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We assessed the preference for two behavioural weight loss programs, Diabetes Prevention Program (DPP) and Healthy Weight for Living (HWL) in adults with obesity. A cross-sectional survey was fielded on the Amazon Mechanical Turk. Eligibility criteria included reporting BMI ≥30 and at least two chronic health conditions. Participants read about the programs, selected their preferred program, and answered follow-up questions. The estimated probability of choosing either program was not significantly different from .5 (N = 1005, 50.8% DPP and 49.2% HWL, p = .61). Participants' expectations about adherence, weight loss magnitude, and dropout likelihood were associated with their choice (p < .0001). Non-White participants (p = .040) and those with monthly income greater than $4999 (p = .002) were less likely to choose DPP. Participants who had postgraduate education (p = .007), did not report high serum cholesterol (p = .028), and reported not having tried losing weight before (p = .025) were more likely to choose DPP. Those who chose HWL were marginally more likely to report that being offered two different programs rather than one would likely affect their decision to enrol in one of the two (p = .052). The enrolment into DPP and HWL was balanced, but race, educational attainment, income, previous attempt to lose weight, and serum cholesterol levels had significant associations with the choice of weight loss program., (© 2023 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Objective: Lifestyle interventions have had limited effectiveness in work sites when evaluated in randomized trials. This study assessed the effectiveness of a novel lifestyle intervention for weight loss (Healthy Weight for Living [HWL]) implemented with or without meal replacements (MR) in work sites. HWL used a new behavioral approach emphasizing reducing hunger and building healthy food preferences, and, unlike traditional lifestyle interventions, it did not require calorie counting., Methods: Twelve work sites were randomized to an 18-month intervention (n = 8; randomization within work sites to HWL, HWL + MR) or 6-month wait-listed control (n = 4). Participants were employees with overweight or obesity (N = 335; age = 48 [SD 10] years; BMI = 33 [6] kg/m 2 ; 83% female). HWL was group-delivered in person or by videoconference. The primary outcome was 6-month weight change; secondary outcomes included weight and cardiometabolic risk factors measured at 6, 12, and 18 months in intervention groups., Results: Mean 6-month weight change was -8.8% (95% CI: -11.2% to -6.4%) for enrollees in HWL and -8.0% (-10.4% to -5.5%) for HWL + MR (p < 0.001 for both groups vs. controls), with no difference between interventions (p = 0.40). Clinically meaningful weight loss (≥5%) was maintained at 18 months in both groups (p < 0.001)., Conclusions: A new lifestyle intervention approach, deliverable by videoconference with or without MR, supported clinically impactful weight loss in employees., (© 2023 The Obesity Society.)

Background: Personalizing approaches to prevention and treatment of obesity will be a crucial aspect of precision health initiatives. However, in considering individual susceptibility to obesity, much remains to be learned about how to support healthy weight management in different population subgroups, environments and geographical locations., Subjects/methods: The International Weight Control Registry (IWCR) has been launched to facilitate a deeper and broader understanding of the spectrum of factors contributing to success and challenges in weight loss and weight loss maintenance in individuals and across population groups. The IWCR registry aims to recruit, enroll and follow a diverse cohort of adults with varying rates of success in weight management. Data collection methods include questionnaires of demographic variables, weight history, and behavioral, cultural, economic, psychological, and environmental domains. A subset of participants will provide objective measures of physical activity, weight, and body composition along with detailed reports of dietary intake. Lastly, participants will be able to provide qualitative information in an unstructured format on additional topics they feel are relevant, and environmental data will be obtained from public sources based on participant zip code., Conclusions: The IWCR will be a resource for researchers to inform improvements in interventions for weight loss and weight loss maintenance in different countries, and to examine environmental and policy-level factors that affect weight management in different population groups. This large scale, multi-level approach aims to inform efforts to reduce the prevalence of obesity worldwide and its associated comorbidities and economic impacts., Trial Registration: NCT04907396 (clinicaltrials.gov) sponsor SB Roberts; Tufts University IRB #13075., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Lifestyle interventions for weight loss combine support for changing diet and physical activity with weight management education and are considered the first line treatment for obesity. A variety of diet-focused interventions including time-restricted eating are also increasingly being promoted for weight management. This chapter reviews different types of interventions for weight management, their underlying health behavior change models, and effectiveness to date in randomized trials. The results justify increasing efforts to improve program effectiveness generally, and to personalize interventions to support long-term adherence. The high prevalence of obesity worldwide, combined with the known increase in risk of non-communicable diseases with duration of excess weight, provides a compelling justification for routine delivery of effective weight management interventions in the community and in clinical care., (© 2022. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Understanding the impacts of activity on energy balance is crucial. Increasing levels of activity may bring diminishing returns in energy expenditure because of compensatory responses in non-activity energy expenditures. 1-3 This suggestion has profound implications for both the evolution of metabolism and human health. It implies that a long-term increase in activity does not directly translate into an increase in total energy expenditure (TEE) because other components of TEE may decrease in response-energy compensation. We used the largest dataset compiled on adult TEE and basal energy expenditure (BEE) (n = 1,754) of people living normal lives to find that energy compensation by a typical human averages 28% due to reduced BEE; this suggests that only 72% of the extra calories we burn from additional activity translates into extra calories burned that day. Moreover, the degree of energy compensation varied considerably between people of different body compositions. This association between compensation and adiposity could be due to among-individual differences in compensation: people who compensate more may be more likely to accumulate body fat. Alternatively, the process might occur within individuals: as we get fatter, our body might compensate more strongly for the calories burned during activity, making losing fat progressively more difficult. Determining the causality of the relationship between energy compensation and adiposity will be key to improving public health strategies regarding obesity., Competing Interests: Declaration of interests The authors have no conflicts of interest to declare., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

(1) Background: The influence of food culture on eating behavior and obesity risk is poorly understood. (2) Methods: In this qualitative study, 25 adults in France with or without overweight/obesity participated in semi-structured interviews ( n = 10) or focus groups ( n = 15) to examine attitudes to food consumption and external pressures that influence eating behavior and weight management. Results were compared to an equivalent study conducted in the United States, thereby contrasting two countries with markedly different rates of obesity. Emerging key themes in the French data were identified through coding using a reflexive approach. (3) Results: The main themes identified were: (1) influence of commensality, social interactions, and pleasure from eating on eating behavior, (2) having a balanced and holistic approach to nutrition, (3) the role of environmental concerns in food consumption, (4) relationship with "natural" products (idealized) and food processing (demonized), (5) perceptions of weight status and management. Stress and difficulties in hunger cue discernment were viewed as important obstacles to weight management in both countries. External pressures were described as a major factor that explicitly influences food consumption in the U.S., while there was an implicit influence of external pressures through eating-related social interactions in France. In France, products considered "natural" where idealized and juxtaposed against processed and "industrial" products, whereas this was not a salient aspect in the U.S. (4) Conclusions: This first comparative qualitative study assessing aspects of food culture and eating behaviors across countries identifies both common and divergent attitudes to food and eating behavior. Further studies are needed to inform the development of effective behavioral interventions to address obesity in different populations.

Environmental factors such as food availability and variety can function as cues for overeating in individuals susceptible to overweight or obesity, but relatively little is known about other types of environmental factors that may also be important. This qualitative study compared and contrasted categories of internal and external cues through focus groups and key informant interviews with 24 adults (26 to 77 years old) in the United States who had a body mass index within the healthy range (21.6 ± 2.5 kg/m 2 ) or had overweight or obesity (29.1 ± 3.6 kg/m 2 ). Five domains of external factors influencing food intake were identified: (a) Environmental cues including food availability and variety; (b) normative expectations for dietary intake; (c) food palatability; (d) overt social pressures to overeat; and (e) perceived social expectations around eating. All external domains were noted by participants with overweight or obesity to be challenging, and solutions to avoid overeating were lacking; however, overt social pressures and perceived social expectations appeared to be especially problematic. By explicitly defining different domains of external factors that challenge healthy weight regulation, this study identifies specific targets to address in interventions for healthy weight management.

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: ML has received institutional research funds and support for meeting attendance from Diabetes UK, European Association for the Study of Obesity, Novo Nordisk, and Cambridge Weight Plan and pPersonal payments for advisory boards and consultancy from Novo Nordisk and Counterweight. AA is co-inventor on a pending provisional patent application on the use of biomarkers for prediction of weight loss responses, and co-founder/owner of the University of Copenhagen spin-out company Personalized Weight Management Research Consortium (Gluco-diet.dk). AA is consultant or a member of advisory boards for the following concerns with potential interest in the area: Basic Research, Beachbody; BioCare Copenhagen, Gelesis, Groupe Éthique et Santé, McCain Foods, Nestlé Research Center, and Weight Watchers. AA is coauthor of several diet and cookery books, including personalised nutrition for weight loss. SBR is founder of iDiet (www.theidiet.com) and coauthor of three books on healthy eating and weight management for adults and children. She has received institutional research funds from Nutrients and institutional royalty from Gelesis.

Background: The ability to identify and measure behaviors that are related to weight loss and the prevention of weight regain is crucial to understanding the variability in response to obesity treatment and the development of tailored treatments., Objectives: The overarching goal of the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project is to provide obesity researchers with guidance on a set of constructs and measures that are related to weight control and that span and integrate obesity-related behavioral, biological, environmental, and psychosocial domains. This article describes how the behavioral domain subgroup identified the initial list of high-priority constructs and measures to be included, and it describes practical considerations for assessing the following four behavioral areas: eating, activity, sleep, and self-monitoring of weight. Challenges and considerations for advancing the science related to weight loss and maintenance behaviors are also discussed., Significance: Assessing a set of core behavioral measures in combination with those from other ADOPT domains is critical to improve our understanding of individual variability in response to adult obesity treatment. The selection of behavioral measures is based on the current science, although there continues to be much work needed in this field., (© 2018 The Obesity Society.)

Objective: To examine the association of program delivery factors with weight loss (WL) in enrollees in iDiet ® , a commercial WL program., Methods: Data were from 644 adults enrolling in an 11-week group WL program and 461 who reported weight to 11 weeks (complete reporters). Predictors of %WL were analyzed using ANCOVA, including meeting type (in-person vs. videoconference), participant type (worksite employees vs. community members), age, gender, BMI, and payment structure., Results: Mean starting BMI was 32.4 ± 7.1 (mean ± SD); WL was 6.1 ± 3.9% in all enrollees in an intention-to-treat analysis and 7.4 ± 3.4% in complete reporters. Videoconference participants, older adults, and enrollees in incentivized programs were more likely to be complete reporters (P < 0.004). %WL at 11 weeks was not associated with gender, starting BMI, or videoconference versus in-person groups. Worksite participants had greater %WL than community participants (+1.2%, P < 0.001), and there was no significant difference in %WL between programs paid by the employee or employer. Greater %WL was achieved by individuals ≥30 versus < 30 years (+2.2%, P < 0.001) and by those enrolling in January-March versus April-June (+1.4%, P = 0.02)., Conclusions: iDiet participants had clinically impactful mean WL. The observed high mean WL in worksites and videoconference-delivered programs broadens options for scalable WL program implementation., (© 2017 The Obesity Society.)

A systematic review was conducted of randomized trials of workplace weight management interventions, including trials with dietary, physical activity, environmental, behavioral, and incentive-based components. Main outcomes were defined as change in weight-related measures. Keywords related to weight management and workplace interventions were used to search relevant databases, and 23 eligible studies were reviewed in detail using a data extraction form and quality assessment checklist. The trials were conducted mainly in the USA and Europe, with four additional countries represented. Interventions were mostly multicomponent and were implemented in both sexes and in a range of employment categories. Intervention effectiveness appeared unrelated to region of the world and was highest in 6-12-month trials. The results ranged widely from clinically significant 8.8-kg weight loss in one trial to less effective than the control treatment in others. Some workplace interventions achieve clinically significant benefits, and further studies are needed to replicate those results in wider sociocultural and geographical contexts.

Objective: To examine the effects of diets varying in carbohydrate and glycemic index (GI) on changes in body composition, resting metabolic rate (RMR), and metabolic adaptation during and after weight loss., Methods: Adults with obesity (n = 91) were randomized to one of four provided-food diets for 17 weeks. Diets differed in percentage energy from carbohydrate (55% or 70%) and GI (low or high) but were matched for protein, fiber, and energy. Body weight, body composition, RMR, and metabolic adaptation (measured RMR-predicted RMR) were measured during weight loss and subsequent weight stability., Results: No effect of dietary carbohydrate content or GI on body weight loss or percentage of weight lost as fat mass (FM) was observed. Measured RMR was significantly lower (-226 kJ/day [95% CI: -314 to -138 kJ/day], P < 0.001) than predicted RMR following weight loss, but this difference was attenuated after 5 weeks of weight stability. Metabolic adaptation did not differ by dietary carbohydrate content or GI and was not associated with weight regain 12 months later., Conclusions: Moderate-carbohydrate and low-GI diets did not preferentially reduce FM, preserve lean mass, or attenuate metabolic adaptation during weight loss compared to high-carbohydrate and high-GI diets., (© 2015 The Obesity Society.)

There is intense controversy over whether low-carbohydrate or low-fat diets are more efficacious for weight management. Using precise methodology, Hall et al. (2015) demonstrated that a low-carbohydrate diet promoted greater fat oxidation than an isocaloric low-fat diet but, in contrast to popular speculation, did not cause greater body fat loss., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Childhood cancer survivors are at an increased risk of obesity but causes for this elevated risk are uncertain. We evaluated total energy expenditure in childhood cancer survivors using the doubly labeled water method in a cross-sectional study of 17 survivors of pediatric leukemia or lymphoma (median age, 11.5 y). Mean total energy expenditure was 2073 kcal/d, which was nearly 500 kcal/d lower than estimated energy requirements with recommended levels of physical activity. This energy gap is likely to contribute to the risk of obesity in this population and future trials are needed to assess implications and potential treatment strategies.

Background: A high prevalence of obesity has been increasingly recognized in survivors of pediatric ALL. However, longitudinal patterns of weight change during and after treatment, and associated factors, are less well elucidated., Procedure: In a retrospective cohort of 83 pediatric patients with ALL diagnosed between 1985 and 2010, we examined body mass index (BMI) status at several key time points: diagnosis; end of induction; end of consolidation; every 6 months during maintenance; and yearly for up to 5 years post-treatment., Results: At diagnosis, 21% were overweight (BMI = 85-94.9th percentile) or obese (BMI ≥ 95th percentile). At the end of treatment and 5 years post-treatment, approximately 40% were overweight or obese. The mean BMI z-score was 0.2 (58th percentile) at diagnosis and increased significantly during induction (Δ = 0.5, P < 0.0001). It increased again during the first 6 months of maintenance (Δ = 0.2, P < 0.01) and did not significantly change over the remainder of maintenance (BMI z-score at the end of treatment = 0.8, 79th percentile) and 5 years post-treatment (BMI z-score = 0.7, 76th percentile). High BMI z-score at diagnosis was associated with an increased risk of being overweight/obese at treatment completion (OR = 2.9, 95% CI: 1.6-5.1). Weight gain during treatment was associated with being overweight/obese 5 years post-treatment (OR = 3.8, 95% CI: 1.1-12.5)., Conclusion: Children with ALL are at risk of becoming overweight/obese early in treatment. Increases in weight are maintained throughout treatment and beyond. Lifestyle interventions are needed targeting weight control early during treatment, particularly for patients overweight/obese at diagnosis and those who experience substantial weight gain during treatment., (© 2014 Wiley Periodicals, Inc.)

Background and Objective: Previous studies of survivors of pediatric acute lymphoblastic leukemia (ALL) have drawn heterogeneous conclusions regarding the prevalence of obesity and risk factors for developing obesity in pediatric ALL survivors. We sought to determine the prevalence of obesity in pediatric ALL survivors and examine risk factors for obesity through a systematic review and meta-analysis., Methods: A MEDLINE search was performed from its inception through 2013. Studies met the inclusion criteria if they (1) included at least 10 survivors of pediatric ALL; (2) assessed the prevalence or indicators of obesity; and (3) compared obesity among ALL survivors to a reference population or external control group. Extracted data included patient and treatment characteristics, study design, population used for comparison, and prevalence of obesity., Results: Forty-seven studies met the inclusion criteria. Despite significant heterogeneity among the studies (I(2) = 96%), the mean BMI z score in 1742 pediatric ALL survivors was 0.83 (95% confidence interval: 0.60-1.06), which corresponds to the 80th BMI percentile, indicating a significantly higher BMI in pediatric ALL survivors than the reference population. Subgroup analyses found a high prevalence of obesity in ALL survivors regardless of survivors' receipt of cranial irradiation, gender, or age at diagnosis., Conclusions: Obesity is prevalent in pediatric ALL survivors and is independent of patient- and treatment-related characteristics. Clinicians need to screen for obesity and its associated health conditions early in survivorship.

Objective: To examine associations between eating behavior constructs and weight loss (WL) in a 6-month WL intervention in worksites., Design and Methods: A cluster-randomized controlled trial of a group behavioral WL intervention versus wait-listed control was conducted at four worksites. Measures included body weight and the eating behavior constructs restraint, disinhibition, hunger, and their sub-constructs. Rates of intervention meeting attendance and weight self-monitoring were also quantified., Results: WL was greater in intervention participants than controls (ΔI = -8.1±6.8 kg, ΔC = +0.9±3.6 kg, P<0.001). Between-group analyses showed that the intervention was associated with increased restraint (ΔI = 5.43±4.25, ΔC = 0.29±3.80, P<0.001), decreased disinhibition (ΔI = -2.5±3.63, ΔC = 0.66±1.85, P < 0.001) and decreased hunger (ΔI = -2.79±3.13, ΔC = 0.56±2.63, P < 0.001), and changes in all eating behavior subscales. Greater WL in intervention participants was correlated with higher baseline hunger (r = -0.25, P = 0.03), increased restraint (r = -0.35, P=0.001), decreased disinhibition (r = 0.26, P = 0.02), and decreased hunger (r = 0.36, P = 0.001). However, in a multiple regression model including rates of meeting attendance and self-monitoring, decreased hunger was the only eating behavior change that predicted weight loss (R(2) =0.57, P<0.001)., Conclusion: Decreased hunger was the strongest predictor of WL in this intervention with relatively high mean WL. Further studies are needed to confirm the central role of hunger management in successful WL., (Copyright © 2013 The Obesity Society.)

Background: Worksites are potentially effective locations for obesity control because they provide opportunities for group intervention and social support. Studies are needed to identify effective interventions in these settings., Objective: We examined the effects of a multicomponent lifestyle intervention on weight loss and prevention of regain in 4 worksites (2 intervention and 2 control sites)., Design: Overweight and obese employees (n = 133) enrolled in this pilot worksite-randomized controlled trial with a 0-6-mo weight-loss phase and a 6-12-mo structured weight-maintenance phase. The intervention combined recommendations to consume a reduced-energy, low-glycemic load, high-fiber diet with behavioral change education. Outcome measurements included changes in body weight and cardiometabolic risk factors., Results: The mean ± SEM weight loss was substantial in intervention participants, whereas control subjects gained weight (-8.0 ± 0.7 compared with +0.9 ± 0.5 kg, respectively; P < 0.001), and 89% of participants completed the weight-loss phase. Intervention effects were not significant at the 0.05 level but would have been at the 0.10 level (P = 0.08) in a mixed model in which the worksite nested within group was a random factor. There were also significant improvements in cardiometabolic risk factors in intervention compared with control subjects regarding fasting total cholesterol, glucose, systolic blood pressure, and diastolic blood pressure (P ≤ 0.02 for each). No significant weight regain was observed in participants who enrolled in the structured weight-maintenance program (0.5 ± 0.7 kg; P = 0.65), and overweight and obese employees in intervention worksites who were not enrolled in the weight-loss program lost weight compared with subjects in control worksites (-1.3 ± 0.5 compared with +0.7 ± 0.2 kg, respectively; P = 0.02)., Conclusion: Worksites can be effective for achieving clinically important reductions in body weight and improved cardiometabolic risk factors. This trial was registered at clinicaltrials.gov as NCT01470222.

Objective: The causes of adult weight gain leading to obesity are uncertain. We examined the association of adult weight gain and obesity with subscales of eating behavior characteristics in older women., Methods and Procedures: Current height and weight, eating behavior subscales (disinhibition subscales-habitual, situational, and emotional; restraint subscales-flexible and rigid; hunger subscales-internal and external) as assessed using the Eating Inventory (EI), and self-reported body weight at six prior age intervals were reported by 535 women aged 55-65 years. Multiple regression analysis was used to examine the relationships between EI subscale scores and weight change from the age interval of 30-39 to 55-60 years and current BMI., Results: The strongest correlate of weight gain over 20 years was susceptibility to overeating in response to everyday cues within the environment (habitual disinhibition; partial correlation coefficient (r) = 0.25, P < 0.001); susceptibility to overeating in response to emotional states such as depression (emotional disinhibition) was a quantitatively weaker but significant correlate (partial r = 0.17, P < 0.001), and susceptibility to overeating in response to specific situations such as social occasions (situational disinhibition) was not associated with weight gain. Flexible control of dietary restraint attenuated the influence of habitual disinhibition in particular on weight gain and BMI, and was less effective in attenuating associations of emotional or situational disinhibition., Discussion: Lifestyle modification programs for prevention and treatment of adult-onset obesity currently focus on reducing situational and emotional overeating; the results of this study suggest that a stronger emphasis on strategies that target habitual overeating may be warranted.

Background: There remains no consensus about the optimal dietary composition for sustained weight loss., Objective: The objective was to examine the effects of 2 dietary macronutrient patterns with different glycemic loads on adherence to a prescribed regimen of calorie restriction (CR), weight and fat loss, and related variables., Design: A randomized controlled trial (RCT) of diets with a high glycemic load (HG) or a low glycemic load (LG) at 30% CR was conducted in 34 healthy overweight adults with a mean (+/-SD) age of 35 +/- 6 y and body mass index (kg/m(2)) of 27.6 +/- 1.4. All food was provided for 6 mo in diets controlled for confounding variables, and subjects self-administered the plans for 6 additional months. Primary and secondary outcomes included energy intake measured by doubly labeled water, body weight and fatness, hunger, satiety, and resting metabolic rate., Results: All groups consumed significantly less energy during CR than at baseline (P < 0.01), but changes in energy intake, body weight, body fat, and resting metabolic rate did not differ significantly between groups. Both groups ate more energy than provided (eg, 21% and 28% CR at 3 mo and 16% and 17% CR at 6 mo with HG and LG, respectively). Percentage weight change at 12 mo was -8.04 +/- 4.1% in the HG group and -7.81 +/- 5.0% in the LG group. There was no effect of dietary composition on changes in hunger, satiety, or satisfaction with the amount and type of provided food during CR., Conclusions: These findings provide more detailed evidence to suggest that diets differing substantially in glycemic load induce comparable long-term weight loss.

Objective: To compare the effects of two calorie-restricted diets that differ in glycemic load (GL) on glucose tolerance and inflammation., Research Methods and Procedures: Thirty-four healthy overweight adults, ages 24 to 42 years, were randomized to 30% provided calorie-restricted diets with high (HG) or low (LG) glycemic load for 6 months. Outcomes were changes in glucose-insulin dynamics and C-reactive protein (CRP) levels., Results: Compared with baseline, levels of fasting insulin, homeostasis model assessment of insulin resistance, post-load insulin at 30 minutes, and incremental area-under-the-curve-insulin during the oral glucose tolerance test were significantly lower in both groups at 6 months (p range, 0.01 to 0.05), but after adjustment for baseline values and weight change, there were no differences between the two groups with regard to changes over time in any parameter. The mean percentage change in insulin sensitivity by a frequently sampled intravenous glucose tolerance test was +26% in the HG group and +24% in the LG group (p = 0.83); first-phase acute insulin release was -20% in the HG group and -21% in the LG group (p = 0.77). More participants on the LG diet (14 of 16 subjects) had a decline in serum CRP, compared with those on the HG diet (7 of 16 subjects) (p < 0.05)., Discussion: In healthy overweight adults provided with food for 6 months, the dietary GL did not seem to influence chronic adaptations in glucose-insulin dynamics above that associated with weight loss. This finding highlights the importance of absolute weight loss over the dietary macronutrient composition used to achieve weight loss. The finding of greater declines in CRP concentration after consumption of a low-GL diet warrants further investigation.

There is considerable uncertainty over whether any one dietary pattern broadly facilitates weight loss or maintenance of weight loss, and current dietary guidelines recommend a spectrum of dietary composition for the general population. However, emerging evidence suggests that specific dietary compositions may work better for identifiable groups of overweight/obese individuals based on their individual metabolic status. In particular, characteristics of insulin dynamics, such as insulin sensitivity or insulin secretion status, may interact with diets that vary in macronutrient composition to influence the weight loss achieved with a hypocaloric diet.

Objective: The use of anthropometric measures (eg, skinfold thicknesses, BMI) to assess obesity is not without controversy and has not been explored with respect to the use among groups of children with growth retardation (ie, stunting). Therefore, the objective of this study was to determine whether growth retardation affects the accuracy of field methods for assessing body composition in children., Methods: A cross-sectional study was conducted in 30 stunted children and 30 nonstunted children who were matched for age- and weight-for-height z score and living in the shantytowns of São Paulo, Brazil. Body composition (fat mass, fat-free mass, and percentage of body fat [%BF]) was measured by H2(18)O dilution (reference technique) using group-specific values for the hydration of fat-free mass and dual-energy x-ray absorptiometry. BMI and body composition that were calculated from 3 pediatric skinfold prediction equations were evaluated for accuracy of %BF in comparison with the reference technique., Results: Stunted children were shorter and weighed less than nonstunted children, but BMI did not differ significantly between groups. All 3 skinfold equations tested resulted in a calculated %BF that was significantly lower than that measured by H2(18)O dilution for both stunted and nonstunted groups, and %BF as calculated by any of the skinfold equations tested did not significantly predict %BF by H2(18)O dilution. In contrast, BMI significantly predicted %BF in both stunted and nonstunted children, and this relationship did not differ by growth status., Conclusion: BMI but not skinfolds significantly predicted %BF measured by H2(18)O dilution. The relationship between BMI and %BF did not differ between stunted and nonstunted children; this indicates that BMI can be used in field studies of obesity and stunting. However, the prediction of %BF by BMI is relatively poor in both groups of children, and continued investigation of more accurate field methods for measuring %BF is warranted.

Objective: To examine relative associations of dietary composition variables with body mass index (BMI; calculated as kg/m2) among young and middle-aged US adults. We hypothesized that in subjects with physiologically plausible reported energy intakes, fiber intake would be inversely associated with BMI, independent of other dietary composition and sociodemographic variables., Subjects and Design: Data from adults age 20 to 59 years in the Continuing Survey of Food Intakes by Individuals (CSFII) 1994-1996 were used. Exclusions were pregnancy or lactation, food insecurity, missing weight or height data, or having only one dietary recall. Based on our previously published methods, a physiologically plausible reported energy intake was calculated as being within +/-22% of predicted energy requirements for the mean of two 24-hour recalls., Results: Reporting plausibility ([reported energy intake/predicted energy requirements]x100) averaged 83% in the total sample (N=4,539) and increased to 96% in the plausible sample (n=1,932). Only approximately 5% of the plausible sample consumed the Adequate Intake for fiber. In plausibly reporting women, fiber, its interaction with percentage energy from fat, and energy density were independently associated with BMI. Only percentage energy from fat was associated with BMI in men reporting plausibly. Compared with the total sample, stronger relationships between diet and BMI were observed among the plausible reporters. In women, a low-fiber (< 1.5 g/MJ), high-fat (> or = 35% energy) diet was associated with the greatest increase in risk of overweight or obesity compared with a high-fiber, low-fat diet., Conclusions: Weight control advice for US women should place greater emphasis on consumption of fiber.

Background: Little is known about the determinants of individual variability in body weight and fat loss after gastric bypass surgery or about the effects of massive weight loss induced by this surgery on energy requirements., Objectives: The objectives were to determine changes in energy expenditure and body composition with weight loss induced by gastric bypass surgery and to identify presurgery predictors of weight loss., Design: Thirty extremely obese women and men with a mean (+/- SD) age of 39.0 +/- 9.6 y and a body mass index (BMI; in kg/m(2)) of 50.1 +/- 9.3 were tested longitudinally under weight-stable conditions before surgery and after weight loss and stabilization (14 +/- 2 mo). Total energy expenditure (TEE), resting energy expenditure (REE), body composition, and fasting leptin were measured., Results: Subjects lost 53.2 +/- 22.2 kg body weight and had significant decreases in REE (-2.4 +/- 1.0 MJ/d; P < 0.001) and TEE (-3.6 +/- 2.5 MJ/d; P < 0.001). Changes in REE were predicted by changes in fat-free mass and fat mass. The average physical activity level (TEE/REE) was 1.61 at both baseline and follow-up (P = 0.98). Weight loss was predicted by baseline fat mass and BMI but not by any energy expenditure variable or leptin. Measured REE at follow-up was not significantly different from predicted REE., Conclusions: TEE and REE decreased by 25% on average after massive weight loss induced by gastric bypass surgery. REE changes were predicted by loss of body tissue; thus, there was no significant long-term change in energy efficiency that would independently promote weight regain.

Background: The specific underlying causes of adult weight gain remain uncertain., Objective: The objective was to determine the association of 3 measures of eating behavior with weight gain and body mass index (BMI; in kg/m(2)) in adults., Design: Current dietary restraint, disinhibition, and hunger were assessed with the use of the Eating Inventory in 638 healthy, nonsmoking women aged 55-65 y. In addition, subjects reported their current weight and height, their weight for 6 age intervals, and changes in voluntary dietary energy restriction over the past 10 y. Current weight and height were validated in 10% of subjects., Results: Current disinhibition strongly predicted weight gain and current BMI (partial r = 0.27 and 0.34, respectively, both P < 0.001). Neither restraint nor hunger was a significant independent predictor of either variable, but the positive associations between disinhibition and both weight gain and BMI were attenuated by restraint (P = 0.016 and 0.010, respectively, after adjustment for confounding variables). In the subpopulation of women who reported a stable level of voluntary dietary energy restriction, disinhibition also strongly predicted weight gain and higher BMI, and restraint was negatively associated with weight gain (partial r = -0.17, P = 0.019)., Conclusions: Higher disinhibition is strongly associated with greater adult weight gain and higher current BMI, and dietary restraint may attenuate this association when disinhibition is high. These findings suggest that eating behavior has an important role in the prevention of adult-onset obesity and that further studies are warranted.

In mammals, trait variation is often reported to be greater among males than females. However, to date, mainly only morphological traits have been studied. Energy expenditure represents the metabolic costs of multiple physical, physiological, and behavioral traits. Energy expenditure could exhibit particularly high greater male variation through a cumulative effect if those traits mostly exhibit greater male variation, or a lack of greater male variation if many of them do not. Sex differences in energy expenditure variation have been little explored. We analyzed a large database on energy expenditure in adult humans (1494 males and 3108 females) to investigate whether humans have evolved sex differences in the degree of interindividual variation in energy expenditure. We found that, even when statistically comparing males and females of the same age, height, and body composition, there is much more variation in total, activity, and basal energy expenditure among males. However, with aging, variation in total energy expenditure decreases, and because this happens more rapidly in males, the magnitude of greater male variation, though still large, is attenuated in older age groups. Considerably greater male variation in both total and activity energy expenditure could be explained by greater male variation in levels of daily activity. The considerably greater male variation in basal energy expenditure is remarkable and may be explained, at least in part, by greater male variation in the size of energy-demanding organs. If energy expenditure is a trait that is of indirect interest to females when choosing a sexual partner, this would suggest that energy expenditure is under sexual selection. However, we present a novel energetics model demonstrating that it is also possible that females have been under stabilizing selection pressure for an intermediate basal energy expenditure to maximize energy available for reproduction.

Low total energy expenditure (TEE, MJ/d) has been a hypothesized risk factor for weight gain, but repeatability of TEE, a critical variable in longitudinal studies of energy balance, is understudied. We examine repeated doubly labeled water (DLW) measurements of TEE in 348 adults and 47 children from the IAEA DLW Database (mean ± SD time interval: 1.9 ± 2.9 y) to assess repeatability of TEE, and to examine if TEE adjusted for age, sex, fat-free mass, and fat mass is associated with changes in weight or body composition. Here, we report that repeatability of TEE is high for adults, but not children. Bivariate Bayesian mixed models show no among or within-individual correlation between body composition (fat mass or percentage) and unadjusted TEE in adults. For adults aged 20-60 y (N = 267; time interval: 7.4 ± 12.2 weeks), increases in adjusted TEE are associated with weight gain but not with changes in body composition; results are similar for subjects with intervals >4 weeks (N = 53; 29.1 ± 12.8 weeks). This suggests low TEE is not a risk factor for, and high TEE is not protective against, weight or body fat gain over the time intervals tested.

The doubly labeled water (DLW) method measures total energy expenditure (TEE) in free-living subjects. Several equations are used to convert isotopic data into TEE. Using the International Atomic Energy Agency (IAEA) DLW database (5,756 measurements of adults and children), we show considerable variability is introduced by different equations. The estimated rCO2 is sensitive to the dilution space ratio (DSR) of the two isotopes. Based on performance in validation studies, we propose a new equation based on a new estimate of the mean DSR. The DSR is lower at low body masses (

BackgroundExcess energy intake from meals consumed away from home is implicated as a major contributor to obesity, and ∼50% of US restaurants are individual or small-chain (non-chain) establishments that do not provide nutrition information.ObjectiveTo measure the energy content of frequently ordered meals in non-chain restaurants in three US locations, and compare with the energy content of meals from large-chain restaurants, energy requirements, and food database information.DesignA multisite random-sampling protocol was used to measure the energy contents of the most frequently ordered meals from the most popular cuisines in non-chain restaurants, together with equivalent meals from large-chain restaurants.SettingMeals were obtained from restaurants in San Francisco, CA; Boston, MA; and Little Rock, AR, between 2011 and 2014.Main outcome measuresMeal energy content determined by bomb calorimetry.Statistical analysis performedRegional and cuisine differences were assessed using a mixed model with restaurant nested within region×cuisine as the random factor. Paired t tests were used to evaluate differences between non-chain and chain meals, human energy requirements, and food database values.ResultsMeals from non-chain restaurants contained 1,205±465 kcal/meal, amounts that were not significantly different from equivalent meals from large-chain restaurants (+5.1%; P=0.41). There was a significant effect of cuisine on non-chain meal energy, and three of the four most popular cuisines (American, Italian, and Chinese) had the highest mean energy (1,495 kcal/meal). Ninety-two percent of meals exceeded typical energy requirements for a single eating occasion.ConclusionsNon-chain restaurants lacking nutrition information serve amounts of energy that are typically far in excess of human energy requirements for single eating occasions, and are equivalent to amounts served by the large-chain restaurants that have previously been criticized for providing excess energy. Restaurants in general, rather than specific categories of restaurant, expose patrons to excessive portions that induce overeating through established biological mechanisms.

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

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

Emerging research indicates that eating timing may influence dietary intake and metabolic health. However, studies to date have not examined the association of multiple measures of eating timing with both dietary intake and metabolic health in adults with overweight and obesity. To examine the association of multiple measures of eating timing with dietary intake (ie, dietary composition, diet quality, and eating frequency) and metabolic health (ie, body composition and cardiometabolic risk). This is a cross-sectional analysis of baseline data from a weight loss and maintenance intervention collected from May 2015 to January 2018. Participants were women with overweight or obesity who were dependents of active duty and retired military personnel (N = 229; mean ± standard error, BMI = 34.7 ± 0.4 kg/m2, age = 40.9 ± 0.7 years). The study was conducted at military installations in Massachusetts, Connecticut, New York, Colorado, and Kentucky. Eating timing variables examined included daily eating interval (time between first and last eating occasion), time-restricted eating (≤11 hours daily eating interval), early energy eaters (eating ≥60% of energy during the first half of time awake), and bedtime eaters (eating within 2 hours of bedtime). The main analysis was limited to those reporting plausible energy intake (64% of total sample [n = 146]). Linear, quantile, or logistic regression models were used to determine the association of eating timing with measures of dietary intake and metabolic health. In individuals reporting plausible energy intake, each additional 1 hour in daily eating interval was associated with 53 kcal higher energy intake, higher glycemic load, eating frequency, and waist circumference (P < 0.05 for all). Significant associations were observed for: time-restricted eating and a lower energy intake, glycemic load, and eating frequency; early energy eating and higher carbohydrate intake; bedtime eating and a higher energy intake, glycemic load, and eating frequency. These findings lend support for the mechanistic targeting of eating timing in behavioral interventions aimed at improving dietary intake and body composition. [ABSTRACT FROM AUTHOR]

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

There is substantial variability in the effectiveness of group lifestyle interventions for weight loss. We examined associations between intervention weight loss counselors and participant weight loss and program engagement in a structured lifestyle intervention. Data were from 575 adults (87% female, 51 (12) years, baseline BMI: 32.4 (7.2) kg/m2) in an 11-week structured group lifestyle program. Participants self-enrolled in groups led by 11 weight loss counselors based on meeting times. All weight loss counselors received the same training. Linear mixed models were used to evaluate counselor predictors of participant percent (%) weight loss and program engagement (weight reporting throughout 11 weeks). Of the 575 participants, 415 (72%) defined as complete reporters, i.e. reported weight weekly, lost a mean 7.3% weight (range: +3.1% to 16.2%). Participant weight loss differed between weight loss counselors (p = 0.003), and adjusted mean participant weight loss by weight loss counselor ranged from 6% to 9%. Weight loss was greater for weight loss counselors with a graduate degree in nutrition than weight loss counselors with another graduate degree (8.3% versus 6.4%, p = 0.05), but was not different between weight loss counselors with and without graduate degrees. Higher counselor BMI was associated with higher participant weight loss (p = 0.005). These results demonstrate the potential for quantitatively important effects of weight loss counselor characteristics on participant success and engagement in structured lifestyle interventions, indicating a need for research in this area. [ABSTRACT FROM AUTHOR]

Background: Nutrition clubs (NC) operate in community settings and provide members with nutrition education and meal replacements for weight management. NC are owned and operated by distributors of Herbalife products. There are over 6200 NC in the US, but there has been no independent assessment of the association of these NC with biomarkers of health.Methods: We conducted a cross-sectional pilot study to compare the health status of 100 NC members to 100 community-matched controls (CC) in the greater Boston area. Each CC was matched to a NC member for community of residence (zip code), age category, gender, BMI category, race/ethnicity, education level (category), and readiness to make health changes. Measures obtained included cardio-metabolic risk factors, body composition, markers of nutritional status, reported health status, dietary intake, physical activity, sleep and depression.Results: Participants were predominantly female (64%) and Hispanic (73%). NC members had significantly lower fasting insulin (P < 0.001) and lower HbA1c (P = 0.008), higher levels of 25 hydroxy-vitamin D (P = 0.001), and vitamin E:cholesterol ratio (P < 0.001), and lower prevalence of metabolic syndrome (P = 0.02) compared to CC. In addition, most of the NC members (99%) were satisfied with Herbalife NC membership for themselves and their families. A higher percentage of NC members (86%) compared to CC (32%) reported being in much better or somewhat better health compared to a year ago (P < 0.001); and they reported significantly better physical health (P = 0.03), and fewer sleep problems (P = 0.03).Conclusion: Herbalife NC membership was positively associated with perceived health and measured cardiometabolic benefits. However, causality cannot be inferred from these findings. [ABSTRACT FROM AUTHOR]

While short-term studies demonstrate consistent effects of dietary protein, fiber, glycemic index and energy density on energy intake, long-term effectiveness trials typically indicate small or non-significant effects of these dietary factors on long-term weight change. In consequence, most lifestyle interventions for weight control typically focus on a single dietary factor, such as low energy density, to achieve reductions in energy intake. This paper proposes a multiple-dietary-factor model for the effects of dietary factors on energy intake and the regulation of energy balance that assumes additive effects of different dietary factors. The model is consistent with emerging evidence from recent studies examining pairs of dietary factors. Randomized clinical trials are now needed to determine whether multiple-dietary-factor prescriptions combined with standard behavior modification techniques lead to improved sustainability of weight loss in lifestyle interventions compared to conventional single-dietary-factor prescriptions. [ABSTRACT FROM AUTHOR]

Background: The double burden of obesity and underweight is increasing in developing countries and simple methods for the assessment of fat mass in children are needed. Aim: To develop and validate a new anthropometric predication equation for assessment of fat mass in children. Subjects and methods: Body composition was assessed in 145 children aged 9.8 ± 1.3 (SD) years from São Paulo, Brazil using dual energy X-ray absorptiometry (DEXA) and skinfold measurements. The study sample was divided into development and validation sub-sets to develop a new prediction equation for FM (PE). Results: Using multiple linear regression analyses, the best equation for predicting FM ( R2 == 0.77) included body weight, triceps skinfold, height, gender and age as independent variables. When cross-validated, the new PE was valid in this sample ( R2 == 0.80), while previously published equations were not. Conclusion: The PE was more valid for Brazilian children that existing equations, but further studies are needed to assess the validity of this PE in other populations. [ABSTRACT FROM AUTHOR]

The article discusses a study on the accuracy of stated energy contents of foods in restaurants conducted in the U.S. from January to June 2010. The study used a validated bomb calorimetry technique in measuring energy contents in foods from quick-serve and sit-down restaurants. There was no significant difference found between the overall absolute stated energy contents and absolute measured energy contents. The stated energy contents of individual foods were found inaccurate when compared to the measured energy contents. The implications of the findings for the prevention and treatment of obesity are tackled.

Calorie restriction (CR) enhances immune response and prolongs life span in animals. However, information on the applicability of these results to humans is limited. T-cell function declines with age. We examined effects of CR on T-cell function in humans. Forty-six overweight, nonobese participants aged 20–42 years were randomly assigned to 30% or 10% CR group for 6 months. Delayed-type hypersensitivity (DTH), T-cell proliferation (TP), and prostaglandin E2 (PGE2) productions were determined before and after CR. DTH and TP to T-cell mitogens were increased in both groups over baseline (p ≤ .019). However, number of positive responses to DTH antigens (p = .016) and TP to anti-CD3 reached statistical significance only after 30% CR (p = .001). Lipopolysaccharide-stimulated PGE2 was reduced in both groups but reached statistical significance after 30% CR (p ≤ .029). These results, for the first time, show that 6-month CR in humans improves T-cell function. [ABSTRACT FROM PUBLISHER]

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

Background. The association of psychological eating behavior constructs with overweight and obesity during early adult life and middle age has been documented in several studies. However, the association of eating behavior with unexplained weight change in old age is relatively unexplored. Methods. Body weight, eating behavior (dietary restraint, distribution, and hunger as assessed by the Eating Inventory), reported dietary intake, and physical activity level were assessed at baseline in 36 nonobese postmenopausal women aged 61.3 ± 3.1 years (mean ± standard deviation). Measurements were repeated 4.4 ± 0.9 years later, and changes in body weight were examined in relation to baseline and follow-up eating behavior scores, reported dietary intake, and physical activity level. Results. Participants had no major changes in health or lifestyle characteristics over the study interval. Weight change ranged from 7.5 to +5.8 kg (mean +0.3 ± 3.5 kg), and there were no significant changes in reported dietary, intake. Mean hunger score (calculated as the mean of baseline and follow-up hunger score) predicted weight change per year over the study period (bivariate r = 0.386, p = .020) even in statistical models adjusted for mean dietary intake variables (partial r = 0.658, p = .003). Restraint, disinhibition, and physical activity level did not predict weight change. Conclusions. Reported hunger assessed by the Eating Inventory was associated with unintentional weight change in healthy postmenopausal women. The Eating Inventory questionnaire may provide a clinically useful tool for identifying older individuals at risk of undesirable weight change, and particularly unintentional weight loss, a factor strongly associated with increased morbidity and premature death in this population. [ABSTRACT FROM AUTHOR]

It is estimated that 11% of births in developing counties are term Iow-birth-weight (LBW); however, there is limited information on the development of these infants. Our objectives were to determine the effect of psychosocial intervention on the development of LBW infants and to compare term LBW and normal-birth-weight (NBW) infants. Term LBW (n = 140) and NBW infants (n = 94) were enrolled from the main maternity hospital in Kingston, Jamaica. The LBW infants were randomly assigned to control or intervention comprising weekly home visits from birth to 8 wk and from 7 to 24 mo of age. Development was assessed at 15 and 24 mo with the Griffiths Scales. The intervention benefited the infants' developmental quotient (DQ, P < 0.05) and performance subscale at 15 mo (P < 0.02), the hand and eye (P < 0.05) and performance subscales (P < 0.02) at 24 mo, and home environment at 12 mo. The effect of the intervention on development was mediated in part by the improvement in the home environment. The control LBW infants had significantly lower scores than the NBW in DQ and several subscales, whereas there were no significant differences between the NBW and the LBW infants after intervention. In conclusion, term LBW was associated with developmental delays, which were reduced with psychosocial intervention. [ABSTRACT FROM AUTHOR]

Background: Little is known about the determinants of individual variability in body weight and fat loss after gastric bypass surgery or about the effects of massive weight loss induced by this surgery on energy requirements. Objectives: The objectives were to determine changes in energy expenditure and body composition with weight loss induced by gastric bypass surgery and to identify presurgery predictors of weight loss. Design: Thirty extremely obese women and men with a mean (±SD) age of 39.0 ± 9.6 y and a body mass index (BMI; in kg/m²) of 50.1 ± 9.3 were tested longitudinally under weight-stable conditions before surgery and after weight loss and stabilization (14±2 mo). Tdtal energy expenditure (TEE), resting energy expenditure (REE), body composition, and fasting leptin were measured. Results: Subjects lost 53.2 ± 22.2 kg body weight and had significant decreases in REE (-2.4 ± 1.0 MJ/d; P < 0.001) and TEE (-3.6 ± 2.5 MJ/d; P < 0.001). Changes in REE were predicted by changes in fat-free mass and fat mass. The average physical activity level (TEE/REE) was 1.61 at both baseline and follow-up (P = 0.98). Weight loss was predicted by baseline fat mass and BMI but not by any energy expenditure variable or leptin. Measured REE at follow-up was not significantly different from predicted REE. Conclusions: TEE and REE decreased by 25% on average after massive weight loss induced by gastric bypass surgery. REE changes were predicted by loss of body tissue; thus, there was no significant long-term change in energy efficiency that would independently promote weight regain. [ABSTRACT FROM AUTHOR]

FBody composition methods were examined in 20 women [body mass index (BMI) 48.7 ± 8.8 kg/m²] before and after weight loss [-44.8 ± 14.6 (SD) kg] after gastric bypass (GBP) surgery. The reference method, a three-compartment (3C) model using body density by air displacement plethysmography and total body water (TBW) by H[sub 2][sup 18]0 dilution (3C-H[sub 2][sup 18]O), showed a decrease in percent body fat (%BF) from 51.4 to 34.6%. Fat-free mass hydration was significantly higher than the reference value (0.738) in extreme obesity (0.756; P < 0.001) but not after weight reduction (0.747; P = 0.16). %BF by H[sub 2][sup 18]O dilution and air displacement plethysmography differed significantly from %BF by 3C-H[sub 2][sup 18]O in extreme obesity (P < 0.05) and 3C models using ²H[sub 2]O or bioelectrical impedance analysis (BIA) to determine TBW improved mean %BF estimates over most other methods at both time points. BIA results varied with the equation used, but BIA better predicted %BF than did BMI at both time points. All methods except BIA using the Segal equation were comparable to the reference method for determining changes over time. A simple 3C model utilizing air displacement plethysmography and BIA is useful for clinical evaluation in this population. [ABSTRACT FROM AUTHOR]