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Background: The positive impact of Roux-en-Y gastric bypass on weight, comorbidities, and health-related quality of life is well documented. However, 50 percent of patients regain some of the lost weight after 2 years with Roux-en-Y gastric bypass and present a mean weight regain of 10 to 15 percent after several years, partially losing the previously obtained benefits. The authors hypothesize that body contouring could decrease weight regain, leading to better long-term weight control after Roux-en-Y gastric bypass., Methods: In a matched control study, variations in weight for 98 patients with body contouring after Roux-en-Y gastric bypass were compared with those of 102 matched control patients with Roux-en-Y gastric bypass alone. Data were collected prospectively at 1, 3, 6, 9, 12, and 18 months after Roux-en-Y gastric bypass and then yearly until 7 years., Results: After a massive mean weight loss of 45.2 kg during the first 2 years after Roux-en-Y gastric bypass, patients with Roux-en-Y gastric bypass alone presented a higher continuous mean weight regain than those with Roux-en-Y gastric bypass and body contouring (1.78 kg/year versus 0.51 kg/year of weight regain, respectively; p = 0.001). After 7 years, patients with Roux-en-Y gastric bypass presented significantly higher mean weight regain than patients with Roux-en-Y gastric bypass and body contouring (i.e., 10.8 percent versus 3.6 percent mean weight gain, respectively; p < 0.001). Netting out mean skin excision weight of 2.04 kg by body contouring, the weight regain was 22.9 kg for patients with Roux-en-Y gastric bypass alone and only 6.2 kg for those with Roux-en-Y gastric bypass and body contouring., Conclusions: The authors demonstrated that patients with body contouring present better long-term weight control after Roux-en-Y gastric bypass. Therefore, body contouring must be considered as a reconstructive operation in the treatment of morbid obesity., Clinical Question/level of Evidence: Therapeutic, III.

As obesity has reached epidemic proportions, the management of this global disease is of clinical importance. The availability and popularity of natural dietary supplements for the treatment of obesity has risen dramatically in recent years. The purpose of this paper was to review the effect of commonly available over the counter plant-derived supplements used to suppress appetite for obesity control and management. The data were obtained from the electronic databases PubMed, SpringerLink, Google Scholar, ScienceDirect, and MEDLINE with full text (via EBSCOHost) and the databases were accessed during late 2012 - early January 2013. The botanical species discussed in this review include Camellia sinensis, Caralluma fimbriata, Citrus aurantium, Coleus forskohlii, Garcinia cambogia and Phaseolus vulgaris. This review found that many botanical species including crude extracts and isolated compounds from plants have been shown to provide potentially promising therapeutic effects including appetite control and weight loss. However, many of these crude extracts and compounds need to be further investigated to define the magnitude of the effects, optimal dosage, mechanisms of action, long term safety, and potential side effects.

Various botanical extracts are used as adjuncts in treating obesity. A recent review concerning botanical products used to suppress appetite has included a discussion of Citrus aurantium and p-synephrine. The authors have incorrectly equated the actions of C. aurantium with ephedra in terms of adrenergic receptor binding, pharmacological effects and safety. Current research literature is reviewed which clarifies these issues.

Objective: We sought to better understand why so few severely obese patients undergo bariatric surgery in the United States., Design and Methods: We conducted a telephone survey to assess the weight control practices of severely obese patients who were not actively seeking bariatric surgery in Group Health, a health system in Washington State., Results: Among 295 severely obese participants surveyed (63% response rate), most reported actively working on weight loss (58%), although current use of commercial weight loss programs (10%) and obesity pharmacotherapy (0.1%) was low. Household income and white race were strongly associated with lifetime use of commercial programs, suggesting a possible disparity in use of effective treatment for obesity. Many were interested in learning more about bariatric surgery (49%) and pharmacotherapy (53%), but few had ever discussed surgery (26%) or pharmacotherapy (33%) with their physician. Finally, although only 29% had coverage for bariatric surgery, those with coverage were not more likely to have discussed bariatric surgery with their physician., Conclusions: Overall, our survey of severely obese patients who are not currently seeking bariatric surgery suggests that interest in obesity treatments is high, coverage and receipt of treatment is low, and that there is a potential socioeconomic disparity related to the use of commercial programs., (Copyright © 2013 The Obesity Society.)

Overview: As obesity has reached epidemic proportions, the management of this global disease is of clinical importance. The availability and popularity of natural dietary supplements for the treatment of obesity has risen dramatically in recent years., Aims: The aim of this paper was to assess the current evidence of commonly available natural supplements used to suppress appetite for obesity control and management in humans using a systematic search of clinical trials meeting an acceptable standard of evidence., Methods: The electronic databases PubMed, Web of Science, Google Scholar, ScienceDirect, and MEDLINE with full text (via EBSCOHost) were accessed during late 2012 for randomized controlled clinical trials (RCTs) using natural plant extracts as interventions to treat obesity through appetite regulation. A quality analysis using a purpose-designed scale and an estimation of effect size, where data were available, was also calculated. The inclusion criteria included the following: sample participants classified as overweight or obese adults (aged 18-65 years), randomized, double blind, controlled design, suitable placebo/control intervention, sample size >20, duration of intervention >2 weeks, have measurable outcomes on appetite or food intake and anthropometry, and full paper in English., Results: There were 14 studies that met the inclusion criteria. The findings from published double blind RCTs revealed mostly inconclusive evidence that plant extracts are effective in reducing body weight through appetite suppression. Caralluma fimbriata extract and a combination supplement containing Garcinia cambogia plus Gymnema sylvestre were the only exceptions., Conclusion: According to the findings from this systematic review, the evidence is not convincing in demonstrating that most dietary supplements used as appetite suppressants for weight loss in the treatment of obesity are effective and safe. A balance between conclusive findings by double blind RCTs and advertisement is required to avoid safety concerns and dissatisfaction from consumers., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: The goal of this study was to compare young adults (YA) and older adults (OA) in the National Weight Control Registry on motivations for weight loss and weight-loss behaviors., Design and Methods: Participants (n = 2,964, 82% female, 94% White, BMI = 24.8 ± 4.4) were divided into two age groups (18-35 vs. 36-50) and compared on motivations, strategies for weight loss, diet, physical activity (PA), and the three-factor eating questionnaire., Results: YA were 28.6% of the sample (n = 848). YA and OA achieved similar weight losses (P = 0.38), but duration of maintenance was less in YA (43 vs. 58 months, P < 0.001). YA were more likely to cite appearance and social motivations for weight loss, were less motivated by health, and were less likely to report a medical trigger for weight loss (P's < 0.001). YA were more likely to use exercise classes and to lose weight on their own, and less likely to use a commercial program (P's < 0.001). YA reported engaging in more high-intensity PA (P = 0.001). There were no group differences in total calories consumed (P = 0.47), or percent calories from fat (P = 0.97), alcohol (P = 0.52), or sugar-sweetened beverages (P = 0.26)., Conclusions: YA successful weight losers (SWL) are motivated more by appearance and social influences than OA, and physical activity appears to play an important role in their weight-loss efforts. The differences reported by YA and OA SWL should be considered when developing weight-loss programs for YA., (Copyright © 2012 The Obesity Society.)

Background/aims: Obesity is one of the most serious public health problems. Laparoscopic sleeve gastrectomy (LSG), a type of bariatric surgery, is emerging as the new promising therapy for the treatment of morbid obesity., Methodology: In the present study we aimed to assess the effects of LSG on body weight and other obesity related pathological conditions., Results: A total of 19 obese subjects underwent LSG surgery. All patients underwent complete evaluation including anthropometric/clinical parameters and laboratory tests. Hypertension (HT), diabetes mellitus (DM), body mass index (BMI), and hyperlipidemia were significantly reduced after LSG., Conclusions: Results of this study demonstrate that LSG induces stable weight loss and resolution of obesity-associated comorbidities.

Objective: Better weight loss outcomes are achieved in adults and youth who adhere to obesity treatment regimens (i.e., session attendance and prescribed changes in weight control behaviors). However, more research is needed regarding children's adherence to a range of behaviors relevant for weight maintenance over long-term follow-up., Design and Methods: Overweight children (N = 101, aged 7-12 years), along with an overweight parent, participated in a 20-week family-based behavioral weight loss treatment (FBT) and were then assigned to either a behaviorally focused or socially focused 16-week weight maintenance treatment (MT). Treatment attendance and child and parent adherence (i.e., reported use of skills targeted within treatment) were examined in relation to child percent overweight change from baseline to post-FBT, post-MT, and 2-year follow-up., Results: Higher attendance predicted better child weight outcomes at post-MT, but not at 2-year follow-up. Adherence to self-regulatory skills/goal-setting skills predicted child weight outcomes at 2-year follow-up among the behaviorally focused MT group., Conclusions: Future research is needed to examine mediators of change within family-based weight control interventions, including behavioral and socially based targets. Incorporating self-regulatory weight maintenance skills into a comprehensive MT may maximize children's sustained weight control., (Copyright © 2012 The Obesity Society.)

Greater use of key self-regulatory behaviors (e.g., self-monitoring of food intake and weight) is associated with greater weight loss within behavioral weight loss treatments, although this association is less established within widely-available commercial weight loss programs. Further, high hedonic hunger (i.e., susceptibility to environmental food cues) may present a barrier to successful behavior change and weight loss, although this has not yet been examined. Adult men and women (N=111, body mass index M±SD=31.5±2.7kg/m(2)) were assessed before and after participating in a 12-week commercial weight loss program. From pre- to post-treatment, reported usage of weight control behaviors improved and hedonic hunger decreased, and these changes were inversely associated. A decrease in hedonic hunger was associated with better weight loss. An improvement in reported weight control behaviors (e.g., self-regulatory behaviors) was associated with better weight loss, and this association was even stronger among individuals with high baseline hedonic hunger. Findings highlight the importance of specific self-regulatory behaviors within weight loss treatment, including a commercial weight loss program developed for widespread community implementation. Assessment of weight control behavioral skills usage and hedonic hunger may be useful to further identify mediators of weight loss within commercial weight loss programs. Future interventions might specifically target high hedonic hunger and prospectively examine changes in hedonic hunger during other types of weight loss treatment to inform its potential impact on sustained behavior change and weight control., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

With the explosion of Internet accessibility, online delivery offers potential for significantly greater reach of evidence-based obesity treatment programs for adults. Online behavioral weight control has been shown to produce significant weight loss, with more recent programs demonstrating larger losses and general consumer satisfaction. A growing literature indicates several program parameters that may offer greatest engagement in online obesity interventions and better weight loss outcomes, including interactive, dynamic Web site features and synchronous counselor contact, although this research is in the early stages, and a clear picture of the essential components for the most effective online obesity program remains to be determined. Further research is required to enhance weight loss outcomes, determine cost-effectiveness of Internet-delivered programs, and identify the individuals most likely to benefit from treatment in this format., (© Diabetes Technology Society)

Objective: This systematic review and meta-analysis examined the effectiveness of social-support-based weight-loss interventions in adult populations with excess weight or obesity., Methods: We performed a systematic review of randomized controlled trials that reported on the effectiveness of weight-loss interventions which incorporated a social connectedness component. To this end, we conducted a rigorous database search of MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, and PubMed for relevant articles. The quality of eligible trials was evaluated by the Cochrane Risk-of-Bias2 tool. Five meta-analyses on intervention effectiveness in terms of weight loss were executed at 2-4-month assessment, 6-month assessment, end of intervention, and 3- and 6-month follow-up., Results: Twenty-four trials involving couples or peers targeting weight loss in 4 919 adults with BMI ≥ 25 met inclusion criteria. Meta-analyses detected no significant effect of social-support-based weight-loss interventions at either 2-4 month or 6-month assessment. There were, however, significant effects at end of intervention [95% CI 0.39, p = 0.04] and at 3-month [95% CI 0.63, p < 0.01] and 6-month [95% CI 0.34, p = 0.05] follow-up., Conclusions: There seem to be a significant effect at the end of intervention and 3- and 6-month follow-up. However, further high-quality studies are needed before drawing any clear conclusions., Trial Registration: PROSPERO 2020 CRD42020173696., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Although bariatric surgery is associated with significant overall weight loss, many patients experience suboptimal outcomes. Our objective was to document the preliminary efficacy of a behavioral intervention for bariatric surgery patients with relatively poor long-term weight loss and to explore the factors related to outcome at an academic medical center in the United States., Methods: Patients with a body mass index (BMI) ≥ 30 kg/m(2) who had undergone bariatric surgery ≥ 3 years before study entry and had <50% excess weight loss were enrolled. The participants were randomly assigned to a 6-month behavioral intervention or wait list control group. The assessments were conducted at baseline (before intervention) and 6 months (after intervention) and 12 months (6-mo follow-up)., Results: On average, the participants (n = 36) had undergone surgery 6.6 years before study entry. The average age was 52.5 ± 7.1 years, and the BMI was 43.1 ± 6.2 kg/m(2); most participants were women (75%) and white (88.9%). The intervention patients had a greater percentage of excess weight loss than did the wait list control group at 6 (6.6% ± 3.4% versus 1.6% ± 3.1%) and 12 (5.8% ± 3.5% versus .9% ± 3.2%) months. However, the differences were not significant and the results varied. The intervention patients with more depressive symptoms (P = .005) and less weight regain before study entry (P = .05) experienced a greater percentage of excess weight loss., Conclusion: Behavioral intervention holds promise in optimizing long-term weight control after bariatric surgery. More research is needed on when to initiate the intervention and to identify which patients will benefit from this type of approach., (Copyright © 2012 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

The National Weight Control Registry (NWCR) is the largest ongoing study of individuals successful at maintaining weight loss; the registry enrolls individuals maintaining a weight loss of at least 13.6 kg (30 lb) for a minimum of 1 year. The current report uses multivariate latent class cluster analysis to identify unique clusters of individuals within the NWCR that have distinct experiences, strategies, and attitudes with respect to weight loss and weight loss maintenance. The cluster analysis considers weight and health history, weight control behaviors and strategies, effort and satisfaction with maintaining weight, and psychological and demographic characteristics. The analysis includes 2,228 participants enrolled between 1998 and 2002. Cluster 1 (50.5%) represents a weight-stable, healthy, exercise conscious group who are very satisfied with their current weight. Cluster 2 (26.9%) has continuously struggled with weight since childhood; they rely on the greatest number of resources and strategies to lose and maintain weight, and report higher levels of stress and depression. Cluster 3 (12.7%) represents a group successful at weight reduction on the first attempt; they were least likely to be overweight as children, are maintaining the longest duration of weight loss, and report the least difficulty maintaining weight. Cluster 4 (9.9%) represents a group less likely to use exercise to control weight; they tend to be older, eat fewer meals, and report more health problems. Further exploration of the unique characteristics of these clusters could be useful for tailoring future weight loss and weight maintenance programs to the specific characteristics of an individual.

Background: The Healthy Obsession Model (HOM) suggests that successful weight controllers must develop a preoccupation with the planning and execution of target behaviors to reach and maintain healthy weights (e.g., controlled eating, consistent selfmonitoring). This model further posits that committed weight controllers will feel substantial anxiety or frustration when lapses occur, which, in turn, will motivate them to reinstate target behaviors., Methods: The present study tested the HOM by examining the perceptions and attitudes of four very successful and four relatively unsuccessful adolescent weight controllers 1 year after completing immersion treatment. We expected that successful weight controllers, more so than unsuccessful weight controllers, would report more elaborate definitions of their healthy obsessions and describe more negative reactions to potential and actual lapses. In-depth interviews were conducted using a version of the Scanlan Collaborative Interview Method., Results and Conclusions: Reliable coding of the interviews produced results that supported the hypothesis that highly successful weight controllers seem to nurture strong healthy obsessions, including clear definitions of healthy obsessions, heightened commitment based on the emotional impact of excess weight, and negative reactions to lapses. In addition, these adolescent weight controllers seemed motivated by some of the same factors that elite athletes identified in the Sport Commitment Model (e.g., Emotional and Experiential Consequences; Social Support of Parents, Friends, and Peers; Institutional Influences; and Valuable Opportunities).

Background: Weight control behaviors are common among young people and are associated with poor health outcomes. Yet clinicians rarely ask young people about their weight control; this may be due to uncertainty about which questions to ask, specifically around whether certain weight loss strategies are healthier or unhealthy or about what weight loss behaviors are more likely to lead to adverse outcomes. Thus, the aims of the current study are: to confirm, using item response theory analysis, that the underlying latent constructs of healthy and unhealthy weight control exist; to determine the 'red flag' weight loss behaviors that may discriminate unhealthy from healthy weight loss; to determine the relationships between healthy and unhealthy weight loss and mental health; and to examine how weight control may vary among demographic groups., Methods: Data were collected as part of a national health and wellbeing survey of secondary school students in New Zealand (n = 9,107) in 2007. Item response theory analyses were conducted to determine the underlying constructs of weight control behaviors and the behaviors that discriminate unhealthy from healthy weight control., Results: The current study confirms that there are two underlying constructs of weight loss behaviors which can be described as healthy and unhealthy weight control. Unhealthy weight control was positively correlated with depressive mood. Fasting and skipping meals for weight loss had the lowest item thresholds on the unhealthy weight control continuum, indicating that they act as 'red flags' and warrant further discussion in routine clinical assessments., Conclusions: Routine assessments of weight control strategies by clinicians are warranted, particularly for screening for meal skipping and fasting for weight loss as these behaviors appear to 'flag' behaviors that are associated with poor mental wellbeing.

Background: Primary care is the first port of call for advice about weight control. There is hence a need for simple, effective interventions that can be delivered without specialist skills. We have developed such an intervention; the 10 Top Tips (10TT). This intervention was effective with respect to weight loss in a volunteer population, but has yet to be tested in primary care. The aim of this trial is therefore to test the effectiveness of the 10TT intervention in primary care, incorporating clinical outcomes and health economic analyses., Methods/design: The trial is a two-arm, individually-randomised, controlled trial in obese (BMI ≥ 30) adults (n = 520) in primary care, comparing weight loss in patients receiving the 10TT intervention with weight loss in a control group of patients receiving usual care. The intervention is based on habit formation theory, using written materials to take people through a set of simple weight control behaviours with strategies to make them habitual; an approach that could make it more successful than others in establishing long-term behaviour change. Patients will be recruited from 14 General Practices across England. Randomisation will be through telephoning a central randomisation service using a computer-generated list of random numbers. Patients are followed up at 3, 6, 12, 18 and 24 months. The primary outcome is weight loss at 3 months, with assessment by a health professional who is blind to group allocation. Other follow-ups will be un-blinded. We will examine whether weight loss is maintained up to 24 months. We will also assess changes in the automaticity of the 10TT target behaviours and improvement in clinical markers for potential co-morbidities. Finally, we will undertake a full economic evaluation to establish cost-effectiveness in the NHS context., Discussion: If proven to be effective when delivered through primary care, 10TT could make a highly cost-effective contribution to improvements in population health., Trial Registration: ISRCTN16347068.

Objective: This study examined the 24-month outcomes of a randomized controlled trial of a group-based behavioral weight control (BWC) program combined with either activity-based peer intervention or aerobic exercise., Methods: At baseline, 118 obese adolescents (68% female; BMI = 31.41 ± 3.33) ages 13 to 16 years (mean = 14.33; SD = 1.02) were randomized to receive 1 of 2 weight loss interventions. Both interventions received the same 16-week group-based cognitive-behavioral treatment, combined with either aerobic exercise or peer-based adventure therapy. Eighty-nine adolescents (75% of original sample) completed the 24-month follow-up. Anthropometric and psychosocial measures were obtained at baseline, at the end of the 16-week intervention, and at 12 and 24 months following randomization., Results: An intent-to-treat mixed factor analysis of variance indicated a significant effect for time on both percent over 50th percentile BMI for age and gender and standardized BMI score, with no differences by intervention group. Post hoc comparisons showed a significant decrease in percent overweight at 4 months (end of treatment), which was maintained at both 12- and 24-month follow-up visits. Significant improvements on several dimensions of self-concept were noted, with significant effects on physical appearance self-concept that were maintained through 24 months., Conclusions: Both BWC conditions were effective at maintaining reductions in adolescent obesity and improvements in physical appearance self-concept through 24-month follow-up. This study is one of the first to document long-term outcomes of BWC intervention among adolescents.

This article examined moderators of the association between BMI and unhealthy weight control behaviors suggested by the Dual Pathway Model among 4,529 adolescents from the Health Behavior in School-Aged Children survey. An obese classification was associated with unhealthy weight control behaviors for boys and girls. Low life satisfaction, high negative affect, and body size dissatisfaction were associated with unhealthy weight control behaviors among boys as was low life satisfaction for girls. Among girls, healthy weight classification, coupled with low negative affect or body size satisfaction, was protective against unhealthy weight control behaviors. Improved self-care may decrease obesity and unhealthy weight control behaviors.

African-American women with type 2 diabetes experience limited weight loss in behavioral weight control programs. Some research suggests that overly ambitious weight loss expectations may negatively affect weight losses achieved but it is unknown whether they affect weight loss among African-American women. The current study examined personal weight loss goals and expected satisfaction with a reasonable weight loss among African-American women with type 2 diabetes starting a behavioral obesity treatment. We also explored associations among these factors and weight loss treatment outcomes. Self-identified African-American women (N = 84) in a 24-session group program were assessed at baseline and 6-month follow-up. At baseline, women indicated weight loss goals of 14.1 ± 6.6 kg (14% of initial weight). They also reported relatively high expected satisfaction with a reasonable weight loss (7-10%). On average, participants lost 3.0 ± 3.9 kg (3% of initial weight) and attended 73 ± 21% of group sessions. Neither weight loss goals nor expected satisfaction with a reasonable weight loss was correlated with either actual weight loss outcome or attendance. Having higher personal weight loss goals was associated with lower expectations of satisfaction with a reasonable weight loss. This suggests that African-American women with type 2 diabetes enter treatment hoping to lose far more weight than they are likely to achieve. It is important to understand the psychosocial sequelae of failing to reach these goals on subsequent weight maintenance and future weight loss attempts within this population.

Purpose of Review: It is often hypothesized that increasing the volume of physical activity in the American lifestyle will slow and possibly even reverse the epidemic of obesity. Herein, we review the evidence pertaining to the role of physical activity in weight control from interventions performed in adults., Recent Findings: Evidence exists both for and against the role of physical activity in weight control. High levels of physical activity and successful maintenance of body weight may be a result of better coupling between energy intake and energy expenditure, potentially mediated by physiological changes in appetite, albeit in the presence of large interindividual variability. Prospective studies, however, find little evidence of the more physically active members of a population gaining less excess weight than those who are the least physically active., Summary: When considering the impact of physical activity on body weight regulation, it is important to keep in mind that there are multiple hormones that acutely suppress (or stimulate) food intake and that the integration of these signals influence overall energy balance in a manner that is not yet fully understood. Moreover, cognitive and social influences may override these signals. Even though the impact of physical activity for weight control is still controversial, little doubt exists that increasing regular physical activity, particularly energy expended during structured exercise, is important for improving physical fitness and cardiovascular health.

Bariatric/metabolic surgeries are remarkably effective in reducing weight over a sustained period of time, and they also have significant beneficial effects on glucose homeostasis. Interestingly, the metabolic benefits of these surgeries frequently occur before significant weight loss. Given these findings, it is perhaps not surprising that obesity researchers are asking, how does bariatric/metabolic surgery work? Establishing these mechanisms can offer new insights into the physiology of energy balance and the control of metabolism. In the second half of the 13(th) International Symposium of the Merck Frosst/CIHR Research Chair in Obesity, four papers that address the mechanisms of bariatric/metabolic surgery were presented. The papers that follow this viewpoint all make use of animal models to reveal the neurohumoral mechanisms underlying weight loss and improved glucose homeostasis after experimental bariatric surgery. The rodent models of the commonly used clinical procedures have shown that energy intake is increased, food reward is altered and that the proximal gut is important in the control of energy balance and glucose homeostasis. Taken together, these models shed light on the mechanisms of bariatric/metabolic surgery and offer new insights that, in the future, may lead to less invasive therapies.

Weight management is a dynamic process, with a pre-treatment phase, a treatment (including process) phase and post-treatment maintenance, and where relapse is possible during both the treatment and maintenance. Variability in the statistical power of the studies concerned, heterogeneity in the definitions, the complexity of obesity and treatment success, the constructs and measures used to predict weight loss and maintenance, and an appreciation of who and how many people achieve it, make prediction difficult. In models of weight loss or maintenance: (i) predictors explain up to 20-30% of the variance; (ii) many predictors are the sum of several small constituent variables, each accounting for a smaller proportion of the variance; (iii) correlational or predictive relationships differ across study populations; (iv) inter-individual variability in predictors and correlates of outcomes is high and (v) most of the variance remains unexplained. Greater standardization of predictive constructs and outcome measures, in more clearly defined study populations, tracked longitudinally, is needed to better predict who sustains weight loss. Treatments need to develop a more individualized approach that is sensitive to patients' needs and individual differences, which requires measuring and predicting patterns of intra-individual behaviour variations associated weight loss and its maintenance. This information will help people shape behaviour change solutions to their own lifestyle needs., (© 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.)

Objectives: To examine the association between perceived overweight status and weight control, discrepancies between perceived and measured weight status, and opportunities for health care professionals (HCPs) to correct weight perception among US adults., Design: Population-based cross-sectional study., Subjects: In all, 16,720 non-pregnant adults from the 2003 to 2008 National Health and Nutrition Examination Survey., Results: Overall, 64% (73% women, 55% men) reported a desire to weigh less and 48% (57% women, 40% men) reported pursuing weight control. Weight control was positively associated with overweight perception (odds ratio (OR) women 3.74; 95% confidence interval (CI) 2.96, 4.73; OR men 2.82; 95% CI 2.11, 3.76) and an HCP diagnosis of overweight/obesity (OR women 2.22; 95% CI 1.69, 2.91; OR men 2.14; 95% CI 1.58, 2.91), independent of measured weight status. A large proportion of overweight individuals (23% women, 48% men) perceived themselves as having the right weight. Also, 74% of overweight and 29% of obese individuals never had an HCP diagnosis of overweight/obesity. Although the majority of overweight/obese individuals (74% women, 60% men) pursued at least one weight management strategy, fewer (39% women, 32% men) pursued both dietary change and physical activity. Among overweight/obese adults, those with an HCP diagnosis of overweight/obesity were more likely to diet (74 versus 52%), exercise (44 versus 34%), or pursue both (41 versus 30%, all P<0.01) than those who remained undiagnosed., Conclusion: HCPs have unused opportunities to motivate their patients to control and possibly lose weight by correcting weight perceptions and offering counseling on healthy weight loss strategies.

Objective: A lower glycaemic index (GI) diet is associated with a reduction in glycosylated Hb (HbA(1c)) in people with diabetes. Yet, little research has been conducted to determine the effects of specific goals regarding consumption of low GI (LGI) foods on diabetes outcomes. The present study evaluated a behavioural intervention on dietary intake, weight status and HbA(1c), which included a goal to consume either six or eight servings of LGI foods daily., Design: A parallel two-group design was used. Following the 5-week intervention, participants were randomly assigned to the group of six (n 15) or eight (n 20) servings of LGI foods daily and followed up for 8 weeks. Dietary intake was assessed using the mean of 4 d food records., Setting: A metropolitan community in the USA., Subjects: Individuals aged 40-65 years with type 2 diabetes of ≥1 year and HbA(1c) ≥ 7·0 % were eligible., Results: There was no significant difference between goal difficulty groups with regard to GI servings at the end of the study. However, mean consumption of LGI foods increased by 2·05 (SE 0·47) and 1·65 (SE 0·40) servings per 4184 kJ in the six (P < 0·001) and eight (P < 0·001) LGI serving groups, respectively. For all participants combined, there were significant decreases in mean HbA(1c) (-0·58 (SE 0·21) %; P = 0·01), weight (-2·30 (SE 0·78) kg; P = 0·01), BMI (-0·80 (SE 0·29) kg/m(2); P = 0·01) and waist circumference (-2·36 (SE 0·81) cm; P = 0·01)., Conclusions: An intervention including a specific goal to consume six to eight servings of LGI foods daily can improve diabetes outcomes. Clinicians should help patients set specific targets for dietary change and identify ways of achieving those goals.

This study investigated whether eating disorders and the use of unhealthy weight control methods increased over time in male and female university undergraduate students. Data from three random sample surveys of college students were collected over a 13-year period to investigate trends in disordered eating and unhealthy weight control behaviors. Data were collected in 2008 from 641 male and female randomly sampled undergraduate students were compared to 274 randomly sampled undergraduates surveyed in 2002 and 493 surveyed in 1995. Behaviors falling within the diagnostic category of eating disorders not otherwise specified (EDNOS) in both males and females significantly increased over time in accordance with the use of unhealthy weight control methods. Eating disorders should be routinely addressed by college health professionals through both treatment and prevention efforts, especially considering the frequent concurrent psychiatric and physiological comorbidities.

Objectives: To determine the effectiveness of a weight-management program with personal counseling by phone or e-mail., Methods: A randomized controlled trial of a 6-month program comparing two modes of intervention delivery (phone, n = 462; Internet, n = 464) with self-directed materials (control, n = 460), among overweight employees. Change in body weight after 2 years was the main outcome., Results: Among complete cases, weight loss in the Internet group was 1.2 kg (95% confidence interval [CI], -1.9 to -0.4) and in the phone group 0.8 kg (95% CI, -1.5 to 0.03), compared with the control group. Multiple imputation of missing body weight resulted in comparative weight losses of -0.9 kg (95% CI, -2.0 to 0.3) and -0.4 kg (95% CI, -1.4 to 0.7)., Conclusions: Among complete cases, the Internet intervention showed modest long-term weight loss, but among all participants neither program version was more effective than self-help.

This research aimed (1) to examine the agreement between body mass index (BMI)-based nutritional status and perceived nutritional status overall and by socio-demographic factors and (2) to state the association between the accuracy of weight perception and weight control practices in the Chilean adult population. A population-based cross-sectional study was carried out with 5,192 Chilean adult participants from the Chilean National Health Survey 2016–2017. Agreement between BMI-based weight status and body weight perception for the total sample and across subgroups was determined using the weighted kappa coefficient. The agreement between BMI-based and perceived nutritional status of the total sample was fair (kappa = 0.38). A higher rate of weight perception accuracy was identified in women, younger respondents, and participants with higher education, a higher income, and from urban areas than their counterparts. Respondents with overweight or obesity tended to underestimate their nutritional status. Actions to lose weight were higher in those who had the right perception of their overweight/obesity condition and those who overestimated their body weight, regardless of their nutritional status. In all groups, weight loss behaviors were more related to the perceived than the BMI-based nutritional status. The consequences of accurate perception of the nutritional status are discussed including its effects on body weight and mental health.

In this study, we describe diet and lifestyle practices of professional jockeys. Participants completed a 59-item nutrition, lifestyle, and health questionnaire (n = 21) and a 7-day estimated food diary (n = 18). Acute weight loss strategies included the use of saunas (86%), exercising to induce sweating (81%), and restricted energy intake (71%). Of the smokers (38%), 56% used smoking to control weight. Most (86%) jockeys reported attaining a 2-kg weight loss for racing (if required) 24-48 h before or on the designated race-day. Mean daily energy intake (1803 ± 564 kcal) was low and appeared to provide an insufficient availability of energy for sustainment of usual daily and metabolic processes. Carbohydrate intake (3.7 ± 1.3 g · kg⁻¹) was below recommendations for athletes. A substantial proportion of jockeys failed to meet the estimated average requirement and lower threshold intake for a number of micronutrients. Jockeys consumed well below (0-2) the recommended five daily servings of fruit and vegetables set by the World Health Organization. Pressures of the jockey lifestyle and rigid weight limits appear to encourage unhealthy weight management practices in this group and may risk long term-health.

Two thirds of the adults in the United States are overweight or obese. Binge eating is a barrier to treatment adherence and sustained weight loss, and can be seen as a form of experiential avoidance. The current study analyzed the impact of binge eating on weight reduction in a previously published study of a 1-day acceptance and commitment therapy (ACT) workshop (N = 83) and the psychological processes accounting for the binge-eating results. ACT participants reported less binge eating, which in turn significantly mediated changes in weight. Mediation analyses also showed that reductions in binge eating were mediated by changes in experiential avoidance. The study suggests that ACT and its targeted processes of change may be particularly relevant to binge eating, and that targeting binging is a possible pathway for improving weight management.

Clinical obesity treatments are of limited reach. Self-directed weight control attempts are common, but little attention has been given to providing guidance for such efforts in the population. The present research tests a brief intervention approach to weight control. Pilot data were collected from 66 University of Minnesota employees (72.7% women, 81.8% white) randomized to an assessment-only control condition or a single intervention session to teach empirically valid self-directed weight-control methods. Mean baseline weight was 87.1 kilograms (range 64.0-120.3 kilograms). Though statistically nonsignificant, intervention participants averaged greater weight loss by 6 months than controls (-.80 kilograms vs. -.19 kilograms), F(1, 44)=.47, p=.50, Cohen's d=.21. There was a significant group×time interaction for self-weighing frequency, F(2, 41)=10.84, p<.001. With some enhancement and more attention to dissemination, a brief self-directed program has potential as a useful approach to population weight-gain prevention.

Introduction: The recommendation to lose weight has been the guiding principle in the treatment of type 2 diabetic patients. However, to facilitate this process, it is vital to understand factors associated with personal feelings about body weight and related behaviour., Methods: The objectives of this cross-sectional study were (1) to determine mean BMI and weight of satisfaction and (2) to measure the association between body weight satisfaction vs. sex, BMI, glycaemic control (as measured by Fasting Blood Glucose (FBG), and attempts to lose weight among type 2 diabetic patients. Descriptive statistics and non-parametric tests were employed (SPSS 16). A total of 67 subjects were recruited from Klinik Kesihatan Bandar Kuantan (age = 54.1 +/- 8.1 years; female = 62.7%; Malay = 73.1%; overweight/obese = 62.7%) who completed a set of self-administered questionnaires., Results: The mean BMI and weight of satisfaction were 27.9 +/- 5.3 kg/m2 and 62.7 +/- 10.9 kg respectively. A greater proportion of women (65.0%) reported dissatisfaction with their body weight. Patients with higher BMI generally reported greater dissatisfaction with body weight compared to those with lesser BMI (p = 0.090). There was no significant difference in the glycaemic control of patients who were satisfied or dissatisfied with their weight (p = 0.839). There was also no significant association between body weight satisfaction and diet (p = 0.957), physical activity (p = 0.517) or both (p = 0.734)., Conclusion: This study implies that body weight satisfaction alone is not a strong factor that may drive type 2 diabetic patients to control their body weight.

Based on positive deviance (examining the practices of successful individuals), we identified five primary themes from 36 strategies that help to maintain long-term weight loss (weight control) in 61 people. We conducted in-depth interviews to determine what successful individuals did and/or thought about regularly to control their weight. The themes included weight-control practices related to (a) nutrition: increase water, fruit, and vegetable intake, and consistent meal timing and content; (b) physical activity: follow and track an exercise routine at least 3x/week; (c) restraint: practice restraint by limiting and/or avoiding unhealthy foods; (d) self-monitor: plan meals, and track calories/weight progress; and (e) motivation: participate in motivational programs and cognitive processes that affect weight-control behavior. Using the extensive data involving both the practices and practice implementation, we used positive deviance to create a comprehensive list of practices to develop interventions for individuals to control their weight.

Background and Aims: The degree of motivation before starting the treatment represents a pre-treatment predictor of successful weight management. The aim of this study is to develop and validate a new self-reported questionnaire of motivation and readiness to change before starting a lifestyle modification program (the TREatment MOtivation and REadiness test) (TRE-MORE) for overweight patients., Methods and Results: TRE-MORE was evaluated in a consecutive series of 129 obese patients attending our Outpatient Clinic. Validation of the questionnaire was performed through test-retest reliability, internal consistency, psychopathological correlates, and concurrent validity. Subjects have been evaluated by means of a clinical interview, and different self-reported questionnaires, assessing the eating specific and general psychopathology, and quality of life. TRE-MORE total and subscales scores showed good test-retest reliability and internal consistency. We identified 10 items grouped in 3 areas (obstacles and desire to overcome, taking care of themselves, and sharing the problems, current lifestyle). TREMORE scores were significantly correlated with eating specific psychopathology and quality of life measures. Univariate and Receiver Operating Characteristic curve analysis showed that TRE-MORE total and subscales scores represent a good model for predicting a weight loss >5% of the initial weight after 6 months of treatment., Conclusion: TRE-MORE represents a validated and easy-to-use questionnaire assessing at the meantime the treatment motivation and readiness with good predictive capacity for weight loss.

Background: One way to improve weight control may be to place greater emphasis on the main reasons why individuals want to lose weight., Purpose: To evaluate the effects of emphasizing physical appearance, health, or both on behavioral weight-control outcome., Design: RCT. Data were collected from 2003 to 2005 and analyzed in 2009., Setting/participants: 203 women aged 18-55 years (M=41.8, SD=9.2) and BMI>27 and <40 (M=34.2, SD=3.7) who rated both appearance and health as important reasons for weight loss, enrolled at a university medical center., Intervention: A 6-month weekly behavioral intervention alone (Standard) was compared to an enhanced focus on physical appearance (Appearance), health benefits of weight loss (Health), or both appearance and health (Combined). The 6-month period of acute intervention was followed by six monthly booster sessions., Main Outcome Measures: The primary outcome was change in body weight (kg). Additional outcomes included the Multidimensional Body-Self Relations Questionnaire, Medical Outcomes Study Short Form-36, and questions about satisfaction with weight, appearance, and health. Assessments were conducted at 0, 6, 12, and 18 months., Results: Appearance demonstrated significantly greater weight loss compared to Standard at 6 months (p=0.0107). Combined demonstrated greater weight loss compared to Standard at 6 and 12 months (p's=0.0034 and 0.0270, respectively). Although addressing motivators differentially affected satisfaction at 6 months, satisfaction was unrelated to weight outcome over the following year., Conclusions: Behavioral interventions incorporating components with a focus on physical appearance were associated with improved short-term weight loss. The mechanism for this effect is unclear and warrants further study., (Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: To examine the relationship between energy intake, appetite control and exercise, with particular reference to longer term exercise studies. This approach is necessary when exploring the benefits of exercise for weight control, as changes in body weight and energy intake are variable and reflect diversity in weight loss., Recent Findings: Recent evidence indicates that longer term exercise is characterized by a highly variable response in eating behaviour. Individuals display susceptibility or resistance to exercise-induced weight loss, with changes in energy intake playing a key role in determining the degree of weight loss achieved. Marked differences in hunger and energy intake exist between those who are capable of tolerating periods of exercise-induced energy deficit, and those who are not. Exercise-induced weight loss can increase the orexigenic drive in the fasted state, but for some this is offset by improved postprandial satiety signalling., Summary: The biological and behavioural responses to acute and long-term exercise are highly variable, and these responses interact to determine the propensity for weight change. For some people, long-term exercise stimulates compensatory increases in energy intake that attenuate weight loss. However, favourable changes in body composition and health markers still exist in the absence of weight loss. The physiological mechanisms that confer susceptibility to compensatory overconsumption still need to be determined.

Background: Weight control has been major health issue in the prevention of lifestyle-related diseases especially among middle-aged working males in Japan. The computerized behavioral program is expected as an effective and feasible intervention tool., Purpose: The purpose of this study is to examine two hypotheses. The first was that first month weight loss effect is obtained by a behavioral program assisted by computer-tailored advices (Kenkou-tatsujin [KTP]) among overweight males and maintained for 7 months; the second was that the effects in the full KTP is superior to the booklet only., Method: Fifty-one males (body mass index [BMI] = 26.2) were randomly allocated to the KTP group (KTPG) or control group (CG). The KTPG (n = 23) read a booklet, set target behaviors, received advises, and self-monitored their weight and the targeted behaviors for 7 months. The CG (n = 28) read the same booklet. Weight, BMI, biological indices, and daily behaviors were compared at baseline, first, third, and seventh month. The subanalysis among 36 obese subjects was added., Results: In KTPG, weight loss was larger at the first month (-1.1 vs. -0.3 kg), walking steps increased for the seventh month, and several biological indices tended to improve more at the third month than CG. However, the difference of weight loss was not significant at the seventh month. Among the obese subjects, weight loss in KTPG was larger than CG at the third month (-3.0 vs. -1.4 kg)., Conclusion: Weight loss effects of KTP were significant at 1 month, walking steps increase was maintained for 7 months.

Using the National Longitudinal Study of Adolescent Health and multi-level modeling, we examine the role of social comparison with schoolmates in adolescent girls' weight control. Specifically, we focus on how girls' own weight control is influenced by the body sizes and weight-control behaviors of their schoolmates. Our findings suggest that comparisons with similar others (in this case, girls of a similar body size) appear to have the strongest association with individual girls' reports of trying to lose weight. For example, the odds that an overweight girl is engaged in weight control increase substantially when many overweight girls in her school are also trying to lose weight. This study highlights how schools play an important role in shaping girls' decisions to practice weight control and demonstrates how social comparison theory improves our understanding of how health behaviors are linked to social contexts.

The ongoing obesity epidemic has made recruiting qualified Army applicants increasingly difficult. A cohort of 10,213 Army enlisted subjects was enrolled in the Assessment of Recruit Motivation and Strength (ARMS) study from February 2005 through September 2006. Overweight recruits obtained a waiver for enlistment (n = 990) if they passed a screening physical fitness test. Recruits were evaluated for enrollment into the Army Weight Control Program (AWCP) and discharged during the 15 months following enlistment. Enrollment was higher among overweight recruits than recruits who met entrance standards (men: adjusted OR = 13.3 [95% CI: 10.3, 17.2]; women: adjusted OR = 3.6 [3.3, 3.9]). Although the discharge frequency was higher in the waiver group than in those who met standards (25.4% versus 19.9%, p < 0.001), there were only 10 (0.5% of total) discharges directly attributed to weight. Granting overweight waivers through the ARMS program increases enrollment to the AWCP but has little effect on weight-related attrition.

Background: Little is known about the effectiveness of behavioral strategies to prevent long-term weight gain among adolescents and young adults., Objective: The objective was to assess the relation of dietary and physical activity weight-control strategies, alone and together, with subsequent weight change., Design: This was a prospective study of 4456 female adolescents and young adults aged 14-22 y in the ongoing Growing Up Today Study. Weight-control behaviors, including dietary approaches and physical activity, were self-reported in 2001 and were used to predict weight change from 2001 to 2005., Results: In 2001-2002, 23.7% of female adolescents and young adults were trying to maintain their weight and another 54.4% were trying to lose weight. Approximately 25% used each of the following weight-control strategies: not eating snacks, following low-calorie or low-fat diets, and limiting portion sizes. In addition, 47.7% reported exercising at least occasionally for weight control. During 4 y of follow-up, participants gained an average of 3.3 kg. None of the dietary approaches to weight control predicted less weight change; however, females who exercised > or =5 d/wk gained significantly less weight than did their peers (-0.9 kg; 95% CI: -1.4, -0.4). The most successful strategy for weight-gain prevention among the females was to limit portion sizes (-1.9 kg; 95% CI: -2.6, -1.1) combined with frequent exercise., Conclusions: Our results suggest that physical activity is a necessary strategy for long-term weight control among adolescents and young adult females. Combining dietary weight-control approaches with physical activity is the most effective method for reducing weight gain.

The purpose of this pilot study was to evaluate the differences in weight control behaviors, dietary intake, and physical activity between overweight adolescents who lost weight and overweight adolescents who did not lose weight. This cross-sectional study compared 62 overweight adolescents who lost weight in the past with 68 overweight adolescents who did not lose weight. Youth responded to questions regarding weight control behaviors during the past year, physical activity, sedentary activity, and dietary intake. Results showed that adolescents who lost weight were more likely to report using healthful weight control behaviors such as drinking less soda and increasing their exercise level, self-weighing, consuming diets higher in protein, and spending less time watching television compared to overweight adolescents who did not lose weight. Unhealthful weight control behaviors and specific weight loss plans were not associated with weight loss in these teenagers. Adolescents would benefit from hearing this information to prevent the development of these behaviors. Providers should advise adolescents to engage in healthful weight control behaviors, such as increasing physical activity and decreasing the amount of time spent watching television, to assist with weight management.

Objective: Successful weight management relies on at least two health behaviors, eating and exercise. However, little is known about their interaction on a motivational and behavioral level. Based on the Hierarchical Model of Motivation the authors examined whether exercise-specific motivation can transfer to eating regulation during a lifestyle weight control program. The authors further investigated whether general, treatment-related, and exercise motivation underlie the relation between increased exercise and improved eating regulation., Design: Overweight/obese women participated in a 1-year randomized controlled trial (N = 239). The intervention focused on promoting physical activity and internal motivation for exercise and weight loss, following Self-Determination Theory. The control group received general health education., Main Outcome Measures: General and exercise specific self-determination, eating self-regulation variables, and physical activity behavior., Results: General self-determination and more autonomous exercise motivation predicted eating self-regulation over 12 months. Additionally, general and exercise self-determination fully mediated the relation between physical activity and eating self-regulation., Conclusion: Increased general self-determination and exercise motivation seem to facilitate improvements in eating self-regulation during weight control in women. These motivational mechanisms also underlie the relationship between improvements in exercise behavior and eating regulation., (PsycINFO Database Record (c) 2009 APA, all rights reserved.)

Background: Approximately one-quarter of high school students currently use cigarettes. Previous research has suggested some youth use smoking as a method for losing weight. The purpose of this study was to describe the association of current cigarette use with specific healthy and unhealthy weight control practices among 9th-12th grade students in the United States., Methods: Youth Risk Behavior Survey data (2005) were analyzed. Behaviors included current cigarette use, trying to lose weight, and current use of 2 healthy and 3 unhealthy behaviors to lose weight or to keep from gaining weight. Separate logistic regression models calculated adjusted odds ratios (AORs) for associations of current cigarette use with trying to lose weight (Model 1) and the 5 weight control behaviors, controlling for trying to lose weight (Model 2)., Results: In Model 1, compared with students who were not trying to lose weight, students who were trying to lose weight had higher odds of current cigarette use (AOR = 1.30, 95% CI: 1.15-1.49). In Model 2, the association of current cigarette use with the 2 healthy weight control behaviors was not statistically significant. Each of the 3 unhealthy weight control practices was significantly associated with current cigarette use, with AORs for each behavior approximately 2 times as high among those who engaged in the behavior, compared with those who did not., Conclusion: Some students may smoke cigarettes as a method of weight control. Inclusion of smoking prevention messages into existing weight management interventions may be beneficial.

Objective: To analyze whether caregiver and family characteristics predict success in a family-based lifestyle intervention program for children and adolescents., Method: Participants were 111 overweight and obese children (7-15 years) who attended a family-based weight-reduction program. Body mass index (BMI) and BMI standard deviation scores (BMI-SDS) of index child, and BMI of family members, family adversity characteristics, depression, and attachment attitudes of the primary caregiver were assessed., Results: Risk of nonresponse (

Background: Obesity is a major risk factor for development and progression of hypertension and diabetes, which often coexist in obese patients. Losing weight by means of energy restriction and physical activity has been effective in preventing and managing these diseases. However, weight control behaviors among overweight/obese adults with these conditions are poorly understood., Methods: Using self-reported data from 143,386 overweight/obese participants (aged >or= 18 years) in the 2003 Behavioral Risk Factor Surveillance System, we examined the proportion of overweight/obese adults who tried to lose weight and their weight control strategies by hypertension and/or diabetes status., Results: Among all participants, 58% of those with hypertension, 60% of those with diabetes, and 72% of those with both diseases tried to lose weight, significantly higher than the 50% of those with neither condition (Bonferroni corrected P < 0.017 for all comparisons). The multivariate-adjusted odds ratio (AOR) for trying to lose weight was 1.11 (95% confidence interval [CI]: 1.05-1.17) in participants with hypertension, 1.02 (95% CI: 0.90-1.15) in participants with diabetes, and 1.18 (95% CI: 1.07-1.29) in participants with both diseases (participants with neither condition as the referent). Among 78,446 participants who tried to lose weight, 23% of those with hypertension only and 28% of those with both hypertension and diabetes reported adopting a low fat/low calorie (LF/LC) diet in controlling their weight, significantly higher than 19% of those with neither disease (Bonferroni corrected P < 0.017 for all comparisons). Participants with both diseases had a significantly lower percentage of adopting physical activity in controlling their weight than those with neither condition (6% versus 12%, P < 0.01). After multivariate adjustment, the AOR for adopting a LF/LC diet plus physical activity to lose weight was 1.46 (95% CI: 1.15-1.84) in participants with both diseases. The AOR for adopting a LF/LC diet only to lose weight was 1.72 (95% CI: 1.35-2.20) in participants with both diseases and was 1.21 (95% CI: 1.03-1.40) in participants with hypertension only., Conclusion: The proportion of overweight/obese patients with diagnosed hypertension and/or diabetes who attempted to lose weight remains suboptimal and the weight control strategies varied significantly among these patients.

Internet-based weight control programs have been showing promising results; however, as of yet, it is unclear which website components are critical for producing and maintaining weight loss. The aim of this study is to examine the utilization patterns of a weight control website and the relationship of the Web features to weight loss and maintenance. One hundred and twenty three (N = 123) participants took part in a 12-month behavioral weight control program over the Internet and their website utilization patterns were monitored. When examining the clustering of Web feature utilization and weight loss, the "feedback" factor (progress charts, physiological calculators, and past journals) was the best predictor of weight loss during the treatment period (baseline to 6 months), while the "social support" factor (Web chats and biographical information/e-mail addresses of participants) was the best predictor during maintenance. Weight loss in an online weight control program was related to dynamic Web features that provided feedback, support, and motivation to participants.

Objective: To assess the association between self-assessed stair-climbing limitation and weight control among family medicine patients, after adjustment for age, gender, marital status, body mass index (BMI), and co-morbidity., Methods: This study was a retrospective analysis of a cohort of 840 adult family medicine patient records drawn from a large family medicine department in Rochester, Minnesota. Weight control was measured as no change or decline in BMI over approximately 1 year., Results: Adjusting for co-morbidity and other confounders using multiple logistic regression analysis revealed that limited stair-climbing ability was unrelated to weight control over approximately 1 year. Instead, patients with BMI > or = 30 were more likely to control their weight (p<0.01), and age exhibited a non-linear relationship with weight control. The odds of weight control were lower for patients between the ages of 36 and 45 years than for those aged 18-35 years (p<0.01)., Conclusions: In our sample of family medicine patients, self-assessed stair-climbing limitations did not preclude weight control. Weight gain prevention programmes might be targeted at patients who are entering middle age.