weight loss

‘#Micro-Strategies’ May Help Maintain #Weight Loss Long Term

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Behavioral and psychological strategies such as setting daily goals, maintaining a positive mindset, and thinking about past successes may be the key to maintaining weight loss long term among participants of commercial weight management programs, suggests a new US study.

Suzanne Phelan, PhD, and colleagues studied over 4500 successful weight loss maintainers who had used WW International (formerly Weight Watchers). Phelan has reported receiving a research grant from WW International.

The study, published online January 23 in Obesity and supported by WW, showed that, compared with over 500 obese individuals with stable weight, weight loss maintainers were more likely to use a variety of self-monitoring and psychological coping strategies.

They were also more willing to ignore food cravings and had stronger habits towards healthy eating, say the researchers, who also found that weight loss maintainers had better quality of life.

Phelan, of California Polytechnic State University, San Luis Obispo, and coauthors say the results reveal a series of key strategies for successful weight loss maintenance with commercial weight management programs.

These include “setting daily intake goals, recording daily intake, measuring foods, thinking about past successes, and remaining positive in the face of weight regain.”

They add that future research “should consider emphasizing these components in development of effective weight maintenance programs.”

Understanding the Role Micro-Behaviors Play

Although the central pillars of weight control — a lower calorie diet, high levels of physical activity, and frequent self-monitoring — are related to the degree and duration of weight loss, the role of micro-behaviors, such as setting daily goals, combating negative thoughts and keeping healthy foods visible, is less well understood, say Phelan and colleagues.

With up to 15% of individuals seeking to lose weight through commercial weight management programs, the researchers sought to identify novel behavioral and psychological strategies among weight loss maintainers using such programs.

The team identified adults from the WW Success Registry who had maintained weight loss of at least 9.1 kg (20 lb) for a year or more, alongside a control group of people with a body mass index (BMI) of at least 30 kg/m2 whose weight had been stable for 5 years or more.

A total of 4781 WW participants completed a weight control strategies questionnaire. They were an average age of 53.9 years, had a mean BMI of 27.6 kg/m2, and most were white (94.5%).

Participants had maintained an average 23.8% weight loss for 3.3 years.

In addition, 665 weight-stable obese individuals completed the questionnaire and were used as the control group. They were a mean age of 48.5 years, had a mean BMI of 38.9 kg/m2, and 83.9% were white.

Individuals in the control group were more likely than weight loss maintainers to be employed, although they were also more likely to be less educated, nonwhite, male, younger, and had a lower income, all factors that were taken into account in the analyses.

“Novel” Relationship: Weight Control Strategies, Habit Strength, QoL

Researchers found that weight loss maintainers were more likely than controls to make healthy dietary choices, at mean scores of 3.3 versus 1.9 (P = .0001).

They were also more likely to use self-monitoring and psychological coping strategies than controls, at mean scores of 2.6 versus 0.7 and 2.5 versus 1.1, respectively (P = .0001 for both).

In addition, weight loss maintainers reported a greater willingness to ignore food cravings than controls, at mean scores of 4.4 versus 3.5, and had greater habit strength towards healthy eating, at mean scores of 5.3 versus 3.2 (P = .0001 for both).

The researcher team calculates that healthy dietary strategies, self-monitoring, psychological coping strategies, and habit strength for healthy eating were independent contributors to the between-group differences, accounting for 49.5% of the variance in scores.

The results also indicate that weight loss maintainers had significantly higher quality of life scores on the Food Craving Acceptance & Action scale than controls and were more likely to make an effort to maintain their current weight (P = .0001 for both).

Describing the relationship between weight control strategies and habit strength and improved quality of life as “novel,” the team says it “may serve as a motivator for continued weight loss maintenance.”

However, they caution that the study is limited by its cross-sectional nature and the potential lack of generalizability to other commercial programs and more socioeconomically or ethnically diverse populations.

“The practical implications of the current study’s findings are to highlight some key strategies that most characterized successful weight loss maintainers in a large, commercial weight management program,” they reiterate.

“Future research should consider emphasizing these components in development of effective weight maintenance programs,” they state.

Obesity. 2020;28:421-428. Full text

#Mindfulness training may support #weight loss

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Mindfulness training may improve the effectiveness of intensive weight management programmes, according to findings of a small new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

The study included 53 adults attending a tier 3-based obesity service in the United Kingdom. Among those recruited into the study, 33 participants completed at least three of four group sessions where they were taught mindfulness-based eating behaviour strategies. A retrospective control group, composed of 33 randomly chosen participants who had not been taught mindfulness techniques, was also included.

The study found participants who received mindfulness teaching had significantly greater weight-loss of 2.85 kg than control participants who had no mindfulness teaching (P=.036). Participants also had a statistically significant improvement of 14.3 points (4% improvement) in overall self-reported eating style (P=.009) between assessments performed at baseline and following completion of attendance at the group sessions.

Qualitative feedback showed participants felt better able to plan meals in advance after the sessions and felt more confident in self-managing weight-loss.

The authors noted a relatively high drop-out rate from the group sessions and said alternative means of administering mindfulness programmes to patients with obesity should be explored.

#Can #weight loss reverse #Afib?

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  • Noticias Médicas Univadis

Researchers have demonstrated for the first time that obese people with atrial fibrillation (AF) can reduce or reverse the condition by losing weight.

The analysis included 355 overweight or obese participants with AF from the Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up (LEGACY) study. Weight loss was categorised as: group one (<3%), group two (3-9%), and group three (≥10%). Change in AF type was determined by clinical review and seven-day Holter yearly. AF type was categorised as per the Heart Rhythm Society consensus.

The authors found that in Group one, 41 per cent progressed from paroxysmal to persistent AF and 26 per cent from persistent to paroxysmal or no AF. In Group two, 32 per cent progressed from paroxysmal to persistent AF and 49 per cent reversed from persistent to paroxysmal or no AF. Notably in Group three, 3 per cent progressed to persistent AF and 88 per cent reversed from persistent to paroxysmal or no AF.

Presenting the findings in the journal Europace, the authors said the findings provide further insight into the role of upstream intervention to potentially alter the AF disease process.

#Diabetes reversed with #weight loss alone

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Type 2 diabetes (T2D) can be reversed with an intensive weight management programme, according to findings from a randomised trial in adults with T2D for up to six years, published in The Lancet.

The Diabetes Remission Clinical Trial (DiRECT) included 298 patients from 49 practices who were randomly assigned to receive either an intervention programme or best-practice care according to guidelines (control). The intervention comprised withdrawal of antidiabetic and antihypertensive drugs, total diet replacement (825-853kcal/day formula diet for 3-5 months), stepped food reintroduction (2-8 weeks), and structured support for long-term weight loss maintenance.

At 12 months, the authors recorded a loss of 15kg or more in 24 per cent of participants in the intervention group and no participants in the control group. Diabetes remission was achieved in 46 per cent of participants in the intervention group and 4 per cent of participants in the control group.

“Our findings suggest that the very large weight losses targeted by bariatric surgery are not essential to reverse the underlying processes which cause type 2 diabetes. The weight loss goals provided by this programme are achievable for many people,” said author Professor Roy Taylor

Lean M EJ, Leslie WS, Barnes AC et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. The Lancet. Published Online 05 December 2017. DOI: 10.1016/ S0140-6736(17)33102-1

#Garcinia for #Weight Loss: Modest Effect With Safety Caveats

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Gayle N. Scott, PharmD

Question

Is garcinia a safe and effective dietary supplement for patients hoping to lose weight?

Response from Gayle N. Scott, PharmD
Assistant Professor, Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, Virginia

Garcinia became a rock star in the dietary supplement world after a 2012 endorsement by television host Dr Mehmet Oz, who called it a “revolutionary fat buster.” (The endorsement was removed from the Dr Oz website following a Senate hearing on questionable weight loss products.[1]) Described as the “Oz effect,” Dr Oz’s endorsement of a dietary supplement usually has a substantial impact on product sales,[2,3,4] even when scientific evidence is not favorable.

Garcinia (Garcinia gummi-gutta, formerly known as Garcinia cambogia) is a small- to medium-sized tree native to India, Nepal, and Sri Lanka. Other common names include brindleberry, Malabar tamarind, and kudam puli (pot tamarind).[2] In the United States, garcinia products derived from the fruit are available as dietary supplements that are often promoted for weight loss. The major organic acid in the fruit is hydroxycitric acid (HCA), which is thought to account for the pharmacologic effects of garcinia. Animal research suggests that HCA may inhibit enzymes that synthesize fatty acids.[2]

A 2011 meta-analysis[3] reviewed nine clinical trials of garcinia extract (HCA) for weight loss; little research has been published since. The meta-analysis revealed a small yet statistically significant difference in weight loss in favor of HCA over placebo (mean difference: -0.88 kg; 95% confidence interval, -1.75 to -0.00, P < .05). This corresponds to about a 1% body weight loss in the HCA group compared with placebo,[3] in contrast to an average 3% weight loss in patients taking orlistat compared with placebo.[4] The study design showed considerable heterogeneity, and the duration of treatment and the dose of HCA used in the different trials varied widely. Two of the studies lasted 12 weeks, and the rest lasted 2-8 weeks. The persistence of weight loss and long-term safety with garcinia are unknown.[3]

The most common adverse effects reported were headache, nausea, and upper respiratory and gastrointestinal tract symptoms, but most of the trials reported no significant differences in adverse events between HCA and placebo.[3]

However, multiple case reports have implicated HCA-containing products in serious adverse reactions.[5] Hepatitis and hepatic failure requiring transplantation have been described in several case reports.[6,7,8] Serotonin toxicity in a 35-year-old woman who was also taking escitalopram has been reported.[9] Animal research suggests that HCA may increase serotonin levels.[10] Mania in patients with and without a history of psychiatric illness has been reported.[11]

The dietary supplements associated with these adverse effects often contained multiple ingredients, including HCA. For example, previous formulations of the combination weight loss product Hydroxycut® contained HCA along with various other supplements. Hydroxycut products that contained HCA have been associated with mania,[12] rhabdomyolysis,[13] hepatotoxicity, and other adverse effects.[14,15] Whether HCA or another Hydroxycut ingredient was responsible for the toxicities is unknown.[5]

Currently, not enough research is available to recommend garcinia or HCA-containing products for weight loss.

Currently, not enough research is available to recommend garcinia or HCA-containing products for weight loss. If garcinia or HCA-containing products are beneficial, the effects appear to be modest. Rare but serious adverse effects have been reported, and long-term toxicity is unknown. No published studies have lasted beyond 3 months.

Patients taking medications that affect serotonin (eg, dextromethorphan, selective serotonin reuptake inhibitors, tramadol) should avoid HCA. Given the reports of hepatic toxicity, patients with liver disease or patients taking potentially hepatotoxic drugs (eg, carbamazepine, isoniazid) should not take HCA.

#Diabetes: weight loss may not always be a good thing

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The finding could be the first suggestive evidence of an adverse reaction to what is generally considered a common-sense intervention.

While weight loss reduces the long-term risk for cardiovascular disease and mortality for the majority of patients with type 2 diabetes (T2D), for a small subgroup, weight-loss intervention may lead to dramatically worse outcomes.

That’s according to the authors of a new study published in The Lancet Diabetes & Endocrinology , who utilised machine-learning techniques to analyse data from the Look AHEAD (Action for Health in Diabetes) trial, which was halted in 2012 because its results did not reach statistical significance.

While 85 percent of the study sample did experience a clinically meaningful, significant reduction in cardiovascular mortality and morbidity during an intensive weight loss intervention, 15 per cent of participants with well-controlled diabetes and poor self-reported general health experienced negative effects that rendered the overall study outcome neutral. The subgroup also reported substantially poorer compliance with the exercise portion of the intervention and experienced less improvement in several intermediate health outcome.

The authors suggest that HbA1c levels and a short questionnaire on general health might identify people with type 2 diabetes who are likely to derive most benefit from an intensive lifestyle intervention aimed at weight loss.

Could cash rewards boost weight loss?

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Experts say they could provide a low cost strategy to improve population health.

Using a payment/rewards programme may help to improve weight loss when combined with an evidence-based weight loss programme, according to the findings of a new study published in  Social Science and Medicine .

In the Incentives for Obesity (TRIO) trial, 161 overweight or obese individuals were randomised to either a control or reward arm of a four-month weight loss programme at the LIFE (Lifestyle Improvement and Fitness Enhancement) Centre at Singapore General Hospital. Those in the reward arm paid a fee of S$165.00 (€107) to access a programme that provided rewards of up to S$660 (€427) for meeting weight loss and physical activity goals.
Average weight loss was more than twice as great in the reward arm compared to the control arm at month 4 (3.4kg versus 1.4 kg). At months 8 and 12, weight loss remained greater in the reward group (3.3kg versus 1.8kg and 2.3kg versus 0.8kg, respectively).

“This study shows that the enhancement and maintenance of weight loss is feasible through a rewards programme with participant ownership, coupled with an evidence-based, medical weight loss programme,” said Dr Kwang Wei Tham, director of the LIFE Centre and senior consultant at the Department of Endocrinology, Singapore General Hospital.

Vegetarian diet almost twice as effective for weight loss

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Even though all participants reduced their calorie intake by 500kcal/day, those who went vegetarian lost more body weight and muscle fat.

Dieters who go vegetarian not only lose weight more effectively than those on conventional low-calorie diets but also improve their metabolism by reducing muscle fat, a new study published in the Journal of the American College of Nutrition has found.

Since losing muscle fat improves glucose and lipid metabolism, this finding is particularly important for people with metabolic syndrome and type 2 diabetes, says lead author, Dr. Hana Kahleová, Director of Clinical Research of the Physicians Committee for Responsible Medicine in Washington DC.

Seventy-four subjects with type 2 diabetes were randomly assigned to follow either a vegetarian diet or a conventional anti-diabetic diet. The vegetarian diet consisted of vegetables, grains, legumes, fruits and nuts, with animal products limited to a maximum of one portion of low-fat yoghurt per day. The conventional diabetic diet followed the official recommendations of the European Association for the Study of Diabetes (EASD). Both diets were restricted by 500 kilocalories per day compared to individual normal calorie intake.

The vegetarian diet was found to be almost twice as effective in reducing body weight, resulting in an average loss of 6.2kg compared to 3.2kg with the conventional diet.

Can mindful eating help weight loss efforts?

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Encouraging patients to pay special attention to how food tastes could help them lose weight.

Latest data from the OECD suggests the obesity epidemic has spread further in the past five years, although at a slower pace than before. More than one in two adults and one in six children are now overweight or obese in the OECD area.

Efforts continue to find new ways to address the epidemic and scientists believe they may have identified a novel approach to the issue through a programme that focuses on mindful eating or the practice of increasing one’s awareness and focus on eating. This includes planning meals and snacks, paying special attention to how food tastes and eating as a singular activity as opposed to eating while doing other activities.

A total of 80 participants were part of a randomised controlled trial which evaluated the effectiveness of an online, 15-week weight management programme called Eat Smart, Move More, Weigh Less (ESMMWL). Participants that completed ESMMWL lost more weight (1.9kg) than participants in the control group (0.3kg). They also had a significantly larger increase in their mindfulness scores than the control group. The authors said the results suggest a beneficial association between mindful eating and weight loss.

The findings were presented at this year’s European Congress on Obesity .

Obesity: Balloon in a capsule achieves sustained weight loss

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Almost 90% of the weight lost was maintained over six months.

Findings from a new study show patients who consumed a gas-filled balloon capsule lost twice as much weight than through diet, exercise and lifestyle therapy alone.

In a double-blinded randomised, sham-controlled trial of 387 patients, about half received treatment with the gas-filled Obalon balloon, while the other half received a sugar-filled sham capsule.

Patients who had a body mass index of between 30-40kg/m2, swallowed three capsules over a 12-week period. All patients also underwent 25 minutes of lifestyle therapy administered by a registered dietician every three weeks. After six months, patients were informed which capsule they received and those with the Obalon balloons had them removed endoscopically.

Average total weight loss after six months was 6.81 per cent for Obalon balloon patients, while those in the control group had 3.59 per cent total average weight loss. Balloon-treated patients had nearly 25 per cent excess weight loss. Six months after the balloons were removed, 89.5 per cent of the average total weight lost during the treatment period was maintained.

The finding was presented at Obesity Week 2016 .