A Randomized Controlled Trial of Behavioral Weight Loss Treatment Versus Combined Weight Loss/Depression Treatment Among Women with Comorbid Obesity and Depression

Background  

Obesity is associated with clinical depression among women. However, depressed women are often excluded from weight loss trials.     

Mediators and Moderators of Outcome in the Behavioral Treatment of Childhood Social Phobia

ObjectiveThe current study examined mediators and moderators of treatment response among children and adolescents (ages 7–17 years) with a primary diagnosis of social phobia.MethodParticipants were 88 youths participating in one of two randomized controlled treatment trials of Social Effectiveness Therapy for Children. Potential mediators included changes in observer-rated social skill and child-reported loneliness after 12 weeks of Social Effectiveness Therapy for Children. Age and depressive symptoms were examined as potential moderators.ResultsLoneliness scores and social effectiveness during a role-play task predicted changes in social anxiety and overall functioning at posttreatment. Changes in social anxiety were mediated by child-reported loneliness. Outcomes were not moderated by age or depressive symptoms.ConclusionsFindings support the role of loneliness as an important mechanism of change during treatment for childhood social phobia.     

Weight Bias and Weight Loss Treatment Outcomes in Treatment-Seeking Adults

Background  

Few studies have explored the relationship between weight bias and weight loss treatment outcomes.     

Small Changes in Nutrition and Physical Activity Promote Weight Loss and Maintenance: 3-Month Evidence from the ASPIRE Randomized Trial

Background  Current obesity interventions use intensive behavior changes to achieve large initial weight loss. However, weight regain after treatment is common, and drop out rates are relatively high. Smaller behavioral changes could produce initial weight loss and be easier to sustain after active treatment. Purpose  We examined the efficacy of an intervention that targeted small but cumulative participant-chosen changes in diet and physical activity (ASPIRE) and compared this treatment to standard didactic and wait-list control groups. The primary outcome measures were body weight, waist circumference, and intra-abdominal fat. Methods  Fifty-nine overweight or obese sedentary adults were randomized to one of three groups: (1) the ASPIRE group (n = 20), (2) a standard educationally-based treatment group (n = 20), or (3) a wait list control group (n = 19) for 4 months. Active treatment groups received identical resistance and aerobic training programs. Results  Intention-to-treat analyses showed that participants in the ASPIRE group lost significantly more weight than the standard and control groups (−4.4 vs. −1.1 and +0.1 kg, respectively), and the greater initial weight loss in the ASPIRE group was sustained 3 months after active treatment (4.1 kg). An alternative analytic strategy (0.3 kg/month weight gain for those lost to follow-up) showed continued weight loss (−0.2 kg after active treatment; −4.6 kg from baseline) at follow-up in the ASPIRE group. Similar patterns were observed for the other adiposity measures. Conclusion  More modest behavioral changes are capable of promoting weight loss, decreasing adiposity markers and sustaining these changes over 3 months. Longer-term studies comparing this approach with traditional behavioral weight loss treatments are warranted.     

The Role of Stigma in Weight Loss Maintenance Among U.S. Adults

Background

Challenges of maintaining long-term weight loss are well-established and present significant obstacles in obesity prevention and treatment. A neglected but potentially important barrier to weight-loss maintenance is weight stigmatization.

Purpose

We examined the role of weight stigma—experienced and internalized—as a contributor to weight-loss maintenance and weight regain in adults.

Methods

A diverse, national sample of 2702 American adults completed an online battery of questionnaires assessing demographics, weight-loss history, subjective weight category, experienced and internalized weight stigma, weight-monitoring behaviors, physical activity, perceived stress, and physical health. Analyses focused exclusively on participants who indicated that their body weight a year ago was at least 10% less than their highest weight ever (excluding pregnancy), the weight loss was intentional, and that attempts to lose or maintain weight occurred during the past year (n = 549). Participants were further classified as weight regainers (n = 235) or weight-loss maintainers (n = 314) based on subsequent weight loss/gain. Data were collected in 2015 and analyzed in 2016.

Results

Hierarchical logistic regression models showed that internalized weight stigma and subjective weight category made significant individual contributions to prediction of weight-loss maintenance, even after accounting for demographics, perceived stress, experienced stigma, physical health, and weight-loss behaviors. For every one-unit increase in internalized weight stigma, the odds of maintaining weight loss decreased by 28% (95% CI: 14–40%, p < .001).

Conclusions

Findings provide initial evidence that overlooked psychosocial factors, like weight stigma, may hinder weight-loss maintenance. Implications for addressing stigma in obesity-focused clinical interventions are highlighted.

     

Psychosocial Mediators of Physical Activity and Fitness Changes in the Activity Counseling Trial

Background  

Improved understanding of the mediators of physical activity (PA) interventions could lead to improvements in theory and programs.     

Low Dose Lithium Treatment of Behavioral Complications in Alzheimer's Disease: Lit-AD Randomized Clinical Trial

BackgroundA case series suggested efficacy for lithium to treat agitation in dementia, but no placebo-controlled trials have been conducted.ObjectivesTo evaluate low-dose lithium treatment of agitation in Alzheimer's disease (AD).MethodIn a four-site trial, patients with AD and agitation/aggression score ≥4 on the Neuropsychiatric Inventory (NPI) were randomized, double-blind, to lithium carbonate 150–600 mg daily or placebo for 12 weeks. Primary efficacy outcome was change in NPI agitation/aggression; secondary efficacy outcome was treatment response (30% reduction in NPI score for agitation/aggression plus psychosis and a Clinical Global Impression (CGI) score of much or very much improved). Safety profile of lithium was assessed.ResultsFifty-eight of 77 patients (75.3%) completed the trial. In linear mixed effects model analyses, lithium was not significantly superior to placebo for agitation/aggression. Proportion of responders was 31.6% on lithium and 17.9% on placebo (χ²=1.26, p = 0.26). Moderate or marked improvement (CGI) was greater on lithium (10/38=36.8%) than placebo (0/39=0%, Fisher's exact test p <0.001). In exploratory analyses, improvement on lithium was greater than placebo on NPI delusions and irritability/lability (p's<0.05). Lithium showed greater reduction than placebo in patients with high Young Mania Rating Scale scores (β=5.06; 95%CI,1.18 to 8.94, p = 0.01). Oral dose and serum levels demonstrated similar associations with efficacy outcomes. Lithium did not differ significantly from placebo on safety outcomes.ConclusionsLow-dose lithium was not efficacious in treating agitation but was associated with global clinical improvement and excellent safety. A larger trial may be warranted of likely lithium-responsive behavioral symptoms that overlap with mania.     

The SHED-IT Community Trial: A Randomized Controlled Trial of Internet- and Paper-Based Weight Loss Programs Tailored for Overweight and Obese Men

Background

There is limited evidence for effective obesity treatment programs that engage men.

Purpose

This study evaluated the efficacy of two gender-tailored weight loss interventions for men, which required no face-to-face contact.

Methods

This was a three-arm, randomized controlled trial: (1) Resources (n?=?54), gender-tailored weight loss materials (DVD, handbooks, pedometer, tape measure); (2) Online (n?=?53), Resources materials plus study website and e-feedback; and (3) Wait-list control (n?=?52). The interventions lasted 3 months and were grounded in Social Cognitive Theory.

Results

At 6 months, significantly greater weight loss was observed for the Online (?4.7 kg; 95 % CI ?6.1, ?3.2) and Resources (?3.7 kg; 95 % CI ?4.9, ?2.5) groups compared to the control (?0.5 kg; 95 % CI ?1.4, 0.4). Additionally, both intervention groups significantly improved body mass index, percent body fat, waist circumference, blood pressure, physical activity, quality of life, alcohol risk, and portion size, compared to controls.

Conclusions

Men achieved significant weight loss after receiving novel, minimal-contact, gender-tailored programs, which were designed for widespread dissemination.     

Barbadin Potentiates Long-Term Effects of Lorcaserin on POMC Neurons and Weight Loss

Obesity is a serious global health problem because of its increasing prevalence and comorbidities, but its treatments are limited. The serotonin 2C receptor (5-HT_2CR), a G-protein-coupled receptor, activates proopiomelanocortin (POMC) neurons in the arcuate nucleus of hypothalamus (ARH) to reduce appetite and weight gain. However, several 5-HT analogs targeting this receptor, e.g., lorcaserin (Lor), suffer from diminished efficacy to reduce weight after prolonged administration. Here, we show that barbadin (Bar), a novel β-arrestin/β2-adaptin inhibitor, can prevent 5-HT_2CR internalization in cells and potentiate long-term effects of Lor to reduce appetite and body weight in male mice. Mechanistically, we demonstrate that Bar co-treatment can effectively maintain the sensitivity of the 5-HT_2CR in POMC^ARH neurons, despite prolonged Lor exposure, thereby allowing these neurons to be activated through opening the transient receptor potential cation (TRPC) channels. Thus, our results prove the concept that inhibition of 5-HT_2CR desensitization can be a valid strategy to improve the long-term weight loss effects of Lor or other 5-HT_2CR agonists, and also provide an intellectual framework to develop effective long-term management of weight by targeting 5-HT_2CR desensitization.SIGNIFICANCE STATEMENT By demonstrating that the combination of barbadin (Bar) with a G-protein-coupled receptor (GPCR) agonist can provide prolonged weight-lowering benefits in a preclinical setting, our work should call for additional efforts to validate Bar as a safe and effective medicine or to use Bar as a lead compound to develop more suitable compounds for obesity treatment. These results prove the concept that inhibition of serotonin 2C receptor (5-HT_2CR) desensitization can be a valid strategy to improve the long-term weight loss effects of lorcaserin (Lor) or other 5-HT_2CR agonists. Since GPCRs represent a major category as therapeutic targets for various human diseases and desensitization of GPCRs is a common issue, our work may provide a conceptual framework to enhance effects of a broad range of GPCR medicines.     

Collateral Effects of Behavioral Treatment for Problem Behavior on Caregiver Stress

Journal of Autism and Developmental Disorders - When individuals with autism and intellectual and developmental disabilities exhibit severe problem behavior, assessment and treatment are often...