A Higher Meal Frequency May be Associated with Diminished Weight Loss after Bariatric Surgery

OBJECTIVE

This study aimed to investigate the relationship between meal frequency, the occurrence of vomiting and weight loss among patients submitted to Roux-en-Y gastric bypass up to 9 months after surgery.

METHODS

Female patients (n = 80) were followed at 3-month intervals for 9 months. Weight, BMI, 24-hour dietary recall, drug consumption and vomiting episodes were recorded and compared with nutritional outcome.

RESULTS

The BMI values at 3, 6 and 9 months were 45.1 ± 9.7, 39.9 ± 7.6 and 35.4 ± 8.2 kg/m², respectively. The corresponding choleric intakes were 535.6 ± 295.7, 677.1 ± 314.7 and 828.6 ± 398.2 kcal/day, and the numbers of daily meals were 5.0 ± 2.5, 4.7 ± 1.8 and 4.9 ± 1.0, respectively. The peak of vomiting episodes occurred within 6 months; however, patients tolerated this complication despite its high prevalence. A significant negative correlation between weight loss and diet fractioning, but not vomiting, was observed throughout the entire postoperative period (P = 0.001).

CONCLUSIONS

1) Frequent small meals were associated with a reduction in weight loss after gastric bypass and a decrease in vomiting episodes at 6 months, and 2) vomiting did not interfere with nutritional outcome. Unless required because of vomiting or other reasons, multiple small meals may not be advantageous after such intervention.     

Clinical Experience of Weight Loss Surgery in Morbidly Obese Korean Adolescents

Purpose

Comprehensive multidisciplinary weight management programs encompassing various conservative measures have shown only modest weight loss results in obese children and adolescents; therefore, bariatric surgery for this population has become a matter of discussion. This study aimed to present our experience with and outcomes for laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in morbidly obese Korean adolescents.

Materials and Methods

The prospectively established database of all patients undergoing bariatric surgery at Soonchunhyang University Seoul Hospital, Korea between January 2011 and January 2013 was retrospectively reviewed. Adolescents aged 14 to 20 years were included in the present analyses.

Results

Twenty-two adolescents underwent bariatric surgery during the study period; 14 underwent LSG and 8, LRYGB. Of these, 17 were female and 5 were male. The mean age was 19 years. Their mean body weight and body mass index (BMI) before surgery were 115 kg and 40.1 kg/m². The only postoperative complication was intraluminal bleeding in 1 patient, which was managed conservatively. The mean BMI decreased to 29.1 kg/m² after a mean follow-up of 10 months. The percent excess weight loss (%EWL) at 1, 3, 6, and 12 months postoperatively were 19.6, 39.9, 52.6, and 74.2%, respectively. Only 1 patient showed %EWL less than 30% at 12 months after surgery. All patients with diabetes and sleep apnea were cured of their disease, and other comorbidities also improved or resolved after surgery.

Conclusion

Bariatric surgery leads to significant short-term weight loss along with resolution of obesity-related comorbidities in obese children and adolescents.     

Replication and Extension of the Weight Loss For Life Community-Based Treatment Protocol

Maintaining weight-loss beyond 6–9 months within behavioral treatments has been problematic. However, a social cognitive theory-driven, community-based curriculum emphasizing the generalization of physical activity-related self-regulation, to eating-related self-regulation (phase 1 treatment; n = 55), demonstrated success at both inducing lost weight over its initial 6 months, and maintaining that loss through month 24. The present replication study contrasted those outcomes with a phase 2 version of the year-long treatment (n = 74) that added a follow-up component during year 2 consisting of 5 brief phone interactions to reinforce self-regulatory skills. Participants were all women with obesity (body mass index 30–40 kg/m²; mean age = 48 years). In phase 2, the mean weight loss of 6.3% during baseline-month 6, and regain of 0.7% through month 24, did not significantly differ from phase 1. However, phase 2 methods were associated with significantly better retention of improvements in self-regulation, fruit/vegetable intake, and physical activity. For phase 2 results, second-year change in fruit/vegetable consumption completely mediated the significant relationship between self-regulation and weight change, and change in physical activity completely mediated the significant relationship between self-regulation and weight change, over the 2-year study. Findings suggest the importance of moderate physical activity and more intensive follow-up focused on self-regulation processes.     

A Randomized Pilot Study of a Phone-Based Mindfulness and Weight Loss Program

ABSTRACT

This study evaluated the feasibility and efficacy of integrating mindfulness training into a phone-based weight loss program to improve outcomes in those with high levels of emotional eating. Participants were 75 enrollees into an employer-sponsored weight loss program who reported high levels of overeating in response to thoughts and feelings. Seventy-five overweight and obese participants (92% female, 65% Caucasian, aged 26 to 68 years) were randomized to the new mindfulness weight loss program (n = 50) or the standard behavioral weight loss program (n = 25). Both programs consisted of 11 coaching calls with health coaches and registered dietitians with supplemental online materials. Satisfaction, engagement, and percent weight lost did not significantly differ for intervention vs. control at six months. Intervention participants had significantly better scores at six-month follow-up on mindful eating, binge eating, experiential avoidance, and one mindfulness subscale. Exploratory analyses showed that improvements on several measures predicted more weight loss in the intervention group. This pilot study found that integrating mindfulness into a brief phone-based behavioral weight loss program was feasible and acceptable to participants, but did not produce greater weight loss on average, despite hypothesized changes in mindful eating. Only one third of intervention participants reported participating in mindfulness exercises regularly. Mechanisms of change observed within the intervention group suggest that for adults with high levels of emotional eating those who embrace mindful eating and meditation may lose more weight with a mindfulness intervention.     

Effectiveness of Web-Based Self-Disclosure Peer-to-Peer Support for Weight Loss: Randomized Controlled Trial

Background

Obesity is one of the most common public health problems in the industrialized world as a cause of noncommunicable diseases. Although primarily used for one-on-one communication, email is available for uninterrupted support for weight loss, but little is known about the effects of dietitian group counseling for weight control via the Internet.

Objective

We developed a Web-based self-disclosure health support (WSHS) system for weight loss. This study aims to compare the effect of weight change between those using the WSHS and those using the email health support (EHS).

Methods

This study was designed as an open prospective individual randomized controlled trial. Eligible participants were aged 35 to 65 years with a body mass index (BMI) of ≥25.0 in their latest health examination. Participants were randomly assigned to either the WSHS group or the EHS group. Thirteen registered dietitians under the direction of a principal dietitian each instructed 6 to 8 participants from the respective groups. All participants in the WSHS group could receive nutritional advice and calculate their nutritive intake from a photograph of a meal on their computer screen from the Internet sent to them by their dietitian, receive supervision from the registered dietitian, and view fellow participants’ weight changes and lifestyle modifications. In the EHS group, a participant could receive one-on-one nutritional advice and calculate his/her nutritive intake from the photograph of a meal on computer screen sent by email from his/her dietitian, without being able to view fellow participants’ status. The follow-up period was 12 weeks for both groups. The primary outcome measure was change in body weight. The secondary outcome measure included changes in BMI and waist circumference. The intergroup comparison of the changes before and after intervention was evaluated using analysis of covariance.

Results

A total of 193 participants were randomly assigned to either the WSHS group (n=97) or the EHS group (n=96). Ten from the WSHS group and 8 from the EHS group dropped out during the study period, and the remaining 87 in the WSHS group and 88 in the EHS group were followed up completely. Weight loss was significantly greater in the WSHS group than in the EHS group (–1.6 kg vs –0.7 kg; adjusted P=.04). However, there were few differences in waist circumference between the 2 groups. (–3.3 cm vs –3.0 cm; adjusted P=.71).

Conclusions

Our newly developed WSHS system using forced self-disclosure had better short-term weight loss results. Further study in a longer-term trial is necessary to determine what effects this type of intervention might have on long-term cardiovascular disease.

Trial Registration

University Hospital Medical Information Network Clinical Trial Registration (UMIN-CTR): UMIN000009147; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000010719&language=E (Archived by WebCite at http://www.webcitation.org/6HTCkhb1p).     

Determinants of Successful Weight Loss After Using a Commercial Web-Based Weight Reduction Program for Six Months: Cohort Study

Background

The Internet is widely available and commonly used for health information; therefore, Web-based weight loss programs could provide support to large parts of the population in self-guided weight loss. Previous studies showed that Web-based weight loss interventions can be effective, depending on the quality of the program. The most effective program tools are visual progress charts or tools for the self-monitoring of weight, diet, and exercises. KiloCoach, a commercial program currently available in German-speaking countries, incorporates these features. A previous investigation showed that the program effectively supports users in losing weight.

Objective

We investigated weight loss dynamics stratified by weight loss success after 6-month use of KiloCoach. Furthermore, we analyzed possible associations between intensity of program use and weight loss. The results are intended for tailoring user recommendations for weight-loss Internet platforms.

Methods

Datasets of KiloCoach users (January 1, 2008 to December 31, 2011) who actively used the platform for 6 months or more were assigned to this retrospective analysis. Users (N=479) were 42.2% men, mean age of 44.0 years (SD 11.7), with a mean body mass index (BMI) of 31.7 kg/m² (SD 3.2). Based on the weight loss achieved after 6 months, 3 success groups were generated. The unsuccessful group lost <5%, the moderate success group lost 5%-9.9%, and the high success group lost ≥10% of their baseline body weight. At baseline, the unsuccessful (n=261, 54.5%), moderate success (n=133, 27.8%), and high success (n=85, 17.8%) groups were similar in age, weight, BMI, and gender distribution.

Results

After 6 months, the unsuccessful group lost 1.2% (SD 2.4), the moderate success group lost 7.4% (SD 1.5), and the high success group lost 14.2% (SD 3.8) of their initial weight (P<.001). Multivariate regression showed that early weight loss (weeks 3-4), the total number of dietary protocols, and the total number of weight entries were independent predictors for 6-month weight reduction (all P<.001) explaining 52% of the variance in weight reduction. Sensitivity analysis by baseline carried forward method confirmed all independent predictors of 6-month weight loss and reduced the model fit by only 11%. The high success group lost weight faster and maintained weight loss more efficiently than the other groups (P<.001). Early weight loss was associated with weight maintenance after 1 year and 2 years (both P<.001). Weight dynamics did not differ between men and women over 6 months when adjusted for baseline and usage parameters (P=.91). The percentage of male long-term users was unusually high (42.2%).

Conclusions

Our results suggest that early weight loss and close program adherence (ie, 5 dietary protocols per week and weekly entering of current weight), especially in the early phase of program usage, can improve weight loss outcome.     

Self-Directed Interventions to Promote Weight Loss: A Systematic Review of Reviews

Background

A wide range of self-directed weight-loss interventions are available, providing users with a variety of tools delivered through various formats to regulate weight-related behavior patterns. However, it is unclear how effective self-directed interventions are and how they promote weight loss and weight maintenance.

Objective

A systematic review of reviews was conducted to examine the effectiveness of such interventions and to identify intervention content associated with effectiveness.

Methods

MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library for systematic reviews were searched from 2000-2012 for reviews of the effectiveness of self-directed interventions on weight loss and weight maintenance in adults. Two reviewers used predefined inclusion criteria to select relevant reviews and assess their quality using the Overview Quality Assessment Questionnaire (OQAQ). We extracted data on effectiveness and on relationships between intervention characteristics and effectiveness.

Results

Twenty reviews were included and quality assessed. Findings relevant to self-directed interventions, including interactive websites, smartphone applications, and text messaging (short message service, SMS) were summarized. Findings were mixed but promising. For example, one review of Internet-based interventions found that, when used in conjunction with standard weight loss programs, these interventions resulted in a significant average increase in weight loss of 1.5 kg over evaluation periods. Unfortunately, only 7 of 20 reviews were of high methodological quality according to OQAQ scores, and only 4 employed meta-analyses. Few reviews linked intervention content to effectiveness.

Conclusions

Current evidence suggests that self-directed interventions can independently promote weight loss and can augment interventions involving personal contact. Particular change techniques and delivery modes including individualized feedback, email counseling, and online social support appear to enhance effectiveness. Further reviews of the content of self-directed weight-loss intervention studies are needed to clarify which change techniques delivered through which delivery formats optimize intervention effectiveness.     

Barriers to and Facilitators of Participation in Weight Loss Intervention for Patients with Suboptimal Weight Loss after Bariatric Surgery: A Qualitative Study among Patients,Physicians, and Therapists

IntroductionNot all patients with suboptimal weight loss after bariatric surgery are willing to participate in postoperative behavioral intervention to improve their weight loss. The objective of this study was to explore barriers to and facilitators of participation in postoperative behavioral intervention.MethodsThirty semi-structured interviews were conducted with patients (18), physicians (6), and therapists (6) (i.e., psychologists, dieticians, or physiotherapists). A thematic analysis approach was used.ResultsEmotional responses caused by confrontation with suboptimal weight loss hampered patients'' deliberation about participation; insufficient exploration of their need for help limited patients'' ability to make informed decisions; patients were receptive to their physician''s advice when their physician respected their autonomy; using visual weight loss graphs helped to explain suboptimal weight loss to patients; and financial costs and time constraints obstructed participation.ConclusionsTo improve adequate intervention participation, healthcare providers should focus on emotion regulation, support patients in exploring their own need for help, and respect patients'' autonomy.     

The Maintenance of Treatment Effects in the Long-Term Management of Obesity

This article reviews the efficacy of strategies designed to improve the maintenance of treatment effects in the long-term management of obesity. Included are the results from controlled trials that evaluated strategies such as extended therapy, relapse prevention training, monetary incentives, food provision, and peer support as well as the use of very-low-calorie diets and phar-macotherapy. Improved maintenance of weight loss was observed in behavior therapy extended beyond 6 months and in long-term pharmacotherapy (dexfenfl-uramine or the combination of fenfluramine + phentermine) used in conjunction with behavior therapy or dietary counseling. Following the termination of long-term therapy, a regaining of weight was observed across all treatment modalities. These findings are discussed in terms of a "continuous-care" model of obesity management.     

Effect of a Web-Based Behavior Change Program on Weight Loss and Cardiovascular Risk Factors in Overweight and Obese Adults at High Risk of Developing Cardiovascular Disease: Randomized Controlled Trial

BackgroundWeb-based programs are a potential medium for supporting weight loss because of their accessibility and wide reach. Research is warranted to determine the shorter- and longer-term effects of these programs in relation to weight loss and other health outcomes.ObjectiveThe aim was to evaluate the effects of a Web-based component of a weight loss service (Imperative Health) in an overweight/obese population at risk of cardiovascular disease (CVD) using a randomized controlled design and a true control group.MethodsA total of 65 overweight/obese adults at high risk of CVD were randomly allocated to 1 of 2 groups. Group 1 (n=32) was provided with the Web-based program, which supported positive dietary and physical activity changes and assisted in managing weight. Group 2 continued with their usual self-care (n=33). Assessments were conducted face-to-face. The primary outcome was between-group change in weight at 3 months. Secondary outcomes included between-group change in anthropometric measurements, blood pressure, lipid measurements, physical activity, and energy intake at 3, 6, and 12 months. Interviews were conducted to explore participants’ views of the Web-based program.ResultsRetention rates for the intervention and control groups at 3 months were 78% (25/32) vs 97% (32/33), at 6 months were 66% (21/32) vs 94% (31/33), and at 12 months were 53% (17/32) vs 88% (29/33). Intention-to-treat analysis, using baseline observation carried forward imputation method, revealed that the intervention group lost more weight relative to the control group at 3 months (mean –3.41, 95% CI –4.70 to –2.13 kg vs mean –0.52, 95% CI –1.55 to 0.52 kg, P<.001), at 6 months (mean –3.47, 95% CI –4.95 to –1.98 kg vs mean –0.81, 95% CI –2.23 to 0.61 kg, P=.02), but not at 12 months (mean –2.38, 95% CI –3.48 to –0.97 kg vs mean –1.80, 95% CI –3.15 to –0.44 kg, P=.77). More intervention group participants lost ≥5% of their baseline body weight at 3 months (34%, 11/32 vs 3%, 1/33, P<.001) and 6 months (41%, 13/32 vs 18%, 6/33, P=.047), but not at 12 months (22%, 7/32 vs 21%, 7/33, P=.95) versus control group. The intervention group showed improvements in total cholesterol, triglycerides, and adopted more positive dietary and physical activity behaviors for up to 3 months verus control; however, these improvements were not sustained.ConclusionsAlthough the intervention group had high attrition levels, this study provides evidence that this Web-based program can be used to initiate clinically relevant weight loss and lower CVD risk up to 3-6 months based on the proportion of intervention group participants losing ≥5% of their body weight versus control group. It also highlights a need for augmenting Web-based programs with further interventions, such as in-person support to enhance engagement and maintain these changes.

Trial Registration

ClinicalTrials.gov NCT01472276; http://clinicaltrials.gov/ct2/show/study/NCT01472276 (Archived by Webcite at http://www.webcitation.org/6Z9lfj8nD).     

低分子肝素对大鼠创伤性深静脉血栓形成中促细胞分裂原活化蛋白激酶通路的影响

观察低分子肝素治疗大鼠创伤性深静脉血栓形成的效果,从基因水平探讨低分子肝素治疗创伤性深静脉血栓形成的作用机制。将150只SD大鼠采用定量击打双侧大腿 双后肢石膏固定的方式造模,再将造模后5天有血栓形成的大鼠,随机分为药物治疗组和对照组,分别用低分子肝素和生理盐水进行干预,第一次干预后3h,各组随机取10只大鼠股静脉血管及其主要属支,采用Trizol一步法提取总RNA,运用Gene-chip Rat Genome 4302.0芯片测定股静脉RNA表达。倍数变化分析筛查出差异性表达基因,进一步行path-way分析。结果表明:对照组比较,药物组血栓消退率较高(x2=4.698,P<0.05);有1229个基因呈现差异性表达,该基因主要参与了MAKP、Ca2 、细胞因子及受体信号传导通路,参与MAPK通路的始动基因如IL1、TGF、FGF及其受体,末端效应基因如c-Junn、ur77、p53等均呈现上调。低分子肝素可调控促细胞分裂原活化蛋白激酶(MAPK)信号通路并影响血栓的预后。     

Effects of Dietary Self-Monitoring,Physical Activity,Liraglutide 3.0 mg,and Placebo on Weight Loss in the SCALE IBT Trial

IntroductionIndividuals who enroll in intensive behavioral therapy (IBT) programs are asked to make several lifestyle changes simultaneously. However, few studies have examined the relative effects of adherence to different treatment components on weight loss.ObjectiveThis secondary analysis of the SCALE IBT trial assessed adherence to the medication regimen, dietary self-monitoring, and physical activity recommendations and their relative contributions to weight change in individuals with obesity who were provided with IBT combined with either liraglutide 3.0 mg or placebo.MethodsSCALE IBT was a double-blinded, multicenter, randomized controlled trial comparing 56-week weight losses in individuals with obesity who received liraglutide 3.0 mg (n = 142) or placebo (n = 140), as an adjunct to IBT. Adherence to dietary self-monitoring, physical activity, and medication usage (liraglutide or placebo) were measured during the 56-week treatment period. A regression model was used to estimate the relative contribution of adherence to each treatment component to weight loss at week 56.ResultsThe proportion of individuals who adhered to each intervention component decreased over time. Compared with non-adherence, complete adherence to dietary self-monitoring and physical activity recommendations were associated with estimated weight changes of −7.2% (95% CI −10.4 to −4.0; p < 0.0001) and −2.0% (95% CI −3.2 to −0.8; p = 0.0009), respectively. Complete adherence to liraglutide predicted an additional weight loss of −6.5% (95% CI −10.2 to −2.9; p = 0.0005) relative to individuals who did not adhere to the medication regimen, while adherence to placebo did not have a statistically significant effect on weight loss (p = 0.33).ConclusionsHigh adherence to dietary self-monitoring and use of liraglutide 3.0 mg was associated with clinically relevant weight loss with IBT and adjunctive pharmacotherapy. The effect of adherence to physical activity was significant but smaller.     

The Recuperative Effects of REM Sleep and Stage 4 Sleep on Human Performance After Complete Sleep Loss: Experiment 1

Twelve young (17–21 yrs) male Navy recruits volunteered for a sleep loss study. After 4 baseline days, the Ss were completely deprived of sleep for 2 days and nights. Next followed an experimental phase of 2 days and nights after which all Ss received 2 nights of uninterrupted sleep. During the experimental phase, the 4 Ss in the REM-deprived group were aroused whenever they showed signs of REM sleep. The 4 Ss of the stage 4-deprived group were aroused whenever they showed signs of entering stage 4 sleep, and the 4 Ss of the Control group had uninterrupted sleep. All tests (speed and accuracy of addition, speed and accuracy of self-paced vigilance, errors of omission in experimenter paced vigilance, immediate recall of word lists, and mood) showed significant impairment after the first night of complete sleep loss. But during the experimental (sleep-stage-deprivation) and recovery phases, all three groups showed equal rates of recovery. Depriving the S of stage REM or stage 4 during recovery sleep does not affect the recuperation rate. Frequent arousals (50–100 per night) also do not impair recovery. The amount of sleep is probably more important than the kind of sleep.