Long-term weight maintenance after an intensive weight-loss program

OBJECTIVE: This prospective study assessed long-term weight maintenance of patients completing an intensive very-low-calorie diet (VLCD) weight-loss program. SUBJECTS: Individuals who had completed the 12-week core education program and lost > or = 10 kg were recruited. RESULTS: Of 154 eligible subjects, follow-up weights were obtained at > or = 2 years in 112 subjects (72.7%, 72 women, 40 men). Subjects had an average initial body mass index of 37.3 kg/m2 and an average weight loss of 29.7 kg in five months. Six hundred and forty-five follow-up weights (median, five per subject) were obtained over two to seven years of follow-up from clinic visits (70%) and self-report by telephone or mail (30%). Subjects regained an average of 2.5% per month of their lost weight during the first two to three years of follow-up; however, their weight stabilized over the next four years. Subjects regained an average of 73.4% of their weight loss during the first three years. The average weight loss maintained for 112 subjects was 22.8% of initial weight loss after an average of 5.3 years of follow-up. When successful weight maintenance was defined as maintaining a weight loss of 5% or 10% of initial (pre-treatment) body weight, 40% were maintaining a 5% weight loss at five years and 25% were maintaining a weight loss of 10% at 7 years. Multiple regression analyses suggested that age had a significant (p=0.004) and positive effect on weight maintenance. CONCLUSIONS: This study suggests that weight maintenance after an intensive VLCD program is improving but still needs intensive efforts to enable most individuals to maintain a substantial percentage of their weight loss long-term.     

Dietary intakes associated with successful weight loss and maintenance during the Weight Loss Maintenance trial

Background

Dietary components effective in weight maintenance efforts have not been adequately identified.

Objective

To determine the effects of changes in dietary consumption on weight loss and maintenance during the Weight Loss Maintenance clinical trial.

Design

Weight Loss Maintenance was a randomized controlled trial. Successful weight loss participants who completed Phase I of the trial and lost 4 kg were randomized to one of three maintenance intervention arms in Phase II and followed for an additional 30 months.

Participants/setting

The multicenter trial was conducted from 2003 through 2007. This substudy included 828 successful weight loss participants.

Methods

The Block Food Frequency Questionnaire (FFQ) was used to assess nutrient intake levels and food group servings. Carbohydrates, proteins, fats, dietary fiber, fruit/vegetable, and dairy servings were utilized as predictor variables. The FFQ was collected on all participants at study entry (beginning of Phase I). Those randomized to Phase II completed the FFQ at three additional time points: randomization (beginning of Phase II), 12 months, and 30 months.

Intervention

The main intervention focused on long-term maintenance of weight loss using the Dietary Approaches to Hypertension diet. This substudy examined if changes to specific dietary variables were associated with weight loss and maintenance.

Statistical analyses performed

Linear regression models that adjusted for change in total energy examined the relationship between changes in dietary intake and weight for each time period. Site, age, race, sex, and a race–sex interaction were included as covariates.

Results

Participants who substituted protein for fat lost, on average, 0.33 kg per 6 months during Phase I (P<0.0001) and 0.07 kg per 6 months during Phase II (P<0.0001) per 1% increase in protein. Increased intake of fruits and vegetables was associated with weight loss in Phases I and II: 0.29 kg per 6 months (P<0.0001) and 0.04 kg per 6 months (P=0.0062), respectively, per 1-serving increase. Substitution of carbohydrates for fat and protein for carbohydrates were associated with weight loss during both phases. Increasing dairy intake was associated with significant weight loss during Phase II (−0.17 kg per 6 months per 1-serving increase, P=0.0002), but not during Phase I. Dietary fiber revealed no significant findings.

Conclusions

Increasing fruits, vegetables, and low-fat dairy may help achieve weight loss and maintenance.     

Weight loss maintenance 1 year after individual counseling

Many individual and group weight loss programs can boast short-term success. There has been little documentation on the long-term success of any particular program. A study was conducted to examine total weight loss for individually counseled patients seen in a hospital outpatient nutrition clinic February to October 1986. All patients who lost weight were contacted via telephone 1 year later to ascertain weight loss maintenance. During this period, 157 patients were seen. In an average of five visits, 119 (75%) lost an average of 9 lb. One year later, 73 (61%) of these patients were contacted, 54 of whom (74%) reported that they had either maintained or lost additional weight during the year. Sixteen (30%) of these 54 individuals lost additional weight during the year--an average of 13 additional lb. Results were similar for men and women. Although based on a small sample size, the results suggest that weight loss counseling can be successful in maintaining as well as losing weight. Such results should encourage dietetic practitioners to track their own patients for long-term results and to share the results with physicians, administrators, and insurers who are concerned about whether their money has been well spent.     

Weight loss goals of patients in a health maintenance organization

Individuals seeking weight loss treatment endorse unrealistic expectations regarding their goals for weight loss, although these conclusions are primarily based on research conducted in obesity specialty clinics and/or controlled clinical trials. This study examined the weight loss goals and predictors of these goals among patients participating in obesity treatment in an applied, clinical setting (i.e., managed care organization). Managed care patients enrolled in a behavioral weight loss program (N = 143; mean age = 46.8 years; mean BMI = 36.9 kg/m²; 89.5% female; 64.5% Caucasian) completed a self-report survey during an initial weight loss session. The survey included items assessing patients' weight loss expectations, including goals for dream, happy, acceptable, and disappointed weights. Participants completed questions regarding contacts with their primary care physician and physician provision of weight loss counseling and/or referrals. They also provided values for current height and weight. BMI's and weight loss associated with dream, happy, acceptable, and disappointed weight goals were 24.8 kg/m² (30.9% loss), 27.1 kg/m² (25.2% loss), 29.3 kg/m² (19.7% loss), and 33.0 kg/m² (10.4% loss), respectively. There were significant gender differences in weight loss goals, with women endorsing more unrealistic goals than men for dream and happy weights, ps < 0.001. Significant predictors of all four weight loss goals included baseline BMI, gender, ethnicity, and frequency of visits with one's primary care physician, ps < 0.01. Consistent with previous research, patients participating in a weight loss program implemented in a managed care setting endorsed unrealistic expectations for weight loss. However, more frequent contact with one's primary care physician was associated with more realistic goals. Future, longitudinal research is needed to document the discrepancy between these goals and actual weight loss achieved in such settings as well as to determine whether excessive goals are associated with diminished treatment outcomes.     

Use of MyPyramid Menu Planner for Moms in a weight-loss intervention during lactation

The Internet offers a valuable resource for promotion of healthy eating and Web-based communication between the dietetics practitioner and client. In a 16-week intervention examining the effects of energy restriction (500 kcal/day) and exercise on body composition in overweight/obese lactating women, MyPyramid Menu Planner for Moms was used to support dietary counseling. Random assignment occurred at 4 weeks postpartum to either an Intervention group (n=14) or Minimal Care group (n=13) from 2008 through 2010. Three 24-hour dietary recalls were obtained using the Nutrition Data System at 4 and 20 weeks postpartum. Individual MyPyramid Menu Planner accounts were created for the Intervention group and used in face-to-face dietary counseling. Repeated measures analysis of variance was used to test for differences between groups for change in dietary intake and weight. Changes in energy, saturated fat, and percent of energy from added sugars were significantly different between Intervention group and Minimal Care group (-613 [521] kcal vs -171 [435] kcal; P=0.03; -14.9 [14.0] g vs +0.9 [13.4] g; P<0.01; and -3.5% [5.3%] vs +2.2% [4.8%]; P<0.01, respectively). The Intervention group significantly increased their whole fruit servings and decreased their total grain and milk servings compared with the Minimal Care group (P<0.05). The Intervention group lost significantly more weight (-5.8 [3.5] kg) than the Minimal Care group (-1.6 [5.4] kg) (P=0.03). Although participants must have access to an Internet-based computer and possess basic food knowledge, these results suggest MyPyramid Menu Planner might prove to be an effective dietary counseling support tool for improving dietary intake and promoting weight loss during lactation.     

Effects of fruit consumption on body mass index and weight loss in a sample of overweight and obese dieters enrolled in a weight-loss intervention trial

ObjectiveFruit and vegetable consumption is an important part of a healthy diet and assumed to aid in the reduction of energy intake and body weight. Fruits and vegetables may display differential effects on weight and weight loss; however, the effects of the two food groups have rarely been investigated separately.MethodsThe present study focused on the effects of fruit consumption on body weight and weight loss in a sample of 77 overweight and obese dieters enrolled in an intervention program. Food consumption was assessed at baseline by food diaries and after the introduction of nutrition software through electronic food records. Body weight and additional physiologic outcomes were assessed three times, once before the intervention and again at the 3- and 6-mo follow-ups.ResultsVegetable and fruit consumption differed in their associations with body weight and weight loss. Although vegetable consumption increased as a result of the intervention (P < 0.01), fruit consumption did not. However, only fruit consumption was associated with body mass index, showing an inverse relation with body weight in cross-sectional and longitudinal analyses (r = ?0.27 to ?0.44). The relation between fruit consumption and body weight remained significant after controlling for age, gender, physical activity level, and daily macronutrient consumption (ΔR² = 0.06–0.13). Further, increases in fruit consumption were associated with subsequent weight loss, controlling for the same covariates (ΔR² = 0.05–0.07).ConclusionThe results indicate unique contributions of fruit consumption to the management of body weight and indicate that a separation of effects for fruit and vegetable food groups may be warranted.     

Latent class growth analysis successfully identified subgroups of participants during a weight loss intervention trial

IntroductionWeight loss interventions often present small mean weight changes over time, despite the fact that a substantial proportion of the participants lost more weight. This effect is often leveled out by the substantial proportion of participants who gained weight during the trial. The aim of this study is to identify and describe distinct subgroups of participants with different weight change trajectories during and after a weight loss intervention.MethodsWe used data from a weight loss intervention that was part of a randomized controlled trial on the preventive effect of a tailor-made weight loss intervention and oral glucosamine sulfate on the incidence of knee osteoarthritis in 407 overweight women aged 50 to 60 years. Latent class growth analysis (LCGA) was used to identify subgroups of participants with different weight change trajectories over time.ResultsUsing LCGA, we identified three subgroups with different trajectories of weight change, one large group (n = 298) with almost no change over time, and two smaller groups (both n = 48), of which one represents participants who steadily gained weight over time, whereas the other represents participants who steadily lost weight over time. Participants that had relatively low body weight around their 40th year of life and that gained weight in the year preceding the study were most likely to belong to the group that lost weight.ConclusionLCGA was a suitable method to identify three distinct groups of participants with different trajectories of weight change. Low body weight at age 40 and weight gain in the year preceding the study were associated with a higher chance of membership of the group that lost weight. It seems weight loss that occurred during this weight loss intervention was mostly recently gained weight.     

Fluoxetine: a randomized clinical trial in the maintenance of weight loss

Because current weight-reduction treatments have considerable recidivism, a therapy that could help patients maintain weight loss would be of benefit. A six-center, randomized, double-blind trial compared the effects of the specific serotonin uptake inhibitor, fluoxetine hydrochloride, and placebo on maintenance of weight loss. Obese outpatients who had lost > or = 3.6 kg after 8 weeks of single-blind fluoxetine 60 mg/day in the qualification phase (N=317 [70.4% of patients entered]; mean +/- standard deviation [SD] weight loss, 6.8 +/- 2.8 kg) were randomly assigned to fluoxetine 20 mg/day (N=104), fluoxetine 60 mg/day (N=106), or placebo (N=107) for 40 weeks (maintenance phase). Patients received minimal nutrition/dietary counseling. Qualification phase clinic visits were biweekly; maintenance phase visits were monthly for 4 months, then bimonthly for 6 months. Patients treated with fluoxetine 60 mg/day continued to lose weight for 8 additional weeks (16 weeks total; maximum mean +/- SD weight loss, 7.2 +/- 4.6 kg); those treated with fluoxetine 20 mg/day or placebo began to regain weight. Mean weights remained below baseline values at week 48 (all groups); treatment differences were not statistically significant. Study completion rates were comparable (fluoxetine 20 mg/day, 67.3%; fluoxetine 60 mg/day, 56.6%; placebo, 67.3%; p = 0.175). Among commonly reported adverse events (> 10% incidence), only asthenia was reported statistically significantly (p < 0.050) more frequently with fluoxetine than with placebo. Few patients discontinued for any single adverse event. Fluoxetine 60 mg/day was effective for a longer period than fluoxetine 20 mg/day or placebo in maintaining weight loss. Overall, fluoxetine was safe and well tolerated.     

Long-term weight-loss maintenance: a meta-analysis of US studies.

BACKGROUND: Current perception is that participants of a structured weight-loss program regain all of their weight loss within 5 y. OBJECTIVE: The objective was to examine the long-term weight-loss maintenance of individuals completing a structured weight-loss program. DESIGN: Studies were required to 1) have been conducted in the United States, 2) have included participants in a structured weight-loss program, 3) have provided follow-up data with variance estimates for > or =2 y. Primary outcome variables were weight-loss maintenance in kilograms, weight-loss maintenance as a percentage of initial weight loss, and weight loss as a percentage of initial body weight (reduced weight). RESULTS: Twenty-nine studies met the inclusion criteria. Successful very-low-energy diets (VLEDs) were associated with significantly greater weight-loss maintenance than were successful hypoenergetic balanced diets (HBDs) at all years of follow-up. The percentage of individuals at 4 or 5 y of follow-up for VLEDs and HBDs were 55.4% and 79.7%, respectively. The results for VLEDs and HBDs, respectively, were as follows: weight-loss maintenance, 7.1 kg (95% CI: 6.1, 8.1 kg) and 2.0 (1.5, 2.5) kg; percentage weight-loss maintenance, 29% (25%, 33%) and 17% (13%, 22%); and reduced weight, 6.6% (5.7%, 7.5%) and 2.1% (1.6%, 2.7%). Weight-loss maintenance did not differ significantly between women and men. Six studies reported that groups who exercised more had significantly greater weight-loss maintenance than did those who exercised less. CONCLUSIONS: Five years after completing structured weight-loss programs, the average individual maintained a weight loss of >3 kg and a reduced weight of >3% of initial body weight. After VLEDs or weight loss of > or =20 kg, individuals maintained significantly more weight loss than after HBDs or weight losses of <10 kg.     

Weight loss in women participating in a randomized trial of low-fat diets

We examined weight changes over 1 and 2 y in 303 women enrolled in a low-fat dietary-intervention trial. Participants were randomly assigned to an intervention group that received intensive instruction in maintaining a low-fat diet or to a control group. After 1 y intervention-group women had decreased fat intake by 45.3 g (from 39.2% to 21.6% energy from fat) and weight by 3.1 kg (all P less than 0.0001); control-group women decreased fat intake by 8.8 g (from 38.9% to 37.3% energy from fat) and weight by 0.4 kg. In both univariate analyses and multivariate models, weight loss was more strongly associated with change in percent energy from fat than with change in total energy intake. These data, which are consistent with both epidemiologic and clinical studies, suggest that body adiposity is a function both of energy balance and the proportion of energy derived from fat.     

美沙酮社区药物维持治疗门诊病人心理干预现状分析

目的对美沙酮社区药物维持治疗门诊病人的心理干预现状进行分析,并评价其心理功能。方法采用随机抽样方法调查了293名美沙酮社区维持治疗门诊病人。结果维持治疗病人中仅有19.8%的病人接受过心理干预,其获得心理干预的主要途径为维持治疗门诊,接受过心理干预与未接受过心理干预的病人,心理功能评分无明显差异。结论现有心理干预模式对改变维持治疗病人的心理功能作用不明显。     

Weight loss during prolonged lactation in rural Bangladeshi mothers

To determine the duration of lactation which is associated with weight loss in rural Bangladeshi mothers and also to determine the relationship with consumption patterns of principal food items, a cross-sectional study was carried out among 791 lactating rural Bangladeshi mothers aged 18-40 years. Results were compared with 333 non-pregnant and non-lactating mothers of a similar age group. The duration of lactation was up to 60 months. The mean difference in body-weight and body mass index (BMI) of lactating mothers who breastfed their children up to 24 months was significantly lower compared to non-lactating mothers of the same age group, but no differences were observed for those who breastfed beyond 24 months. The frequency of consumption of principal food items was comparable between the non-lactating and the lactating mothers who breastfed beyond 24 months. Results of multiple linear regression analysis showed that body-weight of mothers was negatively correlated with 1-12 month(s) and 13-24 months of lactation after controlling for height, education, and food consumption (slope -1.04, p<0.05 and slope -1.23, p<0.05 respectively). Height and consumption of meat and milk were significantly positively correlated with body-weight (slope 0.53, p<0.001; slope 1.44, p<0.001; and slope 0.75, p<0.05 respectively). The study concluded that Bangladeshi women who breastfed up to 24 months were of lower weight than non-lactating mothers, most likely due to the effect of lactation. These mothers were not taking any additional foods during their lactating period. Based on the findings of the study, it is recommended that mothers consume additional energy-rich foods during the first 24 months of lactation to prevent weight loss.     

Weight loss intervention for obese older women: improvements in performance and function

OBJECTIVES: To determine the feasibility of a 3-month weight loss program for obese older women with short-term laboratory, performance, functional, and life quality outcomes. RESEARCH METHODS AND PROCEDURES: This was a pre- and postintervention design. Community-dwelling women (n = 26) > or =60 years old with BMI > or =30 were enrolled in a 3-month weight loss program promoting prudent diet, behavior modification, and physical activity. The primary emphasis of the program was on health, function, and quality of life. The approach was specifically tailored to older subjects through use of large-font instructional materials, supplementation of calcium and vitamin D, and moderate weight loss and physical activity goals. An initial assessment by a bariatric physician was followed by eight visits with a dietitian and a follow-up physician visit. Measurements included anthropometrics, body composition, laboratories, pedometer, physical performance, Short-Form 36 Health Status Survey (SF-36), Life Space Assessment, and dietary assessment. RESULTS: Eighteen participants completed the program. There was a significant decrease in mean body weight (100 +/- 15 vs. 96 +/- 18 kg, p = 0.006), with a mean weight loss of 4.3 +/- 5.5 kg (range -15.5 to +7.20 kg). Significant improvements were observed for diastolic blood pressure, total cholesterol, triglycerides, physical performance, pedometer-measured step counts, and step climb and descent. Self-rated physical functioning (SF-36 subscore) and vitality (SF-36 subscore) were also significantly improved. DISCUSSION: It is feasible for self-selected obese older women to achieve a moderate weight loss and increase in physical activity resulting in short-term improvements in laboratory, physical performance, self-reported function, vitality, and life quality outcomes.     

Depression scores predict adherence in a dietary weight loss intervention trial

Background & aims

Depression has a complex association with cardiometabolic risk, both directly as an independent factor and indirectly through mediating effects on other risk factors such as BMI, diet, physical activity, and smoking. Since changes to many cardiometabolic risk factors involve behaviour change, the rise in depression prevalence as a major global health issue may present further challenges to long-term behaviour change to reduce such risk. This study investigated associations between depression scores and participation in a community-based weight management intervention trial.

Methods

A group of 64 overweight (BMI > 27), otherwise healthy adults, were recruited and randomised to follow either their usual diet, or an isocaloric diet in which saturated fat was replaced with monounsaturated fat (MUFA), to a target of 50% total fat, by adding macadamia nuts to the diet. Subjects were assessed for depressive symptoms at baseline and at ten weeks using the Beck Depression Inventory (BDI-II). Both control and intervention groups received advice on National Guidelines for Physical Activity and adhered to the same protocol for food diary completion and trial consultations. Anthropometric and clinical measurements (cholesterol, inflammatory mediators) also were taken at baseline and 10 weeks.

Results

During the recruitment phase, pre-existing diagnosed major depression was one of a range of reasons for initial exclusion of volunteers from the trial. Amongst enrolled participants, there was a significant correlation (R = −0.38, p < 0.05) between BDI-II scores at baseline and duration of participation in the trial. Subjects with a baseline BDI ≥10 (moderate to severe depression symptoms) were more likely to dropout of the trial before week 10 (p < 0.001). BDI-II scores in the intervention (MUFA) diet group decreased, but increased in the control group over the 10-week period. Univariate analysis of variance confirmed these observations (adjusted R² = 0.257, p = 0.01). Body weight remained static over the 10-week period in the intervention group, corresponding to a relative increase in the control group (adjusted R² = 0.097, p = 0.064).

Conclusions

Depression symptoms have the potential to affect enrolment in and adherence to dietbased risk reduction interventions, and may consequently influence the generalisability of such trials. Depression scores may therefore be useful for characterising, screening and allocating subjects to appropriate treatment pathways.