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Background: Socioecological factors are associated with key health behaviors that are critical for weight management, and major life events may disrupt engagement in these behaviors. However, the influence of socioecological factors on health behaviors in the midst of major life events is not clear and is difficult to study due to the random and sporadic nature of their occurrence. The COVID‐19 pandemic provided a unique opportunity to study a major life event and its impacts on diet, physical activity, and body weight. Objective: This cross‐sectional study aimed to investigate associations between socioecological factors (environmental, interpersonal, and individual) and self‐reported weight change during a major life event using data collected during the COVID‐19 pandemic, and whether the associations were mediated through self‐reported changes in eating and physical activity behaviors. Methods: Participants self‐reported socioecological factors, weight change, and changes in eating behaviors (EB) and physical activity (PA) via online questionnaires between December 2020 and October 2021. Changes in EB and PA were measured using scales with higher scores reflecting more positive changes during the COVID‐19 pandemic. Results: Participants (n = 1283) were mostly female (84.9%) with age 52.1 ± 14.1 years (mean ± SD) and BMI of 32.9 ± 8.2 kg/m2. Stronger healthy eater and exercise identities (individual factors) were associated with higher EB scores (EBS) and PA scores (PAS), respectively (p's < 0.00001). Less discouragement for healthy eating by family/friends (interpersonal factor) was associated with higher EBS (p = 0.002). Higher EBS and PAS were associated with weight loss. The indirect effect of healthy eater identity (−0.72; 95% CI: −0.90, −0.55) and discouragement for diet (0.07; 95% CI: 0.03, 0.12) on weight change through EBS were significant, as was the indirect effect of exercise identity (−0.25; 95% CI: −0.35, −0.15) on weight change through PAS. Conclusions: Stronger identities and less discouragement from family/friends may support health promoting behaviors and weight loss during a major life event, as well as identify additional behavioral targets for lifestyle interventions. Clinical Trial Registration: IWCR was registered at ClinicalTrials.gov (NCT04907396). [ABSTRACT FROM AUTHOR]

Background: People with physical disabilities (PWD) have an increased risk of obesity and related comorbidities compared with people without physical disabilities (PWoD). Previously identified contributors to weight loss maintenance pose challenges to PWD. However, it is not known if PWD experience less success in weight management. Methods: Six hundred and nine participants in the International Weight Control Registry (IWCR) were eligible for this analysis (PWD, n = 174; PWoD, n = 435). Self‐reported weight history metrics were compared using general linear models. Perceived weight history category was compared using Chi‐squared tests. Importance of diet and physical activity strategies for weight management were compared using Wilcoxon rank‐signed tests. Results: PWD reported higher current body mass index (BMI) (36.1 ± 0.7 vs. 31.0 ± 0.5; p < 0.0001) and more weight loss attempts (9.1 ± 0.7 vs. 7.1 ± 0.4; p = 0.01) than PWoD. Current weight loss percentage (PWD 13.0 ± 1.0; PWoD, 13.0 ± 0.6; p = 0.97) and weight loss category (χ2 [3, N = 609] = 2.9057, p = 0.41) did not differ between the groups. There were no differences in any weight strategy between PWD who were successful and those who regained. Conclusions: PWD and PWoD in the IWCR achieved similar levels of weight maintenance success. However, higher BMI and more weight loss attempts suggest that PWD may face challenges with weight management. More research is needed to identify strategies leading to success for PWD. [ABSTRACT FROM AUTHOR]

Summary: We assessed the preference for two behavioural weight loss programs, Diabetes Prevention Program (DPP) and Healthy Weight for Living (HWL) in adults with obesity. A cross‐sectional survey was fielded on the Amazon Mechanical Turk. Eligibility criteria included reporting BMI ≥30 and at least two chronic health conditions. Participants read about the programs, selected their preferred program, and answered follow‐up questions. The estimated probability of choosing either program was not significantly different from.5 (N = 1005, 50.8% DPP and 49.2% HWL, p =.61). Participants' expectations about adherence, weight loss magnitude, and dropout likelihood were associated with their choice (p <.0001). Non‐White participants (p =.040) and those with monthly income greater than $4999 (p =.002) were less likely to choose DPP. Participants who had postgraduate education (p =.007), did not report high serum cholesterol (p =.028), and reported not having tried losing weight before (p =.025) were more likely to choose DPP. Those who chose HWL were marginally more likely to report that being offered two different programs rather than one would likely affect their decision to enrol in one of the two (p =.052). The enrolment into DPP and HWL was balanced, but race, educational attainment, income, previous attempt to lose weight, and serum cholesterol levels had significant associations with the choice of weight loss program. [ABSTRACT FROM AUTHOR]

Background: The burden of obesity and chronic disease is increasing in the older US Hispanic/Latino adult population. There is limited evidence on successful weight management strategies as perceived by this population. Assessing barriers and opportunities for weight management using mixed methods is a robust approach to collect in‐depth information that can be applied to the development of well‐tailored weight management interventions for this population. Objective: The objective of this study was to assess perceived individual, interpersonal, and environmental factors that influence weight management in older Hispanic/Latino adults. Methods: This community‐based cross‐sectional study included 23 Hispanic/Latino older (>50y) adults with obesity (BMI >30 kg/m2). Perceived barriers and opportunities for weight management were assessed through validated questionnaires and focus groups. Prospectively registered on ClinicalTrials.gov (NCT03978416) on 7 June 2019. Results: In this demographically heterogeneous population, language acculturation was generally low, and the frequency of poor dietary behaviors was high. Participants linked financial strain to lower diet quality, as well as anxiety to uncontrolled eating and food cravings. Social support and trust in healthcare professionals were perceived as priorities for healthy eating. Structural and environmental barriers such as affordability and availability of culturally preferred foods were also identified as influences on food choices and eating behavior. Conclusions: This study revealed opportunities for culturally tailored weight management interventions in older Hispanic/Latino adults with obesity. Clinical Trial Registry Number: NCT03978416 (ClinicalTrials.gov) [ABSTRACT FROM AUTHOR]

Objective: Lifestyle interventions have had limited effectiveness in work sites when evaluated in randomized trials. This study assessed the effectiveness of a novel lifestyle intervention for weight loss (Healthy Weight for Living [HWL]) implemented with or without meal replacements (MR) in work sites. HWL used a new behavioral approach emphasizing reducing hunger and building healthy food preferences, and, unlike traditional lifestyle interventions, it did not require calorie counting. Methods: Twelve work sites were randomized to an 18‐month intervention (n = 8; randomization within work sites to HWL, HWL + MR) or 6‐month wait‐listed control (n = 4). Participants were employees with overweight or obesity (N = 335; age = 48 [SD 10] years; BMI = 33 [6] kg/m2; 83% female). HWL was group‐delivered in person or by videoconference. The primary outcome was 6‐month weight change; secondary outcomes included weight and cardiometabolic risk factors measured at 6, 12, and 18 months in intervention groups. Results: Mean 6‐month weight change was −8.8% (95% CI: −11.2% to −6.4%) for enrollees in HWL and −8.0% (−10.4% to −5.5%) for HWL + MR (p < 0.001 for both groups vs. controls), with no difference between interventions (p = 0.40). Clinically meaningful weight loss (≥5%) was maintained at 18 months in both groups (p < 0.001). Conclusions: A new lifestyle intervention approach, deliverable by videoconference with or without MR, supported clinically impactful weight loss in employees. [ABSTRACT FROM AUTHOR]

In low‐ and middle‐income countries (LMIC), growth impairment is common; however, the trajectory of growth over the course of the first month has not been well characterised. To describe newborn growth trajectory and predictors of growth impairment, we assessed growth frequently over the first 30 days among infants born ≥2000 g in Guinea‐Bissau, Nepal, Pakistan and Uganda. In this cohort of 741 infants, the mean birth weight was 3036 ± 424 g. For 721 (98%) infants, weight loss occurred for a median of 2 days (interquartile range, 1–4) following birth until weight nadir was reached 5.9 ± 4.3% below birth weight. At 30 days of age, the mean weight was 3934 ± 592 g. The prevalence of being underweight at 30 days ranged from 5% in Uganda to 31% in Pakistan. Of those underweight at 30 days of age, 56 (59%) had not been low birth weight (LBW), and 48 (50%) had reached weight nadir subsequent to 4 days of age. Male sex (relative risk [RR] 2.73 [1.58, 3.57]), LBW (RR 6.41 [4.67, 8.81]), maternal primiparity (1.74 [1.20, 2.51]) and reaching weight nadir subsequent to 4 days of age (RR 5.03 [3.46, 7.31]) were highly predictive of being underweight at 30 days of age. In this LMIC cohort, country of birth, male sex, LBW and maternal primiparity increased the risk of impaired growth, as did the modifiable factor of delayed initiation of growth. Interventions tailored to infants with modifiable risk factors could reduce the burden of growth impairment in LMIC. Key messages: In our study, 98% of infants initially lost weight after birth before beginning weight gain.Although most infants began weight gain by 2 days of age, those with delayed initiation of weight gain were more likely to be underweight at 30 days of age.Male sex, country of birth, low birth weight, maternal primiparity and delayed initiation of weight gain were predictors of being underweight at 30 days of age and of wasting at 30 days of age. [ABSTRACT FROM AUTHOR]

Despite the utility of social cognitive theory for facilitating individual behavior changes needed for initial weight loss, this model has been less effective in facilitating adherence to recommended lifestyle changes required for sustainable weight-loss maintenance. One potential reason for the limited long-term effectiveness of lifestyle interventions guided by this model is that the model does not consider the important influence that biology can have on weight-relevant behaviors, during both weight loss and weight-loss maintenance, via sensations of hunger and satiety and changes in energy metabolism (expenditure and fat oxidation). We describe here a proposed revision to social cognitive theory that allows for biological factors to exist in reciprocal determinism with behavioral, environmental, and personal factors, with the goal of creating a theoretical basis for lifestyle interventions with greater personalization in order to facilitate better long- term adherence and improve weight-loss maintenance. [ABSTRACT FROM AUTHOR]

Physiological adaptations to intentional weight loss can facilitate weight regain. This review summarizes emerging findings on hypothalamic and brainstem circuitry in the regulation of body weight and identifies promising areas for research to improve therapeutic interventions for sustainable weight loss. There is good evidence that body weight is actively regulated in a homeostatic fashion similar to other physiological parameters. However, the defended level of body weight is not fixed but rather depends on environmental conditions and genetic background in an allostatic fashion. In an environment with plenty of easily available energy-dense food and low levels of physical activity, prone individuals develop obesity. In a majority of individuals with obesity, body weight is strongly defended through counterregulatory mechanisms, such as hunger and hypometabolism, making weight loss challenging. Among the options for treatment or prevention of obesity, those directly changing the defended body weight would appear to be the most effective ones. There is strong evidence that the mediobasal hypothalamus is a master sensor of the metabolic state and an integrator of effector actions responsible for the defense of adequate body weight. However, other brain areas, such as the brainstem and limbic system, are also increasingly implicated in body weight defense mechanisms and may thus be additional targets for successful therapies. [ABSTRACT FROM AUTHOR]

Background: The ability to identify and measure behaviors that are related to weight loss and the prevention of weight regain is crucial to understanding the variability in response to obesity treatment and the development of tailored treatments.Objectives: The overarching goal of the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project is to provide obesity researchers with guidance on a set of constructs and measures that are related to weight control and that span and integrate obesity-related behavioral, biological, environmental, and psychosocial domains. This article describes how the behavioral domain subgroup identified the initial list of high-priority constructs and measures to be included, and it describes practical considerations for assessing the following four behavioral areas: eating, activity, sleep, and self-monitoring of weight. Challenges and considerations for advancing the science related to weight loss and maintenance behaviors are also discussed.Significance: Assessing a set of core behavioral measures in combination with those from other ADOPT domains is critical to improve our understanding of individual variability in response to adult obesity treatment. The selection of behavioral measures is based on the current science, although there continues to be much work needed in this field. [ABSTRACT FROM AUTHOR]

Objective: To examine the association of program delivery factors with weight loss (WL) in enrollees in iDiet® , a commercial WL program.Methods: Data were from 644 adults enrolling in an 11-week group WL program and 461 who reported weight to 11 weeks (complete reporters). Predictors of %WL were analyzed using ANCOVA, including meeting type (in-person vs. videoconference), participant type (worksite employees vs. community members), age, gender, BMI, and payment structure.Results: Mean starting BMI was 32.4 ± 7.1 (mean ± SD); WL was 6.1 ± 3.9% in all enrollees in an intention-to-treat analysis and 7.4 ± 3.4% in complete reporters. Videoconference participants, older adults, and enrollees in incentivized programs were more likely to be complete reporters (P < 0.004). %WL at 11 weeks was not associated with gender, starting BMI, or videoconference versus in-person groups. Worksite participants had greater %WL than community participants (+1.2%, P < 0.001), and there was no significant difference in %WL between programs paid by the employee or employer. Greater %WL was achieved by individuals ≥30 versus < 30 years (+2.2%, P < 0.001) and by those enrolling in January-March versus April-June (+1.4%, P = 0.02).Conclusions: iDiet participants had clinically impactful mean WL. The observed high mean WL in worksites and videoconference-delivered programs broadens options for scalable WL program implementation. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of diets varying in carbohydrate and glycemic index (GI) on changes in body composition, resting metabolic rate (RMR), and metabolic adaptation during and after weight loss.Methods: Adults with obesity (n = 91) were randomized to one of four provided-food diets for 17 weeks. Diets differed in percentage energy from carbohydrate (55% or 70%) and GI (low or high) but were matched for protein, fiber, and energy. Body weight, body composition, RMR, and metabolic adaptation (measured RMR-predicted RMR) were measured during weight loss and subsequent weight stability.Results: No effect of dietary carbohydrate content or GI on body weight loss or percentage of weight lost as fat mass (FM) was observed. Measured RMR was significantly lower (-226 kJ/day [95% CI: -314 to -138 kJ/day], P < 0.001) than predicted RMR following weight loss, but this difference was attenuated after 5 weeks of weight stability. Metabolic adaptation did not differ by dietary carbohydrate content or GI and was not associated with weight regain 12 months later.Conclusions: Moderate-carbohydrate and low-GI diets did not preferentially reduce FM, preserve lean mass, or attenuate metabolic adaptation during weight loss compared to high-carbohydrate and high-GI diets. [ABSTRACT FROM AUTHOR]

Objective To examine changes in children's meal orders, price, and revenue following the implementation of a healthier children's menu in a full-service restaurant chain. Methods In April 2012, the healthier menu was implemented, featuring more meals meeting nutrition standards, healthy side dishes by default, and removal of French fries and soda (which could be substituted). Orders ( n = 352,192) were analyzed before (September 2011 to March 2012; PRE) and after (September 2012 to March 2013; POST) implementation. Results Children's meal prices increased by $0.79 for breakfasts and $0.19 for non-breakfast meals from PRE to POST. Revenue continued to increase post-implementation. Orders of healthy meals, strawberry and vegetable sides, milk, and juice increased, and orders of French fries and soda decreased ( P < 0.0001). Orders at POST were more likely to include healthy sides ( P < 0.0001) and substitutions ( P < 0.0001) and less likely to include a la carte sides ( P < 0.0001) and desserts ( P < 0.01), versus PRE. Total calories ordered by children accepting all defaults decreased (684.2 vs. 621.2; P < 0.0001) and did not change for those not accepting defaults (935.0 vs. 942.9; P = 0.57). Conclusions Healthy children's menu modifications were accompanied by healthier ordering patterns, without removing choice or reducing revenue, suggesting that they can improve child nutrition while restaurants remain competitive. [ABSTRACT FROM AUTHOR]

Objective To examine the relationship between dietary characteristics of self-selected foods and energy balance in a cafeteria-style dining hall. Methods Ad libitum dietary intake from a self-selection menu was measured over two days in 151 adults (70% female, mean age 41 years, mean BMI 24.9 kg/m2). The associations of dietary variables with energy balance (calculated as measured energy intake/predicted energy requirements, pER) were assessed. Results Measured energy intake was significantly correlated with pER (R2=0.83, P < 0.001). In mixed multiple regression models, percent energy from protein was negatively associated with energy balance ( R2=0.04, P = 0.02), and percent energy from liquid sources ( R2 = 0.02, P = 0.05), total dietary variety in females ( R2 = 0.39, P < 0.001), and energy density ( R2 = 0.57, P < 0.001) were positively associated with energy balance. In addition, glycemic index was inversely associated with energy balance in normal-weight individuals ( R2 = 0.14, P < 0.001) but not in overweight or obese individuals. Conclusions There are independent associations of dietary protein, liquid calories, energy density, dietary variety, and glycemic index with energy balance, indicating additive effects of these dietary factors on energy intake and energy balance. Intervention studies are needed to determine whether dietary prescriptions combining these dietary factors facilitate long-term prevention of weight gain. [ABSTRACT FROM AUTHOR]

Objective To examine associations between eating behavior constructs and weight loss (WL) in a 6-month WL intervention in worksites. Design and Methods A cluster-randomized controlled trial of a group behavioral WL intervention versus wait-listed control was conducted at four worksites. Measures included body weight and the eating behavior constructs restraint, disinhibition, hunger, and their sub-constructs. Rates of intervention meeting attendance and weight self-monitoring were also quantified. Results WL was greater in intervention participants than controls (Δ I = −8.1±6.8 kg, Δ C = +0.9±3.6 kg, P<0.001). Between-group analyses showed that the intervention was associated with increased restraint (Δ I = 5.43±4.25, Δ C = 0.29±3.80, P<0.001), decreased disinhibition (Δ I = −2.5±3.63, Δ C = 0.66±1.85, P < 0.001) and decreased hunger (Δ I = −2.79±3.13, Δ C = 0.56±2.63, P < 0.001), and changes in all eating behavior subscales. Greater WL in intervention participants was correlated with higher baseline hunger ( r = −0.25, P = 0.03), increased restraint ( r = −0.35, P=0.001), decreased disinhibition ( r = 0.26, P = 0.02), and decreased hunger ( r = 0.36, P = 0.001). However, in a multiple regression model including rates of meeting attendance and self-monitoring, decreased hunger was the only eating behavior change that predicted weight loss ( R2=0.57, P<0.001). Conclusion Decreased hunger was the strongest predictor of WL in this intervention with relatively high mean WL. Further studies are needed to confirm the central role of hunger management in successful WL. [ABSTRACT FROM AUTHOR]

Theoretical calculations suggest that small daily reductions in energy intake can cumulatively lead to substantial weight loss, but experimental data to support these calculations are lacking. We conducted a 1-year randomized controlled pilot study of low (10%) or moderate (30%) energy restriction (ER) with diets differing in glycemic load in 38 overweight adults (mean ± s.d., age 35 ± 6 years; BMI 27.6 ± 1.4 kg/m2). Food was provided for 6 months and self-selected for 6 additional months. Measurements included body weight, resting metabolic rate (RMR), adherence to the ER prescription assessed using 2H218O, satiety, and eating behavior variables. The 10%ER group consumed significantly less energy (by 2H218O) than prescribed over 12 months (18.1 ± 9.8%ER, P = 0.04), while the 30%ER group consumed significantly more (23.1 ± 8.7%ER, P < 0.001). Changes in body weight, satiety, and other variables were not significantly different between groups. However, during self-selected eating (6–12 months) variability in % weight change was significantly greater in the 10%ER group (P < 0.001) and poorer weight outcome on 10%ER was predicted by higher baseline BMI and greater disinhibition (P < 0.0001; adj R2 = 0.71). Weight loss at 12 months was not significantly different between groups prescribed 10 or 30%ER, supporting the efficacy of low ER recommendations. However, long-term weight change was more variable on 10%ER and weight change in this group was predicted by body size and eating behavior. These preliminary results indicate beneficial effects of low-level ER for some but not all individuals in a weight control program, and suggest testable approaches for optimizing dieting success based on individualizing prescribed level of ER. [ABSTRACT FROM AUTHOR]

Objectives. Many previous investigations of the recovery of emotional well-being, particularly the resolution of depression, following an acute cardiac event assume that all patients follow a similar, linear trajectory. However, it is possible that there are different groups of patients who follow different trajectories. This study tested for multiple trajectories of anxiety and depression and identified the characteristics of patients most at risk for persistent or worsening anxiety and depression in the 12 months following their cardiac event. Method. A consecutive sample of 226 women was interviewed following either acute myocardial infarction (AMI) or coronary artery bypass graft surgery (CABGS). The Hospital Anxiety and Depression Scale were administered on four occasions over 12 months. Growth curve and growth mixture modelling were used to identify trajectories of change and univariate tests were employed to establish predictors of each trajectory. Results. Most women began with relatively low levels of anxiety and/or depression that improved over the 12 month period (84% women showed this trajectory for anxiety, 89% for depression). A smaller group began with relatively high levels of anxiety and/or depression that worsened over time (16% for anxiety, 11% for depression). Patients in the latter group were more likely to report high levels of loneliness, have a first language other than English, perceive their cardiac disease as more severe (anxiety group only) and have diabetes (depression group only). Trajectories were non-linear, with most change occurring in the initial 2-month period. Conclusion. Growth modelling techniques highlight that change in anxiety and depression following an acute event follows neither a single nor linear trajectory. Most women showed early resolution of anxiety and depression following their event, indicative of a normal bereavement or adjustment response. A minority of women reported worsening anxiety and/or depression in the year following their cardiac event, particularly those who lacked social support or were from non-English speaking backgrounds. Intervention studies to explore support options for these women are warranted, both prior to and following their event. [ABSTRACT FROM AUTHOR]

The article provides the results of a study on the association of weight gain, body mass index (BMI) and obesity with subscales of eating behavior characteristics in older women in New England. High habitual disinhibition was linked with weight gain. Women with high scores for habitual disinhibition and low core for flexible restraint gained ∼22 kilogram over the 20 year age interval. High habitual and emotional overeating were associated with high BMI.

The article discusses the results of a study on the impact of dietary glycemic load on type 2 diabetes risk factors during weight loss. The contributors to the development of glucose intolerance and type 2 diabetes mellitus are identified including insulin resistance and low-grade systemic inflammation. The measurement of glucose using the hexokinase method is also reported.

Objectives. To examine the dimensionality, structure, and reliability of the HADS among female cardiac patients. Design. Data were collected by self-administered questionnaires at two times-admission to hospital and at 2-month follow-up. Method. Confirmatory factor analysis was used to examine the dimensionality and structure of the HADS. Internal consistency was assessed by computing Cronbach alpha. Pearson product-moment correlation coefficients were calculated to assess test--retest reliability. Results. A two-factor model, in which the subscales were permitted to correlate, was found to provide a good fit to the scale's 14 items compared to single factor and orthogonal two-factor models. These two factors explained 41.4% of the total variance. The anxiety and depression subscales were moderately correlated (r = .60), with good internal consistency and test--retest reliability found for the subscales and total HADS scores. Conclusions. These results provide support for the HADS as a reliable measure for the assessment of anxiety and depression symptomatology among female cardiac patients. [ABSTRACT FROM AUTHOR]