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Objective: To analyse the comparative effectiveness of different health wearable-based physical activity (PA) promotion intervention strategies against each other and control for reducing body weight and body mass index (BMI) in individuals with overweight/obesity and chronic comorbidities., Design: Systematic review and network meta-analysis (PROSPERO identifier: CRD42020158191)., Data Sources: We performed two independent searches from December 2019 to September 2020 in PubMed, MEDLINE, Scopus, Web of Science, Central Register of Controlled Trials, EMBASE and PsycINFO databases for articles published in English between 2007 and 2020., Eligibility Criteria for Selecting Studies: Inclusion criteria were based on the PICOS framework. We included randomised controlled trials of health wearable-based interventions using two or more PA intervention arms/strategies and compared their effects on participants' body weight (kg) and BMI (kg/m 2 ) with a control group. Data were analysed using a Bayesian network meta-analysis to directly and indirectly compare the effects of the six different intervention strategies (comparators). The six comparators were: (1) control group (ie, usual care, waitlist); (2) comparison group (ie, traditional, non-health wearable PA interventions); (3) commercial health wearable-only intervention (eg, Fitbit, Polar M400); (4) research grade health wearable-only intervention (ie, accelerometers or pedometers); (5) multicomponent commercial health wearable intervention (eg, Fitbit + nutrition counselling); and (6) multicomponent research grade health wearable intervention. The results were reported as standardised mean differences (SMDs) with associated 95% credible intervals (CrIs)., Results: From 641 screened records, 31 studies were included. For body weight reduction in individuals with overweight/obesity and chronic comorbidities, accelerometer/pedometer-only (SMD -4.44, 95% CrI -8.94 to 0.07) and commercial health wearable-only (SMD -2.76, 95% CrI -4.80 to -0.81) intervention strategies were the most effective compared with the three other treatments and control. For BMI reduction, multicomponent accelerometer/pedometer (SMD -3.43, 95% CrI -4.94 to -2.09) and commercial health wearable-only (SMD -1.99, 95% CrI -4.95 to 0.96) intervention strategies were the most effective compared with the other four conditions., Conclusion: Health wearable devices are effective intervention tools/strategies for reducing body weight and BMI in individuals with overweight/obesity and chronic comorbidities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Maintaining a healthy weight is a military requirement for the Reserve Officer Training Corps (ROTC) cadets. Male and female soldiers often have different approaches to maintaining a healthy weight and mobile health (m-health) tools can be harnessed and tailored to the needs of individual cadets. This study examined gender differences in technology use, weight loss strategies, information needed to maintain a healthy weight, and willingness to participate in m-health research and programs.Objectives: This study examined gender differences in technology use, weight loss strategies, information needed to maintain a healthy weight, and willingness to participate in m-health research and programs. Materials and Methods: A self-administered survey was completed by 404 cadets from ROTC programs in Florida in 2017. Most owned smartphones and used them as their primary internet access. Women had significantly lower body mass index than men (p = 0.037). Most used healthy weight loss strategies, including increasing physical activity, reducing sweets, and reducing fried foods. Women were more likely than men to reduce fried foods (p < 0.0003) and sweets (p = 0.020). Most reported a willingness to participate in m-health weight management research and programs, with women more willing to do so (p = 0.038). Most were willing to participate in m-health programs that used text messages, food/activity/sleep apps, smart watches/fitness trackers, and stress management/anxiety apps. Women were more willing to participate in programs that used apps for stress/anxiety management (p = 0.004) and to track food/activity/sleep (p < 0.0001). Most needed information on eating healthy on a budget and eating healthy on-the-run.Results: Most owned smartphones and used them as their primary internet access. Women had significantly lower body mass index than men (p = 0.037). Most used healthy weight loss strategies, including increasing physical activity, reducing sweets, and reducing fried foods. Women were more likely than men to reduce fried foods (p < 0.0003) and sweets (p = 0.020). Most reported a willingness to participate in m-health weight management research and programs, with women more willing to do so (p = 0.038). Most were willing to participate in m-health programs that used text messages, food/activity/sleep apps, smart watches/fitness trackers, and stress management/anxiety apps. Women were more willing to participate in programs that used apps for stress/anxiety management (p = 0.004) and to track food/activity/sleep (p < 0.0001). Most needed information on eating healthy on a budget and eating healthy on-the-run. Conclusions: Opportunities exist for college health and wellness professionals to use a variety of m-health tools and apps to promote general health and wellness and to help cadets achieve and maintain a healthy weight.

The SMARTsize intervention embeds an evidence-based portion control intervention in regular dietetic care. This intervention was evaluated to explore (1) which patients participated, (2) the implementation process, and (3) the outcomes of the intervention. The intervention was evaluated with an observational study design including measures at baseline, and three, six, and nine months after the start of the program. Data concerning the process (participation, dose delivered, dose received, satisfaction) and the outcomes (self-efficacy, intention, portion control strategies, and Body Mass Index (BMI) were collected with forms and questionnaires filled out by dietitians and patients. Descriptive analyses, comparison analyses, and cluster analyses were performed. Patients were mainly obese, moderately to highly educated women of Dutch ethnicity. Use of the intervention components varied from 50% to 100% and satisfaction with the SMARTsize intervention was sufficient to good (grades 7.2⁻8.0). Statistically significant ( p < 0.001) improvements were observed for self-efficacy (+0.5), portion control strategies (+0.7), and BMI (-2.2 kg/m²), with no significant differences between patients with or without counselling. Three clusters of patients with different levels of success were identified. To conclude, implementing an evidence-based portion control intervention in real-life dietetic practice is feasible and likely to result in weight loss.

Background: Sedentary lifestyle is growing among children and adolescents that may contribute to problems such as overweight and obesity. Consequently, interventions to improve weight loss in this population are necessary. The aim of this current review was to evaluate the effectiveness of game-based interventions to reduce body mass index (BMI) among children who were overweight or obese., Methods: All randomized controlled trials with a game-based approach for lowering weight in obese/overweight youths aged 5-18 years old were identified from January 2005 to June 2017 across PubMed, Web of Science, Embase, Scopus, and ScienceDirect. Two independent reviewers completed data extraction sheets on information such as sample size, country of origin, age of participants, type of interventions, and BMI change from pre- to posttest. A consensus on collected data was obtained, and a final list of studies meeting inclusion and exclusion criteria was arrived at. Data were analyzed using Comprehensive Meta-analysis software, and effect size was measured by standardized mean difference (SMD) and Hedges' g measure. Heterogeneity and publication bias were also examined using I 2 index and funnel plot., Results: A total of 388 articles were identified from electronic and manuals' searches. After deletion of duplicated articles, 138 articles remained that were then screened in terms of relevance. Of those, 41 articles were examined to determine eligibility. Finally, 10 articles met inclusion/exclusion criteria and were entered into the quantitative meta-analysis. Results indicated a small but significant effect size in terms of BMI reduction [SMD, -0.234; standard error (SE), 0.069] among included studies. The average BMI z-score reduction was -0.181 (SE, 0.071). Trials which used other types of interventions along with active game-based approaches achieved greater effect sizes than single game-based interventions. There was a significant difference between studies based on their country of origin, BMI value, and intervention type. Those conducted in United States, those including participants with BMI ≥30, and studies with multicomponent intervention reported a higher reduction of BMI than others. However, no significant difference in BMI was found in terms of variables such as age, sample size, type of participant (overweight/obese), intervention duration, or participant gender. No publication bias was identified, and studies were homogenous (I 2  = 22.5%)., Conclusions: Interventions that involve active gaming may produce small effects in terms of improving BMI among children who are overweight/obese. Therefore, we recommend that supplemental interventions be used to enhance the effectiveness of game-based interventions.

Objective: To examine whether SMS text messaging facilitates a reduction of weight and waist circumference (WC) and favourable changes in lipid profile and insulin levels in clinically healthy overweight and obese subjects., Design: A randomised controlled trial., Setting and Intervention: Primary care health centre in Riga, Latvia. Text messaging once in two weeks., Subjects: A total of 123 overweight and obese men and women aged 30-45 years with no cardiovascular diseases (CVDs) or diabetes., Main Outcome Measures: changes in anthropometric parameters (weight, WC, body mass index (BMI)) and biochemical parameters (lipids, fasting glucose and insulin)., Results: We found a statistically significant decrease in weight (2.4%), BMI and WC (4.8%) in the intervention group, while the control group showed a statistically non-significant increase in weight and BMI and decrease in WC. Between group results obtained over the course of a year showed statistically significant mean differences between weight (-3.4 kg (95% CI -5.5, -1.3)), BMI kg/m 2 (-1.14 (95% CI -1.9, -0.41)), WC (-4.6 cm (95% CI -6.8, -2.3)), hip circumference (-4.0 cm (95% CI -5.9, -2.0)) and fasting insulin (2.43 μU/ml (95% CI 0.6, 4.3)). Mean differences of changes in glucose and lipid levels were statistically non significant: fasting glucose (-0.01 mmol/l (95% CI -0.19, 0.17)), TC mmol/l (-0.04 mmol/l (95% CI -0.29, 0.21)), HDL-C (0.14 mmol/l (95% CI -0.65, 0.09)), LDL-C (-0.02 mmol/l (95% CI -0.22, 0.18)) and TG (0.23 mmol/l (95% CI -0.06, 0.52))., Conclusions: SMS messaging in clinically healthy overweight and obese subjects facilitates a slight decrease in weight, BMI and WC. It is anticipated that the implications of this strategy might facilitate the design of preventive and promotive strategies among high risk groups in Latvia.

Weight loss is the primary recommendation for health improvement in individuals with high body mass index (BMI) despite limited evidence of long-term success. Alternatives to weight-loss approaches (such as Health At Every Size - a weight-neutral approach) have been met with their own concerns and require further empirical testing. This study compared the effectiveness of a weight-neutral versus a weight-loss program for health promotion. Eighty women, aged 30-45 years, with high body mass index (BMI ≥ 30 kg/m(2)) were randomized to 6 months of facilitator-guided weekly group meetings using structured manuals that emphasized either a weight-loss or weight-neutral approach to health. Health measurements occurred at baseline, post-intervention, and 24-months post-randomization. Measurements included blood pressure, lipid panels, blood glucose, BMI, weight, waist circumference, hip circumference, distress, self-esteem, quality of life, dietary risk, fruit and vegetable intake, intuitive eating, and physical activity. Intention-to-treat analyses were performed using linear mixed-effects models to examine group-by-time interaction effects and between and within-group differences. Group-by-time interactions were found for LDL cholesterol, intuitive eating, BMI, weight, and dietary risk. At post-intervention, the weight-neutral program had larger reductions in LDL cholesterol and greater improvements in intuitive eating; the weight-loss program had larger reductions in BMI, weight, and larger (albeit temporary) decreases in dietary risk. Significant positive changes were observed overall between baseline and 24-month follow-up for waist-to-hip ratio, total cholesterol, physical activity, fruit and vegetable intake, self-esteem, and quality of life. These findings highlight that numerous health benefits, even in the absence of weight loss, are achievable and sustainable in the long term using a weight-neutral approach. The trial positions weight-neutral programs as a viable health promotion alternative to weight-loss programs for women of high weight., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: The prevalence of obesity in men in the UK is amongst the highest in Europe but men are less likely than women to use existing weight loss programmes. Developing weight management programmes which are appealing and acceptable to men is a public health priority. Football Fans in Training (FFIT), a men-only weight management programme delivered to groups of men at top professional football clubs, encourages men to lose weight by working with, not against, cultural ideals of masculinity. To inform further development of interventions in football club settings, the current study explored who is attracted to FFIT and why overweight/obese men choose to take part., Methods: A mixed-methods study analysing baseline data on 747 men aged 35-65 years with BMI ≥ 28 kg/m2 who were participants in a randomised controlled trial of FFIT, and data from 13 focus group discussions with 63 men who had attended the programme., Results: Objectively-measured mean body mass index was 35.3 kg/m2 (sd 4.9). Overall over 90% of participants were at very high or extremely high risk of future ill-health. Around three-quarters of participants in all age groups were at 'very high' risk of type 2 diabetes, hypertension and cardiovascular disease (72%, 73% and 80% of men aged 35-44, 45-54 and 55-64 years respectively). A further 21%, 16% and 13% were at 'extremely high' risk. Qualitative data revealed that the powerful 'draw' of the football club attracted men otherwise reluctant to attend existing weight management programmes. The location and style of delivery of early FFIT sessions fostered team spirit; men appreciated being with others 'like them' and the opportunity to undertake weight management in circumstances that enhanced physical and symbolic proximity to something they valued highly, the football club., Conclusions: The delivery of a weight management intervention via professional football clubs attracted men at high risk of ill-health. The setting enabled men to join a weight management programme in circumstances that felt 'right' rather than threatening to themselves as men. FFIT is an example of how to facilitate health promotion activities in a way that is consistent with, rather than challenging to, common ideals of masculinity.

Intentional weight loss among overweight and obese adults (body mass index ≥ 25 kg/m(2)) is associated with numerous health benefits, but weight loss maintenance (WLM) following participation in weight management programming has proven to be elusive. Many individuals attempting to lose weight join formal programs, especially women, but these programs vary widely in focus, as do postprogram weight regain results. We surveyed 2,106 former participants in a community-based, insurance-sponsored weight management program in the United States to identify the pre, during, and post-intervention behavioral and psychosocial factors that lead to successful WLM. Of 835 survey respondents (39.6% response rate), 450 met criteria for inclusion in this study. Logistic regression analyses suggest that interventionists should assess and discuss weight loss and behavior change perceptions early in a program. However, in developing maintenance plans later in a program, attention should shift to behaviors, such as weekly weighing, limiting snacking in the evening, limiting portion sizes, and being physically active every day.

Aim: The authors assessed the predictors of success of a lifestyle intervention (weight loss ≥ 5% and improved glucose tolerance) in individuals at high risk for type 2 diabetes in a 1-year follow-up in a primary health care setting., Methods: High-risk individuals for type 2 diabetes were identified by opportunistic screening in the implementation of the Finnish National Diabetes Prevention Program (FIN-D2D). All together, 3880 individuals participated in the 1-year follow-up. Sociodemographic characteristics, health status and behavior, family history of diabetes, clinical factors, and health care provider were considered possible predictors of lifestyle intervention success., Results: In sum, 19.3% of individuals lost at least 5% of weight, and 32.6% with abnormal glucose tolerance at baseline showed improvement in glucose tolerance. Abnormal glucose tolerance was the strongest predictor of weight loss and improvement in glucose tolerance. High attendance at lifestyle intervention visits, being outside of labor force, and high body mass index at baseline were also related to weight loss, and high education was related to improvement in glucose tolerance., Conclusions: In "real-life settings," glucose tolerance status, number of intervention visits, employment status, education, and body mass index explained the success of lifestyle intervention. These factors may help in targeting interventions, although they may not be generalized to other cultural settings.

Background: Prevention of (serious) overweight can be achieved by means of small behaviour changes in physical activity and/or diet., Objective: To evaluate a mass media campaign promoting energy balance behaviours in a Dutch population. Effects were examined for body mass index (BMI) and five energy balance behaviours., Methods: A representative cohort study of 1200 Dutch adults was employed. Data were collected at four moments. Two campaign waves were launched, following T1 (targeting the general adult population) and T2 [targeting low socio-economic status (SES) men], respectively. Regression analyses were performed to estimate the short-term and long-term effects of campaign exposure., Results: In total, data of 1030 participants (86%) were available. Time trends showed unfavourable changes in most but not all energy balances behaviour for the total sample. No differences were found for BMI. No differences in the outcome measures were found as a result of exposure to the first campaign (19%). A short-term effect of exposure to the second campaign (29% exposure) was found (T2-T3), but only for low SES respondents, with increases in the attention being paid towards food choice (P = 0.02). At long term, BMI was less likely to increase among exposed people with a non-Dutch ethnicity (P = 0.01, T2-T4)., Conclusions: Exposure to the campaign was low. The first campaign wave had no effects on BMI and energy balance behaviours. Small but favourable changes in attention towards food choice and BMI for at-risk populations were observed among those exposed to the second campaign wave.

It is expected that a dietary intervention based on the traditional Mediterranean food pattern should be associated with a reduction in fast-food consumption but this has never been tested before. We assessed the impact of a 12-week dietary intervention, promoting the adoption of a Mediterranean food pattern, on fast-food consumption among seventy-one healthy women aged between 30 and 65 years. The dietary intervention consisted of two group sessions and seven individual sessions with a dietitian. To determine the Mediterranean dietary score (MedScore) and fast-food consumption, an FFQ was administered. During the 12-week intervention, the MedScore significantly increased (from 21.1 (SD 3.6) units at baseline to 28.6 (SD 4.4) units at week 12, P < 0.0001), while the fast-food consumption significantly decreased (from 51.7 (SD 46.4) g/d at baseline to 20.5 (SD 18.2) g/d at week 12, P < 0.0001). Moreover, women who had a higher consumption of fast food at baseline decreased their fast-food consumption to the most (r - 0.50, P < 0.0001). When four subgroups were formed on the basis of median values of Medscore and fast-food consumption changes, it was found that only the subgroup of women which increased the most their MedScore and decreased the most their fast-food consumption experienced a significant decrease in BMI (P < 0.01). In conclusion, a dietary intervention promoting the Mediterranean food pattern led to a decrease in fast-food consumption among healthy women even if it was not a specific target of the intervention. Dietary strategies for increasing intake of healthy foods may be a useful approach for decreasing intake of less healthy foods.

Background: Women with higher body mass index report low rates of and face unique barriers to exercise. Increasing exercise participation can improve mental and physical health independent of weight loss; however, most exercise programs targeting this population focus predominately on losing weight. This paper aims to describe the development of Fit&Fab, a community-based exercise intervention focused on increasing exercise participation and enjoyment for women with obesity. Methods: In partnership with the YMCA, we recruited women ages 35–64 years (body mass index ≥ 30) to participate in 4 focus groups to understand exercise preferences. Formative work was used to identify theory constructs and associated intervention components. Women from the focus groups were recruited for a community advisory board that finalized the intervention design, recruitment, and evaluation plan. Results: Focus groups participants (N = 29) preferred to exercise without men and wanted a cohort-style class that included women of similar exercise levels and body types, incorporated social support, fun activities, and broke exercise into smaller bouts. They wanted a supportive instructor who was fit but understood weight-related challenges. The community advisory board and research team used focus group findings to inform design of the final intervention including group exercise classes, psychosocial support sessions, personalized training, exercise tracking, outcome monitoring, and rewards. Conclusions: Our findings emphasize the need to focus on exercise enjoyment and benefits other than losing weight to improve exercise participation among women with higher body mass index. In addition to having outcomes other than weight loss, exercise interventions with this population should also consider group composition, instructor, and class format. [ABSTRACT FROM AUTHOR]

Hormonal disorders like PCOS (Polycystic Ovary Syndrome), autoimmune thyroid disease (AITD) including Hashimoto's thyroiditis, male hypogonadism are commonly encountered in clinical practice in the US and worldwide, with rising frequency. These typically affect patients during young or middle age, compared with other common chronic illnesses like type 2 diabetes, hypertension, atherosclerotic cardiovascular disease, where onset may usually be in middle or older age. Multiple studies point to the role of disordered lifestyle health behaviors as contributory to these endocrinopathies, and conversely therapeutic lifestyle changes leading to improvement in signs, symptoms, biochemical markers, and sequelae of these conditions. This article presents 3 different real life case studies of the conditions enlisted above and documents the positive impact of lifestyle improvements on their disease condition. Therapeutic lifestyle behaviors are an extremely useful and important component of management of these familiar endocrinologic disorders, and clinicians need to routinely counsel their patients about healthy lifestyle interventions when treating these common syndromes. [ABSTRACT FROM AUTHOR]

Background Exercise Referral Schemes (ERS) are designed so health professionals can refer certain patients to a supervised programme of physical activity. However, evaluations have questioned the effectiveness of these schemes/programmes. The aim of this study was to systematically review the provision of ERS in England and analyse related promotional material. Methods Content analysis methods were used to analyse scheme websites and promotional material. A coding scheme was used to analyse the data, which included information on the programme's aims, inclusion criteria, type of activities, accessibility and cost. Results The study identified 625 sites offering ERS across 168 geographic areas. Findings highlighted a lack of clarity in what constitutes a scheme. Over a third of schemes did not explicitly state their aims, but of those that did, the focus was mainly on notions of physical and mental health benefits. Conclusions This study is the first to review the scope and offer of ERS in the UK by examining promotional material and highlights issues around the stated aims of ERS. More clarity on aims is needed in the material that promotes the schemes and most likely within the schemes themselves. Such improvements could make a difference when considering engagement with delivery stakeholders and potential participants. [ABSTRACT FROM AUTHOR]

Summary: Background: The identification of predictive parameters of the success of multidisciplinary weight loss interventions (MWLI) appears essential to optimize obesity management. The association between baseline cardiorespiratory fitness (CRF) and changes in anthropometric parameters and body composition during MWLI remains underexplored in adolescents with obesity. Objectives: To assess whether baseline CRF was associated with the effectiveness of a 16‐week MWLI measured through improved body mass, body mass index (BMI) and body composition (percentage of total fat mass (FM) as the main criterion). Methods: Cardiorespiratory fitness and body composition were respectively measured by peak oxygen consumption (VO2peak) during maximal exercise tests and dual‐photon x‐ray absorptiometry (DXA), before (T0) and after (T1) a 16‐week MWLI in 165 adolescents (aged 13.3 ± 1.38 years, 61.2% female, BMI 35.11 ± 5.16 kg/m2). Results: Reductions in BMI and total FM percentage between T0 and T1 were greater in subjects with a baseline VO2peak ≥ 3rd quartile compared to the first quartile (p < 0.001) and the interquartile range (p < 0.05 and p < 0.001, respectively). Baseline VO2peak and VO2 at the first ventilator threshold were positively correlated with the reductions in body mass, BMI and total and visceral FM percentages and with the increase in lean mass (LM) percentage between T0 and T1 after adjustment for age and gender (p < 0.001). Conclusion: Initial CRF is associated with the success of MWLI in adolescents with obesity. Improving their aerobic fitness before starting a MWLI might be a promising strategy to optimize its benefits. [ABSTRACT FROM AUTHOR]

Background/Objectives: The escalating obesity epidemic necessitates effective, sustainable weight loss (WL) and maintenance strategies. This study aimed to evaluate the effectiveness of the Weight Loss Maintenance 3 Phases Program (WLM3P) in achieving a clinically significant long-term weight loss (WL) (≥5% initial WL at 18 months) in adults with obesity compared to a standard low-carbohydrate diet (LCD). Subjects/Methods: In this two-phase trial, 112 participants targeting initial WL (0–6 months) and subsequent maintenance (7–18 months) were randomly assigned to either WLM3P or LCD groups. Outcomes assessed included change in body weight (kg, %), improvements in body composition, and metabolic profile. Results: Of 112 randomized participants, 69% (n = 77) completed the study. At 18 months, WL in the WLM3P group (n = 40) was 15.5 ± 8.3% compared to 9.6 ± 8.5% in the LCD group (n = 37) (p < 0.001). The odds ratio of achieving WL ≥ 10% and ≥15% were significantly higher in the WLM3P group. Complete-case analysis revealed significantly greater improvements in BMI, body fat mass, visceral fat area, waist circumference, waist-to-hip ratio, HDL, and triglyceride/HDL ratio in WLM3P than in LCD. No serious adverse events were reported. Conclusion: Both programs effectively promoted clinically relevant WL and its maintenance. However, the WLM3P program was more successful in helping participants achieve greater WL targets of ≥10% and ≥15%, along with other clinical benefits, after an 18-month intervention. Trial registration number: NCT04192357. [ABSTRACT FROM AUTHOR]

To examine health-related self-efficacy for individuals following acquired brain or spinal cord injury prior to enrollment in a weight-loss intervention and associations with demographics, injury characteristics, and additional physiologic variables. Cross-sectional analysis of baseline data for community-dwelling adults following stroke (CVA), traumatic brain injury (TBI), or spinal cord injury (SCI) across three disability-adapted weight-loss interventions. Overall results suggest a significant difference between injury type and self-efficacy as measured by the Self Rated Abilities for Health Practices (SRAHP) scale. On average, individuals with SCI had the lowest overall perceived self-efficacy of the three groups (11.2-unit difference; (CI: −17.4, −5.0), followed by those with TBI (9.5-unit difference; (CI: −16.7, −2.4). There were also differences between groups in age, number of household members, time since injury, sex, race, marital status, physiological measures, and employment status. Results suggest that individuals with different disabilities following neurological injuries have different baseline perceptions in their ability to eat a healthy diet and exercise regularly. Health interventions should be tailored for these groups based on disability-specific barriers and should include components to enhance health-related self-efficacy to address weight management among these populations. Evidence suggests that health-related self-efficacy may differ following different injury types and level of disability may impact one's ability to maintain health-related behaviors Results suggest that individuals with a spinal cord injury may have different baseline perceptions of self-efficacy related to their ability to eat a healthy diet and exercise regularly compared to those with a traumatic brain injury or stroke. Health interventions should be tailored to encompass disability-specific barriers which may impact an individual's health-related self-efficacy. [ABSTRACT FROM AUTHOR]

Patient activation is associated with treatment adherence, self-accountability for healthcare and a healthy lifestyle change. Mobile health (m-Health) apps can lead to greater patient treatment adherence and health behaviour change. This study aimed to evaluate the health behaviour change of elderly people through a healthcare programme focused on activation with the support of technology. Three phases were conducted: (1) pre-intervention – design of the intervention protocol and the app, (2) intervention – randomised clinical trial with 41 overweight/obese elderly people. m-Health app-supported group psychotherapy was compared with group psychotherapy only and individual psychotherapy (control) and (3) post-intervention – statistical analysis, intervention's assistant interviews and app heuristics evaluation. By crossing the results, the study has shown that there was no significant difference in the activation level before and after intervention between groups. However, there was a significant increase from the initial mean score to the final one when considering the three groups together. Group therapy, whether with or without the support of the app, was more effective for behaviour change measured by the achievement of the goals, than individual psychotherapy. The lack of impact on group therapy with app support calls into question which and how much technology support is useful. [ABSTRACT FROM AUTHOR]

Background: Moxibustion has been used in the treatment and prevention of obesity. However, there has been no systematic review or meta-analysis conducted on the use of moxibustion on obesity treatment. This study aimed to evaluate the role of moxibustion in the treatment of obesity. Methods: The Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE/PubMed databases were searched to identify all randomized controlled trials (RCTs) that evaluated the effect of moxibustion on obesity. The primary outcome was body weight. The secondary outcomes were the body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR). The risk of bias assessment and meta-analysis were conducted using the Cochrane Collaboration tool. Results: Eleven RCTs involving 761 participants were included in this systematic review and meta-analysis. Other interventions that were included in the analyses were manual acupuncture, electroacupuncture, embedding therapy, herbal medicine, and diet control. Moxibustion combined with other interventions resulted in a significant improvement in body weight reduction (mean difference [MD] −3.32, 95% confidence interval [CI: −4.25 to −2.38]; I2 = 17%), BMI (MD −1.51, 95% CI [−1.88 to −1.14]; I2 = 76%), and WC (MD −2.82, 95% CI [−3.50 to −2.13]; I2 = 75%), but did not improve HC (MD −2.05, 95% CI [−4.21 to 0.11]; I2 = 0%) or WHR (MD −0.01, 95% CI [−0.03 to 0.01]; I2 = 57%). Conclusions: Moxibustion can be used with other interventions to improve body weight, BMI, and WC in people with obesity. However, the conclusions of this review should be cautiously applied to clinical practice because most of the included studies had a high or unclear risk of bias. [ABSTRACT FROM AUTHOR]

Mexican Americans are among the highest risk groups for obesity and its associated health consequences, including diabetes, heart disease, and cancer. 154 overweight/obese Mexican Americans recruited from the Mexican Consulate in New York City were enrolled in COMIDA (Consumo de Opciones Más Ideales De Alimentos) (Eating More Ideal Food Options), a 12-week Spanish-language lifestyle intervention that included a dietary counseling session, weight-loss resources, and thrice-weekly text messages. Participants' weight (primary outcome); dietary intake, physical activity, and nutrition knowledge (secondary outcomes) were assessed pre- and post-intervention. Of the 109 who completed follow-up, 28% lost ≥ 5% of their baseline body weight. Post-intervention, participants consumed more fruit and less soda, sweet pastries, fried foods and red meat; increased physical activity; and evidenced greater nutrition knowledge. A community-based lifestyle intervention with automated components such as text messaging may be a scalable, cost-effective approach to address overweight/obesity among underserved populations. [ABSTRACT FROM AUTHOR]

Background: The high co-prevalence of obesity and end-stage osteoarthritis requiring arthroplasty, with the former being a risk factor for complications during arthroplasty, has led to increasing interest in employing preoperative weight loss interventions such as bariatric surgery and diet modification. However, the current evidence is conflicting, and this study aimed to investigate the effect of weight loss intervention before arthroplasty in prospective randomized controlled trials. Methods: Four electronic databases (MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials) were searched for prospective randomized controlled trials that compared weight loss interventions with usual care from inception to October 2023 by following the PRISMA guidelines. The Cochrane risk of bias tool and GRADE framework were used to assess the quality of the studies. Meta-analyses were performed when sufficient data were available from 2 or more studies. Results: Three randomized controlled trials involving 198 patients were identified. Two studies employed diet modification, and one study utilized bariatric surgery. All three studies reported significant reductions in body weight and body mass index (BMI), and intervention groups had fewer postoperative complications. There was no difference in the length of stay between the intervention group and the control group. Variable patient-reported outcome measures were used by different research groups. Conclusion: Weight loss intervention can achieve significant reductions in body weight and body mass index before arthroplasty, with fewer postoperative complications reported. Further studies with different populations could confirm the effect of these interventions among populations with different obesity characteristics. [ABSTRACT FROM AUTHOR]

Summary: Importance: The effectiveness of anti‐obesity medications for children and adolescents is unclear. Objective: To update the evidence on the benefits and harms of anti‐obesity medication. Data Sources: Cochrane CENTRAL, MEDLINE, ClinicalTrials.gov and WHO ICTRP (1/1/16–17/3/23). Study Selection: Randomized controlled trials ≥6 months in people <19 years living with obesity. Data Extraction and Synthesis: Screening, data extraction and quality assessment conducted in duplicate, independently. Main Outcomes and Measures: Body mass index (BMI): 95th percentile BMI, adverse events and quality of life. Results: Thirty‐five trials (N = 4331), follow‐up: 6–24 months; age: 8.8–16.3 years; BMI: 26.2–41.7 kg/m2. Moderate certainty evidence demonstrated a −1.71 (95% confidence interval [CI]: −2.27 to −1.14)‐unit BMI reduction, ranging from −0.8 to −5.9 units between individual drugs with semaglutide producing the largest reduction of −5.88 kg/m2 (95% CI: −6.99 to −4.77, N = 201). Drug type explained ~44% of heterogeneity. Low certainty evidence demonstrated reduction in 95th percentile BMI: −11.88 percentage points (95% CI: −18.43 to −5.30, N = 668). Serious adverse events and study discontinuation due to adverse events did not differ between medications and comparators, but medication dose adjustments were higher compared to comparator (10.6% vs 1.7%; RR = 3.74 [95% CI: 1.51 to 9.26], I2 = 15%), regardless of approval status. There was a trend towards improved quality of life. Evidence gaps exist for children, psychosocial outcomes, comorbidities and weight loss maintenance. Conclusions and Relevance: Anti‐obesity medications in addition to behaviour change improve BMI but may require dose adjustment, with 1 in 100 adolescents experiencing a serious adverse event. [ABSTRACT FROM AUTHOR]

Results of behavioral obesity treatments have generally been unsuccessful. Reduction of participants' emotional eating (EE) might be essential. Women with obesity within age-groups of emerging adult, young adult, and middle-aged adult – participating in a community-based obesity treatment centered around self-regulatory skills to control eating – were evaluated over 6 months. There were significant reductions in participants' EE and eating-related self-regulation. Participants' change in self-regulation significantly predicted their changes in depression-related, anxiety-related, and total EE. Participants' age group did not significantly affect either their degree of improvement or self-regulation-EE change relationships. Emphasizing self-regulatory skills development for the control of EE, regardless of age-group in women, was suggested by the study authors. [ABSTRACT FROM AUTHOR]

Social support is associated with improved weight loss and health habits. Incorporation of social support into a group-style weight loss program positively influenced patient outcomes. Improved sense of support, body mass, and health habits support its inclusion to promote weight loss and health habits. [ABSTRACT FROM AUTHOR]

Biologically based therapies such as GLP-1 agonists are used to treat patients with obesity. Medical-surgical nurses should be knowledgeable about GLP-1 agonists so they can educate patients on proper administration, monitoring, and prevention and management of potential adverse effects. [ABSTRACT FROM AUTHOR]

In a national cohort of Veterans, weight change was compared between participants in a US Department of Veterans Affairs (VA) behavioral weight management program (MOVE!) and matched non-participants, and between high-intensity and low-intensity participants. Retrospective cohort study of Veterans with 1 + MOVE! visits in 2008–2017 were matched to MOVE! non-participants via sequential stratification. Percent weight change up to two years after MOVE! initiation of participants and non-participants was modeled using generalized additive mixed models, and 1-year weight change of high-intensity or low-intensity participants was also compared. MOVE! participants (n = 499,696) and non-participant controls (n = 1,336,172) were well-matched, with an average age of 56 years and average BMI of 35. MOVE! participants lost 1.4 % at 12 months and 1.2 % at 24 months, which was 0.89 % points (95 % CI: 0.83–0.96) more at 12 months than non-participants and 0.55 % points (95 % CI: 0.41–0.68) more at 24 months. 9.1 % of MOVE! participants had high-intensity use in one year, and they had 2.38 % point (95 % CI: 2.25–2.52) greater weight loss than low-intensity participation at 12 months (2.8 % vs 0.4 %). Participation in VA's system-wide behavioral weight management program (MOVE!) was associated with modest weight loss, suggesting that program modifications are needed to increase Veteran engagement and program effectiveness. Future research should further explore how variations in program delivery and the use of newer anti-obesity medications may impact the program's effectiveness. • Over 20 years, MOVE! program users had greater weight loss than non-users. • The 9 % of users with greater participation experienced greater weight loss. • Research is needed to more effectively engage Veterans to participate in MOVE!. [ABSTRACT FROM AUTHOR]

The rising prevalence of obesity in children calls for new strategies for the provision of effective care by a multidisciplinary team. Telemedicine has overall proven to be an effective tool for promoting a healthy lifestyle. The main objective of the current paper is to present the protocol of our ongoing CardioMetabolic Prevention (CAMP) study and compare its design with published studies on telemedicine in paediatric obesity. Additionally, we analysed the preliminary anthropometric and laboratory data to test the efficacy of our 12-week intensive program that combines in-person and telemedicine support. The program demonstrated a positive impact on body mass index (BMI) and its z-scores in 21 adolescents, and BMI in 18 participating parents. However, we found no effect on body composition, waist circumference, cardiometabolic parameters, or fitness evaluated via a 6-min walk test in adolescents. In conclusion, the combination of in-person and telemedicine intensive support over 35 h delivered by a multidisciplinary team can be beneficial not only for adolescents with obesity but also for their parents. The ongoing CAMP study serves as a platform for precision medicine in future decisions regarding anti-obesity medication in adolescents with obesity. [ABSTRACT FROM AUTHOR]

ABO blood system is not only important for determining the lifestyle diseases, blood transfusion and exchange but it has also been found to be highly relevant to genetic marker of obesity. Recent studies are trying to explore the relation between blood grouping and obesity, and blood group diets and management of obesity. But still there are limited studies related to reduction of weight from blood group diets. The aim of this study is to examine the association of blood groups and weight reduction through a Moderate-Fat, Balanced Nutrient Reduction Diets among overweight and obese adults. A longitudinal study was conducted over 175 overweight and obese adults (>18 years and <60 years of age) of urban Bihar. A planned diet regime was followed by participants for a period of six months, and their anthropometric measurements were used for statistical analysis. There were substantial decreases in weight, BMI and waist circumference across different blood groups resulted through moderate-fat balanced nutrient reduction diet plan in both genders. For all blood groups, BMI reduction was at least 3.78 kg/m2 through the program, and the program was most effective for blood group O positive participants. [ABSTRACT FROM AUTHOR]

Adult obesity disproportionately affects lower socio-economic groups in high-income countries and perpetuates health inequalities, imposing health and socio-economic burden. This review evaluates the effectiveness of behavioural strategies in reducing weight and cardiovascular disease (CVD) risks among low-income groups based in high-income countries. We searched major databases for randomised controlled trials published between 1 November 2011 and 1 May 2023. Meta-analyses and subgroup analyses were undertaken to analyse the pooled and individual effects of behavioural strategies. Cochrane Risk of bias (RoB 2·0) tool and Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria were used to assess the quality and certainty of evidence. Fourteen trials (3618 adults, aged 40·2 ± 9·7 years with BMI 33·6 ± 2·8 kg/m2) and nine unique interventions were identified. Three trials with high RoB were omitted. Meta-analysis favoured interventions, demonstrating significant reductions in body weight (MD: −1·56 kg, (95 % CI –2·09, −1·03)) and HbA1c (MD: −0·05 %, (95 % CI − 0·10, −0·001)) at intervention end. Sub-group analysis showed no differences in waist circumference, blood pressure or serum lipids. Financial incentives and interactive feedback produced greatest amounts of weight losses ≥ 2 kg (GRADE: moderate). Behavioural strategies are effective weight loss interventions among lower socio-economic groups living in high-income nations. However, the impact on CVD risk remains unclear. [ABSTRACT FROM AUTHOR]

Whānau Pakari is a healthy lifestyle assessment and intervention programme for children and adolescents with obesity in Taranaki (Aotearoa/New Zealand), which, in this region, replaced the nationally funded Green Prescription Active Families (GRxAF) programme. We compared national referral rates from the GRxAF programme (age 5–15 years) and the B4 School Check (B4SC, a national preschool health and development assessment) with referral rates in Taranaki from Whānau Pakari. We retrospectively analysed 5 years of clinical data (2010–2015), comparing referral rates before, during, and after the Whānau Pakari clinical trial, which was embedded within the programme. We also surveyed programme referrers and stakeholders about their experiences of Whānau Pakari, analysing their responses using a multiple-methods framework. After the Whānau Pakari trial commenced, Taranaki GRxAF referral rates increased markedly (2.3 pretrial to 7.2 per 1000 person-years), while NZ rates were largely unchanged (1.8–1.9 per 1000 person-years) (p < 0.0001 for differences during the trial). Post-trial, Taranaki GRxAF referral rates remained higher irrespective of ethnicity, being 1.8 to 3.2 times the national rates (p < 0.001). Taranaki B4SC referrals for obesity were nearly complete at 99% in the last trial year and 100% post-trial, compared with national rates threefold lower (31% and 32%, respectively; p < 0.0001), with Taranaki referral rates for extreme obesity sustained at 80% and exceeding national rates for both periods (58% and 62%, respectively; p < 0.01). Notably, a referral was 50% more likely for referrers who attended a Whānau Pakari training half-day (RR = 1.51; p = 0.009). Stakeholders credited the success of Whānau Pakari to its multidisciplinary team, family-centred approach, and home-based assessments. However, they highlighted challenges such as navigating multidisciplinary collaboration, engaging with families with complex needs, and shifting conventional healthcare practices. Given its favourable referral trends and stakeholder endorsement, Whānau Pakari appears to be a viable contemporary model for an accessible and culturally appropriate intervention on a national and potentially international scale. [ABSTRACT FROM AUTHOR]

Background: Substantial effort has been invested to combat childhood obesity, but overall effects are disappointing, especially in low-income racial minority children. One possible reason is a lack of focus on the important stress-eating connection. Stress can negatively influence eating behaviors, leading to an increased appetite for high-fat and energy-dense foods. Objective: This study aimed to evaluate the preliminary effects of a healthy eating and stress management program targeting multiple theoretical variables on improving eating behavior (dyads' fruit/vegetable intake, emotional eating), food insecurity, anthropometric characteristics (dyads' body mass index, %body fat), cardiovascular health (dyads' blood pressure), and mental well-being (parental stress). Methods: A one-group, quasi-experimental pilot study was conducted among 107 low-income parent-preschooler dyads. The 14-week program included a parent component, a parent-preschooler learning component, and a day care-based preschooler component. Results: The program had positive effects on improving dyads' fruit/vegetable intake, food insecurity, body mass index, and blood pressure and parents' nutrition knowledge, self-efficacy, support, food resource management behavior, problem-focused coping, and home eating environment. The overall satisfaction rate was 95.2%, and 88.1% stated that the program assisted their families with having a healthy lifestyle. Discussion: Results support the preliminary effects of the program on improving health outcomes in rural and urban low-income families. Although warranting further investigation with amore rigorous randomized controlled trial, the healthy eating and stress management program provides a potential solution to the current coexistence of an obesity epidemic and mental health crisis. [ABSTRACT FROM AUTHOR]

The prevalence of women with a raised body mass index (BMI) seeking assisted conception treatment is increasing. Findings of existing studies evaluating the effect of female BMI on intrauterine insemination (IUI) treatment outcomes remain inconsistent. This systematic review and meta-analysis evaluate the effect of female BMI on IUI treatment outcomes. Two authors independently conducted data extraction and assessed study quality. Risk ratios (RR) and 95% confidence intervals were calculated using the Mantel-Haenszel approach for dichotomous outcomes. 11 studies involving 23,145 IUI treatment events, comprising 21,211 cycles from 8 studies, and 1,934 participants in three studies, met the inclusion criteria for the meta-analysis. Two cohorts of women undergoing IUI treatment were compared - women with normal BMI < 25 kg/m2 were compared with a second cohort of women with a BMI category ≥ 25 kg/m2. There was no statistically significant difference in live birth rate (LBR) (RR 1.06, 95% CI 0.86–1.307); clinical pregnancy rate (CPR) (RR 0.94, 95% CI 0.78–1.13); miscarriage (RR 0.92, 95% CI 0.31–2.74) or ectopic pregnancy rate (RR 2.20, 95% CI 0.78–6.23). Our meta-analysis showed that a raised female BMI did not affect IUI treatment outcomes. Nevertheless, weight loss counselling should be offered to women with a raised BMI undergoing IUI, to reduce the associated obstetric morbidity. A meta-analysis of 11 studies found that having a raised female BMI did not change IUI treatment outcomes. [ABSTRACT FROM AUTHOR]

An interview with obesity management experts like Doctors Timothy Krafston of University of Michigan, Dina Hafez Griauzde, and Angela Golden is presented. They cite the reasons why their teams decided to concentrate in treating and managing obesity. They explain the patient journey before the development of the obesity management programs. They discuss the role and importance of administrative and staff buy-in for obesity treatment programs.

Summary: Objective: To examine changes in leukocyte telomere length (LTL) during and after a behavioural weight control program for children with obesity. Methods: We measured LTL among a cohort of 158 children 8–12 years of age with a body mass index greater than or equal to the 95th percentile for age and sex. Children were 55% female, 29% white, 52% Latinx, 8% Asian and 11% Pacific Islander, other or multiethnic. All children participated in a 6‐month, family‐based, group behavioural weight control program and were assessed before treatment, after treatment and 1 year after the end of treatment. To test the sample population slope of LTL over the intervention and maintenance time periods, we fit spline mixed‐effect regression models. Results: LTL increased an average of 0.09 T/S units per year (95% confidence interval [CI] 0.04 to 0.13; p = 0.0001) during the weight control program intervention period, followed by an average decline of −0.05 T/S units per year (95% CI −0.08 to −0.03; p < 0.0001) during the 1 year of follow‐up after the completion of the intervention. Among 26 social, psychological, behavioural and physiological factors we examined, we did not find any predictors of these changes. Conclusions: LTL increased in response to a behavioural weight control program among children with obesity, suggesting an impact on biological health and cellular aging from participation in a behavioural weight control intervention. LTL may be a useful biomarker for assessing changes in response to behavioural interventions. [ABSTRACT FROM AUTHOR]

Physical activity (PA) maintains weight and reduces postnatal weight retention (PWR), thereby lowering obesity-related comorbidities. There is only limited evidence on the most effective postnatal PA for Malaysian women. This review identified evidence-based literature on the effectiveness of PA interventions in managing weight in postnatal women and the preferred type of intervention for them. A systematic literature search was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. Randomised controlled trials and quasi-experimental research related to PA interventions for women during the postnatal period (18 months after delivery) published in English from 2011 to 2021 were searched in ProQuest, Scopus, Springer Link and PubMed using the following keywords: 'physical activity', 'weight management' and 'postnatal women'. Intervention groups with weight and body mass index measured after any supervised PA guidance/counselling with a minimum follow-up of 10 weeks were included in the analysis. Those with pharmacological management and a comparator control group were excluded. A total of six articles met the inclusion criteria. Using the revised Cochrane risk of bias tool for randomised trials, one of these articles was classified as low-risk, two as having some concerns and three as having a high risk of bias. Walking, yoga and Pilates were found to be the most appropriate and preferred types of physical activity, despite having a small but significant impact on postnatal women's weight management. Healthcare professionals should adopt programmes that explicitly target these PA interventions to manage PWR. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of the 8-week, community health worker (CHW)–led La Vida Buena childhood obesity program among Latino children 5 to 8 years old in a rural county along the U.S.-Mexico border. Methods: This quasi-experimental study used a community-based participatory research approach to compare the effectiveness of the La Vida Buena (The Good Life) curriculum as compared with a single educational session. We took anthropomorphic measures and administered parent-reported nutrition and physical activity surveys at baseline, 3 months, and 6 months. The study took place between 2017 and 2020 in Santa Cruz County, Arizona. Results: Change in body mass index (BMI) z-score was negligible for both groups. The parent-reported behavior indicated a shift toward healthier family behaviors and environment in the intervention group. Implications for Practice: This study adds to the growing literature of CHW-led childhood obesity interventions. The engagement of the CHWs in all aspects of the intervention helped to facilitate important behavior changes. Future interventions should emphasize health and wellness rather than BMI z-score and include community, socioeconomic, and systems-level interventions to promote healthy environments. [ABSTRACT FROM AUTHOR]

Summary: Background: Childhood obesity is a critical public health concern. One potential determinant to obesity that is less understood is food insecurity. Objective: To examine the association of food security status on body mass index (BMI) change in a Pediatric Weight Management Intervention (PWMI) consistent with national treatment recommendations. Methods: This analysis included 201 participants from the Healthy Weight Clinic (HWC). Using linear mixed models, we compared BMI and %BMIp95 change per year between the food insecure group and food secure group, adjusting for baseline BMI, age and sex, and SNAP enrolment. Results: In fully adjusted models, children in households with food insecurity had a 0.50 (0.26–0.74) kg/m2 BMI increase per year and a 2.10 (1.02–3.19) %BMIp95 increase per year compared to households that were food secure. Conclusions: When comparing the BMI effect of the HWC between the food insecure group and food secure group, those experiencing food insecurity in the HWC had an increase in BMI compared to those with food security. These findings suggest that food insecurity may reduce the effectiveness of PWMIs consistent with national recommendations; however, more studies should be conducted to better understand this relationship. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the impact of an ongoing multidisciplinary childhood obesity intervention, within a federally qualified health center, on mental health and physical activity outcomes with Latino children from an agricultural community. The program was evaluated using attendance and parent-reports of child mental health and physical activity levels. Paired t-tests and chi squared tests were used to examine pre-post change in outcomes. There were 100 total participants. The mean age was 9.40 years, and the mean BMI percentile was 97.39. Significant post-intervention improvements were observed in mental health externalizing and internalizing problems (p <.0001) and in weekly physical activity frequency (p =.0131) and duration (p =.0280). Childhood obesity interventions should target mental health problems as well as obesity as the two are closely related. Community health centers may be ideal settings for interventions as they can facilitate access to needed services for high-risk populations. [ABSTRACT FROM AUTHOR]

Background: In a remote rural community in central Thailand, obesity prevalence among adults significantly rose from 33.9% in 2012 to 44.8% in 2018. Limited information on weight reduction studies in Thai rural communities was available. The present study aims to evaluate the effect of daily self-weighing combined with personalized counseling in order to reduce body weight (BW) and body mass index (BMI) as well as blood pressure (BP). Methods: A randomized controlled trial was carried out in a rural community in central Thailand. One-hundred and seven adults were randomly allocated (1:2) to intervention and control groups. For 20 weeks, participants in the weight-loss program performed self-weighing twice daily and recorded their weight on the calendar. The program also offers weekly counseling visits by village health volunteers (VHV) who make home visits to participants. The primary outcomes were differences in mean change in BW at 20 weeks from baseline between the intervention and control groups. Results: A total of 107 participants were initially recruited. Of these, 36 participants were allocated to the intervention group and 57 participants to the control group. Significant differences in mean change in BW and BMI at the twelve-, sixteen-, and twenty-week follow-up from baseline between the two groups were observed. At twenty weeks, the mean change in BW was -1.2 kg (95% CI: -2.2, -0.3) and 0.3 kg (95% CI: -0.3, 0.8) in the intervention and control groups, respectively, with p-value = 0.007. Over 20 weeks of the study period, the estimated mean change in BW among the intervention group was 1.0 kg (95% CI -1.7, -0.2) lower than in the control group, with p-value = 0.015. Furthermore, changes in mean BMI and BP over the 20-week follow-up period in intervention participants were recognized. Conclusions: Our study demonstrates that daily self-weighing combined with personalized counseling led by VHV is feasible and can induce weight loss among adults with obesity in a rural community. In addition, the weight-loss program may be a promising additional tool for reducing BP. Trial registration: Trial identification number was TCTR20201020004; first submitted date: 20/10/2020. [ABSTRACT FROM AUTHOR]

To address the unmet need for scalable solutions for lifestyle treatment, we developed a new digital method to promote behavioral change. Here we report that patients with type-2 diabetes in Sweden (n = 331) exposed to the intervention have significantly improved HbA1c during a median follow-up of 1038 days (4 mmol/mol compared with matched controls; P = 0.009). This is paralleled by reduced body weight, ameliorated insulin secretion, increased physical activity, and cognitive eating restraints. Participants with high BMI and insulin resistance have an even larger response, as have non-risk allele carriers for the FTO gene. The findings open a new avenue for scalable lifestyle management with sustained efficacy and highlight a previously unrecognized opportunity for digital precision treatment based on genetics and individual pathophysiology. ClinicalTrials.gov NCT04624321. [ABSTRACT FROM AUTHOR]

Background: Group format weight loss interventions have benefits over individual format, but privacy concerns may limit their uptake. Method: In this study, adults with obesity and interest in losing weight were recruited nationally online and randomly assigned to view one of eight videos describing a hypothetical, group behavioral weight loss intervention. Based on three fully crossed factors, the videos varied on privacy features of intervention (present or not); matching participants to group based on weight loss barriers (matched or not); and intervention format (online or in-person). Participants rated their willingness to join, privacy concerns, and perceived effectiveness of these interventions. They further reported preference for individual or group format interventions and reason for preferences. Results: Description of privacy features, matching of participants, and format did not affect willingness to join, privacy concerns, or perceived effectiveness of the intervention. Privacy concerns were associated with lower willingness to join and lower perceived intervention effectiveness, and greater social anxiety and weight stigma. More participants preferred individual over group format (40.1% vs 33.9%; 26% selected neither) and preference for individual format was associated with greater privacy concerns. Conclusion: Strategies to address privacy concerns in group-based interventions warrant further attention. [ABSTRACT FROM AUTHOR]

Background: The global increase in mean body mass index has resulted in a substantial increase of non-communicable diseases (NCDs), including in many low- and middle-income countries such as Kenya. This paper assesses four interventions for the prevention and control of overweight and obesity in Kenya to determine their potential health and economic impact and cost effectiveness. Methods: We reviewed the literature to identify evidence of effect, determine the intervention costs, disease costs and total healthcare costs. We used a proportional multistate life table model to quantify the potential impacts on health conditions and healthcare costs, modelling the 2019 Kenya population over their remaining lifetime. Considering a health system perspective, two interventions were assessed for cost-effectiveness. In addition, we used the Human Capital Approach to estimate productivity gains. Results: Over the lifetime of the 2019 population, impacts were estimated at 203,266 health-adjusted life years (HALYs) (95% uncertainty interval [UI] 163,752 − 249,621) for a 20% tax on sugar-sweetened beverages, 151,718 HALYs (95% UI 55,257 − 250,412) for mandatory kilojoule menu labelling, 3.7 million HALYs (95% UI 2,661,365–4,789,915) for a change in consumption levels related to supermarket food purchase patterns and 13.1 million HALYs (95% UI 11,404,317 − 15,152,341) for a change in national consumption back to the 1975 average levels of energy intake. This translates to 4, 3, 73 and 261 HALYs per 1,000 persons. Lifetime healthcare cost savings were approximately United States Dollar (USD) 0.14 billion (USD 3 per capita), USD 0.08 billion (USD 2 per capita), USD 1.9 billion (USD 38 per capita) and USD 6.2 billion (USD 124 per capita), respectively. Lifetime productivity gains were approximately USD 1.8 billion, USD 1.2 billion, USD 28 billion and USD 92 billion. Both the 20% tax on sugar sweetened beverages and the mandatory kilojoule menu labelling were assessed for cost effectiveness and found dominant (health promoting and cost-saving). Conclusion: All interventions evaluated yielded substantive health gains and economic benefits and should be considered for implementation in Kenya. [ABSTRACT FROM AUTHOR]

The English National Child Measurement Programme (NCMP) is a nationally mandated public health programme. It provides data for child excess weight indicators in the Public Health Outcomes Framework, part of the government's approach to reducing childhood obesity. Drawing on a meta-ethnographic synthesis of household members' experiences of the programme, we conceptualise the NCMP as a 'technique of futuring' to generate new insights into how it (re)shapes and (re)imagines past, present, and future responsibilities and practices for overweight children, parents, and carers, in potentially harmful ways. For children categorised by the NCMP as overweight, the NCMP is an emotionally significant event, driving new bodily practices, new food practices and changed relationships with peers. This paper outlines how parents come to resist and reframe the programme and its results, to protect their children from a weight-focused future. They consider the potential risks of bullying, dysfunctional eating, and mental health consequences more important than future risks of overweight. We show how parents of children categorised as overweight preserve their claim to 'responsible' and 'good' parenting amongst peers, whilst shifting the blame for childhood obesity to other, 'irresponsible' parents, thus reproducing moralising and responsibilising discourses inherent within the 'behaviour change' messaging of the NCMP and associated research. Finally, we consider a central paradox of this programme and the use of NCMP population level monitoring data to (re)shape lives at the individual and social level – the children it sets out to help are the most likely to experience harm as a result of it. [ABSTRACT FROM AUTHOR]

Background: Obesity is a serious chronic disease that adversely affects health and quality of life. However, a significant percentage of people do not participate in or adhere to weight loss programs. Therefore, a multidisciplinary approach is needed to identify critical barriers to effective obesity management and to examine health practitioners' attitudes and behaviors towards effective obesity treatment. Methods: This systematic review was conducted in accordance with PRISMA 2020. Eligible studies were identified through a systematic review of the literature using Medline, Scopus, Cochrane, Google Scholar, Web of Science, and Embase databases from January 1, 2011 to March 2, 2021. Results: A total of 57 articles were included. Data on 12 663 physicians were extracted from a total of 35 quantitative articles. Some of the most commonly perceived attitude issues included "obesity has a huge impact on overall health", "obesity is a disease" and "HCPs are to blame". Health professionals were more inclined to believe in "using BMI to assess obesity," "advice to increase physical activity," and "diet/calorie reduction advice." The major obstacles to optimal treatment of obesity were "lack of motivation", "lack of time" and "lack of success". Conclusion: Although the majority of health professionals consider obesity to be a serious condition with significant impact on overall health, nearly half of the visits include counseling, pharmacological or surgical interventions regarding lifestyle changes. Increasing the length of physician visits as well as tailoring appropriate training programs could improve health care for obesity. [ABSTRACT FROM AUTHOR]

Pediatric obesity has become a global pandemic in the last century, contributing to short and long-term medical conditions that heighten the risk of morbidity and mortality in children. The 12-month school-based obesity management educational program aims to assess the effect of adherence to the lifestyle educational program and target outcomes, obesity, and hypertension. A total of 363 (nonadherent, N = 179; adherent, N = 184) Saudi school adolescents aged 12–18 were recruited from 60 schools in Riyadh City, Saudi Arabia. Anthropometrics, lipid profile, and blood glucose were measured at baseline and post-intervention. The level of adherence was based on the number of attended educational sessions, and participants were grouped accordingly into two groups: adherent group (attended ≥ 3 sessions) and nonadherent group (attended 1–2 sessions) out of a total of five sessions. Results demonstrated that significantly more participants in the adherent group achieved the primary program goal of reducing obesity indices [body weight, body mass index (BMI), and BMI z-score] than the nonadherent group. Additionally, among adherent obese participants, BMI z-score significantly decreased after the 12-month intervention (post-intervention: 1.5 ± 0.7 vs. baseline: 1.7 ± 0.6, p < 0.05), while the trend in BMI z-score modestly increased in the nonadherent obese participants post-intervention (post-intervention: 1.8 ± 0.7 vs. baseline: 1.7 ± 0.6, p > 0.05). Moreover, there was a substantial reduction in hypertension prevalence only in the adherent group (p = 0.003) and among adherent obese participants in particular (p = 0.03). Furthermore, adherence to session attendance was higher in girls than boys, which led to better outcomes among girls than boys. For the secondary outcomes, lipid profile indices increased in both groups, while no changes were observed in the glycemic profile. In conclusion, greater adherence to educational sessions achieved modest but favorable weight changes and improved blood pressure among obese adolescents. Future intervention studies should take into consideration the need to improve attendance to enhance adherence to the program among adolescents at risk. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Outpatient management of pediatric obesity can be difficult, requiring a significant time commitment from both provider and patient. Multidisciplinary clinic-based programs have shown promising effects in reducing BMI during intervention, but whether these changes are sustained over time is not well studied. The purpose of this study was to determine the post-treatment outcomes of children seen in a multidisciplinary pediatric obesity clinic (MPOC). METHODS: A retrospective chart review was performed using the MPOC database, which included all clinic patients from January 2008 to August 2016 who attended a minimum of 2 visits (n = 472). The primary outcome was the absolute change in BMI Z-score (BMIZ) from the final intervention visit compared to 1- and 2-years post-intervention. Multivariate regression analysis was performed to characterize predictors of change in BMIZ. RESULTS: MPOC patients ranged in age from 3 to 18 years. Mean BMIZ decreased significantly during intervention (-0.13 ± 1.47, P < .001) and was maintained at 1- and 2-years post-intervention. In participants ages 3 to 5, BMIZ further decreased at 1 year post intervention (-0.27 ± 0.26, P < .001). Age at time of referral was the only significant predictor of change in BMIZ. CONCLUSIONS: Outpatient, multidisciplinary intervention for pediatric obesity was effective in reducing or stabilizing BMIZ during and beyond the intervention, particularly when patients were referred at an early age. Although primary prevention is the ideal management, multidisciplinary clinic intervention can be effective in the sustained treatment of pediatric obesity. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Research is needed to inform tailoring supportive strategies for promoting physical activity (PA) in the context of behavioral treatment of obesity. We aimed to identify baseline participant characteristics and short-term intervention response predictors associated with adherence to the study-defined PA goal in a mobile health (mHealth) weight loss trial. Methods: A secondary analysis was conducted of a 12-month weight loss trial (SMARTER) that randomized 502 adults with overweight or obesity to either self-monitoring of diet, PA, and weight with tailored feedback messages (n = 251) or self-monitoring alone (n = 251). The primary outcome was average adherence to the PA goal of ≥150 min·wk−1 of moderate- and vigorous-intensity aerobic activities (MVPA) from Fitbit Charge 2™ trackers over 52 wk. Twenty-five explanatory variables were considered. Machine learning methods and linear regression were used to identify predictors of adherence to the PA goal. Results: The sample (N = 502) was mostly female (80%), White (82%) with the average age of 45 ± 14.4 yr and body mass index of 33.7 ± 4.0 kg·m−2. Machine learning methods identified PA goal adherence for the first week as the most important predictor of long-term PA goal adherence. In the parsimonious linear regression model, higher PA goal adherence for the first week, greater PA FB messages opened, older age, being male, higher education, being single and not having obstructive sleep apnea were associated with higher long-term PA goal adherence. Conclusions: To our knowledge, this is the first study using machine learning approaches to identify predictors of long-term PA goal adherence in a mHealth weight loss trial. Future studies focusing on facilitators or barriers to PA among young and middle-age adults and women with low PA goal adherence are warranted. [ABSTRACT FROM AUTHOR]

Summary: Background: Research has shown children disproportionately gain excess weight over the summer months (vs. school months), with stronger effects for children with obesity. However, the question has not been investigated among children receiving care in paediatric weight management (PWM) programs. Objective: To test for seasonal variability in weight change among youth with obesity in PWM care enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). Method: Longitudinal evaluation of a prospective cohort from 2014 to 2019 among youth in 31 PWM programs. Change in percentage of the 95th percentile for BMI (%BMIp95) was compared by quarter. Results: Participants (N = 6816) were primarily ages 6–11 (48%), female (54%), 40% non‐Hispanic White, 26% Hispanic and 17% Black, and 73% had severe obesity. Children were enrolled on average 424.9 ± 401.5 days. Participants reduced their %BMIp95 every season, but compared with Quarter 3 (July–September), reductions were significantly greater in Q1 (Jan‐March, b = −0.27, 95%CI −0.46, −0.09), Q2 (April–June, b = −0.21, CI −0.40, −0.03), and Q4 (October–December, b = −0.44, CI −0.63, −0.26). Conclusion and Relevance: Across 31 clinics nationwide, children reduced their %BMIp95 every season, but reductions were significantly smaller during the summer quarter. While PWM successfully mitigated excess weight gain during every period, summer remains a high‐priority time. [ABSTRACT FROM AUTHOR]

The article provides information on the association between type 2 diabetes (T2D) and obesity, highlighting the cardiovascular complications of T2D and the significant cost burden it poses to the healthcare system. It emphasizes the importance of prevention through identifying individuals at risk and implementing lifestyle interventions, such as weight loss, and discusses evidence-based interventions, including lifestyle changes, for preventing the progression from pre-diabetes to T2D.