Jeffrey J. VanWormer

The Impact of Regular Self-weighing on Weight Management: A Systematic Literature Review

BackgroundRegular self-weighing has been a focus of attention recently in the obesity literature. It has received conflicting endorsement in that some researchers and practitioners recommend it as a key behavioral strategy for weight management, while others caution against its use due to its potential to cause negative psychological consequences associated with weight management failure. The evidence on frequent self-weighing, however, has not yet been synthesized. The purpose of this paper is to evaluate the evidence regarding the use of regular self-weighing for both weight loss and weight maintenance.MethodsA systematic literature review was conducted using the MEDLINE, CINAHL, and PsycINFO online databases. Reviewed studies were broken down by sample characteristics, predictors/conditions, dependent measures, findings, and evidence grade.ResultsTwelve studies met the inclusion/exclusion criteria, but nearly half received low evidence grades in terms of methodological quality. Findings from 11 of the 12 reviewed studies indicated that more frequent self-weighing was associated with greater weight loss or weight gain prevention. Specifically, individuals who reported self-weighing weekly or daily, typically over a period of several months, held a 1 to 3 kg/m2 (current) advantage over individuals who did not self-weigh frequently. The effects of self-weighing in experimental studies, especially those where self-weighing behaviors could be isolated, were less clear.ConclusionBased on the consistency of the evidence reviewed, frequent self-weighing, at the very least, seems to be a good predictor of moderate weight loss, less weight regain, or the avoidance of initial weight gain in adults. More targeted research is needed in this area to determine the causal role of frequent self-weighing in weight loss/weight gain prevention programs. Other open questions to be pursued include the optimal dose of self-weighing, as well as the risks posed for negative psychological consequences.

Motivational Interviewing and Diet Modification: A Review of the Evidence

Researchers and clinicians have long alluded to the complexities involved in diet modification.7,8 Humans must eat because food consumption is a necessary behavior for survival. Diet modification typically involves “tweaking” a series of existing behaviors versus adopting a new one (eg, exercise) or eliminating an old one (eg, smoking). Due to these and other factors, dietary behavior change is commonly approached with some form of ambivalence or resistance.7 Education is often recognized as a necessary, but insufficient sole strategy for addressing the complex factors that influence eating (eg, environment, economics, and culture), especially among individuals who are not ready to change.

Self-weighing promotes weight loss for obese adults.

BACKGROUND Frequent self-weighing has been proposed as an adjuvant strategy to promote weight loss. Not all experts agree on its utility, and the literature supporting its effectiveness is somewhat limited by methodologic shortcomings related to the subjective assessment of self-weighing frequency. DESIGN A prospective cohort design was utilized to examine 100 participants enrolled in a weight-loss trial that encouraged frequent, objectively measured self-weighing at home. Measurements were made at pretreatment and at follow-up visits at 6 and 12 months. SETTING/PARTICIPANTS Participants were employed, obese adults enrolled in the Weigh By Day trial. Study data were collected between October 2005 and May 2007. INTERVENTION The intervention consisted of a 6-month behavioral weight-loss program that employed telephone counseling, a written manual, and a home telemonitoring scale. MAIN OUTCOME MEASURES The primary outcomes of interest were body weight and clinically meaningful weight loss (i.e., > or =5%). Analyses were performed in March 2008. RESULTS Self-weighing was a significant predictor of body weight over time. Participants lost about 1 extra pound for every 11 days they self-weighed during treatment. In addition, participants who self-weighed at least weekly were 11 times more likely to lose at least 5% of their pretreatment weight after 6 months. Improvements attenuated after 12 months. CONCLUSIONS Self-weighing may be a strategy to enhance behavioral weight-loss programs. Weekly self-weighing seems to be a reasonable, evidence-supported recommendation for successful weight loss, but more research is warranted to determine the independent contribution of self-weighing to successful weight loss, as well as its potential risk of negative psychological impact.

Waning vaccine protection against influenza A (H3N2) illness in children and older adults during a single season

BACKGROUND Recent studies have suggested that vaccine-induced protection against influenza may decline within one season. We reanalyzed data from a study of influenza vaccine effectiveness to determine if time since vaccination was an independent predictor of influenza A (H3N2). METHODS Patients with acute respiratory illness were actively recruited during the 2007-2008 season. Respiratory swabs were tested for influenza, and vaccination dates were determined by a validated immunization registry. The association between influenza RT-PCR result and vaccination interval (days) was examined using multivariable logistic regression, adjusting for calendar time, age and other confounders. RESULTS There were 629 vaccinated participants, including 177 influenza A (H3N2) cases and 452 test negative controls. The mean (SD) interval from vaccination to illness onset was 101.7 (25.9) days for influenza cases and 93.0 (29.9) days for controls. There was a significant association between vaccination interval and influenza result in the main effects model. The adjusted odds ratio (aOR) for influenza was 1.12 (CI 1.01, 1.26) for every 14 day increase in the vaccination interval. Age modified the association between vaccination interval and influenza (p=0.005 for interaction). Influenza was associated with increasing vaccination interval in young children and older adults, but not in adolescents or non-elderly adults. Similar results were found when calendar week of vaccine receipt was assessed as the primary exposure variable. CONCLUSIONS Identification of influenza A (H3N2) was associated with increasing time since vaccination among young children and older adults during a single influenza season.

Is Frequent Self-weighing Associated with Poorer Body Satisfaction? Findings from a Phone-based Weight Loss Trial

OBJECTIVE To examine the effect of self-weighing frequency on weight change and body satisfaction. DESIGN Observational study based on findings from a 6-month randomized controlled telephone-based weight loss trial. Data collected at baseline and 6 months. SETTING Metropolitan community-based sample. PARTICIPANTS Sixty-three obese adults. Mean age 49.5 years, 82% percent white, and 79% female. Mean body mass index at baseline was 34.2 kg/m(2). MAIN OUTCOME MEASURES Change in weight and body satisfaction. ANALYSIS General linear model regression was used to assess the effect of self-weighing on outcomes of interest. Statistical significance was set at alpha level .05. Treatment group and baseline values of dependent variables included as covariates in all analyses. RESULTS Participants who increased their frequency of self-weighing over the 6-month period demonstrated significantly better weight loss outcomes than those who maintained or decreased their frequency of self-weighing (-6.8 kg vs -3.1 kg, F = 8.59, P = .006). There were no significant associations between self-weighing frequency and body satisfaction at 6 months (F = 0.55, P = .58). CONCLUSIONS AND IMPLICATIONS These findings support frequent self-weighing for weight control. There appears to be little or no effect of self-weighing on body satisfaction. Future research should replicate these findings across a larger, more diverse population of overweight adults.

The Role of Aspirin in the Prevention of Cardiovascular Disease

Aspirin therapy is well-accepted as an agent for the secondary prevention of cardiovascular events and current guidelines also define a role for aspirin in primary prevention. In this review, we describe the seminal trials of aspirin use in the context of current guidelines, discuss factors that may influence the effectiveness of aspirin therapy for cardiovascular disease prevention, and briefly examine patterns of use. The body of evidence supports a role for aspirin in both secondary and primary prevention of cardiovascular events in selected population groups, but practice patterns may be suboptimal. As a simple and inexpensive prophylactic measure for cardiovascular disease, aspirin use should be carefully considered in all at-risk adult patients, and further measures, including patient education, are necessary to ensure its proper use.

Validity of diagnostic codes to identify cases of severe acute liver injury in the U.S. Food and Drug Administration's Mini-Sentinel Distributed Database

The validity of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes to identify diagnoses of severe acute liver injury (SALI) is not well known. We examined the positive predictive values (PPVs) of hospital ICD‐9‐CM diagnoses in identifying SALI among health plan members in the Mini‐Sentinel Distributed Database (MSDD) for patients without liver/biliary disease and for those with chronic liver disease (CLD).

Influenza Vaccination Is Not Associated With Detection of Noninfluenza Respiratory Viruses in Seasonal Studies of Influenza Vaccine Effectiveness

Influenza vaccination was not associated with detection of noninfluenza respiratory viruses in young children or older adults with acute respiratory illness. Use of influenza-negative controls did not generate a biased estimate of vaccine effectiveness due to an effect of vaccination on other respiratory virus infections.

Telephone counseling and home telemonitoring: the weigh by day trial.

OBJECTIVE To test the effects of telephone counseling and telemonitoring on weight loss. METHODS A randomized-controlled trial was conducted over 18 months. Participants were assigned to an immediate or delayed-start group. The intervention included a Thin-Link((R)) home telemonitoring scale and biweekly telephone counseling over 6 months. RESULTS The immediate group lost significantly more weight relative to the delayed group over the first 6 months (-7.5 versus +1.3 pounds) and at subsequent visits. CONCLUSION Compared to no treatment, the intervention was effective at producing weight loss. Home telemonitoring may enhance standard weight-loss counseling.

Satisfaction With a Weight Loss Program: What Matters?

Purpose. Satisfaction is understudied in weight loss programs. The purpose of this study was to examine the association between participant/program experiences and satisfaction with a weight loss intervention. Design. A prospective cohort design was utilized. Setting. The study was conducted in the Minneapolis metro area. Sample. Participants were obese employees of a managed care organization. One hundred were enrolled, and 78 had complete data available. Intervention. Treatment included telephone counseling along with a home telemonitoring scale and instructions to self-weigh daily. Measures. Outcomes included overall program satisfaction and willingness to refer the program to others. Predictors included demographics, treatment group, participation in other programs, expected weight, general health, body mass index, diet quality, physical activity, body image, mental health, counseling, and self-weighing. Analysis. Quantitative predictor-outcome associations were examined using multiple logistic regressions. Qualitative satisfaction responses were analyzed using a general inductive approach. Results. Weight loss (odds ratio [OR] = 1.83, p = .008), improved diet (OR = 1.27, p = .092), increased physical activity (OR = 1.05, p = .034), and improved body image (OR = 1.38, p = .051) were independent predictors of overall satisfaction. Treatment group (OR = 14.83, p = .015) and number of counseling calls (OR = 1.49, p = .009) were predictors of willingness to refer the program. Qualitative themes indicated desire to integrate counseling on emotional issues. Conclusion. Health progress explained overall satisfaction, whereas treatment characteristics explained willingness to endorse the intervention. Concentrating on these factors may improve retention. Limitations included self-reported measures.