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This study describes Canadian dietitians' approaches to counseling adults seeking weight-management advice. Fifteen focus groups were conducted at seven sites across Canada. The participants, most of whom worked in clinical or private practice, discussed their approach to specific weight-management counseling scenarios, including women clients with and without associated risk factors (impaired glucose tolerance, hypertension, family history of cardiovascular disease) and long histories of dieting. Results indicate that participants used a lifestyle approach for weight-management counseling, where the main goal was improved client health through healthful eating and increased physical activity. In contrast to clients' perceived weight loss goals, participants rarely included weight loss as a goal for clients with no additional chronic disease risk factors. For clients with risk factors, some participants advocated moderate weight loss, while others aimed for health at any size. Participants also discussed the importance of clients' psychological well-being, particularly in relation to feelings about food and body image. Individualized approaches to setting goals, gathering information, and giving advice/educating were identified as key counseling strategies. Further research to evaluate the effectiveness of dietitians' weight-management approaches and additional counseling training for dietitians will enhance practitioners' skills and confidence in this area. J Am Diet Assoc. 2005;105:1275-1279.

Abstract: Snacking may play a role in weight control. The associations of timing and frequency of snacking with observed weight change and nutrient intake were assessed in an ancillary study to a 12-month randomized controlled trial in Seattle, WA. Overweight-to-obese postmenopausal women (n=123) enrolled in the two dietary weight-loss arms from 2007 to 2008 with complete data at 12 months were included in these analyses. Generalized linear models were used to test the associations between snacking and weight loss (percent) and nutrient intake at the 12-month time point. Participants were, on average, 58 years old and mainly non-Hispanic white (84%). Ninety-seven percent reported one or more snacks per day. Weight loss (percent) was significantly lower among mid-morning (10:30 am to 11:29 am) snackers (7.0%, 95% confidence interval: 4.3 to 9.7) compared to non–mid-morning snackers (11.4%, 95% confidence interval: 10.2 to 12.6; P=0.005). A higher proportion of mid-morning snackers reported more than one snack per day (95.7%), compared to afternoon (82.8%) and evening (80.6%) snackers, although differences were not statistically significant (P>0.005). Women who reported two or more snacks per day vs one or no snacks per day had higher fiber intake (P=0.027). Afternoon snackers had higher fruit and vegetable intake compared to non–afternoon-snackers (P=0.035). These results suggest that snack meals can be a source for additional fruits, vegetables, and fiber-rich foods; however, snacking patterns might also reflect unhealthy eating habits and impede weight-loss progress. Future dietary weight-loss interventions should evaluate the effects of timing, frequency, and quality of snacks on weight loss. [Copyright &y& Elsevier]

Abstract: Background: Dietary components effective in weight maintenance efforts have not been adequately identified. Objective: To determine the effects of changes in dietary consumption on weight loss and maintenance during the Weight Loss Maintenance clinical trial. Design: Weight Loss Maintenance was a randomized controlled trial. Successful weight loss participants who completed Phase I of the trial and lost 4 kg were randomized to one of three maintenance intervention arms in Phase II and followed for an additional 30 months. Participants/setting: The multicenter trial was conducted from 2003 through 2007. This substudy included 828 successful weight loss participants. Methods: The Block Food Frequency Questionnaire (FFQ) was used to assess nutrient intake levels and food group servings. Carbohydrates, proteins, fats, dietary fiber, fruit/vegetable, and dairy servings were utilized as predictor variables. The FFQ was collected on all participants at study entry (beginning of Phase I). Those randomized to Phase II completed the FFQ at three additional time points: randomization (beginning of Phase II), 12 months, and 30 months. Intervention: The main intervention focused on long-term maintenance of weight loss using the Dietary Approaches to Hypertension diet. This substudy examined if changes to specific dietary variables were associated with weight loss and maintenance. Statistical analyses performed: Linear regression models that adjusted for change in total energy examined the relationship between changes in dietary intake and weight for each time period. Site, age, race, sex, and a race–sex interaction were included as covariates. Results: Participants who substituted protein for fat lost, on average, 0.33 kg per 6 months during Phase I (P<0.0001) and 0.07 kg per 6 months during Phase II (P<0.0001) per 1% increase in protein. Increased intake of fruits and vegetables was associated with weight loss in Phases I and II: 0.29 kg per 6 months (P<0.0001) and 0.04 kg per 6 months (P=0.0062), respectively, per 1-serving increase. Substitution of carbohydrates for fat and protein for carbohydrates were associated with weight loss during both phases. Increasing dairy intake was associated with significant weight loss during Phase II (−0.17 kg per 6 months per 1-serving increase, P=0.0002), but not during Phase I. Dietary fiber revealed no significant findings. Conclusions: Increasing fruits, vegetables, and low-fat dairy may help achieve weight loss and maintenance. [Copyright &y& Elsevier]

Abstract: The possibility that lifestyle changes may be shared by the family members of subjects with obesity attending cognitive-behavioral treatment (CBT) for weight loss has been scarcely evaluated. The purpose of this study was to measure the changes in body weight, lifestyle habits, and stage of change toward physical activity in the family members of 149 subjects with overweight/obesity enrolled into a weekly group CBT for weight management in the years 2007-2008. 230 adult (aged >18 years) family members (129 spouses, 72 children (43 female, 29 male), 29 with a different family relationship) completed a self-administered questionnaire at baseline and soon after the end of the completion of their relatives'' program (approximately 6 months later). The questionnaire consisted of qualitative information regarding food choices, estimation of energy and food intake, self-report of height and weight, and motivation toward physical activity. At baseline, self-reported body mass index was normal in 115 cases, in the range 25 to 29.9 in 80 and ≥30 in 35. Following CBT of their relatives, the family members significantly reduced their average daily energy intake (−232 kcal/day; P<0.001) and the reported body weight decreased on average by 1 kg (P=0.001). The analysis of food choices revealed a reduced average daily amount of energy from dressings (−40 kcal, P<0.001), main courses with cheese or fat meat (−24 kcal, P=0.002), refined carbohydrates (−16 kcal, P<0.001), bread (−58 kcal, P<0.001), breakfast biscuits (−23 kcal, P=0.005), chocolate (−7 kcal, P=0.024), and nonalcoholic beverages (fruit juices and carbonated drinks; −10 kcal; P=0.013), whereas fruit consumption was increased (+10 kcal; P=0.023). There was also a shift in the stage of change toward exercising. Body mass index changes of family members and CBT subjects were significantly correlated, mainly within spouses. In conclusion, CBT for weight loss positively influences the lifestyle habits of family members of participants, reducing energy intake and promoting a more favorable attitude toward physical activity. [Copyright &y& Elsevier]

Abstract: Eating frequency has been negatively related to body mass index (BMI). The relationship between eating frequency and weight loss maintenance is unknown. This secondary analysis examined eating frequency (self-reported meals and snacks consumed per day) in weight loss maintainers (WLM) who had reduced from overweight/obese to normal weight, normal weight (NW) individuals, and overweight (OW) individuals. Data collected July 2006 to March 2007 in Providence, RI, included three 24-hour dietary recalls (2 weekdays, 1 weekend day) analyzed using Nutrient Data System for Research software from 257 adults (WLM n=96, 83.3% women aged 50.0±11.8 years with BMI 22.1±1.7; NW n=80, 95.0% women aged 46.1±11.5 years with BMI 21.1±1.4; OW n=81, 53.1% women aged 51.4±9.0 years with BMI 34.2±4.1) with plausible intakes. Participant-defined meals and snacks were ≥50 kcal and separated by more than 1 hour. Self-reported physical activity was highest in WLM followed by NW, and then OW (3,097±2,572 kcal/week, 2,062±1,286 kcal/week, and 785±901 kcal/week, respectively; P<0.001). Number of daily snacks consumed was highest in NW, followed by WLM, and then OW (2.3±1.1 snacks/day, 1.9±1.1 snacks/day, and 1.5±1.3 snacks/day, respectively; P<0.001). No significant group differences were observed in mean number of meals consumed (2.7±0.4 meals/day). Eating frequency, particularly in regard to a pattern of three meals and two snacks per day, may be important in weight loss maintenance. [Copyright &y& Elsevier]

Abstract: Background: Micronutrient deficiencies have been associated with an increase in fat deposition and body weight; thus, adding them to low-fat milk may facilitate weight loss when accompanied by an energy-restricted diet. Objective: The objective was to evaluate the effect of the intake of low-fat milk and low-fat milk with added micronutrients on anthropometrics, body composition, blood glucose levels, lipids profile, C-reactive protein, and blood pressure of women following an energy-restricted diet. Design: A 16-week randomized, controlled intervention study. Participants/settings: One hundred thirty-nine obese women (aged 34±6 years) from five rural communities in Querétaro, Mexico. Intervention: Women followed an energy-restricted diet (−500 kcal) and received in addition one of the following treatments: 250 mL of low-fat milk (LFM) three times/day, 250 mL of low-fat milk with micronutrients (LFM+M) three times/day, or a no milk control group (CON). Weight, height, and hip and waist circumferences were measured at baseline and every 4 weeks. Body composition measured by dual-energy x-ray absorptiometry, blood pressure, and blood analysis were done at baseline and at the end of the 16 weeks. Main outcome measures: Changes in weight and body composition. Statistical analysis: One-factor analysis of variance, adjusted by age, baseline values, and community random effects. Results: After the 16-week intervention, participants in the LFM+M group lost significantly more weight (−5.1 kg; 95% CI: −6.2 to −4.1) compared with LFM (−3.6 kg; 95% CI: −4.7 to −2.6) and CON (−3.2 kg; 95% CI: −4.3 to −2.2) group members (P=0.035). Body mass index change in the LFM+M group (−2.3; 95% CI: −2.7 to −1.8) was significantly greater than LFM group members (−1.5; 95% CI: −2.0 to −1.1) and CON group members (−1.4; 95% CI: −1.9 to −0.9) (P=0.022). Change in percent body fat among LFM+M group members (−2.7%; 95% CI: −3.2 to −2.1) was significantly higher than LFM group members (−1.8%; 95% CI: −2.3 to −1.3) and CON group members (−1.6%; 95% CI: −2.2 to −1.0) (P=0.019). Change in bone mineral content was significantly higher in LFM group members (29 mg; 95% CI: 15 to 44) and LFM+M group members (27 mg; 95% CI: 13 to 41) compared with CON group members (−2 mg; 95% CI: −17 to −14) (P=0.007). No differences were found between groups in glucose level, blood lipid profile, C-reactive protein level, or blood pressure. Conclusions: Intake of LFM+M increases the effectiveness of an energy-restricted diet to treat obesity, but had no effect on blood lipid levels, glucose levels, C-reactive protein, or blood pressure. [Copyright &y& Elsevier]

Abstract: After age 70 to 75 years, average body weight decreases both in ailing and healthy people because of a loss of appetite that results in reduced energy intake and the loss of body fat and lean muscle tissue. This so-called anorexia of aging predisposes elderly people to continued pathologic weight loss and malnutrition—major causes of morbidity and mortality. Health care professionals must understand the many factors involved in the anorexia of aging to help older adults prevent unintentional weight loss. Psychological, social, and cultural factors are important effectors; however, physiological factors are emphasized here because they are not thoroughly understood and they make it inherently difficult for most people to alter their body weight. Monoamines, steroid hormones (glucocorticoids and mineralocorticoids), endocannabinoids, and proteins all influence body weight. This review is an analysis of proteins from the brain, pancreas, adipose tissue, and gastrointestinal tract that are known to affect energy intake and energy balance, with an attempt to identify those factors that may change with aging. The articles included in this review were obtained by a PubMed database search using the keywords mouse OR rat OR human AND aged OR aging OR older OR elderly AND adult AND anorexia OR “unintentional weight loss,” and each of the individual proteins discussed, as well as from the reference lists of those articles. The results reveal that some proteins may be important in the development of unintentional weight loss in elderly persons, whereas others may not have a significant role. However, many of the proteins that could conceivably have a role in unintentional weight loss have not yet been studied with that question in mind. Preventing unintentional weight loss in older adults is an important goal and further research on the role of proteins important for the maintenance of energy balance and the development of unintentional weight loss in elderly persons is warranted. [Copyright &y& Elsevier]

Abstract: Validation of the nutrition standardized language assures the language is accurate for use in practice, policy, and research, but few validation studies have been reported. The purpose of this descriptive study was to validate content of all components of the nutrition diagnostic term involuntary weight loss using experts providing care for older adults in health care settings. A Nutrition Diagnosis Validation Instrument was developed that contained the definition, etiologies, and signs and symptoms of the diagnosis plus items added from literature review. Questions on clarity and completeness of the language were included. The Nutrition Diagnosis Validation Instrument used a Likert-type scale for deriving a Diagnostic Content Validity (DCV) score for all items in the definition, etiology, and signs and symptoms components to define major, minor, and nonrelevant characteristics and a mean total DCV score for the term. In 2008, all Board Certified Specialists in Gerontological Nutrition (CSGs) were recruited by mail. CSGs (n=110, 73% response) reported 15±10 (mean±standard deviation) practice years in gerontological nutrition. The total DCV component scores were 0.80±0.17 (definition), 0.63±0.08 (etiology), and 0.69±0.12 (signs and symptoms). The mean total DCV score of the diagnostic term was 0.69±0.11. Cognitive decline, poor oral health, and impaired skin integrity were identified as missing language. In conclusion, the majority of the definition, etiologies, and signs and symptoms of the term were content-validated, including seven items derived from literature review. The validated items, including recommendations for added language, need to be retested using the same process. [Copyright &y& Elsevier]

Background: Behavioral interventions targeting children with overweight have been successful in facilitating weight loss; however, there is concern that these programs produce disordered eating attitudes among youth. Objective: The purpose of this research was to determine whether youth with overweight receiving one of two behavioral interventions were more likely to report an increase in disordered eating attitudes over time compared to a waitlist control and to determine psychosocial predictors of eating-disordered attitudes at 6-month follow-up. Design: Participants were randomized to one of two behavioral lifestyle interventions or a waitlist control. Data were collected at baseline, post-treatment, and 6-month follow-up. Participants/setting: Participants were 68 youths with overweight, aged 8 to 13 years, and their parent(s) who lived in rural north central Florida. The project ran from January 2006 to January 2008. Intervention: Each treatment condition consisted of 12 group sessions over 16 weeks. Main outcome measures: Parents completed a demographic form and the Child Feeding Questionnaire. Children completed the Children''s Eating Attitudes Test, Schwartz Peer Victimization Scale, and Children''s Body Image Scale. Statistical analyses performed: Mixed 2×2 analyses of variance were used to examine the effect of treatment on eating attitudes. Hierarchical linear regression was used to assess whether baseline levels of psychosocial variables predicted disordered eating attitudes at follow-up, controlling for baseline eating attitudes and treatment condition. Results: Youth who participated in the behavioral interventions did not report significant increases in disordered eating attitudes over time compared to the waitlist control. Across all conditions, higher levels of body dissatisfaction, peer victimization, parent restrictive feeding practices, and concern for child weight at baseline predicted higher levels of disordered eating attitudes at follow-up. Conclusions: These findings do not provide evidence that behavioral interventions lead to an increase in unhealthy eating attitudes and behaviors. Future research should examine the effects of incorporating eating disorder prevention in pediatric weight management programs. [Copyright &y& Elsevier]

Abstract: Increased visibility of food labels is a potential method to reduce the rate of obesity. However, few empirical studies have investigated the impact of nutrition labeling on food selection or energy intake. This study tested the hypothesis that nutrition labeling in combination with nutrition label education would promote reductions in energy intake using a laboratory-based paradigm. Forty-seven male (n=24) and female (n=23) participants visited the Nutrition and Health Research Laboratory for a single lunch session during the months of May through August 2009. Participants were randomly assigned to one of two video groups (Nutrition Labeling Education or Organic Food Movement) and one of two labeling conditions (Nutrition Labels or No Labels). Participants watched a short educational video and then consumed a buffet lunch. Data were analyzed using a three-way analysis of covariance with sex, video condition, and labeling group as the between-subject factors and age and race as covariates. There were main effects of sex and nutrition label condition on lunch energy intake with females consuming less than males and people with nutrition labels consuming less energy than those without, regardless of sex or video condition. Examination of energy intake from low-energy-density and high-energy-density foods showed that the nutrition labeling group consumed less energy from both low-energy-density and high-energy-density food sources. These data support the use of nutrition labels as a way to reduce energy intake. [Copyright &y& Elsevier]

Abstract: Twenty-four–hour dietary recalls are used frequently to study homebound older adults'' eating behaviors. However, the reliability and predictive validity of this method have not been established in this population. The purpose of this study was to examine whether homebound older adults provide reliable and valid measures of total energy intake in 24-hour dietary recalls. Two hundred thirty homebound older adults were interviewed in their homes using a questionnaire to assess eating behaviors and factors that could affect those behaviors. Participants completed three 24-hour dietary recalls at baseline and again at 6-month follow-up. Two subsamples were identified for analyses. For participants who were not hospitalized during the 6-month interval and had their weight measured at both assessments (n=52), sufficient test–retest reliability of energy intake was observed (r=0.59), but energy intake deficiencies relative to estimated energy requirements did not predict actual weight loss (r=0.08). When this sample was supplemented with 91 participants who experienced any adverse event (weight loss of 2.5% or more, hospitalization, institutionalization, or mortality) in the 6-month period (n=143), adverse events were more likely to occur for those with insufficient energy intake (odds ratio 3.49, P=0.009), and in white participants compared to African-American participants (odds ratio 3.13, P=0.016). Adequate test–retest reliability of the 24-hour dietary recall was demonstrated, but additional research with larger samples and longer follow-up intervals is needed to better evaluate the predictive validity of energy intake measures for this population. [Copyright &y& Elsevier]

Abstract: This systematic review assesses the effectiveness and safety of dietary interventions for rheumatoid arthritis. Randomized controlled trials comparing any dietary manipulation with an ordinary diet were included. Eight randomized controlled trials with a total of 366 patients were included. One trial found that fasting, followed by 13 months on a vegetarian eating plan, might reduce pain (mean difference on a zero to 10 scale −1.89, 95% confidence interval [CI] −3.62 to −0.16). Another single trial found that a 12-week Cretan Mediterranean eating plan might reduce pain (mean difference on a 0 to 100 scale −14.00, 95% CI −23.6 to −4.37). Due to inadequate data reporting, the effects of vegan eating plans and elimination diets are uncertain. When comparing any dietary manipulation with an ordinary diet we found a higher total drop-out of 8% (risk difference 0.08, 95% CI −0.01 to 0.17), higher treatment-related drop-out of 5% (risk difference 0.05, 95% CI −0.03 to 0.14) and a significantly higher weight loss (weighted mean difference −3.24, 95% CI −4.81 to −1.67 kg) in the diet groups compared to the control groups. The effects of dietary manipulation, including vegetarian, Mediterranean, and elemental eating plans, and elimination diets on rheumatoid arthritis are still uncertain due to the included studies being small, single trials with moderate to high risk of bias. We conclude that higher dropout rates and weight loss in the groups with dietary manipulation indicate that potential adverse effects should not be ignored. [Copyright &y& Elsevier]

Abstract: A frequently cited concern of very-low-carbohydrate diets is the potential for increased risk of renal disease associated with a higher protein intake. However, to date, no well-controlled randomized studies have evaluated the long-term effects of very-low-carbohydrate diets on renal function. To study this issue, renal function was assessed in 68 men and women with abdominal obesity (age 51.5±7.7 years, body mass index [calculated as kg/m2] 33.6±4.0) without preexisting renal dysfunction who were randomized to consume either an energy-restricted (∼1,433 to 1,672 kcal/day), planned isocaloric very-low-carbohydrate (4% total energy as carbohydrate [14 g], 35% protein [124 g], 61% fat [99 g]), or high-carbohydrate diet (46% total energy as carbohydrate [162 g], 24% protein [85 g], 30% fat [49 g]) for 1 year. Body weight, serum creatinine, estimated glomerular filtration rate and urinary albumin excretion were assessed before and after 1 year (April 2006-July 2007). Repeated measures analysis of variance was conducted. Weight loss was similar in both groups (very-low-carbohydrate: −14.5±9.7 kg, high-carbohydrate: −11.6±7.3 kg; P=0.16). By 1 year, there were no changes in either group in serum creatinine levels (very-low-carbohydrate: 72.4±15.1 to 71.3±13.8 μmol/L, high-carbohydrate: 78.0±16.0 to 77.2±13.2 μmol/L; P=0.93 time × diet effect) or estimated glomerular filtration rate (very-low-carbohydrate: 90.0±17.0 to 91.2±17.8 mL/min/1.73 m2, high-carbohydrate: 83.8±13.8 to 83.6±11.8 mL/min/1.73 m2; P=0.53 time×diet effect). All but one participant was classified as having normoalbuminuria at baseline, and for these participants, urinary albumin excretion values remained in the normoalbuminuria range at 1 year. One participant in high-carbohydrate had microalbuminuria (41.8 μg/min) at baseline, which decreased to a value of 3.1 μg/min (classified as normoalbuminuria) at 1 year. This study provides preliminary evidence that long-term weight loss with a very-low-carbohydrate diet does not adversely affect renal function compared with a high-carbohydrate diet in obese individuals with normal renal function. [Copyright &y& Elsevier]

Abstract: Bariatric surgery forces participants to undergo a volatile dietary adjustment. The purpose of this cross-sectional research was to chronicle food selection during the period from when solid food is reintroduced through 2.5 years. Forty-eight postsurgery Roux-en-Y gastric bypass patients participated in the research. Each food item selection was recorded from a list of foods that consisted of 236 individual foods. Food item selection was then categorized into one of nine conventional US Department of Agriculture–based food-groupings (eg, Dairy). No food selection differences were detected between the men and women in the study. Mean weight loss since surgery was 53.6±20.6 kg. Mean time since surgery was 11.1±7.0 months for the 35 female and 13 male patients. The food selection categories ranged from 63.2% for Condiments to 28.3% for Sweets. Next, food selections were reclassified into 31 more specific bariatric subgroups (eg, Cheeses, Milks, Yogurts). Bariatric subgroup intake ranged from 84.2% for Bottled/Tap Water to 4% for Sugared Beverages. Several group homogeneity differences existed between conventional and bariatric subgroups. Subgroup means were statistically different for the conventional categories of Dairy, Sweets, and Beverages (P>0.05). These differences demonstrate that the standard benchmarks of conventional food groupings sometimes fail to represent accurately food selection in this population. This type of more specific classification information improves eating recommendations provided by dietetics practitioners. Just as exchange food groups are of great value to patients with diabetes, these more specific bariatric food subgroups represent a needed increase in accuracy in dietary recommendations for patients after Roux-en-Y gastric bypass. [Copyright &y& Elsevier]

Abstract: Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgery in which 60% to 80% of the stomach is removed longitudinally, resulting in a smaller stomach that takes the shape of a “sleeve.” The mechanism for weight loss is gastric restriction and possible neurohormonal changes resulting from lower levels of ghrelin (an appetite-stimulating hormone), as a consequence of removing the gastric fundus. LSG may be more desirable than laparoscopic adjustable gastric banding because there is no foreign object inside the abdomen and no need for postsurgery appointments to adjust the band. LSG may be preferred over Roux-en-Y gastric bypass (RYGB) because LSG is a less complicated operation that does not result in dumping syndrome or malabsorption, yet weight loss is comparable to RYGB. While LSG is suggested to have advantages over the commonly performed laparoscopic adjustable gastric banding and RYGB, there are no long-term (>5 years) outcomes and few studies specific to nutrition care for LSG patients. This article will present a protocol for pre- and postsurgery nutrition care for LSG and the important role the registered dietitian plays in the multidisciplinary team. Postsurgery diet progression from liquids to solids during 6 to 8 weeks should focus on meeting protein and fluid needs. In addition, LSG patients are at risk for nutrient deficiencies due to decreased hydrochloric acid and intrinsic factor from removed parietal cells and reduced dietary intake due to decreased ghrelin levels. Therefore, LSG patients should take daily micronutrient supplements, including vitamin B-12 and potentially supplemental iron, to prevent deficiencies. [Copyright &y& Elsevier]

Abstract: Roux-en-Y gastric bypass is a well-accepted tool for the treatment of obesity and, compared to conventional weight loss methods (eg, diet and exercise) and other weight loss surgeries (eg, gastric banding), it results in considerable weight loss that is maintained long term. Although successful, the mechanisms for weight loss are not completely understood and it is thought that gastrointestinal hormones play a role. Several gastrointestinal hormones have been identified for their effects on appetite, including glucagon-like peptide-1 (GLP-1), peptide tyrosine-tyrosine (PYY), leptin, and ghrelin. This review encompasses a literature search that included 45 primary articles and shows that there are alterations in GLP-1, PYY, leptin, and ghrelin postoperatively. GLP-1 and PYY concentrations were usually found to be higher, whereas ghrelin levels were typically lower post- Roux-en-Y gastric bypass than in individuals with obesity, those who were overweight or of normal weight, and in those who underwent procedures other than Roux-en-Y gastric bypass or who achieved weight loss by lifestyle modification. An understanding of how gastrointestinal hormones change after Roux-en-Y gastric bypass may help dietetics practitioners optimize nutrition care for this patient population. A review of the literature also highlighted some research gaps that should be taken into consideration when designing future studies. [Copyright &y& Elsevier]

Abstract: Objective: Weight loss and consumption of viscous fibers both lower low-density lipoprotein (LDL) cholesterol levels. We evaluated whether or not a whole-grain, ready-to-eat (RTE) oat cereal containing viscous fiber, as part of a dietary program for weight loss, lowers LDL cholesterol levels and improves other cardiovascular disease risk markers more than a dietary program alone. Design: Randomized, parallel-arm, controlled trial. Subjects/setting: Free-living, overweight and obese adults (N=204, body mass index 25 to 45) with baseline LDL cholesterol levels 130 to 200 mg/dL (3.4 to 5.2 mmol/L) were randomized; 144 were included in the main analysis of participants who completed the trial without significant protocol violations. Intervention: Two portions per day of whole-grain RTE oat cereal (3 g/day oat b-glucan) or energy-matched low-fiber foods (control), as part of a reduced energy (∼500 kcal/day deficit) dietary program that encouraged limiting consumption of foods high in energy and fat, portion control, and regular physical activity. Main outcome measures: Fasting lipoprotein levels, waist circumference, triceps skinfold thickness, and body weight were measured at baseline and weeks 4, 8, 10, and 12. Results: LDL cholesterol level was reduced significantly more with whole-grain RTE oat cereal vs control (−8.7±1.0 vs −4.3±1.1%, P=0.005). Total cholesterol (−5.4±0.8 vs −2.9±0.9%, P=0.038) and non–high-density lipoprotein-cholesterol (−6.3±1.0 vs −3.3±1.1%, P=0.046) were also lowered significantly more with whole-grain RTE oat cereal, whereas high-density lipoprotein and triglyceride responses did not differ between groups. Weight loss was not different between groups (−2.2±0.3 vs −1.7±0.3 kg, P=0.325), but waist circumference decreased more (−3.3±0.4 vs −1.9±0.4 cm, P=0.012) with whole-grain RTE oat cereal. Larger reductions in LDL, total, and non–high-density lipoprotein cholesterol levels and waist circumference were evident as early as week 4 in the whole-grain RTE oat cereal group. Conclusions: Consumption of a whole-grain RTE oat cereal as part of a dietary program for weight loss had favorable effects on fasting lipid levels and waist circumference. [Copyright &y& Elsevier]

Abstract: Excess weight is associated with negative health outcomes. Meal replacements are effective in promoting favorable body composition changes in civilian populations; however, their efficacy with military service members who have unique lifestyles is unknown. The objective of this randomized controlled trial was to determine the efficacy of the Army''s education-based weight-management program, “Weigh to Stay,” with and without meal replacements for improving blood lipids, and to promote weight and body fat loss in overweight US Army soldiers. Soldiers (n=113; 76 males/37 females) attending Weigh to Stay at Fort Bragg, NC, in 2006/2007 were randomized to Weigh to Stay only or a commercially available meal-replacement program (two meal replacements per day) in conjunction with Weigh to Stay, and followed until Army body fat standards were met or for 6 months if standards were not met. Study completers (n=46) in both treatment groups lost weight (Weigh to Stay: −2.7±4.3 kg; meal replacers: −3.8±3.5 kg) and fat mass (Weigh to Stay, −2.7±3.2 kg; meal replacers: −2.9±2.5 kg), and improved high-density lipoprotein cholesterol concentrations (Weigh to Stay: 13±9 mg/dL [0.34±0.23 mmol/L]; meal replacers: 8±7 mg/dL [0.21±0.18 mmol/L]; P<0.05); however, no between-group differences were observed. Attrition was lower (P=0.009) and success in meeting body fat standards tended to be higher (P=0.06) for the meal replacers vs Weigh to Stay participants. Intent-to-treat analysis demonstrated that meal replacers lost more weight (1.2±0.5 kg), percent body fat (1.0%±0.4%), and fat mass (0.8±0.4 kg) compared to Weigh to Stay volunteers (P<0.05). Our findings suggest that meal replacement use can be recommended as a potential adjunct strategy to Weigh to Stay. [Copyright &y& Elsevier]

Abstract: The purpose of this pilot study was to evaluate the differences in weight control behaviors, dietary intake, and physical activity between overweight adolescents who lost weight and overweight adolescents who did not lose weight. This cross-sectional study compared 62 overweight adolescents who lost weight in the past with 68 overweight adolescents who did not lose weight. Youth responded to questions regarding weight control behaviors during the past year, physical activity, sedentary activity, and dietary intake. Results showed that adolescents who lost weight were more likely to report using healthful weight control behaviors such as drinking less soda and increasing their exercise level, self-weighing, consuming diets higher in protein, and spending less time watching television compared to overweight adolescents who did not lose weight. Unhealthful weight control behaviors and specific weight loss plans were not associated with weight loss in these teenagers. Adolescents would benefit from hearing this information to prevent the development of these behaviors. Providers should advise adolescents to engage in healthful weight control behaviors, such as increasing physical activity and decreasing the amount of time spent watching television, to assist with weight management. [Copyright &y& Elsevier]

Abstract: Larger portion sizes increase energy intake, yet it is unclear whether single-serving packages can reduce intake. This study examined the effects of providing breakfast foods in single-serving packages and nonportioned packages on energy intake of these foods during an 8-week behavioral weight-loss program. In fall 2005, 19 adults (mean body mass index [calculated as kg/m2]=31.8±4.0) were randomized to conditions that provided foods in single-serving packages (Single-Serving) or in nonportioned packages (Standard). Overall amounts and types of foods provided were consistent across conditions: cereal and peaches (weeks 1, 3, 5, and 7) and applesauce and cheese (weeks 2, 4, 6, and 8). Participants were instructed to eat one serving of each food for breakfast and not to consume the provided foods at other times. Mean daily energy intake of the provided foods was the primary dependent variable. The Single-Serving group ate less energy from the combined pairs of foods provided together as compared to Standard (cereal and peaches, 117.0±3.2 kcal/day vs 143.5±39.3 kcal/day; P<0.05 and applesauce and cheese, 174.2±13.5 kcal/day vs 199.0±29.4 kcal/day; P<0.05). This effect was a result of less energy consumed from cereal and applesauce in Single-Serving compared to Standard conditions (cereal, 80.2±2.9 kcal/day vs 106.3±22.9 kcal/day; P<0.01 and applesauce, 44.5±0.6 kcal/day vs 59.3±5.0 kcal/day; P<0.01), with no differences in energy consumption for peaches and cheese (P>0.10). This suggests that single-serving packages may help reduce energy intake at breakfast within the context of a behavioral weight-control program. [Copyright &y& Elsevier]

Abstract: Unrealistic weight-loss goals may impede the success of weight-loss attempts. The aim of this study was to examine the frequency of unrealistic goals and their association with other patient characteristics at the start of a weight-loss program. For patients with a body mass index (calculated as kg/m2) of 30 to 35, 35 to 40, or 40 to 50, medically advised weight-loss goals were set at 10%, 15%, and 20% of current weight, respectively. Personal weight-loss goals exceeding the medically advised goal by >50% were considered unrealistic. Obesity-related beliefs were measured by the “Obesity Cognition Questionnaire” and the eating-behavior self-efficacy scale of the “Obesity Psychosocial State Questionnaire.” From September 2003 until March 2006, 90 patients were enrolled in the study, 26 men and 64 women, with a mean age of 43 years (range=18 to 68 years) and body mass indexes ranging from 30 to 50. Unrealistic goals were observed in 49% of the patients and were more frequent in younger patients (P=0.03), in patients attributing their obesity to physical causes (r=0.35, P=0.001), and in patients not attributing their obesity to behavioral causes (r=−0.28, P=0.008). This study confirms that discrepancies in weight-loss goals between obese patients and professionals occur frequently. Because unrealistic goals can hamper long-term outcomes of weight-loss programs, better outcomes could possibly be achieved by addressing unrealistic weight-loss goals before treatment. [Copyright &y& Elsevier]

Abstract: The prevalence of obesity among older adults has increased during the past 20 years and will affect both medical and social services. Along with an increased risk of cardiovascular disease, diabetes, and several cancers, obesity is associated with increased risk of physical and cognitive disability. However, relatively little attention has been given to the issue of weight management among community-dwelling older adults. Intentional weight loss in obese older adults has not been widely advocated by health care providers due to the uncertainty of whether the benefits outweigh the risks. Limited data in older adults show that intentional weight loss is effective in improving diabetes, cardiovascular risk factors, and physical function. This review describes the changes in body composition associated with aging, the consequences of obesity in older adults, and the effect of intentional weight loss on chronic disease risk factors and physical function. Recommendations for weight loss in obese older adults that minimize the likelihood of adverse effects on muscle mass, bone density, or other aspects of nutritional status are reviewed. Specific recommendations for macronutrient intake, in particular protein, and selected micronutrients, vitamin D and B-12, as well as dietary fiber, and fluid intake as part of a hypocaloric diet and recommendations for physical activity are described. As part of the health professionals team, dietetics practitioners need to be able to guide and manage weight loss treatment options on an individual basis by evaluating the potential benefits against the potential risks in obese older adults. [Copyright &y& Elsevier]

Abstract: Background: Cross-sectional research has found that dieting during adolesence and the use of extreme weight control behaviors are related to less healthful dietary patterns; however, little is known regarding longitudinal relationships. Objective: To describe patterns of weight control behavior over 5 years and examine relationships with nutritional outcomes in adolescents and young adults. Design: Population-based, longitudinal study in Minnesota. Youth completed Time 1 surveys in 1998-1999, and Time 2 surveys were completed in 2003-2004. Subjects/setting: The Project EAT (Eating Among Teens) survey and the Youth and Adolescent Food Frequency Questionnaire were completed by 1,242 females and 1,007 males in school classrooms at Time 1 and by mail at Time 2. Outcome measures and statistical analyses performed: Generalized linear modeling was used to predict each Time 2 outcome of interest (ie, meal and snack frequencies and dietary intake) across patterns of healthful and unhealthful weight control behavior (ie, never-engaging, stopping, starting, and persisting). Results: Approximately 45% of females and 17% of males reported persistent use of unhealthful weight control behaviors at both time points. Persisting to use only healthful weight control behaviors was reported by 10% of females and 15% of males. Among females, persistent use of unhealthful weight control behavior was associated (P<0.05) with measures of poorer dietary intake (eg, lower intakes of calcium and vegetables) and less frequent meals, whereas persistent use of healthful weight control behavior was associated with measures (P<0.05) of better dietary intake (eg, less fast food and fewer sugar-sweetened drinks). Among males, few associations were observed between dietary intake and either unhealthful or healthful weight control behavior. Conclusions: Health professionals should guide youth who have weight concerns by encouraging healthful eating habits to achieve or maintain appropriate weight and nutrition goals. [Copyright &y& Elsevier]

Abstract: Background: Poor long-term success observed with current weight-control strategies stresses the relevance to explore new weight management approaches. Objective: To assess the effects of a Health-At-Every-Size (HAES) intervention on eating behaviors, appetite sensations, metabolic and anthropometric variables, and physical activity levels in women at 6-month and 1-year postintervention. Design: Randomized controlled trial; measurements at baseline, at the end of the intervention period (4 months), and at 6-month and 1-year postintervention (10 months and 16 months, respectively). Intervention and testing took place from September 2003 to August 2006. Participants/setting: Premenopausal overweight/obese women (n=144; mean age of 42.3±5.6 years), recruited from free-living, general community. Intervention: Women were randomly assigned to: HAES group (n=48), social support group (n=48), or control group (n=48). Main outcome measures: Eating behaviors (restraint, disinhibition, and susceptibility to hunger), appetite ratings (desire to eat, hunger, fullness, and prospective food consumption), anthropometric and metabolic variables (body mass index, waist and hip circumferences, blood lipid levels, and blood pressure), and engagement in moderate to intense physical activity (energy cost ≥1.2 kcal×kg−1×15 minutes−1 [≥4.8 metabolic equivalents]). Statistical analyses performed: Changes for each dependent variable were assessed by linear mixed models according to a group (HAES vs social support vs control) by time (baseline vs 4 months vs 10 months vs 16 months) split-plot design. Results: Situational susceptibility to disinhibition and susceptibility to hunger significantly decreased over time in both HAES group (−0.9±0.2 and −1.3±0.5, respectively) and the social support group (−0.4± 0.2 and −1.4±0.5, respectively). Although eating behavior scores observed at 16 months did not differ between HAES and social support groups (situational susceptibility to disinhibition: 2.5±0.2 in HAES group vs 2.7 ± 0.2 in social support group; susceptibility to hunger: 4.2±0.5 in both groups), they were lower in these groups than scores noted in the control group (3.3±0.2 for situational susceptibility to disinhibition and 5.9±0.5 for susceptibility to hunger). Conclusions: These results suggest that, when compared to a control group, an HAES approach could have long-term beneficial effects on eating behaviors related to disinhibition and hunger. In addition, our study did not show distinctive effects of the HAES approach in comparison to a social support intervention. [Copyright &y& Elsevier]

Abstract: Background: Low-energy-density foods with high satiating power may be useful tools for weight management. Energy density of yogurts can range from 0.4 to 1.8 kcal/g. Objective: To test the effects of added inulin, a soluble fiber, on the satiating properties of low-energy-density and high-energy-density yogurt beverages (16 oz or 472 mL). Design: The study followed a within-subject preload design with repeated measures. Each participant completed six conditions, presented in a counterbalanced order. Subjects: Participants were 18 men and 20 women, aged 18 to 35 years. Intervention: The experimental conditions were two high-energy-density yogurt beverages (440 kcal; 0.9 kcal/g) and two low-energy-density yogurt beverages (180 kcal; 0.4 kcal/g) with or without inulin (6 g) and an equal volume of orange juice (180 kcal). A no beverage control condition was used as well. Main outcome measures: Repeated ratings of hunger, fullness, and desire to eat and energy consumption at the lunch meal served 120 minutes postingestion were the main measures. Statistical analyses performed: Repeated measures analyses of variance were used to analyze motivational ratings and energy and nutrient intakes at the test meal. Results: Yogurt beverages and liquid orange juice significantly suppressed appetite and promoted satiety relatively to the no beverage condition. Yogurt beverages had greater satiating power than did orange juice, as evidenced by higher satiety ratings and reduced energy intakes at lunch. The satiating power of low-energy-density yogurt with inulin was comparable to that of high-energy-density yogurt. Conclusions: Energy presented in liquid form can have satiating power. Added fiber can potentiate the satiating properties of low-energy-density liquid yogurts. Adding fiber to low-energy-density foods may be an effective way to suppress appetite and control food intake. [Copyright &y& Elsevier]

Abstract: Dietary modification to achieve weight loss during the postpartum period may be critical for prevention of obesity, particularly in low-income, minority women. The aim of this cross-sectional study was to develop and validate a measure to examine motivations to eat in low-income, minority women during early postpartum. A convenience sample of 179 triethnic women was recruited from the Special Supplemental Program for Women, Infants, and Children clinics from June 2004 to April 2007. Subjects made one visit to a study center where they completed the Eating Stimulus Index and questions regarding individual demographic characteristics including ethnicity, age, income, education, marital status, breastfeeding, and employment status. Weight and height were also measured during this visit and used to calculate body mass index (BMI; calculated as kg/m2). An additional sample of 31 women completed the Eating Stimulus Index on two occasions with 2 weeks between to establish test–retest reliability. The factor structure of the scale was examined with principal components analysis. Total scale scores and subscale scores were calculated and Pearson''s correlation and multiple regression analysis examined relationships to BMI. Principal component analysis produced an eight-factor structure with loadings >0.40. Cronbach''s α coefficients for each subscale ranged from .54 to .89. Subscales of Convenience Eating, Emotional Eating, and Dietary Restraint were related to BMI in mothers. African-American, exclusively formula-feeding, and older women were most vulnerable to convenience eating. White women and those with the highest level of education were most vulnerable to emotional eating. The Eating Stimulus Index is a valid and reliable instrument with the ability to discriminate by weight. It can be used to assess motivations to eat in order to facilitate development of tailored weight-loss messages during early postpartum. [Copyright &y& Elsevier]

Abstract: Many people use smoking as a weight control mechanism and are averse to quitting for fear of weight gain. These weight-concerned smokers tend to be women, are significantly less likely to stop smoking or to join smoking cessation programs, and will relapse more often than smokers who are not weight-concerned. Research suggests that a woman''s motivation to quit smoking correlates positively with her confidence in her ability to control her weight after quitting. Likewise, success in smoking cessation has been associated with increased self-efficacy for weight control. This randomized controlled trial investigated the effects of a weight control program on eating and smoking behaviors in a group of female, weight-concerned smokers from July 2005 to June 2006. Two hundred sixteen subjects who wanted to lose weight but were not yet ready to quit smoking were recruited to participate in a 12-week, cognitive-behavioral weight control program consisting of 12 1-hour sessions. Subjects were randomly assigned to either the weight-control program (intervention group) or the control group. Differences between the intervention and control groups were evaluated using t tests for continuous variables, Wilcoxon rank-sum tests for ordinal variables and χ2 tests for categorical variables. The intervention group had a 14% increase (P<0.001) in self-efficacy for weight control (Weight Efficacy Life-Style Questionnaire), which was associated with improved diet quality (Healthy Eating Index) (r=0.292, P<0.01), weight loss (r=0.582, P<0.001), increased self-efficacy for quitting smoking (Smoking Self-Efficacy Questionnaire) (r=0.291, P<0.014), a decrease in number of cigarettes smoked (r=0.331, P<0.005), and positive movement in stage of change toward smoking cessation (r=0.435, P<0.001). These findings suggest that for this group of weight-concerned smokers'' success in changing eating behavior may trigger a positive change in smoking behavior. [Copyright &y& Elsevier]

Abstract: Accurate information about weight loss is not available for most commercial weight-loss programs. Our objective was to obtain accurate assessments of weight outcomes, behavioral data, and side effects for an intensive behavioral weight-loss program using low-energy diets. Weights, behavioral data, and side effects for 173 consecutive patients were assessed. Treatment options were Medically Supervised, using a minimum of five meal replacements per day, and Healthy Solutions, using meal replacements, fruits, and vegetables. Both options included weekly classes, daily records, midweek phone calls, and a minimum physical activity goal of 2,000 kcal/week. The primary outcome was change in body weight with secondary outcomes related to behavioral changes and side effects. Intention-to-treat (ITT) and completer analyses (completed 9 weeks of treatment) were performed. During 13 months, 173 patients met criteria for analysis. They selected either Healthy Solutions: 56 patients (ITT) and 37 completers; or Medically Supervised: 117 patients (ITT) and 93 completers. Mean (±standard error) weight losses were: Healthy Solutions: ITT=12.8±1.3 kg in 13 weeks and completers=17.0±1.4 kg in 18 weeks; Medically Supervised: ITT=16.6±1.0 kg in 16 weeks and completers=19.7±1.0 kg in 19 weeks. Mean use of meal replacements, fruits, and vegetables exceeded goals. Most side effects were mild and did not affect program continuation. An intensive behavioral weight-loss program using low-energy diets, including five meal replacements daily, is safe and effective. [Copyright &y& Elsevier]

Abstract: Background: Weight loss through dietary modification is key to type 2 diabetes self-management, yet few nationally representative data exist on dietary trends among people with diabetes. Objective: To examine dietary changes, via nutrient intakes, among US adults with diabetes between 1988 and 2004. Design: Nutrition data from the cross-sectional National Health and Nutrition Examination Surveys (Phase I: 1988-1990 and Phase II: 1991-1994) and 1999-2004 of adults with self-reported diabetes were examined. Twenty-four–hour dietary recall data were used to assess changes in energy; carbohydrate; protein; total, saturated, polyunsaturated, and monounsaturated fat; cholesterol; fiber; sodium; and alcohol intake. Statistical analyses: Consumption of total energy and specific nutrients per day were estimated by survey, controlled for age and sex, using multiple linear regression and adjusted means (with standard errors). Results: Between 1988 and 2004 there was no significant change in self-reported total energy consumption among adults with self-reported diabetes (1,941 kcal/day in 1988-1990 to 2,109 kcal/day in 2003-2004, P for trend=0.22). However, there was a significant increase in the consumption of carbohydrate (209 g/day in 1988-1990 to 241 g/day in 2003-2004; P for trend=0.02). In analyses stratified by age group, changes in dietary consumption were noted among persons aged 45 to 64 years; specifically, increases in total energy (1,770 to 2,100 kcal/day, P for trend =0.01) and carbohydrate consumption (195 to 234 g/day, P for trend=0.02). Conclusions: Despite recommendations to lose weight, daily energy consumption by individuals with diabetes showed no significant change, except in individuals aged 45 to 64 years, where an increase was observed. Overall, there was an increase in carbohydrate consumption. Emphasizing the equal importance of energy reduction and changes in dietary composition for people with diabetes is important for optimal self-management. [Copyright &y& Elsevier]

Abstract: Although popular diets focus on weight loss and their favorable biochemical and physiological effects, fewer investigations have evaluated the biological impact of these diets during weight maintenance. To study this issue, three popular diets—Atkins, South Beach, and Ornish—were tested in a randomized and counterbalanced crossover study between January and December 2006. Participants completed each of the three 4-week isocaloric dietary intervention phases followed by a 4-week washout period. They were weighed weekly and caloric adjustments made if weight change exceeded 1 kg. At the completion of each dietary phase, 3-day food records were analyzed, fasting blood sampled, and brachial artery reactivity testing performed. Eighteen adults completed all three isocaloric dietary phases. During the South Beach and Ornish maintenance phase, there were significant reductions in low-density lipoprotein cholesterol (11.8%; P=0.01, 16.6%; P=0.0006, respectively) compared to prediet baseline. In addition, in contrast to the Atkins maintenance phase, significant reductions in low-density lipoprotein cholesterol and apolipoprotein B levels were observed after the South Beach (P=0.003, P=0.05; repeated measures analyses of variance) and Ornish maintenance phases (P=0.0004, P=0.006, repeated measures analyses of variance). Brachial artery testing revealed an inverse correlation between flow-mediated vasodilatation and intake of saturated fat (r=−0.33; P=0.016). These data suggest that during weight maintenance, less favorable biological effects are observed during a simulated, high-fat Atkins diet when compared to the South Beach and Ornish diet. The findings support additional study in subjects with visceral obesity and the metabolic syndrome, in whom an increased risk of coronary disease at baseline may be accentuated with chronic consumption of a diet that exhibits unfavorable effects on lipids and endothelial function. [Copyright &y& Elsevier]

Abstract: Objective: Examine characteristics of current and former adolescent and young adult vegetarians and investigate the relationships between vegetarianism, weight, dietary intake, and weight-control behaviors. Design: Cross-sectional analysis using data from a population-based study in Minnesota (Project EAT-II: Eating Among Teens). Setting: Participants completed a mailed survey and food frequency questionnaire in 2004. Participants: Males and females (n=2,516), ages 15-23 years. Main outcome measures: Weight status, dietary intake (fruit, vegetables, fat, calories), unhealthful weight-control behaviors. Analysis: Multiple regression models controlling for socioeconomic status and sex were used to test for significant differences between current, former, and never vegetarians within the younger and older cohort. Results: Participants were identified as current (4.3%), former (10.8%), and never (84.9%) vegetarians. Current vegetarians in the younger and older cohorts had healthier dietary intakes than nonvegetarians with regard to fruits, vegetables, and fat. Among young adults, current vegetarians were less likely than never vegetarians to be overweight or obese. Adolescent and young adult current vegetarians were more likely to report binge eating with loss of control when compared to nonvegetarians. Among adolescents, former vegetarians were more likely than never vegetarians to engage in extreme unhealthful weight-control behaviors. Among young adults, former vegetarians were more likely than current and never vegetarians to engage in extreme unhealthful weight-control behaviors. Conclusions and implications: Adolescent and young adult vegetarians may experience the health benefits associated with increased fruit and vegetable intake and young adults may experience the added benefit of decreased risk for overweight and obesity. However, current vegetarians may be at increased risk for binge eating with loss of control, while former vegetarians may be at increased risk for extreme unhealthful weight-control behaviors. It would be beneficial for clinicians to inquire about current and former vegetarian status when assessing risk for disordered eating behaviors. [Copyright &y& Elsevier]

Abstract: Family variables such as cohesion and nurturance have been associated with adolescent weight-related health behaviors. Integrating family variables that improve family functioning into traditional weight-loss programs can provide health-related benefits. The current study evaluated a family-based psychoeducational and behavioral skill-building weight-loss program for adolescent girls that integrated Family Systems and Social Cognitive Theories. Forty-two overweight (≥95th percentile) female adolescent participants and parents participated in a 16-week randomized controlled trial comparing three groups: multifamily therapy plus psychoeducation (n=15), psychoeducation-only (n=16), or wait list (control; n=11) group. Body mass index, energy intake, and family measures were assessed at baseline and posttreatment. Adolescents in the psychoeducation-only group demonstrated a greater decrease in energy intake compared to the multifamily therapy plus psychoeducation and control groups (P<0.01). Positive changes in family nurturance were associated with lower levels of adolescent energy intake (P<0.05). No significant effects were found for body mass index. Results provide preliminary support for a psychoeducational program that integrates family variables to reduce energy intake in overweight adolescent girls. Results indicate that nurturance can be an important family variable to target in future adolescent weight-loss and dietary programs. [Copyright &y& Elsevier]

Abstract: Objective: Nursing facilities often provide enhanced or fortified foods as part of a “food-first” approach to increasing nutrient intakes in residents with inadequate intakes or who are experiencing weight loss. The study objective was to determine whether energy and protein enhancement of a small number of menu items would result in increased three-meal (breakfast, lunch, and supper) calorie and protein intakes in long-term care residents. Design: A randomized cross-over design was used to compare investigator-weighed food intakes under three menu conditions: control (no meals enhanced); lunch only enhanced; and both breakfast and lunch enhanced. Two breakfast foods (juice and hot cereal) and two lunch foods (soup and potato side dish) were chosen for enhancement. Subjects/setting: Participants were 33 nursing home residents from a facility in South Florida (average age=87.3 years). Statistical analysis: Repeated-measures analysis of variance was used to test the effects of the within-subjects factor (control, lunch enhanced, breakfast and lunch enhanced conditions), the between-subjects factor (smaller vs bigger eater), and the interaction on intakes (gram, kilocalories, and protein). Results: Results revealed that bigger eaters consumed considerably more calories when breakfast foods, but not lunch foods, were enhanced. Smaller eaters achieved an increase in energy intake when either breakfast or lunch was enhanced. Overall daily protein intakes were not substantially increased by food enhancement. These data suggest that for an enhanced food program to be most effective for smaller eaters, who are at greatest risk for undernutrition and weight loss, it should include several enhanced foods at more than one meal. [Copyright &y& Elsevier]

Abstract: Water consumed before a meal has been found to reduce energy intake among nonobese older adults. However, it is unknown whether this effect is evident among overweight and obese older adults, a population who would benefit from strategies to improve energy intake regulation. Our purpose was to determine whether premeal water consumption reduces meal energy intake in overweight and obese older adults. Twenty-four overweight and obese adults (body mass index=34.3±1.2), mean age 61.3±1.1 years, were given an ad libitum standardized breakfast meal on two randomly assigned occasions. Thirty minutes before the meal, subjects were given either a 500-mL water preload or no preload. Energy intake at each meal was covertly measured. Meal energy intake was significantly less in the water preload condition as compared with the no-preload condition (500±32 vs 574±38, respectively; P=0.004), representing an approximate 13% reduction in meal energy intake. The percentage reduction in meal energy intake following the water preload was not related to sex, age, body mass index, or habitual daily water consumption (all P>0.05). Given the high prevalence of overweight and obesity among older adults, future studies should determine whether premeal water consumption is an effective long-term weight control strategy for older adults. [Copyright &y& Elsevier]

Abstract: The health and quality-of-life implications of overweight and obesity span all ages in the United States. We investigated the association between dietary protein intake and loss of lean mass during weight loss in postmenopausal women through a retrospective analysis of a 20-week randomized, controlled diet and exercise intervention in women aged 50 to 70 years. Weight loss was achieved by differing levels of caloric restriction and exercise. The diet-only group reduced caloric intake by 2,800 kcal/week, and the exercise groups reduced caloric intake by 2,400 kcal/week and expended ∼400 kcal/week through aerobic exercise. Total and appendicular lean mass was measured using dual energy x-ray absorptiometry. Linear regression analysis was used to examine the association between changes in lean mass and appendicular lean mass and dietary protein intake. Average weight loss was 10.8±4.0 kg, with an average of 32% of total weight lost as lean mass. Protein intake averaged 0.62 g/kg body weight/day (range=0.47 to 0.8 g/kg body weight/day). Participants who consumed higher amounts of dietary protein lost less lean mass and appendicular lean mass (r=0.3, P=0.01 and r=0.41, P<0.001, respectively). These associations remained significant after adjusting for intervention group and body size. Therefore, inadequate protein intake during caloric restriction may be associated with adverse body-composition changes in postmenopausal women. [Copyright &y& Elsevier]

Abstract: Motivational interviewing is a technique for developing and maintaining motivation. This pilot study examined the feasibility and acceptability of motivational interviewing in online weight-loss treatment groups. Twenty women participated in the 8-week minimal contact intervention, received weekly e-mailed lessons, and were randomized to two online groups using motivational interviewing, either with or without a discussion of values. Acceptability of format and content was measured following the second online group. Self-reported weight and motivation were measured at baseline and 8 weeks. Qualitative analysis of group transcripts examined self-motivational statements uttered by participants during online groups. Eighty-four percent of participants reported willingness to participate again and were comfortable with the discussion topics. The average number of self-motivational statements uttered by participants did not differ by group (P=0.85) and was correlated with an increase in autonomous motivation during the 8 weeks (r=0.58, P=0.05). Higher autonomous motivation at follow-up was associated with greater weight loss (r=0.51, P<0.05). This study suggests that motivational interviewing techniques are acceptable and may be useful for targeting and maintaining motivation in online weight-loss groups. [Copyright &y& Elsevier]

Abstract: Background: Overweight and obesity affect more than 60% of the adult population in the United States. Most adults who are overweight have a history of previous weight-loss treatment. Exploring individuals’ past experiences with weight-loss treatment may allow improvements to the current approach to treatment. Objective: To examine individuals’ prior experiences with weight-loss treatment, their treatment preferences, and what they found to be most and least satisfying. Design: Cross-sectional descriptive study. Subjects/setting: Individuals (N=155) who had registered for a weight-loss study wait list and met standard criteria for a weight-loss program (aged 18 to 55 years and body mass index between 25 and 42). Methods: Questionnaire packets were mailed to participants. Statistical analyses performed: Descriptive analyses of the participants’ past history with weight-loss treatment, treatment preference, self-efficacy, therapeutic efficacy, barriers to adherence to weight-loss treatment, barriers to healthy eating, and experiences associated with following a low-fat diet. Results: One hundred ten participants (71%) returned completed questionnaire packets. The sample (82% white, 84% female, aged 42.6±8.5 years, and body mass index 33.5±5.3) was representative of those who seek weight-loss treatment in research settings. Participants were, on average, aged 21.1±8.9 years when they first tried a weight-loss program; 96.3% had tried to lose weight since that first time. The two most frequently tried programs were doing it on their own (93.5%) and commercial programs (70.8%). Barriers included having trouble controlling what I eat when hungry (71.3%), difficulty motivating myself to eat appropriately (66.2%), and using food as a reward (59.3%). Preferred weight-loss regimens were doing it on their own (30.6%) and a research program (22.4%). Conclusions: Participants were not seeking their preferred treatment. These data can be used to improve weight-loss programs by tailoring programs to meet the needs and preferences of participants. [Copyright &y& Elsevier]

Abstract: Bioelectrical impedance equations are frequently used by food and nutrition professionals to estimate percent fat mass in overweight and obese children. However, it is not known whether they are accurate for such children, as they have been primarily developed for children of varying body weights. The aim of this cross-sectional study was to evaluate the predictive validity of four previously published prediction equations developed for the pediatric population, among a sample of overweight and obese children. Thirty overweight or obese children (mean age=7.57±1.28 years) underwent measurement of fat mass, percent fat mass, and fat-free mass using dual-energy x-ray absorptiometry (DEXA) and bioelectrical impedance analysis (BIA). Impedance values from the BIA were entered into the four prediction equations and Pearson correlations used to determine the significance of associations between each of the BIA prediction equations and DEXA for percent fat mass, fat mass, and fat-free mass. For percent fat mass, paired t tests were used to assess differences between the methods and the technique of Bland and Altman was used to determine bias and error. Results showed that the mean percent fat mass as determined by DEXA for this age group was 40.79%. In comparison with other BIA prediction equations, the Schaefer equation had the closest mean value of 41.98%, and was the only equation not to significantly differ from the DEXA (P=0.121). This study suggests that the Schaefer equation is the only accurate BIA prediction equation for assessing percent fat mass in this sample of overweight and obese children from primarily white backgrounds. [Copyright &y& Elsevier]

Abstract: Inaccurate reporting of energy intake makes it difficult to study the associations between diet and weight status. This study examined reported energy intake at age 9 years as a predictor of girls’ body mass index (BMI) at age 11 years, before and after adjusting for parents’ BMI and girls’ pubertal status. This prospective, observational cohort study included 177 non-Hispanic white girls and their parents. When the subjects were 9 years of age, three 24-hour recalls were used to categorize girls as plausible or implausible over-reporters and under-reporters based on previously published methods. Height and weight was measured to calculate BMI. Linear and hierarchical regression analyses were used to predict girls’ BMI. Results revealed that girls who under-reported had significantly higher BMIs than plausible and overreporters. Among the total sample and among implausible reporters, reported energy intake was not a significant predictor of BMI; however, among plausible reporters, reported energy intake explained 14% of the variance in BMI and remained a significant predictor after adjusting for parental BMI and girls’ pubertal status. Systematic bias related to underreporting in dietary data can obscure relationships with weight status, even among young girls. A relatively simple analytical procedure can be used to identify the magnitude and nature of reporting bias in dietary data. [Copyright &y& Elsevier]

Abstract: Energy underreporting is a concern with dietary intake data; therefore, subject characteristics associated with underreporting energy intake should be elucidated. Baseline self-reported dietary intake and measures of diet and weight history, life status, weight-loss readiness, psychology, eating behavior, physical activity, and self-image of obese middle-aged women (mean body mass index [calculated as kg/m2]=31.0) enrolled in a lifestyle weight-loss program were evaluated. Of the 155 participating, 71 women were identified as underreporting energy intake using the Goldberg cutoff values. Comparison of means between psychosocial and behavioral measures from energy underreporters and energy accurate reporters were used to help develop logistic regression models that could predict likelihood to underreport energy intake based on baseline measures. Characteristics most predictive of energy underreporting included fewer years of education (P=0.01), less-realistic weight-loss goals (P=0.02), higher perceived exercise competence (P=0.07), more social support to exercise (P=0.04), more body-shape concern (P=0.01), and higher perception of physical condition (P=0.03). These results highlight distinct psychosocial and behavioral characteristics that, at baseline, can help identify the likelihood an overweight middle-aged woman entering a weight-loss intervention will underreport energy intake. These results can help provide a framework for screening study participants for probability of energy underreporting, based on baseline psychosocial and behavioral measures. This knowledge can help researchers target at-risk subjects and, through education and training, improve the accuracy of self-reported energy intake and, ultimately, the accuracy of energy and nutrient intake relationships with health and disease. [Copyright &y& Elsevier]

Abstract: Multiple factors influence long-term weight-loss success, as shown by the National Weight Control Registry. We evaluated the influence of two of those factors, diet instruction by a registered dietitian (RD) and frequency of weigh-in visits, on initial weight-loss success. Twenty-six overweight subjects with a baseline body mass index of 33.2±3.7 and a mean age of 43±12 years were enrolled in a weight-loss study. The 11-week weight loss period included 33 total visits, with weekly RD-instructed classes with a weigh-in, and 22 semiweekly related weigh-in visits without an RD present. Classes covered topics in the areas of energy restriction, dietary change, exercise, and behavior modification. Subjects were enrolled at different time points within the class topic rotation but all completed the 11-week program. The mean weight loss for all subjects was 3.8±2.8 kg (P<0.001). Weight loss (%) was significantly correlated with attendance of RD-instructed classes (r=0.451, P=0.021) but not attendance at weigh-ins that did not include RD-instructed classes (r=0.329, P=0.101). We conclude that RD-led dietary instruction was more beneficial than frequent weigh-in visits alone in promoting weight loss. [Copyright &y& Elsevier]

Abstract: Objective: The objective of this study was to investigate the effect of 1-year ad libitum consumption of diacylglycerol oil on body weight and serum triglyceride in Japanese men and women. Design/subjects/intervention: In a 1-year double-blind, placebo-controlled parallel trial with clinic visits at month 0, 3, 6, 9, and 12, a total of 312 Japanese men (n=174) and women (n=138) (aged 22 to 73 years) with body mass index (calculated as kg/m2) ≥25 and/or fasting serum triglyceride level ≥150 mg/dL (1.70 mmol/L) (aged 22 to 73 years) were randomly assigned to the diacylglycerol (n=155) or triacylglycerol (n=157) group. Participants substituted their usual home cooking oil with the assigned test oils. Main outcome measures: Changes in anthropometrics and serum triglyceride level were monitored at 3-month intervals across a 12-month period. Results: In the intention-to-treat analysis, body weight decreased significantly in the diacylglycerol group when compared to the triacylglycerol group (P=0.013). Changes in body weight and body mass index during the study period differed between the two groups by 0.87 kg (P=0.002) and 0.32 kg (P=0.002), respectively. Participants with higher initial body mass index or greater percentage of total fat intake as diacylglycerol exhibited greater reduction in body weight. Total energy intake and physical activity were not significantly different between the groups during the study. Serum triglyceride levels decreased significantly from values in individuals with hypertriglyceridemia, but did not differ between groups. Conclusions: Modest body weight reduction was observed after 1-year ad libitum consumption of diacylglycerol oil as part of a regular diet in comparison to that of triacylglycerol oil; weight loss was greatest in participants who were obese at baseline. The weight reduction observed in diacylglycerol group was attributed to the substitution of usual home cooking oil with diacylglycerol, because total energy intake and physical activity did not differ between groups. [Copyright &y& Elsevier]

Abstract: Objective: To assist health professionals who counsel patients with overweight and obesity, a systematic review was undertaken to determine types of weight-loss interventions that contribute to successful outcomes and to define expected weight-loss outcomes from such interventions. Design: A search was conducted for weight-loss–focused randomized clinical trials with ≥1-year follow-up. Eighty studies were identified and are included in the evidence . Outcomes measures: The primary outcomes were a measure of weight loss at 6, 12, 24, 36, and 48 months. Eight types of weight-loss interventions—diet alone, diet and exercise, exercise alone, meal replacements, very-low-energy diets, weight-loss medications (orlistat and sibutramine), and advice alone—were identified. By using simple pooling across studies, subjects mean amount of weight loss at each time point for each intervention was determined. Statistical analyses performed: Efficacy outcomes were calculated by meta-analysis and provide support for the pooled data. Hedges’ gu was combined across studies to obtain an average effect size (and confidence level). Results: A mean weight loss of 5 to 8.5 kg (5% to 9%) was observed during the first 6 months from interventions involving a reduced-energy diet and/or weight-loss medications with weight plateaus at approximately 6 months. In studies extending to 48 months, a mean 3 to 6 kg (3% to 6%) of weight loss was maintained with none of the groups experiencing weight regain to baseline. In contrast, advice-only and exercise-alone groups experienced minimal weight loss at any time point. Conclusions: Weight-loss interventions utilizing a reduced-energy diet and exercise are associated with moderate weight loss at 6 months. Although there is some regain of weight, weight loss can be maintained. The addition of weight-loss medications somewhat enhances weight-loss maintenance. [Copyright &y& Elsevier]

Abstract: This study examined whether different methods of self-monitoring eating and exercise behaviors affect the process of self-monitoring and change in body weight in overweight adults. Forty-two subjects participated in a 16-week correspondence-based weight-loss intervention using a pretest–posttest randomized design. Dietary intake was prescribed at 1,200 to 1,500 kcal/day and <30% dietary fat. Physical activity was progressed to 200 minutes/week. Participants were randomly assigned to self-monitoring eating and physical activity behaviors using a traditional detailed method or transitioning to an abbreviated method. Transitioning to an abbreviated method returned significantly more diaries than using a traditional detailed method (P=0.04). Participants completing the study showed no significant difference in weight loss between the traditional detailed method (−7.5±5.3 kg) and the abbreviated method (−7.6±5.5 kg), with similar results for intention-to-treat analysis (detailed method −3.9±5.3 kg vs abbreviated method −4.3±5.8 kg). Weight loss was significantly associated with number of self-monitoring diaries completed (r=0.53, P<0.05). Findings suggest the self-monitoring process, rather than the detail of self-monitoring, is important for facilitating weight loss and change in eating and physical activity behaviors. Transitioning to a simplified approach to self-monitoring does not negatively affect short-term weight loss in overweight adults. These results may have implications for improving self-monitoring in overweight adults during periods of weight loss. [Copyright &y& Elsevier]

Abstract: Ketogenic diets have been associated with reductions in free-living physical activity, a response that can be counterproductive in individuals trying to lose weight. To explore whether popular low-carbohydrate diets might impact the desire to exercise by raising blood ketone concentrations, fatigue and perceived effort during exercise were compared in untrained, overweight adults adhering to a ketogenic low-carbohydrate diet or to a control diet low in carbohydrate, but not ketogenic (5%, 65%, and 30% or 40%, 30%, and 30% of energy from carbohydrate, fat, and protein, respectively). In this prospective, randomized, 2-week pilot study, all meals and snacks were provided to subjects, and energy intake was strictly controlled to provide approximately 70% of that needed for weight maintenance. At baseline and at the end of week 2, exercise testing was conducted in fasting participants. Weight loss and the reductions in fat mass did not differ by group during the trial. At week 2, blood β-hydroxybutyrate concentrations were 3.6-fold greater for the ketogenic vs nonketogenic group (P=0.018) and correlated significantly with perceived exercise effort (r 2=0.22, P=0.049). Blood β-hydroxybutyrate was also significantly correlated to feelings of “fatigue” (r=0.458, P=0.049) and to “total mood disturbance” (r=0.551, P=0.015) while exercising. These pilot data indicate that ketogenic, low-carbohydrate diets enhance fatigability and can reduce the desire to exercise in free-living individuals. [Copyright &y& Elsevier]

Abstract: Calcium from dairy sources is beneficial to weight loss; however, no studies have compared the effects of dairy to nondairy sources of calcium on weight loss. This pilot study explored differences between soy and skim milk on changes in anthropometric values in premenopausal women. In a prospective randomized controlled trial, 14 women with overweight/obesity were randomly assigned to 720 mL soy milk (n=7) or an equivalent volume of skim milk (n=7) daily for 8 weeks. Subjects followed a 500-kcal deficit diet based on metabolic rate data. There were no anthropometric differences between soy and skim milk groups at baseline. Subjects followed an energy-restricted diet; both groups experienced reductions in kilogram weight (4.27±2.05 vs 3.76±2.25; P=0.668), body fat percent (1.30±1.37 vs 1.87±1.45; P=0.464), and abdominal circumference (11.28±5.23 vs 8.66±2.51; P=0.259) while attenuating losses of fat-free mass (1.12±1.29 vs 0.43±1.12; P=0.299) during the 8-week study. There were no significant differences in weight, fat percent, abdominal circumference, and fat-free mass between groups. To optimize the weight loss effects of calcium, one can consume 720 mL of either soy milk or skim milk daily. [Copyright &y& Elsevier]

Abstract: Popular weight-loss plans often have conflicting recommendations, which makes it difficult to determine the most healthful approach to weight loss. Our study compares the dietary quality of popular weight-loss plans. Dietary quality, measured by the Alternate Healthy Eating Index (AHEI), was calculated via sample menus provided in published media for the New Glucose Revolution, Weight Watchers, Atkins, South Beach, Zone, Ornish, and 2005 US Department of Agriculture Food Guide Pyramid (2005 Food Guide Pyramid) plans. The criterion for determining which weight-loss plans were the most popular was their status on the New York Times Bestseller list. Weight Watchers and the 2005 Food Guide Pyramid plan were included because they are the largest commercial weight-loss plan, and the current government recommendation, respectively. Analysis of variance was used to compare nutrient information among the weight-loss plans. The AHEI scores adjusted for energy content were also compared. Of a maximum possible score of 70, the AHEI scores for each weight-loss plan from the highest to the lowest plan were: Ornish (score 64.6), Weight Watchers high-carbohydrate (score 57.4), New Glucose Revolution (score 57.2), South Beach/Phase 2 (score 50.7), Zone (score 49.8), 2005 Food Guide Pyramid (score 48.7), Weight Watchers high-protein (score 47.3), Atkins/100-g carbohydrate (score 46), South Beach/Phase 3 (score 45.6), and Atkins/45-g carbohydrate (score 42.3). Dietary quality varied across popular weight-loss plans. Ornish, Weight Watchers high-carbohydrate, and New Glucose Revolution weight-loss plans have an increased capacity for cardiovascular disease prevention when assessed by the AHEI. [Copyright &y& Elsevier]

Abstract: Objective: To identify predictors of weight loss in a tri-ethnic population of low-income mothers. Design: An 8-week dietary and physical activity program was tested. Demographic data were collected at baseline; anthropometric, dietary, physical activity, and psychosocial data were measured at baseline and week 8. Subjects/setting: A convenience sample of 114 Hispanic, African-American, and white, low-income mothers with a body mass index ≥25 (calculated as kg/m2) participated in the intervention. Intervention: Weight-loss classes that incorporated nutrition, physical activity, and behavior modification were administered for 8 weeks. Main outcome measures: Anthropometry (body weight, weight loss). Statistical analyses performed: Analysis of variance, χ2 tests, and Spearman and Pearson correlations were used to test for associations between baseline and change data and total weight loss. Hierarchical regression was employed to assess the marginal importance of factors beyond socioeconomic influences. Results: Correlates of weight loss included less satisfaction with appearance (r=0.24), greater percentage of energy from protein (r=−0.22), enhanced nutrition knowledge (r=−0.23), and higher scores for benefits of weight loss (r =−0.20) at baseline; and the change in healthful eating attitudes (r=−0.28) and social support (r=−0.21) at 8 weeks. The predictive models of baseline and change variables represented 11.4% and 13.8% of the variance, respectively. Conclusions: Weight-management programs serving low-income mothers should provide techniques to enhance social support, attitudes toward healthful eating, benefits of weight loss, and nutrition knowledge. [Copyright &y& Elsevier]

Abstract: The objective of this study was to determine whether a weight-loss diet high in soy-protein−rich foods leads to greater weight loss and reductions in waist circumference, fat mass, and cardiovascular disease risk factors than a control diet. Groups of overweight women (body mass index [calculated as kg/m2] of 28 to 33, aged 25 to 49 years) were counseled to decrease their caloric intake by 500 kcal/day for a period of 12 weeks; in addition, the soy-protein−rich group was counseled to consume 15 g soy protein/1,000 kcal daily. Soy-protein−rich foods were provided to subjects. Body weight, waist circumference, percent body fat, fat-free mass, lipids, glucose, and insulin were measured at repeated intervals. Forty-seven women completed the study. Both groups lost a similar amount of weight both when a completers only (−3.18%±0.63% vs −4.04%±0.95% for soy-protein−rich and control diets, respectively) and a last-observation-carried-forward analysis (−1.93%±0.50% vs −2.50%±0.67%, for soy-protein−rich and control diets, respectively) were performed. There was no difference between groups in change in percent fat mass (−5.31%±1.50% for soy-protein−rich diet vs −3.94%±1.68% for control diet), percent fat-free mass, and waist circumference. There was no dietary assignment-by-group interaction on lipid, glucose, and insulin concentrations when analyses were done on completers only or on all subjects using a last-observation-carried-forward approach. Percent change in any of the biochemical parameters studied over the 12-week period was not significantly different between groups. Our results do not lend support to the emerging notion that soy-protein−rich foods could be considered potential functional foods for weight management, in the quantities consumed in this study. [Copyright &y& Elsevier]