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Intentional weight loss has been shown to increase bone loss short term but the long-term effects are not known. Data from the Look AHEAD clinical trial shows that a long term intentional weight loss intervention was associated with greater bone loss at the hip in men.PurposeIntentional weight loss has been shown to increase bone loss short term and increase frailty fracture risk, but the long-term effects on bone mineral density (BMD) are not known.MethodsData from a subgroup from the Look AHEAD (LA) multicenter, randomized clinical trial was used to evaluate whether a long term intentional weight loss intervention would increase bone loss. In a preplanned substudy, BMD was assessed at 5 of the 16 LA clinical centers using dual-energy X-ray absorptiometry at baseline, year 8, and the observational visit 12.6-16.3 years after randomization (year 12-16).ResultsAt year 8, bone density loss (%) was greater in the Intensive Lifestyle Intervention (ILI) group compared with the control group (DSE) for the femoral neck (p = 0.0122) but this finding was not observed at the year 12-16 visit. In analyses stratified by gender, bone density loss (%) was greater at the total hip for men in the ILI group than the DSE group at both the year 8 and year 12-16 visits (year 8 p = 0.0263 and year 12-16 p = 0.0062). This finding was not observed among women.ConclusionLong term intentional weight loss was associated with greater bone loss at the hip in men. These results taken with the previously published Look AHEAD data from the entire clinical trial showing increased frailty fracture risk with weight loss in the ILI group suggest that when intentional weight loss is planned, consideration of bone density preservation and fracture prevention strategies is warranted.Trial registrationClinicaltrials.gov Identifier: NCT00017953. June 21, 2001.

Overweight and obesity are major risk factors for a number of non-communicable diseases such as type 2 diabetes, hypertension, stroke, heart attack and others. Intentional weight loss has been widely documented as an effective way of reducing the risk of such chronic diseases. As a result of the positive health consequences of weight reduction, many people all over the world are attempting weight loss to reap these health benefits. Common methods being used to achieve weight loss include self-help measures and structured programmes such as commercial weight loss programmes. Although commercial weight loss programmes are increasingly being patronised, little is known about the long-term outcomes of such programmes. The purpose of this study was to ascertain the prevalence of weight loss maintenance success in previous participants of a commercial weight loss programme in Accra, Ghana, who had been out of the weight loss programme for a median period of 4.75 years. A cross-section of 230 participants were randomly selected for this study. Baseline and end-line anthropometric data, length of stay in the programme and post treatment time were extracted from the programme's database. Weight measurements taken at follow up were used in calculating the percent weight loss at follow up. Successful weight loss maintenance was defined as achieving at least five percent weight loss below baseline weight at follow up otherwise unsuccessful. Comparisons of successful weight loss maintainers (SWLM) and unsuccessful weight loss maintainers (UWLM) were conducted using Analysis of covariance (ANCOVA) for continuous variables and Pearson chi-square for categorical variables. The mean baseline weight, height, Body Mass Index (BMI) and age for the cohort were 96.5±16.3kg, 1.65±0.08m, 35.4±5.4kg/m2, and 39.7±9.2yrs, respectively. The prevalence of weight loss maintenance success was 23.9%. More than half (52.2%) of the study cohort either returned to baseline weight or further re-gained some weight beyond baseline weight at follow up. Seventeen percent of the study cohort retained at least 95% of losses previously attained during the weight loss programme. Long-term maintenance of lost weight is achievable in a substantial proportion of weight losers and must be actively promoted by health professionals. The results can be generalised to majority of those who enter this commercial weight loss programme and not only the successful ones. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify the impacts of weight change and weight change intention on health-related quality of life (HRQL) among community-dwelling Korean elderly individuals. Method: Data on those aged 75 years and above from the Korean National Health and Nutrition Examination Survey were analyzed using multiple regression analysis. Results: Compared with no weight change, unintentional weight loss was associated with significantly lower adjusted overall HRQL and lower scores in the subdimensions of mobility, pain/discomfort, usual activities, and self-care (in order), whereas intentional weight loss was associated with significantly poorer scores for anxiety/depression. Weight gain showed no statistically significant differences in comparison with no weight change. Discussion: These findings suggest that weight maintenance or weight gain should be recommended rather than weight loss, whether unintentional or intentional, regardless of weight status, to improve HRQL among the elderly. [ABSTRACT FROM AUTHOR]

Randomized, controlled trials (RCTs) show intentional weight loss improves body composition and physical function in older adults; however, the long-term benefits (and risks) are unknown. We conducted a pilot study to assess the feasibility of recalling prior RCT participants to examine the long-term effects of intentional weight loss on body composition and physical function. A weighted, random sample of 60 older adults who were randomized to caloric restriction plus exercise (CR + EX) or exercise (EX) only in 5 prior RCTs (mean age at randomization, 67.3 years; 69% women, 80% white) were invited to participate. Follow-up was obtained on 89% (42 clinic visits, 10 phone interviews, 1 death) an average of 3.5 years (range, 2.2–5.8 years) after RCT completion. Despite greater weight, fat and lean mass loss during the RCT (mean difference in change (95% CI): −4.19 (−7.52, −0.86), −2.75 (−5.10, −0.40), and −2.32 (−3.69, −0.95) kg, respectively) in those randomized to CR + EX, long-term changes in weight (2.05 (−2.35, 6.45) kg) and body composition (1.80 (−1.56, 5.17) and 0.03 (−2.20, 2.26) kg for fat and lean mass, respectively) from baseline and physical function at long-term follow-up (mean difference in 400-m walk and SPPB (95% CI): 23.2 (−19.3, 65.6) sec and −0.03 (−1.02, 0.96) points, respectively) were similar in CR + EX and EX only. Although improvements in weight and body composition following intentional weight loss may not be sustained long-term, physical function does not appear to be negatively impacted. A larger study is needed to confirm these results. [ABSTRACT FROM AUTHOR]

Background: Diabetes adversely impacts cognition. Lifestyle change can improve diabetes control and potentially improve cognition. We examined whether weight loss through reduced caloric intake and increased physical activity was associated with slower cognitive aging in older adults with type 2 diabetes mellitus.Methods: The Look AHEAD randomized controlled clinical trial delivered 10 years of intensive lifestyle intervention (ILI) that yielded long-term weight losses. During 5 years spanning the end of intervention and postintervention follow-up, repeated cognitive assessments were obtained in 1,091 individuals who had been assigned to ILI or a control condition of diabetes support and education (DSE). We compared the means and slopes of scores on cognitive testing over these repeated assessments.Results: Compared with DSE, assignment to ILI was associated with a -0.082 SD deficit in mean global cognitive function across repeated assessments (p = .010). However, overweight (body mass index [BMI] < 30 kg/m2) ILI participants had 0.099 (95% confidence interval [CI]: -0.006, 0.259) better mean global cognitive function compared with overweight DSE participants, while obese (BMI ≥ 30 kg/m2) ILI participants had -0.117 (-0.185, -0.049) SD worse mean composite cognitive function scores (interaction p = .014) compared to obese DSE participants. For both overweight and obese participants, cognitive decline was marginally (-0.014 SD/y overall) steeper for ILI participants (p = .068), with 95% CI for differences in slopes excluding 0 for measures of attention and memory.Conclusions: The behavioral weight loss intervention was associated with small relative deficits in cognitive function among individuals who were obese and marginally greater cognitive decline overall compared to control. ClinicalTrials.gov Identifier: NCT00017953. [ABSTRACT FROM AUTHOR]

ABSTRACT Intentional weight loss is an important treatment option for overweight persons with type 2 diabetes mellitus (DM), but the effects on long-term fracture risk are not known. The purpose of this Look AHEAD analysis was to evaluate whether long-term intentional weight loss would increase fracture risk in overweight or obese persons with DM. Look AHEAD is a multicenter, randomized clinical trial. Recruitment began in August 2001 and follow-up continued for a median of 11.3 years at 16 academic centers. A total of 5145 persons aged 45 to 76 years with DM were randomized to either an intensive lifestyle intervention (ILI) with reduced calorie consumption and increased physical activity designed to achieve and maintain ≥7% weight loss or to diabetes support and education intervention (DSE). Incident fractures were ascertained every 6 months by self-report and confirmed with central adjudication of medical records. The baseline mean age of participants was 59 years, 60% were women, 63% were white, and the mean BMI was 36 kg/m2. Weight loss over the intervention period (median 9.6 years) was 6.0% in ILI and 3.5% in DSE. A total of 731 participants had a confirmed incident fracture (358 in DSE versus 373 in ILI). There were no statistically significant differences in incident total or hip fracture rates between the ILI and DSE groups. However, compared to the DSE group, the ILI group had a statistically significant 39% increased risk of a frailty fracture (HR 1.39; 95% CI, 1.02 to 1.89). An intensive lifestyle intervention resulting in long-term weight loss in overweight/obese adults with DM was not associated with an overall increased risk of incident fracture but may be associated with an increased risk of frailty fracture. When intentional weight loss is planned, consideration of bone preservation and fracture prevention is warranted. © 2017 American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

Dieting attempts have become popular worldwide. Dieting, however, seems to have both positive and negative health-related consequences. So far, only a few studies have focused on the determinants of dieting in detail. This study explores the association between self-report dieting attempts and intentional weight loss (IWL) during the previous year and several demographic, lifestyle, health, and psychological factors in a cross-sectional study design using data from the representative Finnish Health 2000 Survey. The sample comprised 2147 men and 2378 women, aged 30−69. Information for potential determinants was assembled via health examinations, interviews, and questionnaires. Approximately 24% of the men and 39% of the women reported dieting attempts and 10% of the men and 15% of the women reported IWL. Dieting attempts were associated with younger age, education, BMI, formerly smoking, more favourable values in lifestyle variables, and unfavorable values in serum HDL and triglycerides, a worse sense of coherence, concerns about one’s appearance, and concerns about one’s health. Among men, diabetics and those sleeping ≤6 h a night more frequently reported dieting attempts and those with osteoarthritis reported IWL. Moreover, the gradient between BMI and dieting attempts was significantly stronger in men than in women. Men seem to attempt dieting when they have actual health-related reasons, while such reasons are not so strongly associated with dieting in women. These findings can be used for determining subpopulations with obesity and real weight-loss needs and, alternatively, subpopulations with normal weight unnecessarily attempting dieting.

The global epidemic of obesity and its related disease in combination with robust physiological defence of intentional weight loss generates a pressing need for effective weight loss therapies. Bariatric surgery, which works very effectively at delivering substantial sustained weight loss, has been an enigma with respect to mechanism of action. Naive concepts of restriction and malabsorption do not explain the efficacy of the most commonly used bariatric procedures. This century has seen increased interest in unravelling the mystery of the mechanisms underlying surgery associated weight loss with a focus on integrative gastrointestinal (GI) physiology, gut–brain signalling, and beyond weight loss effects on metabolism. GI interventions, some very minor, can alter GI wall stretch and pressure receptors; a range of GI hormones affecting hunger and satiety; bile acid metabolism and signalling; the characteristics of GI microbiome; portal vein nutrient sensing; and circulating concentrations of amino acids. Understanding the mechanisms involved should present targets for less invasive effective therapies. [ABSTRACT FROM AUTHOR]

Background: Impairment in health-related quality of life (HRQOL) is described as a major concern for severely obese adolescents seeking intentional weight loss. We aimed to compare HRQOL in obese adolescents seeking weight loss with body mass index (BMI)-matched younger adults and community norms. Methods: Eighty-one adolescents (14-18.8 years) with BMI 30-60 kg/m completed the Short Form (SF)-36 prior to commencing a weight loss program. Each adolescent was matched for BMI and gender with two obese adults seeking weight loss, 10 and 20 years older, respectively. The groups were compared across all eight scale scores and mental and physical component summary scores (MCS and PCS). Summary scores were also compared to community norms. Results: The adolescents had higher scores than those in their 20s for all SF-36 scales and summary scores, indicating better HRQOL. Compared with community norms, obese adolescents had lower PCS and comparable MCS scores. Both groups of adults had lower PCS scores, but MCS was lower in those in their 20s compared with both adolescents and those in their 30s. There were no gender differences in patterns of responses across the three age groups. Conclusions: Obese adolescents seeking intentional weight loss have significant impairment in physical aspects of HRQOL, but self-reported mental HRQOL appears to be similar to community controls. In contrast, obese participants in their 20s report clinically significant impairment in mental HRQOL. When considering adolescents for bariatric surgery, careful assessment is needed. We need a greater understanding of the emotional distress reported by those in their 20s. [ABSTRACT FROM AUTHOR]

Unintentional weight gain is commonly observed in adult humans, often provoking intentional weight loss attempts followed by unintentional weight regain. This episodic variation in body weight over a period of time has been referred to as 'weight cycling'. Over the last two decades, weight cycling has been associated with a number of morbid health conditions and increased mortality. This article provides a comprehensive evaluation of recent weight-cycling evidence, looks to understand design differences between studies and study outcomes, assesses the need for further research on particular health outcomes, and proposes alternative methodologies that will bridge the needs and capabilities of research. Searches were conducted per PRISMA guidelines. Articles on weight cycling in the literature were initially identified using search strings in Pub Med. Eligibility assessment of the remaining articles was performed independently by three reviewers to identify publications that presented direct evidence. Twenty human studies (in addition to seven animal studies) were selected and retained; 12 accounted for the intentionality of weight loss. Although weight regain following successful weight loss remains one of the most challenging aspects of body-weight regulation, evidence for an adverse effect of weight cycling appears sparse, if it exists at all. [ABSTRACT FROM AUTHOR]

Weight loss in older adults has been a controversial topic for more than a decade. An obesity paradox has been previously described and the issue of weight status on health outcomes remains a highly debated topic. However, there is little doubt that physical activity (PA) has a myriad of benefits in older adults, especially in obese individuals who are inactive and have a poor cardiometabolic profile. In this review, we offer a critical view to clarify misunderstandings regarding the obesity paradox, particularly as it relates to obese older adults. We also review the evidence on PA and lifestyle interventions for the improvement of cardiorespiratory fitness, which can prevent disease and provide benefits to obese older adults, independent of weight changes. [ABSTRACT FROM AUTHOR]

Obesity is an independent risk factor for the development of coronary heart disease and chronic heart failure. It is associated with hypertension, dyslipidemia, and insulin resistance, in addition to vascular endothelial cell dysfunction and a proinflammatory prothrombotic state. Obesity furthermore, is associated with left ventricular remodeling leading to hypertrophy and diastolic and systolic dysfunction. Intentional weight loss of as little at 5% to 10% body weight improves cardiac and vascular function, blood pressure control, lipid profile, insulin resistance, diabetes control, and prevents or delays the onset of type 2 diabetes mellitus. These reductions in cardiovascular risk factors and improvements in cardiovascular function are seen with intentional weight loss achieved by any combination of exercise, calorie-restriction, behavioral weight loss programs, pharmacologic-induced, and surgical procedures. This review focuses on the cardiovascular effects of intentional weight loss achieved through intensive lifestyle modifications. [ABSTRACT FROM AUTHOR]

Background.: Although weight loss reduces risk for comorbid diseases, many observational studies suggest that weight loss is associated with increased mortality risk, leading to reluctance by clinicians to consider weight reduction as a strategy to maintain health and independence in older adults. However, whether the observed weight loss is intentional is difficult to determine and may not accurately represent the mortality risk associated with intentional weight reduction. Data from the Arthritis, Diet, and Activity Promotion Trial (ADAPT) were used to determine whether randomization to a weight reduction program was associated with total mortality in overweight/obese older adults. Methods. ADAPT (n = 318; mean age 69 ± 6 years, body mass index 34 ± 5 kg/m2,72% female) assessed the influence of weight loss (achieved through dietary counseling and lifestyle modification) and/or exercise on function in overweight/ obese older adults with knee osteoarthritis. ADAPT ended in December 1999. Participant vital was ascertained status through December 2006 using the National Death and Social Security Indexes. Results. The mortality rate for those randomized to the 18-month weight loss intervention (n = 159, mean weight loss = -4.8 kg, 15 deaths) was lower than that for those not randomized to the weight loss intervention (n = 159, mean weight loss = -1.4 kg, 30 deaths; hazard rate ratio = 0.5,95% confidence interval 0.3-1.0). Results were not appreciably changed when analyses were stratified by age, gender, baseline weight status, or magnitude of weight loss. Conclusions. In older adults, intentional weight loss was not associated with increased total mortality and may reduce mortality risk. Observational studies of weight loss, especially when intentionality cannot be rigorously established, may be misleading with respect to the effect of weight loss on mortality. [ABSTRACT FROM PUBLISHER]

Objective: To further our understanding of how intentional weight loss (IWL) and overeating are related, we examined the shared genetic and environmental variance between lifetime IWL and overeating. Method: Interview data were available for 1,976 female twins (both members of 439 and 264 pairs of monozygotic and dizygotic twins, respectively), mean age = 40.61, SD = 4.72. We used lifetime diagnostic data for eating disorders obtained from a semistructured psychiatric telephone interview, examined in a bivariate twin analysis. Both lifetime behaviors were measured on a 3-point scale, where absence of IWL or overeating formed one anchor on the scale and lifetime anorexia nervosa (AN) and bulimia nervosa (BN) formed the opposite anchors, respectively. Results: In line with previous findings, a higher body mass index was significantly associated with the lifetime presence of IWL and/or overeating (odds ratio = 1.13, 95% confidence interval (CI): 1.08–1.19). The best fitting twin model contained additive genetic and nonshared environmental influence influencing both IWL and overeating, with correlations between these influences of 0.61 (95% CI: 0.35–0.92) and 0.24 (95% CI: 0.07–0.42), respectively. Discussion: About 37% of genetic risk factors were considered to overlap between IWL and overeating, and with only 6% of overlap between environmental risk factors. Thus, considerable independence of risk factors was indicated. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2009 [ABSTRACT FROM AUTHOR]

The article discusses the results of research on the association of smoking with recurrent dieting and body mass index (BMI) among Finnish adults. It states that the effect of environmental and genetic factors were examined by studying twin pairs discordant for dieting and smoking. It says that recurrent dieting was connected with former smoking in both sexes and current smoking among women.

OBJECTIVE:: To investigate whether current smoking and lifetime snuff use are associated with a lifetime history of major (=5?kg) intentional weight loss in young adults, and to examine the dependence of this association on familial factors. DESIGN:: Cross-sectional population-based questionnaire survey of young adult Finnish twins participating in the fourth wave of the longitudinal FinnTwin-16-study in 2000-2002. SUBJECTS:: A total of 4521 young adult Finnish twins aged 23-27?y. MEASUREMENTS:: Questionnaire data on the number of intentional weight-loss episodes and on body mass index (BMI), cigarette smoking and snuff use, educational level, and number of subjects' own children. RESULTS:: Current daily smoking was strongly associated with a history of two or more intentional major weight-loss episodes (lost =5?kg twice or more lifetime) both in women odds ratio (OR 1.87; 95%; confidence interval (CI) 1.39-2.50) and in men (OR 2.00; 95% CI 1.37-2.90). Frequent lifetime snuff use was statistically significantly associated with recurrent intentional weight loss episodes in men (OR 1.51; 95% CI 1.08-2.13). Among the twin pairs discordant for daily smoking, the smoking twin was more likely than the nonsmoking co-twin to have recurrent intentional weight-loss episodes (OR 1.57; 95% CI 1.03-2.41). These episodes were also strongly associated with high BMI. Education was inversely related to recurrent intentional weight-loss episodes in men. CONCLUSION:: Tobacco use is strongly associated with a lifetime history of recurrent intentional major weight-loss episodes in early adulthood. This represents a major challenge to existing attitudes on smoking prevention and the promotion of healthful weight control.International Journal of Obesity (2004) 28, 796-802. doi:10.1038/sj.ijo.0802627 Published online 16 March 2004 [ABSTRACT FROM AUTHOR]

Work environment, pressure to be fashionable, and the unattainable images of female perfection promoted in modern commercial culture and the mass media may influence how women evaluate their weight. Beauticians'' profession places particular emphasis on beauty and it might put them at greater risk of dissatisfaction with their weight and body shape. However, there has been relatively little attention given to the issue of body perception and intentional weight loss among them. This study compared self-perceived and actual weight categories and the percentage of subjects with intentional weight loss among beauticians and non-beauticians in Taiwan. The results showed that a higher percentage of beauticians than non-beauticians overestimated their weight category. Beauticians were more dissatisfied with their body weight, more desirous to be in the underweight category, and more frequently endeavored to lose weight by dieting, taking weight-loss medicines, and self-induced vomiting when compared with non-beauticians. These practices and misconceptions are all strongly associated with the development of eating disorders [Copyright &y& Elsevier]

Summary Short-term studies indicate that intentional weight loss (IWL) among obese persons significantly improves health variables that are often precursors or markers of chronic diseases (e.g. heart diseases, type-2 diabetes). Hence, it is logical to assume that IWL among obese persons would lead to increased longevity. On the whole, epidemiological studies, including recent ones that use conservative analytic approaches such as distinguishing between apparently IWL and unintentional weight loss (UWL), adjusting for potential confounders and excluding apparently unhealthy subjects, indicate that apparently IWL appears to neither increase nor decrease mortality rate. However, it is important to note that none of the existing studies were designed specifically to test the hypothesis that IWL reduces mortality rate, and given methodological problems, these studies do not provide a satisfactory way to address the body mass index (BMI)–mortality question. Several controlled clinical trials suggest that IWL may reduce mortality rate. However, even in these studies, it is important to acknowledge that subjects are randomized to conditions that produce more or less weight loss and not to distinct levels of weight loss per se . Nevertheless, while we await additional data from better designed studies, given our incomplete knowledge, we conclude that it seems more likely than not that IWL achieved by medically recommended methods does not increase and probably decreases mortality rate. [ABSTRACT FROM AUTHOR]