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Maintenance of Lost Weight and Long-Term Management of Obesity
Abstract
Weight loss can be achieved through a variety of modalities, but long-term maintenance of lost weight is much more challenging. Obesity interventions typically result in early weight loss followed by a weight plateau and progressive regain. This review describes current understanding of the biological, behavioral, and environmental factors driving this near-ubiquitous body weight trajectory and the implications for long-term weight management. Treatment of obesity requires ongoing clinical attention and weight maintenance-specific counseling to support sustainable healthful behaviors and positive weight regulation.
... Of the five girls who agreed to participate in the qualitative interviews, two maintained their weight loss over time, and three experienced weight regain. Reasoning for this weight regain is a complex intersection of factors, including biology, behavior, and environment [17]. ...
... Additionally, in the long term, they reported mixed results on the health habits they either were or were not maintaining after transitioning home. Sustained weight loss is a challenge; there are multiple factors, including biology, behavior, and environment, that collectively promote weight regain [17]. This is why a long-term strategy, including support and weight-maintenance-specific counseling are needed to support individual's weight loss goals [17], as well as consideration of pharmacotherapy and bariatric surgery when appropriate [22]. ...
... Sustained weight loss is a challenge; there are multiple factors, including biology, behavior, and environment, that collectively promote weight regain [17]. This is why a long-term strategy, including support and weight-maintenance-specific counseling are needed to support individual's weight loss goals [17], as well as consideration of pharmacotherapy and bariatric surgery when appropriate [22]. Closer clinical monitoring and support during this initial transition period and beyond may benefit future graduates by promoting healthy lifestyle habits and longterm weight regulation [17]. ...
Background
Residential programs have been utilized for the treatment of adolescents with severe obesity, yet few have been evaluated.
Objective
The objectives were to (1) evaluate the effect of a long‐term residential treatment program focused on treating adolescent girls with obesity and (2) explore girls' perceptions of weight management during and after participating in the program.
Methods
A mixed‐methods approach was used to examine changes in weight outcomes over time among adolescent girls who completed the program (N = 12), and conduct qualitative interviews to explore perceptions of weight management after completion (N = 5).
Results
Girls in the program showed a reduction in mean BMI of 16.1 ± 4.2 kg/m² (−36.3% ± 5.9%) over a mean of 57 weeks. At follow‐up, three participants regained weight while two maintained their completion weight. The program shifted girls' health goals from weight loss to improved overall health. Experiences of social connection and disconnection were identified as components that impacted weight management trajectories over time.
Conclusion
This program demonstrated clinically meaningful improvements in BMI. The structured nature and the emphasis on therapeutic methods were key components of the program. Social support was identified by participants as being integral to successful weight maintenance over time.
... 10 The effectiveness of these initiatives differs, though; many people find it difficult to keep weight down over time, which causes a return to obesity. 11 The study's aim is to investigate the spread of obesity among physician's patients through several demographic, socioeconomic, and lifestyle aspects. ...
... 6,16,17 The study showed that physicians who had attempted to lose weight were more likely to be overweight or obese, which is in agreement with a study that has confirmed that recurrent attempts to lose weight, followed by a period of recovery, can lead to a higher BMI over time. This phenomenon, called 'weight cycling,' has been known in studies, such as the one by Hall and Kahan (2018), Khattab (2024), Ferrario et al. (2024), which demonstrated that ineffective efforts at weight loss can lead to psychological and physiological concerns that will harmfully affect future efforts at weight loss. 11,18,19 Other studies have confirmed an association between chronic diseases and higher BMI; however, this study was unsuccessful to prove a significant association. ...
... This phenomenon, called 'weight cycling,' has been known in studies, such as the one by Hall and Kahan (2018), Khattab (2024), Ferrario et al. (2024), which demonstrated that ineffective efforts at weight loss can lead to psychological and physiological concerns that will harmfully affect future efforts at weight loss. 11,18,19 Other studies have confirmed an association between chronic diseases and higher BMI; however, this study was unsuccessful to prove a significant association. This difference may be attributed to the healthier population of physicians, who have a greater availability of healthcare and earlier detection of chronic diseases. ...
Introduction
Obesity, defined by a high body mass index (BMI), is a significant global health issue that has increased over recent decades, leading to higher rates of type 2 diabetes, heart diseases, and some cancers.
Aim
To explore the demographic, socioeconomic, and lifestyle factors affecting obesity in medical professionals, identify causes, and create effective weight control strategies.
Material and methods
A cross-sectional study of 200 physicians utilized face-to-face interviews and a standardized questionnaire to gather data on demographics, lifestyle, and weight management, with BMI assessed according to WHO guidelines.
Results and discussion
In Babylon, a troubling 75.5% of physicians are overweight or obese, with the highest rates among women aged over 46, likely due to menopause. Additionally, 78% of those who do not exercise regularly have elevated BMI levels. Factors like job stress and ineffective weight management exacerbate obesity, particularly among private clinic physicians. Notably, 56.5% of physician’s express dissatisfaction with their weight, especially those in higher BMI categories.
Conclusions
A study reveals a strong correlation between BMI and age in female physicians, with obesity rates soaring to 59.1% in those aged 46 and older, primarily due to menopause. Overall, 75.5% of physicians fall into overweight or obese categories, especially among middle-aged individuals. Key factors influencing higher BMI include insufficient exercise and failed weight loss efforts. Furthermore, there is a notable inverse relationship between weight dissatisfaction in overweight and obese individuals compared to those with normal weight.
... The most signi cant weight loss was observed between T0 and T6, aligning with evidence that the initial phase of weight reduction is typically the most pronounced (12,13). Thereafter, weight maintenance became predominant, despite external challenges such as the holiday season, during which a temporary weight increase was observed but subsequently reversed, indicating adherence resilience (13)(14)(15). ...
... The most signi cant weight loss was observed between T0 and T6, aligning with evidence that the initial phase of weight reduction is typically the most pronounced (12,13). Thereafter, weight maintenance became predominant, despite external challenges such as the holiday season, during which a temporary weight increase was observed but subsequently reversed, indicating adherence resilience (13)(14)(15). In contrast but consistent with literature (12), the control group undergoing standard treatment did not exhibit signi cant weight changes throughout the study period, underscoring the e cacy of the intervention program. ...
Background: Elevated prevalence of obesity has increasingly challenged public health systems worldwide, with rural areas being particularly affected. This trial aimed to evaluate the effectiveness of a general practitioner (GP)-centered, multifactorial intervention for obesity management in rural areas. Methods: The HAPpEN trial was a pragmatic, controlled study conducted in six rural primary care practices in Upper Franconia, Germany, with 98 adults (BMI ≥30 kg/m²) enrolled and a 12-month follow-up rate of 62.2%. Exclusion criteria included severe comorbidities restricting physical activity. The intervention combined GP-led behavioral strategies, monthly motivational counselling, nutritional guidance, physical activity, educational workshops, and digital self-monitoring with community activities to foster engagement. The control group received standard care. Primary outcomes included body weight, body mass index (BMI), waist circumference, blood pressure, heart rate, and metabolic parameters such as hemoglobin A1c (HbA1c), fasting glucose, cholesterol, triglycerides, high- and low-density lipoprotein, C-reactive protein and uric acid. Results: The intervention group showed significant reductions in body weight (−5.0 ± 7.7 kg, 95% CI: [-7.24, - 2.83], p< 0.001) and BMI (−1.7 ± 2.6 kg/m², 95% CI: [-2.48, -0.99]), p< 0.001] over 12 months. Waist circumference (−11.5 ± 11.1 cm, 95% CI: [-15.57, -7.34], p< 0.001), systolic blood pressure (−8.3 ± 14.2 mmHg, 95% CI: [-13.22, -3.30], p= 0.04) and HbA1c levels (-3.3 ± 6.2 mmol/mol, 95% CI: [-5.33, -1.30], p< 0.001) significantly improved, with HbA1C normalizing in many cases. A negative correlation was identified between program engagement and weight loss (r s = −0.453, p< 0.001). Conclusion: The GP-centered, multifactorial intervention significantly reduced body weight and improved metabolic health markers in individuals with obesity. Sustained program engagement correlated with enhanced weight loss, underscoring the importance of structured support in rural obesity management. These findings emphasize the key role of GPs in obesity care and suggest the potential for broader application. Trial registration : DRKS00033916, March, 20 th 2024 retrospectively registered.
... In contrast, many HCPs and PwO held perceptions that AOMs are for than being a multifactorial disease of gene-environmental interactions driving susceptibility to the modern obesogenic environment [3,14]. ...
... Despite reporting previously being unable to achieve or maintain a meaningful treatment effect with lifestyle changes alone, many PwO still receive recommendations from HCPs to repeat such efforts prior to evidence-based adjunct therapies [17]. The ongoing emphasis on lifestyle changes and belief in their effectiveness conflict with the understanding of obesity as a multifactorial chronic disease in which physiology causes variable responses to lifestyle interventions [14]. The inflated perception of the effectiveness of lifestyle changes to cause long-term weight reduction may explain why PwO and HCPs allocated most responsibility for disease management to the individual with obesity, with much less responsibility assigned to HCPs. ...
Objective
The objective of this study was to understand the perceptions of and drivers/barriers to antiobesity medication (AOM) use among people with obesity (PwO) and health care providers (HCPs) in the United States.
Methods
In 2022, PwO and HCPs completed cross-sectional surveys that included questions on perceptions of obesity management and AOMs. Data were analyzed using descriptive statistics.
Results
Survey participants (1007 PwO and 474 HCPs) emphasized the effectiveness of lifestyle change and the patient's responsibility to address obesity. PwO reported a willingness to take newly approved AOMs long term. HCPs believed that their patients would adhere to AOMs long term if they experienced success. Both PwO and HCPs perceived an increased effectiveness of a multimodal approach to combining AOMs with HCP-guided lifestyle intervention. Potential barriers to long-term use of AOMs for both groups included concerns regarding long-term side effects and outcomes, costs and insurance coverage, and perception of AOMs that do not align with treatment of a chronic disease.
Conclusions
PwO and HCPs are interested in new AOM options, but educational gaps remain as a barrier to recommended multimodal chronic care. Ongoing education that includes the known effectiveness and safety data of newer AOMs and pending outcome trials could improve shared decision-making in obesity care.
... Because overweight and obesity are associated with increased health risk, effective interventions to lose weight by lifestyle changes, pharmacotherapy or bariatric surgery have been developed. However, weight regain after successful weight loss is frequent [3]. Therefore, combatting weight regain after successful weight loss is one of the Marleen A. van Baak m.vanbaak@maastrichtuniversity.nl and selected those that focused on the potential physiological mechanisms. ...
... This often results in a low Fig. 1 Novel findings related to weight gain-and weight loss-induced processes that may influence the risk of weight regain discussed in this review. Four physiologic areas are concerned: [1,2] the immune cell profile of adipose tissue, [3] the gut microbiome, [4] fat free mass loss during weight loss, and [5,6] appetite control. It should be noted that all these influences require further investigation to establish whether they play a causal role in the process of weight regain [29] RCT with longitudinal follow-up: 5-12 wk WL with VLCD or LCD, 4 wk weight stabilization, 9 months follow-up 57 participants with overweight or obesity %FFML from wk 0 to wk 9-16 associated with WR causality not demonstrated Table 1 Characteristics of the experimental studies in humans included in the review the number of active CD7 + cells [17]. ...
Purpose of Review
This review summarizes the most recent research on the physiology of weight regain. It describes developments in areas that are currently being addressed and that may indicate promising directions for future research.
Recent Findings
Weight regain occurs independent of the way prior weight loss is achieved, i.e. by lifestyle, surgery or pharmacotherapy. Recent novel findings regarding weight regain belong to four areas. First, the immune obesity memory of which besides persistent immune cells promoting weight regain cells have been found that reduce weight regain. Second, the gut microbiome where autologous transplantation can limit weight regain. Third, the composition of the weight loss with the percentage of lost fat-free mass being inverse to the amount of regained weight independent of the weight loss procedure. Fourth, appetite control where after weight loss altered hypothalamic activity promoting hunger and weight regain persists, possibly mediated by altered neurotensin responses. In all four areas more conclusive evidence for their role in weight regain still needs to be obtained.
Summary
Most studies on physiological mechanisms of weight regain are associative in nature and the number of intervention studies is very limited. To bring the field further, carefully designed intervention studies taking into account the dynamic character of weight loss and weight regain are needed.
... As RMR is decreasing, there may be changes in the rate of weight loss until a weight loss plateau occurs, which may require a new dietary goal, as well as continued weight control therapy, as weight loss and weight maintenance may involve different processes [39,40]. One change during the maintenance phase may be for someone to increase their activity expenditure to counteract the reductions in metabolic rate that occur with weight loss [39,40], so that people are not only relying on reduced energy intake to maintain their weight loss. ...
... As RMR is decreasing, there may be changes in the rate of weight loss until a weight loss plateau occurs, which may require a new dietary goal, as well as continued weight control therapy, as weight loss and weight maintenance may involve different processes [39,40]. One change during the maintenance phase may be for someone to increase their activity expenditure to counteract the reductions in metabolic rate that occur with weight loss [39,40], so that people are not only relying on reduced energy intake to maintain their weight loss. Furthermore, the more energy expenditure, the more calories a person can consume to maintain the same weight loss. ...
Background
There are large individual differences in weight loss and maintenance. Metabolic testing can provide phenotypical information that can be used to personalize treatment so that people remain in negative energy balance during weight loss and remain in energy balance during maintenance. Behavioral testing can assess the reinforcing value and change in the temporal window related to the personalized diet and exercise program to motivate people to maintain engagement in healthier eating and activity programs.
Objective
Provide an expository overview of how metabolic testing can be used to personalize weight control. Ideas about incorporating behavioral economic concepts are also included.
Methods
A broad overview of how resting metabolic rate, thermic effect of food and respiratory quotient can be used to improve weight control. Also discussed are behavioral economic principles that can maximize adherence to diet and activity protocols.
Results
Research suggests that measuring metabolic rate can be used to set calorie goals for weight loss and maintenance, thermic effect of food to increase energy expenditure, and respiratory quotient to guide macronutrient composition of the diet and maximize fat loss. Developing programs that foster a strong motivation to eat healthier and be active can maximize treatment success.
Conclusion
Incorporating metabolic measures can personalize behavioral weight loss programs, and the use of behavioral economic principles can increase the probability of adherence and long‐term success in weight control.
... Following an initial diet-induced body weight-loss, 70% of the lost weight is typically regained within five years emphasizing the significant challenge of long-term weight maintenance. 1 Retrospective studies have demonstrated that physical activity is associated with a greater chance of maintaining weight-loss and thus preventing body weight gain. 2 While the acute calorie deficit from a single exercise bout may not alone be sufficient for body weight maintenance, [3][4][5] increasing the level of daily physical activity may influence appetite regulation and promote a more accurate coupling of energy intake and expenditure. 6 Indeed, energy intake seems to have a J-shaped relationship with physical activity levels, so that low levels of physical activity result in dysregulated appetite and high regular levels associate with better appetite control. ...
Physical activity is essential for body weight maintenance after body weight-loss, partly by promoting the coupling between energy intake and expenditure. However, the underlying mechanisms remain largely unknown. Here we demonstrate that running induces small intestine growth independently of GLP-2. In addition, exercise increases L-cell density in the small intestine and glucose-stimulated GLP-1 secretion, and improves the sensitivity both to the gut-derived hormones PYY, CCK and ghrelin, and to treatment with GLP-1 receptor agonist. Moreover, increased physical activity enhances satiation and satiety post-fasting, regulates the gene expression of appetite signals in the intestine, nodose ganglia and brainstem, and induces a greater feeding-response in the activation of hypothalamic and brainstem neurons. This improves overall appetite regulation, and in turn, promotes body weight maintenance. In summary, the present data suggest that increased physical activity improves body weight maintenance by inducing adaptations in the gut and in gut-to-brain communication that control appetite
... Obesity challenges economic growth, costing approximately £27 billion yearly, which includes direct healthcare costs and indirect expenses like decreased productivity and higher absenteeism [1]. Effective management strategies, including significant weight loss, play a crucial role in improving outcomes for individuals with obesity [2]. Weight reduction has been shown to lead to improved health outcomes, such as improved cardiovascular risk factors, decreased obesityrelated complications, improvement in quality of life, prevention of diabetes development, and improved glycaemic control in those living with type 2 diabetes [3][4][5]. ...
Tirzepatide, an anti-obesity medication, demonstrated significant weight loss efficacy in the SURMOUNT-1 randomized controlled trial. This analysis evaluates the cost-efficiency of tirzepatide in the UK by linking clinical outcomes to drug acquisition costs.
Data from SURMOUNT-1 (2539 participants across global sites) were used to assess tirzepatide’s (5, 10, and 15 mg) impact on weight reduction over 72 weeks (72W), with a focus on drug acquisition costs and cost/weight loss outcome. Cost needed to treat and cost-to-target analyses were performed to determine the economic value of achieving specific weight loss goals and improvements in body mass index (BMI).
Tirzepatide demonstrated significant weight loss, with greater reductions at higher doses. Cost/kilogram of weight loss at 72W was £102.86, £85.41, and £89.24 for 5, 10, and 15 mg, respectively. Average per-patient costs at 72W for 5% weight loss were £1852, £1971, and £2186 (5, 10, and 15 mg, respectively; average 28-day costs: £102.90, £109.52, and £121.47). Average per-patient costs for 10% weight loss were £2258, £2209, and £2338 (28-day costs: £125.43, £122.69, and £129.88). The 15 mg dose was the most cost-efficient for achieving higher weight loss targets (15% and 20%).
In the SURMOUNT-1 study, tirzepatide was cost-efficient in the UK for weight management, demonstrating favourable economic outcomes relative to its efficacy in reducing body weight and improving BMI. It provided additional health benefits, including reduced risks for type 2 diabetes and cardiovascular events and improved mental health. Tirzepatide contributed to cost savings and improved efficiency within the healthcare system by decreasing the burden of obesity-related conditions, thus enhancing overall healthcare resource allocation. These findings support its inclusion in clinical practice guidelines and healthcare formularies. Further research is needed to explore real-world adherence, patient-centred outcomes, and the long-term sustainability of weight loss with tirzepatide.
... The management of obesity extends beyond the initial induction of weight loss to include its long-term maintenance-an area often marked by physiological and behavioral challenges [64,103]. The SURMOUNT-4 trial provides supporting evidence on the importance of continued pharmacological intervention [65]. ...
Obesity represents a global health challenge, with a critical and urgent need for long-term, sustainable management strategies. Tirzepatide is a novel dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist. At first approved for the treatment of type 2 diabetes mellitus, tirzepatide represents one of the latest clinically approved and commercially available pharmacological options for obesity management. This narrative review aimed to synthesize existing clinical evidence on the efficacy and safety of tirzepatide in non-diabetic obese individuals. A comprehensive literature search was conducted using the PubMed, Scopus, Web of Science, ClinicalTrials.gov, and Google Scholar databases to identify relevant clinical trials, meta-analyses, and original studies assessing the weight-loss impact of tirzepatide from 2022 onwards. Synthesized evidence indicated that tirzepatide achieved up to 20.9% weight loss over 72 weeks (SURMOUNT-1), 18.4% after lifestyle intervention (SURMOUNT-3), 17.5% in Chinese adults (SURMOUNT-CN), and 25.3% with continued treatment over 88 weeks (SURMOUNT-4). Meta-analyses confirmed higher odds of ≥5–20% weight loss versus semaglutide and liraglutide, significantly reducing body mass index, waist circumference, blood pressure, and atherosclerotic cardiovascular disease risk. Health-related quality of life improved with greater weight loss, and gastrointestinal side effects (nausea, diarrhea, constipation) were common but mild to moderate, with <5% treatment discontinuation. Tirzepatide achieved significant weight loss, cardiometabolic benefits, and improved quality of life in non-diabetic obese individuals, but further research is needed on long-term efficacy, safety, and clinical application.
... At its core, obesity is a relatively enduring condition. A meta-analysis revealed that more than 75% of weight loss is regained after 5 years [139,140]. The cause of this allostatic shift in body energy homeostasis, whereby the body is incapable of maintaining permanent weight loss, has not yet been elucidated. ...
Obesity is a chronic disease with prevalence rates that have risen dramatically over the past four decades. This increase is not due to changes in the human genome but rather to environmental factors that promote maladaptive physiological responses. Emerging evidence suggests that external influences, such as high-fat diets, modify the epigenome—the interface between genes and the environment—leading to persistent alterations in energy homeostasis. This review explores the role of epigenetic mechanisms in obesity, emphasizing insights from transgenic animal models and clinical studies. Additionally, we discuss the evolution of obesity research from homeostatic to allostatic frameworks, highlighting key neuroendocrine regulators of energy balance.
... Despite this landscape of recent drugs for obesity treatment, like semaglutide or tirzepatide, there are several limitations that still challenges to effectively addressing this complex condition (Hall & Kahan, 2018). Many antiobesity drugs provide only modest weight loss results and may not be sufficient for those with severe obesity. ...
The huge obesity prevalence and its associated metabolic disorders highlight the urgent need for new therapeutic strategies beyond lifestyle interventions. Despite the availability of novel pharmacological treatments, the search for more effective and safe anti-obesity compounds remains a challenge. Recent advances in high-performance computational drug discovery have enabled the rapid screening and identification of potential anti-obesity compounds. However, these in silico procedures frequently require complex computational knowledge that limits the use of these techniques for most researchers. To address this gap, we have developed OBE-DB, an accessible and user-friendly platform integrating these computational tools that facilitates the prediction of potential anti-obesity molecules through two complementary approaches: (a) shape similarity analysis against a curated database of approved anti-obesity drugs, and (b) inverse virtual screening of user-submitted molecules against a set of therapeutic protein targets linked to obesity. Our results demonstrate that the server effectively screens and ranks compounds with high predicted activity, outperforming conventional in silico techniques in terms of accuracy and usability. This represents a significant advancement by providing researchers with an intuitive tool to accelerate early-stage drug discovery for obesity treatment. The server is freely accessible without registration, providing users with a detailed report via email upon completion of the predictions. This innovative database and web server is accessible online via http://bio-hpc.eu/software/obe-db/ .
... Metabolic benefits may have conferred weight loss, contributing to additional benefits. [18][19][20] Nagi et al (2024) 21 conducted a systematic review of 19 studies conducted using a prevalence-based approach using the Population Attributable Fraction (PAF) methodology. About half of the studies (53%) were conducted in high-income countries, while the others (47%) were conducted in middle-income countries. ...
Purpose
According to the World Health Organization European Regional Obesity Report, Turkey has the highest rate of overweight and obesity in Europe. This study used a weight loss pharmacoeconomic model to assess the influence of obesity on public health by examining its effects on private health institutions and its financial costs.
Patients and Methods
A micro-costing approach was used to estimate the direct healthcare costs of 10 obesity-related comorbidities from the perspective of private healthcare providers in Turkey. A survey was conducted on a representative sample of physicians in Turkey to determine resource utilization rates for comorbidities in expenditures. The unit costs of each cost item were analyzed for type A, B, and C private hospitals. Costs in the different categories were obtained by multiplying the unit costs by the health resource utilization rate.
Results
When the obesity-related complications were stratified according to weight loss rate, 5%, 10%, and 20%, a higher cost reduction was observed in the 40–49, 50–59, and 60–69 age groups. It should be noted that this decrease in healthcare expenditure was detected in the older age groups (40 to 69) and not in individuals between 20 and 39 years. Another analysis of the weight loss rate revealed that the decrease was highest in Type 2 Diabetes Mellitus costs. A health expenditure that costs 1 unit in a C-segment institution increases 1.44-fold in B-segment and 3-fold in A-segment hospitals. The effects of weight loss on reducing the cost of obesity-related complications indicated that the highest cost reduction was on T2DM, dyslipidemia, and CKD, respectively. Obesity-related complications constituted 28.87% of total costs in Segment A hospitals, 29.13% in Segment B hospitals, and 28.54% in Segment C hospitals.
Conclusion
The current pharmacoeconomic model indicated that complications were the major cost drivers in obesity. Weight loss dramatically reduced healthcare expenditures in obese patients, and T2DM was the leading cause in all age groups.
... Obesity imposes tremendous health risks, but efforts to lose weight are often met with limited success [1,2]. Many find weight loss achieved by weight loss regimens difficult to sustain. ...
Weight loss from an overweight state is associated with a disproportionate decrease in whole-body energy expenditure that may contribute to the heightened risk for weight regain. Evidence suggests that this energetic mismatch originates from lean tissue. Although this phenomenon is well documented, the mechanisms have remained elusive. We hypothesized that increased mitochon-drial energy efficiency in skeletal muscle is associated with reduced expenditure under weight loss. Wildtype (WT) male C57BL6/N mice were fed with high-fat diet for 10 weeks, followed by a subset of mice that were maintained on the obesogenic diet (OB) or switched to standard chow to promote weight loss (WL) for additional 6 weeks. Mitochondrial energy efficiency was evaluated using high-resolution respirometry and fluorometry. Mass spectrometric analyses were employed to describe the mitochondrial proteome and lipidome. Weight loss promoted ~50% increase in the efficiency of oxidative phosphorylation (ATP produced per O 2 consumed, or P/O) in skeletal muscle. However, Weight loss did not appear to induce significant changes in mitochondrial proteome, nor any changes in respiratory supercomplex formation. Instead, it accelerated the remodeling of mitochondrial cardiolipin (CL) acyl-chains to increase tetralinoleoyl CL (TLCL) content, a species of lipids thought to be functionally critical for the respiratory enzymes. We further show that lowering TLCL by deleting the CL transacylase tafazzin was sufficient to reduce skeletal muscle P/O and protect mice from diet-induced weight gain. These findings implicate skeletal muscle mitochondrial efficiency as a novel mechanism by which weight loss reduces energy expenditure in obesity.
... Conventional weight management approaches that emphasise reducing calorie intake to achieve a calorie deficit have a limited long-term efficacy, primarily due to challenges with adherence and physiological adaptation [1][2][3]. With obesity and being overweight now affecting over 2.5 billion individuals globally [4], there is an urgent need to explore innovative interventions that offer broader reach and sustained effectiveness across diverse populations. ...
Time-restricted eating (TRE) has gained attention as an effective approach for weight management and overall well-being by focusing on limiting the eating window, rather than reducing calories. This study explores the biopsychosocial impacts of TRE in free-living individuals using a qualitative design. Twenty-one adults (aged 27–60 years) from Western Australia who had practised TRE for at least three months were purposively recruited, and semi-structured interviews were conducted. The data were analysed using a thematic analysis to identify key themes. The participants reported a range of benefits, including weight loss, reduced joint pain, better digestion, improved mental clarity, increased energy, and a more positive body image. Socially, TRE facilitated simplified daily routines but also introduced challenges, such as disruptions to social interactions and family meal dynamics. Some mixed and negative impacts were reported, including changes in sleep and exercise patterns. These findings highlight TRE’s potential as a holistic dietary intervention. Further research, particularly well-controlled, randomised controlled trials and longitudinal studies, is needed to confirm these insights and guide their appropriate application in clinical and public health settings.
... In the middle SDI region, where IHD burden fluctuates significantly, individual behaviour changes (such as habit adjustments) may yield only short-term benefits without sustained support. Hence, structural population-level interventions addressing broader environmental and systemic factors are essential.43 Governments should allocate resources and adopt effective practices from high-income regions, such as mandatory calorie/nutrient labelling, selective taxes on unhealthy foods and regulation of food ingredients.1 Additionally, efforts should begin with family and school-based education, focusing on raising awareness through targeted funding, incorporating physical education into curricula, providing free healthy school meals, and conducting regular health screenings.44 ...
Aim
This study aimed to estimate the distribution of and changes in the global burden of ischaemic heart disease (IHD) attributable to high body mass index (BMI) and low physical activity (PA) from 1990 to 2021.
Methods
Data on deaths, disability‐adjusted life years (DALYs) and age‐standardized rates for IHD attributable to high BMI and low PA were extracted from the Global Burden of Disease 2021 study. Temporal trends by gender, region and Socio‐Demographic Index (SDI) were analysed using joinpoint regression. Decomposition, health inequality analysis and Bayesian model were utilized.
Results
From 1990 to 2021, global DALYs and deaths for IHD attributable to high BMI and low PA nearly doubled, despite a decline in age‐standardized DALYs ([average annual percent change (AAPC) = −0.26, 95% uncertainty interval (95% UI): −0.45, −0.07), (AAPC = −1.03, 95% UI:−1.18, −0.88]) and deaths rates ([AAPC = −0.53, 95% UI: −0.72, −0.33], [AAPC = −1.13,95% UI: −1.34, −0.92]), respectively. The burden of IHD due to high BMI was predominantly seen in males, while low PA was more prevalent in females. Significant regional and national variation was observed, with the burden shifting from high SDI regions to middle or low SDI regions. Population growth and aging have exacerbated this burden. Health inequities have shown improvement between 1990 and 2021. Projections for the next 15 years suggest rising global age‐standardized DALYs and death rates of IHD attributable to high BMI, while those attributable to low PA may decrease.
Conclusions
Since 1990, the global and regional impact of IHD attributable to high BMI and low PA remains significant, with disparities by gender, age, region and SDI. Countries should implement effective measures to control BMI and promote PA to reduce the IHD burden.
... 2025. a prática regular de exercícios têm demonstrado eficácia na promoção de uma perda de peso saudável e duradoura (Hall & Kahan, 2018 Dessa forma, o objetivo deste estudo de revisão é verificar qual é a contribuição dos exercícios físicos e da dieta alimentar no processo de emagrecimento de pessoas adultas. A nossa hipótese inicia é a de que tanto o exercício físico como a dieta são essenciais para um melhor processo de emagrecimento, contudo, a combinação dos dois se mostrará mais efetiva e viável na manutenção do peso perdido. ...
Introdução: A obesidade é uma doença crônica capaz de gerar inúmeros impactos negativos diminuindo a qualidade de vida do obeso. Estrategias que visem o emagrecimento saudável devem se investigadas e disponibilizadas para a população. Objetivos: Verificar qual é a contribuição dos exercícios físicos e da dieta alimentar no processo de emagrecimento de pessoas adultas. Metodologia: Trata-se de uma revisão integrativa da literatura, que incluiu artigos publicados entre os anos de 2005 e 2024. Resultados: Os resultados indicam que a combinação de exercícios cardiorrespiratórios contínuos e HIIT, juntamente com uma dieta equilibrada, promove uma redução significativa de gordura corporal e melhora na composição corporal. Além disso, o treinamento resistido se mostou crucial para preservar a massa magra durante a perda de peso, ajudando a manter um metabolismo mais elevado e favorecendo a manutenção do peso a longo prazo. Conclusão: A combinação de exercícios físicos com uma dieta adequada é essencial para uma perda de peso eficaz e sustentável. Modalidades de exercícios como os cardiorrespiratórios contínuos, HIIT e o treinamento resistido devem ser incorporados para alcançar e manter um peso saudável. Essa abordagem integrada não apenas facilita a perda de gordura, mas também a preservação da massa magra, que é crucial para a manutenção de um peso saudável a longo prazo.
... None of the intervention studies examined weight loss maintenance as an outcome yet Black/African American adults generally lose less weight and maintain a lower percentage of weight loss compared to their counterparts [52,53]. Digital technologies show promise in supporting weight loss maintenance, which is often more challenging than initial weight loss [54]. Several studies have found that eHealth interventions using text messaging, email, and web-based systems can be effective for short-term weight loss maintenance, typically 3-24 months [55]. ...
Background: Research shows that media-based dietary and behavioral strategies can aid weight loss, but limited studies have been conducted among Black/African American adults. Objective: This review examines the literature on dietary and behavioral strategies for weight loss and maintenance among Black/African American adults, identifying the types of media used alongside these strategies. Methods: The PubMed, Web of Science, CINAHL, and Communication & Mass Media databases were searched for peer-reviewed articles with no restrictions on the publication date. Two reviewers conducted the screening. Studies were included if they had >75% Black/African American adult participants (18 years and older), included behavioral or dietary strategies, had a media component, weight loss or maintenance as an outcome, and published in English language. Results: Nine studies (randomized control trials (n = 5), mixed-method studies (n = 2) and qualitative studies (n = 2)) were included. Behavioral strategies used to lose and maintain weight included goal setting (n = 4), self-monitoring (n = 5), and weekly self-weighing (n = 2). Limiting sugary drinks (n = 3), limiting junk and high fat foods (n = 5), aiming for a set number of calories per day (n = 3), portion control (n = 4), and increasing fruits and vegetable intake (n = 3) were the most common dietary strategies used to lose and maintain weight. Media used in the intervention studies included mHealth text messaging (n = 2), Facebook (n = 2), a website (n = 1), television (n = 1) and a mobile app (n = 1). Conclusions: The findings highlight the limited research on the utilization of media for behavioral and dietary weight loss strategies among Black/African American adults, indicating a need for future studies to explore and optimize media-based strategies for this population.
... Judging individuals with obesity based on their chosen weight loss method, such as GLP-1s, fails to acknowledge the multifaceted influences on obesity, weight, and weight loss including factors that extend far beyond personal control, encompassing biology, genetics, food environment, healthcare access, and socioeconomic status, among others [8]. Clinical trials have repeatedly demonstrated that the vast majority of individuals with obesity who achieve significant weight loss with lifestyle interventions eventually regain it back due to complex metabolic, hormonal, social, and behavioral factors [9][10][11]. Assuming weight and weight loss are entirely within individual control, and thus can be easily managed solely with lifestyle changes, exacerbates weight stigma [12] and can inadvertently promote harmful weight-related cognitions and behaviors, such as disordered eating, in the pursuit of weight loss [13]. ...
Individuals with obesity who use glucagon-like peptide 1 receptor agonists (GLP-1s) for weight loss are often judged for taking a “shortcut” rather than using “optimal” methods (i.e., diet/exercise). This is linked with beliefs that weight is highly controllable, which predict both anti-fat attitudes and maladaptive weight-related behaviors. This study tested how exposure to a woman whose weight was framed as highly controllable or largely uncontrollable and who was described as losing weight with a GLP-1 vs. diet/exercise affected weight stigma attitudes and maladaptive weight-related cognitions through social comparison processes.
Women with overweight and obesity (N = 163) were exposed to a woman with obesity who varied by described weight controllability and weight loss method. Participants reported the extent to which they engaged in global downward social comparison and weight and body size comparisons to the woman, as well as weight stigma attitudes and maladaptive weight-related cognitions (likelihood of engaging in binge eating, restrictive eating, and exercising hard to control weight).
When the woman lost weight with a GLP-1 (vs. diet/exercise) she was judged more negatively due, in part, to higher global downward social comparison. Reading about weight loss with diet/exercise (vs. GLP-1) led to more maladaptive weight-related cognitions through higher weight and body size comparisons. Emphasizing that weight is less controllable did not reduce stigmatizing attitudes towards a GLP-1 user and had a limited effect on weight-related cognitions.
Further research is necessary to identify interventions to reduce weight stigma towards GLP-1 users and maladaptive weight-related cognitions.
... Ongoing chronic hormonal pharmacotherapy may help normalize physiology and promote long-term weight loss maintenance compared to behavior/lifestyle modifications alone (59)(60)(61). Further studies are needed to establish the longterm use of GLP-1RA or GLP-1RA/GIP agonists in maintenance therapy and the results after a course of therapy. ...
Background: The Centers for Disease Control and Prevention (CDC) reports that 42% of adults in the United States (US) are obese, and 10% are severely obese. Obesity has many known associated health risks, and successful treatment decreases those risks. Management always includes diet and lifestyle changes and drug therapy can improve weight loss. The current United States Food and Drug Administration (FDA) approved pharmaceutical therapy choices for long-term use include a combination of phentermine-topiramate, combination bupropion-naltrexone, orlistat, glucagon-like peptide-1 receptor agonists (GLP-1RAs), and dual action GLP-1RAs and gastric inhibitory peptide agonists (GIP). Objectives: This review will summarize evidence comparing the safety and efficacy of GLP-1RAs or GLP-1RAs/GIP agonists with other pharmacologic treatments to achieve and maintain weight loss, improve quality of life, and reduce morbidity in obese adults. Methods: We completed a literature review of multiple databases, including PubMed, Embase, Google Scholar, and Cochrane databases, to identify studies about pharmacologic treatment for overweight or obese adults with or without T2DM and reporting outcomes of mean percentage body weight loss. An emphasis was placed on choosing meta-analyses and primary studies in patients without T2DM. We excluded articles older than 5 years or published in a language other than English. 19 meta-analyses and 2 randomized controlled trials (RCTs) were chosen, and 13 meta-analyses were excluded based on not meeting the inclusion criteria. 6 meta-analyses and 2 RCTs were included. Results: The literature showed that over 52 weeks, liraglutide reduced mean body weight percentage by 4.81% (95% CI: 4.23%-5.39%). Between a 12-68 week period in patients receiving semaglutide, three meta-analyses reported reduced weight by 12.57% [97% CI 10.35%-14.80%,) 10.55% (95% CI 6.96%-14.13%,) and 10.09% (95% CI: 8.33%-11.84%.) Tirzepatide, a novel GLP-1RA and GIP agonist, recently completed a phase-3 RCT, which showed that over 72 weeks, the mean weight percentage decrease was 18.4% (95% CI: 18.5%-23.2%) vs a 3.1% weight gain with placebo, a change of 21.8%. Each of the GLP-1RA agents (including tirzepatide) improved cardiometabolic risk factors. Phentermine-topiramate reduced mean body weight percentage by 8.45% (95% CI, 7.89%–9.01%) after 52-56 weeks. Bupropion-naltrexone reduced mean body weight percentage by 3.01% (95% CI, 2.47%–3.54%) over 56 weeks. Finally, orlistat reduced mean body weight percentage by 2.78% (95% CI, 2.36%–3.20%) after 1-4 years. Semaglutide is a well-established drug with weight loss, but tirzepatide shows the most promise in being the superior agent. Conclusion: It is well known that pharmacotherapy with diet and exercise is more effective than diet and exercise alone in achieving weight loss. The GLP-1RAs are effective for weight loss, with semaglutide more effective than phentermine-topiramate, bupropion-naltrexone, orlistat, and liraglutide. Tirzepatide shows promise as a superior agent, but more comprehensive studies need to be done. When choosing pharmacotherapy, utilizing a GLP-1RA (semaglutide) or a dual GLP-1RA/GIP agonist (tirzepatide) can improve cardiometabolic risk factors and quality of life and is more effective than any other FDA-approved agent. ?
... Although similar studies have conducted interventions and follow-ups in a shorter period, it has been declared that a return to the pre-intervention BMI can be expected in the absence of intervention continuation. 32 The current lifestyle intervention study aimed to be practical and scalable within the existing societal structures of a middle-income country with limited resources. Based on the obtained results, while the significant effects of the intervention on weight control of both sexes were evident in the first follow-up evaluation, the stability of this effect was longer in women than in men. ...
Background
To evaluate a multi-setting lifestyle intervention’s effect on body mass index (BMI) across the entire spectrum in a middle-income adult population over 15 years.
Methods
This pragmatic interventional study included 5153 adults (≥20 years) from a middle-income community, followed for over 15 years with five follow-ups. A multi-setting intervention (school, family, community) aimed to promote healthy lifestyles. The lambda-mu sigma (LMS) method and quantile regression model were used to analyze changes in BMI percentiles (10th-90th) by sex and intervention group.
Results
The intervention showed modest effects on BMI percentiles. In men, it lowered BMI at the 40th and 70th percentiles (overweight/obesity onset) at the first follow-up (β=-0.16, 95% CI: -0.33, -0.001 and β=-0.21, 95% CI: -0.38, -0.04 respectively). In women, the effect emerged later (second follow-up) at the 20th (β=-0.39, 95% CI: -0.60, -0.18), 30th (β=-0.27, 95% CI: -0.49, -0.04), and 60th (β=-0.20, 95% CI: -0.39, -0.02) percentiles (overweight risk), extending to more overweight percentiles (20th-50th) in the third follow-up (βs ranged from -0.28 until -0.26).
Conclusion
Our results indicated the effectiveness of a practical lifestyle intervention to control rising trend of BMI at the onset of overweight and obesity in a middle-income population. These findings can be useful for planning obesity prevention programs in communities with similar socioeconomic statuses.
... Были разработаны различные методы профилактики ожирения, при этом наиболее распространенными отправными точками для снижения веса являются изменения образа жизни, включая изменение привычек питания и физических упражнений [25,30]. Однако вероятность успеха относительно невелика, возможно, из-за плохой долгосрочной приверженности лечению и модификации образа жизни [31]. Фармакотерапия ожирения является основным методом лечения; например, агонисты рецепторов глюкагоноподобного пептида-1 (GLP-1), такие как лираглутид и семаглутид, были одобрены для лечения ожирения [32,33]. ...
Adipose tissue has morphological heterogeneity. Currently, five types of fat cells are known: white, beige, brown, yellow and pink adipocytes. In the future, we will consider white, beige and brown adipocytes. The main pathological role in the development of obesity and a number of other metabolic diseases is played by white adipose tissue. The function of energy storage in white adipocytes is well known. However, in pathological conditions, the mass of white fat can increase significantly, amounting to more than 70% of the total body weight. In addition, white adipocytes are prone to inflammation and pathological production of biologically active substances - adipokines. Many adipokines negatively affect musculoskeletal and bone tissues, exacerbate systemic chronic inflammation and the severity of polymorbid pathology. At the same time, brown adipose tissue, due to its pronounced ability to heat production (thermogenesis), has protective properties. Activation of brown adipose tissue and stimulation of the transformation of white adipocytes into brown ones (the so-called “browning”) with the help of physical activity, medications and dietary supplements seems promising. These methods can be successfully used to combat overweight and obesity. In addition, modern advances in genetics and transplantology allow us to hope for the future use of brown adipocyte transplantation in patients who suffer from severe obesity. Research on the interrelationships of adipose tissue, muscles, cardiovascular, nervous, endocrine and other body systems continue. Undoubtedly, there are many interesting scientific discoveries to be made in medical science.
... 8 Additionally, studies have shown that time-restricted eaters unintentionally reduce their daily energy intake by 10%-30%, due in part to fewer opportunities to eat later in the evening. 2,9 As traditional energyrestricted diets often face challenges with long-term effectiveness, mainly due to difficulties with adherence, 10,11 there is a need to explore alternative approaches such as TRE. ...
Aims
Adherence to any dietary approach is crucial for achieving long‐term benefits. This qualitative study aims to explore the facilitators and barriers to adherence, and how individuals in community settings navigate time‐restricted eating in their daily lives.
Methods
Semi‐structured, in‐depth interviews were conducted with 21 participants who had practised time‐restricted eating (confining the daily eating window to <10h a day; and excluding periodic fasting methods like the 5:2 approach or alternate day fasting) for periods ranging from 3 months to more than 5 years. A qualitative content analysis, underpinned by the Capability‐Opportunity‐Motivation‐Behaviour Model, identified multiple facilitators, barriers, and strategies that evolved over the practice.
Results
Key facilitators included the simplicity and versatility of time‐restricted eating, maintaining a non‐obsessive and non‐dieting mindset, and having a supportive environment. Barriers included hunger and food cravings, an obsessive mindset during the initial stages, and conflicting schedules with social eating occasions, including holidays. Participants employed several coping strategies to successfully navigate adherence and reported confidence in maintaining time‐restricted eating as a lifestyle that contributes to better health and weight management.
Conclusion
Our findings suggest that successful implementation of time‐restricted eating in community settings requires flexibility and viewing it as more than a short‐term weight loss tool. Guidelines are needed to help individuals and practitioners implement better practices and promote healthier behaviours.
... While some treatments, such as lifestyle modifications and medications, can be effective in the short-term, long-term weight loss and maintenance can be challenging. Maintaining long-term weight loss requires sustained lifestyle changes and ongoing support, which can be difficult for individuals to maintain without ongoing professional guidance and community support (19). ...
Obesity, a complex and multifactorial condition, has reached epidemic proportions globally, posing a significant threat to public health. This paper reviews the global epidemiology of obesity and associated comorbidities, exploring key trends, drivers, and implications for healthcare systems. We examine the distribution of obesity across different regions, age groups, and socioeconomic strata, analyzing factors such as dietary changes, physical inactivity, genetic predisposition, and socioeconomic inequalities. The paper delves into the growing burden of obesity-related conditions, including type 2 diabetes, cardiovascular diseases, and certain types of cancer, emphasizing their impact on morbidity, mortality, and healthcare expenditures. We discuss the challenges of obesity management, highlighting the need for multifaceted interventions that address individual behaviors, environmental factors, and social determinants of health. Finally, we explore promising research directions for understanding the complex interplay of factors influencing obesity prevalence and for developing effective strategies for prevention and management.
... Factors such as unhealthy dietary habits, a prevalence of high-energy-dense foods, a lack of physical activity, and an increase in high-pressure work and stress promote the occurrence of obesity (2). However, classical treatment methods for obesity often require long-term persistence and lifestyle changes, which are difficult to practice consistently and are often unsatisfactory (3). Therefore, new treatment strategies for obesity are required, such as the use of natural traditional medicine products that have notable therapeutic effects, favorable safety profiles and clinical evidence. ...
Asiasarum root and rhizome (Asarum) is commonly used as a diaphoretic. Due to its warm and pungent characteristics in traditional Chinese and Korean medicine, it is considered as having the potential to prevent disease. The present study investigated the effects of Asarum extract on the symptoms of obesity in mice, and the regulation of energy metabolism in the liver and skeletal muscle tissues. In addition, to identify the potential molecular targets and signaling pathways involved in the mechanism of action of Asarum extract in obesity, network pharmacological and molecular docking analysis was performed. In vitro studies demonstrated that Asarum extract significantly increased the expression of regulators of energy metabolism [sirtuin 1 (SIRT1), peroxisome proliferator-activated receptor γ coactivator 1-α (PGC1α), nuclear respiratory factor 1, AMP-activated protein kinase (AMPK) and glucose transporter type 4 (GLUT4)] and myogenic regulatory factors (MyoD, myogenin and myosin heavy chain) in C2C12 myotubes. Furthermore, the in vivo studies demonstrated that Asarum extract could reduce increases in body weight, and the levels of blood glucose, insulin, total cholesterol, triglycerides and low-density lipoprotein cholesterol in the sera of obese mice. Asarum extract also improved pathological changes in the liver and pancreatic tissues of obese mice, and significantly increased the ratio of brown fat mass to body weight. In addition, Asarum extract reversed the expression of energy metabolism regulators and myogenic regulatory factors in the gastrocnemius tissues of obese mice. Asarum extract also activated the expression of SIRT1, PGC1α and AMPK in the liver tissues of obese mice. These findings indicated that Asarum extract may exert anti-obesity effects, such as body weight loss, decreases in lipid metabolite levels, and inhibition of pancreatic and liver damage. Using network pharmacological analysis, the mechanisms underlying the effects of Asarum extract on the regulation of energy metabolism were explored, particularly in skeletal muscle and liver tissues.
... Those who have tried to reduce weight in the past are frequently more mindful of their weight situation and could act in more health-conscious manner [10]. The effectiveness of these initiatives differs, though; many people nd it di cult to keep weight down over time, which causes a return into obesity [11]. The aim of study is to exploring the spread of obesity among medical eld individuals by means of several demographic, socioeconomic, and lifestyle aspects. ...
Background Rising worldwide health issue obesity is typified by an excessive body fat buildup endangering health. Over the past few decades, the incidence of obesity has sharply risen, which has resulted in an increase in related health issues like type 2 diabetes, heart illnesses, and certain malignancies. Objective examines demographic, socioeconomic, and lifestyle factors affecting obesity among medical professionals, analyses medical field data to identify obesity reasons and provide realistic weight control and obesity prevention strategies. Method January–June 2024 cross sectional survey of 200 Babylon physicians. Stratified random selection ensured a balanced mix of demographic and socioeconomic traits throughout data collection. Results Of the physician replies, most were female (53%), urbanites (96%), aged 36–45 (43%), and 46–55 (32%), With 78% inactivity, most responders—medical (59.5%)—had private clinics (72%) and Age, private employment, and weight satisfaction were linked to BMI; 74% of respondents were overweight or obese. Though they tried to lose weight, 56.5% of them were dissatisfied with it. Conclusion Doctors are becoming overweight and obese, and BMI is closely connected with age, private work, and weight satisfaction. Doctors are often unhappy with their weight, suggesting weight control concerns. Low physical activity may be linked to work overload. Exercise and lifestyle improvements for doctors are desperately needed. Patient care providers' health will improve by addressing these challenges.
... With a very tight calcemic control, several parenterally administered synthetic vitamin D analogs have displayed a remarkable ability of a long-term weight control in normal mice (Smith et al., 2000). As traditional strategies to manage obesity, such as diet, exercise, or surgery, often yield limited long-term success (Hall and Kahan, 2018;Wadden et al., 2020), and pharmacological interventions, including GLP1 agonists and other synthetic drugs, can cause undesirable side effects (Coulter et al., 2018), there is a growing need for innovative pharmacological approaches. ...
Background
Obesity is an emerging health problem worldwide as it is associated with increased risk of cardiovascular, metabolic, mental disorders, and cancer. Therapeutic weight management remains one of the options for the treatment of excess weight and associated comorbidities. In this study, the therapeutic potential of elocalcitol, a fluorinated derivative of vitamin D, was studied on the model of high-fat diet (HFD)-induced obesity in mice.
Results
It was demonstrated that co-administration of elocalcitol in the doses 15 ug/kg (i.p.) twice a week for 16 weeks prevented body weight gain by approximately 15%. The significant retardation in the body weight gain was observed already on the second week of elocalcitol treatment. Administration of elocalcitol also reduced visceral and epididymal fat accumulation by 55% and 35%, respectively, metabolic syndrome development, and lipid droplets accumulation in the liver of mice exposed to HFD. In contrast, the administration of cholecalciferol (vitamin D)—a precursor to calcitriol, the biologically active form of vitamin D, did not affect significantly the signs of obesity and metabolic syndrome, suggesting that the anti-obese effects of elocalcitol are not related to the canonical vitamin D receptor (VDR). Further studies have demonstrated that the preventive effect of elocalcitol is associated with the decreased levels of sterol regulatory element-binding protein (SREBP) cleavage-activating protein (SCAP) and upregulation insulin-inducing gene-1 (Insig1) mRNA expression suggesting that the anti-obese effect of elocalcitol is mediated via inhibition of SREBP-mediated lipogenesis. We also demonstrated that elocalcitol prevents an increase in the expression of proinflammatory cytokines such as interleukin-1 beta (Il1b), tumor necrosis factor-alpha (Tnf), and interleukin-18 (Il18), and this effect was associated with upregulation of microRNA-146a (miR-146a). Deletion of the miR-146a gene reduced the anti-obese effects of elocalcitol and prevented its actions on the SCAP levels. The data indicate that elocalcitol’s reduction of SCAP is at least partly mediated by miR-146a modulation.
Conclusion
The study demonstrates that elocalcitol prevents HFD-induced obesity and metabolic syndrome in mice, likely by inhibiting SREBP-mediated lipogenesis and upregulating miR-146a. These findings provide valuable insights into the anti-obesity mechanisms of fluorinated D-vitamin analogs and suggest potential therapeutic strategies for obesity prevention.
... Nearly two-thirds of the population achieved clinically meaningful weight loss at 12 months, and over 80% of those who lost 3% or more of baseline body weight by three or 6 months maintained the weight loss or lost additional weight. This level of sustained weight loss in those with weight log data is noteworthy as weight regain at 1 year is common after weight loss programs [31,32]. The large population studied here, of over 66,000 total, and nearly 9000 with 12-month data, not only provides confidence in the statistical findings of this analysis but also highlights the ability of virtual weight care programs to drive weight loss and maintenance at scale. ...
Background
Virtually‐delivered obesity care has the potential to increase access to weight loss interventions at scale. While there is ample literature assessing various weight loss interventions, studies specifically demonstrating outcomes of commercial programs offering antiobesity medications in virtual care settings are lacking.
Methods
This retrospective cohort study assessed the weight loss outcomes of 66,094 participants in a virtual weight care program that prescribes antiobesity medications alongside a digital behavior change program. Outcomes included the primary endpoint of percent weight loss at 12 months, as well as absolute change in body weight, change in body mass index (BMI), categorical weight loss at three, six, and 12 months, and stratifications by program engagement and medication type (first vs. second generation antiobesity medications).
Results
At program enrollment, members were on average 42.6 years old and 91.5% female, with a BMI of 36.0 kg/m². At 12 months, the mean percent weight loss was 8.0%, with weight loss increasing over time from 2.9 kg (SD = 3.7, Cohen's d = 0.8) at 3 months, to 5.8 kg (SD = 6.1, Cohen's d = 0.9) at 6 months, to 8.0 kg (SD = 8.7, Cohen's d = 0.9) at 12 months (p < 0.001 for all time points). At 12 months, 64.2% had achieved ≥ 5% weight loss. Weight loss outcomes increased with program engagement. At 12 months, those engaging at least once weekly lost 10.0% of body weight, while those logging weight at least weekly lost 12.0%.
Conclusion
This study provides real‐world evidence that users of a virtual commercial weight care clinic who were prescribed antiobesity medications achieved clinically significant weight loss at six and 12 months. These findings support the value of virtual platforms in efficiently scaling access to high‐quality weight care.
... Overweight and obesity are associated with increased morbidity and mortality as well as reduced quality of life [2]. There has been limited success in treating and preventing obesity [3] with interventions often resulting in initial weight loss, followed by weight regain [4][5][6]. Causes of obesity are multifactorial, including socioeconomic, environmental, biological and psychological drivers [7]. In behavioural weight loss (BWL) interventions, 5%-10% weight loss targets are promoted due to associated health benefits [8]. ...
Background
Emotional eating (EE) is a barrier to the long-term success of weight loss interventions. Psychological interventions targeting EE have been shown to reduce EE scores and weight (kg), though the mechanisms remain unclear. This review and meta-analysis aimed to identify the specific behaviour change techniques (BCTs) associated with improved outcomes.
Methods
This is a review update and extension, with new studies extracted from searches of CINAHL, PsycINFO, MEDLINE and EMBASE 1 January 2022 to 31 April 2023. EE interventions for adults with BMI > 25 kg/m2 were considered for inclusion. Paper screening, extraction, BCT-coding and risk of bias were completed using the Template for Intervention Description and Replication (TIDieR) checklist, Behaviour Change Taxonomy v1 (BCTTv1) and Risk of Bias2 (RoB2)/Risk of Bias In Non-randomised Studies (ROBINS-I) tool. Narrative syntheses and random effects multi-level meta-analyses were conducted.
Results
In total, 6729 participants were included across 47 studies (13 identified in the update). Forty-two studies contributed to the pooled estimate for the impact of interventions on EE (SMD = −0.99 [95% CI: −0.73 to −1.25], p < 0.001). Thirty-two studies contributed to the pooled estimate for the impact of interventions on weight (−4.09 kg [95% CI: −2.76 to −5.43 kg], p < 0.001). Five BCTs related to identity, values and self-regulation were associated with notable improvements to both weight and EE (‘incompatible beliefs’, ‘goal setting outcome’. ‘review outcome goals’, ‘feedback on behaviour’ and ‘pros/cons’).
Conclusion
Implementation and evaluation of the highlighted BCTs are required. Weight management services should consider screening patients for EE to tailor interventions to individual needs.
Nonnutritive sweeteners were introduced on the market over a century ago to displace the calories of added sugars in foods and beverages and, therefore, facilitate weight loss. In spite of their widespread use, obesity has reached epidemic proportions. The present paper addresses this apparent paradox. Low‐ or no‐energy sweeteners (LNES) are a small group of widely different substances that can be used to modify one single aspect of energy intake, i.e., consumption of added sugars. Their potential benefits for weight management can be predicted by energy balance equations. Decades of research confirm that LNES affect weight via a purely nutritional mechanism, in proportion of their actual displacement of sugar energy. LNES allow a substantial decrease in energy density of beverages (as opposed to solid foods) and can be maximally effective in consumers of sugar‐containing drinks. Their average effect is robust but modest (1–2‐kg weight loss) compared to comprehensive weight‐loss programs (±5 kg), medication, or surgery (+10% of initial weight). Other benefits of LNES include sensory‐specific satiety for sweet foods, improved diet adherence, and facilitation of weight‐loss maintenance. Whether these effects are considered minor or major benefits in the present obesogenic context is a matter of individual definition.
Purpose of Review
To describe the recent literature on acceptance and commitment therapy (ACT) interventions for individuals with obesity. The review begins with a brief overview of the ACT model, describes seminal work in this area, and examines more recent literature on the use of ACT to improve outcomes among individuals with obesity.
Recent Findings
Early trials established ACT’s efficacy for weight loss among adults with obesity. More recent research has focused on testing efficacy among adolescents, measuring effects in “real world” settings, refining interventions to optimize outcomes and enhance scalability, and examining outcomes beyond weight (e.g., internalized weight stigma, eating regulation). Current data indicate that ACT-based interventions produce comparable, or, in some cases, superior weight loss compared to standard behavioral interventions. ACT has also shown promise for improving other outcomes of interest.
Summary
ACT may improve a variety of obesity-related outcomes, although additional research is needed.
Diabetes is a complex metabolic disorder affecting over 37 million people in the United States. Without proper management, diabetes can lead to a myriad of complications, including cardiovascular disease, kidney failure, and vision loss. Obesity is a major contributor to type 2 diabetes, but genetic and physiological factors make weight loss difficult, necessitating medication management for both conditions. Government-approved weight loss medications, including glucagon-like peptide-1 agonists and amylin analogs, have proven to be effective for both conditions. However, intensive glycemic control involving antidiabetic medications, while beneficial for reducing diabetic complications, can often precipitate hypoglycemic events, which are characterized by cardiac arrhythmias, coma, confusion, and even mortality. A new drug under investigation, CagriSema, combines cagrilintide, an amylin analog, with semaglutide, a glucagon-like peptide-1 agonist. This drug is being marketed as a safe and potentially superior medication to lower both Hemoglobin A1c and body weight. In this article, the pathophysiology, current guidelines, and management of diabetes will be reviewed, with an emphasis on the clinical evidence for tight glucose control and avoiding hypoglycemic events. Following this, an overview of recent trials on antidiabetic medications, including those involving CagriSema, will be presented, along with prospects for future trials in this promising area of research.
Daily routines play a large role in the development and progression of chronic disease. This chapter will define routines and summarize the evidence behind the role of routines in terms of mindset, diet, and physical activity in obesity and type 2 diabetes. In addition, practical tools for healthcare professionals to help patients develop healthy routines will be presented, along with recommendations for future large-scale endeavors to support sustainability of these lifestyle changes.
Obesity is a major public health challenge. Glucagon-like peptide-1 receptor agonists (GLP1-RA) and bariatric surgery (BS) are effective weight loss interventions; however, the genetic factors influencing treatment response remain largely unexplored. Moreover, most previous studies have focused on race and ethnicity rather than genetic ancestry. Here we analyzed 10,960 individuals from 9 multiancestry biobank studies across 6 countries to assess the impact of known genetic factors on weight loss. Between 6 and 12 months, GLP1-RA users had an average weight change of −3.93% or −6.00%, depending on the outcome definition, with modest ancestry-based differences. BS patients experienced −21.17% weight change between 6 and 48 months. We found no significant associations between GLP1-RA-induced weight loss and polygenic scores for body mass index or type 2 diabetes, nor with missense variants in GLP1R. A higher body mass index polygenic score was modestly linked to lower weight loss after BS (+0.7% per s.d., P = 1.24 × 10⁻⁴), but the effect attenuated in sensitivity analyses. Our findings suggest known genetic factors have limited impact on GLP1-RA effectiveness with respect to weight change and confirm treatment efficacy across ancestry groups.
Cardiovascular disease presents a ten-fold higher risk of death than suicide in individuals with serious mental illness. Individuals experiencing first-episode psychosis already have high rates of modifiable risk factors contributing to cardiovascular disease. The initial 12 months are crucial for implementing behavioral interventions for effective risk factor modification and disease prevention. Coordinated Specialty Care (CSC) outpatient clinics provide multi-disciplinary team-based treatment for teens and young adults in the early stages of psychotic illness, significantly improving mental health outcomes and quality of life. However, these clinics lack support for addressing lifestyle behavior changes in their clients. The North Carolina Healthy Active Living (NC HeAL) program is an innovative clinical service offered to all CSC clients in this state. It offers personalized health and wellness coaching to help clients achieve meaningful health improvements. This paper provides a detailed description of the program’s development, the target population and setting, the roles and skills of the NC HeAL team, program components and evidence-based program measures. Results of program measures, feasibility, acceptability, implementation, and fidelity will be published separately.
Obesity remains a complex global health issue, necessitating multifaceted treatment approaches. Injectable pharmacotherapies have emerged as effective strategies to manage obesity by targeting metabolic pathways that regulate appetite, energy expenditure, and fat distribution. This review explores the mechanisms, clinical efficacy, and safety profiles of key injectable agents, including GLP-1 and GIP receptor agonists and lipolytic compounds. Additionally, it highlights the aesthetic challenges following significant weight loss, such as skin laxity, and discusses the role of biostimulators and non-invasive technologies in mitigating these effects. Despite the therapeutic promise of injectable agents, their widespread application is hindered by adverse effects, high costs, and accessibility issues. This paper underscores the need for integrative treatment models that combine pharmacological interventions with aesthetic and behavioral therapies to optimize patient outcomes. Future research should focus on refining personalized protocols and expanding the accessibility of these treatments to diverse populations.
Personal health factors and direct and indirect costs of obesity affect employers and employees. This research aimed to understand perceptions of obesity management and anti-obesity medications (AOMs) among employers and employees. In 2022, people with obesity and employers completed cross-sectional surveys about perceptions of obesity and its management, including AOMs. Data were analyzed with descriptive statistics. Data from 461 employed people with obesity (EwO) and 51 employer representatives (ER) were analyzed. Both EwO and ER acknowledged the impact of obesity on future health problems (88.3%; 100.0%) and perceived obesity as a disease (60.5%; 80.4%) to varied degrees. Both groups perceived an incremental value in combining self-directed lifestyle changes and AOMs (57.5%; 66.7%) and perceived healthcare provider-guided lifestyle change alongside AOMs as the most effective approach for maintaining long-term weight reduction (56.4%; 66.6%). More than two-thirds (68.6%) of ER expressed willingness to revisit their AOM coverage decisions, though cost of medication coverage (72.5%) and affordability of medications for employees (68.7%) were identified as barriers. ER believed that data showing reductions in premiums and claims at their organizations (78.4%) would be helpful in supporting the coverage of AOMs. While EwO and ER were receptive toward AOMs, organization-level barriers existed with AOM coverage. Evidence demonstrating the benefits of evidence-based obesity care, direct/indirect cost reductions, and the impact of obesity may address barriers to AOM coverage and improve obesity care and outcomes of their workforces.
Small open reading frames (smORFs) encode microproteins that play crucial roles in various biological processes, yet their functions in adipocyte biology remain largely unexplored. In a previous study, we identified thousands of smORFs in white and brown adipocytes derived from the stromal vascular fraction (SVF) of mice using ribosome profiling (Ribo-Seq). Here, we expand on this work by identifying additional smORFs related to adipocytes using the in vitro 3T3-L1 preadipocyte model. To systematically investigate the functional relevance of these smORFs, we designed a custom CRISPR/Cas9 guide RNA (sgRNA) library and screened for smORFs influencing adipocyte proliferation and differentiation. Through a dropout screen and fluorescence-assisted cell sorting (FACS) of lipid droplets, we identified dozens of smORFs that regulate either cell proliferation or lipid accumulation. Among these, we validated a novel microprotein as a key regulator of adipocyte differentiation. These findings highlight the potential of CRISPR/Cas9-based screening to uncover functional smORFs and provide a framework for further exploration of microproteins in adipocyte biology and metabolic regulation.
Significance
Obesity and its associated metabolic disorders pose significant public health challenges, yet the molecular mechanisms regulating adipocyte function remain incompletely understood. Small open reading frames (smORFs) and their encoded microproteins represent an emerging class of regulatory elements with potential roles in metabolism. Here, we leveraged CRISPR/Cas9 screening to functionally characterize smORFs in adipocytes, identifying novel regulators of cell proliferation and lipid metabolism. Our findings demonstrate that conservation is not a prerequisite for smORF function, as we validated a mouse-specific microprotein that modulates adipocyte differentiation. This work establishes a robust pipeline for unbiased smORF discovery and highlights the potential for species-specific microproteins to regulate adipose biology. Future studies in human adipocytes may uncover additional microproteins with therapeutic relevance for obesity and metabolic disease.
» Obesity is a public health concern, with 41.9% of the US population classified as obese. Obesity increases the risk of chronic disease, type II diabetes, cardiovascular diseases, etc., leading to increased morbidity and mortality. Obesity has been identified as an independent risk factor of postoperative complications, including infection and impaired wound healing, following elective surgery. In total joint arthroplasty, it has been well elucidated that obese patients are predisposed to higher rates of postoperative complications, longer hospital stays, and increased cost of stay.
» Obesity is influenced by the interplay between many societal, behavioral, and socioeconomic factors and requires a multidisciplinary approach to treatment. The patient's care team should be well versed in nutritional counseling, behavioral health counseling, medication management, and surgery to allow for a comprehensive approach.
» Orthopaedic surgeons, dietitians, nutritionists, weight-loss physicians, and bariatric surgeons all play a critical role in treating this patient population. This review highlights the roles of these practitioners in developing an interdisciplinary framework to help patients with hip and knee arthritis lose weight before joint replacement surgery. Not only will this afford more patients the quality-of-life benefits that come with a hip or knee replacement but will also serve to decrease the complication rates associated with this patient cohort.
» The aim of this review was to educate orthopaedic surgeons on various strategies that can be used to best optimize these patients for successful joint replacement surgery.
El libro Crecimiento personal y buenas prácticas comunitarias aborda el desarrollo del bienestar individual y social a través de estrategias de promoción de la salud mental, resiliencia y cohesión comunitaria. Presenta un enfoque integrador basado en modelos teóricos como el biomédico, psicosocial y biopsicosocial, analizando su impacto en la comunidad. También explora hábitos saludables, gestión comunitaria y reducción del estigma en la salud mental. La obra destaca la importancia de la inclusión social y el fortalecimiento de factores de protección para lograr una sociedad más equitativa y saludable.
Background
A chronic inflammatory state characterizes a wide range of diseases for which obesity is a risk factor. Weight loss could reduce levels of circulating inflammatory markers potentially reducing the incidence of associated diseases and improving response to treatment. However, dietary weight loss studies have reported inconsistent effects on serum inflammatory makers and the long‐term effects are unknown.
Objective
To systematically review randomized controlled trials and analyze any differences in serum interleukin‐6 and tumor necrosis factor‐alpha between adults with obesity achieving weight loss through dietary intervention compared to those receiving none or standard care.
Methods
Studies were identified by searching databases from 1966 to November 2024. Randomized controlled trials with at least 12 months' follow‐up were included in this systematic review and meta‐analysis with an assessment of Cochrane risk of bias version 1.
Results
Twelve eligible studies were included. No trials reported a significant effect of weight loss on circulating tumor necrosis factor‐alpha, whilst studies achieving greater than 5% weight loss significantly reduced circulating interleukin‐6 in adults with obesity.
Conclusion
Weight loss interventions achieving and maintaining greater than 5% weight loss appear to be required to reduce circulating interleukin‐6 levels in adults with obesity.
Worldwide, nearly 40% of adults are overweight and 13% are obese. Health consequences of excess weight include cardiovascular diseases, type 2 diabetes, dyslipidemia, and increased mortality. Treating obesity is challenging and calorie restriction often leads to rebound weight gain. Treatments such as bariatric surgery create hesitancy among patients due to their invasiveness. GLP-1 medications have revolutionized weight loss and can reduce body weight in obese patients by between 15% and 25% on average after about 1 year. Their mode of action is to mimic the endogenous GLP-1, an intestinal hormone that regulates glucose metabolism and satiety. However, GLP-1 drugs carry known risks and, since their use for weight loss is recent, may carry unforeseen risks as well. They carry a boxed warning for people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. Gastrointestinal adverse events (nausea, vomiting, diarrhea) are fairly common while pancreatitis and intestinal obstruction are rarer. There may be a loss of lean body mass as well as premature facial aging. A significant disadvantage of using these medications is the high rate of weight regain when they are discontinued. Achieving success with pharmacologic treatment and then weaning to avoid future negative effects would be ideal.
Maladaptive feeding comprises unhealthy eating patterns that jeopardize survival, including over- and underconsumption. These behaviors are often coordinated by endogenous opioid receptors (EORs). Here, we explore the involvement of EORs in obesity and anorexia nervosa (AN), two disorders associated with dysregulated feeding behavior and relevant animal models. While seemingly opposing metabo-psychiatric states, our goal is to highlight common circuit and synaptic mechanisms underlying obesity and AN with a focus on EOR functionality. We examine the neural substrates underlying maladaptive feeding and comorbid conditions including pain, suggesting a role for EOR-driven plasticity in the pathogenesis of both obesity and AN.
Importance
Research investigating weight loss and mortality risk often fails to differentiate between intentional and unintentional weight loss and typically uses body mass index (BMI) as the measure of excess body weight.
Objective
To evaluate associations between weight loss and waist circumference (WC) reduction and mortality, considering weight loss intentionality.
Design, Setting, and Participants
This cohort study used data from the Women’s Health Initiative Observational Study, which had a prospective cohort with mean follow-up of 18.6 years ending in February 2023. The study included women aged 50 to 79 years at 40 clinical centers in the US. Women with missing data, cancer at baseline, or considered underweight at baseline were excluded. Data were collected from September 1993 to February 2023 and were analyzed from June to December 2024.
Exposures
Measured weight loss and WC reduction between baseline and year 3, stratified by women who reported intentional weight loss or not.
Main Outcomes and Measures
Outcomes included adjudicated all-cause, cancer, cardiovascular, and other mortality through the end of follow-up. Cox proportional hazards regression models were used to evaluate the associations (hazard ratios [HRs] and 95% CIs) between weight loss, WC reduction, and mortality over 18.6 years of follow-up.
Results
This study included 58 961 women at baseline (mean [SD] age, 63.3 [7.2] years; mean [SD] BMI, 27.0 [5.6]; mean [SD] WC, 84.1 [13.0] cm). As of February 28, 2023, 29 183 women (49.5%) died from all causes. Intentional weight loss measured by questionnaire was associated with lower subsequent mortality rates for all-cause mortality (HR, 0.88; 95% CI, 0.86-0.90), cancer mortality (HR, 0.87; 95% CI, 0.82-0.92), cardiovascular mortality (HR, 0.87; 95% CI, 0.83-0.91), and other mortality (HR, 0.89; 95% CI, 0.86-0.92), comparing loss of 5 pounds or more to stable weight. Reported intentional weight loss coupled with actual weight reduction of 5% or more was associated only with lower cardiovascular mortality (HR, 0.90; 95% CI, 0.81-0.99). Reported intentional weight loss coupled with measured WC loss was associated with lower rates of all-cause mortality (HR, 0.91; 95% CI, 0.86-0.95), cancer mortality (HR, 0.85; 95% CI, 0.76-0.95), and cardiovascular mortality (HR, 0.79; 95% CI, 0.72-0.87). Unintentional weight loss or unintentional WC loss were each associated with increased mortality risk for all groups, as were weight gain and WC gain.
Conclusions and Relevance
In this cohort study, reported intentional weight loss efforts that were coupled with measured WC reductions were associated with lower risk of all-cause, cancer, and cardiovascular mortality. Attention to diet and exercise that promote reductions in central adiposity should be encouraged.
Objective:
This study aims to: (i) describe the results of recruitment into the eFfEct of an Anti-inflammatory diet for knee oSTeoarthritis (FEAST) randomized controlled trial (RCT); (ii) report baseline characteristics of randomized participants and compare these with four large international cohorts; and (iii) explore cross-sectional associations between dietary inflammatory index (DII®) scores and baseline clinical characteristics.
Methods:
The FEAST RCT compares an anti-inflammatory dietary programme and standard care low-fat dietary programme for adults aged 45-85 years with knee osteoarthritis (OA). At baseline, participants provided medical history (medical comorbidities, symptomatic musculoskeletal sites), completed questionnaires (demographic characteristics, Knee injury and OA Outcome Score (KOOS)) and a 3-day food diary. Both DII® and energy-adjusted DII (E-DIITM) scores were calculated based on 3-day food diary data and was used to quantify the effect of diet on systemic inflammation. Associations between DII/E-DII and KOOS subscales, symptomatic musculoskeletal sites, and comorbidities was assessed using linear and negative binomial regression.
Results:
1121 individuals were screened to identify 182 eligible individuals, from which 144 participants (64% female, 36% male) enrolled, with a mean ± SD age 65 ± 8 years and body mass index 30.3 ± 6.2 kg/m2. Overweight (41%) and obesity (45%) was common. Two-thirds (62%) had ≥1 medical comorbidity, most commonly hypertension (26%). Musculoskeletal pain in sites other than the index knee was reported in 79%, most commonly in the lower back (42%). Mean DII and E-DII scores were 0.58 ± 1.49 and -0.31 ± 1.41, respectively. No associations were found between DII/E-DII and KOOS subscales except for activities of daily living (ADL), number of medical comorbidities and symptomatic MSK sites, and BMI.
Conclusion:
The FEAST cohort is comparable to other knee OA cohorts, supporting generalizability of the results. Despite a relatively pro-inflammatory diet at baseline, DII/E-DII was not associated with KOOS subscales, number of comorbidities or symptomatic musculoskeletal sites.
Metabolic energy stored mainly as adipose tissue is homeostatically regulated. There is strong evidence that human body weight (BW) is physiologically regulated, i.e. maintained within a relatively narrow range in most mammals, including humans. Nevertheless, the prevalence of obesity has increased markedly in recent decades and now constitutes major medical and socioeconomic problems worldwide. This review focuses on understanding this paradox and the clinical issues that it has spawned: how and why do individuals become obese and how can we help those with obesity lose excess BW and body fat and maintain whatever loss they achieve. Excess BW gain occurs when physiological responses that usually resist short-term weight gain fail to compensate for excess caloric intake occurring over extended periods of time, often over many years or even decades. On the other hand, the difficulties of achieving BW loss and maintenance of reduced BW in obese subjects are due, in part, to the operation of the same physiological regulatory system that helps maintain a healthy BW in individuals without obesity. But, given obesity's association with many pathological conditions, we maintain that the physiological processes that resist BW loss and persistently drive regain are examples of dysregulation. Here we review research in humans and animals addressing these and other unresolved issues in the physiology of obesity. We bring important unresolved problems into focus, and, in some cases, propose hypotheses that can further elucidate their mechanisms to provide research opportunities into modalities that might lead to more effective treatments of obesity.
The rate of weight reduction during obesity treatment declines over time and eventually reaches a weight plateau. We investigated factors associated with time to weight plateau (TTWP) in tirzepatide‐treated participants with obesity or overweight in a post‐hoc analysis of SURMOUNT‐1 and SURMOUNT‐4 trials. Participants adherent to tirzepatide treatment and achieving ≥5% weight loss by primary endpoint (week 72 SURMOUNT‐1; week 88 SURMOUNT‐4) were included. Weight plateau was defined as a weight change <5% over a 12‐week interval and all subsequent 12‐week intervals. TTWP was time from randomization to the start of the first 12‐week interval. Association between baseline characteristics and TTWP was assessed. Overall, 1438 participants in SURMOUNT‐1 and 259 in SURMOUNT‐4 were included. Across BMI categories (overweight, class I, II, and III), median TTWP in SURMOUNT‐1 was 24.3, 26.0, 36.1, and 36.1 weeks, respectively ( p <.05, class II and III vs. overweight). By week 72%, 90.2%, 88.9%, 87.6%, and 87.8% of participants in SURMOUNT‐1 had reached a weight plateau across respective BMI categories. Higher doses of tirzepatide (10/15 mg), younger age, and female sex were more likely to reach a weight plateau later. Results in SURMOUNT‐4 were similar. In this post‐hoc analysis, most participants reached a weight plateau by week 72. Higher doses of tirzepatide, younger age, and female sex were associated with a longer TTWP. Further research into modifiers of weight reduction phases with tirzepatide may inform treatment decisions for its use in chronic weight management. Clinical Trial Registration : ClinicalTrials.gov , identifiers NCT04184622 (SURMOUNT‐1) and NCT04660643 (SURMOUNT‐4), available at http://www.clinicaltrials.gov/
Obesity is one of the most acute issues of medicine at the present stage due to the steady increase in morbidity, high risk of complications and comorbid conditions that entail significant financial costs. At the same time, many different etiopathogenetic factors are involved in the formation of obesity. The article presents a literature review concerning the main risk factors and etiologic aspects of the development of overweight and obesity in adults and children. The most relevant pathogenetic mechanisms are considered, including imbalance of adipokines (decrease in adiponectin level and increase in leptin content), formation of low activity chronic inflammation as a result of proinflammatory cytokines, changes in the features of neuroimmune-endocrine interactions, the impact of chronic stress on the human body, vitamin D deficiency, disorders of the “gut – brain” axis, quantitative and qualitative changes in the composition of intestinal microbiota. The main therapeutic approaches and surgical methods in the treatment of obesity are presented. The data available in the literature at the present stage on methods of rehabilitation of patients with obesity, as well as persons with excess body weight, indicating the need for a comprehensive approach and combination of lifestyle modification, physiotherapeutic methods, psychological counseling to achieve positive results are summarized.
Expert panels and governmental guidelines now recommend that obese persons seek modest (i.e., “reasonable”) reductions in body weight rather than striving for “ideal” weights. Little is known, however, about patients’ views of what is a “reasonable” weight loss. This study assessed patients’ goals, expectations, and evaluations of various outcomes before, during, and after 48 weeks of treatment. Before treatment, 60 obese women (99.1 ± 12.3 kg; body mass index of 36.3 ± 4.3 kg/m²) defined their goal weight and 4 other weights: “dream weight”; “happy weight”; “acceptable weight”; and “disappointed weight.” Goal weight averaged a 32% reduction in body weight. A 17-kg weight loss was defined as disappointed; a 25-kg loss, was acceptable. After 48 weeks of treatment and a 16-kg weight loss, 47% of patients did not achieve even a disappointed weight. These data illustrate the dramatic disparity between patients’ expectations and professional recommendations and the need to help patients accept more modest weight loss outcomes.
This study evaluated the effectiveness of four posttreatment programs designed to enhance the long-term maintenance of weight loss. Mildly and moderately obese adults (N= 123) were randomly assigned to one of the following five conditions: (a) behavior therapy only; (b) behavior therapy plus a posttreatment therapist-contact maintenance program; (c) behavior therapy plus posttreatment therapist contact plus a social influence maintenance program; (d) behavior therapy plus posttreatment therapist contact plus an aerobic exercise maintenance program; or (e) behavior therapy plus posttreatment therapist contact plus both the aerobic exercise and social influence maintenance programs. All posttreatment programs were conducted in 26 biweekly sessions during the year following behavioral treatment for obesity. At an 18-month follow-up evaluation, all four conditions that combined behavior therapy with a posttreatment maintenance program yielded significantly greater long-term weight losses than behavior therapy alone.
The brain plays a key role in the controls of energy intake and expenditure and many genes associated with obesity are expressed in the central nervous system. Technological and conceptual advances in both basic and clinical neurosciences have expanded the traditional view of homeostatic regulation of body weight by mainly the hypothalamus to include hedonic controls of appetite by cortical and subcortical brain areas processing external sensory information, reward, cognition, and executive functions. Thus, hedonic controls interact with homeostatic controls to regulate body weight in a flexible and adaptive manner that takes environmental conditions into account. This new conceptual framework has several important implications for the treatment of obesity. Because much of this interactive neural processing is outside awareness, cognitive restraint in a world of plenty is made difficult and prevention and treatment of obesity should be more rationally directed to the complex and often redundant mechanisms underlying this interaction.
Background:
Ultraprocessed food consumption has increased in the past decade. Evidence suggests a positive association between ultraprocessed food consumption and the incidence of overweight and obesity. However, few prospective studies to our knowledge have investigated this potential relation in adults.
Objective:
We evaluated the association between ultraprocessed food consumption and the risk of overweight and obesity in a prospective Spanish cohort, the SUN (University of Navarra Follow-Up) study.
Design:
We included 8451 middle-aged Spanish university graduates who were initially not overweight or obese and followed up for a median of 8.9 y. The consumption of ultraprocessed foods (defined as food and drink products ready to eat, drink, or heat and made predominantly or entirely from processed items extracted or refined from whole foods or synthesized in the laboratory) was assessed with the use of a validated semiquantitative 136-item food-frequency questionnaire. Cox proportional hazards models were used to estimate adjusted HRs and 95% CIs for incident overweight and obesity.
Results:
A total of 1939 incident cases of overweight and obesity were identified during follow-up. After adjustment for potential confounders, participants in the highest quartile of ultraprocessed food consumption were at a higher risk of developing overweight or obesity (adjusted HR: 1.26; 95% CI: 1.10, 1.45; P-trend = 0.001) than those in the lowest quartile of consumption.
Conclusions:
Ultraprocessed food consumption was associated with a higher risk of overweight and obesity in a prospective cohort of Spanish middle-aged adult university graduates. Further longitudinal studies are needed to confirm our results. This trial was registered at clinicaltrials.gov as NCT02669602.
High-protein (HP) intake during weight loss (WL) therapy is often recommended because it reduces the loss of lean tissue mass. However, HP intake could have adverse effects on metabolic function, because protein ingestion reduces postprandial insulin sensitivity. In this study, we compared the effects of ∼10% WL with a hypocaloric diet containing 0.8 g protein/kg/day and a hypocaloric diet containing 1.2 g protein/kg/day on muscle insulin action in postmenopausal women with obesity. We found that HP intake reduced the WL-induced decline in lean tissue mass by ∼45%. However, HP intake also prevented the WL-induced improvements in muscle insulin signaling and insulin-stimulated glucose uptake, as well as the WL-induced adaptations in oxidative stress and cell structural biology pathways. Our data demonstrate that the protein content of a WL diet can have profound effects on metabolic function and underscore the importance of considering dietary macronutrient composition during WL therapy for people with obesity.
Background:
Synonymous with increased use of mobile phones has been the development of mobile health (mHealth) technology for improving health, including weight management. Behavior change theory (eg, the theory of planned behavior) can be effectively encapsulated into mobile phone-based health improvement programs, which is fostered by the ability of mobile phones and related devices to collect and transmit objective data in near real time and for health care or research professionals and clients to communicate easily.
Objective:
To describe SmartLoss, a semiautomated mHealth platform for weight loss.
Methods:
We developed and validated a dynamic energy balance model that determines the amount of weight an individual will lose over time if they are adherent to an energy intake prescription. This model was incorporated into computer code that enables adherence to a prescribed caloric prescription determined from the change in body weight of the individual. Data from the individual are then used to guide personalized recommendations regarding weight loss and behavior change via a semiautomated mHealth platform called SmartLoss, which consists of 2 elements: (1) a clinician dashboard and (2) a mobile phone app. SmartLoss includes and interfaces with a network-connected bathroom scale and a Bluetooth-connected accelerometer, which enables automated collection of client information (eg, body weight change and physical activity patterns), as well as the systematic delivery of preplanned health materials and automated feedback that is based on client data and is designed to foster prolonged adherence with body weight, diet, and exercise goals. The clinician dashboard allows for efficient remote monitoring of all clients simultaneously, which may further increase adherence, personalization of treatment, treatment fidelity, and efficacy.
Results:
Evidence of the efficacy of the SmartLoss approach has been reported previously. The present report provides a thorough description of the SmartLoss Virtual Weight Management Suite, a professionally programmed platform that facilitates treatment fidelity and the ability to customize interventions and disseminate them widely.
Conclusions:
SmartLoss functions as a virtual weight management clinic that relies upon empirical weight loss research and behavioral theory to promote behavior change and weight loss.
Objectives To investigate the contribution of ultra-processed foods to the intake of added sugars in the USA. Ultra-processed foods were defined as industrial formulations which, besides salt, sugar, oils and fats, include substances not used in culinary preparations, in particular additives used to imitate sensorial qualities of minimally processed foods and their culinary preparations.
Design Cross-sectional study.
Setting National Health and Nutrition Examination Survey 2009–2010.
Participants We evaluated 9317 participants aged 1+ years with at least one 24 h dietary recall.
Main outcome measures Average dietary content of added sugars and proportion of individuals consuming more than 10% of total energy from added sugars.
Data analysis Gaussian and Poisson regressions estimated the association between consumption of ultra-processed foods and intake of added sugars. All models incorporated survey sample weights and adjusted for age, sex, race/ethnicity, family income and educational attainment.
Results Ultra-processed foods comprised 57.9% of energy intake, and contributed 89.7% of the energy intake from added sugars. The content of added sugars in ultra-processed foods (21.1% of calories) was eightfold higher than in processed foods (2.4%) and fivefold higher than in unprocessed or minimally processed foods and processed culinary ingredients grouped together (3.7%). Both in unadjusted and adjusted models, each increase of 5 percentage points in proportional energy intake from ultra-processed foods increased the proportional energy intake from added sugars by 1 percentage point. Consumption of added sugars increased linearly across quintiles of ultra-processed food consumption: from 7.5% of total energy in the lowest quintile to 19.5% in the highest. A total of 82.1% of Americans in the highest quintile exceeded the recommended limit of 10% energy from added sugars, compared with 26.4% in the lowest.
Conclusions Decreasing the consumption of ultra-processed foods could be an effective way of reducing the excessive intake of added sugars in the USA.
Objective
Precision medicine utilizes genomic and other data to optimize and personalize treatment. Although more than 2,500 genetic tests are currently available, largely for extreme and/or rare phenotypes, the question remains whether this approach can be used for the treatment of common, complex conditions like obesity, inflammation, and insulin resistance, which underlie a host of metabolic diseases. Methods
This review, developed from a Trans-NIH Conference titled Genes, Behaviors, and Response to Weight Loss Interventions, provides an overview of the state of genetic and genomic research in the area of weight change and identifies key areas for future research. ResultsAlthough many loci have been identified that are associated with cross-sectional measures of obesity/body size, relatively little is known regarding the genes/loci that influence dynamic measures of weight change over time. Although successful short-term weight loss has been achieved using many different strategies, sustainable weight loss has proven elusive for many, and there are important gaps in our understanding of energy balance regulation. Conclusions
Elucidating the molecular basis of variability in weight change has the potential to improve treatment outcomes and inform innovative approaches that can simultaneously take into account information from genomic and other sources in devising individualized treatment plans.
Background
The effectiveness of low-fat diets for long-term weight loss has been debated for decades, with dozens of randomized trials (RCTs) and recent reviews giving mixed results.
Methods
We conducted a random effects meta-analysis of RCTs to estimate the long-term effect of low-fat vs. higher fat dietary interventions on weight loss. Our search included RCTs conducted in adult populations reporting weight change outcomes at ≥1 year, comparing low-fat with higher fat interventions, published through July 2014. The primary outcome measure was mean difference in weight change between interventions.
Findings
Fifty-three studies met inclusion criteria representing 68,128 participants. In the setting of weight loss trials, low-carbohydrate interventions led to significantly greater weight loss than low-fat interventions (n comparisons=18; weighted mean difference [WMD]=1.15 kg, 95% CI=0.52 to 1.79; I²=10%). Low-fat did not lead to differences in weight change compared with other moderate fat weight loss interventions (n=19; WMD=0.36, 95% CI=-0.66 to 1.37; I²=82%), and were superior only when compared with “usual diet” (n=8; WMD=-5.41, 95% CI=-7.29 to −3.54; I²=68%). Similarly, non-weight loss trials and weight maintenance trials, for which there were no low-carbohydrate comparisons, had similar effects for low-fat vs moderate fat interventions, and were superior compared with “usual diet”. Weight loss trials achieving a greater difference in fat intake at follow-up significantly favored the higher fat dietary interventions, as indicated by difference of ≥5% of calories from fat (n=18; WMD=1.04, 95% CI=0.06 to 2.03; I²=78%) or by difference in change serum triglycerides of ≥5 mg/dL (n=17; WMD=1.38, 95% CI=0.50 to 2.25; I²=62%).
Interpretation
These findings suggest that the long-term effect of low-fat diets on body weight depends on the intensity of intervention in the comparison group. When compared to dietary interventions of similar intensity, evidence from RCTs does not support low-fat diets over other dietary interventions.
Accurate measurement of free-living energy intake (EI) over long periods is imperative for understanding obesity and its treatment. Unfortunately, traditional methods rely on self-report and are notoriously inaccurate. Although EI can be indirectly estimated by the intake-balance method, this technique is prohibitively labor-intensive and expensive, requiring repeated measures of energy expenditure via doubly labeled water (DLW) along with multiple dual-energy X-ray absorptiometry (DXA) scans to measure changes in body energy stores.
Our objective was to validate a mathematical method to measure long-term changes in free-living energy intake.
We measured body weight and EI changes (ΔEI) over 4 time intervals by using the intake-balance method in 140 individuals who underwent 2 y of caloric restriction as part of the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy study. We compared the ΔEI values calculated by using DLW/DXA with those obtained by using a mathematical model of human metabolism whose only inputs were the initial demographic information and repeated body weight data.
The mean ΔEI values calculated by the model were within 40 kcal/d of the DLW/DXA method throughout the 2-y study. For individual subjects, the overall root mean square deviation between the model and DLW/DXA method was 215 kcal/d, and most of the model-calculated ΔEI values were within 132 kcal/d of the DLW/DXA method.
Accurate and inexpensive estimates of ΔEI that are comparable to the DLW/DXA method can be obtained by using a mathematical model and repeated body weight measurements. This trial was registered at clinicaltrials.gov as NCT00427193.
© 2015 American Society for Nutrition.
International Journal of Obesity is a monthly, multi-disciplinary forum for papers describing basic, clinical and applied studies in biochemistry, genetics and nutrition, together with molecular, metabolic, psychological and epidemiological aspects of obesity and related disorders
Over the past 20 y, higher-protein diets have been touted as a successful strategy to prevent or treat obesity through improvements in body weight management. These improvements are thought to be due, in part, to modulations in energy metabolism, appetite, and energy intake. Recent evidence also supports higher-protein diets for improvements in cardiometabolic risk factors. This article provides an overview of the literature that explores the mechanisms of action after acute protein consumption and the clinical health outcomes after consumption of long-term, higher-protein diets. Several meta-analyses of shorter-term, tightly controlled feeding studies showed greater weight loss, fat mass loss, and preservation of lean mass after higher-protein energy-restriction diets than after lower-protein energy-restriction diets. Reductions in triglycerides, blood pressure, and waist circumference were also reported. In addition, a review of the acute feeding trials confirms a modest satiety effect, including greater perceived fullness and elevated satiety hormones after higher-protein meals but does not support an effect on energy intake at the next eating occasion. Although shorter-term, tightly controlled feeding studies consistently identified benefits with increased protein consumption, longer-term studies produced limited and conflicting findings; nevertheless, a recent meta-analysis showed persistent benefits of a higher-protein weight-loss diet on body weight and fat mass. Dietary compliance appears to be the primary contributor to the discrepant findings because improvements in weight management were detected in those who adhered to the prescribed higher-protein regimen, whereas those who did not adhere to the diet had no marked improvements. Collectively, these data suggest that higher-protein diets that contain between 1.2 and 1.6 g protein · kg(-1) · d(-1) and potentially include meal-specific protein quantities of at least ∼25-30 g protein/meal provide improvements in appetite, body weight management, cardiometabolic risk factors, or all of these health outcomes; however, further strategies to increase dietary compliance with long-term dietary interventions are warranted.
© 2015 American Society for Nutrition.
Obesity is a major global health problem and predisposes individuals to several comorbidities that can affect life expectancy. Interventions based on lifestyle modification (e.g., improved diet and exercise) are integral components in the management of obesity. However, although weight loss can be achieved through dietary restriction and/or increased physical activity, over the long term many individuals regain weight. The aim of this article is to review the research into the processes and mechanisms that underpin weight regain after weight loss and comment on future strategies to address them. Maintenance of body weight is regulated by the interaction of a number of processes, encompassing homeostatic, environmental and behavioural factors. In homeostatic regulation, the hypothalamus plays a central role in integrating signals regarding food intake, energy balance and body weight while an 'obesogenic' environment and behavioural patterns exert effects on the amount and type of food intake and physical activity. The roles of other environmental factors are also now being considered including sleep debt and iatrogenic effects of medications, many of which warrant further investigation. Unfortunately, physiological adaptations to weight loss favour weight regain. These changes include perturbations in the levels of circulating appetite-related hormones and energy homeostasis, in addition to alterations in nutrient metabolism and subjective appetite. To maintain weight loss, individuals must adhere to behaviours that counteract physiological adaptations and other factors favouring weight regain. It is difficult to overcome physiology with behaviour. Weight loss medications and surgery change the physiology of body weight regulation and are the best chance for long-term success. An increased understanding of the physiology of weight loss and regain will underpin the development of future strategies to support overweight and obese individuals in their efforts to achieve and maintain weight loss.International Journal of Obesity accepted article preview online, 21 April 2015. doi:10.1038/ijo.2015.59.
Energy intake (EI) and physical activity energy expenditure (PAEE) are key modifiable determinants of energy balance, traditionally assessed by self-report despite its repeated demonstration of considerable inaccuracies. We argue here that it is time to move from the common view that self-reports of EI and PAEE are imperfect, but nevertheless deserving of use, to a view commensurate with the evidence that self-reports of EI and PAEE are so poor that they are wholly unacceptable for scientific research on EI and PAEE. While new strategies for objectively determining energy balance are in their infancy, it is unacceptable to use decidedly inaccurate instruments, which may misguide health care policies, future research, and clinical judgment. The scientific and medical communities should discontinue reliance on self-reported EI and PAEE. Researchers and sponsors should develop objective measures of energy balance.International Journal of Obesity accepted article preview online, 13 November 2014. doi:10.1038/ijo.2014.199.
Objective:
To assess the relative impact of an intensive lifestyle intervention (ILI) on use and costs of health care within the Look AHEAD trial.
Research design and methods:
A total of 5,121 overweight or obese adults with type 2 diabetes were randomly assigned to an ILI that promoted weight loss or to a comparison condition of diabetes support and education (DSE). Use and costs of health-care services were recorded across an average of 10 years.
Results:
ILI led to reductions in annual hospitalizations (11%, P = 0.004), hospital days (15%, P = 0.01), and number of medications (6%, P < 0.001), resulting in cost savings for hospitalization (10%, P = 0.04) and medication (7%, P < 0.001). ILI produced a mean relative per-person 10-year cost savings of $5,280 (95% CI 3,385-7,175); however, these were not evident among individuals with a history of cardiovascular disease.
Conclusions:
Compared with DSE over 10 years, ILI participants had fewer hospitalizations, fewer medications, and lower health-care costs.
Harmon S. Jordan, ScD, Karima A. Kendall, PhD, Linda J. Lux, Roycelynn Mentor-Marcel, PhD, MPH, Laura C. Morgan, MA, Michael G. Trisolini, PhD, MBA, Janusz Wnek, PhD
Jeffrey L. Anderson, MD, FACC, FAHA, Chair , Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect , Nancy M. Albert, PhD, CCNS, CCRN,
Background
It has been well-documented that Americans have shifted towards eating out more and cooking at home less. However, little is known about whether these trends have continued into the 21st century, and whether these trends are consistent amongst low-income individuals, who are increasingly the target of public health programs that promote home cooking. The objective of this study is to examine how patterns of home cooking and home food consumption have changed from 1965 to 2008 by socio-demographic groups.
Methods
This is a cross-sectional analysis of data from 6 nationally representative US dietary surveys and 6 US time-use studies conducted between 1965 and 2008. Subjects are adults aged 19 to 60 years (n= 38,565 for dietary surveys and n=55,424 for time-use surveys). Weighted means of daily energy intake by food source, proportion who cooked, and time spent cooking were analyzed for trends from 1965–1966 to 2007–2008 by gender and income. T-tests were conducted to determine statistical differences over time.
Results
The percentage of daily energy consumed from home food sources and time spent in food preparation decreased significantly for all socioeconomic groups between 1965–1966 and 2007–2008 (p ≤ 0.001), with the largest declines occurring between 1965 and 1992. In 2007–2008, foods from the home supply accounted for 65 to 72% of total daily energy, with 54 to 57% reporting cooking activities. The low income group showed the greatest decline in the proportion cooking, but consumed more daily energy from home sources and spent more time cooking than high income individuals in 2007–2008 (p ≤ 0.001).
Conclusions
US adults have decreased consumption of foods from the home supply and reduced time spent cooking since 1965, but this trend appears to have leveled off, with no substantial decrease occurring after the mid-1990’s. Across socioeconomic groups, people consume the majority of daily energy from the home food supply, yet only slightly more than half spend any time cooking on a given day. Efforts to boost the healthfulness of the US diet should focus on promoting the preparation of healthy foods at home while incorporating limits on time available for cooking.
Behavior change interventions are effective to the extent that they affect appropriately-measured outcomes, especially in experimental controlled trials. The primary goal of this study was to analyze the impact of a 1-year weight management intervention based on self-determination theory (SDT) on theory-based psychosocial mediators, physical activity/exercise, and body weight and composition. Participants were 239 women (37.6 +/- 7.1 years; 31.5 +/- 4.1 kg/m(2)) who received either an intervention focused on promoting autonomous forms of exercise regulation and intrinsic motivation, or a general health education program (controls). At 12 months, the intervention group showed increased weight loss (-7.29%,) and higher levels of physical activity/exercise (+138 +/- 26 min/day of moderate plus vigorous exercise; +2,049 +/- 571 steps/day), compared to controls (P < 0.001). Main intervention targets such as more autonomous self-regulation (for treatment and for exercise) and a more autonomous perceived treatment climate revealed large effect sizes (between 0.80 and .96), favoring intervention (P < 0.001). Results suggest that interventions grounded in SDT can be successfully implemented in the context of weight management, enhancing the internalization of more autonomous forms of behavioral regulation, and facilitating exercise adherence, while producing clinically-significant weight reduction, when compared to a control condition. Findings are fully consistent with previous studies conducted within this theoretical framework in other areas of health behavior change.
Background: It is currently unclear whether altering the carbohydrate-to-protein ratio of low-fat, energy-restricted diets augments weight loss and cardiometabolic risk markers.
Objective: The objective was to conduct a systematic review and meta-analysis of studies that compared energy-restricted, isocaloric, high-protein, low-fat (HP) diets with standard-protein, low-fat (SP) diets on weight loss, body composition, resting energy expenditure (REE), satiety and appetite, and cardiometabolic risk factors.
Design: Systematic searches were conducted by using MEDLINE, EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials to identify weight-loss trials that compared isocalorically prescribed diets matched for fat intake but that differed in protein and carbohydrate intakes in participants aged ≥18 y. Twenty-four trials that included 1063 individuals satisfied the inclusion criteria.
Results: Mean (±SD) diet duration was 12.1 ± 9.3 wk. Compared with an SP diet, an HP diet produced more favorable changes in weighted mean differences for reductions in body weight (−0.79 kg; 95% CI: −1.50, −0.08 kg), fat mass (FM; −0.87 kg; 95% CI: −1.26, −0.48 kg), and triglycerides (−0.23 mmol/L; 95% CI: −0.33, −0.12 mmol/L) and mitigation of reductions in fat-free mass (FFM; 0.43 kg; 95% CI: 0.09, 0.78 kg) and REE (595.5 kJ/d; 95% CI: 67.0, 1124.1 kJ/d). Changes in fasting plasma glucose, fasting insulin, blood pressure, and total, LDL, and HDL cholesterol were similar across dietary treatments (P ≥ 0.20). Greater satiety with HP was reported in 3 of 5 studies.
Conclusion: Compared with an energy-restricted SP diet, an isocalorically prescribed HP diet provides modest benefits for reductions in body weight, FM, and triglycerides and for mitigating reductions in FFM and REE.
In an article that forms part of the PLoS Medicine series on Big Food, David Stuckler and colleagues report that unhealthy packaged foods are being consumed rapidly in low- and middle-income countries, consistent with rapid expansion of multinational food companies into emerging markets and fueling obesity and chronic disease epidemics.
Though the benefits of healthy lifestyle choices are well-established among the general population, less is known about how developing and adhering to healthy lifestyle habits benefits obese versus normal weight or overweight individuals. The purpose of this study was to determine the association between healthy lifestyle habits (eating 5 or more fruits and vegetables daily, exercising regularly, consuming alcohol in moderation, and not smoking) and mortality in a large, population-based sample stratified by body mass index (BMI).
We examined the association between healthy lifestyle habits and mortality in a sample of 11,761 men and women from the National Health and Nutrition Examination Survey III; subjects were ages 21 and older and fell at various points along the BMI scale, from normal weight to obese. Subjects were enrolled between October 1988 and October 1994 and were followed for an average of 170 months.
After multivariable adjustment for age, sex, race, education, and marital status, the hazard ratios (95% CIs) for all-cause mortality for individuals who adhered to 0, 1, 2, or 3 healthy habits were 3.27 (2.36-4.54), 2.59 (2.06-3.25), 1.74 (1.51-2.02), and 1.29 (1.09-1.53), respectively, relative to individuals who adhered to all 4 healthy habits. When stratified into normal weight, overweight, and obese groups, all groups benefited from the adoption of healthy habits, with the greatest benefit seen within the obese group.
Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index.
Obesity is a risk factor for cardiovascular events. Weight loss might protect against cardiovascular events, but solid evidence is lacking.
To study the association between bariatric surgery, weight loss, and cardiovascular events.
The Swedish Obese Subjects (SOS) study is an ongoing, nonrandomized, prospective, controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care. Patients were recruited between September 1, 1987, and January 31, 2001. Date of analysis was December 31, 2009, with median follow-up of 14.7 years (range, 0-20 years). Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women. Exclusion criteria were identical in surgery and control patients. Surgery patients underwent gastric bypass (13.2%), banding (18.7%), or vertical banded gastroplasty (68.1%), and controls received usual care in the Swedish primary health care system. Physical and biochemical examinations and database cross-checks were undertaken at preplanned intervals.
The primary end point of the SOS study (total mortality) was published in 2007. Myocardial infarction and stroke were predefined secondary end points, considered separately and combined.
Bariatric surgery was associated with a reduced number of cardiovascular deaths (28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group; adjusted hazard ratio [HR], 0.47; 95% CI, 0.29-0.76; P = .002). The number of total first time (fatal or nonfatal) cardiovascular events (myocardial infarction or stroke, whichever came first) was lower in the surgery group (199 events among 2010 patients) than in the control group (234 events among 2037 patients; adjusted HR, 0.67; 95% CI, 0.54-0.83; P < .001).
Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.
A 56-week randomized controlled trial was conducted to evaluate safety and efficacy of a controlled-release combination of phentermine and topiramate (PHEN/TPM CR) for weight loss (WL) and metabolic improvements. Men and women with class II and III obesity (BMI ≥ 35 kg/m(2)) were randomized to placebo, PHEN/TPM CR 3.75/23 mg, or PHEN/TPM CR 15/92 mg, added to a reduced-energy diet. Primary end points were percent WL and proportions of patients achieving 5% WL. Secondary end points included waist circumference (WC), systolic and diastolic blood pressure (BP), fasting glucose, and lipid measures. In the primary analysis (randomized patients with at least one postbaseline weight measurement who took at least one dose of assigned drug or placebo), patients in the placebo, 3.75/23, and 15/92 groups lost 1.6%, 5.1%, and 10.9% of baseline body weight (BW), respectively, at 56 weeks (P < 0.0001). In categorical analysis, 17.3% of placebo patients, 44.9% of 3.75/23 patients, and 66.7% of 15/92 patients, lost at least 5% of baseline BW at 56 weeks (P < 0.0001). The 15/92 group had significantly greater changes relative to placebo for WC, systolic and diastolic BP, fasting glucose, triglycerides, total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). The most common adverse events were paresthesia, dry mouth, constipation, dysgeusia, and insomnia. Dropout rate from the study was 47.1% for placebo patients, 39.0% for 3.75/23 patients, and 33.6% of 15/92 patients. PHEN/TPM CR demonstrated dose-dependent effects on weight and metabolic variables in the direction expected to be beneficial with no evidence of serious adverse events induced by treatment.
There is a general perception that almost no one succeeds in long-term maintenance of weight loss. However, research has shown that ≈20% of overweight individuals are successful at long-term weight loss when defined as losing at least 10% of initial body weight and maintaining the loss for at least 1 y. The National Weight Control Registry provides information about the strategies used by successful weight loss maintainers to achieve and maintain long-term weight loss. National Weight Control Registry members have lost an average of 33 kg and maintained the loss for more than 5 y. To maintain their weight loss, members report engaging in high levels of physical activity (≈1 h/d), eating a low-calorie, low-fat diet, eating breakfast regularly, self-monitoring weight, and maintaining a consistent eating pattern across weekdays and weekends. Moreover, weight loss maintenance may get easier over time; after individuals have successfully maintained their weight loss for 2–5 y, the chance of longer-term success greatly increases. Continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss are also associated with long-term success. National Weight Control Registry members provide evidence that long-term weight loss maintenance is possible and help identify the specific approaches associated with long-term success.
Socially acceptable body weight is increasing.¹ If more individuals who are overweight or obese are satisfied with their weight, fewer might be motivated to lose unhealthy weight. This study assessed the trend in the percentage of adults who were overweight or obese and trying to lose weight during 3 periods from 1988 through 2014.
Background:
Weight regain after successful weight loss interventions is common.
Objective:
To establish the efficacy of a weight loss maintenance program compared with usual care in obese adults.
Design:
2-group, parallel, randomized trial stratified by initial weight loss (<10 kg vs. ≥10 kg), conducted from 20 August 2012 to 18 December 2015. Outcome assessors were blinded to treatment assignment. (ClinicalTrials.gov: NCT01357551).
Setting:
3 primary care clinics at the Veterans Affairs Medical Center in Durham and Raleigh, North Carolina.
Patients:
Obese outpatients (body mass index ≥30 kg/m2) who lost 4 kg or more of body weight during a 16-week, group-based weight loss program.
Intervention:
The maintenance intervention, delivered primarily by telephone, addressed satisfaction with outcomes, relapse-prevention planning, self-monitoring, and social support. Usual care involved no contact except for study measurements.
Measurements:
Primary outcome was mean weight regain at week 56. Secondary outcomes included self-reported caloric intake, walking, and moderate physical activity.
Results:
Of 504 patients in the initial program, 222 lost at least 4 kg of body weight and were randomly assigned to maintenance (n = 110) or usual care (n = 112). Retention was 85%. Most patients were middle-aged white men. Mean weight loss during initiation was 7.2 kg (SD, 3.1); mean weight at randomization was 103.6 kg (SD, 20.4). Estimated mean weight regain was statistically significantly lower in the intervention (0.75 kg) than the usual care (2.36 kg) group (estimated mean difference, 1.60 kg [95% CI, 0.07 to 3.13 kg]; P = 0.040). No statistically significant differences in secondary outcomes were seen at 56 weeks. No adverse events directly attributable to the intervention were observed.
Limitations:
Results may not generalize to other settings or populations. Dietary intake and physical activity were self-reported. Duration was limited to 56 weeks.
Conclusion:
An intervention focused on maintenance-specific strategies and delivered in a resource-conserving way modestly slowed the rate of weight regain in obese adults.
Primary funding source:
Veterans Affairs Health Services Research and Development Service.
Background:
Liraglutide 3·0 mg was shown to reduce bodyweight and improve glucose metabolism after the 56-week period of this trial, one of four trials in the SCALE programme. In the 3-year assessment of the SCALE Obesity and Prediabetes trial we aimed to evaluate the proportion of individuals with prediabetes who were diagnosed with type 2 diabetes.
Methods:
In this randomised, double-blind, placebo-controlled trial, adults with prediabetes and a body-mass index of at least 30 kg/m(2), or at least 27 kg/m(2) with comorbidities, were randomised 2:1, using a telephone or web-based system, to once-daily subcutaneous liraglutide 3·0 mg or matched placebo, as an adjunct to a reduced-calorie diet and increased physical activity. Time to diabetes onset by 160 weeks was the primary outcome, evaluated in all randomised treated individuals with at least one post-baseline assessment. The trial was conducted at 191 clinical research sites in 27 countries and is registered with ClinicalTrials.gov, number NCT01272219.
Findings:
The study ran between June 1, 2011, and March 2, 2015. We randomly assigned 2254 patients to receive liraglutide (n=1505) or placebo (n=749). 1128 (50%) participants completed the study up to week 160, after withdrawal of 714 (47%) participants in the liraglutide group and 412 (55%) participants in the placebo group. By week 160, 26 (2%) of 1472 individuals in the liraglutide group versus 46 (6%) of 738 in the placebo group were diagnosed with diabetes while on treatment. The mean time from randomisation to diagnosis was 99 (SD 47) weeks for the 26 individuals in the liraglutide group versus 87 (47) weeks for the 46 individuals in the placebo group. Taking the different diagnosis frequencies between the treatment groups into account, the time to onset of diabetes over 160 weeks among all randomised individuals was 2·7 times longer with liraglutide than with placebo (95% CI 1·9 to 3·9, p<0·0001), corresponding with a hazard ratio of 0·21 (95% CI 0·13-0·34). Liraglutide induced greater weight loss than placebo at week 160 (-6·1 [SD 7·3] vs -1·9% [6·3]; estimated treatment difference -4·3%, 95% CI -4·9 to -3·7, p<0·0001). Serious adverse events were reported by 227 (15%) of 1501 randomised treated individuals in the liraglutide group versus 96 (13%) of 747 individuals in the placebo group.
Interpretation:
In this trial, we provide results for 3 years of treatment, with the limitation that withdrawn individuals were not followed up after discontinuation. Liraglutide 3·0 mg might provide health benefits in terms of reduced risk of diabetes in individuals with obesity and prediabetes.
Funding:
Novo Nordisk, Denmark.
Weight changes are accompanied by imbalances between calorie intake and expenditure. This fact is often misinterpreted to suggest that obesity is caused by gluttony and sloth and can be treated by simply advising people to eat less and move more. However, various components of energy balance are dynamically interrelated and weight loss is resisted by counterbalancing physiological processes. While low carbohydrate diets have been suggested to partially subvert these processes by increasing energy expenditure and promoting fat loss, our meta-analysis of 32 controlled feeding studies with isocaloric substitution of carbohydrate for fat found that both energy expenditure (26 kcal/d; p<0.0001) and fat loss (16g/d; p<0.0001) were greater with lower fat diets. We review the components of energy balance and the mechanisms acting to resist weight loss in the context of static, settling point, and set-point models of body weight regulation, with the set-point model being most commensurate with current data.
Objective:
To quantify the feedback control of energy intake in response to long-term covert manipulation of energy balance in free-living humans.
Methods:
A validated mathematical method was used to calculate energy intake changes during a 52-week placebo-controlled trial in 153 patients treated with canagliflozin, a sodium glucose co-transporter inhibitor that increases urinary glucose excretion, thereby resulting in weight loss without patients being directly aware of the energy deficit. The relationship between the body weight time course and the calculated energy intake changes was analyzed using principles from engineering control theory.
Results:
It was discovered that weight loss leads to a proportional increase in appetite resulting in eating above baseline by ∼100 kcal/day per kilogram of lost weight-an amount more than threefold larger than the corresponding energy expenditure adaptations.
Conclusions:
While energy expenditure adaptations have often been considered the main reason for slowing of weight loss and subsequent regain, feedback control of energy intake plays an even larger role and helps explain why long-term maintenance of a reduced body weight is so difficult.
Diets to treat obesity have been in existence since Hippocrates treated obesity some 2500 years ago. There are currently a wide variety of diets and a common misconception that a single magical diet can cure overweight and obesity. Systematic reviews and meta-analyses indicate that all diets work when adhered to and that initial weight loss can predict the amount of weight lost and maintained for up to 4 years. Individual preferences are thus key in selecting a diet. There are emerging data pinpointing genetic variability in the metabolic responses to variation in macronutrient intake.
Objective:
To test for differential weight loss response to low-fat (LF) vs. low-carbohydrate (LC) diets by insulin resistance status with emphasis on overall quality of both diets.
Methods:
Sixty-one adults, BMI 28-40 kg/m(2) , were randomized in a 2 × 2 design to LF or LC by insulin resistance status in this pilot study. Primary outcome was 6-month weight change. Participants were characterized as more insulin resistant (IR) or more insulin sensitive (IS) by median split of baseline insulin-area-under-the-curve from an oral glucose tolerance test. Intervention consisted of 14 one-hour class-based educational sessions.
Results:
Baseline % carbohydrate:% fat:% protein was 44:38:18. At 6 months, the LF group reported 57:21:22 and the LC group reported 22:53:25 (IR and IS combined). Six-month weight loss (kg) was 7.4 ± 6.0 (LF-IR), 10.4 ± 7.8 (LF-IS), 9.6 ± 6.6 (LC-IR), and 8.6 ± 5.6 (LC-IS). No significant main effects were detected for weight loss by diet group or IR status; there was no significant diet × IR interaction. Significant differences in several secondary outcomes were observed.
Conclusions:
Substantial weight loss was achieved overall, but a significant diet × IR status interaction was not observed. Opportunity to detect differential response may have been limited by the focus on high diet quality for both diet groups and sample size.
Background:
Financial incentives promote many health behaviors, but effective ways to deliver health incentives remain uncertain.
Methods:
We randomly assigned CVS Caremark employees and their relatives and friends to one of four incentive programs or to usual care for smoking cessation. Two of the incentive programs targeted individuals, and two targeted groups of six participants. One of the individual-oriented programs and one of the group-oriented programs entailed rewards of approximately 150 plus $650 in reward payments for successful participants. Usual care included informational resources and free smoking-cessation aids.
Results:
Overall, 2538 participants were enrolled. Of those assigned to reward-based programs, 90.0% accepted the assignment, as compared with 13.7% of those assigned to deposit-based programs (P<0.001). In intention-to-treat analyses, rates of sustained abstinence from smoking through 6 months were higher with each of the four incentive programs (range, 9.4 to 16.0%) than with usual care (6.0%) (P<0.05 for all comparisons); the superiority of reward-based programs was sustained through 12 months. Group-oriented and individual-oriented programs were associated with similar 6-month abstinence rates (13.7% and 12.1%, respectively; P=0.29). Reward-based programs were associated with higher abstinence rates than deposit-based programs (15.7% vs. 10.2%, P<0.001). However, in instrumental-variable analyses that accounted for differential acceptance, the rate of abstinence at 6 months was 13.2 percentage points (95% confidence interval, 3.1 to 22.8) higher in the deposit-based programs than in the reward-based programs among the estimated 13.7% of the participants who would accept participation in either type of program.
Conclusions:
Reward-based programs were much more commonly accepted than deposit-based programs, leading to higher rates of sustained abstinence from smoking. Group-oriented incentive programs were no more effective than individual-oriented programs. (Funded by the National Institutes of Health and CVS Caremark; ClinicalTrials.gov number, NCT01526265.).
Test the efficacy of SmartLoss(SM) , a smartphone-based weight loss intervention, in a pilot study.
A 12-week randomized controlled trial. Adults (25 ≤ BMI ≤ 35 kg/m(2) ) were randomized to SmartLoss (n = 20) or an attention-matched Health Education control group (n = 20). SmartLoss participants were prescribed a 1,200 to 1,400 kcal/d diet and were provided with a smartphone, body weight scale, and accelerometer that wirelessly transmitted body weight and step data to a website. In the SmartLoss Group, mathematical models were used to quantify dietary adherence based on body weight and counselors remotely delivered treatment recommendations based on these objective data. The Health Education group received health tips via smartphone. A mixed model determined if change in weight and other endpoints differed between the groups (baseline was a covariate).
The sample was 82.5% female. Mean ± SD baseline age, weight (kg), and BMI were 44.4 ± 11.8 years, 80.3 ± 11.5 kg, and 29.8 ± 2.9 kg/m(2) , respectively. One participant was lost to follow-up in each group before week 4. Weight loss was significantly (P < 0.001) larger in the SmartLoss (least squares mean ± SEM: -9.4 ± 0.5%) compared with the Health Education group (-0.6 ± 0.5%).
SmartLoss efficaciously promote clinically meaningful weight loss compared with an attention-matched control group. Smartphone-based interventions might prove useful in intervention dissemination.
© 2015 The Obesity Society.
The National Institutes of Health, led by the National Heart, Lung, and Blood Institute, organized a working group of experts to discuss the problem of weight regain after weight loss. A number of experts in integrative physiology and behavioral psychology were convened with the goal of merging their perspectives regarding the barriers to scientific progress and the development of novel ways to improve long-term outcomes in obesity therapeutics. The specific objectives of this working group were to: (1) identify the challenges that make maintaining a reduced weight so difficult; (2) review strategies that have been used to improve success in previous studies; and (3) recommend novel solutions that could be examined in future studies of long-term weight control.
Specific barriers to successful weight loss maintenance include poor adherence to behavioral regimens and physiological adaptations that promote weight regain. A better understanding of how these behavioral and physiological barriers are related, how they vary between individuals, and how they can be overcome will lead to the development of novel strategies with improved outcomes.
Greater collaboration and cross-talk between physiological and behavioral researchers is needed to advance the science and develop better strategies for weight loss maintenance.
© 2014 The Obesity Society.
Mathematical models of human weight dynamics have been validated in research settings, but are they applicable in the real world of clinical obesity treatment? We compared model calculations to weight loss data from 49 patients in a medically-supervised, outpatient weight loss program. A range of expected weight losses was defined for each patient based on uncertainties in their baseline energy requirements and physical activity changes. Assuming that energy intake was within the prescribed range, the observed and model-calculated weight losses were highly correlated (r=0.9, p<0.0001) and the mean calculated loss of 14.0±9.1 kg (mean±SD) achieved over 13.2±9.4 weeks was not significantly different from the data (13.2±8.9 kg; p=0.14). However, the model identified 14 patients whose weight losses were less than expected, suggesting the possibility of non-compliance. Therefore, mathematical models can be clinically useful tools for prospective goal-setting and assessment of compliance, both of which are important considerations for treating obesity.
Ninety years ago, an editorial in JAMA questioned the prevailing approach to obesity treatment: “When we read that ‘the fat woman has the remedy in her own hands—or rather between her own teeth’ . . . there is an implication that obesity is usually merely the result of unsatisfactory dietary bookkeeping. . . [Although logic suggests that body fat] may be decreased by altering the balance sheet through diminished intake, or increased output, or both . . . [t]he problem is not really so simple and uncomplicated as it is pictured.”1 Since then, billions of dollars have been spent on research into the biological factors affecting body weight, but the near-universal remedy remains virtually the same, to eat less and move more. According to an alternative view, chronic overeating represents a manifestation rather than the primary cause of increasing adiposity. Attempts to lower body weight without addressing the biological drivers of weight gain, including the quality of the diet, will inevitably fail for most individuals. This Viewpoint summarizes the evidence for this seemingly counterintuitive hypothesis, versions of which have been debated for more than a century.2
Background:
Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients.
Methods:
In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years.
Results:
The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P=0.51).
Conclusions:
An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.).
The challenge of weight-loss maintenance is well known, but few studies have followed successful weight losers over an extended period or evaluated the effect of behavior change on weight trajectories.
To study the weight-loss trajectories of successful weight losers in the National Weight Control Registry (NWCR) over a 10-year period, and to evaluate the effect of behavior change on weight-loss trajectories.
A 10-year observational study of self-reported weight loss and behavior change in 2886 participants (78% female; mean age 48 years) in the NWCR who at entry had lost at least 30 lbs (13.6 kg) and kept it off for at least one year. Data were collected in 1993-2010; analysis was conducted in 2012.
Weight loss (kilograms; percent weight loss from maximum weight).
Mean weight loss was 31.3 kg (95% CI=30.8, 31.9) at baseline, 23.8 kg (95% CI=23.2, 24.4) at 5 years and 23.1±0.4 kg (95% CI=22.3, 23.9) at 10 years. More than 87% of participants were estimated to be still maintaining at least a 10% weight loss at Years 5 and 10. Larger initial weight losses and longer duration of maintenance were associated with better long-term outcomes. Decreases in leisure-time physical activity, dietary restraint, and frequency of self-weighing and increases in percentage of energy intake from fat and disinhibition were associated with greater weight regain.
The majority of weight lost by NWCR members is maintained over 10 years. Long-term weight-loss maintenance is possible and requires sustained behavior change.
Previous research shows diminished weight loss success in insulin-resistant (IR) women assigned to a low-fat (LF) diet compared to those assigned to a low-carbohydrate (LC) diet. These secondary analyses examined the relationship between insulin-resistance status and dietary adherence to either a LF-diet or LC-diet among 81 free-living, overweight/obese women [age = 41.9 ± 5.7 years; body mass index (BMI) = 32.6 ± 3.6 kg/m(2) ]. This study found differential adherence by insulin-resistance status only to a LF-diet, not a LC-diet. IR participants were less likely to adhere and lose weight on a LF-diet compared to insulin-sensitive (IS) participants assigned to the same diet. There were no significant differences between IR and IS participants assigned to LC-diet in relative adherence or weight loss. These results suggest that insulin resistance status may affect dietary adherence to weight loss diets, resulting in higher recidivism and diminished weight loss success of IR participants advised to follow LF-diets for weight loss.
Reduced energy expenditure following weight loss is thought to contribute to weight gain. However, the effect of dietary composition on energy expenditure during weight-loss maintenance has not been studied.
To examine the effects of 3 diets differing widely in macronutrient composition and glycemic load on energy expenditure following weight loss.
A controlled 3-way crossover design involving 21 overweight and obese young adults conducted at Children's Hospital Boston and Brigham and Women's Hospital, Boston, Massachusetts, between June 16, 2006, and June 21, 2010, with recruitment by newspaper advertisements and postings.
After achieving 10% to 15% weight loss while consuming a run-in diet, participants consumed an isocaloric low-fat diet (60% of energy from carbohydrate, 20% from fat, 20% from protein; high glycemic load), low-glycemic index diet (40% from carbohydrate, 40% from fat, and 20% from protein; moderate glycemic load), and very low-carbohydrate diet (10% from carbohydrate, 60% from fat, and 30% from protein; low glycemic load) in random order, each for 4 weeks.
Primary outcome was resting energy expenditure (REE), with secondary outcomes of total energy expenditure (TEE), hormone levels, and metabolic syndrome components.
Compared with the pre-weight-loss baseline, the decrease in REE was greatest with the low-fat diet (mean [95% CI], -205 [-265 to -144] kcal/d), intermediate with the low-glycemic index diet (-166 [-227 to -106] kcal/d), and least with the very low-carbohydrate diet (-138 [-198 to -77] kcal/d; overall P = .03; P for trend by glycemic load = .009). The decrease in TEE showed a similar pattern (mean [95% CI], -423 [-606 to -239] kcal/d; -297 [-479 to -115] kcal/d; and -97 [-281 to 86] kcal/d, respectively; overall P = .003; P for trend by glycemic load < .001). Hormone levels and metabolic syndrome components also varied during weight maintenance by diet (leptin, P < .001; 24-hour urinary cortisol, P = .005; indexes of peripheral [P = .02] and hepatic [P = .03] insulin sensitivity; high-density lipoprotein [HDL] cholesterol, P < .001; non-HDL cholesterol, P < .001; triglycerides, P < .001; plasminogen activator inhibitor 1, P for trend = .04; and C-reactive protein, P for trend = .05), but no consistent favorable pattern emerged.
Among overweight and obese young adults compared with pre-weight-loss energy expenditure, isocaloric feeding following 10% to 15% weight loss resulted in decreases in REE and TEE that were greatest with the low-fat diet, intermediate with the low-glycemic index diet, and least with the very low-carbohydrate diet.
clinicaltrials.gov Identifier: NCT00315354.
Behavioural weight management interventions consistently produce 8-10% reductions in body weight, yet most participants regain weight after treatment ends. One strategy for extending the effects of behavioural interventions has been the provision of extended care. The current study is a systematic review and meta-analysis of the literature on the effect of extended care on maintenance of weight loss. Through database searches (using PubMED, PsychInfo and Cochrane Reviews) and manual searches through reference lists of related publications, 463 studies were identified. Of these, 11 were included in the meta-analysis and an additional two were retained for qualitative analysis. The average effect of extended care on weight loss maintenance was g=0.385 (95% confidence interval: 0.281, 0.489; P<0.0001). This effect would lead to the maintenance of an additional 3.2 kg weight loss over 17.6 months post-intervention in participants provided extended care compared with control. There was no significant heterogeneity between studies, Q=5.63, P=0.845, and there was minimal evidence for publication bias. These findings suggest that extended care is a viable and efficacious solution to addressing long-term maintenance of lost weight. Given the chronic disease nature of obesity, extended care may be necessary for long-term health benefits.