Weight Management Strategies Research Articles

Bioactive compounds regulate appetite through the melanocortin system: a review.

Obesity, a significant health crisis, arises from an imbalance between energy intake and expenditure. Enhancing appetite regulation has garnered substantial attention from researchers as a novel and effective strategy for weight management. The melanocortin system, situated in the hypothalamus, is recognized as a critical node in the regulation of appetite. It integrates long-term and short-term hormone signals from the periphery as well as nutrients, forming a complex network of interacting feedback mechanisms with the gut-brain axis, significantly contributing to the regulation of energy homeostasis. Appetite regulation by bioactive compounds has been a focus of intensive research due to their favorable safety profiles and easy accessibility. These bioactive compounds, derived from a variety of plant and animal sources, modulate the melanocortin system and influence appetite and energy homeostasis through multiple pathways: central nervous system, peripheral hormones, and intestinal microbiota. Here, we review the anatomy, function, and receptors of the melanocortin system, outline the long-term and short-term regulatory hormones that act on the melanocortin system, and discuss the bioactive compounds and their mechanisms of action that exert a regulatory effect on appetite by targeting the melanocortin system. This review contributes to a better understanding of how bioactive compounds regulate appetite via the melanocortin system, thereby providing nutritional references for citizens' dietary preferences.

Association between menopause, body composition, and nonalcoholic fatty liver disease: A prospective cohort in northern China

BackgroundThe association between menopause, changes in body composition, and nonalcoholic fatty liver disease is not clear, and there is a lack of weight management strategies for perimenopausal women from the perspective of preventing nonalcoholic fatty liver disease. MethodsA total of 1316 postmenopausal and 3049 premenopausal women in the Kailuan cohort in China between 2006 and 2017 were enrolled and followed up till 2021. Cox regression models, including the causal mediation analyses, were used to estimate the association between menopause and nonalcoholic fatty liver disease and the potential mediation effect of changes in body composition. We also explored the impact of weight changes on the correlation between menopause and nonalcoholic fatty liver disease. ResultsWomen who experienced menopause had a higher risk of nonalcoholic fatty liver disease than premenopausal women (9-year cumulative incidence: 56.87 % vs. 48.80 %, adjusted hazard ratio = 1.219, 95 % confidence interval: 1.088–1.365). The nine-year cumulative incidence of nonalcoholic fatty liver disease was higher among overweight/obese postmenopausal women (67.24 % vs. 45.74 %, P < 0.001) and those with abdominal obesity (63.36 % vs. 49.69 %, P < 0.001); however, the hazard ratio of menopause for nonalcoholic fatty liver disease was more evident in women with a body mass index under 23.0 kg/m2 (hazard ratio = 1.434, 95 % confidence interval: 1.168–1.759) and those with normal waist circumference (hazard ratio = 1.362, 95 % confidence interval: 1.129–1.643), which could partially be explained by the visceral fat index (7.09 % and 7.35 % mediation, respectively). Weight loss of 3 % or more or reduction in waist circumference by 5 % or more was associated with a 31.1 % reduction (95 % confidence interval, 20.8 %–40.0 %) or a 14.2 % reduction (95 % confidence interval, 1.1 %–25.6 %) in the risk of nonalcoholic fatty liver disease among the premenopausal women. For postmenopausal women, weight gain of 3 % or more was associated with an increased risk of nonalcoholic fatty liver disease, especially in individuals with a body mass index under 23.0 kg/m2. ConclusionMenopause was associated with a higher risk of nonalcoholic fatty liver disease, partially by increasing visceral fat. Controlling weight in perimenopausal women may reduce the risk.

Sex- and metabolic-specific association between cumulative body mass index and incident chronic kidney disease: a prospective community-based cohort study

Background and AimDifference in metabolic status may cause inconsistent association between body mass index (BMI) and chronic kidney disease (CKD) in men and women. This study aimed to quantify sex-specific association between cumulative BMI (cumBMI) and incident CKD by different metabolic status. Methods and ResultsParticipants free of CKD from the Kailuan Study were followed biennially from baseline (June 2006 to October 2007) to December 2019. cumBMI was calculated by use of follow-up BMI and follow-up time and was divided into low weight (<18.5 kg/m2), normal weight (18.5 to 23.9 kg/m2), overweight (24 to 27.9 kg/m2), and obesity (≥28 kg/m2) according to Chinese criteria. Metabolic health was defined as the absence of hypertension, dyslipidemia, and diabetes at baseline. CKD was defined as having estimated glomerular filtration rate <60 mL/min/1.73m2. This study included 76984 participants, with a mean age of 50.0 ± 11.6 years and 80.0% of men. Overweight (HR=1.24, 95% CI: 1.16–1.31) and obesity (HR=1.94, 95% CI: 1.77–2.12) were associated with higher risk of incident CKD in men regardless of metabolic status. Corresponding population attributable risk percentages for overweight and obesity were 10.3% (95%CI: 7.1–12.9) and 12.7% (95%CI: 10.6–14.7), respectively. However, low weight (HR=1.56, 95% CI: 1.05–2.30) and obesity (HR=1.32, 95% CI: 1.01–1.73) were associated with higher risk of incident CKD in metabolically healthy women but not in metabolically unhealthy women. ConclusionsThis study demonstrated sex- and metabolic-specific associations between BMI and CKD occurrence and advocates an individualized weight management strategy.

Youth Health Trends in Northern Portugal: Analyzing Diet, Physical Activity, and Body Image

(1) Background: In the face of global concerns regarding unhealthy lifestyles among youths, understanding dietary habits, physical activity, and weight management strategies among third-cycle students in Portugal becomes essential. This study aims to evaluate the extent to which middle school students adhere to the Mediterranean diet and assess their physical activity habits and overall weight perceptions. (2) Methods: This study is a cross-sectional observational study. Using self-reported data from a sample of 232 students aged between 12 and 18, this study delved into their dietary patterns, engagement in physical activities, perceptions of weight, and weight management approaches, measured by the KIDMED and YRB questionnaires. (3) The results demonstrated that adolescents engaged in a varied diet, and 65.5% had recently engaged in physical activity. However, 25% reported exercise-related injuries, suggesting potential safety gaps. Extreme weight management practices were minimal, but a disparity in weight perception and weight loss desire emerged, hinting at underlying societal and media influences. Gender differences in certain habits were minimal. (4) Conclusions: While students were generally inclined towards healthy habits, there are evident areas of concern, particularly regarding safety in physical activities and weight perceptions. In the future, interventions should be implemented to increase students’ literacy and raise awareness of the Mediterranean diet and physical well-being.

Influence of slow and rapid weight loss periods on physiological performance, mood state and sleep quality in male freestyle wrestlers: a study from Sichuan Province, China.

This study aims to investigate the changes in physiological performance, mental state and sleep quality during the weight reduction phase prior to competition in male freestyle wrestlers. This study included 16 male freestyle wrestlers from Sichuan Province, China. Participants were evaluated at three time points: the first day of slow weight reduction (T1, March 26), the first day of rapid weight reduction (T2, April 26) and the day before the competition (T3, May 3), and measurements were taken for physiological performance, mood state and sleep quality. The most relevant findings indicated the following: Morning heart rate, creatine kinase and fatigue scores increased by 12.6, 64.6, and 19.0%, respectively, from T1 to T2 (p < 0.05), and decreased by 14.1, 36.6, and 16.8%, respectively, from T2 to T3 (p < 0.05). Hemoglobin and testosterone levels decreased by 3.0 and 16.8%, respectively, from T1 to T3 (p < 0.05), and by 2.9 and 18.2%, respectively, from T2 to T3 (p < 0.05); The secondary findings revealed the following: The total mood disturbance scores decreased by 3.8% from T2 to T3 (p = 0.072), positive mood scores decreased by 9.0% from T1 to T2 (p = 0.090), the Pittsburgh Sleep Quality Index total scores increased by 14.4% from T1 to T2 (p = 0.323) and total work output and average power output decreased by 7.3 and 7.8%, respectively, from T1 to T3 (p = 0.067, p = 0.052); Regression analyses predicted negative mood (Y 1 = 62.306-0.018 × maximum power output) and sleep quality (Y 2 = 2.527 + 0.278 × Immunoglobulin G) during the weight reduction period. The combined slow and rapid weight reduction approach effectively minimized body fat in athletes with limited effect on their physiological performance and sleep quality. However, the effects were adverse on certain health variables and anaerobic power in Chinese male freestyle wrestlers. The identified correlations between negative mood and maximum power, and between sleep quality and immunoglobulin G, shed new light on factors influencing athletes' well-being during weight reduction, and underscored the need for careful monitoring of physiological variables in future weight management strategies.

Weight-control compensatory behaviors patterns and correlates: a scoping review.

Weight-control compensatory behaviors appear to be a commonly utilized strategy for health management. Individuals engaging in such behaviors believe that the negative consequences from unhealthy behaviors will be neutralized by the positive consequences of healthy behaviors. Existing research has not reached a consensus on whether such behaviors are beneficial to health. This review aims to (1) summarize the patterns of weight-control compensatory health behaviors in different populations, (2) highlight correlates, predictors, and consequences of compensatory health behaviors, and (3) identify gaps for future research. This review identified existing literature using online databases, CINAHL and PubMed. Primary research articles published after 2000 with non-clinical participants of 12 years or older who engaged in compensatory behaviors for weight control purposes were selected. Descriptive statistics were extracted from 35 studies. Different patterns for weight-control compensatory behaviors emerged between the female and male sexes. Meanwhile, no clear association of such behaviors was found across weight status. Studies reviewed also highlighted three main areas of compensatory behaviors for weight management, namely dietary behaviors, physical activity, and alcohol consumption. Weight-control compensatory behaviors had significant negative correlations with mental health indicators, such as psychosocial functioning, emotional differentiation ability, and body esteem. Weight-control compensatory behaviors may be a widely used weight management strategy and can be presented in diverse ways. Although believed to be promoting health, such behaviors appear to be associated with poor psychological well-being. This emerging topic warrants more in-depth investigation to establish the direction of causation. Future research may investigate the relationship between weight-control compensatory behaviors and various aspects of health over longer time periods, examine the engagement of multiple weight-control compensatory behaviors, and focus on high-risk populations.

Development and feasibility testing of a time-restricted eating intervention for women living with overweight/obesity and HIV in a resource-limited setting of South Africa

BackgroundHuman Immunodeficiency Virus (HIV) and type 2 diabetes (T2D) are amongst the leading causes of death in South Africa. The preferred first-line anti-retroviral treatment contains dolutegravir (DTG), shown to increase body weight, may compound the already high rates of obesity and associated risk for T2D. South Africa has widespread food insecurity, making traditional dietary strategies difficult to implement. Time-restricted eating (TRE) may be an appropriate intervention in resource-limited communities.MethodsThis article outlines the development and feasibility testing of a TRE intervention to inform the design of a TRE randomised controlled trial in women (20–45 years old) living with overweight/obesity and HIV, receiving DTG-based treatment from a resource-limited community in Cape Town, South Africa. Factors influencing TRE adoption were identified using the Capability, Opportunity, Motivation – Behaviour model and the Theoretical Domains Framework, combining in-depth interviews (IDIs) and focus group discussions. Participants from the IDIs went on to participate in a single arm 4-week TRE pilot trial where feasibility was explored in terms of reach, acceptability, applicability, and implementation integrity. An iterative, thematic analysis approach was employed to analyse the qualitative data.ResultsParticipants included 33 isiXhosa-speaking women (mean age 37.1 years, mean BMI 35.9 kg/m2). Thematic analysis identified psychological capability (knowledge of fasting), social influences (cultural preferences, family support), and reflective motivation (awareness of weight, health impact, motivation for TRE) as key factors influencing adoption of TRE for weight management. In a 4-week TRE pilot trial (n = 12), retention was 100%. Positive outcomes perceived included improved energy, appetite control and weight loss. TRE was perceived as acceptable, easy, and enjoyable. Family support facilitated adherence, while habitual and social eating and drinking practices were barriers. Compliance was high, aided by self-selected eating times, reminders, and weekly calls. Recommendations included the incorporation of dietary education sessions and text messages to provide additional support and reminders.ConclusionsThis study indicates that TRE is a feasible weight management strategy in women living with overweight/obesity and HIV, receiving DTG-based treatment in a resource-limited community. These findings will ensure that the forthcoming TRE randomised controlled trial is adapted and optimised to the local South African context.

Effect of telemedicine interventions on weight loss: A systematic review and meta-analysis.

Obesity and its associated health challenges represent a pressing global concern. Telemedicine interventions offer a promising solution for effective weight loss support. This study examines the impact of telemedicine interventions on weight loss support. We conducted a search of PubMed, Scopus, and Web of Science, starting from their inception. Both researchers systematically selected articles and extracted data using a designated data collection form. To assess the risk of bias in the included studies, we employed the Mixed Methods Appraisal Tool. Publication bias was evaluated through funnel plots and Egger's and Begg's tests. Utilizing the gathered data, we computed the standardized mean differences (Hedges's g) between the treatment and control groups. We estimated heterogeneity variance using the Q test and I2 statistic. The analysis was carried out using Stata 17.0. Out of a total of 2626 retrieved articles, 30 studies were included in the analysis. Telemedicine interventions can cause weight loss in people (Hedges's g = 0.09, 95% CI: -0.13, 0.39; p-value < 0.001). The type of telemedicine intervention and target population were a significant moderator of the heterogeneity between studies (p < 0.05). This study highlights the potential of telemedicine interventions as valuable tools in weight loss programs. Embracing these technologies can enhance the effectiveness of weight management strategies for diverse populations.

Topiramate added to metformin for obesity control in women with polycystic ovary syndrome: a randomized clinical trial.

Polycystic ovary syndrome (PCOS) is often linked with obesity, and weight management can improve endocrine and cardiometabolic features. To evaluate the effects of adding topiramate (TPM) to metformin (MTF) on weight control, hormonal and metabolic outcomes in women with PCOS. In a randomized, double-blind, placebo-controlled trial, participants with PCOS and body mass index ≥30 kg/m² or ≥27 kg/m² associated with hypertension, type 2 diabetes, or dyslipidemia followed a 20 kcal/kg diet in addition to 850 mg of MTF or a previous MTF regimen. They were randomized to receive either TPM or placebo (P) alongside MTF. Anthropometric measurements, blood pressure, modified Ferriman-Gallwey score (mFGS), and adverse events were assessed every 4 weeks for 6 months. The primary endpoint was the percent change in body weight from baseline in both groups. Secondary endpoints included changes in clinical, cardiometabolic, and hormonal parameters and psychosocial features. Thirty-one participants were in the MTF+P group and 30 in the MTF+TPM group. The MTF+TPM group showed greater mean weight loss at 3 months (-3.4% vs. -1.6%, p=0.03) and 6 months (-4.5% vs. -1.4%, p=0.03). Both groups improved androgens, lipids, and psychosocial scores. Participants with ≥3% weight loss at 6 months improved mFGS (8.4 to 6.5, p=0.026). Paresthesia was more common in the MTF+TPM group (23.3% vs. 3.2%, p=0.026). Combining TPM with MTF and a low-calorie diet may be an effective, low-cost, easy-to-use, and safe strategy for weight management in women with PCOS, with mild adverse effects.

Race, Ethnicity, and Geography as Determinants of Excessive Weight and Low Physical Activity in Pediatric Population: Protocol for Systematic Review and Meta-Analysis.

The rationale for the current study is the sparsity of data on the combined effect of the environmental and individual risks of obesity and sedentary lifestyle in children of different races/ethnicities from different regions. An effective weight management strategy is hard to design due to insufficient evidence. This work was initiated to study race, ethnicity, and geography as determinants of excessive weight and low physical activity in the pediatric population. To achieve this aim, we systematically review publications on daily length of physical activity of light, moderate, and vigorous intensity, as well as sedentary time and BMI and its dynamics in children of different races/ethnicities and geographies. The extracted data are stratified into six major geographic regions and six races/ethnicities. Then, a random-effects meta-analysis is used to calculate the pooled mean of each outcome measure. A ridge regression is constructed to explore age-related change in BMI. A Kruskal-Wallis H test is applied to compare the pooled duration of physical activity and sedentary time in the subgroups. Finally, we calculate paired correlation coefficients between BMI and physical activity/inactivity for each group. The findings can be further used in public health surveillance to clarify the epidemiology of obesity, to guide priority setting and planning, and to develop and evaluate public health policy and strategy.

Comparative analysis of basal metabolic rate measurement methods in overweight and obese individuals: A retrospective study.

The global prevalence of overweight and obesity is on the rise, presenting significant health challenges worldwide. Obesity is associated with various chronic diseases and imposes substantial economic burdens on society. Accurate assessment of basal metabolic rate (BMR) is crucial for effective weight management strategies. This retrospective study, conducted at Baskent University Hospital between October 2019 and October 2023, analyzed data from 133 overweight and obese individuals. Various methods including indirect calorimetry (IC), predictive equations (Harris-Benedict and Mifflin-St Jeor), and bioelectrical impedance analysis (BIA) were used to estimate BMR. Additionally, demographic, clinical, and body composition data were recorded. The mean BMR measured using IC was 1581 ± 322 kcal/day, which was significantly lower than the BMR estimated by other methods such as BIA (1765.8 ± 344.09 kcal/day), Harris-Benedict (1787.64 ± 341.4 kcal/day), and Mifflin-St Jeor equations (1690.08 ± 296.36 kcal/day) (P < .001). Among the predictive equations, the Mifflin-St Jeor method provided BMR estimates closest to the gold standard IC. When BMR measurement methods were compared to IC, 36.8% of measurements with the Harris-Benedict equation method, 50.4% with the Mifflin-St Jeor equation method, and 36.1% with the BIA method were within ± 10% agreement with IC measurements. Significant correlations were found between BMR and body composition parameters such as fat-free mass, muscle mass, and fat mass (R = 0.681, P < .001; R = 0.699, P < .001; R = 0.595, P < .001, respectively). Regression analysis identified that variables such as weight, height, body mass index, and muscle mass significantly predicted BMR measured by IC, accounting for 69.1% of the variance. This study underscores the challenges in assessing BMR in overweight and obese individuals. While IC remains the gold standard, predictive equations and BIA offer alternative methods. The Mifflin-St Jeor equation emerged as a practical option, closely aligning with IC results. However, discrepancies between methods and the influence of body composition highlight the importance of individualized approaches to BMR assessment in weight management strategies.

Gestational weight gain trajectories in patients with gestational diabetes mellitus: a retrospective cohort study.

Aims/Background Gestational diabetes mellitus is a common pregnancy complication that affects approximately 14% of pregnancies worldwide and can lead to adverse maternal and neonatal outcomes. This study aimed to investigate the trajectories of gestational weight gain among gestational diabetes mellitus patients and to inform the development of effective weight management strategies. Methods Demographic and antenatal examination data from 1421 pregnant women diagnosed with gestational diabetes mellitus were retrospectively analysed. Quantitative data comparisons were performed using Chi-square tests, Fisher's exact test, t-tests, and one-way analysis of variance. Group-based trajectory modelling was employed to identify the trajectories of gestational weight gain among patients with gestational diabetes mellitus. Results This study revealed that pre-pregnancy body mass index and types of gestational diabetes mellitus significantly influence gestational weight gain (p < 0.05). Group-based trajectory modelling identified three distinct gestational weight gain trajectories. Patients with gestational diabetes mellitus demonstrated a continuous weight gain throughout pregnancy, while women who were overweight or obese before pregnancy were more likely to follow a low-speed growth trajectory. Women in the rapid growth trajectory group were more inclined to deliver by caesarean section and were more likely to give birth to macrosomic infants. Conclusion Our research underscores the importance of identifying and distinguishing between different gestational weight gain trajectories in pregnant women, thereby identifying high-risk groups, which is crucial for improving the health conditions of both mothers and newborns.

Reviewing the recurrence rates in stage I-III HR or ER positive breast cancer in obese patients given multi-modal weight loss plan post-treatment with aromatase inhibitors.

15 Background: Aromatase inhibitors (AIs) in the treatment of endocrine recepter positive breast cancer stages I-III, poses significant challenges in the management of obesity. Obesity is not only associated with an increased risk of breast cancer incidence but also with higher rates of cancer recurrence and poorer treatment outcomes. Moreover, the use of AIs, while effective in reducing estrogen levels and preventing ER or HR positive breast cancer recurrence, may exacerbate weight gain and metabolic disturbances in obese individuals. Weight management strategies have experienced increased attention in breast cancer survivors in recent years, especially overweight or obese individuals. Novel data makes it possible to infer that obesity management activities and multimodal programs that incorporate dietary counseling and physical activity can reduce recurrence rates. Methods: Participants in this study were individuals with Stage I-III endocrine receptor positive breast cancer who had completed adjuvant therapy and had a BMI in the 40s or 50s, increasing risk of recurrence. Eligible patients were identified based on the start date for endocrine therapy. High-risk patients were then assigned to either the intervention or control group. Those in the intervention group received access to a dietician, along with informational pamphlets on physiology and weight loss strategies. Additionally, they were offered discounts to certain gyms or provided free access to fitness facilities. Both intervention and control groups were briefed about the study, with those in the intervention group encouraged to utilize the provided resources for weight management. Results: The evidence from our study will underscore the potential benefits of multimodal weight loss interventions in overweight or obese breast cancer survivors, particularly in improving anthropometric outcomes and enhancing overall quality of life. Conclusions: While the studies included in our analysis demonstrated reductions in body weight, BMI, and waist circumference, as well as improvements in quality of life measures, there remains a notable gap in understanding the impact of these interventions on breast cancer recurrence rates, especially in the context of endocrine-positive breast cancer treated with Aromatase Inhibitors (AIs).

Optimizing Bodybuilding Training Frequency for Weight Loss and Psychological Well-Being in Overweight Individuals: A 12-Week Study

Background: The increasing incidence of overweight and obesity raises a global public health challenge, with overweight individuals (BMI 25–29.9) at higher risk for chronic diseases like cardiovascular conditions and diabetes (WHO, 2024). While lifestyle changes, including dieting and exercise, are key strategies for weight management, bodybuilding is gaining attention for its potential in fat loss and improving body composition. However, the optimal frequency for bodybuilding sessions in overweight individuals remains unclear. This study explores the effects of different training frequencies on body weight, BMI, and fat loss. Methods: This cross-sectional study involved 90 participants, all classified as overweight (BMI 25–29.9). Participants were recruited through online advertisements and were divided into three groups, each following a 12-week bodybuilding training regimen with varying frequencies: twice, thrice, or five times weekly. Baseline body weight and BMI were recorded before training, and changes were assessed at the end of the program. A short questionnaire evaluated the effects of the training on weight loss, body composition, and psychological outcomes. Results: This study involved 90 participants, primarily aged 25-34 (48.9%). The demographic analysis revealed that males constituted 66.7% of the sample, exhibiting a mean weight loss of 75.23 pounds (p &lt; 0.001) after 12 weeks of bodybuilding training, effectively rejecting the hypothesis that bodybuilding training has no significant impact on weight loss. Additionally, while no significant differences in weight loss were observed based on training frequency (F(2, 87) = 0.791, p = 0.457), both weight loss and body mass index (BMI) significantly improved with training. Conclusion: Overall, regular bodybuilding training positively influenced weight loss, body composition, and psychological well-being.

Time-restricted eating affects human adipose tissue fat mobilization.

Time-restricted eating (TRE), a dietary approach that confines food intake to specific time windows, has shown metabolic benefits. However, its impact on body weight loss remains inconclusive. The objective of this study was to investigate the influence of early TRE (eTRE) and delayed TRE (dTRE) on fat mobilization using human adipose tissue (AT) cultures. Subcutaneous AT was collected from 21 participants with severe obesity. We assessed fat mobilization by measuring glycerol release in AT culture across four treatment conditions: control, eTRE, dTRE, and 24-h fasting. TRE had a significant impact on lipolysis (glycerol release [mean (SD)] in micromoles per hour per gram: control, 0.05 [0.003]; eTRE, 0.10 [0.006]; dTRE, 0.08 [0.005]; and fasting, 0.17 [0.008]; p < 0.0001). Both eTRE and dTRE increased lipolysis compared with the control group, with eTRE showing higher glycerol mobilization than dTRE during the overall 24-h time window, especially at the nighttime/habitual sleep episode (p < 0.0001). Further analysis of TRE based on fasting duration revealed that, independently of the time window, glycerol release increased with fasting duration (in micromoles per hour per gram: 8 h = 0.08 [0.001]; 12 h = 0.09 [0.008]; and 16 h of fasting = 0.12 [0.011]; p < 0.0001). This study provides insights into the potential benefits of TRE on fat mobilization and may guide the design of future dietary strategies for weight management and metabolic health.

Low CD4 counts predict excessive weight gains during first-line treatment for HIV.

Weight gain is common after antiretroviral initiation, especially among females, those of black race and lower baseline CD4, although this may potentially be due to lower baseline weight. Use of tenofovir disoproxil fumarate or efavirenz can suppress weight gain. Data were pooled from the ADVANCE (n = 1053), NAMSAL (n = 613) and WHRI001 (n = 536) trials investigating first-line regimen. Week 96 weight and body mass index (BMI) was stratified by baseline CD4. Multivariable models of weight change and incident obesity (BMI ≥30 kg/m2) were adjusted for baseline CD4, age, sex, tenofovir disoproxil fumarate, efavirenz, baseline BMI and trial. Participants across all treatment arms experienced weight gain from baseline to week 96, with baseline CD4 count, baseline HIV RNA, tenofovir alafenamide and dolutegravir use, and female sex significant predictors. Mean unadjusted weight change was highest with CD4 < 100 (+8.6 kg; SD = 8.2) and lowest with CD4 ≥ 350 (+3.0 kg; SD = 6.5). This weight gain in CD4 < 100 was highest for participants on tenofovir alafenamide-inclusive treatment, such that absolute weight at week 96 was highest in the CD4 < 100 group. Although not statistically significant, obesity rate (BMI ≥ 30 kg/m2) in those taking TAF/FTC + DTG with CD4 < 100 overtook that seen in CD4 ≥ 350, despite lower baseline obesity prevalence. The unadjusted findings were corroborated in multivariable longitudinal models. Participants with low CD4 may demonstrate significant 'overshoot' weight gain, in addition to 'return to health', with a trend towards increased risk of obesity when initiated on TAF/FTC + DTG. Use of tenofovir disoproxil fumarate and efavirenz were associated with smaller weight gains. Effective weight management strategies are needed, especially for individuals with low baseline CD4.

Cognitive and behavioral weight management strategies during the menopausal transition: Insights from the Menopause and Weight Loss (ME-WEL) project

ObjectiveMost women experience weight gain during the menopausal transition, often attributed to behavioral factors. Nevertheless, some women successfully maintain a healthy weight during this phase. This study aims to identify the successful cognitive and behavioral weight management strategies employed by postmenopausal women who effectively maintained a healthy weight during the menopausal transition (from premenopause to postmenopause). MethodSemi-structured interviews were conducted with 31 Portuguese postmenopausal women, aged 45–65 years (mean and standard deviation 54.06 ± 5.51) who successfully maintained a healthy weight (body mass index: 18.5 kg/m2–24.9 kg/m2) during the menopausal transition. The interviews were conducted via telephone (n = 29) and Zoom (n = 2), based on the participant's preference, and ranged from 11 to 52 min (22.06 ± 9.95). Using MAXQDA software, deductive-dominant content analysis of the interviews was performed. The Interface of R for the Multidimensional Analyses of Texts and Questionnaire software was used for lexical analysis. ResultsThe qualitative analysis of cognitive and behavioral strategies for successful weight management yielded 17 categories and 37 sub-categories. Effective cognitive and behavioral strategies (e.g., planning content, stimulus control, support: help from others) were identified, mostly aligning with the Oxford Food and Activity Behaviors Taxonomy. Five new categories emerged: dietary choices, intuitive eating, food literacy, psychological self-care, and effortful inhibition. ConclusionKnowing effective cognitive and behavioral weight management strategies for menopausal women is relevant, especially considering their status as a high-risk group. This knowledge provides a valuable guide for designing weight management interventions, emphasizing the essential role of behavioral change.

Consideration of Use of Semaglutide and Tirzepatide Prior to Pregnancy

In reproductive-age females with elevated body mass index (BMI), weight loss is often recommended independent of their reproductive and family planning goals. However, it is clear that lifestyle methods for losing weight often fall short of achieving and maintaining weight loss. As approaches to addressing obesity and weight optimization evolve beyond the simplistic notion of “eat less and move more,” there has been a growing acceptance of weight loss medications as part of comprehensive weight management strategies. It should also be noted that health optimization cannot be solely attributed to reducing BMI or kilograms of body weight. The objective of this paper is not to contribute to the well-established weight stigma in medicine, but rather to highlight a thoughtful approach to the use of weight loss medication in a cohort where the prevalence is expected to rise independent of the indication.

Weight Loss Programs: Why Do They Fail? A Multidimensional Approach for Obesity Management.

Despite the prevalence of weight loss programs, their success rates remain discouraging, with around half of individuals regaining lost weight within two years. The primary objective of this review is to explore the factors contributing to the failure of weight loss programs and to provide insights into effective weight management strategies. Factors contributing to the failure of weight loss programs include the impracticality of restrictive diets, potential metabolic impacts, limited focus on lifestyle changes, genetic predispositions, psychological influences, socioeconomic status, and medical conditions. A holistic approach considering these factors is crucial for safe and sustainable weight loss. Key findings indicate the importance of holistic approaches to weight management, including lifestyle modifications, medical interventions, and behavioral and psychological strategies. Effective weight loss strategies emphasize low-calorie, nutrient-rich diets, regular physical activity, and interventions tailored to individual needs. Combining multiple approaches offers the best chance of successful weight management and improved health outcomes. This review provides insights into the complexities of obesity management and the factors contributing to the failure of weight loss programs. It highlights the necessity of adopting a holistic approach that addresses dietary habits, physical activity, genetic factors, psychological well-being, and socioeconomic influences. Recommendations include implementing lifestyle modifications, medical interventions when necessary, and integrating behavioral and psychological support to achieve sustainable weight loss and mitigate the global health challenge posed by obesity.

Efficacy and safety of once-weekly tirzepatide for weight management compared to placebo: An updated systematic review and meta-analysis including the latest SURMOUNT-2 trial.

Tirzepatide, a newly developed dual glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, has received approval for treating type 2 diabetes (T2D) and is currently being studied for its potential in long-term weight control. We aim to explore the safety and efficacy of once-weekly subcutaneous tirzepatide for weight loss in T2D or obese patients. A comprehensive search was performed on various databases including PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception up to April 29, 2024, to identify randomized controlled trials (RCTs) that assessed the efficacy of once-weekly tirzepatide compared to a placebo in adults with or without T2D. The mean difference (MD) and risk ratio (RR) were calculated for continuous and dichotomous outcomes, respectively. The risk of bias was evaluated using the RoB-2 tool (Cochrane), while the statistical analysis was conducted utilizing RevMan 5.4.1 software. Seven RCTs comprising 4795 individuals ranging from 12 to 72 weeks were identified. Compared to the placebo group, tirzepatide at doses of 5, 10, and 15 mg demonstrated significant dose-dependent weight loss. The mean difference (MD) in the percentage change in body weight (BW) was -8.07% (95% CI -11.01, -5.13; p < 0.00001), -10.79% (95% CI -13.86, -7.71; p < 0.00001), and -11.83% (95% CI -14.52, -9.14; p < 0.00001), respectively. Additionally, the MD in the absolute change in BW was -7.5 kg (95% CI -10.9, -4.1; p < 0.0001), -11.0 kg (95% CI -16.9, -5.2; p = 0.0002), and -11.5 kg (95% CI -16.2, -6.7; p < 0.00001), for the 5, 10, and 15 mg doses, respectively. All three doses of tirzepatide also significantly reduced body mass index and waist circumference. Furthermore, it led to a greater percentage of patients experiencing weight loss exceeding 5, 10, 15, 20, and 25%. Moreover, tirzepatide showed great success in reducing blood pressure, blood sugar levels, and lipid profiles. In terms of safety, gastrointestinal side effects were the most frequently reported adverse events in all three doses of tirzepatide groups, which were generally mild-to-moderate and transient. Tirzepatide treatment could lead to remarkable and sustained weight loss that is well-tolerated and safe, representing a novel and valuable therapeutic strategy for long-term weight management.