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Background: Exercising at a consistent versus variable time of day cross-sectionally relates to greater moderate to vigorous physical activity (MVPA) among weight loss maintainers. This study evaluated the relationships between exercise timing and both MVPA levels and habit strength, as well as stability in exercise timing, over 1 year among maintainers in the National Weight Control Registry., Methods: Participants (n = 709) completed questionnaires assessing exercise timing, MVPA, and exercise automaticity (a measure of habit) at baseline and 1-year follow-up. At each assessment, participants were labeled temporally consistent exercisers if >50% of their exercise sessions per week occurred in one time window: early morning, late morning, afternoon, or evening. Participants exercising consistently during the same window at both assessments were labeled as having stable patterns., Results: Temporally consistent exercise at baseline, regardless of its specific time, related to greater MVPA over time (Ps< .05). Approximately half of temporally consistent exercisers at baseline exhibited stable patterns. Early morning exercise and greater exercise automaticity at baseline predicted stable patterns (Ps< .005). Temporally consistent exercise, especially during the early morning, related to greater automaticity across time (Ps< .01)., Conclusions: Consistent exercise timing may help maintainers accrue more MVPA. Consistent early morning exercise was most strongly related to exercise automaticity and routine stability.

Objective: The current study is a secondary analysis of the Live SMART trial, a randomized controlled trial comparing a behavioral weight loss (BWL) condition delivered via smartphone (SMART) to a group-based BWL condition (GROUP) and a control condition (CONTROL). Given the established importance of self-monitoring for weight loss, the aims were to evaluate bidirectional associations between adherence to self-monitoring and weight change and to examine the moderating effect of treatment condition on these associations., Method: Adults with overweight/obesity (n = 276; 83% women; 92.8% White; Mage = 55.1 years; Mbody mass index = 35.2 kg/m2) were instructed to self-monitor dietary intake, daily weight, and physical activity minutes via paper diaries in GROUP and CONTROL and via a smartphone application in SMART. All participants were weighed monthly at the research center. Adherence to self-monitoring was assessed via examination of self-monitoring records., Results: Generalized linear mixed models revealed that adherence to self-monitoring of dietary intake, self-weighing, and physical activity for each month was associated with weight change throughout that month, such that increased frequency of self-monitoring led to greater weight loss (ps < .001). For the GROUP condition only, poorer weight losses in 1 month were prospectively associated with poor adherence to self-monitoring the following month (ps ≤ .01)., Conclusions: Results provide evidence of a bidirectional association between self-monitoring and weight change. Better self-monitoring was consistently associated with better weight loss across intervention and tracking modalities. Poorer weight loss was prospectively associated with poorer self-monitoring in group treatment, suggesting that social influences could drive adherence in this form of treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective: This study aimed to evaluate whether consistency in time of day that moderate- to vigorous-intensity physical activity (MVPA) is performed relates to MVPA levels among successful weight loss maintainers in the National Weight Control Registry., Methods: Participants (n = 375) reporting MVPA on ≥ 2 d/wk completed measures of temporal consistency in physical activity (PA) (> 50% of MVPA sessions per week occurring during the same time window: early/late morning, afternoon, or evening), PA levels, PA automaticity, and consistency in cues underlying PA habit formation (e.g., location)., Results: Most (68.0%) participants reported temporally consistent MVPA. These individuals reported higher MVPA frequency (4.8 ± 1.6 vs. 4.4 ± 1.5 d/wk; P = 0.007) and duration (median [IQR]: 350.0 [200.0-510.0] vs. 285.0 [140.0-460.0] min/wk; P = 0.03), and they were more likely to achieve the national MVPA guideline (≥ 150 min/wk) than temporally inconsistent exercisers (86.3% vs. 74.2%, P = 0.004). Among temporally consistent exercisers, 47.8% were early-morning exercisers; MVPA levels did not differ by time of day of routine MVPA performance (P > 0.05). Greater automaticity and consistency in several cues were related to greater MVPA among all participants., Conclusions: Most participants reported consistent timing of MVPA. Temporal consistency was associated with greater MVPA, regardless of the specific time of day of routine MVPA performance. Consistency in exercise timing and other cues might help explain characteristic high PA levels among successful maintainers., (© 2019 The Obesity Society.)

Timing of energy intake, a temporal dietary pattern, may enhance health. Eating a greater amount of energy earlier and a smaller amount of energy later in the day, a behavioral circadian rhythm, may assist with chronoenhancement. Chronoenhancement seeks to enhance entrainment (synchronization) of biological and behavioral circadian rhythms. In humans, research reports that eating a greater amount of energy early and a smaller amount of energy later in the day increases dietary induced thermogenesis, improves cardiometabolic outcomes, and enhances weight loss. However, little human research has examined if this eating pattern enhances regularity of biological circadian rhythm. In a randomized controlled 8-week pilot study, the influence of energy distribution timing on weight loss and regularity of sleep onset and wake times (marker for biological circadian rhythm) was examined. Within an hypocaloric, three-meal prescription, participants (n = 8) were assigned to either: 1) Morning: 50%, 30%, and 20% of kcal at breakfast, lunch, and dinner, respectively; or 2) Evening: 20%, 30%, and 50% of kcal at breakfast, lunch, and dinner, respectively. Percent weight loss and regularity of sleep onset and wake times were significantly (p < 0.05) greater for Morning than Evening. To enhance understanding of the influence of energy distribution timing on health, longer studies conducted in free-living participants, with dietary intake assessed using time-stamped methods, that include measures of the circadian timing system are needed. This small review is based upon a symposium presentation at the Society of the Study of Ingestive Behavior in 2017., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Eleven recommendations, based on systematic reviews, were developed for the Evidence Analysis Library's prevention of type 2 diabetes project. Two recommendations, medical nutrition therapy (MNT) and weight loss, were rated strong., Objective: Present the basis of systematic reviews for MNT and weight loss recommendations., Methods: Literature searches using Medline were conducted to identify studies that met eligibility criteria. The MNT literature search covered a time span of 1995 to 2012, the weight loss literature search covered 2008 to 2012 due to inclusion of a Cochrane Review meta-analysis of randomized controlled trials (RCTs) published in 2008. Eligibility criteria for inclusion of articles included original research using higher-quality study designs (ie, RCTs, case control, cohort, crossover, and nonrandomized trials) with participants aged >18 years and meeting prediabetes or metabolic syndrome diagnostic criteria. MNT was defined as individualized and delivered by a registered dietitian nutritionist or international equivalent and length of weight loss interventions was ≥3 months., Main Outcome Measures: Two-hour postprandial blood glucose level, glycated hemoglobin level, albumin-to-creatinine ratio (metabolic syndrome samples only), fasting blood glucose level, high-density lipoprotein cholesterol level, systolic and diastolic blood pressure, triglyceride levels, urinary albumin excretion rate (metabolic syndrome samples only), waist circumference (WC), and waist-to-hip ratio were evaluated., Results: For MNT, 11 publications were included, with all 11 using an RCT study design and 10 including participants with prediabetes. A majority of publications reported significant improvements in glycemic outcomes, WC, and blood pressure. For weight loss, 28 publications were identified, with one meta-analysis (only included RCTs) and 20 publications using an RCT study design, with the meta-analysis and 10 RCTs including participants with prediabetes. A majority of publications reported significant improvements in glycemic outcomes, triglyceride level, WC, and blood pressure., Conclusions: Systematic reviews provided strong evidence that MNT and weight loss alter clinical parameters in ways that should reduce the risk of developing type 2 diabetes., (Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Objective: Taste blindness to 6-n-propylthiouracil (PROP) associates with increased fat preference and intake. No studies have matched a diet to a woman's PROP phenotype to improve weight loss. This study investigated (1) whether PROP nontaster (NT) women would lose more weight following a low-carbohydrate (LC) diet than a low-fat (LF) diet, and (2) whether PROP supertaster (ST) women would lose more weight following a LF diet than a LC diet., Methods: One hundred seven women (BMI = 34.8 ± 0.5 kg/m 2 ), classified as PROP NTs (n = 47) and STs (n = 60), were randomized to a LC or LF diet within a 6-month lifestyle intervention. Assessments included 4-day dietary recalls and biobehavioral and psychosocial questionnaires., Results: At 6 months, NTs lost more weight following the LC than the LF diet (-8.5 ± 0.5 kg vs. -6.6 ± 0.5 kg, P = 0.008); there was no difference between STs following either diet (-8.8 ± 0.4 vs. -8.9 ± 0.5, P = 0.35). Dietary self-reports were unrelated to weight loss, and prescription of a LC diet associated with greater self-efficacy., Conclusions: NT women lost more weight following the LC diet compared to the LF diet. Screening for PROP phenotype may help personalize diet therapy for NT women to optimize their short-term weight loss., (© 2017 The Authors. Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS).)

The purpose of this study was to explore relations between food craving, caloric intake, and body mass index (BMI) changes over the course of an 18-month weight loss trial. Two-hundred two obese adults (mean BMI = 34.9 kg/m 2 ; mean age = 51.30 years, 92.2% White; 57.8% female) who participated in a behavioral weight loss trial completed measures of food craving, caloric intake, and BMI at baseline, 6 and 18 months. From baseline to 6 months, higher initial food cravings were associated with more gradual and less steep reductions in BMI. Additionally, the relation between changes in food craving and BMI changes varied by levels of change in caloric intake, such that BMI change and change in food cravings were positively associated at low levels of change in caloric intake, but were unrelated at average and high levels of change in caloric intake. Similarly, from baseline to 6 months and from 6 to 18 months, the relation between changes in food craving and BMI changes also varied by initial levels of caloric intake. Explicit clinical targeting of food craving management may be beneficial for individuals beginning weight loss programs, especially for those who report higher levels of food craving at baseline. Baseline caloric intake and change in calorie intake over time may serve as moderators of the relation between food cravings and BMI.

Objective: Food cravings are thought to be the result of conditioning or pairing hunger with consumption of certain foods., Methods: In a 2-year weight loss trial, subjects were randomized to one of four diets that varied in macronutrient content. The Food Craving Inventory (FCI) was used to measure cravings at baseline and at 6 and 24 months. Food intake was also measured at those time points. To measure free-living consumption of food items measured in the FCI, items on the FCI were matched to the foods consumed from the food intake assessments. Secondarily, the amount of food consumed on food intake assessments from foods on the FCI was analyzed., Results: Three hundred and sixty-seven subjects with overweight and obesity were included. There was an association between change from baseline FCI item consumption and change in cravings at months 6 (P < 0.001) and 24 (P < 0.05). There was no association between change from baseline amount of energy consumed per FCI item and change in cravings., Conclusions: Altering frequency of consuming craved foods is positively associated with cravings; however, changing the amount of foods consumed does not appear to alter cravings. These results support the conditioning model of food cravings and provide guidance on how to reduce food cravings., (© 2017 The Obesity Society.)

Objective: To evaluate a commercial online weight loss program and activity tracker, which are popular but have unknown efficacy., Methods: Two hundred seventy-nine participants with BMI 27 to 40 kg/m 2 were randomized to 12 months of the Weight Watchers Online program alone (WWO) or with the ActiveLink ® activity tracking device (WWO+AL) or an online newsletter (Control)., Results: Weight losses at 3 months were significantly greater in WWO (2.7 kg [95% confidence interval (CI), 2.0-3.5 kg] than Control (1.3 kg [95% CI, 0.5-2.0 kg]; P = 0.01); neither differed from WWO+AL (2.0 kg [95% CI, 1.3-2.7 kg]; Ps > 0.56). Significantly more WWO participants (24.5%) achieved ≥ 5% weight loss at 3 months than Control (9.4%) (P = 0.01); neither differed from WWO+AL (17.6%) (Ps = 0.13-0.28). At 12 months, there were no significant differences between groups in weight loss (Ps > 0.52). WWO (25.5%) continued to have a higher proportion of participants achieving ≥ 5% weight loss than Control (12.9%) (P = 0.04); neither differed from WWO+AL (14.3%) (Ps > 0.10). There were no significant between-group differences in change in physical activity (Ps > 0.17)., Conclusions: WWO produced significantly more weight loss at 3 months relative to Control, but not at 12 months. Significantly more WWO than Control participants lost ≥ 5% at both 3 and 12 months. Participants receiving an activity tracking device did not achieve greater weight loss or physical activity increases than those in a Control condition., (© 2017 The Obesity Society.)

Objective: Behavioral economic theory predicts that reductions in consumption of highly valued commodities, such as drugs or palatable food items, are facilitated by increasing engagement in reinforcing substitutes. The current study prospectively examines changes in engagement in and enjoyment of food versus food-free activities during an 18-month behavioral weight loss intervention., Method: Participants were 202 overweight/obese individuals who took part in an 18-month behavioral weight loss treatment and were randomly assigned to a traditional hypocaloric, low-fat diet condition or a traditional hypocaloric, low-fat diet plus a goal to limit variety in snack food consumption condition. At baseline and 6, 12, and 18 months, participants were weighed and completed a measure that assessed recent frequency of engagement in and enjoyment of a variety of both food and food-free activities., Results: Growth models revealed a statistically significant decrease in the relative percentage of food-related reinforcement (vs. food-free) over time (reinforcement ratio, or RR), with the greatest reduction during the first 6 months of treatment. Food-related reinforcement decreased over time, and food-free reinforcement increased. Additionally, the RR change predicted change in body mass index (BMI) from 0 to 6 months and 0 to 18 months, such that greater changes in RR were associated with greater changes in BMI., Conclusions: Findings suggest that behavioral weight loss treatment may promote a shift away from food-related reinforcement toward food-free reinforcement and that this change may predict BMI change. Future interventions may consider targeting increasing engagement in enjoyable food-free activities to help with long-term maintenance., (PsycINFO Database Record (c) 2014 APA, all rights reserved.)

Objective: Social support is believed to contribute to weight loss success, yet the type of support received is rarely assessed. To develop more effective weight loss interventions, examinations of the types of support that are associated with positive outcomes are needed. Self-Determination Theory suggests that support for an individual's autonomy is beneficial and facilitates internalization of autonomous self-regulation. We examined whether autonomy support and directive forms of support were associated with weight loss outcomes in a larger randomized controlled trial., Method: Adults (N = 201; 48.9 ± 10.5 years; 78.1% women) participating in a weight loss trial were assessed at 0, 6, and 18 months. Autonomy support (AS), directive support, and autonomous self-regulation (ASR) were measured at 0 and 6 months and examined in relation to 18-month weight loss outcomes., Results: Baseline AS and ASR did not predict outcomes; however, AS and ASR at 6 months positively predicted 18-month weight losses (ps < .05), encouragement of healthy eating at 6 months was negatively related to 18-month weight losses (p < .01), and other forms of directive support were not associated with outcomes., Conclusions: Autonomy support predicted better weight loss outcomes while some forms of directive support hindered progress. Weight loss trials are needed to determine whether family members and friends can be trained to provide autonomy support and whether this is more effective than programs targeting more general or directive forms of support.

Objective: To develop and validate the Weight Control Strategies Scale (WCSS), a self-report instrument to assess the use of specific behaviors thought to facilitate weight loss., Design and Methods: Factor analysis was conducted on 323 overweight and obese adults (mean age = 48.7 ± 10.9 years, mean body mass index = 35.4 ± 4.9 kg/m(2) , 74% female) enrolled in three different behavioral weight loss trials who completed the WCSS prior to starting treatment. To evaluate construct validity, additional data on dietary intake, physical activity, treatment session attendance, and weight change were obtained from a subsample of participants before and after participation in a 48-week weight loss program., Results: Principal components analysis with varimax rotation revealed a four-component solution for the WCSS, representing the following subscales: Dietary Choices, Self-monitoring Strategies, Physical Activity, and Psychological Coping (α from 0.79 to 0.89). Longitudinal analyses showed that WCSS subscale scores increased during treatment (P < 0.01). In adjusted models, changes in WCSS total and subscale scores were associated with post-treatment weight loss (P < 0.01). Additionally, changes in WCSS Dietary Choices and Physical Activity subscales were related to post-treatment changes in total daily kilocalorie consumption (P = 0.019) and weekly kilocalorie expenditure through physical activity (P < 0.001), respectively., Conclusions: Findings support the validity and reliability of the WCSS in a weight loss treatment-seeking sample., (Copyright © 2013 The Obesity Society.)

As many people struggle with maintenance of weight loss, the study of successful weight loss maintainers (SWLM) can yield important insights into factors contributing to weight loss maintenance. However, little research has examined how SWLM differ from people who are obese or normal weight (NW) in brain response to orosensory stimulation. The goal of this study was to determine if SWLM exhibit different brain responses to orosensory stimulation. Brain response to 1-min orosensory stimulation with a lemon lollipop was assessed using functional magnetic resonance imaging among 49 participants, including SWLM (n = 17), NW (n = 18), and obese (n = 14) controls. Significant brain responses were observed in nine brain regions, including the bilateral insula, left inferior frontal gyrus, left putamen, and other sensory regions. All regions also exhibited significant attenuation of this response over 1 min. The SWLM exhibited greater response compared with the other groups in all brain regions. Findings suggest that the response to orosensory stimulation peaks within 40 s and attenuates significantly between 40 and 60 s in regions associated with sensation, reward, and inhibitory control. Greater reactivity among the SWLM suggests that greater sensory reactivity to orosensory stimulation, increased anticipated reward, and subsequently greater inhibitory processing are associated with weight loss maintenance.

Dietary goals specific for lowering energy density (ED) may promote a nutrient-dense diet and weight loss. This pilot study examined the effects of ED-based diet prescriptions on diet quality and weight loss during a 3-month behavior-based obesity intervention conducted in a research setting. Forty-four adults with overweight/obesity (age 52.1±7.6 years, body mass index [BMI; calculated as kg/m(2)] 34.8±4.8, 81.8% women, and 93.2% white) were recruited between December 2009 and March 2010 and randomly assigned to: Low ED (consume ≥10 foods ≤1.0 kcal/g dietary ED and ≤2 foods ≥3.0 kcal/g dietary ED per day (n=15); Low-Energy, Low-Fat (1,200 to 1,500 kcal/day, ≤30% energy from fat (n=15); or Low-ED, Low-Energy, Low-Fat (n=14). Participants received 12 weekly group sessions led by a research interventionist. Dietary intake (measured by 3-day food records), self-reported physical activity, and weight were measured at baseline and 3 months. Intent-to-treat analyses showed all conditions reduced dietary ED and energy intake (P<0.001). Low-ED and Low-ED, Low-Energy, Low-Fat interventions increased fruit consumption (P<0.05). All conditions increased self-reported physical activity (P<0.001), with no difference between conditions. Although participants in all conditions lost weight (P<0.001), those in the Low-ED condition lost more (P<0.05) than those in the Low-ED, Low-Energy, Low-Fat condition (Low-ED -20.5±7.0 lb, Low-Energy, Low-Fat -16.9±10.1 lb, and Low-ED, Low-Energy, Low-Fat -12.5± 6.5 lb). A diet prescription that lowered ED increased fruit intake and enhanced weight loss compared with other weight loss prescriptions., (Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Due to the high prevalence of overweight and obesity, developing strategies to improve weight loss and weight loss maintenance is imperative. One dietary environmental variable that has received little attention in being targeted in an intervention to assist with obesity treatment is dietary variety. Experimental research has consistently shown that greater dietary variety increases consumption, with the effect of variety on consumption hypothesized to be a consequence of the differential experience of the more varied sensory properties of food under those conditions with greater dietary variety. As reduced energy intake is required for weight loss, limiting variety, particularly in food groups that are high in energy-density and low in nutrient-density, may assist with reducing energy intake and improving weight loss. A series of investigations, both observational and experimental, were conducted to examine if limiting variety in an energy-dense, non-nutrient-dense food group, snack foods (i.e., cookies, chips), assisted with reducing energy intake of the food group and improving weight loss. Results of the investigations suggest that a prescription for limiting variety in a food group can be implemented during obesity treatment, limiting variety is associated with the occurrence of monotony, and that reducing food group variety is related to decreased consumption of that food group. Future research is needed to ascertain the long-term effect of prescriptions targeting dietary variety on weight loss and weight loss maintenance., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Dietary variety is a factor that influences consumption but has received little attention in obesity treatment., Objective: This study examined the effect of limiting the variety of different non-nutrient-dense, energy-dense foods (NND-EDFs) (i.e., chips, ice cream, cookies) on dietary intake and weight loss during an 18-mo lifestyle intervention., Design: Two hundred two adults aged 51.3 ± 9.5 y with a BMI (in kg/m2) of 34.9 ± 4.3 (57.8% women, 92.2% white) were randomly assigned to 1 of 2 interventions: Lifestyle (1200-1500 kcal/d, ≤30% of energy as fat; n = 101) or Lifestyle + limited variety (LV) (limit variety of NND-EDFs, i.e., 2 choices; n = 101). Both interventions involved 48 group sessions. Dietary intake, NND-EDF hedonics, NND-EDF variety in the home, and weight were assessed at 0, 6, 12, and 18 mo., Results: Intent-to-treat analyses showed that the Lifestyle+LV group consumed less variety (P < 0.01) and energy daily (P < 0.05) from NND-EDFs than did the Lifestyle group at 6, 12, and 18 mo. The Lifestyle+LV group consumed less total energy daily (P < 0.05) at 6 mo than did the Lifestyle group. The Lifestyle+LV group reported less (P < 0.05) NND-EDF variety in the home at 6 and 18 mo than did the Lifestyle group. The hedonics of one chosen NND-EDF decreased more (P < 0.05) in the Lifestyle+LV group. Despite these effects, no difference in percentage weight loss occurred at 18 mo (Lifestyle+LV: -9.9 ± 7.6%; Lifestyle: -9.6 ± 9.2%)., Conclusions: Limitations in dietary variety decreased intakes in the targeted area but did not affect weight loss. Limiting variety in more areas may be needed to improve weight loss and weight-loss maintenance. This trial was registered at clinicaltrials.gov as NCT01096719.

Eating frequency has been inversely related to BMI but the impact of eating frequency on weight loss is unclear. This randomized controlled trial pilot study examined the effect of eating frequency on hunger, energy intake, and weight loss during a 6-month behavioral weight loss intervention. Participants (age: 51.0 ± 9.9 years, BMI: 35.5 ± 4.8 kg/m(2), 57.8% female, 94.1% white) were randomized to one of two eating frequency prescriptions: Three meal (n = 25): three eating bouts/day; or grazing (n = 26): eat at least 100 kcals every 2-3 h. Both groups attended 20 sessions and had identical dietary (1,200-1,500 kcals/day, <30% kcals from fat) and physical activity goals (200 min/week). Assessments were conducted at 0, 3, and 6 months. Using intent-to-treat analyses, grazing reported a greater eating frequency than three meal at 6 months (5.8 ± 1.1 eating bouts/day vs. 3.2 ± 0.6 eating bouts/day, P < 0.001). Grazing reported a significant reduction in hunger from 0 to 6 months (56.3 ± 15.7 mm vs. 47.9 ± 18.5 mm, P < 0.05). Energy intake and BMI were significantly (P < 0.001) reduced from 0 to 6 months (energy intake: 2,198 ± 692 kcals/day vs. 1,266 ± 353 kcals/day; BMI: 35.5 ± 4.8 kg/m(2) vs. 30.6 ± 4.9 kg/m(2)). There were no significant differences in energy intake or BMI between the groups. While eating more frequently reduced hunger, it may not be related to greater reductions in energy intake or BMI during a behavioral weight loss intervention.

Eating frequency has been negatively related to body mass index (BMI). The relationship between eating frequency and weight loss maintenance is unknown. This secondary analysis examined eating frequency (self-reported meals and snacks consumed per day) in weight loss maintainers (WLM) who had reduced from overweight/obese to normal weight, normal weight (NW) individuals, and overweight (OW) individuals. Data collected July 2006 to March 2007 in Providence, RI, included three 24-hour dietary recalls (2 weekdays, 1 weekend day) analyzed using Nutrient Data System for Research software from 257 adults (WLM n=96, 83.3% women aged 50.0±11.8 years with BMI 22.1±1.7; NW n=80, 95.0% women aged 46.1±11.5 years with BMI 21.1±1.4; OW n=81, 53.1% women aged 51.4±9.0 years with BMI 34.2±4.1) with plausible intakes. Participant-defined meals and snacks were ≥50 kcal and separated by more than 1 hour. Self-reported physical activity was highest in WLM followed by NW, and then OW (3,097±2,572 kcal/week, 2,062±1,286 kcal/week, and 785±901 kcal/week, respectively; P<0.001). Number of daily snacks consumed was highest in NW, followed by WLM, and then OW (2.3±1.1 snacks/day, 1.9±1.1 snacks/day, and 1.5±1.3 snacks/day, respectively; P<0.001). No significant group differences were observed in mean number of meals consumed (2.7±0.4 meals/day). Eating frequency, particularly in regard to a pattern of three meals and two snacks per day, may be important in weight loss maintenance., (Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

Research shows a positive relationship between dietary energy density (ED) and body mass index (BMI), but dietary ED of weight loss maintainers is unknown. This preliminary investigation was a secondary data analysis that compared self-reported dietary ED and food group servings consumed in overweight adults (OW: BMI=27-45kg/m(2)), normal weight adults (NW: BMI=19-24.9 kg/m(2)), and weight loss maintainers (WLM: current BMI=19-24.9kg/m(2) [lost≥10% of maximum body weight and maintained loss for ≥5years]) participating in 2 studies, with data collected from July 2006 to March 2007. Three 24-h phone dietary recalls from 287 participants (OW=97, NW=85, WLM=105) assessed self-reported dietary intake. ED (kcal/g) was calculated by three methods (food+all beverages except water [F+AB], food+caloric beverages [F+CB], and food only [FO]). Differences in self-reported consumption of dietary ED, food group servings, energy, grams of food/beverages, fat, and fiber were assessed using one-way MANCOVA, adjusting for age, sex, and weekly energy expenditure from self-reported physical activity. ED, calculated by all three methods, was significantly lower in WLM than in NW or OW (FO: WLM=1.39±0.45kcal/g; NW=1.60±0.43 kcal/g; OW=1.83±0.42 kcal/g). Self-reported daily servings of vegetables and whole grains consumed were significantly higher in WLM compared to NW and OW (vegetables: WLM=4.9±3.1 servings/day; NW=3.9±2.0 servings/day; OW=3.4±1.7 servings/day; whole grains: WLM=2.2±1.8 servings/day; NW=1.4±1.2 servings/day; OW=1.3±1.3 servings/day). WLM self-reported consuming significantly less energy from fat and more fiber than the other two groups. Self-reported energy intake per day was significantly lower in WLM than OW, and WLM self-reported consuming significantly more grams of food/beverages per day than OW. These preliminary findings suggest that consuming a diet lower in ED, characterized by greater intake of vegetables and whole grains, may aid with weight loss maintenance and should be further tested in prospective randomized controlled trials., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Much attention has been paid to the behavioral characteristics of successful weight loss maintenance, but less is known about the cognitive processes that underlie this process. The purpose of this study was to investigate cognitive interference from food-related cues in long-term weight loss maintainers (WLM; N = 15) as compared with normal weight (NW; N = 19) and obese (OB; N = 14) controls. A Food Stroop paradigm was used to determine whether successful WLM differed from controls in both the speed and accuracy of color naming words for low-calorie and high-calorie foods. A significant group × condition interaction for reaction time was observed (P = 0.04). In post hoc analyses, no significant differences in reaction time across the three groups were observed for the low-calorie foods (P = 0.66). However, for the high-calorie foods, WLM showed a significantly slower reaction time than the NW (0.04) and OB (0.009) groups (885 ± 17.6, 834 ± 15.8, 816 ± 18.3 ms, respectively). No significant group differences were seen for number of correct trials in 45 s (P = 0.12). The differential interference among WLM did not appear to generalize to other types of distracters (i.e., nonfood). Overall, findings from this study suggest that WLM differ from OB and NW controls in their cognitive responses to high-calorie food cues. Future research is needed to better understand why this bias exists and whether and how interventions can change cognitive processes to better facilitate long-term weight control.

Larger portion sizes increase energy intake, yet it is unclear whether single-serving packages can reduce intake. This study examined the effects of providing breakfast foods in single-serving packages and nonportioned packages on energy intake of these foods during an 8-week behavioral weight-loss program. In fall 2005, 19 adults (mean body mass index [calculated as kg/m(2)]=31.8+/-4.0) were randomized to conditions that provided foods in single-serving packages (Single-Serving) or in nonportioned packages (Standard). Overall amounts and types of foods provided were consistent across conditions: cereal and peaches (weeks 1, 3, 5, and 7) and applesauce and cheese (weeks 2, 4, 6, and 8). Participants were instructed to eat one serving of each food for breakfast and not to consume the provided foods at other times. Mean daily energy intake of the provided foods was the primary dependent variable. The Single-Serving group ate less energy from the combined pairs of foods provided together as compared to Standard (cereal and peaches, 117.0+/-3.2 kcal/day vs 143.5+/-39.3 kcal/day; P<0.05 and applesauce and cheese, 174.2+/-13.5 kcal/day vs 199.0+/-29.4 kcal/day; P<0.05). This effect was a result of less energy consumed from cereal and applesauce in Single-Serving compared to Standard conditions (cereal, 80.2+/-2.9 kcal/day vs 106.3+/-22.9 kcal/day; P<0.01 and applesauce, 44.5+/-0.6 kcal/day vs 59.3+/-5.0 kcal/day; P<0.01), with no differences in energy consumption for peaches and cheese (P>0.10). This suggests that single-serving packages may help reduce energy intake at breakfast within the context of a behavioral weight-control program.

Background: Prior research indicates that successful weight-loss maintainers (SWLs) work harder than people of normal weight to maintain their weight loss, including greater dietary restriction of fat and higher physical activity levels. However, little work to date has examined how SWLs differ biologically from normal-weight (NW) and obese controls., Objective: The objective was to compare the brain responses of SWLs to food pictures with those of NW and obese controls., Design: Blood oxygen level-dependent responses to high- and low-energy food pictures were measured in 18 NW controls, 16 obese controls, and 17 SWLs., Results: Group differences were identified in 4 regions, which indicated significant change in activation in response to the food pictures. SWLs showed greater activation in the left superior frontal region and right middle temporal region than did NW and obese controls-a pattern of results confirmed in exploratory voxel-wise analyses. Obese controls also showed greater activation in a bilateral precentral region., Conclusions: These results suggest that SWLs show greater activation in frontal regions and primary and secondary visual cortices-a pattern consistent with greater inhibitory control in response to food cues and greater visual attention to the food cues. A greater engagement of inhibitory control regions in response to food cues as well as a greater monitoring of foods may promote control of food intake and successful weight-loss maintenance.

This study examined the relation between method of weight loss and long-term maintenance among successful weight losers enrolled in a weight-loss maintenance trial. Participants were 186 adults (mean age = 51.6 +/- 10.7 years, mean BMI = 28.6 +/- 4.7 kg/m(2)) enrolled in the STOP Regain trial who had lost at least 10% of their body weight in the past 2 years using a very low-calorie diet (VLCD; n = 24), commercial program (n = 95), or self-guided approach (n = 67). Participants were randomized to a weight-maintenance intervention delivered face to face or over the internet or to a newsletter control condition, and followed for 18 months. At study entry, individuals who had used a VLCD had achieved a weight loss of 24% of their maximum weight within the past 2 years compared to 17% achieved by those who had used a commercial program or self-guided approach (P < 0.001). However, individuals who had used a VLCD regained significantly more weight than the other two groups and by 6 months, there were no significant differences in overall percent weight loss (i.e., initial weight loss and maintenance) between VLCD, commercial, and self-guided methods. In contrast, individuals who had used a self-guided approach maintained their weight losses from baseline through 18 months. The large initial weight losses achieved by individuals who had used a VLCD were not maintained over time, whereas individuals who had used a self-guided approach maintained their initial weight losses with the greatest success. The generalizability of these findings is limited by the sizeable weight losses achieved by study participants.

Objective: Intentional weight loss is recommended for those with type 2 diabetes, but the strategies patients attempt and their effectiveness for weight management are unknown. In this investigation we describe intentional weight loss strategies used and those related to BMI in a diverse sample of overweight participants with type 2 diabetes at enrollment in the Look AHEAD (Action for Health in Diabetes) clinical trial., Research Design and Methods: This was a cross-sectional study of baseline weight loss strategies, including self-weighing frequency, eating patterns, and weight control practices, reported in 3,063 women and 2,082 men aged 45-74 years with BMI > or =25 kg/m(2)., Results: Less than half (41.4%) of participants self-weighed > or =1/week. Participants ate breakfast 6.0 +/- 1.8 days/week, ate 5.0 +/- 3.1 meals/snacks per day, and ate 1.9 +/- 2.7 fast food meals/week. The three most common weight control practices (increasing fruits and vegetables, cutting out sweets, and eating less high-carbohydrate foods) were reported by approximately 60% of participants for > or =20 weeks over the previous year. Adjusted models showed that self-weighing less than once per week (B = 0.83), more fast food meals consumed per week (B = 0.14), and fewer breakfast meals consumed per week (B = -0.19) were associated (P < 0.05) with a higher BMI (R(2) = 0.24)., Conclusions: Regular self-weighing and breakfast consumption, along with infrequent consumption of fast food, were related to lower BMI in the Look AHEAD study population.

This study compared weight control strategies during the winter holidays among successful weight losers (SWL) in the National Weight Control Registry and normal weight individuals (NW) with no history of obesity. SWL (n = 178) had lost a mean of 34.9 kg and had kept > or = 13.6 kg off for a mean of 5.9 years. NW (n = 101) had a body mass index of 18.5-24.9 kg/m(2). More SWL than NW reported plans to be extremely strict in maintaining their usual dietary routine (27.3% vs. 0%) and exercise routine (59.1% vs. 14.3%) over the holidays. Main effects for group indicated that SWL maintained greater exercise, greater attention to weight and eating, greater stimulus control, and greater dietary restraint, both before and during the holidays. A Group x Time interaction indicated that, over the holidays, attention to weight and eating declined significantly more in SW than in NW. More SWL (38.9%) than NW (16.7%) gained > or = 1 kg over the holidays, and this effect persisted 1 month later (28.3% and 10.7%, respectively). SWL worked harder than NW did to manage their weight, but they appeared more vulnerable to weight gain during the holidays., ((c) 2008 APA, all rights reserved)

Objective: The objective was to examine whether having a weight loss experience that lives up to one's expectations is related to maintenance in a group of successful weight losers participating in the STOP Regain trial., Research Methods and Procedures: Participants (N = 314, 81% women, mean age, 51.3 +/- 10.1 years; BMI = 28.6 +/- 4.8 kg/m2) who lost >or=10% of their body weight within the past 2 years were randomly assigned to a maintenance program delivered either face-to-face or via the Internet or to a control group and assessed at 0, 6, 12, and 18 months., Results: At study entry, participants had lost 19% of their body weight, yet 86% of participants were currently trying to lose more weight. Further losses of 13% of body weight were needed to reach self-selected ideal weights, with heavier participants wanting to lose more (p < 0.001). The weight loss-related benefits participants achieved did not live up to their expectations (p

Several recent studies suggest that daily weighing is important for long-term weight control, but concerns have been raised about possible adverse psychological effects. The "STOP Regain" clinical trial provides a unique opportunity to examine this issue both cross-sectionally and prospectively. Successful weight losers (N = 314) were randomly assigned to a control or to a face-to-face or Internet intervention designed to help them maintain their weight loss and were then followed for 18 months. The intervention groups reported increases in daily self-weighing, which were associated with successful weight loss maintenance. We found no evidence that increases in frequency of weighing or daily weighing per se had any adverse effects in this study population. Rather, increases in self-weighing were associated with increases in dietary restraint (p < .001), decreases in disinhibition (p < .003), and decreases in depressive symptoms (p < .002). Moreover, those who weighed daily at 18 months were less likely to report having >or=4 binge episodes per month (p = .03). Daily weighing appears to be an important aspect of weight loss maintenance and was not associated with adverse psychological effects.

Background: Since many successful dieters regain the weight they lose, programs that teach maintenance skills are needed. We developed a maintenance program based on self-regulation theory and tested the efficacy of delivering the program face to face or over the Internet., Methods: We randomly assigned 314 participants who had lost a mean of 19.3 kg of body weight in the previous 2 years to one of three groups: a control group, which received quarterly newsletters (105 participants), a group that received face-to-face intervention (105), and a group that received Internet-based intervention (104). The content of the programs in the two intervention groups was the same, emphasizing daily self-weighing and self-regulation, as was the frequency of contact with the groups. The primary outcome was weight gain over a period of 18 months., Results: The mean (+/-SD) weight gain was 2.5+/-6.7 kg in the face-to-face group, 4.7+/-8.6 kg in the Internet group, and 4.9+/-6.5 kg in the control group, with a significant difference between the face-to-face group and the control group (2.4 kg; 95% confidence interval [CI], 0.002 to 10.8; P=0.05). The proportion of participants who regained 2.3 kg or more over the 18-month period was significantly higher in the control group (72.4%) than in the face-to-face group (45.7%; absolute difference, 27%; 95% CI, 14 to 39; P<0.001) or the Internet group (54.8%; absolute difference, 18%; 95% CI, 5 to 30; P=0.008). Daily self-weighing increased in both intervention groups and was associated with a decreased risk of regaining 2.3 kg or more (P<0.001)., Conclusions: As compared with receiving quarterly newsletters, a self-regulation program based on daily weighing improved maintenance of weight loss, particularly when delivered face to face. (ClinicalTrials.gov number, NCT00067145 [ClinicalTrials.gov].), (Copyright 2006 Massachusetts Medical Society.)

Objective: Decreases in variety of foods consumed within high-fat-dense food groups and increases in variety of foods consumed within low-fat-dense food groups are associated with lower energy intake and greater weight loss during obesity treatment and may assist with weight loss maintenance. This study examined food group variety in 2237 weight loss maintainers in the National Weight Control Registry, who had lost 32.2 +/- 18.0 kg (70.9 +/- 39.5 lbs) and maintained a weight loss of at least 13.6 kg (30 lbs) for 6.1 +/- 7.7 years., Research Methods and Procedures: At entry into the registry, registry members completed a food frequency questionnaire from which amount of variety consumed from different food groups was assessed. To provide a context for interpreting the level of variety occurring in the diet of registry participants, food group variety was compared between registry participants and 96 individuals who had recently participated in a behavioral weight loss program and had lost at least 7% of initial body weight., Results: Registry members reported consuming a diet with very low variety in all food groups, especially in those food groups higher in fat density. Registry participants consumed significantly (p < 0.001) less variety within all food groups, except fruit and combination foods, than recent weight losers after 6 months of weight loss treatment., Discussion: These results suggest that successful weight loss maintainers consume a diet with limited variety in all food groups. Restricting variety within all food groups may help with consuming a low-energy diet and maintaining long-term weight loss.

A multicomponent, family-based intervention with ≥ 26 contact hours is recommended for the treatment of childhood overweight and obesity. This intervention utilizes behavioral strategies to improve diet, physical activity, and sedentary behaviors. The evidence-based recommendations for this treatment have predominantly come from randomized trials in which the intervention is implemented by research-trained staff in academic research settings, with the intervention delivered to fairly homogeneous samples that are limited in being inclusive of those experiencing health disparities. Thus, there are challenges in implementing the recommended intervention into practice. In particular, there are implementation challenges related to providers, contact time, and settings that impact all children. Specifically, the structure of the intervention may diminish its ability to be delivered by many types of providers in different settings, limiting overall accessibility. There are implementation challenges affecting children who experience health disparities, as it is not clear how efficacious the recommended intervention is for African American or Latinx children, or children from households with low income. Several strategies to reduce identified implementation challenges, such as reducing contact time and intensity of the dietary intervention, are discussed. However, use of these strategies may reduce the effect size of the weight improvements commonly seen with the recommended intervention. Suggestions for future research regarding implementation, specifically using study designs that enhance the ability to create cost-efficient and adaptive interventions that can generalize to many different children and families, are provided. [ABSTRACT FROM AUTHOR]

Summary: Background: The optimal role for involving parents in adolescent obesity treatment is unknown. Objective: To demonstrate that two parent approaches within adolescent obesity treatment are distinct, as evidenced by differential parent outcomes, and determine the preliminary efficacy of each approach on adolescent weight loss. Methods: Adolescent/parent dyads (N = 82; mean adolescent age = 13.7 ± 1.2 years) participated in TEENS+, a 4‐month behavioural weight loss treatment. Participants were randomized to: (1) TEENS+parents as coaches (PAC; parent skills training), or (2) TEENS+parent weight loss (PWL; adult behavioural weight loss). Assessments occurred at 0, 4 (post‐treatment), and 7‐months. Within‐ and between‐group repeated measures general linear mixed models examined change in parent weight (∆kg; primary outcome); parenting, feeding, weight control strategies, home environment, and adolescent body mass index (∆BMI; secondary outcomes). Results: PWL parents had greater 4‐month weight losses (∆kg0–4m = −5.14 ± 4.87 kg) compared to PAC (−2.07 ± 3.89 kg; between‐group p < 0.01). Key constructs differed between groups as expected. Both groups yielded significant within‐group adolescent ∆BMI0–4m (PWL: −0.97 ± 1.38 kg/m2 vs. PAC: −0.93 ± 1.42 kg/m2; ps < 0.01); during maintenance, adolescents in PWL had ∆BMI4–7m increases (+0.41 ± 1.07 kg/m2; p = 0.02) while PAC did not (+0.05 ± 1.31 kg/m2; p = 0.82). Conclusion: Parent treatments were distinct in implementation and both yielded significant 4‐month adolescent weight loss. Differential weight patterns were observed during maintenance, favouring PAC, warranting further exploration. [ABSTRACT FROM AUTHOR]

Summary: A multicomponent approach for the treatment of pediatric overweight/obesity, which includes behavioral strategies to alter diet and physical activity/sedentary behavior, has graded recommendations for its use. Dietary interventions to be used within this approach do not. In adults, research indicates that strongly graded dietary interventions providing greater structure (or more control over the types/amount of food consumed) produce better weight outcomes. For this critical review, dietary interventions recommended by the Expert Committee for the treatment of pediatric overweight/obesity were categorized according to their potential degree of dietary structure, and their impact on weight outcomes was described. Four levels of dietary structure were reviewed, operationalized as alterations to the following: food groups, such as fruits and vegetables (low structure); daily eating occasions, such as meals (moderate structure); large nutrients, such as energy (high structure); and energy plus additional dietary alterations (very high structure). In total, 24 interventions (four low, three moderate, five high, and 12 very high structure structure) were identified and reviewed. Reductions in standardized body mass index increased with increasing structure, and interventions ≥6 months had better outcomes than interventions <6 months. Future research should empirically test dietary intervention structure to determine its impact on weight status during pediatric overweight/obesity treatment. [ABSTRACT FROM AUTHOR]

Summary: Background: Migraine and obesity are comorbid particularly in women of reproductive age. Obesity treatment involves reducing energy intake and improving dietary quality but the effect of these changes on migraine is largely unknown. Objective: To determine if adherence to dietary intervention targets (ie, total energy, dietary fat intake, and dietary quality) were associated with improvements in migraine and weight. Methods: Eighty‐four women with overweight/obesity and migraine were randomized to and completed either a 16‐week behavioral weight loss (BWL) or a migraine education (ME) intervention. For 28 days at baseline and posttreatment, women recorded monthly migraine days, duration, and maximum pain intensity via smartphone‐based diary. At each assessment, weight was measured and dietary intake (total energy intake, percent (%) energy from fat, and diet quality, as measured by the Healthy Eating Index, 2010 [HEI‐2010]) was assessed using three nonconsecutive 24‐hour diet recalls. Results: There were no significant group differences in change mean migraine days per month (BWL: ‐2.6+4.0, ME: ‐4.0+4.4; p = 0.1). Participants in BWL significantly reduced their percent fat intake 3.8% (p = 0.004) and improved total diet quality (HEI‐2010) by 6.7 points (p = 0.003) relative to baseline and those in ME (%fat: +0.3%; p = 0.821; HEI‐2010: +0.7; p = 0.725). After controlling for race/ethnicity and weight change, changes in dietary intake were not related to changes in migraine characteristics or weight loss among BWL participants (p's > 0.05). Conclusions: Changes in dietary intake among participants were small and may have been insufficient to improve migraine in women with overweight/obesity and migraine. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine whether weight losses from a primarily smartphone-based behavioral obesity treatment (SMART) differed from those of a more intensive group-based behavioral obesity treatment (GROUP) and a control condition (CONTROL).Methods: A total of 276 adults with overweight/obesity were randomly assigned to 18 months of GROUP-based treatment with meetings weekly for 6 months, meetings biweekly for 6 months, and meetings monthly for 6 months and self-monitoring via paper diaries with written feedback; SMART-based treatment with online lessons, self-monitoring, and feedback plus monthly weigh-ins; or a CONTROL condition with self-monitoring via paper diaries with written feedback and monthly weigh-ins.Results: Among the 276 participants (17% men; 7.2% minority; mean [SD] age: 55.1 [9.9] years; weight: 95.9 [17.0] kg; BMI: 35.2 [5.0] kg/m2 ), 18-month retention was significantly higher in both GROUP (83%) and SMART (81%) compared with CONTROL (66%). Estimated mean (95% CI) weight change over 18 months did not differ across the three conditions: 5.9 kg (95% CI: 4.5-7.4) in GROUP, 5.5 kg (95% CI: 3.9-7.1) in SMART, and 6.4 kg (95% CI: 3.7-9.2) in CONTROL.Conclusions: Mobile online delivery of behavioral obesity treatment can achieve weight loss outcomes that are at least as good as those obtained via the more intensive gold standard group-based approach. [ABSTRACT FROM AUTHOR]

Background When a hypocaloric, low-fat diet is prescribed, intake of currently consumed foods can decrease, foods naturally low in fat and/or added sugar may increase, or fat- or sugar-modified foods may increase. Objective To examine food group intake change and its relation to reductions in energy and fat intake and weight during a lifestyle intervention. Design Secondary cohort analysis. Participants One hundred sixty-nine participants (aged 52.0±8.6 years, body mass index 34.9±4.5, 92% white, 97.6% non-Hispanic, and 56.8% women) with complete data at 0 and 6 months collected in a research setting. Main outcome measures From three 24-hour telephone dietary recalls, 165 food groups from Nutrition Data System for Research software were coded into 25 larger food groups assessing intake of higher-fat and/or added-sugar food groups vs naturally lower-fat and/or added-sugar food groups and into 17 larger food groups assessing intake of nonmodified vs fat- and/or sugar-modified food groups. Statistical analyses performed Repeated measures analyses of covariance (intervention group: covariate) assessed changes from 0 to 6 months. Hierarchical regressions examined changes in food group intake and changes in energy intake, percent energy from fat intake, and weight from 0 to 6 months. Results Significant reductions ( P <0.05) in intake of high-fat and/or high-added-sugar food groups (Higher-Fat Dairy; Higher-Fat Eggs; Higher-Fat Fats; Higher-Fat Fruit; Higher-Fat Meat; Nonmodified Higher-Fat Fats, Oils, and Sweets; Nonmodified Higher-Fat Sugar-Sweetened Fats, Oils, and Sweets; Nonmodified Regular-Fat Dairy; and Nonmodified Regular-Fat Sugar-Sweetened Dairy) occurred. Decreases in the Higher-Fat Meat group were significantly ( P <0.05) related to decreases in energy intake, percent energy from fat intake, and weight. Conclusions When a hypocaloric, low-fat diet is prescribed, reductions in high-fat and/or high-added-sugar food groups occur. Targeting reductions in high-fat meats may improve outcomes. [ABSTRACT FROM AUTHOR]

Background: The use of mobile phones for physical activity (PA) promotion and assessment represents an attractive research area because this technology is characterized by a widespread reach and dynamic features.Purpose:The purpose of this study was to conduct a systematic review of mobile phone–based approaches for encouraging and assessing PA.Methods:Eligible studies were identified through a search of PubMed and PsycINFO and required to address the usability of mobile phones for PA promotion and/or measurement, be written in English, and be published in a peer-reviewed journal between 2010 and 2013.Results:Fifty-two studies were included in this review. The use of mobile phones for PA promotion, assessment, and both promotion and assessment were addressed by 27, 19, and 6 studies, respectively. Out of 26 studies that reported a PA behavior change outcome, 13 observed favorable PA changes, 3 found mixed results, and 10 found no improvements. Ten studies examined the validity of mobile phones for PA assessment and 9 reported favorable outcomes. Participants found mobile phones to be highly acceptable.Discussion:The findings suggest that mobile phones have great potential as a PA promotion and assessment tool among a variety of individuals.Translation to Health Education Practice:Mobile phones may provide practitioners with efficient ways to promote PA and valid ways to assess PA. [ABSTRACT FROM PUBLISHER]

Background. Primary care is an ideal setting to treat pediatric obesity. Effective, low-intensity (≤25 contact hours over 6 months) interventions that reduce standardized body mass index (z-BMI) and can be delivered by primary care providers are needed. Objective. This pilot randomized controlled trial investigated the effect of 3 low-intensity (≤25 contact hours over 6 months) pediatric obesity treatments on z-BMI. Methods. Twenty-two families (children 8.0 ± 1.8 years, z-BMI of 2.34 ± 0.48) were randomized into 1 of 3, 6-month, low-intensity conditions: newsletter (N), newsletter and growth monitoring (N + GM), or newsletter and growth monitoring plus family-based behavioral counseling (N + GM + BC). Anthropometrics and child eating and leisure-time behaviors were measured. Results. Mixed-factor analyses of variance found a significant (P < .05) main effect of time for z-BMI and servings per day of sugar sweetened beverages, with both decreasing over time. Conclusion. Low-intensity obesity treatments can reduce z-BMI and may be more feasible in primary care. [ABSTRACT FROM PUBLISHER]

The article discusses a study which evaluated the relationship between physical activity (PA) and moderate- to vigorous-intensity PA (MVPA) strength output and body mass index (BMI). It describes how the study was conducted and discusses the use of the Physical Activity Readiness Questionnaire in determining the participants' eligibility. It also cites an increase in the MVPA strength output as PA varied weekly during treatment for obesity.

Objective: To determine whether daily self-weighing (DSW) is associated with disordered eating (DE) symptoms within an adult lifestyle intervention (LI), and to examine changes in DE symptoms during the 18-month trial. Method: One-hundred and seventy-eight adults (53% female, 90% White, 52.0 ± 8.6 years, BMI = 35.0 ± 4.4 kg/m2) were enrolled in a randomized trial testing 2 dietary prescriptions within a LI (standard vs. limited dietary variety). Both arms were taught DSW and had the same contact schedule and calorie and activity goals. Frequency of weighing and DE were assessed at 0, 6, 12, and 18 months. Analyses controlled for treatment arm. Results: At baseline, 16.3% of participants reported weighing a daily compared with 83.7%, 72.3%, and 68.2% at 6, 12, and 18 months, respectively. There was no relationship between change in frequency of self-weighing and change in DE symptoms at any time point. Further, there were no significant differences between those who weighed a daily versus < daily on DE composite scores at baseline or 6 months; at 12 and 18 months participants who weighed a daily reported lower DE scores compared with those who weighed < daily (p = .008 and .043 at 12 and 18 months, respectively). Participants who weighed a daily achieved better weight losses than those weighing < daily at 12 and 18 months (p = .003 and <.001). There was a significant reduction overtime in DE symptoms (p < .0001 ) and a reduction in odds of meeting criteria for Binge Eating Disorder (BED; ps < .001). Conclusions: Daily self-weighing did not appear to be related to increased disordered eating behavior and was associated with better weight loss outcomes. [ABSTRACT FROM AUTHOR]

Objective: Behavioral weight-loss programs (BWL) provide limited instruction on how to change the environmental context of weight-regulating behaviors, perhaps contributing to regain. Drawing on social ecological models, this trial evaluated a comprehensive weight-loss program that targeted both an individual's behavior and his or her physical and social home environment. Method: Overweight and obese adults (N = 201; 48.9 ± 10.5 years; 78.1% women) were randomized to BWL or to BWL plus home-environment changes (BWL + H). Groups met weekly for 6 months and bimonthly for 12 months. BWL + H participants were given items to facilitate healthy choices in their homes (e.g., exercise equipment, portion plates) and attended treatment with a household partner. Weight loss at 6 and 18 months was the primary outcome. Results: BWL + H changed many aspects of the home environment and produced better 6-month weight losses than BWL (p = .017). At 18 months, no weight-loss differences were observed (p = .19) and rates of regain were equivalent (p = .30). Treatment response was moderated by gender (6 months, p = .011; 18 months, p = .006). Women lost more weight in BWL + H than BWL at 6 and 18 months, whereas men in BWL lost more weight than those in BWL + H at 18 months. Partners, regardless of gender, lost more weight in BWL + H than BWL at both time points (ps < .0001). Conclusion: The home food and exercise environment is malleable and targeting this microenvironment appears to improve initial weight loss, and in women, 18-month outcomes. Research is needed to understand this gender difference and to develop home-focused strategies with more powerful and sustained weight-loss effects. [ABSTRACT FROM AUTHOR]

Given the importance of physical activity (PA) for weight control, identifying strategies to achieve higher PA levels is imperative. We hypothesized that performing a greater variety of self-reported moderate-to-vigorous activities (MVPAs) would relate to higher objectively measured MVPA minutes in two groups who were successfully maintaining their body weight: weight loss maintainers (WLM/n = 226) and normal-weight individuals (NW/n = 169). The Paffenbarger Questionnaire and RT3 accelerometer were used to determine variety/number of different MVPAs performed and MVPA minutes, respectively. The variety/number of different activities performed by WLM and NW was similar (1.8 ± 1.2 versus 1.7 ± 1.2, P = 0.52). Regression analyses showed that greater variety (P < 0.01) and WLM status (P < 0.05) were each positively related to greater MVPA minutes/day and meeting the ⩾250 MVPA minutes/week guideline for long-term weight maintenance. The association between greater variety and higher MVPA was similar in NW and WLM. Future studies should test whether variety can facilitate engagement in higher MVPA levels for more effective weight control. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined the relation between method of weight loss and long-term maintenance among successful weight losers enrolled in a weight-loss maintenance trial. Participants of the trial were adults who had lost at least 10% of their body weight using a very low-calorie diet (VLCD). Results showed that participants who had used VLCD regained more weight. The study also found that individuals who had used a self-guided approach maintained their initial weight losses with the greatest success.

Background: HFousehold food availability is consistently linked to dietary intake; yet behavioral weight control treatment includes only minimal instruction on how to change the home environment to support dietary goals. This pilot study examined whether it is feasible to change the household food environments of behavioral weight loss participants through the use of a commercially available grocery home delivery service. Methods: Overweight participants (N = 28; BMI = 31.7 ± 3.6 kg/m² 89.3% women, 47.9 ± 9.5 years) were randomly assigned to 8-weeks of standard behavioral weight loss (SBT) or to SBT plus home food delivery (SBT+Home). SBT+Home participants were instructed to do their household grocery shopping via an online service affiliated with a regional supermarket chain and were reimbursed for delivery charges. Results: Compared to SBT, SBT+Home produced significantly greater reductions in the total number of foods in the home (p = .01) and number of foods that were high in fat (p = .002). While the groups did not differ in 8-week weight losses, within SBT+Home there was a trend for the number of home deliveries to be associated with weight loss (p = .08). Participants reported that the home delivery service was easy to use and that it helped decrease impulse purchases and lead to healthier choices; however, few planned to continue using the service after the study. Conclusion: Encouraging weight loss participants to use a commercially available online grocery ordering and home delivery service reduces the overall number of food items in the home and decreases access to high-fat food choices. More research is needed to determine whether this is a viable strategy to strengthen stimulus control and improve weight loss outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Limiting meal variety decreases hedonic ratings of eaten foods more so than non-eaten foods, demonstrating sensory-specific satiety. Exposure to a food over time decreases the food''s hedonic ratings, indicating monotony. The effect of limiting food group variety over time on long-term sensory-specific satiety and monotony is unknown. Thirty overweight adults were randomized to one of two 8-week behavioral weight loss interventions. One condition limited snack food intake to one chosen snack food (reduced variety), while the other limited snack food intake to <1 serving/day (control), with no variety limit. In the reduced variety condition, hedonic ratings of the chosen snack food showed a decrease (p <.05) over time and decreased more (p <.05) than hedonic ratings of other snack foods. Weight loss (−7.4±5.8 lb) occurred in both conditions. Limiting food group variety over 8 weeks produced long-term sensory-specific satiety and monotony. Future research should examine if limiting food group variety over an extended time affects intake and could be used as a technique in weight loss interventions. [Copyright &y& Elsevier]

Although adolescents with obesity have heightened risk for eating pathology, the impact of differential parent involvement on eating pathology after obesity treatment is unknown. We examined differences in eating pathology in adolescents whose parents were randomized to distinct interventions within adolescent obesity treatment. Participants were 82 adolescent/parent dyads (adolescents: 63 % female; 55 % racial/ethnically marginalized) enrolled in TEENS+, a 4-month behavioral weight loss intervention. Parents were randomized to either a parent weight loss treatment (TEENS+PWL) or parent skills training (TEENS+PAC). Adolescents completed the Eating Disorder Examination-Questionnaire with Instructions (EDE-Q-I) and Child Depression Inventory (CDI) at baseline, 4 m, and 7 m. Group differences in eating pathology (global score; eating concern, weight concern, shape concern, restraint) and depression across time points were evaluated with linear mixed models. No significant differences were observed between TEENS+PAC and TEENS+PWL in eating pathology or depression, nor were there group by time interactions. Time point differences were observed for all EDE-Q-I and CDI outcomes, except eating concerns; pairwise contrasts revealed a variety of change patterns. Weight and shape concerns decreased from 0 to 4 m; observed reductions were maintained at 7 m. Restraint was highest at 4 m and decreased at 7 m but did not return to baseline. EDE-Q-I global scores significantly declined over time. Depression decreased over time, but a significant difference was only observed between 0 and 7 m. Neither parent intervention yields harm related to eating pathology in adolescents engaged in obesity treatment. Obesity treatment does not appear to have iatrogenic effects on eating pathology in adolescents. • Examined eating pathology among adolescents in obesity treatment. • Investigated differences between two distinct parent interventions. • Obesity treatment does not appear to have iatrogenic effects on eating pathology. • Both parent approaches offer protection against eating pathology. [ABSTRACT FROM AUTHOR]

Background: Decreasing dietary energy density is recommended to promote weight loss. However, it is unclear whether decreasing dietary energy density is best accomplished by increasing the number of low energy dense (LED) foods (≤1 kcal/g) or by decreasing the number of high energy dense (HED) foods (≥3 kcal/g) in the diet, and whether these actions have different effects on weight loss. We explored how the number of LED and HED foods consumed affected dietary energy density and change in BMI during the 6-month weight-loss phase of an 18-month weight loss trial. Methods: A secondary analysis of 202 adults 21-65y with a BMI between 27 and 45 kg/m² participating in a weight loss trial was conducted. Participants were randomized to 1 of 2 conditions - a standardized lifestyle intervention or a standardized lifestyle intervention plus a goal to limit consumption of non-nutrient-dense, energy-dense foods to 2 foods. Dietary intake, assessed via 3, 24-hour recalls, and BMI were measured at baseline and 6 months. Generalized linear models were used to examine the association between residualized changes in LED foods and HED foods and dietary energy density and change in BMI between baseline and 6 months. All analyses were adjusted for age, sex, race, education, treatment group, change in energy intake, and number of LED or HED foods. Results: At baseline, participants had a daily average energy density of 1.25 kcal/g, which decreased to 0.82 kcal/g at 6-months (p<0.0001). Similarly, daily number of LED foods consumed increased from 4.46 to 5.64 foods/day while daily HED foods consumed decreased from 4.02 to 2.98 foods/day (p<0.0001). In fully-adjusted models, a 1-unit increase in LED foods was associated with a 0.07 decrease in the overall energy density of the diet while a 1-unit decrease in HED foods was associated with a 0.08 decrease in energy density (p<0.05); no significant changes in BMI were detected. However, when we examined changes in BMI among those who decreased (>1 unit), maintained (< 1-unit), or increased (>1 unit) the number of LED or HED foods, significantly greater changes in BMI were observed among those with stable (-3.3 ± 0.4 kg/m²) or increased LED food intake (-3.5 ± 0.4 kg/m²) compared to those who decreased LED foods (-2.4 kg ± 0.5 kg/m², p<0.05). No differences in BMI were observed among those who decreased, maintained, or increased the number of HED foods, though similar decreases in energy density were observed among those who decreased HED foods or increased LED foods (-0.6 kcal/g). Conclusions: Decreasing HED foods and increasing LED foods both reduced the overall ED of the diet, but increasing LED foods was associated with significant reductions in BMI. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To determine whether baseline intake or initial changes in intake of fruits (F), vegetables (V), snack foods (SF), and reduced-calorie snack foods (RCSF) during standard behavioral weight loss treatment predict BMI reductions among overweight adolescents. Given conflicting messages between child and adult weight loss interventions, the role of RCSF in adolescent weight control was of particular interest. Methods: Seventy-two adolescents, 13–16years old, participating in a 16-week behavioral weight loss trial with diet records at baseline and 4weeks were included. Height and weight were measured at 0 and 16weeks. Frequency of intake of F, V, SF, and RCSF were obtained from 7-day food records at 0 and 4weeks. Results: Male gender, higher initial frequency of intake of V and increased frequency of intake of F and RCSF over the first 4weeks of treatment accounted for 43% of the variance in BMI reduction at 16weeks (p <.001). Conclusions: Early changes in eating habits, including increased frequency of intake of F and RCSF may promote greater adolescent BMI reductions. [ABSTRACT FROM AUTHOR]