Thomas A Wadden

University of Pennsylvania | UP · Perelman School of Medicine

Objective To explore the efficacy and safety of semaglutide 2.4 mg in people with overweight/obesity who were also being treated with antidepressants (ADs). Methods Across the Semaglutide Treatment Effect for People with obesity (STEP) 1–3 and 5 trials, adults with overweight/obesity and type 2 diabetes (STEP 2 only) were enrolled. People with sev...

Background It is not known whether behavioral weight loss can attenuate blood oxygen level-dependent responses to food stimuli. Objectives This randomized controlled trial assessed the effects of a commercially available behavioral weight loss program (WeightWatchers) compared to a wait-list control on blood-oxygen-level-dependent response to food...

The effects of tirzepatide, a glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, on weight reduction after successful intensive lifestyle intervention are unknown. This double-blind, placebo-controlled trial randomized (1:1) adults with body mass index ≥30 or ≥27 kg/m ² and at least one obesity-related compli...

Objective Experiences and internalization of weight stigma are associated with greater self‐reported psychological distress and symptoms of psychiatric disorders such as depression and anxiety. However, little is known about the extent to which individuals who have experienced and internalized weight stigma are diagnosed with or provided treatment...

12001 Background: Obesity is a poor prognostic factor in early breast cancer. The Breast Cancer Weight Loss (BWEL) trial (Alliance for Clinical Trials in Oncology A011401; NCT02750826) evaluates the impact of a WLI on invasive disease-free survival in breast cancer patients (pts) with a body mass index (BMI) ³27 kg/m ² . Here we report the impact o...

Objective: To test the long-term effects of a group-based, psychological intervention designed to reduce internalized weight stigma (IWS, i.e., self-stigma), delivered in combination with behavioral weight loss (BWL) treatment, compared to BWL alone. Method: Adults with obesity who had experienced and IWS (N = 105, Mage = 49 years, 90.5% women,...

Background/purpose: Obesity in midlife is an established risk factor for dementia. In middle-aged adults, elevated body mass index (BMI) is associated with lower neurocognition and smaller hippocampal volumes. It is unclear whether behavioral weight loss (BWL) can improve neurocognition. The purpose of this study was to evaluate whether BWL, compa...

Internalized weight stigma has gained increasing attention in empirical studies, though questions remain about the adequacy of existing measures. The current study utilized a mixed methods approach, including a novel semi-structured interview, to revisit the conceptualization of internalized weight stigma and explore in more depth the stereotypes a...

IntroductionIdentifying eating behaviors associated with suboptimal weight loss following bariatric surgery remains important. This study assessed the relationship between eating behaviors and weight loss following bariatric surgery in a racially diverse sample.Methods Participants were assessed before surgery and 6 and 12 months postoperatively, w...

Objective: This study evaluated the effect of once-weekly semaglutide 2.4 mg on 2-year control of eating. Methods: In STEP 5, adults with overweight/obesity were randomized 1:1 to semaglutide 2.4 mg or placebo, plus lifestyle modification, for 104 weeks. A 19-item Control of Eating Questionnaire was administered at weeks 0, 20, 52, and 104 in a...

Objective: (1) Examine weight changes in older adults (mean=76 yrs) with type 2 diabetes and overweight/obesity during the COVID-shutdown; (2) Compare the behavioral and psychosocial effects of the shutdown in those who had large weight losses (>5%); small weight losses (2-5%), remained weight stable (±2%) or gained weight (>2%). Methods: Look A...

Ariana M Chao,1,2 Jena Shaw Tronieri,2 Anastassia Amaro,3 Thomas A Wadden2 1Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA; 2Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; 3Division of Endocrinology, Diabetes and Metabo...

The STEP 5 trial assessed the efficacy and safety of once-weekly subcutaneous semaglutide 2.4 mg versus placebo (both plus behavioral intervention) for long-term treatment of adults with obesity, or overweight with at least one weight-related comorbidity, without diabetes. The co-primary endpoints were the percentage change in body weight and achie...

Background: There is growing interest in identifying factors associated with healthy aging. This cross-sectional study evaluated associations of psychological resilience with factors associated with aging in older adults with type 2 diabetes mellitus (T2DM). Methods: Participants were 3199 adults (72.2 ± 6.2 years of age, 61% female, 61% White,...

Studies comparing individuals with loss of control (LOC) eating who do and do not have objectively large binge episodes have found that degree of LOC is more important than binge size to psychological and behavioral outcomes. However, the relative importance of these characteristics has not been investigated in a population with binge eating disord...

Objective: To assess the efficacy of liraglutide 3.0 mg, a glucagon-like peptide-1 (GLP-1) receptor agonist, for binge eating disorder (BED). Methods: Adults with a body mass index (BMI) ≥ 27 kg/m2 enrolled in a pilot, 17-week double-blind, randomized controlled trial of liraglutide 3.0 mg/day for BED. The primary outcome was number of objective...

Individuals with a higher body weight are the targets of pervasive social stigma. This stigma can become self-directed or internalized, leading to self-devaluation due to weight. Internalized weight stigma is associated with adverse outcomes for mental and physical health, yet little is known about how to prevent or diminish this internalization. T...

This study assessed the relationships between binge eating disorder (BED) and eating self‐efficacy in a sample of patients prior to bariatric surgery. The study also examined the extent that BED status accounted for variance in self‐efficacy after controlling for demographic factors (age, sex and race), physical variables (comorbidities and body ma...

OBJECTIVE Patients with type 2 diabetes are encouraged to lose weight, but excessive weight loss in older adults may be a marker of poor health and subsequent mortality. We examined weight change during the postintervention period of Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) with diabetes support and education...

Aim: To explore changes in body weight and cardiometabolic risk factors after treatment withdrawal in the STEP 1 trial extension. Materials and methods: STEP 1 (NCT03548935) randomized 1961 adults with body mass index ≥30 kg/m2 (or ≥ 27 kg/m2 with ≥1 weight-related comorbidity) without diabetes to 68-weeks' once-weekly subcutaneous semaglutide 2...

Objective: Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) and diabetes support and education (DSE) (control) in 5,145 individuals with overweight/obesity and type 2 diabetes, found no significant differences in all-cause or cardiovascular mortality or morbidity during 9.6 (median) years of intervention. Participant...

Objective: This study aimed to measure the impact of the COVID-19 pandemic on self-reported life experiences in older adults with diabetes and obesity. Methods: Participants were surveyed in 2020 regarding negative and positive impacts of the pandemic across domains of personal, social, and physical experiences. A cumulative negative risk index...

This chapter describes behavioral treatment for adults with obesity. It reviews the components and structure of treatment, presents weight loss outcomes, discusses methods to improve long‐term weight loss, and describes strategies to improve dissemination and implementation of behavioral treatments. The goal of behavioral treatment is to help patie...

Importance Phase 3 trials have not compared semaglutide and liraglutide, glucagon-like peptide-1 analogues available for weight management. Objective To compare the efficacy and adverse event profiles of once-weekly subcutaneous semaglutide, 2.4 mg, vs once-daily subcutaneous liraglutide, 3.0 mg (both with diet and physical activity), in people wi...

Objective: To conduct post hoc secondary analysis examining the association between change in physical activity. Measured with self-report and accelerometry, from baseline to 1 and 4 years and cardiovascular disease (CVD) outcomes in the Look AHEAD Trial. Research design and methods: Participants were adults with overweight/obesity and type 2 di...

The Breast Cancer Weight Loss (BWEL) trial is a randomized controlled trial designed to determine whether weight loss after a breast cancer diagnosis can reduce the risk of cancer recurrence in women with overweight or obesity. The BWEL trial will compare the efficacy of a telephone-based weight-loss intervention plus health education materials ver...

Semaglutide is a glucagon-like peptide-1 receptor agonist that was recently approved by the US Food and Drug Administration for chronic weight management. This paper reviews data on the mechanism of action, weight-loss and cardiometabolic efficacy, and safety of semaglutide 2.4 mg/week for obesity. Semaglutide has demonstrated the largest weight lo...

Objective: To evaluate changes in the prevalence of depressive symptoms, loneliness, and insomnia among older adults with type 2 diabetes from 2016 to 2020 and to assess risk factors for these conditions including demographics, multimorbidity, BMI, treatment group, and pre-coronavirus 2019 (COVID-19) measure scores. Research design and methods:...

Objective Weight stigma is associated with impaired health, attributed in part to reductions in health-promoting behaviors. This review analyzed evidence of the association between weight stigma and physical activity (PA) in adults and youth. Methods Three databases were searched for terms related to weight stigma and PA. Eligible studies reported...

Aim: We evaluated gastrointestinal (GI) adverse events (AEs) with once-weekly semaglutide 2.4 mg in adults with overweight/obesity and their contribution to weight loss (WL). Materials and methods: AE analyses pooled data from the Semaglutide Treatment Effect in People With Obesity (STEP) 1-3 trials for participants randomized to 68 weeks' semag...

In adults with overweight or obesity, continued treatment with OW s.c. semaglutide 2.4 mg led to clinically relevant weight loss, while switching to placebo led to significant weight regain; these data underscore the chronicity and relapsing nature of obesity, and the need for continued treatment. Publication History Publication Date: 24 September...

In adults with overweight or obesity, semaglutide 2.4 mg as an adjunct to IBT led to significantly greater weight loss and improvements in CVD risk factors and glucose metabolism vs. placebo plus IBT. Publication History Publication Date: 24 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469...

In adults with overweight or obesity, once-weekly s.c. semaglutide 2.4 mg plus lifestyle intervention induced a mean weight loss of approximately 15% by week 68. Clinically beneficial weight loss of≥10% was achieved by over two-thirds of participants. Publication History Publication Date: 24 September 2021 (online) © 2021. Thieme. All rights reser...

Semaglutide 2.4 mg, as adjunct to lifestyle intervention, was efficacious for weight management in adults with overweight or obesity and T2D, providing significantly greater weight loss vs. placebo and semaglutide 1.0 mg at week 68. Publication History Publication Date: 24 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme V...

This systematic review synthesized research evaluating the relationship between genetic predictors and weight loss after bariatric surgery. Fifty-seven studies were identified that examined single genes or genetic risk scores. Uncoupling protein (UCP) rs660339 was associated with excess weight loss after surgery in 4 of 6 studies. The most commonly...

Objective This review synthesizes literature on changes in binge eating (BE) and loss of control eating (LOC) following weight loss and the association between BE/LOC and weight loss in children and adolescents. Methods A systematic literature search was conducted in PubMed, Scopus, and PsycInfo. Eligible studies included all peer-reviewed journal...

Objective The Action for Health in Diabetes (Look AHEAD) study previously reported that intensive lifestyle intervention (ILI) reduced incident depressive symptoms and improved health-related quality of life (HRQOL) over nearly 10 years of intervention compared with a control group (the diabetes support and education group [DSE]) in participants wi...

Background: In people with overweight or obesity, long-term maintenance of weight loss is challenging. Subcutaneous (s.c.) semaglutide, a glucagon-like peptide-1 analogue, has shown clinically-relevant weight loss in a phase 2 trial in people with obesity. STEP 4 investigated the impact of continued semaglutide 2.4 mg treatment, vs switching to pla...

Background: Semaglutide, a glucagon-like peptide-1 analogue, is being investigated in people with overweight or obesity. A post-hoc analysis of the STEP 4 trial was conducted to identify whether early weight loss is predictive of later weight loss with maintenance once-weekly subcutaneous (s.c.) semaglutide 2.4 mg. Methods: STEP 4 was a randomized,...

Background: Semaglutide is a long-acting, subcutaneous (s.c.), glucagon-like peptide-1 analogue that is currently being investigated for obesity management in adults with overweight or obesity in the phase 3 STEP clinical trial program. Varying degrees of weight loss were observed with once-weekly s.c. semaglutide 2.4 mg in STEP 1, and a post-hoc a...

Background: Despite the increasing global adverse health impact of obesity, there are few pharmacological options for effective weight management. STEP 1 investigated the efficacy and safety of the glucagon-like peptide-1 analogue, subcutaneous (s.c.) semaglutide, for weight management in adults with overweight or obesity. Methods: This randomized,...

Background: In people with overweight/obesity and type 2 diabetes (T2D), achievement of weight loss can be a challenge. STEP 2 investigated the efficacy and safety of semaglutide 2.4 mg for weight management in adults with overweight/obesity and T2D. Methods: This randomized, double-blind, double-dummy, placebo-controlled, phase 3 trial was conduct...

Importance The effect of continuing vs withdrawing treatment with semaglutide, a glucagon-like peptide 1 receptor agonist, on weight loss maintenance in people with overweight or obesity is unknown. Objective To compare continued once-weekly treatment with subcutaneous semaglutide, 2.4 mg, with switch to placebo for weight maintenance (both with l...

Background This trial assessed the efficacy and safety of the GLP-1 analogue once a week subcutaneous semaglutide 2·4 mg versus semaglutide 1·0 mg (the dose approved for diabetes treatment) and placebo for weight management in adults with overweight or obesity, and type 2 diabetes. Methods This double-blind, double-dummy, phase 3, superiority stud...

Importance Weight loss improves cardiometabolic risk factors in people with overweight or obesity. Intensive lifestyle intervention and pharmacotherapy are the most effective noninvasive weight loss approaches. Objective To compare the effects of once-weekly subcutaneous semaglutide, 2.4 mg vs placebo for weight management as an adjunct to intensi...

Background Obesity is a global health challenge with few pharmacologic options. Whether adults with obesity can achieve weight loss with once-weekly semaglutide at a dose of 2.4 mg as an adjunct to lifestyle intervention has not been confirmed. Methods In this double-blind trial, we enrolled 1961 adults with a body-mass index (the weight in kilogr...

In the approval process for new weight management therapies, regulators typically require estimates of effect size. Usually, as with other drug evaluations, the placebo-adjusted treatment effect (i.e., the difference between weight losses with pharmacotherapy and placebo, when given as an adjunct to lifestyle intervention) is provided from data in...

Dietary modification is central to obesity treatment. Weight loss diets are available that include various permutations of energy restriction, macronutrients, foods, and dietary intake patterns. Caloric restriction is the common pathway for weight reduction, but different diets may induce weight loss by varied additional mechanisms, including by fa...

Background: Weight bias against persons with obesity impairs health care delivery and utilization and contributes to poorer health outcomes. Despite rising rates of pet obesity (including among dogs), the potential for weight bias in veterinary settings has not been examined. Subjects/methods: In two online, 2 × 2 experimental studies, the effec...

Objectives The goal of the present study was to determine whether baseline mindful eating, general mindful awareness, or acceptance was most strongly associated with short- and long-term weight loss in a lifestyle modification program. Methods Data were from 178 participants (baseline BMI = 40.9 ± 5.9 kg/m², age = 44.2 ± 11.2 years; 87.6% female;...

Introduction: Individuals 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. Objective: This secondary analysis of the SCALE IBT trial assessed adherence to the...

Objective: To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared with standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. Research design and methods: Data were from 4,827 participants during their fir...

Background Most patients who undergo bariatric surgery experience significant weight loss and improvements in obesity-related co-morbidities in the first 6–18 months after surgery. However, 20%–30% of patients experience suboptimal weight loss or significant weight regain within the first few postoperative years. Psychosocial functioning may contri...

Approximately 90 million U.S. adults (42.4%) now live with obesity,¹ which is disproportionately present in socioeconomically disadvantaged persons and affects 57% of Black women.¹ Obesity increases the risk of many adverse health conditions, including cardiovascular disease, type 2 diabetes, multiple types of cancers, impaired quality of life, and...

Objective This study was designed to determine whether intensive lifestyle intervention (ILI) aimed at weight loss lowers cancer incidence and mortality. Methods Data from the Look AHEAD trial were examined to investigate whether participants randomized to ILI designed for weight loss would have reduced overall cancer incidence, obesity‐related ca...

Objective The aim of this study was to investigate the 6‐month nonintervention follow‐up effects of a cognitive behavioral intervention for weight bias internalization (WBI; i.e., self‐stigma) combined with behavioral weight loss (BWL). Methods Adults with obesity and elevated WBI were previously randomized to receive BWL alone or in combination w...

Introduction Obesity is associated with an increased risk of cardiovascular morbidity and mortality. Four medications are approved by the US Food and Drug Administration (FDA) for chronic weight management when used as an adjunct to a reduced-calorie diet and increased physical activity in adults. These medications result in clinically significant...

Objective To evaluate the state of the literature for whether food addiction may warrant consideration as a distinct psychiatric disorder in the Diagnostic and Statistical Manual (DSM) using Blashfield et al.'s (1990; Comprehensive Psychiatry , 31 (1), 15–19) five criteria. This framework was utilized because it has recently been applied to examine...

Rationale: Weight loss is recommended to treat obstructive sleep apnea (OSA). Objective: Determine whether initial benefit of intensive lifestyle intervention (ILI) for weight loss on OSA severity is maintained at 10 years. Methods: 10-year follow-up polysomnograms of 134 of 264 adults in Sleep AHEAD with overweight/obesity, type 2 diabetes me...

Objective The obesity epidemic is a public health concern, warranting further research into pharmacological treatments for weight management (WM) as an adjunct to lifestyle interventions. The Semaglutide Treatment Effect in People with obesity (STEP) program aims to investigate the effect of semaglutide versus placebo on weight loss, safety, and to...

Whether intentional weight loss reduces mortality in overweight/obese individuals with diabetes is unclear. Look AHEAD, a randomized trial of intensive lifestyle intervention (ILI) and diabetes support and education (DSE) (control) in 5145 individuals with overweight/obesity and type 2 diabetes, is ideal for examining this due to large sample, exte...

A WW (formerly Weight Watchers) program adapted for persons with type 2 diabetes mellitus (T2DM) previously was found to be more effective than standard care (SC) intervention for weight loss, improved glycemic control, and weight- and diabetes-related quality of life measures. With data from the same national trial, this study examined whether WW...

Objective This study evaluated weight changes after cessation of the 10‐year intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study. It was hypothesized that ILI participants would be more likely to gain weight during the 2‐year observational period following termination of weight‐loss–maintenance counseling...

Individual weight loss outcomes with intensive behavioral therapy (IBT) for obesity are variable. The present study assessed whether visit attendance, dietary self-monitoring, medication, and meal-replacement adherence were associated with 52-week weight loss with IBT and tested whether these relationships were independent of associations with earl...

Jonathan D Chevinsky,1 Thomas A Wadden,2 Ariana M Chao2,3 1SUNY Downstate Health Sciences University, Brooklyn, NY, USA; 2Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA; 3University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USACor...

Objective: Previous studies have shown additive weight loss when intensive behavioral therapy (IBT) was combined with weight-loss medication. The present multisite study provides the first evaluation, in primary care, of the effect of the Centers for Medicare and Medicaid Services-based IBT benefit, delivered alone (with placebo) or in combination...

Background: Some weight loss medications, including liraglutide 3.0 mg, are thought to facilitate weight loss by improving appetite control. However, no studies have evaluated their long-term appetitive effects. Subjects/methods: This study examined changes in appetite in a subsample of 113 adults with obesity (76.1% female, 55.8% white, BMI = 3...

The U.S. Preventive Services Task Force has recommended that primary care clinicians screen all adults for obesity and provide those affected intensive multicomponent behavioral interventions. Approximately 95 million U.S. adults qualify for such care, also referred to as lifestyle modification. Using the Guidelines (2013) for Managing Overweight a...

Objective: To test the effects of a cognitive-behavioral intervention for weight bias internalization (WBI; i.e., self-stigma) combined with behavioral weight loss (BWL). Method: Adults with obesity and elevated WBI were randomly assigned to BWL alone or combined with the Weight Bias Internalization and Stigma Program (BWL + BIAS). Participants...

Objective: To examine the effects of an intensive lifestyle intervention (ILI) on cardiovascular disease (CVD), the Action for Health in Diabetes (Look AHEAD) trial randomized 5,145 participants with type 2 diabetes and overweight/obesity to a ILI or diabetes support and education. Although the primary outcome did not differ between the groups, th...

Objective: To compare depressive symptomatology as assessed by two frequently used measures, the Beck Depression Inventory (BDI-1A) and Patient Health Questionnaire (PHQ-9). Methods: Investigators conducted a cross-sectional secondary analysis of data collected as part of the follow-up observational phase of the Look AHEAD study. Rates of agreem...

Background Bariatric surgery is associated with improved cardiovascular outcomes and also affects lipid levels, but few studies have compared the effects of Roux-en-Y gastric bypass (RYGB) surgery with those of laparoscopic sleeve gastrectomy (LSG) on serum fatty acid levels. The present study compares the effects of RYGB and LSG surgeries on serum...

Objective: This exploratory analysis examined the effects of intensive behavioral therapy (IBT) for obesity ("IBT-alone"), IBT plus liraglutide 3.0 mg/d ("IBT-liraglutide"), and IBT plus liraglutide 3.0 mg/d plus 12 weeks of a portion-controlled diet that provided 1,000 to 1,200 kcal/d ("Multicomponent") on changes in food cravings, eating behavio...

This study examined the effects of intensive behavioural therapy (IBT) for obesity (IBT‐alone), IBT plus liraglutide 3.0 mg/day (IBT‐liraglutide), and IBT‐liraglutide combined with 12 weeks of a portion‐controlled diet (Multicomponent) on changes in general health‐related (HR) quality of life (QoL) and weight‐related QoL. Adults with obesity (79.3%...

Objective: The Centers for Medicare and Medicaid Services (CMS) initiated coverage of intensive behavioral therapy (IBT) for obesity in 2011, providing beneficiaries 14 to 15 brief, individual counseling visits in 6 months. CMS offered general recommendations for delivering IBT but did not provide an evidence-based treatment protocol, which was th...

Purpose of Review This narrative review provides an overview of the relationships among tobacco smoking, eating behaviors, and body weight. The aims are to (1) examine the concurrent and longitudinal associations between tobacco smoking and body weight, (2) describe potential mechanisms underlying the relationships between smoking and body weight,...

Objective: Weight bias internalization (WBI) is associated with poor weight-related health. The purpose of this study was to identify the prevalence and correlates of WBI in a large sample of adults in a commercial weight management programme. Methods: WW (the new Weight Watchers) members participated in an online survey. Participants (N = 18,76...

Purpose of Review This review describes the results of randomized controlled trials that have evaluated the efficacy of behavioral interventions for obesity in primary care settings. Recent Findings Most studies have found that high-intensity behavioral counseling (providing 12 or more sessions per year, as defined by the US Preventative Services...