Efficacy of Lifestyle Modification for Long-Term Weight Control

ArticleinObesity research 12 Suppl(S12):151S-62S · January 2005with23 Reads
DOI: 10.1038/oby.2004.282 · Source: PubMed
Abstract
A comprehensive program of lifestyle modification induces loss of approximately 10% of initial weight in 16 to 26 weeks, as revealed by a review of recent randomized controlled trials, including the Diabetes Prevention Program. Long-term weight control is facilitated by continued patient-therapist contact, whether provided in person or by telephone, mail, or e-mail. High levels of physical activity and the consumption of low-calorie, portion-controlled meals, including liquid meal replacements, can also help maintain weight loss. Additional studies are needed of the effects of macronutrient content (e.g., low-fat vs. low-carbohydrate diets) on long-term changes in weight and health. Research also is needed on effective methods of providing comprehensive weight loss control to the millions of Americans who need it.
    • "Reducing the consumption of added sugars is a commonly recommended approach for managing obesity, diabetes, and other metabolic diseases. Studies have shown that vigorous physical activity and a healthier diet are effective at controlling and reducing weight [49] . However , the sustainability of these intensive lifestyle modifications is difficult, resulting in individuals regaining their initial weight loss [50, 51]. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: In developed countries with westernized diets, the excessive consumption of added sugar in beverages and highly refined and processed foods is associated with increased risk for obesity, diabetes, and cardiovascular diseases. As a major constituent of added sugars, fructose has been shown to cause a variety of adverse metabolic effects, such as impaired insulin sensitivity, hypertriglyceridemia, and oxidative stress. Recent studies have shown that ketohexokinase isoform C is the key enzyme responsible in fructose metabolism that drive's fructose's adverse effects. The objective of this study was to identify botanical ingredients with potential for inhibitory activity against ketohexokinase-C and fructose-induced metabolic effects by using a series of in vitro model systems. Methods: Extracts from 406 botanicals and 1200 purified phytochemicals were screened (initial concentration of 50 μg/mL and 50 μM, respectively) for their inhibitory activity using a cell free, recombinant human ketohexokinase-C assay. Dose response evaluations were conducted on botanical extracts and phytochemicals that inhibited ketohexokinase-C by > 30% and > 40%, respectively. Two different extract lots of the top botanical candidates were further evaluated in lysates of HepG2 cells overexpressing ketohexokinase-C for inhibition of fructose-induced ATP depletion. In addition, extracts were evaluated in intact Hep G2 cells for inhibition of fructose-induced elevation of triglyceride and uric acid production. Results: Among the botanical extracts, phloretin (Malus domestica) extracts were the most potent (IC50: 8.9-9.2 μg/mL) followed by extracts of Angelica archangelica (IC50: 22.6 μg/mL-57.3 μg/mL). Among the purified phytochemicals, methoxy-isobavachalcone (Psoralea corylifolia, IC50 = 0.2 μM) exhibited the highest potency against ketohexokinase isoform C activity followed by osthole (Angelica archangelica, IC50 = 0.7 μM), cratoxyarborenone E (Cratoxylum prunifolium, IC50 = 1.0 μM), and α-/γ-mangostin (Cratoxylum prunifolium, IC50 = 1.5 μM). Extracts of Angelica archangelica, Garcinia mangostana, Petroselinum crispum, and Scutellaria baicalensis exhibited ketohexokinase inhibitory activity and blocked fructose-induced ATP depletion and fructose-induced elevation in triglyerides and uric acid. Conclusions: Angelica archangelica, Garcinia mangostana, Petroselinum crispum, and Scutellaria baicalensis were the top four botanical candidiates identified with inhibitory activity against ketohexokinase-C. Future studies are needed to show proof of mechanism and the efficacy of these botanical extracts in humans to blunt the negative metabolic effects of fructose-containing added sugars.
    Full-text · Article · Jun 2016
    • "Behavioral interventions can effectively promote weight loss [1,2]. Maintaining improvements in weight and related behaviors following the end of interventions is challenging [3][4][5][6][7][8][9]. Evidence from maintenance-focused interventions for physical activity, diet, and weight suggests the need for extended contact after initial intervention [10][11][12]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Extending contact with participants after initial, intensive intervention may support maintenance of weight loss and related behaviors. Objective: This community-wide trial evaluated a text message (short message service, SMS)-delivered, extended contact intervention ('Get Healthy, Stay Healthy' (GHSH)), which followed on from a population-level, behavioral telephone coaching program. Methods: This study employed a parallel, randomized controlled trial: GHSH compared with no continued contact (standard practice). Participants (n=228) were recruited after completing a 6-month lifestyle telephone coaching program: mean age = 53.4 (standard deviation (SD)=12.3) years; 66.7% (152/228) female; mean body mass index (BMI) upon entering GHSH=29.5 kg/m2 (SD = 6.0). Participants received tailored text messages over a 6-month period. The message frequency, timing, and content of the messages was based on participant preference, ascertained during two tailoring telephone calls. Primary outcomes of body weight, waist circumference, physical activity (walking, moderate, and vigorous sessions/week), and dietary behaviors (fruit and vegetable serves/day, cups of sweetened drinks per day, takeaway meals per week; fat, fiber and total indices from the Fat and Fiber Behavior Questionnaire) were assessed via self-report before (baseline) and after (6-months) extended contact (with moderate-vigorous physical activity (MVPA) also assessed via accelerometry). Results: Significant intervention effects, all favoring the intervention group, were observed at 6-months for change in weight (-1.35 kg, 95% confidence interval (CI): -2.24, -0.46, P=.003), weekly moderate physical activity sessions (0.56 sessions/week, 95% CI: 0.15, 0.96, P=.008) and accelerometer-assessed MVPA (24.16 minutes/week, 95% CI: 5.07, 43.25, P=.007). Waist circumference, other physical activity outcomes and dietary outcomes, did not differ significantly between groups. Conclusions: The GHSH extended care intervention led to significantly better anthropometric and physical activity outcomes than standard practice (no contact). This evidence is useful for scaling up the delivery of GHSH as standard practice following the population-level telephone coaching program.
    Article · May 2016
    • "In studies on lifestyle modification, researchers found initial weight loss of ~10%. However, long-term weight loss was not sustained, with weight gain after the first 6 months and continued weight gain with the termination of maintenance therapy [10]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: The increasing prevalence of obesity continues to become a major public health concern, increasing the need for more effective approaches towards weight loss. Current weight loss approaches include weight-loss medications along with nutritional education and exercise, behavioral strategies aimed at lifestyle modifications, or nutritionally restrictive dieting. The purpose of our study was to see if a more comprehensive, “Biopsychosocial” approach that integrates the biological, psychological and behavioral issues, would help patients lose weight. Methods: A “Biopsychosocial” approach was used to help patients lose weight at an outpatient weight loss clinic. The program teaches the role of insulin in weight loss, uses appetite suppressants to reduce cravings, implements cognitive behavioral therapy to reframe thinking, and utilizes behavioral therapy to break old eating habits through six visits. From 2011-2013, 142 patients who completed at least 8 weeks of treatment were retrospectively reviewed and analyzed. Data included demographics, duration of treatment, medications, weight, and BMI. Results: Participants lost an average of 22.8 pounds, or 10.8% from the initial weight (p<0.001) over an average of 86 days of treatment. Conclusion: A “Biopsychosocial” approach is effective for weight loss. Further prospective study is needed.
    Full-text · Article · Mar 2016 · PLoS ONE
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