James O. Hill

Self-help weight loss versus a structured commercial program after 26 weeks: a randomized controlled study.

PURPOSEnThere have been few randomized controlled trials of commercial weight-loss programs. This ongoing study compares the effects of a self-help program and a commercial program on weight loss and other measures of obesity in overweight and obese men and women.nnnSUBJECTS AND METHODSnWe report the results of the first 26 weeks of a multicenter, randomized, 2-year study of 423 subjects who had a body mass index of 27 to 40 kg/m(2). Subjects were randomly assigned to either a self-help program, consisting of two 20-minute sessions with a nutritionist and provision of printed materials and other self-help resources, or to attendance at meetings of a commercial program (Weight Watchers). Outcome measures were changes in body weight, body mass index, waist circumference, and body fat. Changes in serum homocysteine levels were measured in a subsample of participants during the first 12 weeks.nnnRESULTSnAfter 26 weeks, subjects in the commercial program, as compared with those in the self-help program, had greater decreases in body weight [mean (+/- SD) -4.8+/-5.6 vs -1.4+/-4.7 kg] and body mass index (-1.7+/-1.9 vs -0.5+/-1.6 kg/m(2), both P<0.001) in intention-to-treat analyses. Among subjects measured at week 26, mean waist circumference (-4.3+/-10.5 vs -0.7+/-12.7 cm) and fat mass (-3.8 +/-7.0 vs -1.5+/-7.6 kg, both P<0.05) also decreased more among subjects in the commercial program. Mean serum homocysteine levels improved in the commercial program compared with self-help (-0.5+/-1.3 vs 0.9+/-1.8 microM, P<0.05).nnnCONCLUSIONSnA structured commercial weight-loss program is more likely to be effective for managing moderately overweight patients than brief counseling and self-help.

Low levels of physical activity are associated with dysregulation of energy intake and fat mass gain over 1 year

BACKGROUNDnPrevious studies suggest that appetite may be dysregulated at low levels of activity, creating an energy imbalance that results in weight gain.nnnOBJECTIVEnThe aim was to examine the relation between energy intake, physical activity, appetite, and weight gain during a 1-y follow-up period in a large sample of adults.nnnDESIGNnParticipants included 421 individuals (mean ± SD age: 27.6 ± 3.8 y). Measurements included the following: energy intake with the use of interviewer-administered dietary recalls and calculated by using changes in body composition and energy expenditure, moderate-to-vigorous physical activity (MVPA) with the use of an arm-based monitor, body composition with the use of dual-energy X-ray absorptiometry, and questionnaire-derived perceptions of dietary restraint, disinhibition, hunger, and control of eating. Participants were grouped at baseline into quintiles of MVPA (min/d) by sex. Measurements were repeated every 3 mo for 1 y.nnnRESULTSnAt baseline, an inverse relation existed between body weight and activity groups, with the least-active group (15.7 ± 9.9 min MVPA/d, 6062 ± 1778 steps/d) having the highest body weight (86.3 ± 13.2 kg) and the most-active group (174.5 ± 60.5 min MVPA/d, 10260 ± 3087 steps/d) having the lowest body weight (67.5 ± 11.0 kg). A positive relation was observed between calculated energy intake and activity group, except in the lowest quintile of activity. The lowest physical activity group reported higher levels of disinhibition (P = 0.07) and cravings for savory foods (P = 0.03) compared with the group with the highest level of physical activity. Over 1 y of follow-up, the lowest activity group gained the largest amount of fat mass (1.7 ± 0.3 kg) after adjustment for change in MVPA and baseline fat mass. The odds of gaining >3% of fat mass were between 1.8 and 3.8 times as high for individuals in the least-active group as for those in the middle activity group.nnnCONCLUSIONSnThese results suggest that low levels of physical activity are a risk factor for fat mass gain. In the current sample, a threshold for achieving energy balance occurred at an activity level corresponding to 7116 steps/d, an amount achievable by most adults. This trial was registered at clinicaltrials.gov as NCT01746186.

Evaluation of the Effectiveness of Making Weight Watchers Available to Tennessee Medicaid (TennCare) Recipients

ABSTRACTINTRODUCTIONIn 2006, Tennessee Medicaid (TennCare) offered its recipients access to Weight Watchers for a nominal fee. The aim of this study was to determine the weight change among adult participants.METHODSThis is a retrospective analysis of weight change among overweight and obese TennCare recipients who participated in the program. Weight change was calculated as the median difference from the first date of participation to the last. Weight change was also calculated as median percentage change from initial weight and categorized as weight loss or gain of 0 to 5, ≥5 to 10, and ≥10xa0%.RESULTSDuring the study period, 1,605 individuals started the program and 1192 had at least one follow-up weight measurement and thus met the inclusion criteria for the study. Women (nu2009=u20091149) had a BMI of 39.6xa0kg/m2 and men (nu2009=u200943) had a BMI of 43.0xa0kg/m2. The median weight loss for all participants was 1.9xa0kg, or 1.8xa0% of initial weight. Twenty percent of participants lost 5xa0% or more of their initial body weight while participating in the program. Over 13xa0% of participants only attended two meetings; on average, these participants lost 0.5xa0% of initial weight. Over 23xa0% of participants attended 13 or more meetings, and they lost an average of 6.4xa0% of initial weight.DISCUSSIONTwenty percent of TennCare recipients who joined Weight Watchers lost a clinically significant amount of weight. Participants who attended more meetings lost more weight. Reimbursement for Weight Watchers has been maintained by all of the Medicaid managed care organizations in Tennessee. Partnerships that allow low-income populations to access weight loss programs may provide a valuable weight management tool.

The Myth of Healthy Obesity

In this issue, Kramer and colleagues meta-analysis provides strong evidence that “healthy obesity” is a myth. The editorialists discuss the meta-analysis and conclude that no level of obesity is h...

Changes in body composition over 8 years in a randomized trial of a lifestyle intervention: The look AHEAD study

To determine the effects of an intensive lifestyle intervention versus a comparison group on body composition in obese or overweight persons with type 2 diabetes at baseline and at 1, 4, and 8 years.

Controversies Regarding Reported Trends: Has the Obesity Epidemic Leveled Off in the United States?

Obesity has become a public health crisis in the United States and many other countries as the prevalence has been growing and has reached a very high level. Many studies have been conducted to examine the trends and related risk factors of obesity. However, some studies provided mixed results. The symposium reviewed the best available evidence regarding the recent trends in the United States and Europe to address the controversies regarding whether the increasing trend has leveled off and to provide some related recommendations. Four leading experts in the field presented key findings and made recommendations for future research and intervention efforts.

Commentary: Physical activity and weight control

References 1 Luke A, Cooper RS. Physical activity does not influence obesity risk: Time to clarify the public health message. Int J Epidemiol 2013; doi:10.1093/ije/dyt159. 2 Ng SW, Popkin BM. Time use and physical activity: a shift away from movement across the globe. Obes Rev 2012;13:659–80. 3 Dugas LR, Harders R, Merrill S et al. Energy expenditure in adults living in developing compared with industrialized countries: a meta-analysis of doubly labeled water studies. Am J Clin Nutr 2011;93:427–41. 4 Swinburn BA, Sacks G, Hall KD et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet 2011;378:804–14. 5 Swinburn BA. Nutrition signposting: the ‘eat more’ message seems to be getting through: what about the ‘eat less’ message? Public Health Nutr 2012;15:483–85. 6 Moodie R, Stuckler D, Monteiro C et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet 2013;381:670–79. 7 Stuckler D, McKee M, Ebrahim S, Basu S. Manufacturing Epidemics: The role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco. PLoS Med 2012;9:e1001235. 8 World Health Organization. Global Strategy on Diet, Physical Activity and Health. Geneva: World Health Organization, 2004. 9 Beaglehole R, Bonita R, Horton R. Independent global accountability for NCDs. Lancet 2013;381:602–05. 10 Commission on the Social Determinants of Health. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Geneva: World Health Organization, 2008. 11 Egger G, Swinburn B. Planet Obesity. Sydney: Allen and Unwin, 2011.

Dietary patterns in weight loss maintenance: results from the MedWeight study

PurposeThe dietary habits contributing to weight loss maintenance are not sufficiently understood. We studied weight loss maintainers in comparison with regainers, to identify the differentiating behaviors.MethodsThe MedWeight study is a Greek registry of weight loss maintainers and regainers. Participants had intentionally lost ≥10xa0% of their weight and either had maintained this loss for over a year, or had regained weight. Questionnaires on demographics and lifestyle habits were completed online. Dietary assessment was carried out by two telephone 24-h recalls.ResultsPresent analysis focused on 361 participants (32xa0years old, 39xa0% men): 264 maintainers and 97 regainers. Energy and macronutrient intake did not differ by maintenance status (1770xa0±xa0651xa0kcal in maintainers vs. 1845xa0±xa0678xa0kcal in regainers, pxa0=xa00.338), although protein intake per kg of body weight was higher in maintainers (1.02xa0±xa00.39 vs. 0.83xa0±xa00.28xa0g/kg in regainers, pxa0<xa00.001). Physical activity energy expenditure was greater for maintainers in men (by 1380xa0kcal per week, pxa0=xa00.016), but not women. Salty snacks, alcohol and regular soda were more frequently consumed by men regainers. Principal component analysis identified a healthy dietary pattern featuring mainly unprocessed cereal, fruit, vegetables, olive oil and low-fat dairy. Male maintainers were 4.6 times more likely to follow this healthy pattern compared to regainers (OR 4.6, 95xa0% CI 2.0–11.0). No similar finding was revealed in women. Other characteristics of maintainers but not of regainers were: involvement in meal preparation and eating at home for men, and a higher eating frequency and slower eating rate for women.ConclusionsMen maintaining weight loss were much more likely to adhere to a healthy eating pattern. Eating at home, involvement in meal preparation, higher eating frequency and slower eating rate were also associated with maintenance. These lifestyle habits of successful maintainers provide target behaviors to improve obesity treatment.

A randomized clinical trial of a weight loss maintenance intervention in a primary care population

In‐person weight loss maintenance visits have been shown to reduce weight regain after initial weight loss. This study examined, in a primary care population, whether in‐person visits plus portion‐controlled meals were more effective in reducing 12‐month weight regain than mailed materials plus portioncontrolled meals.

The MedWeight study: Design and preliminary results

BAGKGROUND: Weight loss maintenance contributing behaviors have not been adequately studied in Mediterranean populations. OBJECTIVE: The MedWeight study created a registry of weight loss maintainers and regainers, to assess and compare their features and lifestyle habits. METHODS: Participants had intentionally lost ≥10% of their starting weight; maintainers were keeping the weight off for one year minimum, whereas regainers had regained the loss. Volunteers answered online questionnaires, regarding medical history, body weight, diet and exercise habits, social support, and personality traits. Two telephone 24-h dietary recalls per volunteer are conducted. Questionnaire follow-up will take place one year after study entrance. RESULTS: Thus far, 169 maintainers and 57 regainers participated in the study, 43% men. Mean age was 32 years, with regainers being older than maintainers. Maintainers were sustaining a 21% loss, for over four years. Maximum weight and maximum Body Mass Index (BMI) did not differ between groups, but maintainers originally lost more weight than regainers. Maintainers lost weight mainly by themselves, whereas more regainers had consulted with a dietitian. CONCLUSIONS: Preliminary data showed no differences between groups in maximum weight and BMI ever reached, but differences were found in weight loss methods employed and initial weight loss achieved.