Lauren E. Bradley

Endogenous hindbrain glucagon-like peptide-1 receptor activation contributes to the control of food intake by mediating gastric satiation signaling.

Exogenous activation of central nervous system glucagon-like peptide-1 (GLP-1) receptors (GLP-1Rs) reduces food intake. Experiments addressed whether endogenous central GLP-1R activity is involved in the control of normal feeding and examined which gastrointestinal satiation signals contribute to this control. Given that nucleus tractus solitarius (NTS) neurons are the source of central GLP-1, that caudal brainstem circuits mediate the intake suppression triggered by exogenous hindbrain GLP-1R activation, and that these neurons process gastrointestinal vagal signals, the role of endogenous hindbrain GLP-1R activation to intake control was the focus of the analysis. Food intake increased with GLP-1R antagonist [Exendin-(9-39) (Ex-9)] [10 microg, fourth intracerebroventricular (icv)] delivery to overnight food-deprived rats after ingestion of 9 ml Ensure diet. Direct medial NTS injection of a ventricle subthreshold dose (1.0 microg) of Ex-9 increased food intake and established the contribution of this GLP-1R population to the effect observed with ventricular administration. To determine whether satiation signals of gastric vs. intestinal origin drive the GLP-1R-mediated NTS effect on food intake, two experiments were performed in overnight-fasted rats. In one, Ensure was infused intraduodenally (0.4 ml/min for 20 min); in another, the stomach was distended (9 ml SILASTIC brand balloon) for 15 min before fourth icv Ex-9. The intake suppression by duodenal nutrient infusion was not affected by GLP-1R blockade, but the feeding suppression after gastric distension was significantly attenuated by fourth icv Ex-9. We conclude that endogenous NTS GLP-1R activation driven by gastric satiation signals contributes to the control of normal feeding.

What do we know about mobile applications for diabetes self-management? A review of reviews

Diabetes is a chronic illness with significant health consequences, especially for those who are unable to adhere to the complex treatment regimen. Self-management tasks such as regular medication and insulin use, frequent blood sugar checks, strict diet management, and consistent exercise can be quite challenging. Mobile technologies, specifically mobile applications (apps), present a unique opportunity to help patients improve adherence to these behaviors. The availability of commercial diabetes self-management apps is increasing rapidly, making it difficult for patients and providers to stay informed about app options. A number of reviews have described commercial app technology and use for patients with diabetes. The aims of this article are to summarize the results and themes of those reviews, to review outcomes of apps described in the research literature, and to identify areas for further consideration in the use of mobile apps for diabetes self-management.

A Survey of Bariatric Surgery Patients’ Interest in Postoperative Interventions

BackgroundA substantial minority of bariatric surgery patients display clinically significant weight regain and recurrence of obesity-related comorbidities. Although postoperative follow-up and behavioral interventions are associated with better weight loss outcomes, many patients fail to attend or receive these services. More information is needed to better target and increase the probability of sustained treatment in those patients experiencing postoperative weight regain. The purpose of this study was to understand the challenges that patients perceive themselves to be facing and assess their receptivity and preferences for postoperative interventions.MethodsA survey developed by the authors was sent to patients who received bariatric surgery from a program based in an academic medical center between September 2008 and December 2010 (n = 751).ResultsData from 154 responders indicate that the vast majority of individuals who have undergone bariatric surgery are satisfied with surgery and their weight losses; however, most reported being on a trajectory of weight regain. Patients endorsed concerns about both current eating behavior and, additional, future weight regain. In addition, these patients expressed strong interest in participating in postoperative programs aimed at stopping and reversing regain.ConclusionsThe results provide novel information about bariatric surgery patients’ receptivity to and preferences for interventions after bariatric surgery.

The Effects of a Brief Acceptance-Based Behavioral Treatment Versus Traditional Cognitive-Behavioral Treatment for Public Speaking Anxiety An Exploratory Trial Examining Differential Effects on Performance and Neurophysiology

Individuals with public speaking anxiety (PSA) experience fear and avoidance that can cause extreme distress, impaired speaking performance, and associated problems in psychosocial functioning. Most extant interventions for PSA emphasize anxiety reduction rather than enhancing behavioral performance. We compared the efficacy of two brief cognitive-behavioral interventions, a traditional cognitive-behavior treatment (tCBT) and an acceptance-based behavior treatment (ABBT), on public speaking performance and anxiety in a clinical sample of persons with PSA. The effects of treatment on prefrontal brain activation were also examined. Participants (n = 21) were randomized to 90 min of an ABBT or a tCBT intervention. Assessments took place at pre- and post-treatment and included self-rated anxiety and observer-rated performance measures, a behavioral assessment, and prefrontal cortical activity measurements using functional near-infrared spectroscopy (fNIRS). Exploratory results indicated that participants in the ABBT condition experienced greater improvements in observer-rated performance relative to those in the tCBT condition, while those in the tCBT condition experienced greater reductions in subjective anxiety levels. Individuals in the ABBT condition also exhibited a trend toward greater treatment-related reductions in blood volume in the left dorsolateral prefrontal cortex relative to those who received tCBT. Overall, these findings preliminarily suggest that acceptance-based treatments may free more cognitive resources in comparison with tCBT, possibly resulting in greater improvements in objectively rated behavioral performances for ABBT interventions.

Lifestyle Modification for the Treatment of Obesity

Despite the success of bariatric surgery in producing massive weight loss, as well as improvement in morbidity and mortality, less than 1 % of those who meet the National Institutes of Health’s criteria for bariatric surgery present for surgery each year. The remaining individuals likely could experience improvements in their health with even modest weight loss. Many of these individuals likely make efforts to lose weight, either as a result of self-motivation or physician recommendation. The most commonly practiced treatment is lifestyle modification, undertaken in a self-directed fashion, through a self-help book or program, or commercial weight-loss program. The obesity treatment literature has consistently found that individuals who engage in lifestyle modification interventions can lose approximately 7–10 % of their initial body weight and experience clinically significant improvements in weight-related health problems.

Remote assessments and behavioral interventions in post-bariatric surgery patients

Sustained weight loss and health improvements after bariatric surgery require long-term monitoring and, for a significant minority of patients, postoperative intervention. Unfortunately, many patients demonstrate difficulty engaging in long-term follow-up and treatment due to time restrictions, geographic limitations, and financial burden. Conducting assessments and interventions remotely may help to mitigate these barriers, allowing for greater access to care and improved outcomes. This review will summarize the results of research using remote methods to conduct assessments and implement interventions with patients after bariatric surgery. Benefits and challenges of implementing these approaches will be highlighted, and future directions in this area will be discussed.

Measurement of adherence in bariatric surgery: a systematic review

After bariatric surgery, rates of adherence to behavioral recommendations, including attending regular appointments and following specific dietary, physical activity, and vitamin use recommendations, tend to be highly variable across studies. Lack of consistency in measurement of adherence is a likely contributor to this variability, making it challenging to determine the prevalence and impact of nonadherence in this population. PubMed was searched for articles measuring behavioral adherence or compliance in patients after bariatric surgery, resulting in 85 articles. Articles were reviewed for the definition and measurement of adherence in each area (appointment attendance, as well as dietary, physical activity, and vitamin use adherence), and on the use and reporting of recommended adherence measurement strategies. Over half of the articles measured adherence to appointment attendance. Significant variability was found across adherence definitions and measurement methods, and use of recommended adherence measurement strategies was poor. Adherence was mostly commonly measured via self-report (either verbal or written) using cutoffs for adherent versus nonadherent behavior. Over half of studies assessed adherence up to ≥2 years postsurgery. Recommendations for ways to improve adherence measurement in patients who have had bariatric surgery are outlined.

Mindfulness in a weight loss intervention: Some utility and some challenges

The impact of mindfulness techniques on difficult to treat conditions such as disordered eating and obesity has generated considerable research interest recently. Mindfulness has the potential to improve weight loss and behavior change through a variety of mechanisms, including increased awareness of internal experiences (hunger, mood), adaptive emotional coping, and cognitive flexibility. Through its influence on the physiological stress response, it may also result in decreased hunger and preference for high-sugar/fat foods and, potentially, decreased abdominal fat. Taken together, we believe there is a good rationale for the potential utility of mindfulness, through a number of pathways, to enhance weight loss and behavior change.