Zayna M. Bakizada

Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity.

Weight stigma is a chronic stressor that may increase cardiometabolic risk. Some individuals with obesity self‐stigmatize (i.e., weight bias internalization, WBI). No study to date has examined whether WBI is associated with metabolic syndrome.

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/gender differences in neural correlates of food stimuli: a systematic review of functional neuroimaging studies.

Sex and gender differences in food perceptions and eating behaviours have been reported in psychological and behavioural studies. The aim of this systematic review was to synthesize studies that examined sex/gender differences in neural correlates of food stimuli, as assessed by functional neuroimaging. Published studies to 2016 were retrieved and included if they used food or eating stimuli, assessed patients with functional magnetic resonance imaging or positron emission tomography, and compared activation between men and women. Fifteen studies were identified. In response to visual food cues, women, compared with men, showed increased activation in the frontal, limbic and striatal areas of the brain as well as the fusiform gyrus while fasted. Differences in neural response to gustatory stimuli were inconsistent. This suggests that women may be more reactive to visual food stimuli, especially when hungry. However, findings are based on a small number of studies, and additional research is needed to establish a more definitive explanation and conclusion.

Management of Obesity

This review examines weight loss and accompanying improvements in obesity-related comorbidities produced by intensive lifestyle intervention, pharmacotherapy, and bariatric surgery. Obese individuals lose approximately 6 to 8 kg (approximately 6% to 8% of initial weight) with 6 months of participation in a high-intensity lifestyle intervention (≥ 14 treatment visits) consisting of diet, physical activity, and behavior therapy. Such losses reduce progression to type 2 diabetes in at-risk people and decrease blood pressure and triglyceride levels. All diets, regardless of macronutrient composition, can produce clinically meaningful weight loss (> 5%) if they induce a deficit ≥ 500 kcal/d. Physical activity of 150 to 180 min/wk yields modest short-term weight loss compared with diet but contributes to improvements in obesity-related conditions. Gradual weight regain is common after lifestyle intervention but can be prevented by continued participation in monthly weight loss maintenance sessions, as well as by high levels of physical activity (ie, 200 to 300 min/wk). Patients unable to reduce satisfactorily with lifestyle intervention may be candidates for pharmacotherapy, recommended as an adjunct. Five medications have been approved by the US Food and Drug Administration for chronic weight management, and each has its own risk/benefit profile. The addition of these medications to lifestyle intervention increases mean weight loss by 2.5 to 8.9 kg compared with placebo. Patients with severe obesity who are unable to reduce successfully with lifestyle intervention and pharmacotherapy are eligible for bariatric surgery, including Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding. The first two procedures yield long-term (≥ 3 years) reductions of ≥ 20% of initial weight that are associated with decreases in morbidity and potentially mortality. Greater resources and dissemination efforts are needed to increase the availability of these three approaches for the millions of Americans who would benefit from them.

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.

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.

A randomized controlled trial of lorcaserin and lifestyle counselling for weight loss maintenance: changes in emotion- and stress-related eating, food cravings and appetite: Appetite and weight loss

Anti‐obesity medication may help people maintain diet‐induced reductions in appetite. The present exploratory analysis assessed the effects of lorcaserin on changes at 24 weeks post‐randomization in emotion‐ and stress‐related eating, food cravings and other measures of appetite (i.e. binge eating, cognitive restraint, disinhibition, hunger, preoccupation with eating and fullness). The parent study investigated the efficacy of combined lorcaserin and behavioural treatment in facilitating weight loss maintenance (WLM) in 137 adults (mean age = 46.1 years, 86.1% female, 68.6% black) who had lost ≥5% of initial weight during a 14‐week, low‐calorie diet (LCD) run‐in. Participants were randomly assigned to lorcaserin or placebo and were provided with group WLM counselling sessions. Emotion‐ and stress‐related eating, food cravings and appetite were measured at the start of the LCD (week −14), randomization (0) and week 24. From randomization, lorcaserin‐treated participants had significantly greater improvements in emotion‐ and stress‐related eating compared to placebo‐treated participants (P = 0.04). However, groups did not differ significantly after randomization in changes in the frequency of food cravings, binge eating or other measures of appetite (Ps > 0.05). Compared to placebo, lorcaserin may improve emotion‐ and stress‐related eating.