Jena Shaw Tronieri

Lorcaserin plus lifestyle modification for weight loss maintenance: Rationale and design for a randomized controlled trial

BACKGROUND/AIMS Few studies have examined the efficacy of recently approved medications for chronic weight management in facilitating the maintenance of lost weight. This paper provides an overview of the design and rationale for a trial investigating whether lorcaserin, when combined with behavioral weight loss maintenance sessions (WLM), will facilitate the maintenance of losses of ≥5% of initial weight. METHODS In this two-phase trial, participants with obesity will enroll in a 14-week run-in diet program consisting of weekly group lifestyle modification sessions and a 1000-1200kcal/d meal replacement diet. Participants who complete this weight induction phase and lose at least 5% of initial weight will then be randomized to 52weeks of WLM plus lorcaserin or WLM plus placebo. We hypothesize that at 52weeks post randomization, participants assigned to WLM plus lorcaserin will achieve significantly better maintenance of the prior 5% weight loss. RESULTS We will recruit 182 adults with obesity to participate in the diet run-in, 136 of whom (75%) are expected to become eligible for the randomized controlled trial. Co-primary outcomes include the percentage of participants who maintain a loss of at least 5% of initial weight at week 52 and change in weight (kg) from randomization to week 52. CONCLUSIONS This two-phase design will allow us to determine the potential efficacy of chronic weight management using lorcaserin for maintaining initial losses of at least 5% body weight, induced by the use of a structured meal-replacement diet. This combined approach holds promise of achieving larger long-term weight losses. CLINICAL TRIAL REGISTRATION NCT02388568 on ClinicalTrials.gov.

A Randomized Trial of Lorcaserin and Lifestyle Counseling for Maintaining Weight Loss Achieved with a Low-Calorie Diet: Lorcaserin and Lifestyle for Weight Loss Maintenance

Improving the maintenance of lost weight remains a critical challenge, which can be addressed by long‐term behavioral and/or pharmacological interventions.

Sex Differences in Obesity and Mental Health

Purpose of ReviewThe purposes of this study were to examine the relationships between obesity and a wide range of mental health issues and to identify where sex differences exist and may vary across disorders.Recent FindingsResearch on sex differences in the relationship between obesity and psychiatric disorders is more abundant in some areas, such as depression and eating disorders, than others, such as anxiety, trauma, and substance use. However, for most of the disorders, their relationships with obesity and sex are complex and are usually moderated by additional variables. Thus, studies that find stronger relationships for women between depression and obesity cross-sectionally do not tell the whole story, as longitudinal studies suggest that this relationship may also be present among men, particularly when confounders are considered. For those with eating disorders, men and women with obesity are fairly equally affected, and weight and shape concerns may play a role in maintaining these behaviors for both sexes. Weight stigma, though, seems to have worse consequences for women than men with obesity.SummarySex differences exist in relation to the associations between mental health and obesity. However, these differences vary by disorder, with disorder-specific moderators playing a role, such as age for depressive disorders, comorbid depression for anxiety disorders, and weight and shape concerns for eating disorders. More work is needed to understand if sex differences play a role in the relationship between obesity and anxiety, trauma, and substance use disorders.

Binge Eating and Weight Loss Outcomes in Individuals with Type 2 Diabetes: 4‐Year Results from the Look AHEAD Study

This study aims to assess whether an intensive lifestyle intervention (ILI) for weight reduction precipitates binge eating (BE) and whether BE attenuates 4‐year weight loss among participants with type 2 diabetes and overweight or obesity.

Short- and Long-Term Changes in Health-Related Quality of Life with Weight Loss: Results from a Randomized Controlled Trial: Health-Related Quality of Life and Weight Loss

The objective of this study was to determine the effects of weight loss and weight loss maintenance (WLM) on weight‐specific health‐related quality of life in a 66‐week trial.

Causal Attributions for Obesity Among Patients Seeking Surgical Versus Behavioral/Pharmacological Weight Loss Treatment

Obesity is frequently attributed to causes such as laziness and lack of willpower and personal responsibility. The current study identified causal attributions for obesity among patients seeking bariatric surgery and compared them to those among patients seeking less invasive weight loss treatment (behavioral/pharmacological). The 16-item Causal Attributions for Obesity scale (CAO; rated 1–7) was administered to 102 patients seeking bariatric surgery (sample 1) and 178 patients seeking behavioral/pharmacological weight loss treatment (sample 2). Between-subjects analyses compared CAO ratings for the two samples. Results showed that behavioral factors were the highest-rated attributions in both samples. Sample 1 had higher ratings of biological and environmental factors than did sample 2. Overall, patients seeking bariatric surgery had a more complex conceptualization of obesity than did patients seeking behavioral/pharmacological treatment. Trial registration: NCT02388568

Sociocultural and Familial Factors Associated with Weight Bias Internalization

Background/Aims: Sociocultural and familial factors associated with weight bias internalization (WBI) are currently unknown. The present study explored the relationship between interpersonal sources of weight stigma, family weight history, and WBI. Methods: Participants with obesity (N = 178, 87.6% female, 71.3% black) completed questionnaires that assessed the frequency with which they experienced weight stigma from various interpersonal sources. Participants also reported the weight status of their family members and completed measures of WBI, depression, and demographics. Participant height and weight were measured to calculate body mass index (BMI). Results: Linear regression results (controlling for demographics, BMI, and depression) showed that stigmatizing experiences from family and work predicted greater WBI. Experiencing weight stigma at work was associated with WBI above and beyond the effects of other sources of stigma. Participants who reported higher BMIs for their mothers had lower levels of WBI. Conclusion: Experiencing weight stigma from family and at work may heighten WBI, while having a mother with a higher BMI may be a protective factor against WBI. Prospective research is needed to understand WBIs developmental course and identify mechanisms that increase or mitigate its risk.

Reconsidering the Psychosocial-Behavioral Evaluation Required Prior to Bariatric Surgery: Psychosocial-Behavioral Evaluation

Fisher et al. (1) recently reported that patients with psychiatric diagnoses who underwent bariatric surgery lost as much weight as those without such diagnoses. Patients with serious mental illness (SMI), as compared with those without, had higher postoperative rates of emergency visits and hospitalization. However, it is unclear whether these visits were related to bariatric surgery, or whether they would have occurred in equal rates in patients with SMI who did not undergo bariatric surgery. An accompanying commentary by Mitchell (2) concluded that SMI, in patients whose psychiatric status is stable, should not be an exclusion criterion for bariatric surgery.

Preference for People-First Language Among Patients Seeking Bariatric Surgery

cations, surgery length, and the need for conversion to open cholecystectomy. A recent systematic review2 finding limited data to support the validity of FLS manual skill examination tasks or the scoring method suggested that demonstrating differences in scores between novices and experts does little to confirm content validity. In a review of 53 632 LCs from an insurance database, Schwaitzberg et al3 reported that FLS-certified surgeons had, counterintuitively, a higher rate of BDI compared with non-FLS−certified surgeons (0.47% vs 0.14%, P = .001). A 2003 study4 determined that 97% of BDIs during LC were attributable to errors in perception, judgment, and knowledge, but the FLS examination addresses only basic laparoscopic skills.1 When combined with the results of the present study, those study results bring into question whether FLS certification positively influences rates of intraoperative complications, one of the stated certification goals. This study is limited by its retrospective design and potential selection bias given that it is a single-institution study. In addition, the residents at our institution participate very early in hands-on training in laparoscopic surgery; thus, it is possible that owing to this extensive early exposure, the operative outcomes at our institution were not substantially influenced by the implementation of mandator y FLS certification. Today’s residents face greater hurdles to achieve board certification, including mounting student debt, longer training periods, and a growing list of mandatory certifications.5 The first-time pass rate for FLS is 96%,6 suggesting a low discriminating value. There does not appear to be evidence that mandatory FLS certification has improved LC outcomes. As such, one must reassess the value of continuing FLS in its current format as a high-stakes examination.

“Last Supper” Predicts Greater Weight Loss Early in Obesity Treatment, but Not Enough to Offset Initial Gains

Background: Many participants experience clinically significant fluctuations in weight before beginning a behavioral weight loss program. Pre-treatment weight gain, often referred to as the “last supper” effect, may limit total weight loss from the time of the pre-treatment screening visit and could be an indicator that a participant will respond poorly to behavioral intervention. Methods: Data were from the weight loss phase of a two-phase weight loss maintenance trial, in which 178 participants with obesity (screening BMI = 40.5 ± 6.0 kg/m2, 87.6% female; 71.3% black) were provided with a 14 week lifestyle intervention that included a meal replacement diet. Participants were categorized as having gained >1.15%, remained weight stable, or lost >1.15% of initial weight between the pre-treatment screening visit and the first treatment session (48.7 ± 29.4 days). We first examined whether the weight change groups differed in baseline eating characteristics (e.g., emotional eating, self-regulation, craving frequency) using one-way ANCOVAs. Linear mixed models were then used to compare weight change groups on total weight loss from the screening visit to week 14 and in-treatment weight loss from weeks 1 to 14. Results: Nearly half of the sample (48.9%) gained >1.15% of initial weight during the pre-treatment period (+2.5 ± 1.2%); 41.0% remained weight stable (+0.2 ± 0.6%); and 10.1% lost >1.15% of initial weight (-2.2 ± 0.9%). There were no significant differences between the groups in baseline eating characteristics. As measured from the screening weight, the weight-gain group had a lower total loss of 6.8%, compared to 7.8% in the weight stable group (p = 0.02) and 9.0% in the weight-loss group (p = 0.003). The weight-gain group lost more weight in the first 4 weeks of treatment, but in-treatment losses did not differ among the groups at week 14. Conclusion: Pre-treatment weight gain was not an indicator of a poor response to a behavioral weight loss intervention and was associated with greater weight loss early in treatment. However, weight gain during the pre-treatment period may limit the total weight loss that participants achieve from the time that they first enroll in a weight loss program.