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Background: Excess gestational weight gain is common and an important risk factor for adverse pregnancy outcomes. Regular weighing can be used to assess and manage weight gain, but NICE guidelines do not recommend routine weighing during antenatal care. Trials that have tested the effectiveness of self-weighing to manage GWG have been unsuccesful in engaging women in regular self-weighing, although the reasons for lack of engagement are not fully understood. This study aimed to understand why this lack of engagement occurred by exploring the naturally occurring thoughts and feelings of pregnant women (9 to 15 weeks gestational age) who were asked to weigh themselves at home., Methods: Twenty-five women were recruited to take part. Participants completed short questionnaires at their first-trimester and 20-week scans. After recruitment, participants were asked to weigh themselves at roughly the same time each week for 8 weeks. Whilst they weighed themselves they were asked to audio-record their current weight and describe any thoughts or feelings that occurred as they weighed themselves. These audio recordings were then sent to researchers using a secure messaging service., Results: Most of the recruited women (56%) were unaware of guidelines for gestational weight gain, and only 40% could identify the ideal rate of GWG for their BMI group. Thematic analysis of the think-aloud recordings resulted in three main themes: "understanding weight gain in pregnancy", "taking action to prevent weight gain" and "reactions to self-weighing". Overall, there was a relatively positive response to self-weighing and some participants used self-weighing to reflect on the reasons for weight gain and plan actions they could take to avoid excess gain. Negative emotional responses tended to be related to a lack of guidance about what level of weight gain or loss was "healthy", or to other worries about the pregnancy. Of the women recruited who submitted at least one think aloud recording (n 10), 80% found self-weighing to be useful, and said they would likely continue to self-weigh at home., Conclusions: Women had complex emotions about self-weighing during pregnancy but overall found it useful, suggesting it could be encouraged as part of self-regulatory interventions to control GWG. Clear guidelines about appropriate gestational weight gain could help to reduce anxiety., Trial Registration: The study was prospectively registered with ISRCTN ISRCTN10035244 .

Background: Self-regulation for weight loss requires regular self-monitoring of weight, but the frequency of weight tracking commonly declines over time., Objective: This study aimed to investigate whether it is a decline in weight loss or a drop in motivation to lose weight (using physical activity tracking as a proxy) that may be prompting a stop in weight monitoring., Methods: We analyzed weight and physical activity data from 1605 Withings Health Mate app users, who had set a weight loss goal and stopped tracking their weight for at least six weeks after a minimum of 16 weeks of continuous tracking. Mixed effects models compared weight change, average daily steps, and physical activity tracking frequency between a 4-week period of continuous tracking and a 4-week period preceding the stop in weight tracking. Additional mixed effects models investigated subsequent changes in physical activity data during 4 weeks of the 6-week long stop in weight tracking., Results: People lost weight during continuous tracking (mean -0.47 kg, SD 1.73) but gained weight preceding the stop in weight tracking (mean 0.25 kg, SD 1.62; difference 0.71 kg; 95% CI 0.60 to 0.81). Average daily steps (beta=-220 daily steps per time period; 95% CI -320 to -120) and physical activity tracking frequency (beta=-3.4 days per time period; 95% CI -3.8 to -3.1) significantly declined from the continuous tracking to the pre-stop period. From pre-stop to post-stop, physical activity tracking frequency further decreased (beta=-6.6 days per time period; 95% CI -7.12 to -6.16), whereas daily step count on the day's activity was measured increased (beta=110 daily steps per time period; 95% CI 50 to 170)., Conclusions: In the weeks before people stop tracking their weight, their physical activity and physical activity monitoring frequency decline. At the same time, weight increases, suggesting that declining motivation for weight control and difficulties with making use of negative weight feedback might explain why people stop tracking their weight. The increase in daily steps but decrease in physical activity tracking frequency post-stop might result from selective measurement of more active days., (©Kerstin Frie, Jamie Hartmann-Boyce, Susan Jebb, Jason Oke, Paul Aveyard. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 17.03.2020.)

Objective: To examine the extent to which people who are trying to lose weight naturally self-regulate in response to self-weighing and to identify barriers to self-regulation. Design/Main Outcome Measures: Twenty-four participants, who were overweight and trying to lose weight, recorded their thoughts during daily weighing for eight weeks. Semi-structured follow-up interviews assessed participant experiences. Qualitative analysis identified steps of the self-regulation process and barriers to self-regulation. Exploratory regression analysis assessed the relationship between the self-regulation steps and weight loss. Results: On 90% of 498 occasions, participants compared their weight measurement to an expectation or goal, and on 58% they reflected on previous behaviour. Action planning only occurred on 20% of occasions, and specific action planning was rare (6%). Only specific action planning significantly predicted weight loss (-2.1 kg per 1 SD increase in the predictor, 95% CI = -3.9, -0.3). Thematic analysis revealed that barriers to the interpretation of daily weight changes were difficulties in understanding day-to-day fluctuations, losing the overview of trends, forgetting to weigh, and forgetting previous measurements. Conclusion: Specific action planning can lead to weight loss, but is rare in a naturalistic setting. Barriers to self-regulation relate to the interpretation of weight changes.

An increase in dietary protein intake has been shown to improve weight loss maintenance in the DIOGenes trial. Here, we analysed whether the source of the dietary proteins influenced changes in body weight, body composition, and cardiometabolic risk factors during the weight maintenance period while following an energy-restricted diet. 489 overweight or obese participants of the DIOGenes trial from eight European countries were included. They successfully lost >8% of body weight and subsequently completed a six month weight maintenance period, in which they consumed an ad libitum diet varying in protein content and glycemic index. Dietary intake was estimated from three-day food diaries. A higher plant protein intake with a proportional decrease in animal protein intake did not affect body weight maintenance or cardiometabolic risk factors. A higher plant protein intake from non-cereal products instead of cereal products was associated with benefits for body weight maintenance and blood pressure. Substituting meat protein for protein from other animal sources increased insulin and HOMA-IR (homeostasis model assessment of insulin resistance). This analysis suggests that not only the amount of dietary proteins, but also the source may be important for weight and cardiometabolic risk management. However, randomized trials are needed to test the causality of these associations., Competing Interests: A.A. is advisor or a member of advisory boards for a number of food and pharmaceutical producers: Arena Pharmaceuticals Inc., United States; Basic Research, United States; BioCare Copenhagen, Denmark; Dutch Beer Knowledge Institute, Netherlands; Gelesis Inc., United States; IKEA Food Scientific Advisory Board, Sweden; MacDonald’s, United States; McCain Foods Limited, United States; Nestlé Research Centre, Switzerland; Nongfu Spring Water, China; Novo Nordisk, Denmark; Omega ACO, Sweden; Orexigen Therapeutics Inc., United States; Pathway Genomics Corporation, United States; S-Biotek, Denmark; Weight Watchers, United States. The other authors declare no personal or financial conflict of interest with respect to this study.

Larger serving sizes and more frequent eating episodes have been implicated in the rising prevalence of obesity at a population level. This study examines the relative contributions of meal size and frequency to weight gain in a large sample of British children. Using 3-day diet diaries from 1939 children aged 21 months from the Gemini twin cohort, we assessed prospective associations between meal size, meal frequency and weight gain from two to five years. Separate longitudinal analyses demonstrated that every 10 kcal increase in meal size was associated with 1.5 g/wk or 4% (p = 0.005) faster growth rate, while meal frequency was not independently associated with growth (β = 0.3 g/wk p = 0.20). Including both meal parameters in the model strengthened associations (meal size: β = 2.6 g/wk, p < 0.001; meal frequency: β = 1.0 g/wk, p = 0.001). Taken together, the implication is that meal size promotes faster growth regardless of frequency, but meal frequency has a significant effect only if meal size is assumed to be held constant. Clearer advice on meal size and frequency, especially advice on appropriate meal size, may help prevent excess weight gain.

Background: Successful weight maintenance following weight loss is challenging for many people. Identifying predictors of longer-term success will help target clinical resources more effectively. To date, focus has been predominantly on the identification of predictors of weight loss. The goal of the current study was to determine if changes in anthropometric and clinical parameters during acute weight loss are associated with subsequent weight regain., Methodology: The study consisted of an 8-week low calorie diet (LCD) followed by a 6-month weight maintenance phase. Anthropometric and clinical parameters were analyzed before and after the LCD in the 285 participants (112 men, 173 women) who regained weight during the weight maintenance phase. Mixed model ANOVA, Spearman correlation, and linear regression were used to study the relationships between clinical measurements and weight regain., Principal Findings: Gender differences were observed for body weight and several clinical parameters at both baseline and during the LCD-induced weight loss phase. LCD-induced changes in BMI (Spearman's ρ = 0.22, p = 0.0002) were inversely associated with weight regain in both men and women. LCD-induced changes in fasting insulin (ρ = 0.18, p = 0.0043) and HOMA-IR (ρ = 0.19, p = 0.0023) were also associated independently with weight regain in both genders. The aforementioned associations remained statistically significant in regression models taking account of variables known to independently influence body weight., Conclusions/significance: LCD-induced changes in BMI, fasting insulin, and HOMA-IR are inversely associated with weight regain in the 6-month period following weight loss.

The agricultural and technological revolutions of the late 20th century have influenced both of the discretionary components of the energy balance equation, namely energy intake and physical activity. These changes act synergistically in the direction of encouraging weight gain and represent an unprecedented change in man's ecological niche. Obesity is the predictable biologic response to these external changes. This paper reviews the physiologic responses to modern diets and their effect on energy regulation. The energy density of foods is identified as a key element in influencing energy intake due to weak satiety signals that fail to compensate for very energy-dense foods. Evidence is also presented to show that interactions between energy-dense diets and low-levels of physical activity are key elements in encouraging weight gain due to an asymmetry between the hunger and satiety arms of human appetite control.

Aims: To assess weight change in the Healthier You: NHS Diabetes Prevention Programme (NHS DPP) delivered via video conferencing (remote) sessions or delivered via specific digital interventions through apps or websites, during the COVID‐19 pandemic compared to group‐based face‐to‐face interventions, pre‐pandemic. Methods: Prospectively collected national service‐level data relating to individuals with non‐diabetic hyperglycaemia (HbA1c 42–47 mmol/mol (6.0%–6.4%) or fasting plasma glucose 5.5–6.9 mmol/L) referred to the NHS DPP from June 2016 to March 2022. Results: Between March 2020 and March 2022, 335,961 people were referred to the programme and were offered a choice of remote or digital intervention. This was preceded by 556,793 people referred to the face‐to‐face programme between June 2016 and February 2022. Uptakes to intervention sessions were 47% for those offered a choice and 39% for face‐to‐face. Remote and digital participants were significantly younger (60 and 56 vs. 65 years) and heavier (86.1 kg and 91.0 kg vs. 84.1 kg) compared to face‐to‐face. Weight change was assessed for 42,407 remote, 7699 digital and 97,205 face‐to‐face participants with sufficient time to have finished the programme and no missing data. Mean weight losses for participants attending at least one intervention session were: 2.40 (2.36–2.44) kg, 2.59 (2.49–2.68) kg and 2.01 (1.98–2.04) kg for remote, digital and face‐to‐face participants respectively. Corresponding mean weight losses for those who completed the programme were: 3.24 (3.19–3.30) kg, 4.76 (4.60–4.92) kg and 3.04 (3.00–3.07) kg. There were no significant differences in weight change between interventions by ethnicity and deprivation. Conclusions: Weight losses achieved through remote and digital interventions were greater than those previously achieved through face‐to‐face interventions, without evidence of exacerbation of health inequalities. [ABSTRACT FROM AUTHOR]

An economic perspective is crucial to understand the broad consequences of childhood excess weight (CEW). These can manifest in the form of elevated health care and societal costs, impaired health status, or inefficiencies in the allocation of resources targeted at its prevention, management, or treatment. Although existing systematic reviews provide summaries of distinct economic research strands covering CEW, they have a restricted focus that overlooks relevant evidence. The overarching aim of this structured review was to update and enhance recent key reviews of four strands of economic evidence in this area, namely, (1) economic costs associated with CEW, (2) health utilities associated with CEW, (3) economic evaluations of interventions targeting CEW, and (4) economic determinants and broader consequences of CEW. Our de novo searches identified six additional studies for the first research strand, five studies for the second, thirty-one for the third, and two for the fourth. Most studies were conducted in a small number of high-income countries. Our review highlights knowledge gaps across all the research strands. Evidence from this structured review can act as data input into future economic evaluations in this area and highlights areas where future economic research should be targeted. [ABSTRACT FROM AUTHOR]

Background: Many people with obesity receive weight loss consultations by general practice nurses (GPNs) in routine primary care. This exploratory study aimed to characterise the components of these consultations, including behaviour change techniques (BCTs), and dietary and physical activity recommendations. Methods: We analysed audio recordings of weight management consultations conducted by 8 GPNs as part of the 'usual care' group in a randomised controlled trial (ISRCTN75092026). Consultations were coded against three taxonomies to classify BCTs, dietary recommendations, and physical activity recommendations. Associations between coded content and weight loss were assessed. Differences in the content of consultations where weight loss was < 5% or ≥ 5% from baseline weight at 6 months were explored. Results: One hundred and fifty audio recordings were available from 53 out of 140 (38%) participants in the usual care group. Participants had on average 3 (SD = 1) recorded consultations over 3 months, lasting 14 (SD = 7) minutes each. Weight change at 3, 6, and 12 months was -3.6% (SD = 4.3), -5.5% (SD = 6.0) and -4.2% (SD = 6.5) for participants with audio recordings. GPNs used 3.9 (SD = 1.6) of 93 BCTs, 3.3 (SD = 2.7) of 30 dietary recommendations and 1.4 (SD = 1.2) of 10 physical activity recommendations per consultation. The most commonly employed BCTs were feedback on outcome of behaviour (80.0%), problem solving (38.0%), and social reward (34.3%). The most common dietary recommendations were about portion size (31.3%), nutrients (28.0%), and balanced diet (19.7%). The main physical activity recommendation was about walking (30.3%). There was no association between weight loss and the number of dietary recommendations, physical activity recommendations, or BCTs used per consultation, or per participant. Social reward was the only technique used significantly more in consultations of participants that lost ≥ 5% of their baseline weight at 6 months. Conclusions: The study provides a new method that could be used to describe the content of weight management consultations. Specific dietary or physical activity recommendations and BCTs were used infrequently and inconsistently in this group of GPNs. Although replication is required in larger samples, this may point to a weakness in current practice. [ABSTRACT FROM AUTHOR]

Aim: To examine the impact of open-group behavioural weight-management programmes on the risk of diabetes among those with a body mass index (BMI) of ≥28 kg/m2 and those with non-diabetic hyperglycaemia (NDH). Methods: This was a secondary analysis of data from the WRAP trial, in which participants (N = 1267; aged ≥18 years, BMI ≥ 28 kg/m2) were randomized to brief intervention (BI; self-help booklet), a weight-management programme (WW; formerly Weight Watchers) for 12 weeks, or WW for 52 weeks. We used multinomial logistic regression to examine the effect of intervention group on the risk of hyperglycaemia and diabetes at 12 months in all participants with glycaemic status at both time points (N = 480; 38%) and those with NDH at baseline (N = 387; 31%). We used mixed effects models and linear fixed effects models to examine the effect of intervention group on body weight and HbA1c at 12 months in people with NDH. Results: There was a 61% relative reduction in the risk of NDH at the 12-month follow- up (12 weeks vs. BI: relative risk ratio [RRR] = 0.39 [95% CI 0.18, 0.87], P = .021; 52 weeks vs. BI: RRR = 0.38 [95% CI 0.17, 0.86], P = .020). For intervention effects on the risk of diabetes, confidence intervals were wide and overlapped 1 [12 weeks vs. BI: RRR = 0.49 [95% CI 0.12, 1.96], P = .312; 52 weeks vs. BI: RRR = 0.40 [95% CI 0.10, 1.63], P = .199). Participants with hyperglycaemia at baseline in the weightmanagement programme were more probable to have normoglycaemia at the 12- month follow-up [12-week programme vs. BI: RRR = 3.57 [95% CI 1.24, 10.29], P = .019; 52-week programme vs. BI: RRR = 4.14 [95% CI 1.42, 12.12], P = .009). Conclusions: Open-group behavioural weight-management programmes can help to prevent the development of NDH in people with overweight and obesity and to normalize glycaemia in people with NDH. [ABSTRACT FROM AUTHOR]

Background: Though many overweight and obese adults attempt to lose weight without formal support, little is known about the strategies used in self-directed weight loss attempts. We set out to assess cognitive and behavioural strategies for weight loss and their associations with weight change. Methods: Prospective, web-based cohort study of overweight UK adults (BMI≥25kg/m2) trying to lose weight through behaviour change. Strategy use was assessed using the OxFAB questionnaire and evaluated (1) at the domain level, (2) through exploratory factor analysis, and (3) in a model of strategies deemed a priori to be “essential” to weight management. Associations with weight change at 3 months were tested using linear regression. Results: 486 participants answered all questions; 194 reported weight at baseline and at 3 months (mean weight change -3.3kg (SD 4.1)). Greater weight loss was significantly associated with the motivational support domain (-2.4kg, 95% CI -4.4 to -0.4), dietary impulse control (from factor analysis) (-0.6kg, 95% CI -1.1 to -0.03), and weight loss planning and monitoring (from factor analysis) (-1.3kg, 95% CI -2.0 to -0.5). Higher scores in the model of essential behavioural strategies were significantly associated with greater weight loss (compared to participants using 6 or fewer of the 9 strategies, using 7 or more of the 9 strategies was associated with a 2.13kg greater weight loss (SE 0.58, p<0.001)). Conclusions: Despite heterogeneity in the strategies employed for weight loss, coherent patterns of behaviours emerged for individual participants, some of which were associated with greater weight loss, including strategies relating to dietary impulse control, weight loss planning and monitoring, motivational support, information seeking and self-monitoring. Trials could test the effect of promoting use of these patterns on weight loss. [ABSTRACT FROM AUTHOR]

Objective: Evidence on the effectiveness of behavioral weight management programs often comes from uncontrolled program evaluations. These frequently make the assumption that, without intervention, people will gain weight. The aim of this study was to use data from minimal intervention control groups in randomized controlled trials to examine the evidence for this assumption and the effect of frequency of weighing on weight change.Methods: Data were extracted from minimal intervention control arms in a systematic review of multicomponent behavioral weight management programs. Two reviewers classified control arms into three categories based on intensity of minimal intervention and calculated 12-month mean weight change using baseline observation carried forward. Meta-regression was conducted in STATA v12.Results: Thirty studies met the inclusion criteria, twenty-nine of which had usable data, representing 5,963 participants allocated to control arms. Control arms were categorized according to intensity, as offering leaflets only, a single session of advice, or more than one session of advice from someone without specialist skills in supporting weight loss. Mean weight change at 12 months across all categories was -0.8 kg (95% CI -1.1 to -0.4). In an unadjusted model, increasing intensity by moving up a category was associated with an additional weight loss of -0.53 kg (95% CI -0.96 to -0.09). Also in an unadjusted model, each additional weigh-in was associated with a weight change of -0.42 kg (95% CI -0.81 to -0.03). However, when both variables were placed in the same model, neither intervention category nor number of weigh-ins was associated with weight change.Conclusions: Uncontrolled evaluations of weight loss programs should assume that, in the absence of intervention, their population would weigh up to a kilogram on average less than baseline at the end of the first year of follow-up. [ABSTRACT FROM AUTHOR]

Objectives Identifying eating behaviors which contribute to excess weight gain will inform obesity prevention strategies. A tendency to clear one's plate when eating may be a risk factor for obesity in an environment where food is plentiful. Whether plate clearing is associated with increased body weight in a cohort of US participants was examined. Methods Nine hundred and ninety-three US adults (60% male, 80% American European, mean age = 31 years) completed self-report measures of habitual plate clearing together with behavioral and demographic characteristics known to be associated with obesity. Results Plate clearing tendencies were positively associated with BMI and remained so after accounting for a large number of other demographic and behavioral predictors of BMI in analyses (β = 0.18, 95% CIs = 0.07, 0.29, P < 0.001); an increased tendency to plate clear was associated with a significantly higher body weight. Conclusions The tendency to clear one's plate when eating is associated with increased body weight and may constitute a risk factor for weight gain. [ABSTRACT FROM AUTHOR]

Understanding how dietary intake changes over time is important for studies of diet and disease and may inform interventions to improve dietary intakes. We investigated how a dietary pattern (DP) tracked over 10-years in the Swedish Obese Subjects (SOS) study control group. Dietary intake was assessed at multiple time-points in 2037 severely obese individuals (BMI 41±4 kg/m2). Reduced rank regression was used to derive a dietary pattern using dietary energy density (kJ/g), saturated fat (%) and fibre density (mg/kJ) as response variables and score respondents at each follow-up. Tracking coefficients for the DP, its key foods and macronutrient response variables and corrected for time-dependent and time-independent covariates were calculated using generalised estimating equations to take into account all available data. The DP tracking coefficient was moderate for women (0.40; 95% CI: 0.38–0.42) and men (0.38; 95% CI: 0.35–0.41). Of the eleven foods key to this DP, fruit and vegetable intakes had the strongest tracking coefficient for both sexes. Fast food and candy had the lowest tracking coefficients for women and men respectively. Scores for an energy dense, high saturated fat, low fibre density DP appear moderately stable over a 10-year period in this severely obese population. Furthermore, some food groups appear more amenable to change while others, often the most healthful, appear more stable and may require intervention before adulthood. [ABSTRACT FROM AUTHOR]

Dairy products have previously been reported to be associated with beneficial effects on body weight and metabolic risk markers. Moreover, primary data from the Diet, Obesity and Genes (DiOGenes) study indicate a weight-maintaining effect of a high-protein–low-glycaemic index diet. The objective of the present study was to examine putative associations between consumption of dairy proteins and changes in body weight and metabolic risk markers after weight loss in obese and overweight adults. Results were based on secondary analyses of data obtained from overweight and obese adults who completed the DiOGenes study. The study consisted of an 8-week weight-loss phase and a 6-month weight-maintenance (WM) phase, where the subjects were given five different diets varying in protein content and glycaemic index. In the present study, data obtained from all the subjects were pooled. Dairy protein intake was estimated from 3 d dietary records at two time points (week 4 and week 26) during the WM phase. Body weight and metabolic risk markers were determined at baseline (week − 9 to − 11) and before and at the end of the WM phase (week 0 and week 26). Overall, no significant associations were found between consumption of dairy proteins and changes in body weight and metabolic risk markers. However, dairy protein intake tended to be negatively associated with body weight gain (P= 0·08; β = − 0·17), but this was not persistent when controlled for total protein intake, which indicates that dairy protein adds no additional effect to the effect of total protein. Therefore, the present study does not report that dairy proteins are more favourable than other proteins for body weight regulation. [ABSTRACT FROM PUBLISHER]

The present multi-centre randomised weight-loss trial evaluated the efficacy of a low-intensity 12-week online behavioural modification programme, with or without a fortified diet beverage using a 2 × 2 factorial design. A total of 572 participants were randomised to: (1) an online basic lifestyle information (OBLI) intervention, consisting of one online informational class about tips for weight management; (2) an online behavioural weight management (OBWM) intervention, entailing 12 weekly online classes focused on weight-loss behaviour modification; (3) an OBLI intervention plus a fortified diet cola beverage (BEV) containing green tea extract (total catechin 167 mg), soluble fibre dextrin (10 g) and caffeine (100 mg) (OBLI+BEV); (4) OBWM+BEV. Assessments included height, weight, dual-energy X-ray absorptiometry-derived body composition, and waist circumference (WC). Attrition was 15·7 %. Intention-to-treat (ITT) models demonstrated a main effect for type of Internet programme, with those assigned to the OBWM condition losing significantly more weight (F= 7·174; P= 0·008) and fat mass (F= 4·491; P= 0·035) than those assigned to the OBLI condition. However, there was no significant main effect for the OBWM condition on body fat percentage (F= 2·906; P= 0·089) or WC (F= 3·351; P= 0·068), and no significant main effect for beverage use or significant interactions between factors in ITT models. A 12-week, low-intensity behaviourally based online programme produced a greater weight loss than a basic information website. The addition of a fortified diet beverage had no additional impact. [ABSTRACT FROM PUBLISHER]

Background: Differences in the interindividual response to dietary intervention could be modified by genetic variation in nutrient-sensitive genes. Objective: This study examined single nucleotide polymorphisms (SNPs) in presumed nutrient-sensitive candidate genes for obesity and obesity-related diseases for main and dietary interaction effects on weight, waist circumference, and fat mass regain over 6 mo. Design: In total, 742 participants who had lost ≥8% of their initial body weight were randomly assigned to follow 1 of 5 different ad libitum diets with different glycemic indexes and contents of dietary protein. The SNP main and SNP-diet interaction effects were analyzed by using linear regression models, corrected for multiple testing by using Bonferroni correction and evaluated by using quantile-quantile (Q-Q) plots. Results: After correction for multiple testing, none of the SNPs were significantly associated with weight, waist circumference, or fat mass regain. Q-Q plots showed that ALOX5AP rs4769873 showed a higher observed than predicted P value for the association with less waist circumference regain over 6 mo (-3.1 cm/allele; 95% CI: -4.6, -1.6; /VBonferroni-corrected P = 0.000039/0.076), independently of diet. Additional associations were identified by using Q-Q plots for SNPs in ALOX5AP, TNF, and KCNJ11 for main effects; in LPL and TUB for glycemic index interaction effects on waist circumference regain; in GHRL, CCK, MLXIPL, and LEPR on weight; in PPARC1A, PCK2, ALOX5AP, PYY, and ADRB3 on waist circumference; and in PPARD, FABP1, PLAUR, and LP1N1 on fat mass regain for dietary protein interaction. Conclusion: The observed effects of SNP-diet interactions on weight, waist, and fat mass regain suggest that genetic variation in nutrient-sensitive genes can modify the response to diet. This trial was registered at clinicaltrials.gov as NCT00390637. [ABSTRACT FROM AUTHOR]

A significant contributor to the rising rates of human obesity is an increase in energy intake. The 'protein leverage hypothesis' proposes that a dominant appetite for protein in conjunction with a decline in the ratio of protein to fat and carbohydrate in the diet drives excess energy intake and could therefore promote the development of obesity. Our aim was to test the 'protein leverage hypothesis' in lean humans by disguising the macronutrient composition of foods offered to subjects under ad libitum feeding conditions. Energy intakes and hunger ratings were measured for 22 lean subjects studied over three 4-day periods of in-house dietary manipulation. Subjects were restricted to fixed menus in random order comprising 28 foods designed to be similar in palatability, availability, variety and sensory quality and providing 10%, 15% or 25% energy as protein. Nutrient and energy intake was calculated as the product of the amount of each food eaten and its composition. Lowering the percent protein of the diet from 15% to 10% resulted in higher (+12±4.5%, p = 0.02) total energy intake, predominantly from savoury-flavoured foods available between meals. This increased energy intake was not sufficient to maintain protein intake constant, indicating that protein leverage is incomplete. Urinary urea on the 10% and 15% protein diets did not differ statistically, nor did they differ from habitual values prior to the study. In contrast, increasing protein from 15% to 25% did not alter energy intake. On the fourth day of the trial, however, there was a greater increase in the hunger score between 1-2 h after the 10% protein breakfast versus the 25% protein breakfast (1.6±0.4 vs 25%: 0.5±0.3, p = 0.005). In our study population a change in the nutritional environment that dilutes dietary protein with carbohydrate and fat promotes overconsumption, enhancing the risk for potential weight gain. [ABSTRACT FROM AUTHOR]

Background: The scale of overweight and obesity in the UK places a considerable burden on the NHS. In some areas the NHS has formed partnerships with commercial companies to offer weight management services, but there has been little evaluation of these schemes. This study is an independent audit of the Weight Watchers NHS Referral scheme and evaluates the weight change of obese and overweight adults referred to Weight Watchers (WW) by the NHS. Method: Data was obtained from the WW NHS Referral Scheme database for 29,326 referral courses started after 2nd April 2007 and ending before 6th October 2009 [90% female; median age 49 years (IQR 38 - 61 years); median BMI 35.1 kg/m² (IQR 31.8 - 39.5 kg/m²). Participants received vouchers (funded by the PCT following referral by a healthcare professional) to attend 12 WW meetings. Body weight was measured at WW meetings and relayed to the central database. Results: Median weight change for all referrals was -2.8 kg [IQR -5.9 - -0.7 kg] representing -3.1% initial weight. 33% of all courses resulted in loss of ≥5% initial weight. 54% of courses were completed. Median weight change for those completing a first course was -5.4 kg [IQR -7.8 - -3.1 kg] or -5.6% of initial weight. 57% lost ≥5% initial weight. Conclusions: A third of all patients who were referred to WW through the WW NHS Referral Scheme and started a 12 session course achieved ≥5% weight loss, which is usually associated with clinical benefits. This is the largest audit of NHS referral to a commercial weight loss programme in the UK and results are comparable with other options for weight loss available through primary care. [ABSTRACT FROM AUTHOR]

Background: Experimental studies show that a reduction in dietary energy density (ED) is associated with reduced energy intake and body weight. However, few observational studies have investigated the role of ED on long-term weight and waist circumference change. Methods and Principal Findings: This population-based prospective cohort study included 89,432 participants from five European countries with mean age 53 years (range: 20-78 years) at baseline and were followed for an average of 6.5 years (range: 1.9-12.5 years). Participants were free of cancer, cardiovascular diseases and diabetes at baseline. ED was calculated as the energy intake (kcal) from foods divided by the weight (g) of foods. Multiple linear regression analyses were performed to investigate the associations of ED with annual weight and waist circumference change. Mean ED was 1.7 kcal/g and differed across study centers. After adjusting for baseline anthropometrics, demographic and lifestyle factors, follow-up duration and energy from beverages, ED was not associated with weight change, but significantly associated with waist circumference change overall. For 1 kcal/g ED, the annual weight change was -42 g/year [95% confidence interval (CI): -112, 28] and annual waist circumference change was 0.09 cm/year [95% CI: 0.01, 0.18]. In participants with baseline BMI<25 kg/m2, 1 kcal/g ED was associated with a waist circumference change of 0.17 cm/year [95% CI: 0.09, 0.25]. Conclusion: Our results suggest that lower ED diets do not prevent weight gain but have a weak yet potentially beneficial effect on the prevention of abdominal obesity as measured by waist circumference. [ABSTRACT FROM AUTHOR]

Obesity implies a failure of autoregulatory homeostatic responses to caloric excess. We studied the mechanisms, effectiveness, and limits of such responses in six lean (21.9 ± 1.3 kg/m2), healthy men based in a metabolic suite for 17 wk of progressive intermittent overfeeding (OF) (3 wk, baseline; 3 wk, 20% OF; 1 wk, ad libitum; 3 wk, 40% OF; 1 wk, ad libitum; 3 wk, 60% OF; 3 wk, ad libitum). Body composition was assessed by a four-compartment model using dual X-ray absorptiometry, deuterium dilution, and plethysmography. Magnetic resonance imaging assessed subcutaneous/visceral fat at abdominal level at baseline and at the end of 60% OF. Energy intake was assessed throughout, energy expenditure (EE) and substrate oxidation rates were measured repeatedly by whole body calorimetry (calEE), and free-living EE (TEE) was measured by doubly labeled water at baseline and after 60% OF. At the end of 60% OF, calEE and TEE had increased by just 11.4% (P = 0.001) and 16.2% (P = 0.001), respectively. Weight and body fat (fat mass) had increased by 5.98 kg (8.8%, P = 0.001) and 3.31 kg (22.6%, P = 0.01), respectively. The relative increase in visceral fat (32.6%, P = 0.02) exceeded that of subcutaneous fat (13.3%, P = 0.002) in the abdominal region. The computed energy cost of tissue accretion differed from the excess ingested by only 13.1% (using calEE) and 11.6% (using TEE), indicating an absence of effective dissipative mechanisms. We conclude that elevations in EE provide very limited autoregulatory capacity in body weight regulation, and that regulation must be dominated by hypothalamic modulation of energy intake. This result supports present conclusions from genetic studies in which all known causes of human obesity are related to defects in the regulation of appetite. [ABSTRACT FROM AUTHOR]

Obesity in children arises from a complex interplay between genetic susceptibility and behaviour, primarily relating to dietary habits and physical activity. Evidence for specific behavioural factors that promote or protect against excess weight gain in children is more limited than in adults, and the effects of growth and development are not clear. A number of behavioural risk factors has been postulated, including diets with a high energy density, high consumption of sugar-sweetened beverages, large portion sizes, eating patterns, high levels of sedentary behaviour and low levels of physical activity. However, most evidence is derived from cross-sectional studies which frequently yield conflicting results. More prospective studies with accurate measures of exposures and outcomes in terms of body composition are needed to provide more robust evidence on which to base interventions to achieve long-term behavioural change and prevent excess weight gains in children. [Copyright &y& Elsevier]

Background: Relatively little is known about dietary changes and their relationships with weight change during behavioural weight loss interventions. In a secondary analysis of data from a multicentre RCT, we investigated whether greater improvements in diet would be achieved by overweight adults following a 12 month group-based commercial weight loss programme (CP) than those receiving standard care (SC) in primary practice, and if these dietary changes were associated with greater weight loss.Methods: Adults with a BMI 27-35 kg/m2 and >1 risk factor for obesity-related disorders were recruited in study centres in Australia and the UK during 2007-2008. Dietary intake and body weight were measured at baseline, 6 and 12 months. Linear mixed effects models compared mean changes in dietary macronutrient intake, fibre density and energy density over time between groups, and their relationships with weight loss.Results: The CP group demonstrated greater mean weight loss than the SC group at 6 months (3.3 kg, 95% CI: 2.2, 4.4) and 12 months (3.3 kg, 95% CI: 2.1, 4.5). Diet quality improved in both intervention groups at 6 and 12 months. However, the CP group (n = 228) achieved significantly greater mean reductions in energy intake (mean difference; 95% CI: - 503 kJ/d; - 913, - 93), dietary energy density (- 0.48 MJ/g; - 0.81, - 0.16), total fat (- 6.9 g/d; - 11.9, - 1.8), saturated fat (- 3.3 g/d; - 5.4, - 1.1), and significantly greater mean increases in fibre density (0.30 g/MJ; 0.15, 0.44) at 6 months than the SC group (n = 239). Similar differences persisted at 12 months and the CP group showed greater mean increases in protein density (0.65 g/MJ). In both groups, weight loss was associated with increased fibre density (0.68 kg per g/MJ, 95% CI: 0.08, 1.27) and protein density (0.26 kg per g/MJ, 95% CI: 0.10, 0.41).Conclusions: Following a group-based commercial program led to greater improvements in diet quality than standard care. Increases in dietary protein and fibre density were independently associated with weight loss in both behavioural weight loss interventions. Greater increases in protein and fibre density in the commercial program likely contributed to their greater weight loss.Trial Registration: ISRCTN: ISRCTN85485463 Registered 03/08/2007 Retrospectively Registered. [ABSTRACT FROM AUTHOR]

Summary: Guidelines ask health professionals to offer brief advice to encourage weight loss for people living with obesity. We tested whether referral to one of three online programmes could lead to successful weight loss. A total of 528 participants aged ≥18 years with a body mass index of ≥30 kg/m2 were invited via a letter from their GP. Participants were randomised to one of three online weight loss programmes (NHS Weight Loss Plan, Rosemary Online or Slimming World Online) or to a control group receiving no intervention. Participants self‐reported weight at baseline and 8 weeks. The primary outcome was weight change in each of the active intervention groups compared with control. We also compared the proportion of participants losing ≥5% or ≥10% of body weight. For Rosemary, Online mean weight loss was modestly greater than control (−1.5 kg [95% confidence interval (CI) −2.3 to −0.6]) and more than three times as many participants in this group lost ≥5% (relative risk [RR] = 3.64, 95% CI: 1.63–8.1). For Slimming World, mean weight loss was not significantly different from control (−0.8 kg [95%CI −1.7 to 0.1]), twice as many participants lost ≥5% (RR = 2.70, 1.17–6.23). There was no significant difference in weight loss for participants using the NHS Weight Loss Plan (−0.4 kg, [95% CI −1.3 to 0.5]), or the proportion losing ≥5% (RR = 2.09, 0.87–5.01). Only one of three online weight loss programmes was superior to no intervention and the effect size modest among participants living with obesity. [ABSTRACT FROM AUTHOR]

People with obesity often struggle to maintain their weight loss after a weight loss period. Furthermore, the effect of weight loss on appetite and food preferences remains unclear. Hence this study investigated the effect of weight loss on subjective appetite and food preferences in healthy, overweight and obese volunteers. A subgroup of adult participants (n = 123) from the Diet Obesity and Genes (DiOGenes) study (subgroup A) was recruited from across six European countries. Participants lost ≥8% of initial body weight during an 8-week low calorie diet (LCD). Subjective appetite and food preferences were measured before and after the LCD, in response to a standardized meal test, using visual analogue rating scales (VAS) and the Leeds Food Choice Questionnaire (FCQ). After the LCD, participants reported increased fullness (p < 0.05), decreased desire to eat (p < 0.05) and decreased prospective consumption (p < 0.05) after consuming the test meal. An interaction effect (visit x time) was found for hunger ratings (p < 0.05). Area under the curve (AUC) for hunger, desire to eat and prospective consumption was decreased by 18.1%, 20.2% and 21.1% respectively whereas AUC for fullness increased by 13.9%. Preference for low-energy products measured by the Food Preference Checklist (FPC) decreased by 1.9% before the test meal and by 13.5% after the test meal (p < 0.05). High-carbohydrate and high-fat preference decreased by 11.4% and 16.2% before the test meal and by 17.4% and 22.7% after the meal (p < 0.05). No other effects were observed. These results suggest that LCD induced weight loss decreases the appetite perceptions of overweight volunteers whilst decreasing their preference for high-fat-, high-carbohydrate-, and low-energy products. [ABSTRACT FROM AUTHOR]

Clinical trials have shown that providing advice and support for people with excess weight can lead to meaningful weight loss. Despite this evidence and guidelines endorsing this approach, provision in real-world clinical settings remains low. We used Strong Structuration Theory (SST) to understand why people are often not offered weight management advice in primary care in England. Data from policy, clinical practice and focus groups were analysed using SST to consider how the interplay between weight stigma and structures of professional responsibilities influenced clinicians to raise (or not) the issue of excess weight with patients. We found that general practitioners (GPs) often accounted for their actions by referring to obesity as a health problem, consistent with policy documents and clinical guidelines. However, they were also aware of weight stigma as a social process that can be internalised by their patients. GPs identified addressing obesity as a priority in their work, but described wanting to care for their patients by avoiding unnecessary suffering, which they were concerned could be caused by talking about weight. We observed tensions between knowledge of clinical guidelines and understanding of the lived experience of their patients. We interpreted that the practice of 'caring by not offering care' produced the outcome of an absence of weight management advice in consultations. There is a risk that this outcome reinforces the external structure of weight stigma as a delicate topic to be avoided, while at the same time denying patients the offer of support to manage their weight. • Guidelines recommend weight management be offered routinely in primary care. • Despite evidence of effectiveness, many patients are not offered weight management. • Strong structuration theory enables interactional analysis of weight stigma and clinical practice. • Avoiding the topic of weight, and the associated stigma, can be understood as a form of caring. • In attempting to avoid causing distress, healthcare professionals fail to offer support. [ABSTRACT FROM AUTHOR]

Background--We sought to separately examine the effects of either weight loss or diets varying in protein content and glycemic index without further changes in body weight on cardiovascular risk factors within the Diet, Obesity, and Genes study (DiOGenes). Methods and Results--DiOGenes is a pan-European controlled dietary intervention study in 932 overweight adults who first lost body weight on an 8-week low-calorie diet and were then randomized to 1 of 5 ad libitum diets for 26 weeks. The diets were either high or low protein or high or low glycemic index in 4 combinations or control. Weight loss (- 11.23 kg: 95% confidence interval, - 11.54 to - 10.92; P<0.001 ) reduced high-sensitivity C-reactive protein (- 1.15 mg/L; 95% confidence interval, - 1.30 to -0.41; P<0.001 ), low- and high-density lipoprotein cholesterol, triglycerides, and blood pressure. During the 26-week weight maintenance period in the intention-to-treat analysis, the further decrease of high-sensitivity C-reactive protein blood levels was -0.46 mg/L greater (95% confidence interval, -0.79 to -0.13) in the groups assigned to low-glycemic-index diets than in those on high-glycemic-index diets (P<0.001). Groups on low-protein diets achieved a -0.25 mg/L greater reduction in high-sensitivity C-reactive protein (95% confidence interval, -0.59 to -0.17) than those on high-protein diets (P<0.001), whereas lipid profiles and blood pressure were not differently affected. Conclusions--This large-scale intervention study clearly separates weight loss from dietary composition-related effects. Low-glycemic-index carbohydrates and, to a lesser extent, low-protein intake may specifically reduce low-grade inflammation and associated comorbidities in overweight/obese adults. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Reducing the glycemic index (GI) of the diet may decrease metabolic risk, primarily through reduction and stabilization of blood glucose. The objective of this research was to investigate whether incorporation of lower or higher GI foods into mixed meals had different effects on daylong glucose profiles, measured in interstitial fluid by a continuous glucose-monitoring system. Methods: The study was a randomized, balanced, two-way crossover intervention of 2×1-wk periods of lower and higher GI diets. Participants were 12 overweight healthy adult women (mean body mass index ± standard deviation 27.5±2.3kg/m2). Changes in GI were achieved through substitution of key staple carbohydrate-rich foods. After a 4-d run-in on each dietary regimen, participants wore the continuous glucose-monitoring system over 2 d of identical controlled feeding in the laboratory, separated by 1 d of ad libitum consumption at home. Results: On controlled days, diets differed in GI by 15 U and provided equal energy, macronutrients, and fiber. On ad libitum days, diet diaries revealed a difference in GI of 14±1 U (mean ± standard error), with no detectable difference in energy, macronutrient, or fiber intake. No differences were observed in glucose profiles between higher and lower GI interventions in the controlled or ad libitum setting. There was significant agreement in area under the glucose curve on repeated controlled feeding days (intraclass correlation 0.75). Conclusion: This study indicates that a difference in dietary GI of 14–15 U is insufficient to alter daylong glycemia as measured in interstitial fluid by the continuous glucose-monitoring system. [Copyright &y& Elsevier]