Female undergraduates (N = 170; M = 20.27 years old) at a college in the northeastern United States completed assessments of interest in cosmetic surgery, body image, and weight management behavior. Regression analyses indicated that women who had higher BMIs, higher body surveillance, higher body shame, and who engaged in more unhealthy weight management behaviors were more interested in obtaining cosmetic surgery. Body appreciation was significantly negatively correlated with interest in cosmetic surgery but did not significantly predict it when other factors were considered in a regression model. Results suggest that self-objectification and engaging in a constellation of appearance-related risk behaviors may place women at risk for pursuing cosmetic surgery.

P347Physician-led, weight loss advice prior to atrial fibrillation ablation, overall weight change and clinical outcomes

Abstract Background Randomised trial, controlled study and international guidelines have advocated weight loss in AF patients with obesity as a means of attaining better AF burden control and maintenance of sinus rhythm. However, previous study required patients to undertake a highly structured weight management programme, detailed counselling, meal plans and behaviour modification. Aim To assess if weight-loss can be attained through a 5-minute, target-driven, physician-led counselling amongst overweight/obese patients referred AF ablation, without the need for intensive weight management programme. Subsequently to assess this can lead to better clinical outcomes (reduction in AF recurrence and readmission). Methods All patients referred for AF ablation in a tertiary centre over a 6-month period were included. Baseline weight and BMI at initial encounter plus weight and BMI at day of AF ablation were recorded. Optional physician-led counselling was provided, with aim for target weight loss of &amp;lt;10% or reduction of 3 point in BMI. Initial contact to AF ablation is 6 months. Clinical outcomes such as symptomatic AF &amp;gt;3 months post AF ablation and readmission for symptomatic AF were recorded. Follow-up duration of 6 months post ablation. Patients received counselling were designated Group 1, and those who did not were designated Group 2. Outcomes 146 new AF referrals for ablation seen over the 6-month period. 105 (71.9%) are paroxysmal AF, 37 (25.3%) are persistent, 4 permanent AF. Mean BMI 34.4 (+/- 5.1). Out of which, 76% have BMI &amp;gt; 30 (Obese), 47.6% possess BMI &amp;gt;35 (Morbidly obese), with 1 patient with BMI exceeding 50. 21.9% patients received physician-led counselling to lose weight. Basic demographics (age, gender), proportion of pAF and duration of AF, use of antiarrhythmic drugs were not statistically different between the two groups. Among AF patients receiving weight-loss counselling (Group 1), they have higher mean weight and BMI, 108kg (+/- 14.3) and BMI 33.7 (+/-4.3), as compared to those who did not received counselling (Group 2), 87.5kg (+/- 16.2) and BMI 29.5 (+/-4.3). At point of AF ablation, Group 1 has median weight loss of (-)4.5kg, mean reduction of BMI (-)2.0 points, while Group 2 has median weight gain of 3.6kg, increase of BMI 1.1 point. Overall statistically significant difference in weight change (p &amp;lt;0.001). Composite clinical outcomes at 6 months post ablation comprising recurrence of AF and readmission for symptomatic AF were higher in Group 2 as compared to Group 1, 38% vs 13% (p = 0.03). Summary This small cohort study suggests that concise physician-led weight loss counselling (without dietician-led meal plan or extensive weight loss programme) provided to AF patients with increased BMI can lead to significant weight loss and lower BMI in the run-up to AF ablation. This is also associated with statistically significant reduction in recurrence of AF and hospital re-admission.

Parent-perceived barriers to child weight management: Measure validation in a clinical sample.

Although families face many barriers to obtaining and maintaining a healthy weight status for children, there remains a lack of psychometrically sound tools to assess perceived barriers. The Barriers to Child Weight Management (BCWM) scale quantitatively assesses parents' perceptions of barriers to engaging in positive weight-related behaviors but has not been validated within a clinical sample. The present study sought to validate the BCWM scale among parents of children presenting to a tertiary pediatric weight management clinic. Participants included 258 parents of children aged 6-18 years presenting to a tertiary care behavioral weight management program. Parents completed the BCWM prior to the initial clinic visit. Confirmatory factor analysis was conducted to test the previously identified 4-factor structure within a clinical sample. Overall model fit was good with the addition of 2 theoretically appropriate model respecifications, χ2(144) = 278.60, p < .001, comparative fit index = .90, root mean square error of approximation = .05, standardized root mean square residual = .06. The BCWM is a promising tool to assess parental perceptions of barriers to healthy weight-related behaviors among youth presenting for clinical weight management intervention. Incorporation of this measure into pediatric weight-management appointments may aid in quickly identifying points of intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

726-P: Mediterranean Diet Adherence and Association with Cardiometabolic Risk after Behavioral Weight Intervention in Older Adults

Adherence to a Mediterranean (Med) diet pattern, characterized by increased intake of fruits, nuts/seeds, vegetables, legumes, whole grains, seafood, yogurt and vegetables, and decreased intake of red/processed meats, refined grains, starches and added sugars, is associated with reduced cardiometabolic risk independent of total calorie intake or single nutrients. We examined whether adherence to Med diet was associated with risk factor change in the context of a behavioral weight management trial for U.S. community-dwelling older adults at elevated diabetes and cardiovascular risk. The Pitt Retiree Study (n=322) examined the impact of 12 weekly group lifestyle sessions on weight and cardiometabolic risk (BMI, waist, glucose, lipids, and blood pressure) in older adults (age 65-80 yrs). Dietary goals included calorie reduction, &amp;lt;30% of total calories from fat, lean protein at most meals, and following USDA MyPlate guidelines but not a Med diet. Adherence to a Med diet pattern (0-14 score) was assessed at baseline, 4, 12, and 24 months and categorized as low (0-5), moderate (6-9), or high (≥10). The baseline median Med diet score was 6 (range 0-13), with 45% categorized as low, 50% moderate, 5% high. Women were more adherent than men (p&amp;lt;0.01). Adjusting for sex, higher scores were correlated with older age (p=0.02), lower baseline BMI (p=0.01) and smaller waist (p=0.01). Median [IQR] scores improved at 4 months (+1 [0, +2] p&amp;lt;.001) with 27% low, 63% moderate, 10% high. Each 1-unit Med diet increase was associated with -0.1 kg/m2 BMI (SE=0.04, p=.006) and -1.0 mmHg Systolic BP (SE=0.47, p=0.03) at 4 months. Med diet improvement was maintained at 12 (+1, [0, +2] p&amp;lt;.001) and 24 months (n=299, +1 [0, +2] p&amp;lt;.001). Adherence to a food pattern consistent with a Med diet improves after lifestyle intervention, even when not specifically prescribed, and is associated with weight and blood pressure benefits. Importantly, older adults sustain change in dietary quality over 2 years. Disclosure R.G. Miller: None. E.M. Venditti: None. M.D. Marcus: None. L.J. Germeroth: None. R.P.K. Conlon: None. M.D. Levine: None. T. Costacou: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R18DK096404)

1274-P: Prevalence of Addictive-Like Eating in Hispanic Adolescents with Obesity Seeking Weight Management Treatment

Background: There is a growing body of literature exploring food addiction (FA) in adolescents with obesity and how it impacts treatment outcomes. Several studies have evaluated the prevalence of FA in youth with obesity as measured by the Yale Food Addiction Scale for children (YFAS-c) and rates vary from 4-22%. The rates of obesity in Hispanic youth is reported to be higher than in other ethnic groups however there is a paucity of literature exploring the prevalence of FA in this population. Due to our geographic location and our majority Hispanic patient population, we examined 1) the prevalence of FA in Hispanic adolescents with obesity and 2) the association between FA and demographic characteristics. Methods: Baseline data from a RCT on behavioral weight management interventions was used. Participants who self-identified as Hispanic, were 14-18 years of age, and with a BMI &amp;gt;95th% met criteria. Fisher’s exact test was used to assess the differences between adolescents with positive and negative YFAS-c scores and demographic characteristics. Results: In a sample of 59 Hispanic youth, 29% met criteria for FA. There was no significant difference in age, gender, or household income between adolescents with positive YFAS-c at baseline compared to those with negative scores. Conclusions: Hispanic youth with obesity have higher rates of FA than previous prevalence reports. This information is essential to consider prior to implementation of a weight management program as it may impact adherence, retention, and ultimately weight outcomes. Baseline behavioral phenotyping may be a strategy to ensure adolescents are receiving the services they require in conjunction with participation in a weight management program. These findings can help inform providers of the importance of screening for FA prior to intervention administration and possibly modifying the intervention content to address addictive like eating behaviors. Disclosure J. Gonzalez: None. C. Fink: None. C. Wee: None. E. Hegedus: None. K. Lopez: None. A. Vidmar: None. Funding eHealth International (CHLA 000193)