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Background: New obesity medications result in large weight losses. However, long-term adherence in a real-world setting is challenging, and termination of obesity medication results in weight regain towards pre-treatment body weight. Therefore, we investigated whether weight loss and improved body composition are sustained better at 1 year after termination of active treatment with glucagon-like peptide-1 (GLP-1) receptor agonist, supervised exercise program, or both combined for 1 year. Methods: We conducted a post-treatment study in extension of a randomised, controlled trial in Copenhagen. Adults with obesity (aged 18–65 years and initial body mass index 32–43 kg/m2) completed an eight-week low-calorie diet-induced weight loss of 13.1 kg (week −8 to 0) and were randomly allocated (1:1:1:1) to one-year weight loss maintenance (week 0–52) with either supervised exercise, the GLP-1 receptor agonist once-daily subcutaneous liraglutide 3.0 mg, the combination of exercise and liraglutide, or placebo. 166 Participants completed the weight loss maintenance phase. All randomised participants were invited to participate in the post-treatment study with outcome assessments one year after treatment termination, at week 104. The primary outcome of the post-treatment assessment was change in body weight from after the initial weight loss (at randomisation, week 0) to one year after treatment termination (week 104) in the intention-to-treat population. The secondary outcome was change in body-fat percentage (week 0–104). The study is registered with EudraCT, 2015-005585-32, and with ClinicalTrials.gov, NCT04122716. Findings: Between Dec 17, 2018, and Dec 17, 2020, 109 participants attended the post-treatment study. From randomisation to one year after termination of combined exercise and liraglutide treatment (week 0–104), participants had reduced body weight (−5.1 kg [95% CI −10.0; −0.2]; P = 0.040) and body-fat percentage (−2.3%-points [−4.3 to −0.3]; P = 0.026)

Objective The aim of this study was to compare self-reported total energy intake (TEI) collected using an online multiple-pass 24-h dietary recall tool (Intake24) with total energy expenditure (TEE) estimated from Fitbit Charge 2-improved algorithms in adults from the NoHoW trial (12-mo weight maintenance after free-living weight loss). Methods Bland–Altman plots were used to assess the level of agreement between TEI and TEE at baseline and after 12 mo. The ratio of TEI to TEE was also calculated. Results Data from 1323 participants (71% female) was included in the analysis (mean ± SD: age 45 ± 12 y, body mass index 29.7 ± 5.4 kg/m2, initial weight loss 11.5 ± 6.5 kg). The TEI was lower than TEE on average by 33%, with limits of agreement ranging from –91% to +25%. Men, younger individuals, those with higher body mass index, those with the greater weight loss before enrollment, and those who gained weight during the study underestimated to a greater extent. Conclusions These findings contribute to the ongoing research examining the validity of technology-based dietary assessment tools., Objective: The aim of this study was to compare self-reported total energy intake (TEI) collected using an online multiple-pass 24-h dietary recall tool (Intake24) with total energy expenditure (TEE) estimated from Fitbit Charge 2-improved algorithms in adults from the NoHoW trial (12-mo weight maintenance after free-living weight loss). Methods: Bland–Altman plots were used to assess the level of agreement between TEI and TEE at baseline and after 12 mo. The ratio of TEI to TEE was also calculated. Results: Data from 1323 participants (71% female) was included in the analysis (mean ± SD: age 45 ± 12 y, body mass index 29.7 ± 5.4 kg/m2, initial weight loss 11.5 ± 6.5 kg). The TEI was lower than TEE on average by 33%, with limits of agreement ranging from –91% to +25%. Men, younger individuals, those with higher body mass index, those with the greater weight loss before enrollment, and those who gained weight during the study underestimated to a greater extent. Conclusions: These findings contribute to the ongoing research examining the validity of technology-based dietary assessment tools.

Background: New obesity medications result in large weight losses. However, long-term adherence in a real-world setting is challenging, and termination of obesity medication results in weight regain towards pre-treatment body weight. Therefore, we investigated whether weight loss and improved body composition are sustained better at 1 year after termination of active treatment with glucagon-like peptide-1 (GLP-1) receptor agonist, supervised exercise program, or both combined for 1 year. Methods: We conducted a post-treatment study in extension of a randomised, controlled trial in Copenhagen. Adults with obesity (aged 18–65 years and initial body mass index 32–43 kg/m2) completed an eight-week low-calorie diet-induced weight loss of 13.1 kg (week −8 to 0) and were randomly allocated (1:1:1:1) to one-year weight loss maintenance (week 0–52) with either supervised exercise, the GLP-1 receptor agonist once-daily subcutaneous liraglutide 3.0 mg, the combination of exercise and liraglutide, or placebo. 166 Participants completed the weight loss maintenance phase. All randomised participants were invited to participate in the post-treatment study with outcome assessments one year after treatment termination, at week 104. The primary outcome of the post-treatment assessment was change in body weight from after the initial weight loss (at randomisation, week 0) to one year after treatment termination (week 104) in the intention-to-treat population. The secondary outcome was change in body-fat percentage (week 0–104). The study is registered with EudraCT, 2015-005585-32, and with ClinicalTrials.gov, NCT04122716. Findings: Between Dec 17, 2018, and Dec 17, 2020, 109 participants attended the post-treatment study. From randomisation to one year after termination of combined exercise and liraglutide treatment (week 0–104), participants had reduced body weight (−5.1 kg [95% CI −10.0; −0.2]; P = 0.040) and body-fat percentage (−2.3%-points [−4.3 to −0.3]; P = 0.026)

To date, few digital behavior change interventions for weight loss maintenance focusing on long-term physical activity promotion have used a sound intervention design grounded on a logic model underpinned by behavior change theories. The current study is a secondary analysis of the weight loss maintenance NoHoW trial and investigated putative mediators of device-measured long-term physical activity levels (six to 12 months) in the context of a digital intervention, Background: To date, few digital behavior change interventions for weight loss maintenance focusing on long-term physical activity promotion have used a sound intervention design grounded on a logic model underpinned by behavior change theories. The current study is a secondary analysis of the weight loss maintenance NoHoW trial and investigated putative mediators of device-measured long-term physical activity levels (six to 12 months) in the context of a digital intervention. Methods: A subsample of 766 participants (Age = 46.2 ± 11.4 years; 69.1% female; original NoHoW sample: 1627 participants) completed all questionnaires on motivational and self-regulatory variables and had all device-measured physical activity data available for zero, six and 12 months. We examined the direct and indirect effects of Virtual Care Climate on post intervention changes in moderate-to-vigorous physical activity and number of steps (six to 12 months) through changes in the theory-driven motivational and self-regulatory mechanisms of action during the intervention period (zero to six months), as conceptualized in the logic model. Results: Model 1 tested the mediation processes on Steps and presented a poor fit to the data. Model 2 tested mediation processes on moderate-to-vigorous physical activity and presented poor fit to the data. Simplified models were also tested considering the autonomous motivation and the controlled motivation variables independently. These changes yielded good results and both models presented very good fit to the data for both outcome variables. Percentage of explained variance was negligible for all models. No direct or indirect effects were found from Virtual Care Climate to long term change in outcomes. Indirect effects occurred only between the sequential paths of the theory-driven mediators. Conclusion: This was one of the first attempts to test a serial mediation model considering psychological mechanisms of change and device-measured physical acti

Background: The use of digital interventions can be accurately monitored via log files. However, monitoring engagement with intervention goals or enactment of the actual behaviors targeted by the intervention is more difficult and is usually evaluated based on pre-post measurements in a controlled trial. Objective: The objective of this paper is to evaluate if engaging with 2 digital intervention modules focusing on (1) physical activity goals and action plans and (2) coping with barriers has immediate effects on the actual physical activity behavior. Methods: The NoHoW Toolkit (TK), a digital intervention developed to support long-term weight loss maintenance, was evaluated in a 2 x 2 factorial randomized controlled trial. The TK contained various modules based on behavioral self-regulation and motivation theories, as well as contextual emotion regulation approaches, and involved continuous tracking of weight and physical activity through connected commercial devices (Fitbit Aria and Charge 2). Of the 4 trial arms, 2 had access to 2 modules directly targeting physical activity: a module for goal setting and action planning (Goal) and a module for identifying barriers and coping planning (Barriers). Module visits and completion were determined based on TK log files and time spent in the module web page. Seven physical activity metrics (steps; activity; energy expenditure; fairly active, very active and total active minutes; and distance) were compared before and after visiting and completing the modules to examine whether the modules had immediate or sustained effects on physical activity. Immediate effect was determined based on 7-day windows before and after the visit, and sustained effects were evaluated for 1 to 8 weeks after module completion. Results: Out of the 811 participants, 498 (61.4%) visited the Goal module and 406 (50.1%) visited the Barriers module. The Barriers module had an immediate effect on very active and total active minutes (very active mi

Aims/hypothesis: Lifestyle interventions are the first-line treatment option for body weight and cardiometabolic health management. However, whether age groups or women and men respond differently to lifestyle interventions is under debate. We aimed to examine age- and sex-specific effects of a low-energy diet (LED) followed by a long-term lifestyle intervention on body weight, body composition and cardiometabolic health markers in adults with prediabetes (i.e. impaired fasting glucose and/or impaired glucose tolerance).Methods: This observational study used longitudinal data from 2223 overweight participants with prediabetes in the multicentre diabetes prevention study PREVIEW. The participants underwent a LED-induced rapid weight loss (WL) period followed by a 3 year lifestyle-based weight maintenance (WM) intervention. Changes in outcomes of interest in prespecified age (younger: 25-45 years; middle-aged: 46-54 years; older: 55-70 years) or sex (women and men) groups were compared.Results: In total, 783 younger, 319 middle-aged and 1121 older adults and 1503 women and 720 men were included in the analysis. In the available case and complete case analyses, multivariable-adjusted linear mixed models showed that younger and older adults had similar weight loss after the LED, whereas older adults had greater sustained weight loss after the WM intervention (adjusted difference for older vs younger adults -1.25% [95% CI -1.92, -0.58], p<0.001). After the WM intervention, older adults lost more fat-free mass and bone mass and had smaller improvements in 2 h plasma glucose (adjusted difference for older vs younger adults 0.65 mmol/l [95% CI 0.50, 0.80], p<0.001) and systolic blood pressure (adjusted difference for older vs younger adults 2.57 mmHg [95% CI 1.37, 3.77], p<0.001) than younger adults. Older adults had smaller decreases in fasting and 2 h glucose, HbA1c and systolic blood pressure

Objective: The aim of our thesis was to test the protein leverage hypothesis in free-living individuals who achieved clinically significant weight loss (≥5%) in the previous 12-months. Methods: This thesis harnessed data from the Navigating to a Healthy Weight (NoHoW) project. The NoHoW trial is an 18-month, three-centre (Denmark, Portugal and United Kingdom), 2×2 factorial RCT with 4 arms. The groups were collapsed for the purposes of our analysis since there was not significant effect of the intervention. The strength of leverage for protein, carbohydrate, and fat with total energy intake (TEI) was tested using log-log regression models (power function). Compositional data analysis was conducted to test the effect of the three macronutrients (baseline) on TEI and 1-year change of BMI, fat mass percentage, and waist circumference. The dietary composition of protein (%E), carbohydrate (%E), and fat (%E) in relation to TEI and each weight-related outcomes were presented using the Geometric Framework approach, visualized through response surfaces, and analysed through mixture models (Scheffe's polynomials). Results: Data of 1003 participants was included in the analysis (mean ± SD: age 46 ± 11.6 years, BMI 29.3 ± 4.9 kg/m2, 71% woman). In the power function, TEI was inversely associated to protein intake (%E). The strength of leverage was the strongest for protein (L coefficient -0.46; P ≤0.001), less for fat (0.43; p≤0.001), and negligible for carbohydrate (-0.11, p=0.01). Similarly, in the compositional data analysis, protein intake was inversely associated with TEI. Furthermore, a lower protein intake (%E) at baseline predicted a greater gain (or less decrease) in BMI, fat mass percent, and waist circumference, over one year of follow-up. Conclusion: We found supportive evidence for protein leverage hypothesis in adults during a 1-year weight loss maintenance period.

Objective: The aim of our thesis was to test the protein leverage hypothesis in free-living individuals who achieved clinically significant weight loss (≥5%) in the previous 12-months. Methods: This thesis harnessed data from the Navigating to a Healthy Weight (NoHoW) project. The NoHoW trial is an 18-month, three-centre (Denmark, Portugal and United Kingdom), 2×2 factorial RCT with 4 arms. The groups were collapsed for the purposes of our analysis since there was not significant effect of the intervention. The strength of leverage for protein, carbohydrate, and fat with total energy intake (TEI) was tested using log-log regression models (power function). Compositional data analysis was conducted to test the effect of the three macronutrients (baseline) on TEI and 1-year change of BMI, fat mass percentage, and waist circumference. The dietary composition of protein (%E), carbohydrate (%E), and fat (%E) in relation to TEI and each weight-related outcomes were presented using the Geometric Framework approach, visualized through response surfaces, and analysed through mixture models (Scheffe's polynomials). Results: Data of 1003 participants was included in the analysis (mean ± SD: age 46 ± 11.6 years, BMI 29.3 ± 4.9 kg/m2, 71% woman). In the power function, TEI was inversely associated to protein intake (%E). The strength of leverage was the strongest for protein (L coefficient -0.46; P ≤0.001), less for fat (0.43; p≤0.001), and negligible for carbohydrate (-0.11, p=0.01). Similarly, in the compositional data analysis, protein intake was inversely associated with TEI. Furthermore, a lower protein intake (%E) at baseline predicted a greater gain (or less decrease) in BMI, fat mass percent, and waist circumference, over one year of follow-up. Conclusion: We found supportive evidence for protein leverage hypothesis in adults during a 1-year weight loss maintenance period.

Background: The use of digital interventions can be accurately monitored via log files. However, monitoring engagement with intervention goals or enactment of the actual behaviors targeted by the intervention is more difficult and is usually evaluated based on pre-post measurements in a controlled trial. Objective: The objective of this paper is to evaluate if engaging with 2 digital intervention modules focusing on (1) physical activity goals and action plans and (2) coping with barriers has immediate effects on the actual physical activity behavior. Methods: The NoHoW Toolkit (TK), a digital intervention developed to support long-term weight loss maintenance, was evaluated in a 2 x 2 factorial randomized controlled trial. The TK contained various modules based on behavioral self-regulation and motivation theories, as well as contextual emotion regulation approaches, and involved continuous tracking of weight and physical activity through connected commercial devices (Fitbit Aria and Charge 2). Of the 4 trial arms, 2 had access to 2 modules directly targeting physical activity: a module for goal setting and action planning (Goal) and a module for identifying barriers and coping planning (Barriers). Module visits and completion were determined based on TK log files and time spent in the module web page. Seven physical activity metrics (steps; activity; energy expenditure; fairly active, very active and total active minutes; and distance) were compared before and after visiting and completing the modules to examine whether the modules had immediate or sustained effects on physical activity. Immediate effect was determined based on 7-day windows before and after the visit, and sustained effects were evaluated for 1 to 8 weeks after module completion. Results: Out of the 811 participants, 498 (61.4%) visited the Goal module and 406 (50.1%) visited the Barriers module. The Barriers module had an immediate effect on very active and total active minutes (very active mi

Aims/hypothesis: Lifestyle interventions are the first-line treatment option for body weight and cardiometabolic health management. However, whether age groups or women and men respond differently to lifestyle interventions is under debate. We aimed to examine age- and sex-specific effects of a low-energy diet (LED) followed by a long-term lifestyle intervention on body weight, body composition and cardiometabolic health markers in adults with prediabetes (i.e. impaired fasting glucose and/or impaired glucose tolerance).Methods: This observational study used longitudinal data from 2223 overweight participants with prediabetes in the multicentre diabetes prevention study PREVIEW. The participants underwent a LED-induced rapid weight loss (WL) period followed by a 3 year lifestyle-based weight maintenance (WM) intervention. Changes in outcomes of interest in prespecified age (younger: 25-45 years; middle-aged: 46-54 years; older: 55-70 years) or sex (women and men) groups were compared.Results: In total, 783 younger, 319 middle-aged and 1121 older adults and 1503 women and 720 men were included in the analysis. In the available case and complete case analyses, multivariable-adjusted linear mixed models showed that younger and older adults had similar weight loss after the LED, whereas older adults had greater sustained weight loss after the WM intervention (adjusted difference for older vs younger adults -1.25% [95% CI -1.92, -0.58], p<0.001). After the WM intervention, older adults lost more fat-free mass and bone mass and had smaller improvements in 2 h plasma glucose (adjusted difference for older vs younger adults 0.65 mmol/l [95% CI 0.50, 0.80], p<0.001) and systolic blood pressure (adjusted difference for older vs younger adults 2.57 mmHg [95% CI 1.37, 3.77], p<0.001) than younger adults. Older adults had smaller decreases in fasting and 2 h glucose, HbA1c and systolic blood pressure

Time-restricted eating (TRE)1 has been conceptualised as a strategy for achieving weight loss and improving metabolic health, but limited knowledge exists about how people can maintain TRE in daily life. This study examined how TRE was maintainable in daily life after a three-month intervention (the RESET study) in which participants were encouraged to consume all food and beverages except water within a 10-h daily window. Specifically, we examined TRE maintenance patterns across participants, including drivers and challenges for maintenance success. A qualitative longitudinal study was conducted, and twenty participants with overweight at high risk of type 2 diabetes were interviewed using a semi-structured interview guide at the end of the intervention and after a three-month follow-up period. Data were analysed longitudinally in two steps inspired by a pattern-oriented longitudinal analysis approach. Seven participants maintained a strict 10-h window, ten maintained an adjusted TRE regimen (e.g., taking days off), and three did not attempt maintenance. Maintenance drivers included consistent daily rhythms and regular meal patterns, subjective experiences (e.g., feeling healthier), making flexible adjustments to the TRE regimen, family support and avoiding feelings of guilt. Maintenance challenges included social evening events, inconsistent daily rhythms and eating patterns, preoccupation with losing weight, lack of family support and self-blame. TRE was manageable for most participants; however, personalised support for adjusting TRE to daily life is needed to ensure long-term maintenance. Future studies should explore the effectiveness of a personalised TRE concept to determine the usefulness of TRE in real-life settings.

Time-restricted eating (TRE)1 has been conceptualised as a strategy for achieving weight loss and improving metabolic health, but limited knowledge exists about how people can maintain TRE in daily life. This study examined how TRE was maintainable in daily life after a three-month intervention (the RESET study) in which participants were encouraged to consume all food and beverages except water within a 10-h daily window. Specifically, we examined TRE maintenance patterns across participants, including drivers and challenges for maintenance success. A qualitative longitudinal study was conducted, and twenty participants with overweight at high risk of type 2 diabetes were interviewed using a semi-structured interview guide at the end of the intervention and after a three-month follow-up period. Data were analysed longitudinally in two steps inspired by a pattern-oriented longitudinal analysis approach. Seven participants maintained a strict 10-h window, ten maintained an adjusted TRE regimen (e.g., taking days off), and three did not attempt maintenance. Maintenance drivers included consistent daily rhythms and regular meal patterns, subjective experiences (e.g., feeling healthier), making flexible adjustments to the TRE regimen, family support and avoiding feelings of guilt. Maintenance challenges included social evening events, inconsistent daily rhythms and eating patterns, preoccupation with losing weight, lack of family support and self-blame. TRE was manageable for most participants; however, personalised support for adjusting TRE to daily life is needed to ensure long-term maintenance. Future studies should explore the effectiveness of a personalised TRE concept to determine the usefulness of TRE in real-life settings.

There is substantial evidence documenting the effects of behavioural interventions on weight loss (WL). However, behavioural approaches to initial WL are followed by some degree of longer-term weight regain, and large trials focusing on evidence-based approaches to weight loss maintenance (WLM) have generally only demonstrated small beneficial effects. The current state-of-the-art in behavioural interventions for WL and WLM raises questions of (i) how we define the relationship between WL and WLM, (ii) how energy balance (EB) systems respond to WL and influence behaviours that primarily drive weight regain, (iii) how intervention content, mode of delivery and intensity should be targeted to keep weight off, (iv) which mechanisms of action in complex interventions may prevent weight regain and (v) how to design studies and interventions to maximise effective longer-term weight management. In considering these issues a writing team within the NoHoW Consortium was convened to elaborate a position statement, and behaviour change and obesity experts were invited to discuss these positions and to refine them. At present the evidence suggests that developing the skills to self-manage EB behaviours leads to more effective WLM. However, the effects of behaviour change interventions for WL and WLM are still relatively modest and our understanding of the factors that disrupt and undermine self-management of eating and physical activity is limited. These factors include physiological resistance to weight loss, gradual compensatory changes in eating and physical activity and reactive processes related to stress, emotions, rewards and desires that meet psychological needs. Better matching of evidence-based intervention content to quantitatively tracked EB behaviours and the specific needs of individuals may improve outcomes. Improving objective longitudinal tracking of energy intake and energy expenditure over time would provide a quantitative framework in which to understand

Background: Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. The Project: First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (>= 5%) WL in the previous 12 months (initial BMI >= 25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness. Impact: The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digit

There is substantial evidence documenting the effects of behavioural interventions on weight loss (WL). However, behavioural approaches to initial WL are followed by some degree of longer-term weight regain, and large trials focusing on evidence-based approaches to weight loss maintenance (WLM) have generally only demonstrated small beneficial effects. The current state-of-the-art in behavioural interventions for WL and WLM raises questions of (i) how we define the relationship between WL and WLM, (ii) how energy balance (EB) systems respond to WL and influence behaviours that primarily drive weight regain, (iii) how intervention content, mode of delivery and intensity should be targeted to keep weight off, (iv) which mechanisms of action in complex interventions may prevent weight regain and (v) how to design studies and interventions to maximise effective longer-term weight management. In considering these issues a writing team within the NoHoW Consortium was convened to elaborate a position statement, and behaviour change and obesity experts were invited to discuss these positions and to refine them. At present the evidence suggests that developing the skills to self-manage EB behaviours leads to more effective WLM. However, the effects of behaviour change interventions for WL and WLM are still relatively modest and our understanding of the factors that disrupt and undermine self-management of eating and physical activity is limited. These factors include physiological resistance to weight loss, gradual compensatory changes in eating and physical activity and reactive processes related to stress, emotions, rewards and desires that meet psychological needs. Better matching of evidence-based intervention content to quantitatively tracked EB behaviours and the specific needs of individuals may improve outcomes. Improving objective longitudinal tracking of energy intake and energy expenditure over time would provide a quantitative framework in which to understand

The purpose of this Individually Randomized Group Treatment Trial was to compare an Acceptance and Commitment Therapy-based (ACT) group intervention and a Cognitive Behavioral Therapy-based (CBT) group intervention for weight loss maintenance in a sample of adult patients with obesity seeking treatment for weight loss. One hundred and fifty-five adults (BMI: Kg/m2 = 43.8 [6.8]) attending a multidisciplinary rehabilitation program for weight loss were randomized into two conditions: ACT and CBT. Demographical, physical, and clinical data were assessed at the beginning of the program (t0), at discharge (t1), and at 6-month follow-up (t2). The following measures were administered: The Acceptance and Action Questionnaire-II (AAQ-II) and the Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM). Generalized linear mixed models were performed to assess differences between groups. Moderation effects for gender and Eating Disorders (ED) have been considered. From baseline to discharge, no significant differences between interventions were found, with the only exception of an improvement in the CORE-OM total score and in the CORE-OM subjective wellbeing subscale for those in the CBT condition. From discharge to follow-up, ACT group participants showed significant results in terms of weight loss maintenance, CORE-OM total score, and CORE-OM and AAQ-II wellbeing, symptoms, and psychological problems subscales. Gender moderated the effects of time and intervention on the CORE-OM subscale reporting the risk for self-harm or harm of others. The presence of an eating disorder moderated the effect of time and intervention on the CORE-OM total score, on the CORE-OM symptoms and psychological problems subscales, and on the AAQ-II. Patients who received the ACT intervention were more likely to achieve a ≥ 5% weight loss from baseline to follow-up and to maintain the weight loss after discharge. The ACT intervention was thus effective in maintaining weight loss over time.

Background: Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. The Project: First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (>= 5%) WL in the previous 12 months (initial BMI >= 25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness. Impact: The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digit

OBJECTIVE:The aim of the study was to determine, within a weight loss clinical trial for obesity, the impact of intervention arm, weight change, and weight loss maintenance on telomere length (TL). METHODS:Adults (N = 194) with a body mass index between 30 and 45 were randomized to a 5.5-month weight loss program with (n = 100) or without (n = 94) mindfulness training and identical diet-exercise guidelines. We assessed TL at baseline and 3-, 6-, and 12-month postbaseline in immune cell populations (primarily in peripheral blood mononuclear cells [PBMCs], but also in granulocytes and T and B lymphocytes). We defined weight loss maintenance as having lost at least 5% or 10% of body weight (tested in separate models) from preintervention to postintervention, and having maintained this loss at 12 months. We predicted that greater weight loss and weight loss maintenance would be associated with TL lengthening. RESULTS:Neither weight loss intervention significantly predicted TL change nor did amount of weight change, at any time point. Across all participants, weight loss maintenance of at least 10% was associated with longer PBMC TL (b = 239.08, 95% CI = 0.92 to 477.25, p = .049), CD8+ TL (b = 417.26, 95% CI = 58.95 to 775.57, p = .023), and longer granulocyte TL (b = 191.56, 95% CI = -4.23 to 387.35, p = .055) at 12 months after accounting for baseline TL. Weight loss maintenance of 5% or more was associated with longer PBMC TL (b = 163.32, 95% CI = 4.00 to 320.62, p = .045) at 12 months after accounting for baseline TL. These tests should be interpreted in light of corrections for multiple tests. CONCLUSIONS:Among individuals with obesity, losing and maintaining a weight loss of 10% or more may lead to TL lengthening, which may portend improved immune and metabolic function. TL lengthening in this study is of unknown duration beyond 12 months and requires further study. TRIAL REGISTRATION:Clinicaltrials.govidentifierNCT00960414; Open Science Framework (OSF) preregistra

OBJECTIVE:The aim of the study was to determine, within a weight loss clinical trial for obesity, the impact of intervention arm, weight change, and weight loss maintenance on telomere length (TL). METHODS:Adults (N = 194) with a body mass index between 30 and 45 were randomized to a 5.5-month weight loss program with (n = 100) or without (n = 94) mindfulness training and identical diet-exercise guidelines. We assessed TL at baseline and 3-, 6-, and 12-month postbaseline in immune cell populations (primarily in peripheral blood mononuclear cells [PBMCs], but also in granulocytes and T and B lymphocytes). We defined weight loss maintenance as having lost at least 5% or 10% of body weight (tested in separate models) from preintervention to postintervention, and having maintained this loss at 12 months. We predicted that greater weight loss and weight loss maintenance would be associated with TL lengthening. RESULTS:Neither weight loss intervention significantly predicted TL change nor did amount of weight change, at any time point. Across all participants, weight loss maintenance of at least 10% was associated with longer PBMC TL (b = 239.08, 95% CI = 0.92 to 477.25, p = .049), CD8+ TL (b = 417.26, 95% CI = 58.95 to 775.57, p = .023), and longer granulocyte TL (b = 191.56, 95% CI = -4.23 to 387.35, p = .055) at 12 months after accounting for baseline TL. Weight loss maintenance of 5% or more was associated with longer PBMC TL (b = 163.32, 95% CI = 4.00 to 320.62, p = .045) at 12 months after accounting for baseline TL. These tests should be interpreted in light of corrections for multiple tests. CONCLUSIONS:Among individuals with obesity, losing and maintaining a weight loss of 10% or more may lead to TL lengthening, which may portend improved immune and metabolic function. TL lengthening in this study is of unknown duration beyond 12 months and requires further study. TRIAL REGISTRATION:Clinicaltrials.govidentifierNCT00960414; Open Science Framework (OSF) preregistra

Lack of exercise and overeating/unhealthy eating are the main causes of the worldwide escalating global epidemic of overweight and obesity (Pietrabissa et al., 2012)—as defined as a body mass index (BMI) over 30 (Spiegelman and Flier, 2001). The consequences of excess weight range from serious negative health outcomes, to increased risk of premature death. Obese persons—especially those seeking weight loss treatment (Brennan et al., 2014)—also demonstrate high rates of psychopathology, including mood disorders (i.e., depression, anxiety and low self-esteem) (Luppino et al., 2010) and eating disorders (i.e., binge eating disorder—BED; Succurro et al., 2015). These result in significantly impaired health-related quality of life (Slagter et al., 2015; Afshin et al., 2017) and loss of productivity (Fontaine and Barofsky, 2001; Robroek et al., 2011). Obesity and its associated problems also have a growing economic impact on the health care system (Hammond and Levine, 2010; Castelnuovo et al., 2016).

Background: Knowledge is limited on the role the ability to self-regulate plays in the long-term outcome of obesity treatment in children and adolescents with severe obesity. The purpose of this study was to determine whether the ability to self-regulate after an one year intensive, partly inpatient, combined lifestyle intervention is associated with weight loss maintenance in children and adolescents with severe obesity. Methods: One hundred twenty participants (8-19 years) with an average SDS-BMI of 3.41 and their parents/caregivers were included in an intervention study. As primary determinant of weight loss maintenance, general self-regulation ability was evaluated using two behavioral computer tasks assessing inhibitory control and sensitivity to reward. Results: There was no association between inhibitory control at T12 and δSDS-BMI between T12 and T24 (ß = 0. 0002; CI 95% = -0.0010-0.0014; P = 0.761). There was also no relation between sensitivity to reward at T12 and δSDS-BMI between T12 and T24 (ß = -0.0028; CI 95% = -0.0075-0.0019; P = 0.244). None of the psychosocial factors that were examined as moderators, showed a statistically significant interaction, except for parental feeding style (P = 0.023). Conclusions: The ability to self-regulate after an intensive, partly inpatient, multidisciplinary one year intervention for severe obesity in children and adolescents was not associated with the ability to maintain the achieved weight loss during the following year. Factors that explain the large range of long term outcomes need to be elucidated.

Aim: This study aims to examine the factors that are perceived to contribute to lasting weight loss. To try to understand the psychosocial factors- and what aspects of physical activity and the relationship with food is perceived as supporting and/or inhibiting for lasting weight loss. Method: Participants (n=7) who lost weight and kept it off during a minimum of six months were interviewed about their experience of weight loss maintenance using a semistructured interview. To participate in this study one of the criterias was to have a BMI over 25 from start, but a BMI under 30 after their weight loss. The age varied between 23-48 years old, and they had lost 5-15 % of total body weight. Results: The participants had a strong internal motivation and has enjoyed physical activity since early age. Avoiding fast food, and the sugar and fast carbohydrates it contains, and instead make home cooked food was a success factor for the participants in this study. Emotional eating, injuries interfering with physical activity, lack of motivation to perform certain exercises perceived as boring, difficulties getting started with physical activity and certain living conditions are listed as inhibiting factors. The participants received no or neutral social support, this didn't seem to affect the results but contradicts other research findings. Conclusion: To achieve lasting weight loss, factors of success are strong internal motivation and a healthy relationship to food. Early contact with physical activity, and the enjoyment of performing it are also key aspects. The inhibiting factors for weight loss maintenance consisted in emotional eating, injuries interfering with physical activity, lack of motivation to perform certain exercises perceived as boring, difficulties getting started with physical activity and certain living conditions., Syfte och frågeställningar: Den här studien syftar till att undersöka vilka faktorer som upplevs bidra till varaktig viktminskning. Frågeställningarna var designade för att försöka förstå de psykosociala faktorerna och vilka aspekter av fysisk aktivitet samt relation till mat som upplevs som främjande och/eller hämmande för varaktig viktminskning. Metod: Individer (n=7) som gått ner i vikt och bibehållit sin viktminskning i minst sex månader deltog i semistrukturerade intervjuer om deras upplevelse av varaktig viktminskning. Inklusionskriterierna var att deltagarna ska ha haft ett BMI över 25 vid viktminskningsfasens start och ett BMI under 30 vid dess slut samt att viktminskningen ska omfatta 5-15 % av deras kroppsvikt. Deltagarnas ålder sträckte sig mellan 23 och 48 år. Resultat: Deltagarna hade en stark inre motivation och har uppskattat fysisk aktivitet sedan tidigt ålder. De försöker undvika snabbmat som består av socker och snabba kolhydrater och gör istället hemlagad mat. Dessa var framgångsfaktorer för deltagarna i denna studie. Känslomässigt ätande, skador som förhindrar fysisk aktivitet, bristande motivation att utföra vissa träningsformer som ansågs svåra/jobbiga/tråkiga, svårt att komma igång, och vissa levnadsförhållanden som exempelvis arbetstid och boendesituation uppges som hämmande faktorer. Deltagarna fick inget eller neutralt socialt stöd, något som inte verkar ha påverkat resultatet, men motsäger de resultat som återfinns i annan forskning. Slutsats: Främjande faktorer för varaktig viktminskning är stark inre motivation, en hälsosam relation till kost, tidig kontakt med fysisk aktivitet samt att se den som ett roligt och avslappnande inslag i livet. De hämmande faktorerna för varaktig viktminskning består av känslomässigt ätande, skador som försvårar fysisk aktivitet, bristande motivation för att utföra aktiviteter som upplevs vara svåra/jobbiga/tråkiga, svårt att komma igång med fysisk aktivitet samt vissa levnadsförhållanden.

Aim: This study aims to examine the factors that are perceived to contribute to lasting weight loss. To try to understand the psychosocial factors- and what aspects of physical activity and the relationship with food is perceived as supporting and/or inhibiting for lasting weight loss. Method: Participants (n=7) who lost weight and kept it off during a minimum of six months were interviewed about their experience of weight loss maintenance using a semistructured interview. To participate in this study one of the criterias was to have a BMI over 25 from start, but a BMI under 30 after their weight loss. The age varied between 23-48 years old, and they had lost 5-15 % of total body weight. Results: The participants had a strong internal motivation and has enjoyed physical activity since early age. Avoiding fast food, and the sugar and fast carbohydrates it contains, and instead make home cooked food was a success factor for the participants in this study. Emotional eating, injuries interfering with physical activity, lack of motivation to perform certain exercises perceived as boring, difficulties getting started with physical activity and certain living conditions are listed as inhibiting factors. The participants received no or neutral social support, this didn't seem to affect the results but contradicts other research findings. Conclusion: To achieve lasting weight loss, factors of success are strong internal motivation and a healthy relationship to food. Early contact with physical activity, and the enjoyment of performing it are also key aspects. The inhibiting factors for weight loss maintenance consisted in emotional eating, injuries interfering with physical activity, lack of motivation to perform certain exercises perceived as boring, difficulties getting started with physical activity and certain living conditions., Syfte och frågeställningar: Den här studien syftar till att undersöka vilka faktorer som upplevs bidra till varaktig viktminskning. Frågeställningarna var designade för att försöka förstå de psykosociala faktorerna och vilka aspekter av fysisk aktivitet samt relation till mat som upplevs som främjande och/eller hämmande för varaktig viktminskning. Metod: Individer (n=7) som gått ner i vikt och bibehållit sin viktminskning i minst sex månader deltog i semistrukturerade intervjuer om deras upplevelse av varaktig viktminskning. Inklusionskriterierna var att deltagarna ska ha haft ett BMI över 25 vid viktminskningsfasens start och ett BMI under 30 vid dess slut samt att viktminskningen ska omfatta 5-15 % av deras kroppsvikt. Deltagarnas ålder sträckte sig mellan 23 och 48 år. Resultat: Deltagarna hade en stark inre motivation och har uppskattat fysisk aktivitet sedan tidigt ålder. De försöker undvika snabbmat som består av socker och snabba kolhydrater och gör istället hemlagad mat. Dessa var framgångsfaktorer för deltagarna i denna studie. Känslomässigt ätande, skador som förhindrar fysisk aktivitet, bristande motivation att utföra vissa träningsformer som ansågs svåra/jobbiga/tråkiga, svårt att komma igång, och vissa levnadsförhållanden som exempelvis arbetstid och boendesituation uppges som hämmande faktorer. Deltagarna fick inget eller neutralt socialt stöd, något som inte verkar ha påverkat resultatet, men motsäger de resultat som återfinns i annan forskning. Slutsats: Främjande faktorer för varaktig viktminskning är stark inre motivation, en hälsosam relation till kost, tidig kontakt med fysisk aktivitet samt att se den som ett roligt och avslappnande inslag i livet. De hämmande faktorerna för varaktig viktminskning består av känslomässigt ätande, skador som försvårar fysisk aktivitet, bristande motivation för att utföra aktiviteter som upplevs vara svåra/jobbiga/tråkiga, svårt att komma igång med fysisk aktivitet samt vissa levnadsförhållanden.

Background: A formula low-energy diet (LED) reduces weight effectively in obese patients with knee osteoarthritis, but the role of LED in long-term weight-loss maintenance is unclear.Objective: We aimed to determine the effect of intermittent LED compared with daily meal replacements on weight-loss maintenance and number of knee replacements over 3 y.Design: The design was a randomized trial with participants aged >50 y who had knee osteoarthritis and a body mass index [BMI (in kg/m(2))] ≥30. Participants were recruited from the osteoarthritis outpatient clinic at Copenhagen University Hospital in Frederiksberg, Denmark; they had previously completed a 68-wk lifestyle intervention trial and achieved an average weight loss of 10.5 kg (10% of initial body weight). Participants were randomly assigned to either the intermittent treatment (IN) group with LED for 5 wk every 4 mo for 3 y or to daily meal replacements of 1-2 meals for 3 y [regular (RE) group]. Attention by dietitians and the amount of formula products were similar. Primary outcomes were changes in body weight and proportion of participants receiving knee replacements. Outcomes were analyzed on the intention-to-treat-population with the use of baseline-carried-forward imputation for missing data.Results: A total of 153 participants (means ± SDs: BMI: 33.3 ± 4.6; age: 63.8 ± 6.3 y; 83% women) were recruited between June and December 2009 and randomly assigned to the IN (n = 76) or RE (n = 77) group. A total of 53 and 56 participants, respectively, completed the trial. Weight increased by 0.68 and 1.75 kg in the IN and RE groups, respectively (mean difference: -1.06 kg; 95% CI: -2.75, 0.63 kg; P = 0.22). Alloplasty rates were low and did not differ (IN group: 8 of 76 participants; RE group: 12 of 77 participants; P = 0.35).Conclusions: After a mean 10% weight-loss and 1-y maintenance, additional use of daily meal replacements or intermittent LED resulted in weight-loss maintenance for 3 y. These results

An increase in dietary protein intake has been shown to improve weight loss maintenance in the DIOGenes trial. Here, we analysed whether the source of the dietary proteins influenced changes in body weight, body composition, and cardiometabolic risk factors during the weight maintenance period while following an energy-restricted diet. 489 overweight or obese participants of the DIOGenes trial from eight European countries were included. They successfully lost >8% of body weight and subsequently completed a six month weight maintenance period, in which they consumed an ad libitum diet varying in protein content and glycemic index. Dietary intake was estimated from three-day food diaries. A higher plant protein intake with a proportional decrease in animal protein intake did not affect body weight maintenance or cardiometabolic risk factors. A higher plant protein intake from non-cereal products instead of cereal products was associated with benefits for body weight maintenance and blood pressure. Substituting meat protein for protein from other animal sources increased insulin and HOMA-IR (homeostasis model assessment of insulin resistance). This analysis suggests that not only the amount of dietary proteins, but also the source may be important for weight and cardiometabolic risk management. However, randomized trials are needed to test the causality of these associations.

Purpose: To gain more insight into the optimal strategy to achieve weight loss and weight loss maintenance in overweight and obese cancer survivors after completion of initial treatment, this systematic review aimed to provide an overview of the literature on intervention effects on weight, to describe intervention components used in effective interventions, to identify and synthesize behaviour change techniques (BCTs) and to assess the frequency with which these BCTs were used in effective interventions. Methods: Six databases were searched for original research articles describing weight changes in adult overweight cancer survivors after participation in a lifestyle intervention initiated after completion of initial treatment. Two researchers independently screened the retrieved papers and extracted BCTs using the BCT Taxonomy version 1. Results: Thirty-two papers describing 27 interventions were included. Interventions that were evaluated with a robust study design (n = 8) generally showed

An increase in dietary protein intake has been shown to improve weight loss maintenance in the DIOGenes trial. Here, we analysed whether the source of the dietary proteins influenced changes in body weight, body composition, and cardiometabolic risk factors during the weight maintenance period while following an energy-restricted diet. 489 overweight or obese participants of the DIOGenes trial from eight European countries were included. They successfully lost >8% of body weight and subsequently completed a six month weight maintenance period, in which they consumed an ad libitum diet varying in protein content and glycemic index. Dietary intake was estimated from three-day food diaries. A higher plant protein intake with a proportional decrease in animal protein intake did not affect body weight maintenance or cardiometabolic risk factors. A higher plant protein intake from non-cereal products instead of cereal products was associated with benefits for body weight maintenance and blood pressure. Substituting meat protein for protein from other animal sources increased insulin and HOMA-IR (homeostasis model assessment of insulin resistance). This analysis suggests that not only the amount of dietary proteins, but also the source may be important for weight and cardiometabolic risk management. However, randomized trials are needed to test the causality of these associations.

BACKGROUND Text-message and e-mail are emerging as potential methods for improving weight outcomes among obese individuals. The optimal volume, frequency, and timing of such interventions are unknown. This study investigated the effect of adjunct technological support on weight and psychological variables after a 3-month cognitive-behaviour therapy (CBT) group intervention. METHODS Sixty obese adults were randomised to a CBT programme plus intensive (text-message and e-mail; CBT+ITS) or minimal (text-message only; CBT+MTS) technological support. Assessments occurred at baseline, 3-, 6-, 9-, and 15-months. Outcome variables included weight (kg), body mass index (kg/m(2)), waist circumference (cm), binge-eating tendencies, weight self-efficacy, and weight control cognitions and behaviours. RESULTS CBT+ITS (n=31) and CBT+MTS (n=29) participants lost 5.2% (±1.1) and 4.7% (±1.1) of their baseline weight by 3-months, 8.4% (±1.2) and 6.4% (±1.1) by 6-months, 9.6% (±1.3) and 6.4% (±1.3) by 9-months, and sustained a 7.5% (±1.3) and 5.1% (±1.3) loss at 15-months, respectively. There were no significant differences between intensive and minimal support, however, the CBT+ITS group showed a marginal advantage across all anthropometric measures. CONCLUSIONS A low intensity text-message support programme is just as effective as higher intensity technological support for maintaining weight loss in obese adults. This represents a low-cost means of aiding weight loss maintenance without reliance on extended face-to-face treatment.

Siguiendo a los clásicos, el obeso es el nutrido en exceso. En definitiva, lo más característico del obeso es el exceso de grasa corporal, superior al 33 % en el caso de las mujeres y del 25 % en el de los varones. De tal manera que el diagnóstico más preciso se obtiene de las medidas directas de masa grasa que nos ofrece la densitometría (Direk 2013) u otras técnicas de imagen como la resonancia magnética. Sin embargo, la sencillez y difusión de la ecuación del estadístico del siglo XIX, Lamberto Quetelet, han hecho que en la actualidad, la inmensa mayoría de las instituciones públicas y privadas, encabezadas por la Organización Mundial de la Salud, admitan como referencia (OMS 2015) el Índice de Masa Corporal (IMC). (Leer más / full text PDF)http://dx.doi.org/10.5232/ricyde2015.042ed------------------------------------------------------------------------------------------referencias/referencesAnderson, J.W.; Konz, E.C.; Frederich, R. C.; Wood, C. L. (2010). Long-term weightloss maintenance: a meta-analysis of U.S. studies. The American Journal of Clinical Nutrition, 74, 579–584.Beck, E.J., Tapsell, L.C.; Batterham, M.J.; Tosh, S.M.; Huang, X.F. (2010). Oat beta-glucan supplementation does not enhance the effectiveness of an energy-restricted diet in overweight women. British Journal of Nutrition, 103, 1212–1222. Bell, J.A.; Kivimaki, M.;, Hamer, M. (2014). Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies. Obesity Reviews, 15, 504–515.http://dx.doi.org/10.1111/obr.12157Bergman, R.; Stefanovski, D.; Buchanan, T.; Sumner, A.; Reynolds, J.; Sebring, N.; Xiang, A.; Watanabe, R. (2011). A Better Index of Body Adiposity. Obesity, 19,(5) 1083–1089.http://dx.doi.org/10.1038/oby.2011.38Boschi, V.; Iorio, D.; Margiotta, N.; D'Orsi, P.; Falconi, C. (2010). The three-factor eating questionnaire in the Brennan IM, Seimon RV, Luscombe-Marsh ND, Otto B, Horowitz M, Feinle-Bisset C. Effects of acute dietary restricti

Brief self-management interventions to engender successful weight maintenance are seldom tested in obese and overweight populations without diabetes. To test the efficacy of the intervention, aimed at improving proactive coping, in obese and overweight adults at risk for diabetes. Participants (N = 255) were randomly assigned to two experimental groups (N = 185) and a control group (N = 70). Experimental groups received the same intervention in week 1-8 (initial phase) and booster sessions with different content ("standard" vs. "relapse prevention") during week 9-24 (continuance phase). Primary outcomes were proactive coping, diet and Body Mass Index (BMI) at four time points (1 year between first and last measurement). Experimental groups improved in proactive coping during the initial phase and BMI during the continuance phase, whereas the control group did not. No differences emerged in diet. Brief self-management interventions can play a preventive role in chronic illnesses associated with obesity.

Individuals successful at weight loss maintenance (WTLM) utilize similar behaviors but in varying amounts and combinations. Research identifying characteristics which predict WTLM success could be used to develop effective WTLM treatment programs. The purpose of this retrospective analysis was to determine behavioral (e.g., self monitoring of dietary intake) and biological factors (e.g., sex) which may influence WTLM success. Methods: In a previously conducted 12-month WTLM study, weight-reduced middle-aged and older men and women (n = 39) were assigned behavioral goals and asked to daily self-monitor body weight, fruit and vegetable intake, water consumption, and physical activity. This investigation utilized a crisp set qualitative comparative analysis (QCA) to characterize individuals’ weight changes and behaviors. Sex difference in clinically significant weight loss (WL) (≥5% WL) at 12 months was investigated, and growth curve models estimated interaction effects between sex and WTLM predictors. Results: QCA findings suggest patterns of weight change during the initial three months of WTLM treatment may dictate 12-month weight outcomes. No sex difference was found in clinically significant WL or in the interaction of sex and behaviors on weight change. Conclusions: WTLM treatments should provide more intensive support during transition from WL to WTLM, particularly during the first three months.

Objective: The well-documented finding that obese adults have a high likelihood of weight regain following participation in behavioural weight loss programs highlights the importance of developing more effective approaches for weight loss maintenance. One promising approach is to improve the quality of social support for effective weight control available to an obese individual by including support people in behavioural weight loss programs. This paper describes the rationale and design of a randomised controlled trial that evaluates the effectiveness of training support people to assist obese adults in their weight management. Design: The study entails a twoarm randomised controlled trial in which obese participants take part in a one-year (26-session) cognitive-behaviour therapy group weight management program including motivational interviewing strategies (CBT-MI). In one arm, participants receive CBT-MI alone, while in the second arm (CBT-MI-SP) participants also have a support person who attends 10 group sessions designed to teach effective skills for supporting an individual in healthy weight control. Assessments of anthropometric, medical, behavioural, psychological, and social functioning take place at pretreatment, post-treatment, and a one-year follow-up. Conclusions: By helping obese participants to increase and sustain their motivation and skills for weight control, the CBT-MI-SP approach of the current study has the potential to effectively help patients to achieve sustained weight loss while minimising the patient’s need for ongoing, intensive weight control treatment with its attendant costs.

Individuals successful at weight loss maintenance (WTLM) utilize similar behaviors but in varying amounts and combinations. Research identifying characteristics which predict WTLM success could be used to develop effective WTLM treatment programs. The purpose of this retrospective analysis was to determine behavioral (e.g., self monitoring of dietary intake) and biological factors (e.g., sex) which may influence WTLM success. Methods: In a previously conducted 12-month WTLM study, weight-reduced middle-aged and older men and women (n = 39) were assigned behavioral goals and asked to daily self-monitor body weight, fruit and vegetable intake, water consumption, and physical activity. This investigation utilized a crisp set qualitative comparative analysis (QCA) to characterize individuals’ weight changes and behaviors. Sex difference in clinically significant weight loss (WL) (≥5% WL) at 12 months was investigated, and growth curve models estimated interaction effects between sex and WTLM predictors. Results: QCA findings suggest patterns of weight change during the initial three months of WTLM treatment may dictate 12-month weight outcomes. No sex difference was found in clinically significant WL or in the interaction of sex and behaviors on weight change. Conclusions: WTLM treatments should provide more intensive support during transition from WL to WTLM, particularly during the first three months.

Individuals successful at weight loss maintenance (WTLM) utilize similar behaviors but in varying amounts and combinations. Research identifying characteristics which predict WTLM success could be used to develop effective WTLM treatment programs. The purpose of this retrospective analysis was to determine behavioral (e.g., self monitoring of dietary intake) and biological factors (e.g., sex) which may influence WTLM success. Methods: In a previously conducted 12-month WTLM study, weight-reduced middle-aged and older men and women (n = 39) were assigned behavioral goals and asked to daily self-monitor body weight, fruit and vegetable intake, water consumption, and physical activity. This investigation utilized a crisp set qualitative comparative analysis (QCA) to characterize individuals’ weight changes and behaviors. Sex difference in clinically significant weight loss (WL) (≥5% WL) at 12 months was investigated, and growth curve models estimated interaction effects between sex and WTLM predictors. Results: QCA findings suggest patterns of weight change during the initial three months of WTLM treatment may dictate 12-month weight outcomes. No sex difference was found in clinically significant WL or in the interaction of sex and behaviors on weight change. Conclusions: WTLM treatments should provide more intensive support during transition from WL to WTLM, particularly during the first three months.

Current literature emphasizes poor long-term weight loss maintenance (WTLM) outcomes, and the need for inexpensive, practical solutions for effective WTLM is evident. Individuals successful at WTLM utilize similar behaviors but in varying amounts and combinations, seemingly choosing behaviors that best fit their preferences. Researchers have attempted to identify characteristics of individuals that may predict successful WTLM in order to develop flexible WTLM treatments based on individuals' lifestyle and preferences. The purpose of this analysis was to examine sex differences in WTLM outcomes and to identify potential behaviors related to WTLM success. In a 12-month study targeting WTLM, weight-reduced middle-aged and older men and women (n=39) were assigned behavioral goals for body weight, fruit and vegetable intake, water consumption, and physical activity and were asked to daily self-monitor body weight and these behaviors. Sex difference in clinically significant WL ≥5% WL) at 12 months was determined. A growth curve model assessed interactions of sex and WTLM predictors, and a crisp set qualitative comparative analysis (QCA) characterized individuals' weight changes and behaviors. No sex difference was found in clinically significant WL or in the interaction of sex and behaviors on weight change; however, QCA evidence suggests men and women may approach WTLM with different behaviors. Additionally, QCA findings suggest weight change in the first 3 months of WTLM may determine success at 12-months. WTLM treatments should provide more intensive support during the transition period from WL to WTLM. Future research in predictors of WTLM, particularly within the context of sex, is essential.

Weight management is problematic among Americans, as the number of overweight adults has risen to two-thirds of the population (1). Without the identification of successful approaches to promote weight stability, it is predicted that 86% of American adults will be overweight or obese by 2030 (2). Body-weight influenced diseases, such as diabetes and cardiovascular disease, are now leading causes of death (3). Annually, adult Americans are thought to increase their body weight by 0.5-0.9 kg (4). Of this gain, 52% is believed to occur during the winter holiday period of mid-late November to early January (5). Unfortunately, obesity research specific to this high-risk period is limited. Older adults and weight-reduced individuals are thought to be highly susceptible to significant holiday body weight gains (1, 6). To date, little research has investigated effective interventions that may be used to assist in successful body weight maintenance during the winter holiday period. Therefore, our purpose was to determine if daily self-monitoring of body weight, physical activity, and step counts is a feasible and effective tool to prevent weight gain in older, weight-reduced adults during the winter holiday period. This intervention represents a holiday weight maintenance approach that may be translatable to larger, more diverse populations.

Weight management is problematic among Americans, as the number of overweight adults has risen to two-thirds of the population (1). Without the identification of successful approaches to promote weight stability, it is predicted that 86% of American adults will be overweight or obese by 2030 (2). Body-weight influenced diseases, such as diabetes and cardiovascular disease, are now leading causes of death (3). Annually, adult Americans are thought to increase their body weight by 0.5-0.9 kg (4). Of this gain, 52% is believed to occur during the winter holiday period of mid-late November to early January (5). Unfortunately, obesity research specific to this high-risk period is limited. Older adults and weight-reduced individuals are thought to be highly susceptible to significant holiday body weight gains (1, 6). To date, little research has investigated effective interventions that may be used to assist in successful body weight maintenance during the winter holiday period. Therefore, our purpose was to determine if daily self-monitoring of body weight, physical activity, and step counts is a feasible and effective tool to prevent weight gain in older, weight-reduced adults during the winter holiday period. This intervention represents a holiday weight maintenance approach that may be translatable to larger, more diverse populations.

Background Evaluation for obesity management in primary care is limited, and successful outcomes are from intensive clinical trials in hospital settings. Aim To determine to what extent measures of success seen in intensive clinical trials can be achieved in routine primary care. Primary outcome measures were weight change and percentage of patients achieving ≤5% loss at 12 and 24 months. Design of study Prospective evaluation of a new continuous improvement model for weight management in primary care. Setting Primary care, UK. Method Primary care practice nurses from 65 UK general practices delivered interventions to 1906 patients with body mass index (BMI) ≥30 kg/m2 or ≥28 kg/m2 with obesity-related comorbidities. Results Mean baseline weight was 101.2 kg (BMI 37.1 kg/m2); 25% of patients had BMI ≥40 kg/m2 and 74% had ≥1 major obesity-related comorbidity. At final data capture 1419 patients were in the programme for ≥12 months, and 825 for ≥24 months. Mean weight change in those who attended and had data at 12 months (n = 642) was −3.0 kg (95% CI = −3.5 to −2.4 kg) and at 24 months (n = 357) was −2.3 kg (95% CI = −3.2 to −1.4 kg). Among attenders at specific time-points, 30.7% had maintained weight loss of ≥5% at 12 months, and 31.9% at 24 months. A total of 761 (54%) of all 1419 patients who had been enrolled in the programme for >12 months provided data at or beyond 12 months. Conclusion This intervention achieves and maintains clinically valuable weight loss within routine primary care.

The prevalence of obesity and its associated health problems have increased sharply in the past 2 decades. New revisions to Medicare policy will allow funding for obesity treatments of proven efficacy. The authors review studies of the long-term outcomes of calorie-restricting diets to assess whether dieting is an effective treatment for obesity. These studies show that one third to two thirds of dieters regain more weight than they lost on their diets, and these studies likely underestimate the extent to which dieting is counterproductive because of several methodological problems, all of which bias the studies toward showing successful weight loss maintenance. In addition, the studies do not provide consistent evidence that dieting results in significant health improvements, regardless of weight change. In sum, there is little support for the notion that diets lead to lasting weight loss or health benefits.

The prevalence of obesity and its associated health problems have increased sharply in the past 2 decades. New revisions to Medicare policy will allow funding for obesity treatments of proven efficacy. The authors review studies of the long-term outcomes of calorie-restricting diets to assess whether dieting is an effective treatment for obesity. These studies show that one third to two thirds of dieters regain more weight than they lost on their diets, and these studies likely underestimate the extent to which dieting is counterproductive because of several methodological problems, all of which bias the studies toward showing successful weight loss maintenance. In addition, the studies do not provide consistent evidence that dieting results in significant health improvements, regardless of weight change. In sum, there is little support for the notion that diets lead to lasting weight loss or health benefits.

Young M.D., Collins C.E., Callister R., Plotnikoff R.C., Doran C.M., Morgan P.J. (2014). The SHED-IT Weight Loss Maintenance trial protocol: A randomised controlled trial of a weight loss maintenance program for overweight and obese men. Contemporary Clinical Trials, 37(1), 84-97. Available here