Tricia M. Leahey

Weight-loss maintenance in successful weight losers: surgical vs non-surgical methods.

Objective:As large weight losses are rarely achieved through any method except bariatric surgery, there have been no studies comparing individuals who initially lost large amounts of weight through bariatric surgery or non-surgical means. The National Weight Control Registry (NWCR) provides a resource for making such unique comparisons. This study compared the amount of weight regain, behaviors and psychological characteristics in NWCR participants who were equally successful in losing and maintaining large amounts of weight through either bariatric surgery or non-surgical methods.Design:Surgical participants (n=105) were matched with two non-surgical participants (n=210) on gender, entry weight, maximum weight loss and weight-maintenance duration, and compared prospectively over 1 year.Results:Participants in the surgical and non-surgical groups reported having lost approximately 56 kg and keeping ⩾13.6 kg off for 5.5±7.1 years. Both groups gained small but significant amounts of weight from registry entry to 1 year (P=0.034), but did not significantly differ in magnitude of weight regain (1.8±7.5 and 1.7±7.0 kg for surgical and non-surgical groups, respectively; P=0.369). Surgical participants reported less physical activity, more fast food and fat consumption, less dietary restraint, and higher depression and stress at entry and 1 year. Higher levels of disinhibition at entry and increased disinhibition over 1 year were related to weight regain in both groups.Conclusions:Despite marked behavioral differences between the groups, significant differences in weight regain were not observed. The findings suggest that weight-loss maintenance comparable with that after bariatric surgery can be accomplished through non-surgical methods with more intensive behavioral efforts. Increased susceptibility to cues that trigger overeating may increase risk of weight regain regardless of initial weight-loss method.

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.

An Acceptance-Based Behavioral Intervention for Weight Loss: A Pilot Study

On average, participants in behavioral weight-loss interventions lose 8 kilograms (kg) at 6 months, but there is marked variability in outcomes with some participants losing little or no weight. Individuals with difficulties with internal disinhibition (i.e., eating in response to emotions or thoughts) typically lose less weight in such programs and may require an innovative, specialized approach. This pilot study examined the preliminary acceptability and efficacy of a 24-week acceptance-based behavioral intervention for weight loss among overweight and obese adults reporting difficulty with eating in response to emotions and thoughts. Participants were 21 overweight or obese men and women (mean age=52.2±7.6 years; baseline mean body mass index=32.8±3.4). Eighty-six percent completed the 6-month program and a 3-month follow-up assessment. Ratings of program satisfaction averaged 4.9 on a five-point scale. Multilevel modeling analyses indicated participants lost an average of 12.0 kg (SE=1.4) after 6 months of treatment and 12.1 kg (SE=1.9) at 3-month follow-up, thus exceeding the weight losses typically seen in behavioral treatment programs. Decreases in internal disinhibition and weight-related experiential avoidance were found at 6- and 3-months follow-up. Greater decreases in weight-related experiential avoidance were associated with greater weight loss at the end of the program (r=.64, p=.002), suggesting a potential mechanism of action. Although there have been a few preliminary studies using acceptance-based approaches for obesity, this is the first study to specifically target emotional overeaters, a subgroup that might be particularly responsive to this new approach. Our findings provide initial support for the feasibility, efficacy, and acceptability of this approach for this subgroup of participants. Further study with longer follow-up, a more diverse sample, and comparison to a standard behavioral program is clearly warranted.

An Ecological Momentary Assessment of the Effects of Weight and Shape Social Comparisons on Women With Eating Pathology, High Body Dissatisfaction, and Low Body Dissatisfaction

This research examined the effects of naturally occurring appearance comparisons on womens affect, body satisfaction, and compensatory cognitions and behaviors. Using ecological momentary assessment, women with high body dissatisfaction and eating pathology (EPHB), high body dissatisfaction (HB), or low body dissatisfaction (LB) recorded their reactions to appearance-focused social comparisons. EPHB and HB women made more upward appearance comparisons than LB women. All women experienced negative emotions and cognitions after upward comparisons, including increased guilt, body dissatisfaction, and thoughts of dieting. EPHB women were most negatively affected by comparisons; they experienced more intense negative emotions, more thoughts of dieting/exercising, and an increase in eating-disordered behavior after upward comparisons. HB women experienced more negative affective consequences and thoughts of dieting than LB women. Results are consistent with social comparison theory and provide important information that may be used to inform eating disorder treatment and prevention efforts.

An ecological momentary assessment of comparison target as a moderator of the effects of appearance-focused social comparisons.

This research examined whether comparison target moderates the effects of naturally occurring appearance-focused social comparisons on womens affect, appearance esteem, and dieting thoughts. During daily activities, body-satisfied (BS) women and body-dissatisfied (BD) women recorded their comparison targets and reactions to comparison information. For BS women, upward comparisons with peers were associated with more positive affect (PA) and appearance esteem and less guilt than upward comparisons with media images and downward comparisons with peers were associated with less PA than downward comparisons with media images. For BD women, upward comparisons with peers were associated with more appearance esteem and diet thoughts than upward comparisons with media images and downward comparisons with peers were associated with less PA, appearance esteem, and diet thoughts and more guilt than downward comparisons with media images.

Teammates and social influence affect weight loss outcomes in a team-based weight loss competition.

Team‐based internet interventions are increasing in popularity as a way of promoting weight loss in large numbers of individuals. Given that social networks influence health behavior change, this study investigated the effects of teammates and social influence on individual weight loss during a team‐based weight loss competition. Shape Up Rhode Island (SURI) 2009 was a 12‐week online program open to adult residents of Rhode Island. Participants joined with a team and competed with other teams on weight loss and/or physical activity. Overweight/obese (OW/OB) individuals (N = 3,330; 76% female; age = 46.1 ± 10.8; BMI = 31.2 ± 5.3 kg/m2), representing 987 teams, completed the weight loss program. Multilevel modeling was used to examine whether weight loss clustered among teammates and whether percentage of teammates in the weight loss division and reported teammate influence on weight loss were associated with individual weight outcomes. OW/OB completers reported losing 4.2 ± 3.4% of initial body weight. Weight loss was similar among teammates (intraclass correlation coefficient (ICC) = 0.10, P < 0.001). Moreover, having a greater percentage of teammates in the weight loss division and reporting higher social influence for weight loss were associated with greater percent weight loss (Ps ≤ 0.002). Similarly, achieving a clinically significant (5%) weight loss tended to cluster within teams (ICC = 0.09; P < 0.001) and having more teammates in the weight loss division and higher social influence for weight loss were associated with increased likelihood of achieving a 5% weight loss (odds ratio (OR) = 1.06; OR = 1.20, respectively). These results suggest that teammates affect weight loss outcomes during a team‐based intervention. Harnessing and maximizing teammate influence for weight loss may enhance weight outcomes in large‐scale team‐based programs.

Differences in motivations and weight loss behaviors in young adults and older adults in the National Weight Control Registry

The goal of this study was to compare young adults (YA) and older adults (OA) in the National Weight Control Registry on motivations for weight loss and weight‐loss behaviors.

A randomized controlled pilot study testing three types of health coaches for obesity treatment: Professional, peer, and mentor

Despite their popularity, empirical support for health coaches is limited.

The point prevalence of bulimic disorders from 1990 to 2004.

OBJECTIVE This study investigated the point prevalence of probable cases of bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS), and specific eating disorder symptomatology among 6,844 undergraduate women at a single site, examining changes across five 3-year time periods and on a yearly basis from 1990 to 2004. METHOD Participants completed a self-report checklist that assessed the diagnostic criteria for BN (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 1994) and the Bulimia Test (Smith and Thelen, J Consult Clin Psychol, 52, 863-872, 1984) (BULIT) or Bulimia Test-Revised (Thelen et al., Psychol Assess, 3, 119-124, 1991) (BULIT-R). RESULTS Chi-square analyses comparing the percentages of probable cases of BN and EDNOS and the percentages of women who reported frequent binge eating and most compensatory weight control strategies were nonsignificant. Only the percentages of women who endorsed overconcern with weight and shape and diuretic use and excessive exercise as compensatory weight control strategies changed over time. CONCLUSION Consistent with Keel et al.s (Keel et al., Psychol Med, 36, 119-127, 2006) findings regarding the point prevalence rates of BN from 1992 to 2002, results indicated that probable cases of eating disorders remained relatively stable. Methodologically, this research illustrates the importance of examining multiple data points when investigating stability or change in behavior.

Failure to replicate depletion of self-control.

The limited resource or strength model of self-control posits that the use of self-regulatory resources leads to depletion and poorer performance on subsequent self-control tasks. We conducted four studies (two with community samples, two with young adult samples) utilizing a frequently used depletion procedure (crossing out letters protocol) and the two most frequently used dependent measures of self-control (handgrip perseverance and modified Stroop). In each study, participants completed a baseline self-control measure, a depletion or control task (randomized), and then the same measure of self-control a second time. There was no evidence for significant depletion effects in any of these four studies. The null results obtained in four attempts to replicate using strong methodological approaches may indicate that depletion has more limited effects than implied by prior publications. We encourage further efforts to replicate depletion (particularly among community samples) with full disclosure of positive and negative results.