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Summary: Background: The optimal role for involving parents in adolescent obesity treatment is unknown. Objective: To demonstrate that two parent approaches within adolescent obesity treatment are distinct, as evidenced by differential parent outcomes, and determine the preliminary efficacy of each approach on adolescent weight loss. Methods: Adolescent/parent dyads (N = 82; mean adolescent age = 13.7 ± 1.2 years) participated in TEENS+, a 4‐month behavioural weight loss treatment. Participants were randomized to: (1) TEENS+parents as coaches (PAC; parent skills training), or (2) TEENS+parent weight loss (PWL; adult behavioural weight loss). Assessments occurred at 0, 4 (post‐treatment), and 7‐months. Within‐ and between‐group repeated measures general linear mixed models examined change in parent weight (∆kg; primary outcome); parenting, feeding, weight control strategies, home environment, and adolescent body mass index (∆BMI; secondary outcomes). Results: PWL parents had greater 4‐month weight losses (∆kg0–4m = −5.14 ± 4.87 kg) compared to PAC (−2.07 ± 3.89 kg; between‐group p < 0.01). Key constructs differed between groups as expected. Both groups yielded significant within‐group adolescent ∆BMI0–4m (PWL: −0.97 ± 1.38 kg/m2 vs. PAC: −0.93 ± 1.42 kg/m2; ps < 0.01); during maintenance, adolescents in PWL had ∆BMI4–7m increases (+0.41 ± 1.07 kg/m2; p = 0.02) while PAC did not (+0.05 ± 1.31 kg/m2; p = 0.82). Conclusion: Parent treatments were distinct in implementation and both yielded significant 4‐month adolescent weight loss. Differential weight patterns were observed during maintenance, favouring PAC, warranting further exploration. [ABSTRACT FROM AUTHOR]

Summary: A multicomponent approach for the treatment of pediatric overweight/obesity, which includes behavioral strategies to alter diet and physical activity/sedentary behavior, has graded recommendations for its use. Dietary interventions to be used within this approach do not. In adults, research indicates that strongly graded dietary interventions providing greater structure (or more control over the types/amount of food consumed) produce better weight outcomes. For this critical review, dietary interventions recommended by the Expert Committee for the treatment of pediatric overweight/obesity were categorized according to their potential degree of dietary structure, and their impact on weight outcomes was described. Four levels of dietary structure were reviewed, operationalized as alterations to the following: food groups, such as fruits and vegetables (low structure); daily eating occasions, such as meals (moderate structure); large nutrients, such as energy (high structure); and energy plus additional dietary alterations (very high structure). In total, 24 interventions (four low, three moderate, five high, and 12 very high structure structure) were identified and reviewed. Reductions in standardized body mass index increased with increasing structure, and interventions ≥6 months had better outcomes than interventions <6 months. Future research should empirically test dietary intervention structure to determine its impact on weight status during pediatric overweight/obesity treatment. [ABSTRACT FROM AUTHOR]

Summary: Background: Migraine and obesity are comorbid particularly in women of reproductive age. Obesity treatment involves reducing energy intake and improving dietary quality but the effect of these changes on migraine is largely unknown. Objective: To determine if adherence to dietary intervention targets (ie, total energy, dietary fat intake, and dietary quality) were associated with improvements in migraine and weight. Methods: Eighty‐four women with overweight/obesity and migraine were randomized to and completed either a 16‐week behavioral weight loss (BWL) or a migraine education (ME) intervention. For 28 days at baseline and posttreatment, women recorded monthly migraine days, duration, and maximum pain intensity via smartphone‐based diary. At each assessment, weight was measured and dietary intake (total energy intake, percent (%) energy from fat, and diet quality, as measured by the Healthy Eating Index, 2010 [HEI‐2010]) was assessed using three nonconsecutive 24‐hour diet recalls. Results: There were no significant group differences in change mean migraine days per month (BWL: ‐2.6+4.0, ME: ‐4.0+4.4; p = 0.1). Participants in BWL significantly reduced their percent fat intake 3.8% (p = 0.004) and improved total diet quality (HEI‐2010) by 6.7 points (p = 0.003) relative to baseline and those in ME (%fat: +0.3%; p = 0.821; HEI‐2010: +0.7; p = 0.725). After controlling for race/ethnicity and weight change, changes in dietary intake were not related to changes in migraine characteristics or weight loss among BWL participants (p's > 0.05). Conclusions: Changes in dietary intake among participants were small and may have been insufficient to improve migraine in women with overweight/obesity and migraine. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate whether consistency in time of day that moderate- to vigorous-intensity physical activity (MVPA) is performed relates to MVPA levels among successful weight loss maintainers in the National Weight Control Registry.Methods: Participants (n = 375) reporting MVPA on ≥ 2 d/wk completed measures of temporal consistency in physical activity (PA) (> 50% of MVPA sessions per week occurring during the same time window: early/late morning, afternoon, or evening), PA levels, PA automaticity, and consistency in cues underlying PA habit formation (e.g., location).Results: Most (68.0%) participants reported temporally consistent MVPA. These individuals reported higher MVPA frequency (4.8 ± 1.6 vs. 4.4 ± 1.5 d/wk; P = 0.007) and duration (median [IQR]: 350.0 [200.0-510.0] vs. 285.0 [140.0-460.0] min/wk; P = 0.03), and they were more likely to achieve the national MVPA guideline (≥ 150 min/wk) than temporally inconsistent exercisers (86.3% vs. 74.2%, P = 0.004). Among temporally consistent exercisers, 47.8% were early-morning exercisers; MVPA levels did not differ by time of day of routine MVPA performance (P > 0.05). Greater automaticity and consistency in several cues were related to greater MVPA among all participants.Conclusions: Most participants reported consistent timing of MVPA. Temporal consistency was associated with greater MVPA, regardless of the specific time of day of routine MVPA performance. Consistency in exercise timing and other cues might help explain characteristic high PA levels among successful maintainers. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine whether weight losses from a primarily smartphone-based behavioral obesity treatment (SMART) differed from those of a more intensive group-based behavioral obesity treatment (GROUP) and a control condition (CONTROL).Methods: A total of 276 adults with overweight/obesity were randomly assigned to 18 months of GROUP-based treatment with meetings weekly for 6 months, meetings biweekly for 6 months, and meetings monthly for 6 months and self-monitoring via paper diaries with written feedback; SMART-based treatment with online lessons, self-monitoring, and feedback plus monthly weigh-ins; or a CONTROL condition with self-monitoring via paper diaries with written feedback and monthly weigh-ins.Results: Among the 276 participants (17% men; 7.2% minority; mean [SD] age: 55.1 [9.9] years; weight: 95.9 [17.0] kg; BMI: 35.2 [5.0] kg/m2 ), 18-month retention was significantly higher in both GROUP (83%) and SMART (81%) compared with CONTROL (66%). Estimated mean (95% CI) weight change over 18 months did not differ across the three conditions: 5.9 kg (95% CI: 4.5-7.4) in GROUP, 5.5 kg (95% CI: 3.9-7.1) in SMART, and 6.4 kg (95% CI: 3.7-9.2) in CONTROL.Conclusions: Mobile online delivery of behavioral obesity treatment can achieve weight loss outcomes that are at least as good as those obtained via the more intensive gold standard group-based approach. [ABSTRACT FROM AUTHOR]

Objective: Taste blindness to 6-n-propylthiouracil (PROP) associates with increased fat preference and intake. No studies have matched a diet to a woman's PROP phenotype to improve weight loss. This study investigated (1) whether PROP nontaster (NT) women would lose more weight following a low-carbohydrate (LC) diet than a low-fat (LF) diet, and (2) whether PROP supertaster (ST) women would lose more weight following a LF diet than a LC diet.Methods: One hundred seven women (BMI = 34.8 ± 0.5 kg/m2 ), classified as PROP NTs (n = 47) and STs (n = 60), were randomized to a LC or LF diet within a 6-month lifestyle intervention. Assessments included 4-day dietary recalls and biobehavioral and psychosocial questionnaires.Results: At 6 months, NTs lost more weight following the LC than the LF diet (-8.5 ± 0.5 kg vs. -6.6 ± 0.5 kg, P = 0.008); there was no difference between STs following either diet (-8.8 ± 0.4 vs. -8.9 ± 0.5, P = 0.35). Dietary self-reports were unrelated to weight loss, and prescription of a LC diet associated with greater self-efficacy.Conclusions: NT women lost more weight following the LC diet compared to the LF diet. Screening for PROP phenotype may help personalize diet therapy for NT women to optimize their short-term weight loss. [ABSTRACT FROM AUTHOR]

Objective: Food cravings are thought to be the result of conditioning or pairing hunger with consumption of certain foods.Methods: In a 2-year weight loss trial, subjects were randomized to one of four diets that varied in macronutrient content. The Food Craving Inventory (FCI) was used to measure cravings at baseline and at 6 and 24 months. Food intake was also measured at those time points. To measure free-living consumption of food items measured in the FCI, items on the FCI were matched to the foods consumed from the food intake assessments. Secondarily, the amount of food consumed on food intake assessments from foods on the FCI was analyzed.Results: Three hundred and sixty-seven subjects with overweight and obesity were included. There was an association between change from baseline FCI item consumption and change in cravings at months 6 (P < 0.001) and 24 (P < 0.05). There was no association between change from baseline amount of energy consumed per FCI item and change in cravings.Conclusions: Altering frequency of consuming craved foods is positively associated with cravings; however, changing the amount of foods consumed does not appear to alter cravings. These results support the conditioning model of food cravings and provide guidance on how to reduce food cravings. [ABSTRACT FROM AUTHOR]

Objective: To evaluate a commercial online weight loss program and activity tracker, which are popular but have unknown efficacy.Methods: Two hundred seventy-nine participants with BMI 27 to 40 kg/m2 were randomized to 12 months of the Weight Watchers Online program alone (WWO) or with the ActiveLink® activity tracking device (WWO+AL) or an online newsletter (Control).Results: Weight losses at 3 months were significantly greater in WWO (2.7 kg [95% confidence interval (CI), 2.0-3.5 kg] than Control (1.3 kg [95% CI, 0.5-2.0 kg]; P = 0.01); neither differed from WWO+AL (2.0 kg [95% CI, 1.3-2.7 kg]; Ps > 0.56). Significantly more WWO participants (24.5%) achieved ≥ 5% weight loss at 3 months than Control (9.4%) (P = 0.01); neither differed from WWO+AL (17.6%) (Ps = 0.13-0.28). At 12 months, there were no significant differences between groups in weight loss (Ps > 0.52). WWO (25.5%) continued to have a higher proportion of participants achieving ≥ 5% weight loss than Control (12.9%) (P = 0.04); neither differed from WWO+AL (14.3%) (Ps > 0.10). There were no significant between-group differences in change in physical activity (Ps > 0.17).Conclusions: WWO produced significantly more weight loss at 3 months relative to Control, but not at 12 months. Significantly more WWO than Control participants lost ≥ 5% at both 3 and 12 months. Participants receiving an activity tracking device did not achieve greater weight loss or physical activity increases than those in a Control condition. [ABSTRACT FROM AUTHOR]

Objective/Background The role of diet in migraine is not well understood. We sought to characterize usual dietary intake patterns and diet quality in a nationally representative sample of women with and without severe headache or migraine. We also examined whether the relationship between migraine and diet differs by weight status. Methods In this analysis, women with migraine or severe headache status was determined by questionnaire for 3069 women, ages 20-50 years, who participated in the National Health and Nutrition Examination Study, 1999-2004. Women who experienced severe headaches or migraines were classified as migraine for the purposes of this analysis. Dietary intake patterns (micro- and macronutrient intake and eating frequency) and diet quality, measured by the Healthy Eating Index, 2005, were determined using one 24-hour dietary recall. Results Dietary intake patterns did not significantly differ between women with and without migraine. Normal weight women with migraine had significantly lower diet quality ( Healthy Eating Index, 2005 total scores) than women without migraine (52.5 ± 0.9 vs 45.9 ± 1.0; P < .0001). Conclusions Whereas findings suggest no differences in dietary intake patterns among women with and without migraine, dietary quality differs by migraine status in normal weight women. Prospective analyses are needed to establish how diet relates to migraine onset, characteristics, and clinical features in individuals of varying weight status. [ABSTRACT FROM AUTHOR]

Objective Food reinforcement and delay discounting (DD) independently predict body mass index (BMI), but there is no research studying whether these variables interact to improve prediction of BMI. Methods BMI, the relative reinforcing value of high (PMAXHED) and low (PMAXLED) energy dense food, and DD for $10 and $100 future rewards (DD10, DD100) were measured in 199 adult females. Results PMAXHED ( P = 0.017), DD10 ( P = 0.003), and DD100 ( P = 0.003) were independent predictors of BMI. The interaction of PMAXLED × DD10 ( P = 0.033) and DD100 ( P = 0.039), and PMAXHED × DD10 ( P = 0.038) and DD100 ( P = 0.045) increased the variance accounted for predicting BMI beyond the base model controlling for age, education, minority status, disinhibition, and dietary restraint. Based on the regression model, BMI differed by about 2 BMI units for low versus high food reinforcement, by about 3 BMI units for low versus high DD, and by about 4 BMI units for those high in PMAXHED, but low in DD versus high in PMAXHED and high in DD. Conclusion Reducing DD may help prevent obesity and improve treatment of obesity in those who are high in food reinforcement. [ABSTRACT FROM AUTHOR]

Objective To develop and validate the Weight Control Strategies Scale (WCSS), a self-report instrument to assess the use of specific behaviors thought to facilitate weight loss. Design and Methods Factor analysis was conducted on 323 overweight and obese adults (mean age = 48.7 ± 10.9 years, mean body mass index = 35.4 ± 4.9 kg/m2, 74% female) enrolled in three different behavioral weight loss trials who completed the WCSS prior to starting treatment. To evaluate construct validity, additional data on dietary intake, physical activity, treatment session attendance, and weight change were obtained from a subsample of participants before and after participation in a 48-week weight loss program. Results Principal components analysis with varimax rotation revealed a four-component solution for the WCSS, representing the following subscales: Dietary Choices, Self-monitoring Strategies, Physical Activity, and Psychological Coping (α from 0.79 to 0.89). Longitudinal analyses showed that WCSS subscale scores increased during treatment ( P < 0.01). In adjusted models, changes in WCSS total and subscale scores were associated with post-treatment weight loss ( P < 0.01). Additionally, changes in WCSS Dietary Choices and Physical Activity subscales were related to post-treatment changes in total daily kilocalorie consumption ( P = 0.019) and weekly kilocalorie expenditure through physical activity ( P < 0.001), respectively. Conclusions Findings support the validity and reliability of the WCSS in a weight loss treatment-seeking sample. [ABSTRACT FROM AUTHOR]

As many people struggle with maintenance of weight loss, the study of successful weight loss maintainers (SWLM) can yield important insights into factors contributing to weight loss maintenance. However, little research has examined how SWLM differ from people who are obese or normal weight (NW) in brain response to orosensory stimulation. The goal of this study was to determine if SWLM exhibit different brain responses to orosensory stimulation. Brain response to 1-min orosensory stimulation with a lemon lollipop was assessed using functional magnetic resonance imaging among 49 participants, including SWLM (n = 17), NW (n = 18), and obese (n = 14) controls. Significant brain responses were observed in nine brain regions, including the bilateral insula, left inferior frontal gyrus, left putamen, and other sensory regions. All regions also exhibited significant attenuation of this response over 1 min. The SWLM exhibited greater response compared with the other groups in all brain regions. Findings suggest that the response to orosensory stimulation peaks within 40 s and attenuates significantly between 40 and 60 s in regions associated with sensation, reward, and inhibitory control. Greater reactivity among the SWLM suggests that greater sensory reactivity to orosensory stimulation, increased anticipated reward, and subsequently greater inhibitory processing are associated with weight loss maintenance. [ABSTRACT FROM AUTHOR]

Eating frequency has been inversely related to BMI but the impact of eating frequency on weight loss is unclear. This randomized controlled trial pilot study examined the effect of eating frequency on hunger, energy intake, and weight loss during a 6-month behavioral weight loss intervention. Participants (age: 51.0 ± 9.9 years, BMI: 35.5 ± 4.8 kg/m2, 57.8% female, 94.1% white) were randomized to one of two eating frequency prescriptions: Three meal (n = 25): three eating bouts/day; or grazing (n = 26): eat at least 100 kcals every 2-3 h. Both groups attended 20 sessions and had identical dietary (1,200-1,500 kcals/day, <30% kcals from fat) and physical activity goals (200 min/week). Assessments were conducted at 0, 3, and 6 months. Using intent-to-treat analyses, grazing reported a greater eating frequency than three meal at 6 months (5.8 ± 1.1 eating bouts/day vs. 3.2 ± 0.6 eating bouts/day, P < 0.001). Grazing reported a significant reduction in hunger from 0 to 6 months (56.3 ± 15.7 mm vs. 47.9 ± 18.5 mm, P < 0.05). Energy intake and BMI were significantly (P < 0.001) reduced from 0 to 6 months (energy intake: 2,198 ± 692 kcals/day vs. 1,266 ± 353 kcals/day; BMI: 35.5 ± 4.8 kg/m2 vs. 30.6 ± 4.9 kg/m2). There were no significant differences in energy intake or BMI between the groups. While eating more frequently reduced hunger, it may not be related to greater reductions in energy intake or BMI during a behavioral weight loss intervention. [ABSTRACT FROM AUTHOR]

Objective. To determine whether eating, sedentary, and physical activity behaviors differ on weekdays and weekends in a sample of children who are overweight and obese. Methods. Eighty-one children aged 6-9 years old who were overweight or obese and enrolled in a weight management program completed three-day food diaries and three-day Previous Day Physical Activity Recalls (PDPARs) for two weekdays and one weekend day. All data were obtained at baseline prior to intervention delivery. Results. Children consumed a greater percentage of calories from fat ( t == 2.15, p == 0.04) and fewer fruits ( t == 6.83, p < 0.001), vegetables ( t == 2.91, p == 0.002), non-nutrient dense (NND) snack foods ( t == 5.58, p < 0.001), and sweetened drinks ( t == 2.91, p == 0.005) on weekends. Children watched more television ( t == 5.25, p < 0.001), expended more energy ( t == 4.37, p < 0.001), and spent a greater percentage of time in moderate-to-vigorous physical activity ( p < 0.001) on weekends compared to weekdays. Conclusions. Findings demonstrate a number of differences in children's eating and activity habits on weekends and weekdays. They also suggest that attending to differences in food intake and activity habits on weekdays and weekends separately may help to identify periods of high risk, which could be modified with effective intervention approaches. Trial Registration Numbers: NCT00259324, NCT00200265. [ABSTRACT FROM AUTHOR]

Much attention has been paid to the behavioral characteristics of successful weight loss maintenance, but less is known about the cognitive processes that underlie this process. The purpose of this study was to investigate cognitive interference from food-related cues in long-term weight loss maintainers (WLM; N = 15) as compared with normal weight (NW; N = 19) and obese (OB; N = 14) controls. A Food Stroop paradigm was used to determine whether successful WLM differed from controls in both the speed and accuracy of color naming words for low-calorie and high-calorie foods. A significant group × condition interaction for reaction time was observed (P = 0.04). In post hoc analyses, no significant differences in reaction time across the three groups were observed for the low-calorie foods (P = 0.66). However, for the high-calorie foods, WLM showed a significantly slower reaction time than the NW (0.04) and OB (0.009) groups (885 ± 17.6, 834 ± 15.8, 816 ± 18.3 ms, respectively). No significant group differences were seen for number of correct trials in 45 s (P = 0.12). The differential interference among WLM did not appear to generalize to other types of distracters (i.e., nonfood). Overall, findings from this study suggest that WLM differ from OB and NW controls in their cognitive responses to high-calorie food cues. Future research is needed to better understand why this bias exists and whether and how interventions can change cognitive processes to better facilitate long-term weight control. [ABSTRACT FROM AUTHOR]

Objective. Evaluate enrollment numbers, randomization rates, costs, and cost-effectiveness of active versus passive recruitment methods for parent-child dyads into two pediatric obesity intervention trials. Methods. Recruitment methods were categorized into active (pediatrician referral and targeted mailings, with participants identified by researcher/health care provider) versus passive methods (newspaper, bus, internet, television, and earning statements; fairs/community centers/schools; and word of mouth; with participants self-identified). Numbers of enrolled and randomized families and costs/recruitment method were monitored throughout the 22-month recruitment period. Costs (in USD) per recruitment method included staff time, mileage, and targeted costs of each method. Results. A total of 940 families were referred or made contact, with 164 families randomized (child: 7.2±1.6 years, 2.27±0.61 standardized body mass index [zBMI], 86.6% obese, 61.7% female, 83.5% Caucasian; parent: 38.0±5.8 years, 32.9±8.4 BMI, 55.2% obese, 92.7% female, 89.6% caucasian). Pediatrician referral, followed by targeted mailings, produced the largest number of enrolled and randomized families (both methods combined producing 87.2% of randomized families). Passive recruitment methods yielded better retention from enrollment to randomization ( p<0.05), but produced few families (21 in total). Approximately $91 000 was spent on recruitment, with cost per randomized family at $554.77. Pediatrician referral was the most cost-effective method, $145.95/randomized family, but yielded only 91 randomized families over 22-months of continuous recruitment. Conclusion. Pediatrician referral and targeted mailings, which are active recruitment methods, were the most successful strategies. However, recruitment demanded significant resources. Successful recruitment for pediatric trials should use several strategies. Clinical Trials Registration: NCT00259324, NCT00200265 [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined the relation between method of weight loss and long-term maintenance among successful weight losers enrolled in a weight-loss maintenance trial. Participants of the trial were adults who had lost at least 10% of their body weight using a very low-calorie diet (VLCD). Results showed that participants who had used VLCD regained more weight. The study also found that individuals who had used a self-guided approach maintained their initial weight losses with the greatest success.

The article discusses a study which investigated whether having a weight loss experience that lives up to one's expectations is related to maintenance in a group of successful weight losers participating in the STOP Regain trial. Participants who lost body weight within the past 2 years were randomly assigned to a maintenance program delivered either face-to-face or via the Internet or to a control group. The authors found that failure to meet weight loss expectations were not related to subsequent weight maintenance outcomes.

Objective: Large portions increase intake and are hypothesized to contribute to the obesity epidemic. However, it is unclear if portion size affects intake through changes in the unit size of available food or the overall amount of food available for consumption. Thus, this study examined the independent effects of package unit size and amount of food on intake. It was hypothesized that both variables would influence intake.Research Methods and Procedures: Non-obese (BMI <30 kg/m(2)), non-smoking, unrestrained, college-aged men (n = 12) and women (n = 16) who regularly consumed (>or=3 times/wk) snack foods were randomly assigned to one of four groups crossing package unit size (small vs. large) and amount of food (small vs. large). Participants were given a box with 4 snack foods (potato chips, cheese crackers, cookies, and candy) packaged according to their assigned group to take home and eat over 3 days. Dependent variables were energy and gram intake of provided snack foods.Results: An effect of amount of food was found (p < 0.01). A 100% increase in the amount of food provided produced an 81% increase in energy consumed from the snack foods [small amount, 21,037.6 +/- 10,852 kJ (5,028 +/- 2,596 kcal) vs. large amount, 11,640.7 +/- 4,914.1 kJ (2,782 +/- 1,174 kcal)]. No effect of package unit size was found.Discussion: These results suggest that the amount of food available to eat strongly influences intake. [ABSTRACT FROM AUTHOR]

Excessive TV viewing is associated with weight gain across the lifespan; thus developing strategies to decrease household viewing time may be an effective obesity prevention approach. This pilot study (n = 6 families) examined the feasibility and short-term impact of a 2-pronged environmental plus behavioral approach designed to reduce TV time in the entire family. The environmental manipulation involved placing TV Allowances (programmed to turn off power after family members had watched 75% of their baseline hours) on all TVs in the home. A kit with behavioral strategies for reducing TV time was also sent to the home each week and family members self-monitored viewing time. Viewing was objectively assessed with the TV Allowances at baseline and at 8 weeks. A significant decrease in objectively measured TV viewing hours was observed, t(5) = 3.1, p = 0.03, 29.8 ± 10.3 versus 14.9 ± 6.0 h (equivalent of decreasing from 7.5 to 3.7 h per day). Fifty percent of families reduced their viewing time by ≥50%. The acceptability of the intervention was high, with 100% of families reporting they would recommend the TV Allowances to others. Further research is needed to test the long-term efficacy of the program and its impact on weight. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]