J. Graham Thomas

Weight-loss maintenance for 10 years in the National Weight Control Registry.

BACKGROUND 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. PURPOSE 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. METHODS 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. MAIN OUTCOME MEASURES Weight loss (kilograms; percent weight loss from maximum weight). RESULTS 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. CONCLUSIONS 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.

Binge Eating Disorder and the Outcome of Bariatric Surgery at One Year: A Prospective, Observational Study

Previous studies have suggested that binge eating disorder (BED) impairs weight loss following bariatric surgery, leading some investigators to recommend that patients receive behavioral treatment for this condition before surgery. However, many of these investigations had significant methodological limitations. The present observational study used a modified intention‐to‐treat (ITT) population to compare 1‐year changes in weight in 59 surgically treated participants, determined preoperatively to be free of a current eating disorder, with changes in 36 individuals judged to have BED. Changes in weight and binge eating in the latter group were compared with those in 49 obese individuals with BED who sought lifestyle modification for weight loss. BED was assessed using criteria proposed for the Diagnostic and Statistical Manual (DSM) 5. At 1 year, surgically treated participants without BED lost 24.2% of initial weight, compared with 22.1% for those with BED (P > 0.309). Both groups achieved clinically significant improvements in several cardiovascular disease (CVD) risk factors. Participants with BED who received lifestyle modification lost 10.3% at 1 year, significantly (P < 0.001) less than surgically treated BED participants. The mean number of binge eating days (in the prior 28 days) fell sharply in both BED groups at 1 year. These two groups did not differ significantly in BED remission rates or in improvements in CVD risk factors. The present results, obtained in carefully studied participants, indicate that the preoperative presence of BED does not attenuate weight loss or improvements in CVD risk factors at 1 year in surgically treated patients. Longer follow‐up of participants is required.

B-MOBILE - A Smartphone-Based Intervention to Reduce Sedentary Time in Overweight/Obese Individuals: A Within-Subjects Experimental Trial

Purpose Excessive sedentary time (SED) has been linked to obesity and other adverse health outcomes. However, few sedentary-reducing interventions exist and none have utilized smartphones to automate behavioral strategies to decrease SED. We tested a smartphone-based intervention to monitor and decrease SED in overweight/obese individuals, and compared 3 approaches to prompting physical activity (PA) breaks and delivering feedback on SED. Design and Methods Participants [N = 30; Age  = 47.5(13.5) years; 83% female; Body Mass Index (BMI) = 36.2(7.5) kg/m2] wore the SenseWear Mini Armband (SWA) to objectively measure SED for 7 days at baseline. Participants were then presented with 3 smartphone-based PA break conditions in counterbalanced order: (1) 3-min break after 30 SED min; (2) 6-min break after 60 SED min; and (3) 12-min break after 120 SED min. Participants followed each condition for 7 days and wore the SWA throughout. Results All PA break conditions yielded significant decreases in SED and increases in light (LPA) and moderate-to-vigorous PA (MVPA) (p<0.005). Average % SED at baseline (72.2%) decreased by 5.9%, 5.6%, and 3.3% [i.e. by mean (95% CI) −47.2(−66.3, −28.2), −44.5(−65.2, −23.8), and −26.2(−40.7, −11.6) min/d] in the 3-, 6-, and 12-min conditions, respectively. Conversely, % LPA increased from 22.8% to 26.7%, 26.7%, and 24.7% [i.e. by 31.0(15.8, 46.2), 31.0(13.6, 48.4), and 15.3(3.9, 26.8) min/d], and % MVPA increased from 5.0% to 7.0%, 6.7%, and 6.3% (i.e. by 16.2(8.5, 24.0), 13.5(6.3, 20.6), and 10.8(4.2, 17.5) min/d] in the 3-, 6-, and 12-min conditions, respectively. Planned pairwise comparisons revealed the 3-min condition was superior to the 12-min condition in decreasing SED and increasing LPA (p<0.05). Conclusion The smartphone-based intervention significantly reduced SED. Prompting frequent short activity breaks may be the most effective way to decrease SED and increase PA in overweight/obese individuals. Future investigations should determine whether these SED reductions can be maintained long-term. Trial Registration ClinicalTrials.gov NCT01688804

Objective quantification of physical activity in bariatric surgery candidates and normal-weight controls

BACKGROUND Physical activity (PA) is an important component of weight loss programs and should be encouraged for severely obese patients undergoing bariatric surgery. However, few studies have determined the amount and intensity of activities undertaken preoperatively by bariatric surgery patients using objective measures. METHODS Using RT3 tri-axial accelerometers, the present study compared 38 bariatric surgery candidates and 20 normal weight controls on activity counts/hr; the number of minutes daily spent in moderate-to-vigorous intensity PA (MVPA) and vigorous intensity PA; and the level of compliance with national recommendations to accumulate 150 min/wk of MVPA in bouts of > or = 10 minutes. RESULTS Surgery candidates, compared with controls, recorded significantly (P <.01) fewer activity counts/hr (13,799 +/- 3758 counts/hr versus 19,462 +/- 4259 counts/hr) and spent fewer minutes per day engaged in MVPA (26.4 +/- 23.0 min/d versus 52.4 +/- 24.7 min/d) and vigorous PA (1.2 +/- 3.4 min/d vs 11.8 +/- 9.0 min/d). More than two thirds (68%) of the surgery candidates versus 13% of the normal weight controls did not accumulate any MVPA in bouts of > or = 10 minutes and only 4.5% of obese patients met the weekly MVPA recommendation versus 40% of the controls. CONCLUSION The results of our study have shown that bariatric surgery candidates have low PA levels and rarely engage in PA bouts of sufficient duration and intensity to maintain and improve health. Additional research is needed to determine how best to increase PA in bariatric surgery candidates.

Acceptance-based versus standard behavioral treatment for obesity: Results from the mind your health randomized controlled trial

To evaluate the efficacy, as well as potential moderators and mediators, of a revised acceptance‐based behavioral treatment (ABT) for obesity, relative to standard behavioral treatment (SBT).

Can weight loss improve migraine headaches in obese women? Rationale and design of the Women's Health and Migraine (WHAM) randomized controlled trial

BACKGROUND Research demonstrates a link between migraine and obesity. Obesity increases the risk of frequent migraines and is associated with migraine prevalence among reproductive-aged women. These findings are substantiated by several plausible mechanisms and emerging evidence of migraine improvements after surgical and non-surgical weight loss. However, no previous study has examined the effect of weight loss on migraine within a treatment-controlled framework. The WHAM trial is an RCT to test the efficacy of behavioral weight loss as a treatment for migraine. STUDY DESIGN Overweight/obese women (n=140; BMI=25.0-49.9 kg/m(2)) who meet international diagnostic criteria for migraine and record ≥3 migraines and 4-20 migraine days using a smartphone-based headache diary during a 4-week baseline period, will be randomly assigned to 4 months of either group-based behavioral weight loss (intervention) or migraine education (control). Intervention participants will be taught strategies to increase physical activity and consume fewer calories in order to lose weight. Control participants will receive general education on migraine symptoms/triggers and various treatment approaches. Both groups will use smartphones to record their headaches for 4 weeks at baseline, after the 16-week treatment period, and at the end of a 16-week follow-up period. Changes in weight and other potential physiological (inflammation), psychological (depression), and behavioral (diet and physical activity) mediators of the intervention effect will also be assessed. CONCLUSION The WHAM trial will evaluate the efficacy of a standardized behavioral weight loss intervention for reducing migraine frequency, and the extent to which weight loss and other potential mediators account for intervention effects.

An Automated Internet Behavioral Weight-Loss Program by Physician Referral: A Randomized Controlled Trial

OBJECTIVE To evaluate 3- and 6-month weight-loss outcomes achieved when physicians refer overweight/obese patients to an automated 3-month Internet-based behavioral weight-loss intervention. RESEARCH DESIGN AND METHODS A total of 154 patients age 18–70 years with a BMI between 25 and 45 kg/m2 and access to a personal computer and the Internet were randomly assigned to 3 months of Internet behavioral intervention (IBI; n = 77) with 12 weekly videos teaching behavioral weight-loss skills, a platform for submitting self-monitored data, and automated feedback or an education-only Internet-delivered eating and activity control group (IDEA; n = 77). Outcome measures were weight loss after 3 months (primary outcome) and 6 months and changes in weight-control behaviors (secondary outcomes). RESULTS In intent-to-treat analyses with baseline weight carried forward for missing data, IBI produced significantly larger mean (SD) weight losses than IDEA at 3 months (5.5 kg [4.4] vs. 1.3 kg [2.1]) and 6 months (5.4 kg [5.6] vs. 1.3 kg [4.1]) (P < 0.001). Participants in IBI compared with IDEA were also more likely to achieve a clinically significant weight loss of 5% of initial body weight at 3 months (53.3 vs. 9.1%) and 6 months (48.1 vs. 15.6%) (P < 0.001) and reported more frequent use of weight control–related strategies. CONCLUSIONS Physician referral to an Internet-based behavioral weight-loss intervention produced clinically significant weight loss for over half of the patients studied. Further research is needed to determine the effectiveness of implementing this intervention more broadly within diverse health care settings.

Self-reported and objectively measured sedentary behavior in bariatric surgery candidates.

BACKGROUND Sedentary behavior (SB), independent of physical activity, represents a significant health risk. We previously used objective measures to demonstrate that bariatric surgery candidates engage in high levels of SB overall, but supplementing these measures with subjective reports would provide information about time allocated to different forms of SB. The aim of this study was to examine self-reported time spent performing specific types of SB and discrepancy between self-reported and objectively measured estimates of total sedentary time in bariatric surgery candidates. METHODS A total of 52 bariatric surgery candidates (87% female; age = 46.2 ± 9.1 years; body mass index [BMI] = 45.3 ± 6.7) completed the 9-item Sedentary Behavior Questionnaire (SBQ) as a subjective measure of SB and wore the SenseWear Armband (SWA; SenseWear, Pittsburgh, PA) as an objective measure. Paired samples t tests and the intraclass correlation coefficient (ICC) assessed measurement discrepancy. RESULTS Television-viewing was the most frequently performed type of SB (2.7 ± 1.6 hours per day), followed by paper/computer work (1.9 ± 1.8 hours per day), driving/riding in automobile (1.2 ± 1.1 hours per day), and sitting/talking on telephone (1.1 ± 1.2 hours per day). On average, the SBQ and SWA produced similar estimates of daily sedentary time (hours per day) at the group level (9.6 ± 4.8 versus 9.3 ± 1.9; mean difference = -.34 ± 4.6; P = .59), although agreement between the measures at the individual level was poor (mean absolute value of difference = 3.8 ± 2.8 hours per day; ICC = .22; P = .06). CONCLUSION Television-viewing was the single SB in which participants most frequently engaged and thus may be an important modifiable target for reducing total sedentary time in bariatric surgery candidates. The SBQ and SWA can be used similarly to describe SB levels in this patient population at the group level; however, ability of these measures to produce comparable estimates of sedentary time for any individual patient is limited.

Exercise improves quality of life in bariatric surgery candidates: Results from the Bari-Active trial

To examine the impact of a pre‐bariatric surgery physical activity intervention (PAI), designed to increase bout‐related (≥10 min) moderate to vigorous PA (MVPA), on health‐related quality of life (HRQoL).

Objectively measured physical activity in obese women with and without migraine

Aim The aim of this article is to cross-sectionally compare objectively measured physical activity (PA) levels and their association with migraine characteristics in obese women with and without migraine. Methods Obese women seeking weight loss treatment were divided into migraine (n = 25) and control (n = 25) groups matched by age and body mass index (BMI). Participants wore the SenseWear Armband monitor for seven days to objectively evaluate daily light-(LPA) and moderate-to-vigorous intensity PA (MVPA). Migraine diagnosis was confirmed by a neurologist using ICHD-3-beta criteria. Migraine characteristics were tracked daily using a smartphone-based diary over a four-week period immediately preceding the objective PA assessment. Results Migraine participants spent 57.9 fewer minutes/day in LPA (141.1 ± 56.4 vs. 199.1 ± 87.7, p = 0.019) and 24.5 fewer minutes/day in MVPA (27.8 ± 17.0 vs. 52.3 ± 26.0, p < 0.001), compared to controls. Migraine participants reported 4.8 ± 3.1 migraine days/month (mean duration = 17.1 ± 8.9 hours; mean maximum pain severity = 6.4 ± 1.7 on a 0–10 scale). Higher BMI (p < 0.05), but not migraine characteristics, were related to lower total PA. Additionally, total objectively measured PA was not associated with how often PA was reported to exacerbate migraine attacks during the four-week diary assessment. Conclusions Obese women with migraine spent nearly 1.5 hours/day less in PA compared to controls; however, lower PA was not related to migraine characteristics. Further research is needed to identify PA barriers and effective interventions in obese women with migraine.