Successful weight loss among obese U.S. adults

Demographic correlates of weight-loss strategies in US adults: Cross-sectional analysis of NHANES data 2017-2020

Objective

To investigate the frequency of various weight loss strategies among adults in the United States and to explore which weight-loss strategies are associated with several demographic factors.

Methods

The study utilized 2017-2020 data from the National Health and Nutrition Examination Survey. Adult participants (N = 3,130) who had tried to lose weight during the past year were included. Pregnant women and individuals under age 20y were excluded. Weight-loss strategies were categorized into 6 groups: consuming more healthy options (e.g., more fruits); consuming less un-healthy options (e.g., junk food); quality of diet changes (e.g., changed eating habits); assisted weight-loss method (e.g., special diet); exercising; and un-healthy strategies (e.g., vomiting). Adjusted odds ratios (aORs) and 95%CIs were calculated using weighted logistic regression models.

Results

The most frequently employed strategies to achieve weight loss were exercising (60.6%), consuming less un-healthy options (60.4%), and drinking a lot of water (55.3%). Un-healthy strategies were less prevalent among older individuals (aOR:0.46 [95% CI:0.37-0.58]) and those with higher incomes (aOR:0.69 [95% CI:0.54-0.89]). Conversely, individuals with obesity class I (aOR:1.85 [95% CI:1.38-2.48]) and obesity class II/III (aOR:1.69 [95% CI:1.27-2.25) showed an increased likelihood of adopting unhealthy strategies. Similarly, widowed individuals (aOR:1.31 [95% CI:1.03-1.66]) and those who have never been married (aOR:1.36 [95% CI:1.09-1.69]) exhibited a higher tendency for such behaviors compared to married individuals.

Conclusion

The likelihood of using various weight-loss methods differs based on demographic characteristics. Recognizing these tendencies can guide public health initiatives and customized strategies for weight control.

Exploring potential reach and representativeness of a self-weighing weight gain prevention intervention in adults with overweight and obesity

Most adults with obesity do not enrol in comprehensive weight loss interventions when offered. For these individuals, lower burden self-weighing interventions may offer an acceptable alternative, though data is lacking on the potential for reach and representativeness of such interventions. Health system patients with BMI ≥30 kg/m2 (or 25-30 kg/m2 with an obesity comorbidity) completed a general health survey. During the survey, patients were given information about comprehensive weight loss interventions. If they denied interest or did not enrol in a comprehensive intervention, they were offered enrolment in a low-burden weight gain prevention intervention focused on daily self-weighing using a cellular network-connected in-home scale without any dietary or physical activity prescriptions. Enrolment in this program was documented. Among patients offered the self-weighing intervention (n = 85; 55.3% men; 58.8% White; BMI = 34.2 kg/m2), 44.2% enrolled. Compared to those who did not enrol, enrollers had higher educational attainment (57.1% vs. 42.9% with bachelor's degree p = .02), social anxiety (5.8 vs. 2.8, p < .001), and perceptions of the effectiveness of the self-weighing intervention (25.8 vs. 20.9 on 35, p = .007). The most highly endorsed reason for not enrolling in the self-weighing intervention was that it would make individuals overly focused on weight. A low-intensity weight gain prevention intervention may serve as a viable alternative to comprehensive weight loss interventions for the substantial portion of patients who are at risk for continued weight gain but would otherwise not enrol in a comprehensive intervention. Differential enrolment by education, however, suggests potential for inequitable uptake.

A low-burden, self-weighing intervention to prevent weight gain in adults with obesity who do not enroll in comprehensive treatment

Background

For individuals who are eligible but unlikely to join comprehensive weight loss programs, a low burden self-weighing intervention may be a more acceptable approach to weight management.

Methods

This was a single-arm feasibility trial of a 12-month self-weighing intervention. Participants were healthcare patients with a BMI ≥25 kg/m2 with a weight-related comorbidity or a BMI >30 kg/m2 who reported lack of interest in joining a comprehensive weight loss program, or did not enroll in a comprehensive program after being provided program information. In the self-weighing intervention, participants were asked to weigh themselves daily on a cellular connected scale and were sent text messages every other week with tailored weight change feedback, including messages encouraging use of comprehensive programs if weight gain occurred.

Results

Of 86 eligible patients, 39 enrolled (45.3%) in the self-weighing intervention. Self-weighing occurred on average 4.6 days/week (SD = 1.4). At 12 months, 12 participants (30.8%) lost ≥3% baseline weight, 11 (28.2%) experienced weight stability (±3% baseline), 6 (15.4%) gained ≥3% of baseline weight, and 10 (25.6%) did not have available weight data to evaluate. Three participants reported joining a weight loss program during the intervention (7.7%). Participants reported high intervention satisfaction in quantitative ratings (4.1 of 5), and qualitative interviews identified areas of satisfaction (e.g., timing and content of text messages) and areas for improvement (e.g., increasing personalization of text messages).

Conclusion

A low-burden self-weighing intervention can reach adults with overweight/obesity who would be unlikely to engage in comprehensive weight loss programs; the efficacy of this intervention for preventing weight gain should be further evaluated in a randomized trial.

Qualitative study of perceptions of factors contributing to success or failure among participants in a US weight loss trial of financial incentives and environmental change strategies

BACKGROUND

The use of financial incentives and environmental change strategies to encourage health behaviour change is increasingly prevalent. However, the experiences of participants in incentive interventions are not well characterised. Examination of participant perceptions of financial incentives and environmental strategies can offer insights about how these interventions are facilitating or failing to encourage behaviour change.

OBJECTIVE

This study aimed to learn how participants in a randomised trial that tested financial incentives and environmental interventions to support weight loss perceived factors contributing to their success or failure in the trial.

DESIGN

Qualitative study with one-time interviews of trial participants with high and low success in losing weight, supplemented by study records of incentive payments and weight loss.

PARTICIPANTS

24 trial participants (12 with substantial weight loss and 12 with no weight loss) stratified equally across the 4 trial arms (incentives, environmental strategies, combined and usual care) were interviewed.

ANALYTICAL APPROACH

Transcribed interviews were coded and interpreted using an iterative process. Explanation development was completed using an abductive approach.

RESULTS

Responses of trial participants who were very successful in losing weight differed in several ways from those who were not. Successful participants described more robust prior attempts at dietary and exercise modification, more active engagement with self-limitations, more substantial social support and a greater ability to routinise dietary and exercise changes than did participants who did not lose weight. Successful participants often stated that weight loss was its own reward, even without receiving incentives. Neither group could articulate the details of the incentive intervention or consistently differentiate incentives from study payments.

CONCLUSIONS

A number of factors distinguished successful from unsuccessful participants in this intervention. Participants who were successful tended to attribute their success to intrinsic motivation and prior experience. Making incentives more salient may make them more effective for participants with greater extrinsic motivation.

TRIAL REGISTRATION NUMBER

NCT02878343.

Weight Loss Treatment and Longitudinal Weight Change Among Primary Care Patients With Obesity

Importance

Among individuals with obesity, 5% or greater weight loss can improve health. Weight management treatments (WMT) include nutrition counseling, very low-calorie meal replacement (MR), antiobesity medications (AOM), and bariatric surgery; however, little is known about how these WMT are associated with weight change among individual patients and populations.

Objective

To characterize weight status and WMT use among primary care patients and assess associations between WMT and weight trajectories.

Design, Setting, and Participants

Retrospective, population-based cohort study of primary care patients from 1 academic health system in Michigan between October 2015 and March 2020 using cross-sectional analysis to compare obesity prevalence and WMT utilization. For patients with obesity and WMT exposure or matched controls, a multistate Markov model assessing associations between WMT and longitudinal weight status trajectories was used. Data were analyzed from October 2021 to October 2023.

Exposures

Cross-sectional exposure was year: 2017 or 2019. Trajectory analysis exposures were WMT: nutrition counseling, MR, AOM, and bariatric surgery.

Main Outcomes and Measures

Cross-sectional analysis compared mean body mass index (BMI), obesity prevalence, and, among patients with obesity, prospective WMT use. The trajectory analysis examined longitudinal weight status using thresholds of ±5% and 10% of baseline weight with primary outcomes being the 1-year probabilities of 5% or greater weight loss for each WMT.

Results

Adult patients (146 959 participants) consisted of 83 636 female participants (56.9%); 8940 (6.1%) were Asian, 14 560 (9.9%) were Black, and 116 664 (79.4%) were White. Patients had a mean (SD) age of 49.6 (17.7) years and mean (SD) BMI of 29.2 (7.2). Among 138 682 patients, prevalence of obesity increased from 39.2% in 2017 to 40.7% in 2019; WMT use among patients with obesity increased from 5.3% to 7.1% (difference: 1.7%; 95% CI, 1.3%-2.2%). In a multistate model (10 180 patients; 33 549 patient-years), the 1-year probability of 5% or greater weight loss without WMT exposure was 15.6% (95% CI, 14.3%-16.5%) at reference covariates. In contrast, the probability of 5% or greater weight loss was more likely with year-long exposures to any WMT (nutrition counseling: 23.1%; 95% CI, 21.3%-25.1%; MR: 54.6%; 95% CI, 46.5%-61.2%; AOM: 27.8%; 95% CI, 25.0%-30.5%; bariatric surgery: 93.0%; 95% CI, 89.7%-95.0%).

Conclusions and Relevance

In this cohort study of primary-care patients with obesity, all WMT increased the patient-level probability of achieving 5% or greater weight loss, but current rates of utilization are low and insufficient to reduce weight at the population level.

Privacy Concerns in Group Format Lifestyle Interventions for Obesity

BACKGROUND

Group format weight loss interventions have benefits over individual format, but privacy concerns may limit their uptake.

METHOD

In this study, adults with obesity and interest in losing weight were recruited nationally online and randomly assigned to view one of eight videos describing a hypothetical, group behavioral weight loss intervention. Based on three fully crossed factors, the videos varied on privacy features of intervention (present or not); matching participants to group based on weight loss barriers (matched or not); and intervention format (online or in-person). Participants rated their willingness to join, privacy concerns, and perceived effectiveness of these interventions. They further reported preference for individual or group format interventions and reason for preferences.

RESULTS

Description of privacy features, matching of participants, and format did not affect willingness to join, privacy concerns, or perceived effectiveness of the intervention. Privacy concerns were associated with lower willingness to join and lower perceived intervention effectiveness, and greater social anxiety and weight stigma. More participants preferred individual over group format (40.1% vs 33.9%; 26% selected neither) and preference for individual format was associated with greater privacy concerns.

CONCLUSION

Strategies to address privacy concerns in group-based interventions warrant further attention.

Probability of 5% or Greater Weight Loss or BMI Reduction to Healthy Weight Among Adults With Overweight or Obesity

Importance

Information on the probability of weight loss among US adults with overweight or obesity is limited.

Objective

To assess the probability of 5% or greater weight loss, 10% or greater weight loss, body mass index (BMI) reduction to a lower BMI category, and BMI reduction to the healthy weight category among US adults with initial overweight or obesity overall and by sex and race.

Design, Setting, and Participants

This cohort study obtained data from the IQVIA ambulatory electronic medical records database. The sample consists of US ambulatory patients 17 years or older with at least 3 years of BMI information from January 1, 2009, to February 28, 2022. Minimum age was set at 17 years to allow for the change in BMI or weight starting at 18 years. Maximum age was censored at 70 years.

Exposures

Initial BMI (calculated as weight in kilograms divided by height in meters squared) category was the independent variable of interest, and the categories were as follows: lower than 18.5 (underweight), 18.5 to 24.9 (healthy weight), 25.0 to 29.9 (overweight), 30.0 to 34.9 (class 1 obesity), 35.0 to 39.9 (class 2 obesity), and 40.0 to 44.9 and 45.0 or higher (class 3 or severe obesity).

Main Outcomes and Measures

The 2 main outcomes were 5% or greater weight loss (ie, a ≥5% reduction in initial weight) and BMI reduction to the healthy weight category (ie, BMI of 18.5-24.9).

Results

The 18 461 623 individuals in the sample had a median (IQR) age of 54 (40-66) years and included 10 464 598 females (56.7%) as well as 7.7% Black and 72.3% White patients. Overall, 72.5% of patients had overweight or obesity at the initial visit. Among adults with overweight and obesity, the annual probability of 5% or greater weight loss was low (1 in 10) but increased with higher initial BMI (from 1 in 12 individuals with initial overweight to 1 in 6 individuals with initial BMI of 45 or higher). Annual probability of BMI reduction to the healthy weight category ranged from 1 in 19 individuals with initial overweight to 1 in 1667 individuals with initial BMI of 45 or higher. Both outcomes were generally more likely among females than males and were highest among White females. Over the 3 to 14 years of follow-up, 33.4% of persons with overweight and 41.8% of persons with obesity lost 5% or greater of their initial weight. At the same time, 23.2% of persons with overweight and 2.0% of persons with obesity reduced BMI to the healthy weight category.

Conclusions and Relevance

Results of this cohort study indicate that the annual probability of 5% or greater weight loss was low (1 in 10) despite the known benefits of clinically meaningful weight loss, but 5% or greater weight loss was more likely than BMI reduction to the healthy weight category, especially for patients with the highest initial BMIs. Clinicians and public health efforts can focus on messaging and referrals to interventions that are aimed at clinically meaningful weight loss (ie, ≥5%) for adults at any level of excess weight.

A Pilot Goal-Oriented Episodic Future Thinking Weight Loss Intervention for Low-Income Overweight or Obese Young Mothers

BACKGROUND

Episodic future thinking (EFT) has shown efficacy in laboratory settings. We conducted a pilot goal-oriented EFT (GoEFT) intervention in a real-world setting to help low-income overweight or obese mothers lose weight. This paper presents intervention acceptability and efficacy.

METHODS

The study used a single-group, before-after design. During the 3-week intervention, participants (N = 15) completed weekly web-based lessons and online health coaching sessions to manage stress and emotion, eat healthier, and be more physically active. Participants completed online surveys at baseline and immediately after the intervention. They also completed an interview to evaluate intervention acceptability. We applied paired t-tests to evaluate efficacy and used content analysis to discover interview themes.

RESULTS

Participants consistently identified the intervention as acceptable, noting the usefulness of pre-written goals, GoEFT strategies, and goal progress evaluations. The intervention effectively promoted weight loss (d = -0.69), fruit and vegetable intake (d = 0.45-0.49), and emotion control (d = 0.71). It also reduced fat (d = -0.51) and added sugar intake (d = -0.48) and alleviated stress (d = -0.52). Moreover, the intervention increased autonomous motivation (d = 0.75-0.88) and self-efficacy (d = 0.46-0.61).

CONCLUSION

The GoEFT intervention was acceptable to participants, showing strong preliminary efficacy.

The interplay between emotion regulation, interpersonal problems and eating symptoms in individuals with obesity: A network analysis study

INTRODUCTION

A complex and bidirectional relationship between eating and psychological symptoms in individuals with obesity has been proposed. This study aims to identify the specific processes playing a role in this association, using a data-driven approach.

METHODS

Two hundred ninety-four adults with obesity, including 106 (36 %) with binge-eating disorder, were consecutively admitted to a specialized public center. They completed self-report questionnaires to assess emotion regulation, interpersonal problems, self-esteem, binge-eating symptoms, and expectancies regarding eating behaviors. To assess the interplay among eating and psychological variables, a network analysis was used. The bridge function analysis was also performed to identify the bridge nodes among three communities (eating symptoms, interpersonal and emotional problems).

RESULTS

The network was stable. Limited access to emotion regulation strategies, eating helps manage negative affect, and non-assertiveness were the nodes with the highest strength centrality. Lack of emotional clarity, non-assertiveness, socially inhibition, and binge-eating were the nodes with the highest bridge strength.

LIMITATIONS

The main limitation of the study is the cross-sectional nature of the findings which prevents to infer causality regarding the association between symptoms in the network.

DISCUSSION

An interplay between eating symptoms and affective and interpersonal factors characterizes individuals with obesity. Across the variety of psychological problems associated with obesity, the present study suggests specific psychological variables and their connections that could be addressed to improve treatment outcome.

Self-Efficacy and Readiness to Change Among Women with Recent Gestational Diabetes Engaging in a Web-Based Lifestyle Intervention: The Balance After Baby Intervention Trial

Few evidence-based programs exist to help women with a history of gestational diabetes reduce their risk of developing type 2 diabetes. In secondary analyses from a randomized clinical trial of a web-based lifestyle intervention program for postpartum women with recent gestational diabetes, we studied changes in self-efficacy for diet and physical activity and readiness to change health behaviors. Women were randomized at ∼6 weeks postpartum and completed questionnaires at 6 weeks and 6, 12, 18, and 24 months. Our study included 181 women (mean age 32.4 ± 5.2 years; 48% White, 19% Asian, 14% Black or African American, 17% other/mixed race; 34% Hispanic). In a linear mixed effects model, women in the intervention had significantly greater improvement in overall self-efficacy scores for physical activity compared with the control group at 24 months (difference in change scores between groups .35, 95% CI: .03 to .67, P = .03). The intervention group also demonstrated significantly greater improvement in self-efficacy scores for both physical activity subdomains, specifically “sticking to it” at 24 months and “making time” at 12 months. Participants in the intervention did not experience a significant difference in change in self-efficacy for diet or readiness to change compared with those in the control arm.

Distinct factors associated with short-term and long-term weight loss induced by low-fat or low-carbohydrate diet intervention

To understand what determines the success of short- and long-term weight loss, we conduct a secondary analysis of dietary, metabolic, and molecular data collected from 609 participants before, during, and after a 1-year weight-loss intervention with either a healthy low-carbohydrate (HLC) or a healthy low-fat (HLF) diet. Through systematic analysis of multidomain datasets, we find that dietary adherence and diet quality, not just caloric restriction, are important for short-term weight loss in both diets. Interestingly, we observe minimal dietary differences between those who succeeded in long-term weight loss and those who did not. Instead, proteomic and gut microbiota signatures significantly differ between these two groups at baseline. Moreover, the baseline respiratory quotient may suggest a specific diet for better weight-loss outcomes. Overall, the identification of these dietary, molecular, and metabolic factors, common or unique to the HLC and HLF diets, provides a roadmap for developing individualized weight-loss strategies.

Consulting Obese and Overweight Patients for Nutrition and Physical Activity in Primary Healthcare in Poland

The aim of this study was to evaluate the dietary and physical activity counseling provided to adults by family doctors. Predictors of counseling in primary healthcare were identified. A cross-sectional study was conducted from January 2020 to December 2021 among 896 adult primary care patients in the city of Łódź [Lodz], Poland. Almost 36% of the respondents were advised to change their eating habits, and 39.6% were advised to increase their physical activity. In a multivariate logistic regression analysis, people in poor health with chronic diseases related to overweight and obesity and with two, three or more chronic diseases, respectively, received advice on eating habits from their GP twice and three times more often than people in good health with no chronic conditions (OR = 1.81; p < 0.05 and OR = 1.63; p < 0.05; OR = 3.03; p < 0.001). People in the age groups 30−39 years and 40−49 years (OR = 1.71; p < 0.05 and OR = 1.58; p < 0.05), widowed (OR = 2.94; p < 0.05), with two, three or more chronic diseases (OR = 1.92; p < 0.01 and OR = 3.89; p < 0.001), and subjectively assessing overweight and obesity (OR = 1.61; p < 0.01) had a better chance of receiving advice on physical activity. The study found a higher proportion of advice on diet and physical activity provided to overweight and obese patients by primary care physicians than in other studies; however, still not all receive the necessary counseling. GPs should advise all patients not to become overweight and obese, not only those already affected by the problem.

The comparison of treatment with orlistat and orlistat plus metformin in relation to insulin resistance and weight loss

Introduction: Obesity is a growing health problem. Many drugs have been developed to treat obesity. Orlistat is a widely used drug to treat this disease. Metformin is an antidiabetic drug. Clinicians often prescribe it to treat insulin resistance and achieve weight loss. Our research aims to compare the effects of orlistat alone and its combination with metformin on weight loss and insulin resistance. Material and Method: This retrospective study was conducted by scanning the data of patients who presented to Antalya Training and Research Hospital Endocrinology, and General Surgery Clinics between 2016 and 2021. 42 morbidly obese patients who met inclusion and exclusion criteria and were prescribed orlistat plus metformin (group 1, n: 28) or orlistat alone (group 2, n: 14) along with a low-calorie diet for three months and were taking it regularly were included. Subsequently, weight, body mass index, fasting blood glucose, fasting insulin, and HOMA-IR (homeostasis model assessment for insulin resistance) were recorded and analyzed at baseline and after three months of taking the medications. Results: After 3 months of treatment, significant weight loss was achieved in both groups compared to baseline weight (p=0.001 group 1, p=0.003 group 2). HOMA-IR values decreased significantly in both groups (p=0.001 group 1, p=0.01 group 2). Both groups lost the same amount of weight after three months (p=0.06). Conclusion: In morbidly obese patients without prediabetes or diabetes, the addition of metformin to orlistat therapy did not add benefits in terms of weight loss or insulin resistance.

Perceptions of body weight that vary by body mass index: Clear associations with perceptions based on personal control and responsibility

This project aimed to identify the perceptions of body weight that vary by body mass index. First, a qualitative study explored body weight perceptions in 17 individuals with overweight. Second, a questionnaire was developed and completed by a UK sample with body mass index from 16.6 to 59.7 kg/m2 (N = 328). A higher body mass index was associated with perceptions of less personal control and responsibility. Body mass index in females was also associated with three other questionnaire factors and body mass index in males with illness/medication. Thus, body mass index was associated with different perceptions of body weight. Focussing on personal control and responsibility may be useful for treatment and prevention.

Effectiveness of Mobile Health Applications for 5% Body Weight Reduction in Obese and Overweight Adults

Background

World Health Organization reports that over 1.9 billion adults are obese. Studies have found that people who reduce their body weight by 5% experience considerable health benefits. Currently, mobile health (mHealth) applications (apps) show effectiveness in body weight reduction. The present study aimed to explore the effectiveness of a popular mHealth app in 5% body weight reduction and to identify factors that affect 5% body weight reduction in obese adults. We investigated the time it took users to achieve 5% body weight reduction according to usage characteristics and factors influencing this period of time.

Methods

This study was a secondary data analysis using data from 23,682 commercial mHealth app users. For analysis, logistic regressions, Kaplan-Meier estimators, log-rank tests, and Cox regressions were used.

Results

Variables in user characteristics including age (odds ratio [OR], 0.976; P<0.001), male (OR, 1.226; P<0.001), initial body mass index (OR, 1.009; P<0.001), frequency of data entry for body weight (OR, 1.004; P<0.001), frequency of exercise (OR, 1.002; P<0.001), and dinner intake (OR, 1.004; P<0.001) made significant contributions in predicting 5% weight reduction in the study cohort. Users who were obese and who more frequently entered their body weight, exercise, and dietary intake data reduced 5% body weight much sooner than other users. Data entry regarding initial body weight (exponentiation of the B coefficient [Exp(B)], 1.002; P<0.001), frequency in body weight entry (Exp(B), 1,001; P<0.001), dinner intake (Exp(B), 1.003; P<0.001), and evening snack intake (Exp(B), 1.001; P<0.001) significantly contributed to predicting the time needed to achieve a 5% body weight reduction in users.

Conclusion

For 5% body weight reduction, mHealth apps are promising tools. Users who frequently monitor their health-related behaviors can expect a 5% reduction in body weight in a short period of time.

Free-Living Energy Balance Behaviors Are Associated With Greater Weight Loss During a Weight Loss Program

Introduction: Free-living movement (physical activity [PA] and sedentary behavior [SB]) and eating behaviors (energy intake [EI] and food choice) affect energy balance and therefore have the potential to influence weight loss (WL). This study explored whether free-living movement and/or eating behaviors measured early (week 3) in a 14-week WL programme or their change during the intervention are associated with WL in women. Methods: In the study, 80 women (M ± SD age: 42.0 ± 12.4 years) with overweight or obesity [body mass index (BMI): 34.08 ± 3.62 kg/m²] completed a 14 week WL program focused primarily on diet (commercial or self-led). Body mass (BM) was measured at baseline, and again during week 2 and 14 along with body composition. Free-living movement (SenseWear Armband) and eating behavior (weighed food diaries) were measured for 1 week during week 3 and 12. Hierarchical multiple regression analyses examined whether early and early-late change in free-living movement and eating behavior were associated with WL. The differences in behavior between clinically significant weight losers (CWL; ≥5% WL) and non-clinically significant weight losers (NWL; ≤ 3% WL) were compared. Results: The energy density of food consumed [β = 0.45, p < 0.001] and vigorous PA [β = -0.30, p < 0.001] early in the intervention (regression model 1) and early-late change in light PA [β = -0.81 p < 0.001], moderate PA [β = -1.17 p < 0.001], vigorous PA [β = -0.49, p < 0.001], total energy expenditure (EE) [β = 1.84, p < 0.001], and energy density of food consumed [β = 0.27, p = 0.01] (regression model 2) significantly predicted percentage change in BM. Early in the intervention, CWL consumed less energy dense foods than NWL [p = 0.03]. CWL showed a small but significant increase in vigorous PA, whereas NWL showed a slight decrease in PA [p = 0.04]. Conclusion: Both early and early-late change in free-living movement and eating behaviors during a 14 week WL program are predictors of WL. These findings demonstrate that specific behaviors that contribute to greater EE (e.g., vigorous PA) and lower EI (e.g., less energy-dense foods) are related to greater WL outcomes. Interventions targeting these behaviors can be expected to increase the effectiveness of WL programs.

Identifying behavioral types of dietary lapse from a mobile weight loss program: Preliminary investigation from a secondary data analysis

Success in behavioral weight loss (BWL) programs depends on adherence to the recommended diet to reduce caloric intake. Dietary lapses (i.e., deviations from the BWL diet) occur frequently and can adversely affect weight loss outcomes. Research indicates that lapse behavior is heterogenous; there are many eating behaviors that could constitute a dietary lapse, but they are rarely studied as distinct contributors to weight outcomes. This secondary analysis aims to evaluate six behavioral lapse types during a 10-week mobile BWL program (eating a large portion, eating when not intended, eating an off-plan food, planned lapse, being unaware of caloric content, and endorsing multiple types of lapse). Associations between weekly behavioral lapse type frequency and weekly weight loss were investigated, and predictive contextual characteristics (psychological, behavioral, and environmental triggers for lapse) and individual difference (e.g., age, gender) factors were examined across lapse types. Participants (N = 121) with overweight/obesity (M_BMI = 34.51; 84.3% female; 69.4% White) used a mobile BWL program for 10 weeks, self-weighed weekly using Bluetooth scales, completed daily ecological momentary assessment of lapse behavior and contextual characteristics, and completed a baseline demographics questionnaire. Linear mixed models revealed significant negative associations between unplanned lapses and percent weight loss. Unplanned lapses from eating a large portion, eating when not intended, and having multiple "types" were significantly negatively associated with weekly percent weight loss. A lasso regression showed that behavioral lapse types share many similar stable factors, with other factors being unique to specific lapse types. Results add to the prior literature on lapses and weight loss in BWL and provide preliminary evidence that behavioral lapse types could aid in understanding adherence behavior and developing precision medicine tools to improve dietary adherence.

Physical Activity, Sleep, and Sedentary Behavior among Successful Long-Term Weight Loss Maintainers: Findings from a U.S. National Study

Despite adults’ desire to reduce body mass (weight) for numerous health benefits, few are able to successfully lose at least 5% of their starting weight. There is evidence on the independent associations of physical activity, sedentary behaviors, and sleep with weight loss; however, this study provided insight on the combined effects of these behaviors on long-term body weight loss success. Hence, the purpose of this cross-sectional study was to evaluate the joint relations of sleep, physical activity, and sedentary behaviors with successful long-term weight loss. Data are from the 2005–2006 wave of the National Health and Examination Survey (NHANES). Physical activity and sedentary behavior were measured with an accelerometer, whereas sleep time was self-reported. Physical activity and sleep were dichotomized into meeting guidelines (active/not active, ideal sleep/short sleep), and sedentary time was categorized into prolonged sedentary time (4th quartile) compared to low sedentary time (1st–3rd quartiles). The dichotomized behaviors were combined to form 12 unique behavioral combinations. Two-step multivariable regression models were used to determine the associations between the behavioral combinations with (1) long-term weight loss success (≥5% body mass reduction for ≥12-months) and (2) the amount of body mass reduction among those who were successful. After adjustment for relevant factors, there were no significant associations between any of the independent body weight loss behaviors (physical activity, sedentary time, and sleep) and successful long-term weight loss. However, after combining the behaviors, those who were active (≥150 min MVPA weekly), regardless of their sedentary time, were significantly (p < 0.05) more likely to have long-term weight loss success compared to the inactive and sedentary referent group. These results should be confirmed in longitudinal analyses, including investigation of characteristics of waking (type, domain, and context) and sleep (quality metrics) behaviors for their association with long-term weight loss success.

Disentangling the obesity paradox in upper gastrointestinal cancers: Weight loss matters more than body mass index

OBJECTIVES

The obesity paradox, whereby obesity appears to confer protection against cancer-related mortality, remains controversial. This has not yet been evaluated in upper gastrointestinal cancers.

DESIGNS

We identified esophageal, cardia, and non-cardia gastric adenocarcinomas in the Veterans Health Administration between 2006-2016. Multivariable Cox proportional hazard models evaluate the impact of BMI at- and prior to- cancer diagnosis on mortality, adjusting for demographics, clinical characteristics, weight loss, and clinical stage (early: T1B/2N0; locally advanced: ≥T2N+).

RESULTS

We identify 1308 patients: 99 % male, median 66 years. In early disease, relative to BMI 30, BMI 18 and 20 at diagnosis had increased risk of death (HR 1.83, 95 %CI: 1.38-2.44 and HR 1.50, 95 %CI: 1.20-1.87, respectively, p < 0.0001). Patients with BMI > 30 did not. In locally advanced disease, at diagnosis BMI 18 (HR 1.58, 95 %CI: 1.0001-1.48, p = 0.05), BMI 20 (HR 1.46, 95 %CI: 1.01-2.09, p = 0.04), and BMI 25 (HR 1.20, 95 %CI: 1.04-1.38, p = 0.01) had increased risk of death, but BMI > 30 did not. In models assessing premorbid BMI and weight loss, increasing amounts of weight loss were associated with mortality independent of BMI in early cancers. For locally advanced cancers, without weight loss, there was no association with death, regardless of BMI.

CONCLUSION

The predominant driver of mortality across clinical stages is weight loss. The obesity paradox appears to exist in early stage disease only. Future studies should investigate mechanisms for the obesity paradox, accompanying physiologic changes with weight loss preceding diagnosis, and if patients with low BMI and weight loss benefit from early nutritional support.

A web-based intervention to increase weight loss treatment initiation: results of a cluster randomized feasibility and acceptability trial

Evidence-based behavioral weight loss treatment is under-utilized. To increase initiation of treatment, we developed a single-session, online, primary care-based intervention ("mobilization tool"). We evaluated the mobilization tool's acceptability for primary care patients with obesity, trial design feasibility, and signal of an effect of the tool on treatment initiation. In this cluster randomized feasibility trial, primary care providers (PCPs) were randomized to a mobilization tool or comparator tool arm. Patients with obesity and a scheduled appointment with a randomized PCP were assigned to complete the mobilization or comparator tool prior to their appointment. The online mobilization tool asks patients to answer questions about a variety of weight-related topics and then provides automated, tailored feedback that addresses psychosocial determinants of weight loss treatment initiation. The comparator tool provided a nontailored description of treatments. All participants were offered free enrollment in behavioral weight loss treatments. Six PCPs were randomized. Sixty patients (57% female; 66% white; aged 55 ± 13 years) participated in this study of 296 contacted for eligibility evaluation (20.2%). Six-month follow-up assessments were completed by 65% (22/34) of the mobilization and 73% (19/26) of comparator tool participants. Participants completing the acceptability survey reported that the mobilization tool was usable, enjoyable, informative, and useful. Weight loss treatment was initiated by 59% (n = 19) of mobilization and 33% (n = 8) of comparator tool participants. The mobilization tool shows promise for increasing treatment initiation among primary care patients, which may increase population weight loss. Trial Registration: Clinicaltrials.gov identifier: NCT02708121.

A Practical Approach to Assist Asthmatics to Lose Weight

Treating patients with obesity, particularly asthmatics, is a complex challenge that requires a unique and individually tailored approach. Obesity, defined by the Centers for Disease Control and Prevention, is a body mass index of 30.0 kg/m² or greater. It affects approximately 43% of adults and 19% of youth in America. It is a multifactorial disease and should be managed with the same intensity as any other medical problem, for it represents a risk factor for the onset and severity of asthma. Furthermore, it is a comorbid condition that exacerbates rhinosinusitis, gastroesophageal reflux disease, obstructive sleep apnea, hypertension, anxiety, and depression. Being obese also increases morbidity for cardio/cerebrovascular diseases, metabolic syndrome, type 2 diabetes, breast and bladder cancer, and migraines. Osteoarthritis, in particular, of the knees and hips, is also associated with obesity, and that too will complicate asthma by hindering a subject's mobility and ability to exercise. This paper reviews the epidemiology and pathophysiology of obesity, its effect on asthma, and practical strategies to achieve weight loss.

Gender Differences in Factors Associated with Clinically Meaningful Weight Loss among Adults Who Were Overweight or Obese: A Population-Based Cohort Study

OBJECTIVES

The impact of heterogeneity on gender difference for achieving clinically meaningful weight loss (cmWL) remains unclear. Here, we explored the potential gender differences in factors associated with cmWL.

METHODS

A total of 60,668 participants with body mass index (BMI) ≥25 kg/m2 at study entry and available BMI values at follow-up were included in this study. cmWL was defined as a weight loss of ≥5% from the study entry to follow-up. The associations of social-demographic factors, personal history of chronic diseases, lifestyle behaviors, and history of BMI with cmWL were evaluated using logistic regression models.

RESULTS

During a median follow-up of 9.13 years, 26.6% of the participants had a cmWL (30.8% for females vs. 23.1% in males; p < 0.001). Participants with older age, obesity at study entry, being more physical activity compared to 10 years ago, being relapsed smokers or consistent current smokers, having a history of chronic diseases (i.e., diabetes, osteoporosis, and stroke), cancer diagnosis during the study period, and more than 10-year follow-up were more likely to achieve cmWL in both males and females (all p < 0.05). The new smoking quitters and participants with less active in physical activity compared to 10 years ago were less likely to achieve cmWL in both males and females (all p < 0.05). Specifically, males with a history of emphysema were more likely to reach cmWL, and for females, those being overweight at 20 years old and current drinkers were more likely to reach cmWL (p < 0.05). Sensitivity analyses demonstrated similar results.

CONCLUSION

Age, BMI status, physical activity, smoking status, family income, and health status were independent factors in males and females for weight management. However, further well-designed prospective studies are warranted to confirm our findings.

Nuclear hormone and peptide hormone therapeutics for NAFLD and NASH

Background

Non-alcoholic steatohepatitis (NASH) is a spectrum of histological liver pathologies ranging from hepatocyte fat accumulation, hepatocellular ballooning, lobular inflammation, and pericellular fibrosis. Based on early investigations, it was discovered that visceral fat accumulation, hepatic insulin resistance, and atherogenic dyslipidemia are pathological triggers for NASH progression. As these pathogenic features are common with obesity, type 2 diabetes (T2D), and atherosclerosis, therapies that target dysregulated core metabolic pathways may hold promise for treating NASH, particularly as first-line treatments.

Scope of Review

In this review, the latest clinical data on nuclear hormone- and peptide hormone-based drug candidates for NASH are reviewed and contextualized, culminating with a discovery research perspective on emerging combinatorial therapeutic approaches that merge nuclear and peptide strategies.

Major Conclusion

Several drug candidates targeting the metabolic complications of NASH have shown promise in early clinical trials, albeit with unique benefits and challenges, but questions remain regarding their translation to larger and longer clinical trials, as well as their utility in a more diseased patient population. Promising polypharmacological approaches can potentially overcome some of these perceived challenges, as has been suggested in preclinical models, but deeper characterizations are required to fully evaluate these opportunities.

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Despite no approved treatments for NASH, several drug candidates have shown promise in early clinical trials.

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Therapies targeting metabolic pathologies of NASH have shown efficacy to reduce hepatic fat content and improve fibrosis.

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Many of these therapies have been rationally designed to mimic nuclear hormone or peptide hormone action.

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Despite provocative preclinical findings of nuclear and peptide hormone combination, clinical translation remains unproven.

Anti-Obesity Natural Products Tested in Juvenile Zebrafish Obesogenic Tests and Mouse 3T3-L1 Adipogenesis Assays

(1) Background: The obesity epidemic has been drastically progressing in both children and adults worldwide. Pharmacotherapy is considered necessary for its treatment. However, many anti-obesity drugs have been withdrawn from the market due to their adverse effects. Instead, natural products (NPs) have been studied as a source for drug discovery for obesity, with the goal of limiting the adverse effects. Zebrafish are ideal model animals for in vivo testing of anti-obesity NPs, and disease models of several types of obesity have been developed. However, the evidence for zebrafish as an anti-obesity drug screening model are still limited. (2) Methods: We performed anti-adipogenic testing using the juvenile zebrafish obesogenic test (ZOT) and mouse 3T3-L1 preadipocytes using the focused NP library containing 38 NPs and compared their results. (3) Results: Seven and eleven NPs reduced lipid accumulation in zebrafish visceral fat tissues and mouse adipocytes, respectively. Of these, five NPs suppressed lipid accumulation in both zebrafish and 3T3-L1 adipocytes. We confirmed that these five NPs (globin-digested peptides, green tea extract, red pepper extract, nobiletin, and Moringa leaf powder) exerted anti-obesity effects in diet-induced obese adult zebrafish. (4) Conclusions: ZOT using juvenile fish can be a high-throughput alternative to ZOT using adult zebrafish and can be applied for in vivo screening to discover novel therapeutics for visceral obesity and potentially also other disorders.

Severe Metabolic Acidosis: A Case of Triple Hit with Ketogenic Diet, Vinegar, and Metformin in an Obese Patient

Obesity is an epidemic with high burden of disease. It is directly proportional to increased risk of morbidity and mortality. Ketogenic diet and herbal supplements have recently gained popularity amongst patients struggling with weight loss. There are limited data available for most of these supplements contrary to the claims laid by the mainstream media. Due to lack of awareness, this patient population is at high risk of adverse effects. We present a case of severe acidosis secondary to ketogenic diet and acetic acid (vinegar) ingestion. The use of dietary acetic acid is usually well tolerated; however, in this case, the large quantities and presence of acute renal injury and metformin use may have worsened the acidosis. Severe ketosis in setting of ketogenic diets is a serious complication, which is infrequently reported in literature. Many of these diets and supplements may seem harmless, but as our case illustrates, when combined with other risk factors, patients can face serious adverse effects and even require hospitalization. It is imperative that such dietary practices are physician supervised to avoid complications. With the recent surge of over-the-counter weight loss supplements and ketogenic diets, physicians also need to engage in dietary discussion with patients when attempting to lose weight.

Interest, Resources, and Preferences for Weight Loss Programs among Primary Care Patients with Obesity

OBJECTIVE

To examine interest, resources, and preferences for weight loss programs among primary care patients with obesity.

METHODS

Primary care patients having a BMI ≥30 kg/m² were recruited in the summer and fall of 2018. Eligible patients were invited to complete an anonymous survey assessing sociodemographic factors, interest in weight loss, resources, and preferences for weight loss programs. Descriptive statistics were used for analysis.

RESULTS

A total of 77 patients completed the anonymous survey. Nearly 90% of patients were interested in participating in a weight loss program and reported having a smartphone. Approximately 80% had high-speed internet and a device with videoconferencing capabilities, whereas only 40% had a tablet or laptop computer. On average, patients preferred weight loss programs delivered in-person and led by a nutritionist or personal trainer. Patients' top three preferences for weight loss content included goal setting, staying motivated, and finding ways to be more active.

CONCLUSIONS

Although primary care patients with obesity were interested in weight loss programs, availability of resources and preferred program characteristics varied.

PRACTICE IMPLICATIONS

This study provides insight on patient interest, resources, and preferences for weight loss programs that may help guide the development of future programs.

A Public Health Messaging Campaign to Reduce Caloric Intake: Feedback From Expert Stakeholders

OBJECTIVE

To obtain expert feedback on a public health messaging campaign to reduce caloric intake in US adults.

DESIGN AND SETTING

In 2018, researchers conducted semistructured telephone interviews with US-based experts in obesity prevention, mental health, and health communications.

PARTICIPANTS

The research team invited 100 experts to participate using purposive and snowball sampling techniques. Of those invited, 60 completed interviews, among which 37 (62%) were obesity prevention experts, 12 (20%) were mental health experts, and 11 (18%) were health communications experts.

MAIN OUTCOME MEASURE

Expert feedback regarding a public health messaging campaign to reduce caloric intake.

ANALYSIS

Two researchers reviewed and coded all transcripts. The team identified major themes and summarized findings.

RESULTS

Most experts identified barriers to effective calorie reduction including social and environmental factors, lack of actionable strategies, and confusion regarding healthy eating messages. Expert suggestions for effective messaging included addressing eating patterns, emphasizing nutrient density, and dissemination through multiple channels and trusted sources. In general, mental health experts more frequently voiced concerns regarding eating disorders, and communications experts raised issues regarding the dissemination of campaigns.

CONCLUSIONS AND IMPLICATIONS

Professionals should identify and address barriers to delivering a calorie reduction campaign before implementation, using strategies that enhance delivery to ensure an effective campaign.

Trends for weight control strategies in Korean adults using the Korea National Health and Nutrition Examination Survey from 2007 to 2017

BACKGROUND

Obesity is an increasing global health problem and is associated with various diseases including stroke, respiratory diseases, diabetes mellitus, and hypertension. Various weight control strategies such as exercise, calorie-restricted diet, anti-obesity medication, herbal medicine, and functional food are being used. The present study aimed to investigate the trends of weight control strategies in Korean adults METHODS: This was a cross-sectional study that used data from the Korea National Health and Nutrition Examination Survey from 2007 to 2017. A total of 64,207 participants were analyzed. The body mass index (BMI), subjective judgment of body appearance, practice of weight control, and methods to control weight were analyzed according to year and sex.

RESULTS

The prevalence rate of obesity in men based on a BMI of 25 or higher was slightly increased from 37.0% in 2007 to 41.1% in 2017. Among the weight control strategies, use of exercise decreased from 83.8% to 80.5% in men, and from 73.4% to 69.5% in women, reduction in the amount of food consumed increased from 47.1% to 60.5% in men and from 65.1% to 70.6% in women, consumption of functional food increased from 3% to 6.2% in men and from 3.2% to 8.7% in women, and rate of skipping meals increased from 6.1% to 12.0% in men and from 11.5% to 14.0% in women.

CONCLUSION

The present study showed that exercise has decreased and dietary control and functional food consumption have increased as weight control strategies in Korean adults during the past decade.

Effect of JumpstartMD, a Commercial Low-Calorie Low-Carbohydrate Physician-Supervised Weight Loss Program, on 22,407 Adults

BACKGROUND

Commercial weight loss programs provide valuable consumer options for those desiring support. Several commercial programs are reported to produce ≥3-fold greater weight loss than self-directed dieting. The effectiveness of JumpstartMD, a commercial pay-as-you-go program that emphasizes a low-to-very-low-carbohydrate real-food diet and optional pharmacologic treatment without prepackaged meals or meal replacement, has not previously been described.

METHODS

Completer and last observation carried forward (LOCF) of clinic-measured weight loss (kg) in 18,769 female and 3638 male JumpstartMD participants.

RESULTS

Completers lost (mean ± SE) 8.7 ± 0.04 kg, 9.5 ± 0.04% with 44.5 ± 0.5% achieving ≥10% weight loss at 3 months (mo, N = 14,999 completers); 11.8 ± 0.1 kg, 12.6 ± 0.1% with 66.4 ± 0.6% achieving ≥10% weight loss at 6 mo (N = 11,805); and 11.5 ± 0.2 kg, 12.0 ± 0.2% with 57.6 ± 0.9% achieving ≥10% weight loss at 12 mo (N = 8514). LOCF estimates were -6.5 ± 0.03 kg, -7.2 ± 0.03% with 27.1 ± 0.3% achieving ≥10% weight loss at 3 mo; -7.7 ± 0.04 kg, -8.5 ± 0.04% with 36.3 ± 0.3% achieving ≥10% weight loss at 6 mo; and -7.7 ± 0.1 kg, -8.4 ± 0.1% with 34.6 ± 0.3% achieving ≥10% weight loss after 12 mo. Frequent health coach meetings was a major determinant of weight loss, with women and men attending ≥75% of their weekly appointments losing 8.8 ± 0.04 and 11.9 ± 0.1 kg, respectively, after 3 mo, 13.1 ± 0.1 and 16.5 ± 0.3 kg after 6 mo, and 16.5 ± 0.3 and 19.4 ± 0.8 kg after 12 mo. Phentermine and phendimetrazine had a minor effect in women only at 1 (6.1% greater weight loss than untreated), 2 (4.1%), and 3 mo (1.2%), but treated patients showed longer enrollment than nontreated during the first 3 (females: +0.4 ± 0.01; males: +0.3 ± 0.04 mo), 6 (females: +1.1 ± 0.04; males: +1.0 ± 0.1 mo), and 12 mo (females: +2.7 ± 0.1; males: +2.4 ± 0.2 mo). JumpstartMD produced generally greater weight loss than published reports for other real-food and prepackaged-meal commercial programs and somewhat greater or comparable losses to meal replacement diets.

CONCLUSION

A one-on-one medically supervised program that emphasized real low-carbohydrate foods produced effective weight loss, particularly in those attending ≥75% of their weekly appointments.

Antiobesity Medication Use in 2.2 Million Adults Across Eight Large Health Care Organizations: 2009-2015

OBJECTIVE

The aim of this study was to examine the prescribing patterns and use of antiobesity medications in a large cohort of patients using data from electronic health records.

METHODS

Pharmacy- and patient-level electronic health record data were obtained on 2,248,407 adults eligible for weight-loss medications from eight geographically dispersed health care organizations.

RESULTS

A total of 29,964 patients (1.3% of total cohort) filled at least one weight-loss medication prescription. This cohort was 82.3% female, with median age 44.9 years and median BMI 37.2 kg/m2 . Phentermine accounted for 76.6% of all prescriptions, with 51.7% of prescriptions being filled for ≥ 120 days and 33.8% filled for ≥ 360 days. There was an increase of 32.9% in medication days for all medications in 2015 compared with 2009. Higher prescription rates were observed in women, black patients, and patients in higher BMI classes. Of 3,919 providers who wrote at least one filled prescription, 23.8% (n = 863) were "frequent prescribers" who wrote 89.6% of all filled prescriptions.

CONCLUSIONS

Weight-loss medications are rarely prescribed to eligible patients. Phentermine accounted for > 75% of all medication days, with a majority of patients filling it for more than 4 months. Less than one-quarter of prescribing providers accounted for approximately 90% of all prescriptions.

Trends in Self-perceived Weight Status, Weight Loss Attempts, and Weight Loss Strategies Among Adults in the United States, 1999-2016

IMPORTANCE

The self-perception of weight and weight loss attempts might promote weight loss and maintenance.

OBJECTIVE

To examine trends in current measured body mass index (BMI) and weight, self-reported weight, self-perceived weight status, weight loss attempts, and weight loss strategies among adults in the United States.

DESIGN, SETTING, AND PARTICIPANTS

This national cross-sectional study used data from continuous National Health and Nutrition Examination Survey (NHANES) data sets (1999-2000 to 2015-2016). Participants were US residents older than 20 years. Data were analyzed from January 2018 to December 2018.

MAIN OUTCOMES AND MEASURES

Current measured BMI and weight, self-reported weight, self-perceived weight status, weight loss attempts, and applied weight loss strategies. Adjusted, self-reported, prior-year weight was calculated using correction equations that considered age, sex, race/ethnicity, and quartile of self-reported prior-year weight.

RESULTS

Data were collected from 48 026 participants (19 792 [41.2%] aged 40-64 years; 24 255 [50.5%] women; 21 725 [45.2%] white) through 9 surveys from 1999-2000 to 2015-2016. Increasing trends were observed in current measured BMI (difference, 1.20; 95% CI, 0.92-1.47; P for trend < .001), current measured weight (difference 2.77 kg; 95% CI, 1.92-3.61 kg; P for trend < .001), adjusted, self-reported, prior-year weight (difference, 2.36 kg; 95% CI, 1.52-3.21 kg; P for trend < .001), and the difference between measured and adjusted self-reported weight (difference 0.70 kg; 95% CI, 0.34-1.07 kg; P for trend < .001). During this period, the proportion of overall participants who had attempted to lose weight increased from 34.3% to 42.2% (difference, 8.0%; 95% CI, 4.1%-10.5%; P for trend < .001). The most commonly reported weight loss strategies with the most rapidly increasing prevalence during the study period were reduced food consumption (21.2%-31.9%; difference, 11.1%; 95% CI, 8.2%-13.3%; P for trend < .001), exercise (18.2%-31.5%; difference, 14.4%; 95% CI, 11.3%-16.9%; P for trend < .001), and frequent water intake (0.2%-26.3%; difference, 26.2%; 95% CI, 24.1%-29.0%; P for trend < .001). Between 2005-2006 and 2015-2016, increases were also observed for the reported consumption of more fruits, vegetables, and salads (0.1%-29.4%; difference, 30.3%; 95% CI, 28.1%-31.2%; P for trend < .001), changing eating habits (0.3%-20.5%; difference, 20.2%; 95% CI, 19.1%-22.3%; P for trend < .001), and the consumption of less sugar, candy, and sweets (0.2%-20.9%; difference, 21.7%; 95% CI, 19.3%-22.6%; P for trend < .001).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, our data indicated an increasing trend in the proportion of participants who attempted to lose weight and a parallel increasing trend in current measured BMI and weight among adults in the United States.

Commitment Lotteries Promote Physical Activity Among Overweight Adults-A Cluster Randomized Trial

Background

The World Health Organization has identified physical inactivity as the fourth leading risk factor for global mortality. People often intend to engage in physical activity on a regular basis, but have trouble doing so. To realize their health goals, people can voluntarily accept deadlines with consequences that restrict undesired future behaviors (i.e., commitment devices).

Purpose

We examined if lottery-based deadlines that leverage regret aversion would help overweight individuals in attaining their goal of attending their gym twice per week. At each deadline a lottery winner was drawn from all participants. The winners were only eligible for their prize if they attained their gym-attendance goals. Importantly, nonattending lottery winners were informed about their forgone prize. The promise of this counterfactual feedback was designed to evoke anticipated regret and emphasize the deadlines.

Methods

Six corporate gyms with a total of 163 overweight participants were randomized to one of three arms. We compared (i) weekly short-term lotteries for 13 weeks; (ii) the same short-term lotteries in combination with an additional long-term lottery after 26 weeks; and (iii) a control arm without lotteries.

Results

After 13 weeks, participants in the lottery arms attained their attendance goals more often than participants in the control arm. After 26 weeks, we observe a decline in goal attainment in the short-term lottery arm and the highest goal attainment in the long-term lottery arm.

Conclusions

With novel applications, the current research adds to a growing body of research that demonstrates the effectiveness of commitment devices in closing the gap between health goals and behavior.

Clinical Trial information

This trial is registered in the Dutch Trial Register. Identifier: NTR5559

Cognitive Restraint and History of Dieting Are Negatively Associated with Organic Food Consumption in a Large Population-Based Sample of Organic Food Consumers

Organic food consumption has risen in many countries during the past decades, but individual motives leading to these choices remain unclear. This study aimed to evaluate the associations between cognitive restraint (CR), history of dieting and organic food intake. This cross-sectional analysis included 20,085 organic food consumers from the NutriNet-Santé cohort. CR (range score 1-4) was evaluated by the Three-Factor-Eating-Questionnaire and practice of dieting (never vs. past/current) was assessed by an ad hoc questionnaire. Frequencies of organic food intake overall and in 16 food groups were assessed by the Organic Food Frequency Questionnaire. Linear regression and analysis of covariance (ANCOVA) were performed to investigate the association between CR score, history of dieting and contribution of organic food intake to the total food intake. A lower overall contribution of organic options in the diet was observed in women with higher levels of CR (β = -3.61%, 95% CI: -4.32; -2.91 for 1 point of CR, p < 0.001) and with a history of dieting (31.1 ± 0.4% in past/current vs. 32.6 ± 0.3% in never dieters; p = 0.001). Consistent associations were observed in men with a history of dieting (26.4 ± 0.8% in past/current vs. 28.7 ± 0.4% in never dieters; p = 0.012). Overall, individuals-in particular women-with higher CR scores or with a history of dieting selected fewer organic food options. Our findings illustrate the complexity of potentially concurrent motives to food choices, in a context of increasing interest in organic food consumption.

Fiber Intake Predicts Weight Loss and Dietary Adherence in Adults Consuming Calorie-Restricted Diets: The POUNDS Lost (Preventing Overweight Using Novel Dietary Strategies) Study

BACKGROUND

The effects of dietary composition on weight loss are incompletely understood. In addition to energy intake, fiber intake, energy density, macronutrient composition, and demographic characteristics have all been suggested to contribute to weight loss.

OBJECTIVE

The primary aim of this analysis was to assess the role of dietary fiber as a predictor of weight loss in participants who consumed calorie-restricted diets (-750 kcal/d from estimated energy needs) for 6 mo, using data from the POUNDS Lost (Preventing Overweight Using Novel Dietary Strategies) Study-a randomized trial that examined the effects of calorie-restricted diets varying in macronutrient composition on weight loss in adults.

METHODS

Data were randomly partitioned to a training data set (70%) in which the effects of fiber and other weight-loss predictors were identified using adjusted Least Absolute Shrinkage and Selection Operator and model averaging. The retained predictors were then fit on the testing data set to assess predictive performance.

RESULTS

Three hundred and forty-five participants (53.9% female) provided dietary records at baseline and 6 mo. Mean ± SD age and BMI for the full sample was 52.5 ± 8.7 y and 32.6 ± 3.9 kg/m2, respectively. Mean ± SD (99% CI) weight change at 6 mo for the full sample was -7.27 ± 5.6 kg (-8.05, -6.48 kg). The final, best fit model (R2 = 0.41) included fiber, energy density, fat, age, adherence, baseline weight, race, and changes from baseline in carbohydrate, fiber, PUFA, and MUFA intake, but the most influential predictor was fiber intake ($\hat{\beta }$ = -0.37; P < 0.0001). In addition, fiber was strongly associated with adherence to the macronutrient prescriptions (P < 0.0001). Interactions between race and adherence, age, baseline weight, carbohydrate, energy density, and MUFAs were also retained in the final model.

CONCLUSION

Dietary fiber intake, independently of macronutrient and caloric intake, promotes weight loss and dietary adherence in adults with overweight or obesity consuming a calorie-restricted diet. This trial was registered at clinicaltrials.gov as NCT00072995.

Nutrition and physical activity counselling by general practitioners in Lithuania, 2000-2014

BACKGROUND

Primary health care plays a crucial role in providing recommendations on a healthy diet and physical activity to assist patients in weight management. The study aimed to evaluate health behaviour counselling provided by general practitioners (GPs) for adults with overweight and obesity in Lithuania between 2000 and 2014.

METHODS

Eight biennial postal surveys to independent nationally representative random samples of Lithuanians aged 20-64 were conducted. Response rates varied from 41.1 to 74%, with a decreasing trend over time. The data of 5867 participants who visited a GP at least once during the last year and had BMI of ≥25.0 kg/m² were analysed. Respondents were asked about GP advice on nutrition and physical activity and changes in their health behaviour during the last year.

RESULTS

The proportion of persons with overweight who reported GP advice on nutrition increased from 23.6% in 2000 to 37.5% in 2010 and advice on physical activity from 11.9 to 17.2% respectively; however, later both proportions decreased slightly. The likelihood of reporting was higher in respondents with higher BMI, more chronic conditions and frequent contact with a GP. Respondents who were living in cities, older and highly educated women were all more likely to report being advised on physical activity. Men and women who received advice from a GP more often reported changes in health behaviour as compared with non-advised individuals.

CONCLUSIONS

Despite increasing trends, the rate of GP advice on nutrition and physical activity reported by patients with overweight and obesity remains low in Lithuania. GP advice appears to have a significant impact on attempts by patients to change behaviour related to weight control. Therefore, there is an obvious need to make additional efforts to increase the frequency of GP counselling and to identify and address barriers to advising patients with overweight.

Effects of Bariatric Surgery on Cardiovascular Disease: A Concise Update of Recent Advances

Patients with obesity often have multiple cardiovascular comorbidities as obesity is an established risk factor for various cardiovascular diseases (CVDs)—e. g., heart failure (HF), coronary artery disease (CAD), hypertension, dysrhythmia, and venous thromboembolism. In the United States, obesity is the nationwide public health issue of the day with the prevalence exceeding 30%. It has become a substantial health and financial burden to the society and national healthcare system; the direct cost accounted for 150 billion US dollars in 2014. Lifestyle interventions have been shown to be successful in the short term, however their long-term results are still equivocal likely due to modest weight reduction and high recurrence rates. For instance, the mean weight reduction in a randomized controlled trial of patients with type 2 diabetes mellitus (DM) and either overweight or obesity was 6.0% in the intensive lifestyle modification arm and 3.5% in the control arm. On the contrary, bariatric surgery is known to be the most effective in achieving substantial and long-term weight loss and can prevent the development of CVD risk factors such as DM, hypertension, and dyslipidemia. Bariatric surgery induces prompt weight loss within a few months which lasts for at least 12–18 months, with mean weight loss of ~35% (~70% loss of excess weight), lowering the risk of all-cause mortality, myocardial infarction, and stroke. Furthermore, recent studies demonstrated that bariatric surgery contributed to the reduction of acute care use for HF, CAD, and hypertension. On the other hand, it was reported that bariatric surgery may worsen the control of certain types of CVD (e.g., dysrhythmia), especially in the early postoperative period. Additionally, the notion that being overweight or obese could contribute to higher survival rate in certain populations (e.g., patients with HF)—also known as “obesity paradox”—has been repetitively documented in the past, while most recent investigations suggested that the observed paradox may be attributable to confounding factors including pre-existing comorbidities. Considering the aforementioned advances in the field, this paper reviews a series of recent studies with regard to the short-term and long-term effects of bariatric surgery on various types of CVDs.

The HealtheSteps™ lifestyle prescription program to improve physical activity and modifiable risk factors for chronic disease: a pragmatic randomized controlled trial

BACKGROUND

Our objective was to determine the influence of the HealtheSteps™ lifestyle prescription program on physical activity and modifiable risk factors for chronic disease in individuals at risk.

METHODS

One hundred eighteen participants were recruited from 5 sites in Southwestern Ontario, Canada and randomized to either the intervention (HealtheSteps™ program, n = 59) or a wait-list control group (n = 59). The study comprised three phases: an Active Phase (0 to 6 months) consisted of bi-monthly in-person lifestyle coaching with access to a suite of eHealth technology supports (Heathesteps app, telephone coaching and a private HealtheSteps™ social network) followed by a Minimally-Supported Phase I (6 to 12 months), in which in-person coaching was removed, but participants still had access to the full suite of eHealth technology supports. In the final stage, Minimally-Supported Phase II (12 to 18 months), access to the eHealth technology supports was restricted to the HealtheSteps™ app. Assessments were conducted at baseline, 6, 12 and 18 months. The study primary outcome was the 6-month change in average number of steps per day. Secondary outcomes included: self-reported physical activity and sedentary time; self-reported eating habits; weight and body composition measures; blood pressure and health-related quality of life. Data from all participants were analyzed using an intent-to-treat approach. We applied mixed effects models for repeated measurements and adjusted for age, sex, and site in the statistical analyses.

RESULTS

Participants in HealtheSteps™ increased step counts (between-group [95% confidence interval]: 3132 [1969 to 4294], p < 0.001), decreased their sitting time (- 0.08 [- 0.16 to - 0.006], p = 0.03), and improved their overall healthful eating (- 1.5 [- 2.42 to - 0.58], p = 0.002) to a greater extent compared to control at 6 months. Furthermore, exploratory results showed that these individuals maintained these outcomes 12 months later, after a minimally-supported phase; and retained improvements in sedentary time and improved healthful eating after 18 months. No differences in self-reported physical activity, health-related quality of life, weight, waist circumference or blood pressure were observed between groups at 6 months.

CONCLUSIONS

Our findings suggest that HealtheSteps™ is effective at increasing physical activity (i.e., step counts per day), decreasing weekday sitting time, and improving healthful eating in adults at increased risk for chronic disease after 6 months; however, we did not see change in other risk factors. Nonetheless, the maintenance of these behaviours with minimal support after 12 and even 18 months indicates the promise of HealtheSteps™ for long-term sustainability.

TRIAL REGISTRATION

The trial was registered on April 6, 2015 with ClinicalTrials.gov (identifier: NCT02413385 ).

Achievement of Guideline-Recommended Weight Loss Among Patients With Ischemic Stroke and Obesity

Background and Purpose- The proportion of patients with acute ischemic stroke or transient ischemic attack (TIA) and obesity who successfully achieve goals for weight reduction recommended by major professional organizations is unknown. Methods- We examined the experience of participants in the placebo group of the IRIS trial (Insulin Resistance Intervention after Stroke) with a body mass index ≥30 kg/m2 at entry. Patients were of age ≥40 years, with a qualifying stroke or TIA within 180 days of randomization and documented insulin resistance without diabetes mellitus. Weights at baseline and at years 1 and 2 after entry were analyzed to determine the proportion of patients achieving a 5% weight loss and achievement of body mass index <27 kg/m2. Results- Of 1937 subjects assigned to placebo, 855 (44%) had obesity at entry. Median age of these 855 subjects was 60 years (interquartile range, 53-68), 41% were women, and median time from stroke/TIA to trial entry was 79 days. Among 788 subjects in the trial at 1 year, 166 (21%) had lost at least 5% of their starting weight and 12 (2%) had achieved a body mass index <27 kg/m2. One hundred nine (14%) participants gained at least 5% of their baseline weight at 1 year. Among 744 subjects in the trial at 2 years, 185 (25%) had lost at least 5% of their baseline weight and 23 (3%) had achieved a body mass index <27 kg/m2. One hundred forty (19%) participants gained at least 5% of their starting weight at 2 years. Conclusions- Only one quarter of obese patients with a recent ischemic stroke or TIA lost a clinically significant amount of weight after their vascular event. Many patients gained weight. Enhancing weight loss after ischemic stroke or TIA may help improve functional outcome and reduce risk for future vascular events, but clinical trials are needed to test and confirm these potential benefits.

Self-Reported Body Weight Changes, Perceptions, and Weight Loss Techniques among Stroke Survivors

BACKGROUND

Little is known about the body weight goals and trends of stroke survivors, despite evidence that overweight and obesity can negatively influence poststroke rehabilitation outcomes. Thus, the purpose of this study was to identify self-reported body weight trends over time in stroke survivors and nonstroke controls (>50 years old) and describe the methods used to attempt to achieve body weight goals.

METHODS

Self-reported body weight 1) at age 25 years, 2) 10 years prior to the current assessment, 3) 1 year prior to the current assessment, 4) current weight, and 5) age of heaviest body weight were collected from adults self-reporting a stroke in the 2011-2012 and 2013-2014 National Health and Nutrition Examination Surveys (stroke: N = 387 and nonstroke: N = 5085). Questionnaires were used to assess body weight goals and weight loss techniques during the previous year.

RESULTS

Of the stroke survivors, 54% reported that their heaviest weight occurred after their stroke. Approximately 70% of stroke and nonstroke were overweight or obese. Only 24% of stroke survivors reported trying to lose weight compared with 35% of nonstroke, with only 10%-15% successful (≥5% body weight loss), during the past year. Popular weight loss methods in both groups included eating less, exercising, and eating more fruits/vegetables. The majority of stroke survivors report their heaviest weight after their stroke and a desire to weigh less; however, few report successful weight loss.

CONCLUSIONS

Future research is needed to identify optimal body weight and ways to incorporate preferred methods of lifestyle modification, including diet and exercise, to promote weight management in stroke survivors.

Weight loss facilitates reduction of left ventricular mass in obese hypertensive patients: The Campania Salute Network

BACKGROUND AND AIMS

Reduction of left ventricular mass index (LVMi) during antihypertensive treatment is less likely to occur in obese subjects. The aim of the study was to assess whether weight loss influences reduction of LVMi in treated, obese, hypertensive patients.

METHODS AND RESULTS

From the Campania Salute Network registry, we identified 1546 obese hypertensive patients (50 ± 9 years, 43% women) with more than 12 months follow-up. Echocardiographic reduction of LVMi was considered as achievement of normal values (<47 g/m^2.7 in women or <50 g/m^2.7 in men) or a reduction of ≥10% during follow-up. Weight loss was considered as ≥5% reduction in body weight, and occurred in 403 patients (26%) during a median follow-up of 50 months (IQrange:31-93). Median weight loss was 8.6% (IQrange:6.5-12). Patients with weight loss had higher baseline body mass index (p < 0.05), while there was no difference in age, sex, duration of hypertension, prevalence of diabetes, metabolic syndrome and average blood pressure during follow-up. During follow-up, 152 patients (9.8%) exhibited reduction of LVMi. Reduction of LVMi was more frequent (12.9% vs 9.1%, p < 0.030) in patients losing weight than in those who did not. In logistic regression analysis, weight loss was associated with reduction of left ventricular mass index (OR 1.51 [95%CI 1.02-2.23], p = 0.039), independent of significant associations with younger age, lower average systolic blood pressure during follow-up, longer follow-up time and higher LVMi at baseline.

CONCLUSION

In treated obese hypertensive patients, weight loss during follow-up promotes significant reduction of LVMi, independent of baseline characteristics and blood pressure control.

Precision Medicine in Weight Loss and Healthy Living

Obesity affects 600 million people globally and over one third of the American population. Along with associated comorbidities, including cardiovascular disease, stroke, diabetes, and cancer; the direct and indirect costs of managing obesity are 21% of the total medical costs. These factors shed light on why developing effective and pragmatic strategies to reduce body weight in obese individuals is a major public health concern. An estimated 60-70% of obese Americans attempt to lose weight each year, with only a small minority able to achieve and maintain long term weight loss. To address this issue a precision medicine approach for weight loss has been considered, which places an emphasis on sustainability and real-world application to individualized therapy. In this article we review weight loss interventions in the context of precision medicine and discuss the role of genetic and epigenetic factors, pharmacological interventions, lifestyle interventions, and bariatric surgery on weight loss.

Body-weight goals, trends, and weight-loss techniques among patients with peripheral arterial disease

BACKGROUND:

Obesity contributes to negative outcomes in peripheral arterial disease (PAD). Little is known about the body-weight goals and trends among patients with PAD.

AIM:

The aim of this study was to explore self-reported body-weight trends and methods used to achieve weight loss in patients with PAD.

METHODS:

Data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) was utilized to compare individuals with PAD who were overweight and obese ( n = 240), to matched individuals without PAD ( n = 480). Self-reported body weight at age 25 years, 10 years prior and 1 year prior to the current assessment, and age and weight of heaviest body weight were compared. Self-reported weight-loss techniques during the past year were compared between groups.

RESULTS:

Individuals with PAD and controls reported similar weights 10 years prior (79.2 kg vs 78.5 kg; p = 0.60) and weight gain over the last 10 years of 5.7 kg. There was no significant difference in reported body weight at age 25 years, 10 years prior, 1 year prior, or heaviest weight. Compared with the control group, fewer participants with PAD reported attempted weight loss in the last year (27.50% vs 36.04%; p = 0.02) and were half as likely to report utilizing exercise as a weight-loss method (12.5% vs 21.7%; p = 0.003).

CONCLUSIONS:

These data indicate that those with PAD are less inclined to attempt weight loss, especially through means of increased physical activity. Future research is needed regarding the effectiveness of intentional weight-loss programs in this population.

Motivators, barriers and strategies of weight management: A cross-sectional study among Finnish adults

BACKGROUND

Weight management (WM) is an ongoing global challenge. The purpose of this study was to analyze motivators, barriers, and strategies of WM among Finnish adults.

METHODS

Data were collected in the 'KULUMA' (Consumers at the Weight Management Market) project among 667 community-dwelling adults in Eastern and Central Finland (Kuopio and Jyväskylä). The self-reported questionnaire collected background information and responses to motivators, barriers, and strategy items. Principal component analysis (PCA) was used to extract components of motivators, barriers, and strategies of WM, along with K-means clustering to categorize the participants.

RESULTS

About 55% of the respondents were aiming to lose weight. The PCA resulted in a 3-component model for motivators (functional aspects, sociological aspects, and psychosocial aspects), a 4-component model for barriers (life situations, food environment, personal issues, and resources) and a 2-component model for the strategies of WM (dietary strategies and life-management strategies). The components had several relationships with demographic characteristics (especially with age) but only a few with weight-related characteristics (e.g. weight loss attempts). Three clusters of participants were formed: Struggling weight managers (WMs), Independent WMs, and Determined WMs. Barriers to WM had a key role in differentiating clusters and weight satisfaction. Determined WMs were the most satisfied with their weight, whereas Struggling WMs perceived the highest level of barriers to WM.

CONCLUSIONS

WM efforts are common among Finnish adults. Generally, weight-related activities and communication in society should focus more on barriers than merely on the motivation or strategies of WM in order to support individuals' WM efforts.

Long-Term Weight Loss and Metabolic Health in Adults Concerned With Maintaining or Losing Weight: Findings From NHANES

More than two-thirds of American adults are overweight or obese, with many attempting to lose weight to avoid adverse health outcomes and improve well-being. Achieving long-term weight loss (LTWL) success, defined as reaching at least a 5% to 10% weight loss goal, is challenging, yet important for overall metabolic health. It is currently unclear whether achieving higher thresholds of LTWL is associated with improved health. Therefore, the purpose of this study was to examine the association between LTWL thresholds (5%-9.9%, 10%-14.9%, 15%-19.9%, ≥20%) and metabolic health (metabolic syndrome and metabolic risk z score) among 7670 US adult respondents to the National Health and Nutrition Examination Survey (2007-2014) who were overweight or obese (past or present), were not underweight in the past year, not pregnant, and attempting to lose or maintain weight. A subsample of 3362 participants was used in the analysis of the metabolic risk z score. Multivariable regression models were constructed adjusting for covariates. Results indicate that the lowest and the 2 highest LTWL thresholds were related to lower odds for metabolic syndrome; for example, greater than or equal to 20% LTWL (odds ratio=0.52; 95% CI, 0.23-0.44; P<.001). All LTWL thresholds were significantly associated with the metabolic risk z score, with the largest effect among the 2 highest LTWL thresholds, that is, 15% to 19.9% LTWL (β=-0.45; 95% CI, -0.54 to -0.36; P<.001) and greater than or equal to 20% LTWL (β=-0.35; 95% CI, -0.53 to -0.17; P<.001). In conclusion, although achieving the currently recommended LTWL target was related to improved metabolic health, the 15% LTWL threshold was associated with more favorable outcomes.

Characterizing Self-Monitoring Behavior and Its Association With Physical Activity and Weight Loss Maintenance

Introduction: Reviewing gaps in self-monitoring during weight loss interventions may help identify individuals demonstrating signs of disengagement in behaviors, including moderate to vigorous physical activity (MVPA), associated with weight loss maintenance. This study examined the associations of different aspects of self-monitoring during a weight loss intervention with 24-month MVPA and weight. Methods: Secondary data analysis from the Tracking Study, a trial comparing weight-tracking frequency during a lifestyle weight loss program, was conducted. Self-monitoring logs from n =339 participants were used to define 4 characteristics and 4 specific gap lengths: short (1-4 weeks), medium (5-8 weeks), long (9-12 weeks), and extra long (>12 weeks). Self-reported MVPA and staff-measured weight were measured at baseline, 6, 12, 18, and 24 months. Generalized estimating equation modeling examined the association between self-monitoring characteristics and reported MVPA and weight. Results: Participants with gaps in self-monitoring as early as the second week of the intervention reported less MVPA and weighed more at 24 months. Furthermore, consistent tracking of MVPA was associated with higher reported MVPA and lower weight. Conclusions: Behavior tracking provides important information about behavioral disengagement early in the intervention process. Future work should test intervention augmentations to improve behavior change when disengagement is detected.

Perceived barriers and facilitators of initiation of behavioral weight loss interventions among adults with obesity: a qualitative study

Background

Evidence-based behavioral weight loss interventions are under-utilized. To inform efforts to increase uptake of these interventions, it is important to understand the perspectives of adults with obesity regarding barriers and facilitators of weight loss intervention initiation.

Methods

We conducted a qualitative study in adults with obesity who had recently attempted weight loss either with assistance from an evidence-based behavioral intervention (intervention initiators) or without use of a formal intervention (intervention non-initiators). We recruited primary care patients, members of a commercial weight loss program, and members of a Veterans Affairs weight loss program. Intervention initiators and non-initiators were interviewed separately using a semi-structured interview guide that asked participants about barriers and facilitators of weight loss intervention initiation. Conversations were audio-recorded and transcribed. Data were analyzed with qualitative content analysis. Two researchers used open coding to generate the code book on a subset of transcripts and a single researcher coded remaining transcripts. Codes were combined into subthemes, which were combined in to higher order themes. Intervention initiators and non-initiators were compared.

Results

We conducted three focus groups with participants who had initiated interventions (n = 26) and three focus groups (n = 24) and 8 individual interviews with participants who had not initiated interventions. Intervention initiators and non-initiators were, respectively, 65% and 37.5% white, 62% and 63% female, mean age of 55 and 54 years old, and mean BMI of 34 kg/m². Three themes were identified. One theme was practical factors, with subthemes of reasonable cost and scheduling compatibility. A second theme was anticipated effectiveness of intervention, with subthemes of intervention content addressing individual needs; social aspects influencing effectiveness; and evaluating evidence of effectiveness. A third theme was anticipated pleasantness of intervention, with subthemes of social aspects influencing enjoyment; anticipated dietary and tracking prescriptions; and identity and self-reliance factors. Different perspectives were identified from intervention initiators and non-initiators.

Conclusions

Strategies to engage individuals in evidence-based weight loss interventions can be developed using these results. Strategies could target individuals’ perceived barriers and benefits to initiating interventions, or could focus on refining interventions to appeal to more individuals.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5795-9) contains supplementary material, which is available to authorized users.

​Depressive symptoms and weight loss behaviors in U.S. adults

OBJECTIVE

We sought to determine whether depressive symptoms are associated with attempting to lose weight and engaging in weight loss behaviors in a large, diverse sample of adults representative of the U.S.

METHODS

Respondents were 23,106 adults, free of cardiovascular disease and diabetes, who participated in the 2005-2014 years of the National Health and Nutrition Examination Survey (NHANES). Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), and weight loss variables were obtained from a Weight History Questionnaire.

RESULTS

PHQ-9 total was not associated with attempting to lose weight in the past year (OR = 1.03, 95%CI = 1.00-1.06, p = 0.074; n = 23,106). Among respondents who attempted to lose weight (n = 9582), PHQ-9 total was associated with a lower odds of exercising (OR = 0.84, 95%CI = 0.79-0.89, p < 0.001) and a greater odds of skipping meals (OR = 1.31, 95%CI = 1.22-1.41, p < 0.001), eating diet foods/products (OR = 1.16, 95%CI = 1.08-1.24, p < 0.001), eating less food (OR = 1.09, 95%CI = 1.04-1.15, p < 0.001), taking non-prescription supplements (OR = 1.31, 95%CI = 1.23-1.41, p < 0.001), taking prescription diet pills (OR = 1.28, 95%CI = 1.10-1.49, p = 0.001), and taking laxatives/vomiting (OR = 1.55, 95%CI = 1.28-1.88, p < 0.001).

CONCLUSIONS

Although depressive symptoms were not associated with attempting to lose weight in the past year, adults who attempted to lose weight tended to employ potentially ineffective/unhealthy weight loss behaviors and avoid effective behaviors. This pattern of behaviors may be another mechanism that explains the excess risk of obesity in depressed adults and may be a modifiable target for future interventions. Given the cross-sectional nature of this study, reverse causality is a possibility. Future studies should investigate the prospective associations between depressive symptoms and weight loss behaviors.

Pharmacotherapy for Patients with Obesity

BACKGROUND

Although pharmacotherapy is not the cornerstone of obesity treatment, it is a valuable tool that could be considered for patients who have not had adequate benefit from lifestyle interventions or who have difficulty maintaining initial weight loss over longer periods.

CONTENT

This review focuses on the role of antiobesity drugs, the mechanisms by which the drugs work, potential pharmacological targets in the neural control of food intake and regulation of body weight, the history of antiobesity drugs, a summary of efficacy and safety data from clinical trials, and the clinical application of pharmacotherapy. Currently, 5 approved drug therapies are available in the US for long-term weight management, with only 2 of these meeting the stronger Food and Drug Administration (FDA) criteria of 5% weight loss relative to a placebo after 1 year and others receiving approval based on the categorical criterion of the proportions of patients achieving 5% weight loss. Interpretation of the results of clinical trials conducted before regulatory agency approval is limited by high dropout rates; thus, the results might not be replicable in clinical practice settings. Many patients who are suitable candidates for pharmacotherapy are not using the new drugs due to lack of insurance coverage and high out-of-pocket costs.

SUMMARY

With the availability of 4 new drugs since 2012, clinicians in the US now have more tools for long-term weight management. The quality of pharmacotherapy clinical investigations needs considerable improvement. Future research should focus on examining the mediators and moderators of response.

Patient factors associated with initiation of behavioral weight loss treatment: a prospective observational study in an integrated care setting

Low enrollment in behavioral weight loss treatments limits their impact. We aimed to identify factors associated with treatment initiation. The participants were outpatients (n = 198) at Veterans Affairs (VA) healthcare facilities who were referred to a free VA-based behavioral weight loss treatment. Participants were assessed on psychosocial factors potentially relevant to treatment initiation. Subsequent treatment initiation was determined via medical record review. Study participants were 77 % male, 60 % African American, and 54 % initiated treatment. In multivariable analyses, treatment initiation was associated with being single, higher anxiety, and patients' perceptions that referring provider supported their weight autonomy. Endorsement of treatment barriers was not associated with treatment initiation. Treatments offering in-person sessions and mood management components were rated as more preferred. Initiation of behavioral weight loss treatments may increase if patients believe that providers respect their weight control autonomy and if healthcare organizations offer treatments that match patients' preferences.