Erik A. Willis

Does the Method of Weight Loss Effect Long-Term Changes in Weight, Body Composition or Chronic Disease Risk Factors in Overweight or Obese Adults? A Systematic Review

Background Differences in biological changes from weight loss by energy restriction and/or exercise may be associated with differences in long-term weight loss/regain. Objective To assess the effect of weight loss method on long-term changes in weight, body composition and chronic disease risk factors. Data Sources PubMed and Embase were searched (January 1990-October 2013) for studies with data on the effect of energy restriction, exercise (aerobic and resistance) on long-term weight loss. Twenty articles were included in this review. Study Eligibility Criteria Primary source, peer reviewed randomized trials published in English with an active weight loss period of >6 months, or active weight loss with a follow-up period of any duration, conducted in overweight or obese adults were included. Study Appraisal and Synthesis Methods Considerable heterogeneity across trials existed for important study parameters, therefore a meta-analysis was considered inappropriate. Results were synthesized and grouped by comparisons (e.g. diet vs. aerobic exercise, diet vs. diet + aerobic exercise etc.) and study design (long-term or weight loss/follow-up). Results Forty percent of trials reported significantly greater long-term weight loss with diet compared with aerobic exercise, while results for differences in weight regain were inconclusive. Diet+aerobic exercise resulted in significantly greater weight loss than diet alone in 50% of trials. However, weight regain (∼55% of loss) was similar in diet and diet+aerobic exercise groups. Fat-free mass tended to be preserved when interventions included exercise.

Nonexercise Energy Expenditure and Physical Activity in the Midwest Exercise Trial 2.

PURPOSE This study aimed to examine compensatory changes in nonexercise energy expenditure (NEEx) and nonexercise physical activity (NEPA) in response to an aerobic exercise training program. METHODS Ninety-two overweight/obese (body mass index, 25-39.9 kg·m) sedentary young adults (18-30 yr) completed a 10-month randomized clinical efficacy trial of aerobic exercise 5 d·wk at either 400 kcal per session (n = 37), 600 kcal per session (n = 37), or control (n = 18). Total daily energy expenditure (TDEE) and resting metabolic rate (RMR) were measured at months 0 and 10. NEPA was measured by an accelerometer at months 0, 3.5, 7, and 10. NEEx was calculated by the following formula: [(total daily energy expenditure × 0.9) - RMR] - net EEEx (EEEx-RMR). Mixed modeling was used to examine differences between groups (group effect), within groups (time effect), and group-time interaction for NEEx and NEPA. RESULTS Within the exercise groups, there were no significant effects (all P > 0.05) of group, time, or group-time interaction for NEPA. In addition, there were no significant within- or between-group differences for change in NEEx. However, activity counts per minute were significantly higher (P < 0.001) in the 600-kcal-per-session group (346 ± 141 min·d) versus controls (290 ± 106 min·d) at month 7 and significantly higher (P < 0.001) in both the 600-kcal-per-session (345 ± 163 min·d) and 400-kcal-per-session groups (317 ± 146 min·d) versus controls (277 ± 116 min·d) at 10 months. CONCLUSIONS A 10-month aerobic exercise training program in previously sedentary, overweight and obese young adults was not associated with compensatory decreases in NEEx or NEPA. Results suggest that overweight and obese individuals do not become less physically active or spend more time in sedentary pursuits in response to exercise.

Digital photography improves estimates of dietary intake in adolescents with intellectual and developmental disabilities

BACKGROUND Dietary assessment of adolescents with intellectual and developmental disabilities (IDD) is challenging due to the limited cognitive abilities of this population. OBJECTIVE The purpose of this study was to determine the feasibility of using of digital images to improve the estimates of energy and macronutrient intake from proxy-assisted 3-day food records in adolescents with IDD. METHOD Participants used a mobile device to take photos of all food and beverages consumed over a three-day period and simultaneously completed a standard parent-assisted 3-day food record at two separate time points. A registered dietitian reviewed and recorded the differences between the standard record and the images. The proxy-assisted records and the photo-assisted records were analyzed separately. RESULTS One hundred and thirty eating occasions were entered (20 participants (age = 14.9 ± 2.2 yrs, 45.0% female)). Photo-assisted records captured significantly higher estimates of energy intake per eating occasion than regular proxy-assisted records (P = 0.001) as well as significantly greater grams of fat (P = 0.011), carbohydrates (P = 0.003), and protein (P = 0.004). CONCLUSION The use of photo-assisted diet records appears to be a feasible method to obtain substantial additional details about dietary intake that consequently may improve the overall estimates of energy and macronutrient intake when using proxy-assisted diet records in adolescents with IDD.

Energy intake, nonexercise physical activity, and weight loss in responders and nonresponders: The Midwest Exercise Trial 2

To compare energy intake, total daily energy expenditure (TDEE), nonexercise energy expenditure (NEEx), resting metabolic rate (RMR), nonexercise physical activity (NEPA), and sedentary time between participants with weight loss <5% (nonresponders) vs. ≥5% (responders) in response to exercise.

Validity of Energy Intake Estimated by Digital Photography Plus Recall in Overweight and Obese Young Adults

BACKGROUND Recent reports have questioned the adequacy of self-report measures of dietary intake as the basis for scientific conclusions regarding the associations of dietary intake and health, and reports have recommended the development and evaluation of better methods for the assessment of dietary intake in free-living individuals. We developed a procedure that used pre- and post-meal digital photographs in combination with dietary recalls (DP+R) to assess energy intake during ad libitum eating in a cafeteria setting. OBJECTIVE To compare mean daily energy intake of overweight and obese young adults assessed by a DP+R method with mean total daily energy expenditure assessed by doubly labeled water (TDEE(DLW)). METHODS Energy intake was assessed using the DP+R method in 91 overweight and obese young adults (age = 22.9±3.2 years, body mass index [BMI; calculated as kg/m(2)]=31.2±5.6, female=49%) over 7 days of ad libitum eating in a university cafeteria. Foods consumed outside the cafeteria (ie, snacks, non-cafeteria meals) were assessed using multiple-pass recall procedures, using food models and standardized, neutral probing questions. TDEE(DLW) was assessed in all participants over the 14-day period. RESULTS The mean energy intakes estimated by DP+R and TDEE(DLW) were not significantly different (DP+R=2912±661 kcal/d; TDEE(DLW)=2849±748 kcal/d, P=0.42). The DP+R method overestimated TDEE(DLW) by 63±750 kcal/d (6.8±28%). CONCLUSION Results suggest that the DP+R method provides estimates of energy intake comparable to those obtained by TDEE(DLW).

Do weight management interventions delivered by online social networks effectively improve body weight, body composition, and chronic disease risk factors? A systematic review.

Introduction Currently, no systematic review/meta-analysis has examined studies that used online social networks (OSN) as a primary intervention platform. Therefore, the purpose of this review was to evaluate the effectiveness of weight management interventions delivered through OSN. Methods PubMed, EMBASE, PsycINFO, Web of Science, and Scopus were searched (January 1990–November 2015) for studies with data on the effect of OSNs on weight loss. Only primary source articles that utilized OSN as the main platform for delivery of weight management/healthy lifestyle interventions, were published in English language peer-reviewed journals, and reported outcome data on weight were eligible for inclusion in this systematic review. Five articles were included in this review. Results One-hundred percent of the studies (n = 5) reported a reduction in baseline weight. Three of the five studies (60%) reported significant decreases in body weight when OSN was paired with health educator support. Only one study reported a clinical significant weight loss of ≥5%. Conclusion Using OSN for weight management is in its early stages of development and, while these few studies show promise, more research is needed to acquire information about optimizing these interventions to increase their efficacy.

Length of moderate-to-vigorous physical activity bouts and cardio-metabolic risk factors in elementary school children.

BACKGROUND Accumulating moderate-to-vigorous physical activity (MVPA) in bouts of 10 min is associated with improved cardio-metabolic risk factors (CMRF) in adults. PURPOSE To assess the association between the lengths of MVPA bouts and CMRF in elementary school age children. METHODS The sample included 396, 2nd and 3rd grade students from eastern Kansas (182 boys, 214 girls; age 7.6 ± 0.6 years; Body Mass Index Percentile [BMI%ile]: 61.6 ± 9.3) in the fall of 2011. Analyses were conducted in 2014. MVPA bouts were defined as sporadic (<5 min), short (5-<10 min) or medium-to-long (≥10 min). Latent profile analysis was used to identify distinct subgroups (classes) based on the composition of MVPA bouts. Bayesian probability-based Wald chi-square test was used to compare CMRF between classes controlling for age, sex, BMI%ile, and total moderate and total vigorous PA. RESULTS Three classes of accumulated physical activity were identified: A (n=78); 97% sporadic 2%, short, 1% medium-to-long bouts; B (n=174); 93% sporadic, 5% short, 2% medium-to-long; C (n=144); and 86% sporadic, 9% short, 5% medium-to-long bouts. Class C had significantly lower BMI%ile (57.3 ± 2.3 (SE)), waist circumference (WC; 55.8 ± 0.5 cm) compared with Class A (BMI%ile=70.9±0.5, p<0.01.030, WC=61.0 ± 1.0 cm, p=0.<0.01). Class B had significantly lower WC (56.6 ± 0.6 cm), p<0.01 than Class A. No significant differences between classes were shown in other outcomes. CONCLUSION Children who accumulated MVPA with a higher percentage of short (5-<10 min) and medium-to-long bouts (≥10min) had lower BMI%ile, and WC compared with children who accumulated MVPA with a lower percentage short and medium-to-long bouts.

Portion-controlled meals provide increases in diet quality during weight loss and maintenance.

BACKGROUND Behavioural weight-loss interventions utilising portion-controlled meals (PCMs) produce significant decreases in weight. However, their impact on diet quality during weight maintenance is unknown. The present study aimed to assess the influence of a weight management intervention employing PCMs and increased physical activity on diet quality during weight loss and weight maintenance. METHODS One hundred and ninety-seven overweight and obese adults [67% women; mean (SD) BMI = 34.0 (4.6) kg m(-2); age = 46.1 (8.9) years] completed an 18-month trial. The weight-loss phase (0-6 months) consisted of energy restriction, which was achieved using PCMs plus fruits and vegetables and increased physical activity. During weight maintenance (6-18 months), participants consumed a diet designed to maintain weight loss. Body weight and dietary intake were assessed at baseline, and at 6, 12 and 18 months. The Healthy Eating Index-2010 (HEI) was calculated using data obtained from 3-day food records. RESULTS Mean (SD) body weight was 14.3% (6.6%) and 8.7% (8.0%) below baseline at 6 and 18 months, respectively. The mean (SD) HEI-2010 score after weight loss [66.6 (9.4)] was significantly higher than baseline [46.4 (8.9)] and remained significantly higher than baseline at 18 months [57.7 (10.6)] (both P < 0.001). CONCLUSIONS A weight management intervention using PCMs resulted in both clinically significant weight loss and increased diet quality scores, demonstrating that the use of PCMs during weight loss allows for meaningful changes in diet quality during weight maintenance.

Distance learning strategies for weight management utilizing social media: A comparison of phone conference call versus social media platform. Rationale and design for a randomized study

Management of obesity in the context of the primary care physician visit is of limited efficacy in part because of limited ability to engage participants in sustained behavior change between physician visits. Therefore, healthcare systems must find methods to address obesity that reach beyond the walls of clinics and hospitals and address the issues of lifestyle modification in a cost-conscious way. The dramatic increase in technology and online social networks may present healthcare providers with innovative ways to deliver weight management programs that could have an impact on health care at the population level. A randomized study will be conducted on 70 obese adults (BMI 30.0-45.0 kg/m(2)) to determine if weight loss (6 months) is equivalent between weight management interventions utilizing behavioral strategies by either a conference call or social media approach. The primary outcome, body weight, will be assessed at baseline and 6 months. Secondary outcomes including waist circumference, energy and macronutrient intake, and physical activity will be assessed on the same schedule. In addition, a cost analysis and process evaluation will be completed.

Energy and Macronutrient Intake in the Midwest Exercise Trial 2 (MET-2).

PURPOSE This study aimed to examine the effect of exercise training over 10 months at two levels of energy expenditure on energy and macronutrient intake in a sample of previously sedentary, overweight/obese young adults. METHODS We conducted a 10-month trial in 141 young adults who were randomized to either supervised exercise 5 d·wk(-1) at 400 and 600 kcal per session or nonexercise control. Participants were instructed to maintain their usual ad libitum diet. Energy/macronutrient intake was assessed at baseline and 3.5, 7, and 10 months over 7-d periods of ad libitum eating in a university cafeteria using digital photography. Foods consumed outside the cafeteria were assessed using multiple-pass recalls. RESULTS There were no significant between-group differences in absolute energy intake at baseline or at any other time point in the total sample or in men. In women, absolute energy intake was significantly greater in the 600-kcal-per-session group versus controls at both 3.5 and 7 months. There were no significant between-group differences in relative energy intake (kcal·kg·d(-1)) at any time point in the total sample, in men or women. There were no significant within- or between-group differences of change in absolute or relative energy intake in any of the three study groups in the total sample or in men or women. No clinically relevant changes in macronutrient intake were observed. CONCLUSIONS Aerobic exercise training does not significantly alter energy or macronutrient intake in overweight and obese young adults. The possibility of a threshold level beyond which increased exercise energy expenditure fails to produce a more negative energy balance and potential sex differences in the energy intake response to increased levels of exercise are potentially important.