A role for olestra in body weight management

Olestra is a fat substitute made from fatty acids esterified to sucrose and can be used in the preparation of virtually any food made with fat. Foods made with olestra retain the mouthfeel, palatability and satiating effects of their full‐fat counterparts without providing any digestible energy. Because olestra provides no energy, it has the potential to be a useful tool in weight loss and weight maintenance. Short‐term studies of olestra replacement in foods demonstrate that fat replacement leads to a net reduction in fat intake. When excess total energy is available, fat replacement also reduces total energy intake in lean and obese men and women. In longer‐term studies in which olestra is incorporated into the daily diet, there is an incomplete compensation for the fat energy replaced by olestra. When overweight men consumed olestra as part of a varied diet over nine months, weight loss continued for the duration of the study, whereas individuals receiving a typical low‐fat diet regained most of the initial weight lost. Other studies are underway to examine the usefulness of olestra in long‐term weight maintenance following weight loss. Post‐marketing surveillance of olestra foods in the United States indicates that substitution of olestra for only 1–2 g of fat d^?1 may be sufficient to prevent the average weight gain reported in adults of 0.5–1.0 kg year^?1.     

Problems in identifying predictors and correlates of weight loss and maintenance: implications for weight control therapies based on behaviour change

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

Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain

Weight loss is difficult to achieve and maintaining the weight loss is an even greater challenge. The identification of factors associated with weight loss maintenance can enhance our understanding for the behaviours and prerequisites that are crucial in sustaining a lowered body weight. In this paper we have reviewed the literature on factors associated with weight loss maintenance and weight regain. We have used a definition of weight maintenance implying intentional weight loss that has subsequently been maintained for at least 6 months. According to our review, successful weight maintenance is associated with more initial weight loss, reaching a self-determined goal weight, having a physically active lifestyle, a regular meal rhythm including breakfast and healthier eating, control of over-eating and self-monitoring of behaviours. Weight maintenance is further associated with an internal motivation to lose weight, social support, better coping strategies and ability to handle life stress, self-efficacy, autonomy, assuming responsibility in life, and overall more psychological strength and stability. Factors that may pose a risk for weight regain include a history of weight cycling, disinhibited eating, binge eating, more hunger, eating in response to negative emotions and stress, and more passive reactions to problems.     

Weight maintenance: challenges,tools and strategies for primary care physicians

Obesity is recognized as a chronic disease and one of the major healthcare challenges facing us today. Weight loss can be achieved via lifestyle, pharmacological and surgical interventions, but weight maintenance remains a lifetime challenge for individuals with obesity. Guidelines for the management of obesity have highlighted the role of primary care providers (PCPs). This review examines the long‐term outcomes of clinical trials to identify effective weight maintenance strategies that can be utilized by PCPs. Because of the broad nature of the topic, a structured PubMed search was conducted to identify relevant research articles, peer‐reviewed reviews, guidelines and articles published by regulatory bodies. Trials have demonstrated the benefit of sustained weight loss in managing obesity and its comorbidities. Maintaining 5–10% weight loss for ≥1 year is known to ameliorate many comorbidities. Weight maintenance with lifestyle modification – although challenging – is possible but requires long‐term support to reinforce diet, physical activity and behavioural changes. The addition of pharmacotherapy to lifestyle interventions promotes greater and more sustained weight loss. Clinical evidence and recently approved pharmacotherapy has given PCPs improved strategies to support their patients with maintenance of weight loss. Further studies are needed to assess the translation of these strategies into clinical practice.     

A systematic review with meta‐analyses of text message‐delivered behaviour change interventions for weight loss and weight loss maintenance

Short Message Service (SMS)‐delivered behaviour change interventions are frequently used to support weight management. This systematic review examines the effectiveness of SMS‐delivered behaviour change interventions for weight management. Electronic databases were searched for randomised controlled trials (RCTs) comparing SMS‐delivered adult weight management interventions to control groups, published between 1990 and 2018. Weight change was examined using random effects meta‐analyses at intervention cessation and postintervention follow‐up. Subgroup analyses examined intervention duration, SMS frequency, theory use, SMS interactivity, and SMS tailoring. Fifteen studies met inclusion criteria (2705 participants). For weight loss interventions (n = 12, 1977 participants), the mean difference in weight change was ?2.28 kg (95% confidence interval [CI] ?3.17 to ?1.36 kg). No studies reported postintervention follow‐up. For weight loss maintenance interventions (n = 3, 728 participants), the mean difference in weight change was ?0.68 kg (95% CI, ?1.31 to ?0.05 kg), and postintervention follow‐up (n = 2, 498 participants) effects were ?0.57 kg (95% CI, ?1.67 to 0.53 kg). No subgroup differences were found. SMS‐delivered behaviour change interventions for weight loss led to significant small to moderate weight loss and weight loss maintenance compared with control groups. Evidence on long‐term effects is limited. SMS‐delivered behaviour change interventions are a potentially effective and scalable intervention option for obesity treatment.     

The prevalence of weight loss maintenance among American adults

BACKGROUND: Previous studies suggest that few individuals achieve long-term weight loss maintenance. Because most of these studies were based on clinical samples and focused on only one episode of weight loss, these results may not reflect the actual prevalence of weight loss maintenance in the general population. DESIGN: A random digit dial telephone survey was conducted to determine the point prevalence of weight loss maintenance in a nationally representative sample of adults in the United States. Weight loss maintainers were defined as individuals who, at the time of the survey, had maintained a weight loss of > or =10% from their maximum weight for at least 1 y. The prevalence of weight loss maintenance was first determined for the total group (n = 500), and then for the subgroup of individuals who were overweight (body mass index BMI > or =27 kg/m2 at their maximum (n = 228). RESULTS: Weight loss was quite common in this sample: 54% of the total sample and 62% of those who were ever overweight reported that they had lost > or =10% of their maximum weight at least once in their lifetime, with approximately one-half to two-thirds of these cases being intentional weight loss. Among those who had achieved an intentional weight loss of > or =10%, 47-49% had maintained this weight loss for at least 1 y at the time of the survey; 25-27% had maintained it for 5 y or more. Fourteen percent of all subjects surveyed and 21% of those with a history of obesity were currently 10% below their highest weight, had reduced intentionally, and had maintained this 10% weight loss for at least 1 y. CONCLUSIONS: A large proportion of the American population has lost > or =10% of their maximum weight and has maintained this weight loss for at least 1 y. These findings are in sharp contrast to the belief that few people succeed in long-term weight loss maintenance.     

Maintenance of weight loss after lifestyle interventions for overweight and obesity,a systematic review

Lifestyle interventions can reduce body weight, but weight regain is common and may particularly occur with higher initial weight loss. If so, one may argue whether the 10% weight loss in clinical guidelines is preferable above a lower weight loss. This systematic review explores the relation between weight loss during an intervention and weight maintenance after at least 1 year of unsupervised follow‐up. Twenty‐two interventions (during at least 1 month) in healthy overweight Caucasians were selected and the mean percentages of weight loss and maintenance were calculated in a standardized way. In addition, within four intervention groups (n > 80) maintenance was calculated stratified by initial weight loss (0–5%, 5–10%, >10%). Overall, mean percentage maintenance was 54%. Weight loss during the intervention was not significantly associated with percentage maintenance (r = ?0.26; P = 0.13). Percentage maintenance also not differed significantly between interventions with a weight loss of 5–10% vs. >10%. Consequently, net weight loss after follow‐up differed between these categories (3.7 vs. 7.0%, respectively; P < 0.01). The analyses within the four interventions confirmed these findings. In conclusion, percentage maintenance does not clearly depend on initial weight loss. From this perspective, 10% or more weight loss can indeed be encouraged and favoured above lower weight loss goals.     

Weight loss/maintenance as an effective tool for controlling type 2 diabetes: novel methodology to sustain weight reduction

The type 2 diabetes epidemic closely parallels the obesity epidemic. Although weight loss is frequently initiated successfully, most patients regain substantial amounts of weight within the first year after completing a weight loss programme. Several studies have shown success over time with weight loss and type 2 diabetes prevention and/or remission. These include the Diabetes Prevention Program and the Look AHEAD study. Novel approaches to weight management have recently found their way onto the internet. With advances in medicine, there has been more patient success in the weight maintenance field. We review the Weight Management System that permits daily counselling to patients who have been losing or maintaining weight. The Weight Management System is a method that combines four fundamental elements: (1) remote daily weight monitoring by the system and the health professional; (2) daily feedback from the system and, when necessary, the health professional; (3) customized information for the needs and desires of the particular patient; and (4) a proprietary algorithm to detect early signs of weight regain. Recent beta testing of this system has confirmed Dr Rena Wing's statistics and has opened up a novel approach to long-term weight management and diabetes prevention.     

Long-term body weight fluctuation in an overweight population

Weight loss programs report such low percentages of overweight subjects who lose weight and maintain the loss that the concern arises whether these results represent anything more than baseline population weight fluctuations. In this study, weights recorded for medical purposes at two clinic visits separated by intervals of 1 to 5 years were analysed for 332 adult patients who were initially at least 20 percent over their ideal body weight. Weight change calculations for this general patient population revealed that 219 (66 percent) had increased in weight by a mean of 5.7 kg, and that 113 (34 percent) had decreased in weight by a mean of 5.3 kg. The 59 patients measured over a 5-year interval showed an 'apparent body weight loss' for 31 percent of this sub-group with a mean decrease of 7.3 kg. Weight loss studies and programs must demonstrate a rate of weight loss maintenance beyond that of a control group before attributing 'weight loss' in a population to any factor other than normal weight fluctuation.     

Prevalence of personal weight control attempts in adults: a systematic review and meta‐analysis

The purpose of this systematic review and meta‐analysis was to estimate the prevalence of personal weight control attempts (weight loss and/or maintenance) worldwide and to identify correlates, personal strategies used and the underlying motives. We included epidemiological/observational studies of adults (≥18 years) reporting prevalence of weight control attempts in the past‐year. Seventy‐two studies (n = 1,184,942) met eligibility criteria. Results from high quality studies showed that 42% of adults from general populations and 44% of adults from ethnic‐minority populations reported trying to lose weight, and 23% of adults from general populations reported trying to maintain weight annually. In general population studies, higher prevalence of weight loss attempts was observed in the decade of 2000–2009 (48.2%), in Europe/Central Asia (61.3%) and in overweight/obese individuals and in women (p < 0.01). Of the 37 strategies (grouped in 10 domains of the Oxford Food and Activity Behaviours Taxonomy) and 12 motives reported for trying to control weight, exercising and dieting (within the energy compensation and restraint domains, respectively) and wellbeing and long‐term health were the most prevalent. To our knowledge, this is the first systematic review to investigate weight control attempts worldwide. Key strategies and motives were identified which have implications for future public health initiatives on weight control.     

A case-control study of successful maintenance of a substantial weight loss: individuals who lost weight through surgery versus those who lost weight through non-surgical means

OBJECTIVE: To determine if method of weight loss (surgery; non-surgery) is associated with current levels of psychosocial functioning or current weight maintenance behaviors in individuals who have lost large amounts of weight. DESIGN: Subjects were 67 cases and 67 controls selected from the National Weight Control Registry, a longitudinal study of individuals successful at long-term maintenance of weight loss. Cases had initially lost weight through bariatric surgery while controls had lost weight through non-surgical means. The current psychosocial functioning and weight maintenance behaviors of cases and controls were assessed and compared. RESULTS: Cases and controls were matched on gender, current weight and total weight loss. Surgical cases reported significantly higher fat intake and lower physical activity levels. There were no differences in cases' and controls' reports of the impact of weight loss on other areas of their lives, neither were there differences on measures of depression or binge-eating. CONCLUSIONS: Reported improvement in psychosocial functioning did not depend upon how weight was initially lost, but cases and controls appear to be using very different behaviors to maintain their weight losses.     

Understanding the impact of rural weight loss interventions: A systematic review and meta‐analysis

Rural adults have a higher risk of developing obesity than urban adults. Several evidence‐based interventions have targeted rural regions, but their impact, defined as reach (number and representativeness of participants) by effectiveness, has not been examined. The purpose of this review was to determine the impact of rural weight loss interventions and the availability of data across dimensions of the reach, effectiveness, adoption, implementation, and maintenance (RE‐AIM) framework. A systematic review was conducted to identify rural weight loss interventions that targeted adults. RE‐AIM‐related data were abstracted from each article. We performed a meta‐analysis to examine effectiveness. Sixty‐four articles reported on rural weight loss interventions, describing 50 unique interventions. The median number of participants was 107. Median participation rate differed between values reported by the authors (62%) and values computed using a standard method (32%). Two studies reported on sample representativeness; none reported comparisons made between target and actual delivery settings. Median weight loss per participant was 3.64 kg. Meta‐analyses revealed the interventions achieved a significant weight reduction, and longer‐duration interventions resulted in greater weight loss. Rural weight loss interventions appear to be effective in supporting clinically meaningful weight loss but reach and cost outcomes are still difficult to determine.     

Long-term efficacy of dietary treatment of obesity: a systematic review of studies published between 1931 and 1999

Methods: MEDLINE surveys were carried out and reference lists were cross‐checked to identify publications on long‐term outcome for dietary treatment of obesity. 898 papers were identified, 17 fulfilled our planned criteria for inclusion (dietary treatment; adults; follow‐up period ≥ 3 years; follow‐up rate ≥ 50% of original study group; information on one of the success criteria: maintenance of all weight initially lost (or further weight reduction) or maintenance of at least nine to 11 kg of initial weight loss; obesity complications of the patient group not over‐represented; English, German or Scandinavian languages). Results: The 17 included publications (hereof three publications on randomized clinical trials with control group relevant for this review) reported on 21 study groups, comprising 3030 patients. Of these 2131 (70%) were followed‐up for 3–14 years (median 5 years). Mean initial weight loss ranged from four to 28 kg (median 11 kg). Overall, 15% (median, range 0–49%) of followed‐up patients fulfilled one of the criteria for success. Overall, success rates seemed stable for up to 14 years of observation. Diet combined with group therapy lead to better long‐term success rates (median 27%) than did diet alone (median 15%) or diet combined with behaviour modification (median 14%). Active follow‐up was generally associated with better success rates than was passive follow‐up (19% vs. 10%). Conventional diet seemed to be most efficacious in addition with group therapy, whereas VLCD apparently was most efficacious if combined with behaviour modification and active follow‐up. Conclusion: The literature on long‐term follow‐up of dietary treatment of obesity, although limited and inhomogeneous, points to an overall median success rate of 15% and a possible adjuvant effect of group therapy, behaviour modification and active follow‐up.     

Effectiveness of web‐based interventions in achieving weight loss and weight loss maintenance in overweight and obese adults: a systematic review with meta‐analysis

The objectives of this systematic review are to evaluate the effectiveness of web‐based interventions on weight loss and maintenance and identify which components of web‐based interventions are associated with greater weight change and low attrition rates. A literature search from 1995 to April 2008 was conducted. Studies were eligible for inclusion if: participants were aged ≥18 years with a body mass index ≥25, at least one study arm involved a web‐based intervention with the primary aim of weight loss or maintenance, and reported weight‐related outcomes. Eighteen studies met the inclusion criteria. Thirteen studies aimed to achieve weight loss, and five focused on weight maintenance. Heterogeneity was evident among the studies with seven research questions examined across interventions of varying intensity. Seven studies were assessed for effectiveness based on percentage weight change, with four studies deemed effective. Although the four meta‐analyses suggest meaningful weight change, it is not possible to determine the effectiveness of web‐based interventions in achieving weight loss or maintenance due to heterogeneity of designs and thus the small number of comparable studies. Higher usage of website features may be associated with positive weight change, but we do not know what features improve this effect or reduce attrition.     

Long-term follow-up of patients attending a combination very-low calorie diet and behaviour therapy weight loss programme.

We examined the effects of treatment with a very-low calorie diet (VLCD) combined with behaviour modification on weight loss and long-term maintenance of weight loss in 118 of 199 patients who completed eight weeks of VLCD. Those who began therapy in 1984 were surveyed by telephone an average of 3.3 years after ending the VLCD. Questionnaire data included reported weight, exercise, eating, work and sleep habits, emotional factors, and current use of behavioural techniques taught in the programme. Results showed that mean maximum weight loss during the time they attended the programme (average 51.6 weeks) was 31.3 kg, corresponding to a decrease in body mass index of 10.7 kg/m2. At follow-up a regain of 60.9% was reported yielding a net overall weight loss of 13.6 kg and decrease in body mass index of 4.4 kg/m2. Seventy-five per cent of subjects showed only a 37.5% regain of the weight they had lost. Those whose weight loss was better maintained at the time of follow-up reported exercising more, eating fewer high fat foods, and using more of the behavioural techniques taught in the programme. This study provides support for the conclusion that some patients treated with VLCD and behaviour modification can maintain significant weight losses over a relatively long period of time and that specific behaviours relate to this success.     

Association of anthropometry and weight change with risk of dementia and its major subtypes: A meta‐analysis consisting 2.8 million adults with 57 294 cases of dementia

Uncertainty exists regarding the relation of body size and weight change with dementia risk. As populations continue to age and the global obesity epidemic shows no sign of waning, reliable quantification of such associations is important. We examined the relationship of body mass index, waist circumference, and annual percent weight change with risk of dementia and its subtypes by pooling data from 19 prospective cohort studies and four clinical trials using meta‐analysis. Compared with body mass index–defined lower‐normal weight (18.5‐22.4 kg/m²), the risk of all‐cause dementia was higher among underweight individuals but lower among those with upper‐normal (22.5‐24.9 kg/m²) levels. Obesity was associated with higher risk in vascular dementia. Similarly, relative to the lowest fifth of waist circumference, those in the highest fifth had nonsignificant higher vascular dementia risk. Weight loss was associated with higher all‐cause dementia risk relative to weight maintenance. Weight gain was weakly associated with higher vascular dementia risk. The relationship between body size, weight change, and dementia is complex and exhibits non‐linear associations depending on dementia subtype under scrutiny. Weight loss was associated with an elevated risk most likely due to reverse causality and/or pathophysiological changes in the brain, although the latter remains speculative.     

Efficacy of weight loss drugs on obesity and cardiovascular risk factors in obese adolescents: a meta‐analysis of randomized controlled trials

Weight loss drugs have been developed to reduce the comorbidities associated with excess weight. We conducted a meta‐analysis of the efficacy of orlistat and sibutramine on weight, body mass index, waist circumference and cardiovascular risk factors in overweight adolescents. MEDLINE and the Cochrane Library were searched for relevant articles using MESH terms and keywords. Studies were included if they had reported quantitative estimates and standard deviations of the association between each weight loss drug and weight, with information on at least one cardiovascular risk factor. A total of eight trials (three orlistat and five sibutramine) with information on 1391 individuals was included in the present analysis. The mean decrease in weight between the intervention and control groups was 5.25 kg (95% confidence interval: 3.03–7.48) after a minimum follow‐up of 6 months. There was evidence of statistical heterogeneity between the studies (I² = 76%) that was no longer apparent after exclusion of trials of orlistat (mean weight decrease = 5.32 kg; I² = 38%). There was little evidence that treatment was associated with adverse effects on cardiovascular risk factors but this requires verification from future large trials with longer study follow‐up.     

Effectiveness of male-only weight loss and weight loss maintenance interventions: a systematic review with meta-analysis

The objectives of this systematic review were to investigate the effectiveness of male-only weight loss and weight loss maintenance interventions and to identify intervention characteristics associated with effectiveness. In May 2011, a systematic literature search with no date restrictions was conducted across eight databases. Twenty-four articles describing 23 studies met the eligibility criteria. All studies included a weight loss intervention and four studies included an additional weight loss maintenance intervention. Study quality was mostly poor for weight loss studies (median = 3/10, range = 1-9) and weight loss maintenance studies (median = 3.5/10, range = 1-6). Twenty-three of 31 individual weight loss interventions (74%) from the eligible studies were considered effective. Meta-analysis revealed a significant difference in weight change favouring weight loss interventions over no-intervention controls at the last reported assessment (weighted mean difference -5.66 kg [-6.35, -4.97], Z = 16.04 [P < 0.00001]). Characteristics common to effectiveness were younger sample (mean age ≤ 42.8 years), increased frequency of contact (> 2.7 contacts/month), group face-to-face contact and inclusion of a prescribed energy restriction. Preliminary evidence suggests men-only weight loss programmes may effectively engage and assist men with weight loss. However, more high-quality studies are urgently needed to improve the evidence base, particularly for maintenance studies.     

The correlates of long-term weight loss: a group comparison study of obesity

OBJECTIVE: Although the majority of weight loss attempts are unsuccessful, a small minority succeed in both weight loss and maintenance. The present study aimed to explore the correlates of this success. METHOD: A group comparison design was used to examine differences between women who were classified as either weight loss maintainers (had been obese (body mass index, BMI=30+ kg/m2) and had lost weight to be considered non-obese (BMI<30 kg/m2) and maintained this weight loss for a minimum of 3 y; n=44), stable obese (maintained an obese weight (BMI=30+ kg/m2) for longer than 3 y; n=58), and weight loss regainers (been obese (BMI=30+ kg/m2), lost sufficient weight to be considered non-obese (BMI<30 kg/m2) and regained it (BMI=30+ kg/m2), n=40). In particular, the study examined differences in profile characteristics, historical factors, help-seeking behaviours and psychological factors. RESULTS: The results showed that in terms of profile and historical factors, the weight loss maintainers had been lighter, were currently older and had dieted for longer than the other groups but were matched in terms of age, class and ethnic group. In terms of help-seeking behaviours, the weight loss maintainers reported having tried healthy eating more frequently but were comparable to the other subjects in terms of professionals contacted. Finally, for psychological factors the weight loss maintainers reported less endorsement for medical causes of obesity, greater endorsement for psychological consequences and indicated that they had been motivated to lose weight for psychological reasons. CONCLUSIONS: Weight loss and maintenance is particularly correlated with a psychological model of obesity. This has implications for improving the effectiveness of interventions and the potential impact of current interest in medical approaches to obesity.     

Long‐term weight loss and weight‐loss maintenance strategies

It has been suggested that about 20% of subjects undergoing weight‐loss programmes can achieve a certain degree of long‐term success. At present, surgery remains the only method resulting in long‐term sustained weight loss, but access remains restricted. Hence it is important to analyse, in addition to pharmacotherapy, the methods to improve the effects of diet, exercise and behavioural modification. Since these techniques are less spectacular than others, there is a risk that their potential will be overlooked, in spite of the fact that they remain the main alternative for most subjects undergoing weight‐loss therapy. This review summarizes realistic treatment alternatives and also provides data from a day care treatment, a strategy not much reported in the literature. This is a standard treatment modality for diabetes but less common in obesity treatment.