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Long term improvement of body weight and metabolism is highly requested in obesity. The specific impact of weight loss associated temporary negative energy balance or modified body composition on metabolism and weight regain is unclear. We randomly assigned 80 post-menopausal women (BMI 33.9 (32.2–36.8)kg/m2) to an intervention (IG) or control group (CG). IG underwent a dietary three month-weight loss intervention followed by a four week-weight maintenance period without negative energy balance. The CG was instructed to keep their weight stable. Phenotyping was performed at baseline (M0), after weight loss (M3), the maintenance period (M4) and 24-month follow-up (M24). Co-primary outcomes were changes of insulin sensitivity (ISI Clamp) and lean body mass (LBM). Energy metabolism and adipose gene expression were secondary endpoints. Between March 2012 and July 2015, 479 subjects were screened for eligibility. 80 subjects were randomly assigned to IG (n = 40) or CG (n = 40). The total number of dropouts was 18 (IG: n = 13, CG: n = 5). LBM and ISI Clamp were stable in the CG between M0 and M3, but were changed in the IG at M3 (LBM: −1.4 (95%CI -2.2-(-0.6)) kg and ISI Clamp : +0.020 (95%CI 0.012–0.028) mg·kg−1·min−1/(mU·l−1)) (p < 0.01 and p < 0.05 for IG vs. CG, respectively). Effects on LBM, ISI Clamp , FM and BMI were preserved until M4. Lower resting energy expenditure per LBM (REE LBM) at M3 and stronger difference of REE LBM between M3 and M4 (ΔREE LBM-M3M4), which indicates a thrifty phenotype, were positively associated with FM regain at M24 (p = 0.022 and p = 0.044, respectively). Gene set enrichment analysis revealed a relationship of this phenotype to weight loss-induced adaption of adipose FGFR1 signaling. Negative energy balance had no additional effect on insulin sensitivity. FGFR1 signaling might be involved in the adaption of energy expenditure to temporary negative energy balance, which indicates a thrifty phenotype susceptible to weight regain. ClinicalTrials.gov number: NCT01105143, https://clinicaltrials.gov/ct2/show/NCT01105143 , date of registration: April 16th, 2010 [ABSTRACT FROM AUTHOR]

Aim: Weight loss is shown to improve obesity-related health problems as long as it is maintained for a long term. The purpose of this systematic review was to investigate the association between binge eating disorder and weight management in overweight and obese adults. Methods: A systematic search following the preferred reporting items for systematic reviews and meta-analyses guidelines was conducted across PubMed, Ebsco and Cochrane Library from inception through December 2020 to identify studies that assessed the association between binge eating disorder and weight management (e.g., weight loss, weight gain and weight loss maintenance) in overweight and obese adults. We included studies that examined adults (≥18 years old) being overweight and obese with and without binge eating behaviour. Two authors independently screened and evaluated studies for methodological quality. Results: Nine articles were selected, including 3685 participants. Three of the included studies were randomised control trials and the remaining were observational studies. The majority of the studies included support that people who have binge eating disorder may have an additional barrier maintaining their weight loss compared to people who do not suffer from binge eating disorder. Conclusion: Our systematic review revealed that binge eating disorder may have a negative association with weight loss maintenance. Further well-conducted prospective cohort studies and randomised clinical trials are required to investigate the possible mechanisms and whether any such mechanisms are modifiable. These will lead us to more efficient strategies targeting weight management. [ABSTRACT FROM AUTHOR]

Biological, genetic, and environmental factors make weight loss very difficult. Acceptance-based behavioral treatment (ABT) supplements standard behavioral treatments (BT) for obesity by teaching skills to accept the discomfort inherent to weight control behaviors and prioritize long-term, values-based goals. Grit, the ability to persevere in goal pursuit, overlaps conceptually with ABT principles and may predict outcomes in ABT. During a randomized controlled trial comparing three weight loss interventions (BT, BT with an emphasis on physical activity [BT + PA], ABT with an emphasis on physical activity [ABT + PA]), this study examined if grit predicted weight loss, intervention engagement (session attendance and dietary self-monitoring), and perceived intervention effectiveness, and whether intervention condition moderated these relationships. Participants (N = 309) with overweight/obesity enrolled in an 18-month weight loss intervention completed the Short Grit Scale at baseline. Weight and PA were measured at baseline, during the intervention (12 and 18 months), and at follow-up (24 and 36 months). Session attendance and dietary self-monitoring were assessed throughout the intervention, and perceived intervention effectiveness at end-of-intervention. The relation of grit to several outcomes depended on condition. In ABT + PA, but not BT or BT + PA, lower grit related to higher weight loss at 12 and 24 months, session attendance, and perceived intervention effectiveness. Grit was not related to PA or dietary self-monitoring in any condition. ABT's focus on building skills to facilitate long-term goal pursuit may be unique and beneficial to those with lower grit. Those with higher grit may already possess ABT-consistent skills and benefit less from ABT. Research on trait-level characteristics like grit in relation to weight must be cautious not to reinforce weight bias; rather, this work suggests that an evidence-based intervention (ABT) may be well-suited to those with lower grit levels seeking weight loss. • We examined grit, perseverance in long-term goal pursuit, in obesity treatments. • Grit predicted outcomes in acceptance-based behavioral treatment (ABT) for obesity. • Lower levels of grit related to greater 12- and 24-month weight losses in ABT. • Lower levels of grit related to greater perceived intervention effectiveness in ABT. • Lower levels of grit related to greater session attendance in ABT. [ABSTRACT FROM AUTHOR]

Background and Aims: This study is a randomized trial that examined the effects of 6 months of unsupervised Nordic walking (NW) and walking (W) exercise following 6 months of supervised training in overweight/obese adults.Methods and Results: After a 6-month program of diet and supervised training participants (n = 27) of NW (66 ± 7 yrs, body mass index (BMI) 34 ± 5) and W (66 ± 8 yrs, BMI 32 ± 5) group continue the training without supervision for other 6 months. Steps count and mean heart rate (HRmean) were performed in each session; anthropometric and body composition, aerobic capacity and strength of the upper and lower limbs were evaluated at baseline, after 6 months of supervised and 6 months of unsupervised training. In the unsupervised training, monthly sessions and steps count decreased over time in both groups (p < 0.05), with no significant changes in HRmean. Compared to the supervised phase, adherence decreased significantly only in the W group in the last 3 months of unsupervised training. Compared to baseline in both groups BMI did not change, but W group lost total fat; only the NW group maintained (p < 0.05) the gains in arm curl (33%) and chair stand (31%); both groups improved in six-minute walking test (p < 0.05).Conclusion: Despite unsupervised training was not effective for a further increase in performance, participants, especially in NW, maintained some of the improvements achieved during the supervision. However, the presence of instructor that guides training, may enhance adherence and health benefits of NW and W exercise.Clinical Trial Registration: clinicaltrials.gov Identifier: NCT03212391 (July 11, 2017). [ABSTRACT FROM AUTHOR]

Objective: To identify patient behaviors and characteristics related to weight regain after Roux-en-Y gastric bypass surgery (RYGB). Background: There is considerable variation in the magnitude of weight regain after RYGB, highlighting the importance of patient-level factors. Methods: A prospective cohort study of adults who underwent bariatric surgery in 6 US cities between 2006 and 2009 included presurgery, and 6-month and annual assessments for up to 7 years. Of 1573 eligible participants, 1278 (81%) with adequate follow-up were included (80% female, median age 46 years, median body mass index 46 kg/m²). Percentage of maximum weight lost was calculated each year after weight nadir. Results: Weight was measured a median of 8 (25th-75th percentile, 7-8) times over a median of 6.6 (25th-75th percentile, 5.9-7.0) years. b coefficients, that is, the mean weight regain, compared with the reference, and 95% confidence interval, are reported. Postsurgery behaviors independently associated with weight regain were: sedentary time [2.9% (1.2-4.7), for highest vs lowest quartile], eating fast food [0.5% (0.2-0.7) per meal/wk], eating when feeling full [2.9% (1.2-4.5)], eating continuously [1.6% (0.1-3.1)], binge eating and loss-of-control eating [8.0% (5.1-11.0) for binge eating; 1.6 (-0.1 to 3.3) for loss of control, vs neither], and weighing oneself

Objectives: Weight loss maintenance (WLM) is the next major challenge in obesity treatment. While most individuals who lose weight intend to keep their weight off, weight regain is common. Temporal Self-Regulation Theory posits that whether intentions lead to behavior depends on self-regulatory capacity, including delay discounting (DD; the tendency to discount a larger future reward in favor of a smaller immediate reward). Episodic Future Thinking (EFT; mental imagery of a future event for which a health goal is important) may improve DD and promote behavior change. Described herein is a trial protocol designed to examine whether EFT improves DD within the context of weight loss maintenance. Method: Participants who lose ≥5% of initial body weight in an online behavioral weight loss intervention will be randomly assigned to a standard weight loss maintenance program (WLM-STD) or a weight loss maintenance program plus EFT (WLM + EFT). Both interventions involve periodic phone and in-person treatment sessions. Participants in WLM + EFT will engage in daily EFT training via smartphone. To control for contact, participants in WLM-STD will engage in daily Healthy Thinking (reviewing strategies for weight management) on their smartphone. Our primary hypothesis is that WLM + EFT will yield better improvements in DD compared to WLM-STD. We will also explore whether DD mediates the relationship between intervention allocation and physical activity (secondary outcome). Weight and contextual variables will be explored. Conclusions: This study is the first to test whether EFT improves DD within the context of weight loss maintenance; results from this experimental medicine approach could have important implications for understanding the impact of both EFT and DD on sustained behavior change. [ABSTRACT FROM AUTHOR]

With improved methods of identification and treatment, the numbers of cancer survivors are increasing. Weight loss is encouraged to reduce recurrence. After cancer treatment, will survivors respond to weight change and receive the benefits of bariatric surgery? To compare weight loss after bariatric surgery of patients treated for cancer with those never diagnosed with cancer. The 10 surgical centers participating in the Longitudinal Assessment of Bariatric Surgery (LABS2). A retrospective review of the LABS database of 2458 participants was completed to determine which patients had answered the question that they had been told they had cancer with a positive response. Cancer survivors were compared for body mass index (calculated as weight in kilograms divided by height in meters squared) at baseline and 1, 3, 5, and 7 years after bariatric surgery with those who responded negatively to this question. Descriptive statistics, Fisher's exact tests, 2-sample independent t tests, Wilcoxon rank sum tests, and multiple linear regression were used. Groups were significantly different in age (P <.0001) and surgery type (P =.02). Other demographic and clinical comparisons were nonsignificant at the.05 significance level. Cancer survivors demonstrated less weight loss at 1 year (P =.0001). Over 7 years, there was no significant difference between the 2 groups. Adjusting for age, sex, baseline body mass index, and surgery type, cancer history was not found to be significant predictor of body mass index change 1-year postbariatric surgery. Patients treated for cancer are not different than the general population in their capacity for long-term weight loss with surgical assistance. [ABSTRACT FROM AUTHOR]

Objective: The role of personality in weight loss maintenance (WLM) is poorly understood. Although the personality trait of conscientiousness has been associated with health-promoting behaviors in general, no study has specifically evaluated the importance of conscientiousness for WLM. This study compared conscientiousness (both in aggregate and on the facet level) and control over healthy lifestyle behaviors (e.g., food quantity and temptations, consistent meal and sleep timing, exercise adherence, and psychosocial health and stress coping) in successful weight loss maintainers and regainers. Method: The sample included 869 National Weight Control Registry participants who reported maintaining ≥30-lb weight loss for ≥1 year (maintainers) and 484 participants from Amazon's MTurk crowdsourcing marketplace who reported trying but failing to maintain weight loss for 1 year (regainers). Both groups self-reported the Cherynshenko Conscientiousness Scale, the Healthy Lifestyle & Personal Control Questionnaire, body mass index, and demographics in an online survey. Results: Maintainers reported higher levels of total conscientiousness (p =.005), order, virtue, responsibility, and industriousness (ps ≤.05), but not self-control, compared with regainers after controlling for basic demographic differences. Unexpectedly, regainers scored significantly higher on the facet of traditionalism (p <.001). Maintainers also reported greater degree of control over food quantity and temptations, consistent meal and sleep timing, and exercise adherence (ps <.001), but not psychosocial health and stress coping, compared to with regainers. Conclusions: Successful weight loss maintainers reported small-to-moderately higher levels of conscientiousness compared with regainers. Evaluating whether conscientiousness can be incorporated into WLM treatment is warranted. [ABSTRACT FROM AUTHOR]

Abstract Worldwide obesity rates remain at a rise, and to treat obesity is at the top of the global public health agenda. In 2013, the AHA/ACC/TOS obesity management guidelines were published, in essence suggesting that any dietary scheme seems to be effective for weight loss, as long as it can induce a sustainable energy deficit. In the present review, we update and critically discuss available information regarding dietary modifications for weight loss and weight loss maintenance, published after the 2013 guidelines. Regarding weight loss, we found no proof to support that a single dietary scheme, be it nutrient-, food group- or dietary pattern- based, is more efficacious of the other for achieving weight loss. For weight loss maintenance, published interventions point towards the same direction, although inconclusively. Most research explores the effect of weight loss regimes on weight loss maintenance and not the effect of the diet during weight loss maintenance, and this literature gap should be more thoroughly investigated. Highlights • Diet modification is an essential component of weight management • A balanced hypo-caloric diet is recommended for weight loss. • Food-focused dietary regimes or specific dietary patterns (i.e. Mediterranean diet) may produce weight loss. • Dietary interventions during weight loss maintenance period remain to be explored. [ABSTRACT FROM AUTHOR]

The long-term efficacy of bariatric surgery is not entirely clear, and weight regain and diabetes relapse are problems for some patients. Exercise is a feasible and clinically effective adjunct therapy for bariatric surgery patients. We hypothesize that exercise is also a critical factor for long-term weight loss maintenance and lasting remission of type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: There are no investigations regarding the effects of consuming low-energy-dense diets rich in multiple functional foods on weight-loss maintenance, inflammatory markers, and cardiovascular disease (CVD) risk factors simultaneously.Method: This randomized controlled trial design was conducted on 90 men and women who were under a previous weight loss diet. Three months of intervention with recruitment at Allzahra Hospital, Isfahan, Iran, was done. Intervention was conducted following achieving 7-11 kg weight loss. Participants were encouraged to consumed these three: an isocaloric control diet (50% of energy from carbohydrate, 35% from fat, 15% from protein), a low-glycemic-index diet (LE) (60% from carbohydrate, 25% from fat, and 15% from protein), and a low-glycemic-index diet rich in multiple functional foods (LE + FF) (60% from carbohydrate, 25% from fat, and 15% from protein). Fasting blood glucose, serum insulin level, lipid profiles, inflammatory markers, adiponectin, systolic and diastolic blood pressure, and anthropometric measurements were assessed using standard guidelines.Results: The percent changes of weight, waist, and body mass index (BMI), systolic and diastolic blood pressure, malondialdehyde (MDA), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF) α, total cholesterol, low-density lipoprotein (LDL) cholesterol, triglyceride, and fasting blood glucose (FBS) were substantially more decreased in the LE + FF group compared to the LE and control groups (p ≤ 0.03). Percent change of adiponectin among the LE + FF group was significantly more enhanced (7.29 ± 0.10) compared with the LE group (1.28 ± 0.20) (p = 0.001). Significantly more increment in the percent change of total antioxidant capacity (TAC) (6.91 ± 0.10) was obtained among the LE + FF group compared to the LE group (1.79 ± 0.04).Conclusions: This study provides established evidence supporting the beneficial effects of a low-energy-dense diet rich in multiple functional foods diet on improving weight-loss maintenance, inflammation, and cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

The gut derived anorexigenic hormone neurotensin (NT) is upregulated after bariatric surgery which may contribute to the sustained weight loss. In contrast, diet-induced weight loss is most often followed by weight regain. We therefore investigated whether diet-induced weight loss impacts levels of circulating NT in mice and humans and whether NT levels predicts body weight change after weight loss in humans. In vivo mice study: Obese mice were fed ad-libitum or a restricted diet (40–60 % of average food intake) for 9 days to obtain similar weight loss as observed in the human study. At termination, intestinal segments, the hypothalamus and plasma were collected for histological, real time PCR, and radioimmunoassay (RIA) analysis. Clinical trial: Plasma samples from 42 participants with obesity, completing an 8-week low-calorie diet in a randomized controlled trial, were analyzed. Plasma NT was measured by RIA at fasting and during a meal test before and after diet-induced weight loss and after one year of intended weight maintenance. In obese mice, food restriction-induced body weight loss of 14 % was associated with a 64 % reduction in fasting plasma NT (p < 0.0001). In the mouse duodenum (p = 0.07) and jejunum (p < 0.05), NT tissue concentration was decreased without tissue atrophy indicative of a physiological downregulation. In the mouse hypothalamus a downregulation of Pomc (p < 0.01) along with upregulation of Npy (p < 0.001) and Agrp (p < 0.0001) expression was found after restricted feeding in support of increased hunger after diet-induced weight loss. Therefore, we investigated the NT response in humans undergoing weight loss maintenance. In humans, similar to the mice, the low-calorie diet induced weight loss of 13 % body weight was associated with 40 % reduction in fasting plasma NT levels (p < 0.001). Meal-induced NT peak responses were greater in humans who lost additional weight during the 1 year maintenance phase compared to participants who regained weight (p < 0.05). Diet-induced weight loss decreased fasting plasma NT levels in both humans and mice with obesity, and regulated hunger-associated hypothalamic gene expression in mice. Meal-induced NT responses were greater in humans who lost additional weight during the 1 year maintenance phase compared to participants who regained weight. This indicates that increased peak secretion of NT after weight loss may contribute to successful maintenance of weight loss. Clinical trial registration number: NCT02094183. • The anorexigenic hormone neurotensin is upregulated after bariatric surgery, which may contribute to sustained weight loss. • Neurotensin was measured using a novel approach with radioimmunoassay directly targeting the total secretion of neurotensin. • We found that diet-induced weight loss reduced plasma neurotensin in mice and humans with obesity. • Interestingly, increased meal-induced neurotensin release predicted successful weight loss maintenance in humans. [ABSTRACT FROM AUTHOR]

Summary 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. [ABSTRACT FROM AUTHOR]

Achieving maintenance of weight loss is crucial to combat obesity. However, most individuals tend to regain weight. Data from successful maintainers show that they remain vigilant and constantly apply techniques to oppose the course of regaining. On the other hand, current advances in obesity research show that the reduced obese state is a state of altered physiology in terms of energy balance. This review describes the physiological adaptations occurring after weight loss that predispose to regaining. Specifically, changes regarding body composition, hormonal background, energy expenditure and control of food intake are discussed. Moreover, metabolites that can act as regain predictors and dietary techniques to oppose regaining are presented. [ABSTRACT FROM AUTHOR]

Summary: Objective: To compare structural knee joint changes in obese patients with knee osteoarthritis (OA) that after an intensive weight loss therapy were randomized to continuous dietetic support, a specialized knee exercise program, or ‘no attention’ for 1 year. Methods: 192 obese individuals with knee OA underwent an intensive 16-week weight loss program with subsequent randomization to one of the three treatment groups. Changes in cartilage loss, bone marrow lesions (BMLs), synovitis, and effusion were assessed using semi quantitative assessments of magnetic resonance imaging (MRI) obtained at weeks 0 and 68 applying the BLOKS score. Results: During the 52 weeks maintenance period the continuous dietary maintenance group support on average gained 1.1 kg (95% CI: −0.3:2.5) body mass, the exercise group gained 6.6 kg (95% CI 5.4:7.8) and the no-attention group gained 4.8 kg (95% CI: 2.9:6.7). There were no statistically significant between-group differences in changes in cartilage loss, synovitis or effusion at the follow-up (analysis of covariance; ANCOVA, P > 0.16), while there was an increased number of medial tibiofemoral BMLs in the exercise group (ANCOVA, P = 0.015) compared to both diet (difference: −0.21 [95%CI −0.40:−0.03]) and “no attention” (difference: −0.26 [95%CI −0.44:−0.07]) groups. Conclusion: In this 1 year follow-up after weight-loss in obese knee OA patients, we found a potentially increased number of BMLs in the exercise group compared to the diet and no attention groups, with no between-group differences in changes in cartilage loss, synovitis or effusion. These findings should be interpreted with caution for exercise compliance, MRI methodology and follow-up time. (ClinicalTrials.gov identifier: NCT00655941) [Copyright &y& Elsevier]

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Copyright of Portuguese Journal of Public Health / Revista Portuguesa de Saúde Pública is the property of Revista Portuguesa de Saúde Pública - Escola Nacional de Saúde Pública and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents a study concerning successful weight loss by the National Weight Control Registry (NWCR) in the U.S. It notes that there is a need to improve weight loss maintenance since is it considered as the weakness of behavioral weight loss treatment programs. It cites that NWCR has educated the public on the health consequences of obesity. It mentions that most of the members of NWCR have used the combination of diet and physical activities for weight loss.

Objective: The authors investigated whether European American (EA) and African American (AA) women took longer to lose weight, and were less likely to maintain weight loss if they perceived others to be overweight. Design: Overweight EA and AA women completed a Figure Rating Scale and the Three-Factor Eating Questionnaire prior to a weight loss intervention. Body composition was assessed by dual energy X-ray absorptiometry prior to and following weight loss. Main Outcome Measures: rate of weight loss, % body fat at follow-up. Results: For EA, but not AA women, perception of others' body size was inversely associated with rate of weight loss and cognitive restraint, and positively associated with body fat gain following intervention. In linear regression modeling, EA, but not AA, women who perceived others as large, subsequently had greater percent body fat 1 year after weight loss than did those who perceived others as lean, independent of age, baseline body fat, and body size deemed "acceptable." Inclusion of cognitive restraint in the model weakened this effect. Conclusion: Among EA but not AA women, perception of others' body size influenced weight loss and maintenance. This effect may have been mediated by cognitive restraint. [ABSTRACT FROM AUTHOR]

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 minutes: before median 24.2, IQR 10.4-43.0 vs after median 24.9, IQR 10.0-46.3; P=.047; total active minutes: before median 45.1, IQR 22.9-74.9 vs after median 46.9, IQR 22.4-78.4; P=.03). The differences were larger when only completed Barriers modules were considered. The Barriers module completion was also associated with sustained effects in fairly active and total active minutes for most of the 8 weeks following module completion and for 3 weeks in very active minutes.Conclusions: The Barriers module had small, significant, immediate, and sustained effects on active minutes measured by a wrist-worn activity tracker. Future interventions should pay attention to assessing barriers and planning coping mechanisms to overcome them.Trial Registration: ISRCTN Registry ISRCTN88405328; https://www.isrctn.com/ISRCTN88405328. [ABSTRACT FROM AUTHOR]

The article presents various clinical trials on weight loss maintenance. The problem of overweight and obesity has reached epidemic proportions due to the recidivism associated with weight loss treatment. They are measured by the body mass index (BMI). The usual course of weight loss therapy shows that weight is lost quickly at first, and the point of greatest loss occurs six months after beginning treatment.

Few studies have examined predictors of weight regain after significant weight losses. This prospective study examined behavioral and psychological predictors of weight regain in 261 successful weight losers who completed an 18-month trial of weight regain prevention that compared a control condition with self-regulation interventions delivered face-to-face or via the Internet. Linear mixed effect models were used to examine behavioral and psychological predictors of weight regain, both as main effects and as interactions with treatment group. Decreases in physical activity were related to weight regain across all 3 groups, and increased frequency of self-weighing was equally protective in the 2 intervention groups but not in the control group. Increases in depressive symptoms, disinhibition, and hunger were also related to weight regain in all groups. Although the impact of changes in restraint was greatest in the Internet group and weakest in the face-to-face group, the latter was the only group with increases in restraint over time and consequent decreases in magnitude of weight regain. Future programs should focus on maintaining physical activity, dietary restraints, and frequent self-weighing and should include stronger components to modify psychological parameters. [ABSTRACT FROM AUTHOR]

Summary: Structured weight loss programs such as those using meal replacements are associated with both short-term and long-term weight loss, but the effectiveness of structured weight loss programs using whole foods has not been established. The primary aim of the present study was to retrospectively establish self-reported weight status in women, 3 years after participation in a 12-week food based structured weight loss program monitored by dietitians. The secondary aim was to determine which factors were associated with successful weight loss maintenance. Eighty-five of the 100 participants who completed the 12-week program participated in an 18-question telephone interview which included self-reported weight. Weight loss from baseline was 3.8 (S.D. 5.5) kg (4.4 (S.D. 6.1) %) (P <0.001). Overall, 61% of participants weighed less than at baseline, 13% had gained weight, and the remaining 26% had maintained their baseline weight. From baseline, 37 (44%) participants had a clinically important weight loss of≥5%, and were, on average, 9.8 (S.D. 4.2) % lighter (P <0.001). The remaining 48 (56%) participants (weight loss<5%) were not significantly different to their weight at baseline (P =0.77). We conclude that a food based structured weight loss program monitored by dietitians, as defined by this intervention, was associated with long-term weight loss maintenance. [Copyright &y& Elsevier]

Several recent studies suggest that daily weighing is important for long-term weight control, but concerns have been raised about possible adverse psychological effects. The ‘STOP Regain’ clinical trial provides a unique opportunity to examine this issue both cross-sectionally and prospectively. Successful weight losers (N = 314) were randomly assigned to a control or to a face-to-face or Internet intervention designed to help them maintain their weight loss and were then followed for 18 months. The intervention groups reported increases in daily self-weighing, which were associated with successful weight loss maintenance. We found no evidence that increases in frequency of weighing or daily weighing per se had any adverse effects in this study population. Rather, increases in self-weighing were associated with increases in dietary restraint (p < .001), decreases in disinhibition (p < .003), and decreases in depressive symptoms (p < .002). Moreover, those who weighed daily at 18 months were less likely to report having ≥4 binge episodes per month (p = .03). Daily weighing appears to be an important aspect of weight loss maintenance and was not associated with adverse psychological effects. [ABSTRACT FROM AUTHOR]

Background: An increasing number of eHealth interventions aim to support healthy behaviors that facilitate weight loss. However, there is limited evidence of the effectiveness of the interventions and little focus on weight loss maintenance. Knowledge about end user values and needs is essential to create meaningful and effective eHealth interventions, and to identify persuasive system design (PSD) principles and behavior change techniques (BCTs) that may contribute to the behavior change required for successful long-term weight loss maintenance.Objective: This study aimed to provide insight into the design of eHealth interventions supporting behavior change for long-term weight maintenance. The study sought to identify the values and needs of people with obesity aiming to maintain weight after weight loss, and to identify PSD principles, BCTs, and design requirements that potentially enable an eHealth intervention to meet end user values and needs.Methods: This study presents the concept of integrating PSD principles and BCTs into the design process of eHealth interventions to meet user values and needs. In this study, individual interviews and focus groups were conducted with people with obesity (n=23) and other key stakeholders (n=27) to explore end user values and needs related to weight loss maintenance. Design thinking methods were applied during the focus group sessions to identify design elements and to explore how eHealth solutions can support the needs to achieve sustainable weight loss maintenance. The PSD model and behavior change taxonomy by Michie were used to identify PSD principles and BCT clusters to meet end user values and needs.Results: A total of 8 key end user values were identified, reflecting user needs for weight loss maintenance support: self-management, personalized care, autonomy, feel supported, positive self-image, motivation, happiness, and health. Goals and planning, feedback and monitoring, repetition and substitution, shaping knowledge, social support, identity, and self-belief were some of the BCT clusters identified to address these concepts, together with PSD principles such as personalization, tailoring, self-monitoring, praise, and suggestions.Conclusions: The process of translating end user values and needs into design elements or features of eHealth technologies is an important part of the design process. To our knowledge, this is the first study to explore how PSD principles and BCTs can be integrated when designing eHealth self-management interventions for long-term weight loss maintenance. End users and other key stakeholders highlighted important factors to be considered in the design of eHealth interventions supporting sustained behavior change. The PSD principles and BCTs identified provide insights and suggestions about design elements and features to include for supporting weight loss maintenance. The findings indicate that a combination of BCTs and PSD principles may be needed in evidence-based eHealth interventions to stimulate motivation and adherence to support healthy behaviors and sustained weight loss maintenance.Trial Registration: ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988. [ABSTRACT FROM AUTHOR]

Background: Maintaining weight after weight loss is a major health challenge, and eHealth (electronic health) solutions may be a way to meet this challenge. Application of behavior change techniques (BCTs) and persuasive system design (PSD) principles in eHealth development may contribute to the design of technologies that positively influence behavior and motivation to support the sustainable health behavior change needed.Objective: This review aimed to identify BCTs and PSD principles applied in eHealth interventions to support weight loss and weight loss maintenance, as well as techniques and principles applied to stimulate motivation and adherence for long-term weight loss maintenance.Methods: A systematic literature search was conducted in PsycINFO, Ovid MEDLINE (including PubMed), EMBASE, Scopus, Web of Science, and AMED, from January 1, 2007 to June 30, 2018. Arksey and O'Malley's scoping review methodology was applied. Publications on eHealth interventions were included if focusing on weight loss or weight loss maintenance, in combination with motivation or adherence and behavior change.Results: The search identified 317 publications, of which 45 met the inclusion criteria. Of the 45 publications, 11 (24%) focused on weight loss maintenance, and 34 (76%) focused on weight loss. Mobile phones were the most frequently used technology (28/45, 62%). Frequently used wearables were activity trackers (14/45, 31%), as well as other monitoring technologies such as wireless or digital scales (8/45, 18%). All included publications were anchored in behavior change theories. Feedback and monitoring and goals and planning were core behavior change technique clusters applied in the majority of included publications. Social support and associations through prompts and cues to support and maintain new habits were more frequently used in weight loss maintenance than weight loss interventions. In both types of interventions, frequently applied persuasive principles were self-monitoring, goal setting, and feedback. Tailoring, reminders, personalization, and rewards were additional principles frequently applied in weight loss maintenance interventions. Results did not reveal an ideal combination of techniques or principles to stimulate motivation, adherence, and weight loss maintenance. However, the most frequently mentioned individual techniques and principles applied to stimulate motivation were, personalization, simulation, praise, and feedback, whereas associations were frequently mentioned to stimulate adherence. eHealth interventions that found significant effects for weight loss maintenance all applied self-monitoring, feedback, goal setting, and shaping knowledge, combined with a human social support component to support healthy behaviors.Conclusions: To our knowledge, this is the first review examining key BCTs and PSD principles applied in weight loss maintenance interventions compared with those of weight loss interventions. This review identified several techniques and principles applied to stimulate motivation and adherence. Future research should aim to examine which eHealth design combinations can be the most effective in support of long-term behavior change and weight loss maintenance. [ABSTRACT FROM AUTHOR]

Background: Mobile phone short message service (SMS) text messaging, has the potential to serve as an intervention medium to promote sustainability of weight loss that can be easily and affordably used by clinicians and consumers. Objective: To develop theoretically driven weight loss sustaining text messages and pilot an mHealth SMS text messaging intervention to promote sustaining recent weight loss in order to understand optimal frequency and timing of message delivery, and for feasibility and usability testing. Results from the pilot study were used to design and construct a patient privacy compliant automated SMS application to deliver weight loss sustaining messages. Methods: We first conducted a pilot study in which participants (N=16) received a daily SMS text message for one month following a structured weight loss program. Messages were developed from diet and exercise guidelines. Following the intervention, interviews were conducted and self-reported weight was collected via SMS text messaging. Results: All participants (N=16) were capable of sending and receiving SMS text messages. During the phone interview at 1 month post-baseline and at 3 months post-baseline, 13/14 (93%) of participants who completed the study reported their weight via SMS. At 3 months post-baseline, 79% (11/14) participants sustained or continued to lose weight. Participants (13/14, 93%) were favorable toward the messages and the majority (10/14, 71%) felt they were useful in helping them sustain weight loss. All 14 participants who completed the interview thought SMS was a favorable communication medium and was useful to receive short relevant messages promptly and directly. All participants read the messages when they knew they arrived and most (11/14, 79%) read the messages at the time of delivery. All participants felt that at least one daily message is needed to sustain weight loss behaviors and that they should be delivered in the morning. Results were then used to develop the SMS text messaging application. Conclusions: Study results demonstrated the feasibility of developing weight loss SMS text messages, and the development of an mHealth SMS text messaging application. SMS text messaging was perceived as an appropriate and accepted tool to deliver health promotion content. (JMIR Mhealth Uhealth 2013;1(1):e5) [ABSTRACT FROM AUTHOR]