Obese patients' perceptions of treatment outcomes and the factors that influence them

The Role of Lifestyle Modification with Second-Generation Anti-obesity Medications: Comparisons, Questions, and Clinical Opportunities

PURPOSE OF REVIEW

This review examines lifestyle modification for obesity management with the goal of identifying treatment components that could support the use of a new generation of anti-obesity medications (AOMs).

RECENT FINDINGS

Semaglutide reliably reduces baseline body weight by approximately 15% at 68 weeks, in contrast to 5-10% for lifestyle modification. Tirzepatide induces mean losses as great as 20.9%. Both medications reduce energy intake by markedly enhancing satiation and decreasing hunger, and they appear to lessen the need for traditional cognitive and behavioral strategies (e.g., monitoring food intake) to achieve calorie restriction. Little, however, is known about whether patients who lose weight with these AOMs adopt healthy diet and activity patterns needed to optimize body composition, cardiometabolic health, and quality of life. When used with the new AOMs, the focus of lifestyle modification is likely to change from inducing weight loss (through calorie restriction) to facilitating patients' adoption of dietary and activity patterns that will promote optimal changes in body composition and overall health.

The relationship between weight history and psychological health-Differences related to gender and weight loss patterns

BACKGROUND

The prevalence and burden of obesity continues to grow worldwide. Psychological comorbidities may not only influence quality of life, but may also hinder successful weight loss. The causality between excess weight and mental health issues is still not fully understood. The aim of the study was to investigate whetherweight history parameters, (ie.age of onset) are related to psychological comorbidities.

METHOD

The data were derived from a representative telephone survey in Germany, collecting information on weight loss patterns and mental health outcomes among individuals with BMI>30kg/m2. Overall, 787 participants were examined in terms of depressive symptoms (Patient Health Questionnaire, PHQ-9) and anxiety (Generalized Anxiety Disorder Questionnaire, GAD7). In addition, participants were asked about different aspects of their weight history (ie. weight loss patterns and trajectories) over the lifespan. The relationship between weight history and mental health was analyzed using multivariate statistics.

RESULTS

According to regression analyses, having had more weight loss attempts, a greater weight loss being desired and being a "weight maintainer" was associated with more symptoms of depression (p < 0.001), whereas a greater desired weight loss and being categorized as a "weight maintainer" was associated with more anxiety (p < 0.001). Moroever, the prevalence of depressive symptoms was significantly higher in male individuals who desire to lose more weight or had more weight loss attempts in the past.

CONCLUSION

Gender-specific differences were observed in terms of weight history parameters, as well as mental health outcomes. Especially for men, weight loss patterns seem to be related to depressive symptoms. Concerning the overall results, it becomes clear that screening for weight history at the beginning of a multidisciplinary weight loss program in the context of gender-specific psychological comorbidities is important. The question remains why some aspects of weight history seem to be more important than others.

Quantifying patients' expectations prior to bariatric surgery with the BODY-Q in an international multicentre cohort

Many people living with obesity may have unrealistic expectations prior to undergoing bariatric surgery. These expectations can lead to frustration, regret and even worse psychological outcomes after surgery. Prior to undergoing bariatric surgery, patients completed the BODY-Q Expectations scale. This 15-item scale asks patients to imagine what their life will be like when 2 years have passed since bariatric surgery. Scores for expectations range from 0 (low) to 100 (high). Linear regression models were used to assess which of the patient characteristics could predict patients' expectations. From 2019 to 2020, a total of 333 patients were recruited from three different countries. The mean score on the BODY-Q Expectations scale was 73.1, ±20. Out of the 15 items on the Expectation scale, people living with obesity found it most likely that bariatric surgery would make them feel better and improve their energy, while it was reported least likely that they would look good without clothes on. Younger age (p = <.01) and race (non-white) (p = .046) were found to be significant predictors for higher scores on the Expectations scale. Participants who identified as non-white from the Netherlands and United States, and those aged under 40 years reported higher expectations compared with participants who identified as white race and were 40 years of age or older. Prior to bariatric surgery, patients aged under 40 years and those who identified as non-white for race had higher expectations that their life would change after bariatric surgery. These relevant findings should be considered when giving pre-operative counselling.

Differences in weight loss outcomes for males and females on a low-carbohydrate diet: A systematic review

It has been widely demonstrated that there are a broad range of individual responses to all weight management regimens, often masked by reports of the mean. Identifying features of responders and non-responders to weight loss regimens enables a more tailored approach to the provision of weight management advice. Low-carbohydrate diets are currently popular, and anecdote suggests that males are more successful at losing weight using this approach. This is feasible given the physiological and socio-psychological differences between the genders. We analysed the extent and variation in weight change for males and females separately through a systematic search for all low-carbohydrate diet trials published since 1985. Very few studies compared weight loss outcomes by gender and, of those that did, most lacked supporting data. The majority of studies reported no gender difference but when a gender difference was found, males were more frequently reported as losing more weight than females on a low-carbohydrate diet. The lack of gender stratification in weight loss trials is concerning, as there are a range of gender-based factors that affect weight loss outcomes. This study highlights the importance of examining weight change for males and females separately, since as failure to do so may mask any potential differences, which, if detected, could assist with better weight loss outcomes.

Cognitive remediation-enabled cognitive behaviour therapy for obesity: a case series

PURPOSE

Despite varied treatment effects, weight recidivism is common and typically associated with the abandonment of prescribed weight management strategies. Literature suggests that difficulty with weight management is associated with deficits in executive functioning, in particular cognitive flexibility and response inhibition, the neurocognitive processes that are involved in goal-directed behaviours, such as dietary adherence. These processes are overlooked by mainstream weight loss programmes. The aim of the study was to assess the effectiveness of a cognitive remediation-enabled cognitive behaviour therapy (CR-CBT) in addressing the neurocognitive, psychological and behavioural correlates of weight loss. It was hypothesised that CR-CBT would improve cognitive flexibility and response inhibition, reduce binge eating, aid weight loss and improve metabolic health.

METHODS

Four adults with obesity (body mass index > 30 kg/m²) received 7 weeks of manualised CR-CBT and were assessed via a case series analysis at baseline, end of treatment and 3-month follow-up. Treatment included 3 weekly 90-min group-based behaviour weight loss sessions for 3 weeks, followed by twice-weekly 50-min individualised CR-CBT sessions for 4 weeks.

RESULTS

Cognitive remediation-enabled cognitive behaviour therapy produced improvements in response inhibition and cognitive flexibility, and reductions in binge eating frequency, weight, and metabolic health readings between baseline and 3-month follow-up.

CONCLUSIONS

This is the first study to assess the effectiveness of CR-CBT in the treatment of obesity. Preliminary indications of treatment success are discussed with respect to study limitations. In light of these results, we recommend further investigation via a randomised control trial (RCT).

LEVEL OF EVIDENCE

Level IV, case series.

Acceptability of Hospital-Based Pediatric Weight Management Services among Patients and Families: A Narrative Synthesis

High rates of attrition from pediatric weight management services are well documented in the literature; however, studies reporting on acceptability of "real-world" services have not previously been reviewed. This narrative synthesis aimed to summarize quantitative and qualitative research reporting on satisfaction of families who attended a secondary or tertiary pediatric weight management service. Electronic databases were searched for studies of family and/or patient satisfaction with hospital-based pediatric weight management services. Included articles were scored on their methodological quality. Searches returned 4509 articles of which 17 were eligible. Education, practical strategies to assist behavior change and the approach of staff were reported as the most valued service aspects. Practical, organizational, and service content issues were reported as the primary reasons for poor engagement or discontinuation of treatment. The majority of recommendations for service improvement related to service content, with the following subthemes: program content, delivery of the weight management intervention, individualized treatment, and treatment expectations. Potential strategies for reducing attrition and improving consumer satisfaction include assessment of families' readiness to change at the outset of treatment and implementation of treatment non-negotiables. Development of a standardized measure of patient satisfaction for use in pediatric weight management service development, evaluation, and comparison is recommended.

Therapeutic lifestyle change intervention improved metabolic syndrome criteria and is complementary to amlodipine/atorvastatin

AIMS

To examine whether addition of amlodipine (5 mg)/atorvastatin (10 mg) A/A to Therapeutic Lifestyle change intervention (TLC) would beneficially modulate Metabolic Syndrome (MetS) and oxidized low-density lipoprotein (Ox-LDL) levels.

METHODS

Patients with MetS (n = 53) were randomized to TLC + placebo or TLC + A/A for 12 months. Anthropometric measurements, blood pressure (BP), lipid profile, plasma Ox-LDL, and area under the curve of free fatty acid (AUC_FFA) during oral glucose tolerance test, a marker of adipose tissue health, were assessed before and after the intervention.

RESULTS

Twenty-six patients completed the study with an overall improvement of MetS (p = 0.02). TLC + placebo was beneficial in reversing MetS comparable to TLC + A/A (54% vs. 39%; p = 0.08). Both treatments decreased systolic BP (p ≤ 0.01). TLC + A/A also decreased diastolic BP and triglyceride levels. The changes in Ox-LDL levels directly correlated with changes in weight in the TLC-placebo group (r = 0.64; p = 0.04). AUC_FFA determined the loss of fat mass (r = 0.472, p = 0.03).

CONCLUSIONS

1) Addition of A/A has the advantage of improving the lipid profile and BP; but TLC alone was comparable to TLC + A/A in improving MetS; 2) weight change determines the TLC-associated change in Ox-LDL levels; and 3) AT metabolic health is a significant predictor of TLC-associated loss of body fat mass.

Low-level laser therapy for weight reduction: a randomized pilot study

Obesity and overweight is a global health crisis and novel methods of treatment are needed to address it. Low-level laser therapy (LLLT) is a currently available non-invasive procedure for lysing excess fat, but there is a lack of consensus exists on LLLT frequency and limited research from studies of LLLT. The purpose of this pilot study is to compare the effect of three of the most common LLLT frequencies on weight, waist circumference, body fat percentage, and quality of life. Sixty overweight (body mass index (BMI) 25-29.9 kg/m²) adult participants were randomized to 12 LLLT treatments: (1) three times weekly for 4 weeks, (2) twice weekly for 6 weeks, or (3) once weekly for 12 weeks. All participants attended an in-person visit at baseline and at weeks 4, 6, 12, and 26. Participants were recruited September 30, 2016 through to August 27, 2017. The majority of the 60 participants were female (90%) with an average age of 43.7 years (± 9.2 years). Most participants (98%) completed 10 or more of the 12 LLLT treatments. When comparing across treatment groups, the greatest reductions from baseline were observed in those assigned to twice weekly for 6 weeks in weight (1 ± 1.7 (±SD) kg by week 6), waist circumference (- 2.0 ± 3.2 in. by week 6 and - 1.5 ± 3.2 in. by week 26), body mass index (- 0.4 ± 0.6 kg/m²), and body fat mass (- 1.1 ± 1.6 kg). This group also had the most significant improvement from baseline in quality of life (+ 0.5 ± 0.8 by week 6), body satisfaction (+ 0.2 ± 0.4 by week 6 and week 26), and body appreciation (+ 0.2 ± 0.3 by week 6 and + 0.3 ± 0.3 by week 26). LLLT twice weekly for 6 weeks could be proposed as the optimal frequency and duration for the management of body weight. Trial registration: https://clinicaltrials.gov/ct2/show/NCT02877004. Registered August 24, 2016.

Insights Following Implementation of an Exercise Intervention in Older Veterans with PTSD

Individuals with post-traumatic stress disorder (PTSD) face numerous barriers to exercise. Little is known about behavioral strategies to promote participation in this population. This is a secondary analysis of individual barriers and goals, exercise prescription characteristics, and patient perceptions of a 12-week, community-based, randomized controlled exercise trial targeting older adults with PTSD, (N = 45; mean age = 68; male = 91%). The most common cited goals for participating included weight loss (65%) and increasing strength (65%). Exercise mode varied among those who completed the program (n = 37), with 14 (38%) using exclusively treadmill; eight (22%) using only bike, and 15 (41%) utilizing a combination. Patient-reported exercise duration and intensity progressively increased over the 12 weeks, and duration differed by mode of exercise. We observed high rates of attendance (84%) and completion (88%) to the program. Patient-reported barriers to attendance most often included health problems (62%) and medical appointments (55%). Participant responses to a program evaluation revealed high levels of satisfaction, preferences for group-based programs, and insights about the acceptability of the exercise environment (physical and social). This study is the first to report on goals, barriers, exercise prescription needs, and individual responses to supervised exercise training in a unique population, that is, older veterans with PTSD. Results of this study can inform future health promotion programs targeting older veterans with PTSD.

Weight loss expectations and determinants in a large community-based sample

While weight-loss expectations have primarily been studied in people enrolled in weight-loss programs, the present study explores patient expectations about weight-loss and identifies related determinants in a large, non-clinical population. 3916 volunteers (age > 18 years) participated in 2012 in a community-based survey in the French-speaking region of Belgium. Participants were asked to define "dream", "goal", "happy", "acceptable", and "disappointed" weights. Other self-reported measures were used to determine each participant's body mass index (BMI), body image discrepancy (BID), subjective norm (SN), weight loss activity, weight history, quality of life (QoL), and demographic and socioeconomic characteristics. The study focused on the determinants of unrealistic weight-loss "goal" (≥10% of initial weight). Results showed median weight loss targets ranged from 5 kg ("disappointed" weight loss) to 21 kg ("dreamed" weight loss). Respondents considered the recommended weight-loss target (5-10%) disappointing. Severe and morbid obesity categories are at high risk of unrealistic weight loss goal. Unrealistic weight-loss goals was associated with female gender, weight loss activity, overweight history and lower QoL in overweight and moderate obesity respondents. These findings confirm the urgent need to help patients accept more modest weight loss outcomes and the need for personalized care that considers the patient's specific profile and both weight loss expectations and determinants.

Multi-sensor ecological momentary assessment of behavioral and psychosocial predictors of weight loss following bariatric surgery: study protocol for a multicenter prospective longitudinal evaluation

BACKGROUND

Bariatric surgery is currently the most effective strategy for producing significant and durable weight loss. Yet, not all patients achieve initial weight loss success and some degree of weight regain is very common, sometimes as early as 1-2 years post-surgery. Suboptimal weight loss not fully explained by surgical, demographic, and medical factors has led to greater emphasis on patient behaviors evidenced by clinical guidelines for appropriate eating and physical activity. However, research to inform such guidelines has often relied on imprecise measures or not been specific to bariatric surgery. There is also little understanding of what psychosocial factors and environmental contexts impact outcomes. To address research gaps and measurement limitations, we designed a protocol that innovatively integrates multiple measurement tools to determine which behaviors, environmental contexts, and psychosocial factors are related to outcomes and explore how psychosocial factors/environmental contexts influence weight. This paper provides a detailed description of our study protocol with a focus on developing and deploying a multi-sensor assessment tool to meet our study aims.

METHODS

This NIH-funded prospective cohort study evaluates behavioral, psychosocial, and environmental predictors of weight loss after bariatric surgery using a multi-sensor platform that integrates objective sensors and self-report information collected via smartphone in real-time in patients' natural environment. A target sample of 100 adult, bariatric surgery patients (ages 21-70) use this multi-sensor platform at preoperative baseline, as well as 3, 6, and 12 months postoperatively, to assess recommended behaviors (e.g., meal frequency, physical activity), psychosocial indicators with prior evidence of an association with surgical outcomes (e.g., mood/depression), and key environmental factors (e.g., type/quality of food environment). Weight also is measured at each assessment point.

DISCUSSION

This project has the potential to build a more sophisticated and valid understanding of behavioral and psychosocial factors contributing to success and risk after bariatric surgery. This new understanding could directly contribute to improved (i.e., specific, consistent, and validated) guidelines for recommended pre- and postoperative behaviors, which could lead to improved surgical outcomes. These data will also inform behavioral, psychosocial, and environmental targets for adjunctive interventions to improve surgical outcomes.

TRIAL REGISTRATION

Registered trial NCT02777177 on 5/19/2016.

Relationship Between Evidence Requirements, User Expectations, and Actual Experiences: Usability Evaluation of the Twazon Arabic Weight Loss App

BACKGROUND

Saudi Arabia has faced a steady growth in the prevalence of obesity. The concurrent and ubiquitous use of mobile technology, such as smartphones and apps, provides an opportunity for the implementation of mHealth technology, a method for delivering behavioral interventions. Despite their effectiveness in promoting lifestyle and diet modification, culturally adapted weight loss apps and related interventions are lacking in Gulf Cooperation Council countries.

OBJECTIVE

The objective of our study was to identify the relationship between adherence to evidence-informed practices, potential user expectations, and actual user experiences in order to enhance the understanding of the overall usability of the Twazon Arabic weight loss app.

METHODS

In 2 previous studies, 39 Saudi women were recruited for focus group discussions and 240 Saudi women were recruited for an app-based weight loss intervention. Usability of the Twazon Arabic weight loss app was evaluated by analyzing the opinions and experiences of 26 participants who engaged with the Twazon app for 4 months; the System Usability Scale (SUS) and word clouds were used. The results were triangulated with potential user expectations obtained in the focus group discussion and with the findings from an Arabic app screening for evidence-informed practices.

RESULTS

The average reported SUS score was 69.3. The most favored features were the calorie counter, step counter, and physical activity calorie counter. The features in need of improvement were the social network, notifications, and the Twazon Saudi Food Database. Twazon users preferred and found useful 7 of the 13 evidence-informed weight loss practices that were integrated into the features of the app.

CONCLUSIONS

Triangulation identified the most notable relationship to be the disparity between user experience and 2 of the evidence-informed practices, namely a minimum weight loss goal of 0.5 to 1 kg/week and social support; no relationship was found between user expectations and evidence-informed weight loss practices. The overall usability of the Twazon Arabic weight loss app ranged between high marginal and acceptable, indicating that some improvements to the app should be considered for implementation in future app-based weight loss interventions of this kind.

Systematic review and retrospective validation of prediction models for weight loss after bariatric surgery

BACKGROUND

Patients often have less than realistic expectations of the weight loss they are likely to achieve after bariatric surgery. It would be useful to have a well-validated prediction tool that could give patients a realistic estimate of their expected weight loss.

OBJECTIVES

To perform a systematic review of the literature to identify existing prediction models and attempt to validate these models.

SETTING

University hospital, United Kingdom.

METHODS

A systematic review was performed. All English language studies were included if they used data to create a prediction model for postoperative weight loss after bariatric surgery. These models were then tested on patients undergoing bariatric surgery between January 1, 2013 and December 31, 2014 within our unit.

RESULTS

An initial literature search produced 446 results, of which only 4 were included in the final review. Our study population included 317 patients. Mean preoperative body mass index was 46.1 ± 7.1. For 257 (81.1%) patients, 12-month follow-up was available, and mean body mass index and percentage excess weight loss at 12 months was 33.0 ± 6.7 and 66.1% ± 23.7%, respectively. All 4 of the prediction models significantly overestimated the amount of weight loss achieved by patients. The best performing prediction model in our series produced a correlation coefficient (R²) of .61 and an area under the curve of .71 on receiver operating curve analysis.

CONCLUSIONS

All prediction models overestimated weight loss after bariatric surgery in our cohort. There is a need to develop better procedures and patient-specific models for better patient counselling.

Is There an Optimal Diet for Weight Management and Metabolic Health?

Individuals can lose body weight and improve health status on a wide range of energy (calorie)-restricted dietary interventions. In this paper, we have reviewed the effectiveness of the most commonly utilized diets, including low-fat, low-carbohydrate, and Mediterranean approaches, in addition to commercial slimming programs, meal replacements, and newly popularized intermittent fasting diets. We also consider the role of artificial sweeteners in weight management. Low-fat diets tend to improve low-density lipoprotein cholesterol the most, while lower-carbohydrate diets may preferentially improve triglycerides and high-density lipoprotein cholesterol. However, differences between diets are marginal. Weight loss improves almost all obesity-related co-morbidities and metabolic markers, regardless of the macronutrient composition of the diet, but individuals do vary in preferences and ability to adhere to different diets. Optimizing adherence is the most important factor for weight loss success, and this is enhanced by regular professional contact and supportive behavioral change programs. Maintaining weight losses in the long term remains the biggest challenge, and is undermined by an "obesogenic" environment and biological adaptations that accompany weight loss.

Impact of Weight-Related Discrimination, Body Dissatisfaction and Self-Stigma on the Desire to Weigh Less

AIM

Currently, health care professionals plead for stabilization of weight and improving health conditions rather than focusing on weight loss only. Individuals with obesity have been shown to report weight loss goals that are much higher than what has been suggested by guidelines. The aim was to determine whether weight discrimination and body dissatisfaction have an impact on how much weight an individual with obesity wants to lose.

METHODS

In this representative telephone survey, 878 participants with obesity were asked about their experiences with weight stigma, their body image concerns, and about the amount of weight they would like to weigh using random digital dialing and Kish selection grid to ensure random selection of participants.

RESULTS

Regression analysis reveals that being female, having a higher BMI, being younger, and trying to lose weight was related to a greater discrepancy between current weight and desired weight. The discrepancy between current weight and desired weight was greater when participants reported discrimination due to their weight as well as internalized stigma and body image concerns.

CONCLUSION

Independent on the weight loss method, treating obesity should include realistic weight loss goals without being affected by social pressure or weight stigma, especially since stigma can result in further weight gain and decline health issues related to obesity and overweight.

A randomized, open-label pilot of the combination of low-level laser therapy and lorcaserin for weight loss

Background

Obesity is a significant public health problem and innovative treatments are needed. The purpose of this pilot study was to assess the preliminary efficacy and safety of a combined treatment of low-level laser therapy (LLLT) and lorcaserin on weight loss, health quality of life (QOL) measures, and cardiovascular risk factors.

Methods

Forty-five overweight and obese adult participants with a body mass index (BMI) >26.9 and <40 were randomized to receive LLLT, lorcaserin, or a combination of the two therapies. All study participants received treatment for 3 months and were followed for 3 months post-treatment. Participants were recruited from June 2014 through September 2014.

Results

The majority of the 44 participants accrued to this study were female (84 %) with an average age of 43.9 years (range 22 to 64 years). Most participants (93 % LLLT alone, 87 % LLLT + lorcaserin) completed at least 80 % of the LLLT treatments. From baseline to end of treatment, significant reductions in waist circumference were noted for each treatment group (-2.3 ± 4.1 cm, -6.0 ± 7.3 cm, and -4.0 ± 5.5 cm for LLLT, lorcaserin and combination respectively); however, the reduction in body weight was only significant in those receiving lorcaserin and combination treatment (-0.4 ± 1.5 kg, -1.3 ± 1.2 kg and -1.3 ± 1.3 kg). No significant differences were noted between the groups. Self-reported satisfaction was higher in the lorcaserin versus the LLLT group.

Conclusion

This small pilot demonstrates that when combined with behavioral intervention, Lorcaserin and LLLT may be effective components of a comprehensive approach to the treatment of overweight and obesity in the clinical setting. Further studies with larger sample size and longer duration of treatment and follow-up are needed to further address efficacy.

Trial Registry Information

Trial registration: NCT02129608. Registered June 15, 2014.

A Survey of Bariatric Surgery Patients' Interest in Postoperative Interventions

BACKGROUND

A substantial minority of bariatric surgery patients display clinically significant weight regain and recurrence of obesity-related comorbidities. Although postoperative follow-up and behavioral interventions are associated with better weight loss outcomes, many patients fail to attend or receive these services. More information is needed to better target and increase the probability of sustained treatment in those patients experiencing postoperative weight regain. The purpose of this study was to understand the challenges that patients perceive themselves to be facing and assess their receptivity and preferences for postoperative interventions.

METHODS

A survey developed by the authors was sent to patients who received bariatric surgery from a program based in an academic medical center between September 2008 and December 2010 (n = 751).

RESULTS

Data from 154 responders indicate that the vast majority of individuals who have undergone bariatric surgery are satisfied with surgery and their weight losses; however, most reported being on a trajectory of weight regain. Patients endorsed concerns about both current eating behavior and, additional, future weight regain. In addition, these patients expressed strong interest in participating in postoperative programs aimed at stopping and reversing regain.

CONCLUSIONS

The results provide novel information about bariatric surgery patients' receptivity to and preferences for interventions after bariatric surgery.

Receptivity to Bariatric Surgery in Qualified Patients

Objectives. Bariatric surgery has been shown to be an effective intervention for weight loss and diabetes management. Despite this, many patients qualified for bariatric surgery are not interested in undergoing the procedure. The objective of this study is to determine the factors influencing receptivity to bariatric surgery among those who qualify for the procedure. Methods. Patients attending a publicly funded weight management clinic who qualified for bariatric surgery were asked to complete an elective questionnaire between February 2013 and April 2014. Results. A total of 371 patients (72% female) completed the questionnaire. Only 87 of 371 (23%) participants were interested in bariatric surgery. Individuals interested in bariatric surgery had a higher BMI (48.0 versus 46.2 kg/m(2), P = 0.03) and believed that they would lose more weight with surgery (51 versus 44 kg, P = 0.0069). Those who scored highly on past weight loss success and financial concerns were less likely to be interested in bariatric surgery, whereas those who scored highly on high receptivity to surgery and positive social support were more likely to be interested in bariatric surgery. Conclusion. Although participants overestimated the effect of bariatric surgery on weight loss, most were still not interested in bariatric surgery.

A virtual reality intervention (Second Life) to improve weight maintenance: Rationale and design for an 18-month randomized trial

Despite the plethora of weight loss programs available in the US, the prevalence of overweight and obesity (BMI≥25kg/m(2)) among US adults continues to rise at least, in part, due to the high probability of weight regain following weight loss. Thus, the development and evaluation of novel interventions designed to improve weight maintenance are clearly needed. Virtual reality environments offer a promising platform for delivering weight maintenance interventions as they provide rapid feedback, learner experimentation, real-time personalized task selection and exploration. Utilizing virtual reality during weight maintenance allows individuals to engage in repeated experiential learning, practice skills, and participate in real-life scenarios without real-life repercussions, which may diminish weight regain. We will conduct an 18-month effectiveness trial (6 months weight loss, 12 months weight maintenance) in 202 overweight/obese adults (BMI 25-44.9kg/m(2)). Participants who achieve ≥5% weight loss following a 6month weight loss intervention delivered by phone conference call will be randomized to weight maintenance interventions delivered by conference call or conducted in a virtual environment (Second Life®). The primary aim of the study is to compare weight change during maintenance between the phone conference call and virtual groups. Secondarily, potential mediators of weight change including energy and macronutrient intake, physical activity, consumption of fruits and vegetables, self-efficacy for both physical activity and diet, and attendance and completion of experiential learning assignments will also be assessed.

Obesity in the Context of Aging: Quality of Life Considerations

The progressive increase in the prevalence of obesity and aging in the population is resulting in increased healthcare and disability spending. The burden of obesity is particularly relevant in old age, due to accumulating co-morbidities and changes in body composition. Sarcopenic obesity, a mix of over- and under-nutrition, causes frailty, disability, and problems in social and psychological areas, impacting overall health-related quality of life (HR-QOL). The relationship between obesity, aging, and HR-QOL is, however, much more complex than generally acknowledged and is difficult to disentangle. The impact of obesity on HR-QOL is particularly strong in young people, who are free of co-morbidities. It progressively attenuates, compared with the general population, with advancing age, when co-morbid conditions are diffusely present and reduce the perceived health status, independent of obesity. However, even this apparent 'obesity paradox' should not minimize the importance of obesity on HR-QOL, as other obesity-associated limitations and disabilities do impact HR-QOL in older age. A patient-centered approach aimed at reducing the disability and social isolation of advancing age is mandatory to improve HR-QOL in any class of obesity.

The Challenges and Opportunities Associated with Reimbursement for Obesity Pharmacotherapy in the USA

Obesity has become a serious public health problem that has stimulated primordial and primary prevention efforts, and a triad of management options (lifestyle, pharmacotherapy, and surgical interventions). A growing body of evidence supports the need for a multi-pronged, clinic-based approach that leverages the synergy between pharmaceutical and lifestyle modification. Recent US policy changes-namely, the passage of the Patient Protection and Affordable Care Act coupled with recognition of obesity as a disease by the American Medical Association-suggest that financial incentives and attitudes towards obesity management are changing. This paradigm shift has implications for current and future obesity pharmacotherapy. However, barriers to pharmacotherapy utilization include patient and physician perceptions of modest efficacy, historical safety issues, regulatory obstacles, and lack of reimbursement. The shifting attitudes and challenges associated not only with a multi-payer system, but also the lack of clearly defined cross-payer reimbursement strategies, prompted a survey to determine coverage for obesity treatment. Participants indicated that federal/state mandates and growth of quality-driven healthcare initiatives will eventually drive wider pharmacotherapy reimbursement within 1-5 years. There are signs that federal/state programs are already moving towards reimbursement by improving quality measures to track obesity outcomes and reduce costs. Future research on clinical and economic outcomes of combination weight-management programs coupled with innovative approaches (e.g., eHealth) in the real-world setting that demonstrate value to patients, healthcare providers, payers, and employers will help reshape obesity management by reducing barriers and broadening reimbursement coverage for anti-obesity pharmacotherapy.

Lower weight loss expectations and healthier eating attitudes in older overweight and obese women attempting weight loss

Weight loss outcomes in overweight and obese individuals may be influenced by individual weight loss expectations (WLEs). Research on these phenomena in older women is lacking. This cross-sectional study compared groups of younger and older women on their WLEs and related attitudes (body dissatisfaction and disordered eating). Twenty-six younger (18-38 years) and 33 older (60-78 years) overweight and obese women were recruited from a weight loss clinic, prior to treatment. Disordered eating attitudes and body dissatisfaction were assessed using validated questionnaires and a pictorial figure-choice scale. Participants reported 10 WLEs categorized according to personal, lifestyle and social factors. Overall, women with a higher body mass index had greater WLEs. Older women reported lower WLEs than younger women (-14.5 kg vs. -22.4 kg) in all categories except past weight. Older women perceived that career success would necessitate the greatest level of weight loss (-18.5 kg), whereas younger women derived their greatest WLEs from mass media (-28.5 kg). Both older and younger groups perceived that their families would be supportive of the smallest amount of weight loss (-8.4 and -17.6 kg, respectively). The groups did not differ on body dissatisfaction, but younger women's disordered eating attitudes were significantly higher (p < .001). Older overweight and obese women have lower WLEs than younger women but experience similar levels of body dissatisfaction and healthier eating attitudes. The attitudinal constructs underlying these differences may be useful in clinical practice to tailor age-specific weight loss interventions.

Weight expectations, motivations for weight change and perceived factors influencing weight management in young Australian women: a cross-sectional study

OBJECTIVE

To examine young Australian women's weight expectations, motivations for weight change and perceived factors influencing weight management, and to determine if these factors differ by age, BMI, marital status, education or income.

DESIGN

Cross-sectional study. An online survey captured respondents' weight, height, ideal weight, main reasons for wanting to change their weight and challenges to managing their weight.

SETTING

Online survey in Australia.

SUBJECTS

Six hundred and twenty women aged 18-30 years currently living in Australia who completed the survey between 31 July and 30 September 2012.

RESULTS

Approximately half of participants (53·1 %) were a healthy weight, 25·2 % overweight and 19·0 % obese. Women unhappy at their current weight (78·1 %) reported a median ideal weight -12·3 % less than their current weight. The key motivators for weight change were to improve health (24·4 %, ranked 1), feel better in oneself (22·3 %) and improve self-confidence (21·5 %). Lack of motivation, time constraints because of job commitments and cost were the most commonly reported factors influencing weight management. Age, BMI, marital status, education and income were found to influence weight expectations, motivations for weight change and/or factors perceived to influence weight management.

CONCLUSIONS

The findings suggest potential implications for weight management interventions and public health messaging targeting young women, to improve long-term health outcomes. Strategies that promote the health benefits of physical activity and healthy eating, feeling better about oneself and improved self-confidence, and address the main factors influencing weight management including lack of motivation, time constraints and cost, may be used to engage this target group.

Unhealthy weight control practices: culprits and clinical recommendations

Preoccupation with weight status and a desire to lose weight appears common. Many individuals seek “magic bullet” approaches to weight loss and waive the risks of using these products. In this paper, we review the challenges of weight maintenance, highlight some unhealthy weight control practices, and discuss the futility and potential danger of unregulated weight control agents. Novel clinical strategies are discussed that health care providers may use to triage patients with obesity in an attempt to make ethical and personalized treatment decisions.

Weighing the Evidence of Common Beliefs in Obesity Research

Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views. We refer to the former as "presumptions" and the latter as "myths." Here, we present nine myths and 10 presumptions surrounding the effects of rapid weight loss; setting realistic goals in weight loss therapy; stage of change or readiness to lose weight; physical education classes; breastfeeding; daily self-weighing; genetic contribution to obesity; the "Freshman 15"; food deserts; regularly eating (versus skipping) breakfast; eating close to bedtime; eating more fruits and vegetables; weight cycling (i.e., yo-yo dieting); snacking; built environment; reducing screen time in childhood obesity; portion size; participation in family mealtime; and drinking water as a means of weight loss. For each of these, we describe the belief and present evidence that the belief is widely held or stated, reasons to support the conjecture that the belief might be true, evidence to directly support or refute the belief, and findings from randomized controlled trials, if available. We conclude with a discussion of the implications of these determinations, conjecture on why so many myths and presumptions exist, and suggestions for limiting the spread of these and other unsubstantiated beliefs about the obesity domain.

Body shape expectations and self-ideal body shape discrepancy in women seeking bariatric surgery: a cross-sectional study

Background

Postoperative body shape expectations (BSE) of bariatric surgery candidates remain relatively unexplored, and may have important implications for weight loss outcomes, treatment satisfaction, and education.

Methods

The ‘Silhouette Figure Rating Scale’ was administered to 69 consecutive female candidates. Self-perceived current and goal body shape and postoperative BSE in four categories; “dream, “happy”, “acceptable”, and “disappointed” were examined.

Results

The mean age and BMI of the sample was 43.4 ± 8.9 years and 48.8 ± 7.0 kg/m². Self-ideal body shape discrepancy of 4.1 ± 1.3 silhouettes was reported, indicating body image dissatisfaction. 53% incorrectly identified the silhouette associated with their actual BMI. Goal body shape (4.3 ± 0.8 silhouettes) corresponded to a BMI figure 23.1 kg/m²- 26.2 kg/m². The postoperative “dream” (4.1 ± 1.0 silhouettes), “happy” (5.0 ± 0.8 silhouettes), “acceptable” (5.3 ± 1.0 silhouettes), and “disappointed” (6.9 ± 1.0 silhouettes) BSE corresponded to silhouettes that were thinner than the thinnest silhouette clinically expected based on a 56.1% excess weight loss 1-year after laparoscopic sleeve gastrectomy (LSG) or a 22.3% to 47.2% total body weight loss.

Conclusions

Women seeking bariatric surgery experience body image dissatisfaction and misperceive their actual body size. BSE do not correspond with evidence-based LSG weight loss outcomes.

Weight loss expectations of laparoscopic sleeve gastrectomy candidates compared to clinically expected weight loss outcomes 1-year post-surgery

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) results in significant, sustainable weight loss in obese individuals (body mass index (BMI) ≥ 40 kg/m(2) or BMI 35.0-39.9 kg/m(2) with major comorbidity). Average clinically expected % excess weight loss (%EWL) has been reported to be 56.1 % 1 year after LSG. Unrealistic weight loss expectations are purported to negatively impact treatment adherence and weight loss outcomes. This study examined the weight loss expectations of LSG candidates in Newfoundland and Labrador, Canada.

METHODS

The Goals and Relative Weights Questionnaire was administered before the start of a bariatric surgery education session to 84 consecutive LSG candidates. Patients reported postoperative weight loss expectations in four categories: "dream", "happy", "acceptable", and "disappointed".

RESULTS

Participants included 69 women and 15 men with an average age and weight of 43.7 years and 136.7 kg. The patients reported average postoperative "dream" and "happy" weights as 71.1 and 80.0 kg, respectively. Patients reported a weight of 86.2 kg as "acceptable" but would be "disappointed" with a weight of 105.6 kg. To achieve the desired amount of weight loss for each category, patients would have to achieve %EWLs of 88.7, 76.4, 68.2, and 40.6 %, respectively.

CONCLUSIONS

Patients have higher weight loss expectations than those that are clinically expected within 1 year after LSG.

Prevalence of self-treatment with complementary products and therapies for weight loss: A randomized, cross-sectional Study in Overweight and Obese Patients in Colombia

BACKGROUND

The use of complementary and alternative medicine for weight loss is becoming increasingly common worldwide. In overweight or obese patients, this practice could be harmful. Available data concerning the use of complementary therapies and products (CTPs) for weight loss in these patients in Colombia are limited.

OBJECTIVES

The aims of this study were to determine the prevalence of self-treatment with CTPs in overweight or obese patients in Colombia and to explore the relationship between CTP use and demographic, anthropometric, and biochemical parameters.

METHODS

This randomized, cross-sectional study was conducted at a registered dieticians' office located at the Center for Nutritional Care, School of Nutrition and Dietetics, University of Antioquia, Medellín, Colombia, and at an outpatient clinic attended by a registered dietician located at the Pablo Tobón Uribe Hospital, Medellín, Colombia. The study enrolled a random sample of overweight (body mass index [BMI], 25-30 kg/m(2)) or obese (BMI, >30 kg/m(2)) male and female patients aged 20 to 50 years received nutritional treatment in Colombia in 2002. Data concerning the use of weight-loss CTPs were gathered, and their possible association with demographic, anthropometric, and biochemical data was explored.

RESULTS

This randomized study comprised 94 patients (70 women, 24 men; mean [SD] age, 36.5 [9.7] years; mean [SD] BMI, 28.4 [4.2] kg/m(2)). Forty-nine (52.1%) patients reported self-treatment with weight-loss CTPs; 40 (42.6%) patients used complementary products, and 21 (22.3%) used complementary therapies. Among the products, inadequately identified herbal medicines (ie, absence of available information concerning the composition of the products or information could not be obtained from the patient [many of the products used were not authorized for distribution in Colombia]), folkloric or home remedies, and commercial diets were most commonly used (40.0%, 40.0%, and 27.5%, respectively). The use of CTPs was more prevalent in women compared with men (P < 0.001; odds ratio [OR] = 6.43). In women, CTP use was significantly higher in patients with a higher educational level (P = 0.008; OR = 3.82) and in those who were single (P = 0.038; OR = 2.97). The use of CTPs was also more frequent in patients with a negative view of their current nutritional therapy (P = 0.002; OR = 6.8).

CONCLUSIONS

In the small group of overweight and obese patients in this study, 52.1% used CTPs. In obese women, those with a higher educational level and/or who were single were more likely to use CTPs. Patients were also more likely to use CTPs if they had a negative view of their current nutritional therapy.

Patient expectations of bariatric surgery are gender specific--a prospective, multicenter cohort study

BACKGROUND

The effect of bariatric surgery on weight loss and improvement of co-morbidities is no longer doubted. However, little attention has been given to the treatment goals from the patient's point of view (patient expectations). The objective of this study was to examine patients' expectations of bariatric surgery and identify gender differences.

METHODS

Bariatric patients were asked to complete a questionnaire. Statistical analysis was performed using chi-square, Pearson correlation coefficient, and Wilcoxon rank sum test.

RESULTS

Overall, 248 patients participated in this study (69.4% females). The male patients (45.2 yr, SD±11.1) were significantly older than the female (41.8 yr, SD±12.0; P = .04) and suffered significantly more often from diabetes, hypertension, hypercholesterolemia, and sleep apnea. One hundred thirty patients (52.4%) expected to lose at least 45 kg and 39 patients (15.7%)>70 kg. The mean expected excess weight loss was 71.8%. Females expected significantly more often that surgery alone would induce weight loss (P = .03). "Improved co-morbidity" was by far the highest ranked parameter.

CONCLUSION

The male bariatric surgery patients were older and suffered from more co-morbidities. Most of the patients had unrealistic weight loss goals and overestimated the effect of the surgical intervention. However, for both female and male patients, "improved co-morbidity" was the most important issue.

A patient-centered electronic tool for weight loss outcomes after Roux-en-Y gastric bypass

BACKGROUND. Current patient education and informed consent regarding weight loss expectations for bariatric surgery candidates are largely based on averages from large patient cohorts. The variation in weight loss outcomes illustrates the need for establishing more realistic weight loss goals for individual patients. This study was designed to develop a simple web-based tool which provides patient-specific weight loss expectations. METHODS. Postoperative weight measurements after Roux-en-Y gastric bypass (RYGB) were collected and analyzed with patient characteristics known to influence weight loss outcomes. Quantile regression was used to create expected weight loss curves (25th, 50th, and 75th %tile) for the 24 months after RYGB. The resulting equations were validated and used to develop web-based tool for predicting weight loss outcomes. RESULTS. Weight loss data from 2986 patients (2608 in the primary cohort and 378 in the validation cohort) were included. Preoperative body mass index (BMI) and age were found to have a high correlation with weight loss accomplishment (P < 0.0001 for each). An electronic tool was created that provides easy access to patient-specific, 24-month weight loss trajectories based on initial BMI and age. CONCLUSIONS. This validated, patient-centered electronic tool will assist patients and providers in patient teaching, informed consent, and postoperative weight loss management.

Associations between physical activity and quality of life outcomes in adults with severe obesity: a cross-sectional study prior to the beginning of a lifestyle intervention

Background

Severely obese individuals who seek lifestyle interventions have impaired quality of life (QoL). Research suggests that physical activity (PA) plays a role in weight reduction and improved health in this group, but knowledge about the association of PA with QoL outcomes is sparse and inconsistent. The aim of this study was to investigate whether a higher level of PA was independently associated with higher QoL in severely obese individuals prior to the beginning of a lifestyle intervention.

Methods

During 2010, a total of 49 severely obese individuals who began a lifestyle intervention programme in Western Norway agreed to participate in the study. Data were collected prior to the beginning of the intervention. QoL was measured by a one-item scale on life satisfaction and the SF-36, PA was measured by an accelerometer, and clinical data were collected by health staff. Linear regression analyses were used to determine the associations between PA and QoL outcomes (life satisfaction, physical functioning, and mental health), adjusting for age, gender, and body mass index (BMI).

Results

In the adjusted analyses, we found positive relationships between PA and life satisfaction (Stand. coeff. 0.39, p = 0.024) and physical functioning (Stand. coeff. 0.34, p = 0.025). There was no association between PA and mental health (Stand. coeff. 0.15, p = 0.376).

Conclusion

This study detected associations between objectively measured PA and life satisfaction as well as physical functioning in a group of severely obese individuals before they began a lifestyle intervention programme.

Equivalent weight loss for weight management programs delivered by phone and clinic

OBJECTIVE

Face-to-face (FTF) weight management is costly and presents barriers for individuals seeking treatment; thus, alternate delivery systems are needed. The objective of this study was to compare weight management delivered by FTF clinic or group conference calls (phone).

DESIGN AND METHODS

Randomized equivalency trial in 295 overweight/obese men/women (BMI = 35.1±4.9, Age = 43.8±10.2, Minority = 39.8%). Weight loss (0-6 months) was achieved by reducing energy intake between 1,200 and 1,500 kcal/day and progressing physical activity (PA) to 300 min/week. Weight maintenance (7-18 months) provided adequate energy to maintain weight and continued 300 min/week of PA. Behavioral weight management strategies were delivered weekly for 6 months and gradually reduced during 7-18 months. A cost analysis provided a comparison of expenses between groups.

RESULTS

Weight change from baseline to 6 months was -13.4 ± 6.7% and -12.3 ± 7.0% for FTF clinic and phone, respectively. Weight change from 6-18 months was 6.4 ± 7.0% and 6.4 ± 5.2%, for FTF clinic and phone, respectively. The cost to FTF participants was $789.58 more per person.

CONCLUSIONS

Phone delivery provided equivalent weight loss and maintenance and reduced program cost. Ubiquitous access to phones provides a vast reach for this approach.

Eating behaviour patterns and BMI in Portuguese higher education students

Our aim was to determine prototypical patterns of eating behaviour among Portuguese higher education students, and to relate these patterns with BMI. Data from 280 higher education students (63.2% females) aged between 18 and 27 years were analysed. Several eating behaviour dimensions (emotional and external eating, flexible and rigid restraint, binge eating, and eating self-efficacy) were assessed, and eating styles were derived through cluster analysis. BMI for current, desired and maximum self-reported weights and the differences between desired and current BMI and between maximum and current BMI were calculated. Women scored higher in emotional eating and restraint, whereas men showed higher eating self-efficacy. Men had higher current, desired and maximum BMI. Cluster analysis showed three eating styles in both male and female subsamples: "Overeating", "High self-efficacy" and "High restraint". High self-efficacy women showed lower BMI values than the others, and restrictive women had higher lost BMI. High self-efficacy men showed lower desired BMI than overeaters, and lower maximum and lost BMI than highly restrictive ones. Restrictive women and men differ on important eating behaviour features, which may be the cause of differences in the associations with BMI. Eating self-efficacy seems to be a central variable influencing the relationships between other eating behaviour dimensions and BMI.

Empirical evidence does not support an association between less ambitious pre-treatment goals and better treatment outcomes: a meta-analysis

Setting realistic weight loss goals may play a role in weight loss. We abstracted data from randomized controlled trials and observational studies conducted between 1998 and 2012 concerning the association of weight loss goals with weight loss. Studies included those that (i) were conducted in humans; (ii) delivered a weight loss intervention; (iii) lasted ≥6 weeks; (iv) assessed baseline weight loss goals; (vi) assessed pre- and post-weight either in the form of body mass index or some other measure that could be converted to weight loss based on information included in the original study or later provided by the author(s); and (vii) assessed the correlation between weight loss goals and final weight loss or provided data to calculate the correlation. Studies that included interventions to modify weight loss goals were excluded. Eleven studies met inclusion criteria. The overall correlation between goal weight and weight at intervention completion was small and statistically insignificant (ρ=0.0 5 ; P = 0.20). The current evidence does not demonstrate that setting realistic goals leads to more favourable weight loss outcomes. Thus, our field may wish to reconsider the value of setting realistic goals in successful weight loss.

Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery

IMPORTANCE

Weight loss surgery (WLS) has been shown to produce long-term weight loss but is not risk free or universally effective. The weight loss expectations and willingness to undergo perioperative risk among patients seeking WLS remain unknown.

OBJECTIVES

To examine the expectations and motivations of WLS patients and the mortality risks they are willing to undertake and to explore the demographic characteristics, clinical factors, and patient perceptions associated with high weight loss expectations and willingness to assume high surgical risk.

DESIGN

We interviewed patients seeking WLS and conducted multivariable analyses to examine the characteristics associated with high weight loss expectations and the acceptance of mortality risks of 10% or higher.

SETTING

Two WLS centers in Boston.

PARTICIPANTS

Six hundred fifty-four patients.

MAIN OUTCOME MEASURES

Disappointment with a sustained weight loss of 20% and willingness to accept a mortality risk of 10% or higher with WLS.

RESULTS

On average, patients expected to lose as much as 38% of their weight after WLS and expressed disappointment if they did not lose at least 26%. Most patients (84.8%) accepted some risk of dying to undergo WLS, but only 57.5% were willing to undergo a hypothetical treatment that produced a 20% weight loss. The mean acceptable mortality risk to undergo WLS was 6.7%, but the median risk was only 0.1%; 19.5% of all patients were willing to accept a risk of at least 10%. Women were more likely than men to be disappointed with a 20% weight loss but were less likely to accept high mortality risk. After initial adjustment, white patients appeared more likely than African American patients to have high weight loss expectations and to be willing to accept high risk. Patients with lower quality-of-life scores and those who perceived needing to lose more than 10% and 20% of weight to achieve "any" health benefits were more likely to have unrealistic weight loss expectations. Low quality-of-life scores were also associated with willingness to accept high risk.

CONCLUSIONS AND RELEVANCE

Most patients seeking WLS have high weight loss expectations and believe they need to lose substantial weight to derive any health benefits. Educational efforts may be necessary to align expectations with clinical reality.

Association Between Fulfilment of Expectations and Health-related Quality of Life after Gastric Bypass

The objective was to examine the relationship between fulfilment of expectations and health-related quality of life 4 and 12 months after gastric bypass. A follow-up study based on patients undergoing gastric bypass at Aalborg Hospital - Aarhus University Hospital during February 2008 to December 2009. Health-related quality of life was assessed by Short Form 36 and summarized into the physical component summary and the mental component summary. Information on expectations was questionnaire based. Associations were analysed by linear regression. Included were 87 gastric bypass patients. Compared with patients with fulfilled expectations having expectations partly fulfilled -7.3 (-11.3; -3.3) or not having expectations fulfilled -11.2 (-18.8 ; -3.5) was associated with low a mental component summary 4 months after surgery. At 12 months follow-up patients who reported not to have expectations fulfilled had a low mental component summary score -16.3 (-26.5; -6.2) when compared to their counterparts with fulfilment of expectations. Not having expectations to changes in general well-being fulfilled is associated with low mental component summary. This is seen at follow-up points 4 and 12 months after gastric bypass.

Overweight and Obesity: Knowledge, Attitudes, and Practices of General Practitioners in France

OBJECTIVE

To describe the current knowledge, attitudes, and practices of French general practitioners (GPs) in the field of adult overweight and obesity management.

RESEARCH METHODS AND PROCEDURES

A cross-sectional telephone survey interviewed a sample of 600 GPs, representative of the private GPs in southeastern France. A four-part questionnaire assessed personal and professional characteristics, attitudes and opinions about overweight and obesity, relevant knowledge and training, and practices (diagnostic methods, clinical assessments, weight loss objectives, types of counseling).

RESULTS

Most GPs knew that weight problems are health-threatening, and 79% agreed that managing these problems is part of their role. Nevertheless, 58% did not feel they perform this role effectively, and one-third did not find it professionally gratifying. Approximately 30% had negative attitudes toward overweight and obese patients; 57% were pessimistic about patients' ability to lose weight; 64% often set weight loss objectives more demanding than guidelines call for; and neither food diaries nor nutritional education were used systematically. GPs' feelings of effectiveness and attitudes toward obese patients were associated with some professional (training) and personal (BMI, personal diet experience) characteristics.

DISCUSSION

GPs' feelings of ineffectiveness may stem from an underlying conflict between practitioners' and patients' representations of weight problems and the relationship problems this causes. Inadequate practices and health care system organization may also play a role.

Relationship Between Morbidly Obese Subjects' Attributions of Low General Well-being, Expectations and Health-Related Quality of Life: Five-year Follow-up After Gastric Banding

Low health-related quality of life among morbidly obese subjects is well-known. However, the relationship may not be simple. We aim to examine the association between pre-operative expectations and health-related quality of life and long-term changes in health-related quality of life after gastric banding. The questionnaires were answered twice: before and five years after gastric banding. Short Form-36 assessed health-related quality of life. Obesity specific questions were used to assess the subjects' attribution of impairment to morbid obesity and their expectations to changes as a result of weight loss. The subjects attribute morbid obesity as a major reason for their impairments in state of health, physical activity, pain and work capacity. As a result of weight loss, the subjects expect improvements even within fields which they did not consider to be impaired due to morbid obesity. We found an inverse association between high expectations and mental component summary score at baseline. At follow-up having expectations fully fulfilled was associated with a higher mental component summary score than having expectations fulfilled only to a fair extension and not having expectations fulfilled. Physical component summary was statistically significant improved at follow-up Morbidly obese subjects' attributions of low general well-being combined with their expectations may be a central part of understanding the mechanisms involved in the association between morbid obesity and low health-related quality of life. Furthermore the impact of morbid obesity on health-related quality of life may be reduced if healthprofessionals bridge the gap between morbidly obese subjects' expectations and their experience.

Ain’t no mountain high enough? Setting high weight loss goals predict effort and short-term weight loss

Although psychological theories outline that it might be beneficial to set more challenging goals, people attempting to lose weight are generally recommended to set modest weight loss goals. The present study explores whether the amount of weight loss individuals strive for is associated with more positive psychological and behavioral outcomes. Hereto, 447 overweight and obese participants trying to lose weight completed two questionnaires with a 2-month interval. Many participants set goals that could be considered unrealistically high. However, higher weight loss goals did not predict dissatisfaction but predicted more effort in the weight loss attempt, as well as more self-reported short-term weight loss when baseline commitment and motivation were controlled for.

Weight management by phone conference call: a comparison with a traditional face-to-face clinic. Rationale and design for a randomized equivalence trial

State-of-the-art treatment for weight management consists of a behavioral intervention to facilitate decreased energy intake and increased physical activity. These interventions are typically delivered face-to-face (FTF) by a health educator to a small group of participants. There are numerous barriers to participation in FTF clinics including availability, scheduling, the expense and time required to travel to the clinic site, and possible need for dependent care. Weight management clinics delivered by conference call have the potential to diminish or eliminate these barriers. The conference call approach may also reduce burden on providers, who could conduct clinic groups from almost any location without the expenses associated with maintaining FTF clinic space. A randomized trial will be conducted in 395 overweight/obese adults (BMI 25-39.9 kg/m(2)) to determine if weight loss (6 months) and weight maintenance (12 months) are equivalent between weight management interventions utilizing behavioral strategies and pre-packaged meals delivered by either a conference call or the traditional FTF approach. The primary outcome, body weight, will be assessed at baseline, 6, 12 and 18 months. Secondary outcomes including waist circumference, energy and macronutrient intake, and physical activity and will be assessed on the same schedule. In addition, a cost analysis and extensive process evaluation will be completed.