Increasing Fruit and Vegetable Intake and Decreasing Fat and Sugar Intake in Families at Risk for Childhood Obesity

Objective: The goal of this study was to evaluate the effect of a parent‐focused behavioral intervention on parent and child eating changes and on percentage of overweight changes in families that contain at least one obese parent and a non‐obese child. Research Methods and Procedures: Families with obese parents and non‐obese children were randomized to groups in which parents were provided a comprehensive behavioral weight‐control program and were encouraged to increase fruit and vegetable intake or decrease intake of high‐fat/high‐sugar foods. Child materials targeted the same dietary changes as their parents without caloric restriction. Results: Changes over 1 year showed that treatment influenced targeted parent and child fruit and vegetable intake and high‐fat/high‐sugar intake, with the Increase Fruit and Vegetable group also decreasing their consumption of high‐fat/high‐sugar foods. Parents in the increased fruit and vegetable group showed significantly greater decreases in percentage of overweight than parents in the decreased high‐fat/high‐sugar group. Discussion: These results suggest that focusing on increasing intake of healthy foods may be a useful approach for nutritional change in obese parents and their children.     

Adherence to behavioral targets and treatment attendance during a pediatric weight control trial

Objective:

Better weight loss outcomes are achieved in adults and youth who adhere to obesity treatment regimens (i.e., session attendance and prescribed changes in weight control behaviors). However, more research is needed regarding children's adherence to a range of behaviors relevant for weight maintenance over long‐term follow‐up.

Design and Methods:

Overweight children (N = 101, aged 7‐12 years), along with an overweight parent, participated in a 20‐week family‐based behavioral weight loss treatment (FBT) and were then assigned to either a behaviorally focused or socially focused 16‐week weight maintenance treatment (MT). Treatment attendance and child and parent adherence (i.e., reported use of skills targeted within treatment) were examined in relation to child percent overweight change from baseline to post‐FBT, post‐MT, and 2‐year follow‐up.

Results:

Higher attendance predicted better child weight outcomes at post‐MT, but not at 2‐year follow‐up. Adherence to self‐regulatory skills/goal‐setting skills predicted child weight outcomes at 2‐year follow‐up among the behaviorally focused MT group.

Conclusions:

Future research is needed to examine mediators of change within family‐based weight control interventions, including behavioral and socially based targets. Incorporating self‐regulatory weight maintenance skills into a comprehensive MT may maximize children's sustained weight control.     

Parent predictors of child weight change in family based behavioral obesity treatment

Family based behavioral treatment for overweight and obese children includes parenting skills targeting the modification of child eating and activity change. The purpose of this study was to examine parenting skills and parent weight change as predictors of child weight change in a sample of 80 parent/child dyads who were enrolled in a family based behavioral weight loss program for childhood obesity. Eighty overweight and obese children and their parents who enrolled in treatment in two sites were included in the study. Variables included those related to parent modeling (parent BMI), home food environment, parenting (parent and child report), and demographics. Results suggested that parent BMI change was a significant predictor of child weight, in that a reduction of 1 BMI unit in the parent was associated with a 0.255 reduction in child BMI. None of the other variables were significant in the final model. This study is consistent with other research showing that parent weight change is a key contributor to child weight change in behavioral treatment for childhood obesity. Researchers and clinicians should focus on encouraging parents to lose weight to assist their overweight and obese child in weight management.     

Increasing healthy eating vs. reducing high energy-dense foods to treat pediatric obesity

Objective: The objective was to compare targeting increased eating of healthy foods vs. reducing intake of high energy‐dense foods within the context of a family‐based behavioral weight control program. Methods and Procedures: Forty‐one 8–12 year‐old children >85th BMI percentile were randomly assigned to a 24‐month family‐based behavioral treatment that targeted increasing fruits and vegetables and low‐fat dairy vs. reducing intake of high energy‐dense foods. Results: Children in the increase healthy food group showed greater reduction in zBMI compared to children in the reduce high energy‐dense food group at 12‐ (?0.30 zBMI units vs. ?0.15 zBMI units, P = 0.01) and 24‐ (?0.36 zBMI units vs ?0.13 zBMI units, P = 0.04) month follow‐up. Parents in the increase healthy food group showed greater reductions in concern about child weight (P = 0.007), and these changes were associated with child zBMI change (P = 0.008). Children in the reduce high energy‐dense group showed larger sustained reductions in high energy‐dense foods (P < 0.05). Baseline levels of high energy‐dense foods (P < 0.05), parent food restraint (P = 0.01), parent concern over parent weight (P = 0.01) and parent acceptance of the child (P < 0.05) moderated child zBMI change, with greater sustained reductions in zBMI for children in the increase healthy food group for each measure. Parent zBMI change followed the same pattern as child changes, and parent and child zBMI changes were correlated (P < 0.001). Discussion: Focusing on healthy food choices within an energy restricted diet may be useful in family‐based weight control programs.     

The Relationship of Childhood Adiposity to Parent Body Mass Index and Eating Behavior

Objective: To better understand risk factors for the development of obesity in early childhood, we examined the association between children's adiposity and their parents' eating behavior and body mass index (BMI). Research Methods and Procedures: Parents of 85 white children 36 months of age (49 boys and 36 girls) completed the Three‐Factor Eating Questionnaire measuring three dimensions of parent eating behavior: disinhibited eating, cognitive restraint of eating, and susceptibility to hunger. Parent BMI (kg/m²) was calculated using self‐reported height and weight. The children's percentage body fat was assessed by dual energy X‐ray absorptiometry analysis. Results: Twenty‐six percent of parents were obese (BMI ≥ 30 kg/m²). Both maternal and paternal BMI were associated with higher scores for disinhibition (r = 0.69 and r = 0.68, p < 0.001), and maternal BMI was also associated with higher scores for hunger (r = 0.51, p < 0.001). There were no significant relationships between children's percentage body fat and parent eating scores, and the correlation between children's percentage body fat and parent BMI was significant only between mothers and daughters (r = 0.35, p = 0.04). Obese parents were no more likely to have a child who was fatter (upper quintile of percentage body fat for gender). Discussion: Among 36 month‐old white children, parent eating behavior was related to parent BMI, but not to children's adiposity. There was only a weak relationship between parent BMI and child adiposity. Despite the aggregation of adiposity within families due to shared genes and environments, children may not express differences in susceptibility to obesity by 3 years of age.     

Low Recognition of Childhood Overweight and Disease Risk among Native‐American Caregivers**

Objectives: Pediatric obesity is a significant and increasing problem in Native‐American communities. The aim of this study was to determine whether parents and other caregivers from three Wisconsin tribes recognized overweight children. We also assessed caregiver attributes associated with levels of concern for risk of future overweight and chronic disease. Research Methods and Procedures: Data were obtained from child health screenings and caregiver surveys. Participants included 366 kindergarten‐through‐second grade child–caregiver dyads. Children's BMI percentiles were calculated and compared with caregiver responses. We assessed the relationships between predictors of caregiver concern for health risk factors and recognition of overweight. Results: Twenty‐six percent of children were overweight (≥95th percentile), and 19% were at risk for being overweight (≥85th to <95th percentile) using Centers for Disease Control standards. Caregivers recognized only 15.1% of overweight children. Factors predictive of child overweight recognition included a child BMI >99th percentile and grandmother as caregiver. Overall, caregivers were more concerned about diabetes and cardiovascular disease than obesity. Parents with diabetes and heart disease were more concerned than others about risk for these diseases; however, only diabetic parents made a connection between child weight status and future risk of obesity‐related disease. Child sex, child age, and parental education level were not significant predictors for caregiver recognition of an overweight child. Discussion: Most caregivers did not recognize overweight children or associate excess weight with increased risk of disease. When designing community interventions, it is crucial to incorporate caregivers’ attitudes and beliefs regarding childhood overweight and risk of future disease.     

The Influence of Parenting Change on Pediatric Weight Control

Objective: Parenting style was examined as a predictor of weight loss maintenance in behavioral family‐based pediatric obesity treatment. Research Methods and Procedures: Fifty obese children who participated in a behavioral family‐based pediatric obesity treatment were studied. Hierarchical regression tested the incremental effect of baseline parenting and parenting during treatment on children's percentage overweight change over 12 months, beyond demographics and adherence to targeted behaviors. Results: Children's percentage overweight significantly decreased at 6 (?16.3) and 12 (?11.1) months. Adherence to program goals significantly increased variance accounted for in the regression model by 10.8%, whereas adding baseline father acceptance and change in father acceptance accounted for another 20.5%. The overall model accounted for 40.6% of the variance in pediatric weight control. ANOVA showed significantly greater percentage overweight decrease from baseline for youth with fathers who increased their acceptance vs. those who decreased acceptance at 6 (?19.8 vs. ?14.6) and 12 (?17.4 vs. ?8.1) months. Discussion: Youth who perceive an increase in father acceptance after treatment had better changes in percentage overweight over 12 months than youth with lower ratings of father acceptance. Future directions include examining how other parenting dimensions impact pediatric obesity treatment outcome and how parental acceptance can be enhanced to improve child weight control.     

A Pilot Randomized Controlled Trial of a Clinic and Home‐Based Behavioral Intervention to Decrease Obesity in Preschoolers

We evaluated the efficacy of a 6‐month clinic and home‐based behavioral intervention (Learning about Activity and Understanding Nutrition for Child Health; LAUNCH) to reduce obesity in preschool children ≥95th BMI percentile compared to enhanced standard of care (Pediatrician Counseling; PC). LAUNCH was a family‐based behavioral intervention that taught parents to use child behavior management strategies to increase healthy eating and activity for their children and themselves. PC presented the same diet and activity recommendations, but was delivered in a one‐time PC session. Eighteen children aged 2–5 years (mean 4.71 ± 1.01) with an average BMI percentile of 98 (±1.60) and an overweight parent were randomized to LAUNCH or PC. Assessments were conducted at baseline, 6 months (end of LAUNCH treatment) and 12 months (6 months following LAUNCH treatment). LAUNCH showed a significantly greater decrease on the primary outcomes of child at month 6 (post‐treatment) BMI z (?0.59 ± 0.17), BMI percentile (?2.4 ± 1.0), and weight gain (?2.7 kg ± 1.2) than PC and this difference was maintained at follow‐up (month 12). LAUNCH parents also had a significantly greater weight loss (?5.5 kg ± 0.9) at month 6 and 12 (?8.0 kg ± 3.5) than PC parents. Based on the data from this small sample, an intensive intervention that includes child behavior management strategies to improve healthy eating and activity appears more promising in reducing preschool obesity than a low intensity intervention that is typical of treatment that could be delivered in primary care.     

Influence of parents' eating behaviors and child feeding practices on children's weight status

Objective : To investigate the effects of mothers’ and fathers’ eating behaviors, child feeding practices, and BMI on percentage body fat and BMI in their children. Research Methods and Procedures : Four hundred fifty‐eight parents (239 mothers, 219 fathers) were asked to complete two questionnaires: the Three‐Factor Eating Questionnaire and the Child Feeding Questionnaire, which measure dimensions of parent eating behavior and child feeding practices, respectively. Parent BMI was calculated from self‐reported height and weight; children's measures included BMI and percentage fat assessed by DXA. Regression analyses were used to analyze relationships between parents’ BMI and questionnaire scores and children's weight status. Results : One hundred forty‐three mothers and 68 fathers returned questionnaires, representing parents of 148 children 3 to 5 years old (78 boys). Children's weight was related to mothers’ BMI, but not fathers’. Girls had a greater BMI if either parent reported being overweight as a child, and both girls and boys were likely to be overweight if their mothers believed they had risky eating habits (fussiness, eating too much, etc.). Girls with fathers who were more controlling had a higher percentage fat; these fathers were also more concerned about their daughters’ future health. Discussion : Mothers exert a strong influence over their children's weight and seem to be more concerned about their children's eating behaviors; however, fathers play a role in imposing child feeding practices. Gender bias may be present in child feeding, as suggested by dissimilar effects of parent practices on the weight status of girls vs. boys. Fathers should be included in future studies analyzing parent feeding practices and children's weight outcome.     

Sex Differences in Obese Children and Siblings in Family‐based Obesity Treatment

Objective: The primary goal was to evaluate sex differences in child weight control programs that targeted increasing physical activity (increase) or the combination of reducing sedentary behavior and increasing physical activity (combined). A second goal was to evaluate the benefits of family‐based interventions on nontargeted siblings. Research Methods and Procedures: Sixty‐seven families with obese children and 89 siblings were randomized to interventions that targeted increasing physical activity (increase) or the combination of reducing sedentary behavior and increasing physical activity (combined). Targeted participants and nontargeted siblings were followed for 1 year. Results: At 12 months, boys showed significantly better percentages of overweight changes (?15.8%) for the combined treatment than girls (?1.0%), with no significant differences for the increase intervention for boys (?9.3%) or girls (?7.6%). Boys adhered to treatment better than girls (p < 0.01). Adherence and predilection for physical activity were significant predictors of targeted child weight loss at 1 year in multiple regression analysis. Predictors of sibling weight loss included age, number of siblings, targeted child percentage of overweight change, and the interaction of group assignment by same sex of treated sibling. Discussion: Gender may influence response to programs that attempt to decrease sedentary behavior, and generalization of treatment effects to siblings may depend on the intervention and characteristics of the siblings.     

Resistance training lowers exercise-induced oxidative stress and homocysteine levels in overweight and obese older adults

Objective: To compare exercise‐induced oxidative stress and levels of homocysteine and cholesterol in normal‐weight and overweight older adults after resistance exercise (RX). Research Methods and Procedures: This interventional study was conducted at a wellness center. Forty‐nine older adults (age range, 60 to 72 years) were stratified by BMI (<25 kg/m² normal weight, ≥25 kg/m² overweight/obese) and then randomly assigned to either a control non‐exercise group or an RX group. The RX group completed a 6‐month training program. Exercise‐induced lipid hydroperoxides (PEROXs) and thiobarbituric‐reactive acid substances, homocysteine, lipoprotein a, cholesterol, and high‐density lipoprotein cholesterol were measured before and after the 6‐month RX program. Results: PEROXs and thiobarbituric‐reactive acid substances were lower in both the overweight/obese and normal‐weight RX‐trained groups compared with control groups (p < 0.05). Homocysteine levels were lower in both overweight/obese and normal‐weight RX groups compared with control groups (p < 0.05). Lipoprotein a, total cholesterol, and high‐density lipoprotein cholesterol were not different in normal‐weight and overweight/obese groups before or after RX. The change in muscle strength was correlated with homocysteine at 6 months (r = ?0.452, p < 0.05), whereas the change in PEROXs was correlated with the change in body fat (r = ?0.329). Discussion: To our knowledge, these data are the first to show that RX reduces exercise‐induced oxidative stress and homocysteine regardless of adiposity, indicating that this protection can be afforded in an older, overweight/obese population as effectively as in healthy older adults. These data suggest that RX may afford some protection against emerging cardiovascular risk factors using a mode of exercise that supports body weight.     

Child and Parent Psychological Problems Influence Child Weight Control

This study used path analytic methods to assess the influence of child psychopathology measured using the Child Behavior Checklist and parent psychiatric symptoms measured using the Cornell Medical Index on changes in child percent overweight in obese 8- to 11-year-old children over 2 years (6 months of treatment, 18 months of follow-up) provided family-based behavioral intervention. Path analysis for the 0–6 month change showed the influence of mother and father psychiatric symptoms and child age on child anxiety/depression scores that in turn influenced child percent overweight change during treatment, accounting for 41 % of the shared variance. The path analysis for follow-up change showed mother and father psychiatric symptoms influenced child social problems at the first stage, and child social problems influenced child percent overweight change, accounting for 68.5% of the shared variance. These results provide the first demonstration that both parent and child problems may influence the short- and long-term success of obese children who participate in family-based behavioral treatment programs.     

Mediators of Weight Loss and Weight Loss Maintenance in Middle‐aged Women

Long‐term behavioral self‐regulation is the hallmark of successful weight control. We tested mediators of weight loss and weight loss maintenance in middle‐aged women who participated in a randomized controlled 12‐month weight management intervention. Overweight and obese women (N = 225, BMI = 31.3 ± 4.1 kg/m²) were randomly assigned to a control or a 1‐year group intervention designed to promote autonomous self‐regulation of body weight. Key exercise, eating behavior, and body image variables were assessed before and after the program, and tested as mediators of weight loss (12 months, 86% retention) and weight loss maintenance (24 months, 81% retention). Multiple mediation was employed and an intention‐to‐treat analysis conducted. Treatment effects were observed for all putative mediators (Effect size: 0.32–0.79, P < 0.01 vs. controls). Weight change was ?7.3 ± 5.9% (12‐month) and ?5.5 ± 5.0% (24‐month) in the intervention group and ?1.7 ± 5.0% and ?2.2 ± 7.5% in controls. Change in most psychosocial variables was associated with 12‐month weight change, but only flexible cognitive restraint (P < 0.01), disinhibition (P < 0.05), exercise self‐efficacy (P < 0.001), exercise intrinsic motivation (P < 0.01), and body dissatisfaction (P < 0.05) predicted 24‐month weight change. Lower emotional eating, increased flexible cognitive restraint, and fewer exercise barriers mediated 12‐month weight loss (R² = 0.31, P < 0.001; effect ratio: 0.37), but only flexible restraint and exercise self‐efficacy mediated 24‐month weight loss (R² = 0.17, P < 0.001; effect ratio: 0.89). This is the first study to evaluate self‐regulation mediators of weight loss and 2‐year weight loss maintenance, in a large sample of overweight women. Results show that lowering emotional eating and adopting a flexible dietary restraint pattern are critical for sustained weight loss. For long‐term success, interventions must also be effective in promoting exercise intrinsic motivation and self‐efficacy.     

Targeting Parents Exclusively in the Treatment of Childhood Obesity: Long‐Term Results

Objective: To report the long‐term change in children's overweight following a family‐based health‐centered approach where only parents were targeted compared with a control intervention where only children were targeted. Research Methods and Procedures: Fifty of the 60 children who participated in the original study were located 7 years later, and their weight and height were measured. At the point of the 7‐year follow‐up, the children were 14 to 19 years of age. Repeated measure ANOVA was used to test differences between the groups in percent overweight at different time‐points. Results: Mean reduction in percent overweight was greater at all follow‐up points in children of the parent‐only group compared with those in the children‐only group (p < 0.05). Seven years after the program terminated, mean reduction in children's overweight was 29% in the parent‐only group vs. 20.2% in the children‐only group (p < 0.05). Discussion: Over the long term, treatment of childhood obesity with the parents as the exclusive agents of change was superior to the conventional approach.     

Child Overweight,Associated Psychopathology,and Social Functioning: A French School‐based Survey in 6‐ to 11‐year‐old Children

The aim of this study was to estimate the prevalence of child overweight in a regional sample of primary school‐aged children, and to examine the relationships among child overweight, psychopathology, and social functioning. A cross‐sectional survey was conducted in 2004 in 100 primary schools of a large French region, with 2,341 children aged 6–11 randomly selected. Child weight and height, lifestyle variables (leisure‐time physical activity (LTPA), watching television (TV), playing video games), and socioeconomic characteristics were collected in parent‐administered questionnaires. Child psychopathology outcomes were assessed using child‐ and parent‐reported instruments (Dominic Interactive (DI) and Strengths and Difficulties Questionnaire (SDQ)). Overweight and obesity were estimated according to the International Obesity Task Force (IOTF) definition. Response rates to the parent questionnaire and DI were 57.4 and 95.1%, respectively. Final sample size was 1,030 children. According to the IOTF, 17.3% of the children were overweight, of whom 3.3% were obese. In univariate analysis, correlates of overweight were low parental education, low monthly income, Disadvantaged School Areas (DSAs), self‐reported generalized anxiety, parent‐reported conduct disorders, emotional problems, and peer difficulties. High monthly income was less frequently associated with overweight. In multivariate analysis, parent‐reported peer difficulties (odds ratio (OR) = 2.06; 95% confidence interval = 1.27–3.35) and DSAs (1.88; 1.03–3.44) were independent factors significantly associated with child overweight. There was a trend of being overweight with elevated TV times (P for trend = 0.02). The psychosocial burden of excess weight appears to be significant even in young children. Findings should be considered for preventing strategies and public health interventions. School‐based overweight prevention programs should be implemented first in disadvantaged areas together with information about weight stigmatization and discrimination.     

Effect of Internet Support on the Long‐Term Maintenance of Weight Loss

Objective: To investigate the efficacy of an Internet weight maintenance program. Research Methods and Procedures: Two hundred fifty‐five healthy overweight and obese adults (mean ± SD BMI, 31.8 ± 4.1 kg/m²) men (18%; mean ± SD age, 45.8 ± 8.9 yrs) participated in a 6‐month behavioral weight control program conducted over interactive television. Treatment was followed by a 12‐month weight maintenance program with three conditions: frequent in‐person support (F‐IPS), minimal in‐person support (M‐IPS) and internet support (IS). Main outcome measures included body weight, program adherence, and social influence components. Results: There were no significant differences among the groups in weight loss (mean ± SD) from baseline to 18 months (7.6 ± 7.3 kg vs. 5.5 ± 8.9 kg vs. 5.1 ± 6.5 kg, p = 0.23 for the IS, M‐IPS, and F‐IPS, respectively). Discussion: Participants assigned to an internet‐based weight maintenance program sustained comparable weight loss over 18 months compared with individuals who continued to meet face‐to‐face. Therefore, the internet appears to be a viable medium for promoting long‐term weight maintenance.     

Activity, inactivity, and screen time in relation to weight and fatness over adolescence in girls

Objective: The impact of activity and inactivity on relative weight and fatness change are best evaluated longitudinally. We examined the longitudinal relationship of physical activity, inactivity, and screen time with relative weight status and percentage body fat (%BF) and explored how it differed by parental overweight status. Research Methods and Procedures: Non‐obese pre‐menarcheal girls (173), 8 to 12 years old, were followed until 4 years post‐menarche. %BF, BMI z‐score, and time spent sleeping, sitting, standing, walking, and in vigorous activity were assessed annually. We developed a physical activity index to reflect time and intensity of activity. Inactivity was defined as the sum of time spent sleeping, sitting, and standing. Screen time was defined as time spent viewing television, videotapes, or playing video games. Parental overweight was defined as at least one parent with BMI > 25. Results: In separate linear mixed effects models, activity, inactivity, and screen time were unrelated to BMI z‐score longitudinally, with and without accounting for parental overweight. After controlling for parental overweight, activity was inversely related (p < 0.001), and inactivity was directly related (p < 0.035) to increased %BF longitudinally. Screen time was unrelated to %BF change. With stratification for parental overweight, effects of activity and inactivity on %BF were observed only among girls with at least one overweight parent. Discussion: In this cohort of initially non‐overweight girls, activity and inactivity were related to accrual of BF over adolescence, particularly among children with at least one overweight parent. These results suggest that girls with a family history of overweight represent a target population of high priority for interventions around physical activity and inactivity.     

Impact of Objective and Subjective Social Status on Obesity in a Biracial Cohort of Adolescents

Objective: To characterize the associations between socioeconomic status (SES), two levels of subjective social status (SSS), and adolescent obesity. Research Methods and Procedures: Cross‐sectional study of 1491 black and white adolescents attending public school in a suburban school district in Greater Cincinnati, Ohio. BMI ≥95th percentile derived from measured height and weight defined overweight. Students rated SSS on separate 10‐point scales for society and school. A parent provided information on parent education and household income for SES. Results: Although there were no sex differences in SES, black students were more likely to come from families with less well‐educated parents and lower incomes (p < 0.001). Black girls had the lowest societal SSS (p = 0.003), lowest school SSS (p = 0.046), and highest BMI (p < 0.001). Prevalence of overweight was highest among black girls (26.0%) and boys (26.2%), intermediate for white boys (17.2%), and least for white girls (11.6%). Logistic regression modeling revealed that parent education, household income, and school SSS were each associated with overweight. In a fully adjusted model, school SSS retained its association to overweight (odds ratio, 1.16; 95% CI, 1.06, 1.26) independent of SES. The association of school SSS was strongest among white girls, intermediate for white and black boys, and absent for black girls. Discussion: Perceptions of social stratification are independently associated with overweight. There were important racial and sex differences in the social status‐overweight association. SSS in the more immediate, local reference group, the school, had the strongest association to overweight.     

Leptin Responses to Weight Loss in Postmenopausal Women: Relationship to Sex‐Hormone Binding Globulin and Visceral Obesity

Objective: Leptin concentrations increase with obesity and tend to decrease with weight loss. However, there is large variation in the response of serum leptin levels to decreases in body weight. This study examines which endocrine and body composition factors are related to changes in leptin concentrations following weight loss in obese, postmenopausal women. Research Methods and Procedures: Body composition (DXA), visceral obesity (computed tomography), leptin, cortisol, insulin, and sex hormone‐binding globulin (SHBG) concentrations were measured in 54 obese (body mass index [BMI] = 32.0 ± 4.5 kg/m²; mean ± SD), women (60 ± 6 years) before and after a 6‐month hypocaloric diet (250 to 350 kcal/day deficit). Results: Body weight decreased by 5.8 ± 3.4 kg (7.1%) and leptin levels decreased by 6.6 ± 11.9 ng/mL (14.5%) after the 6‐month treatment. Insulin levels decreased 10% (p < 0.05), but mean SHBG and cortisol levels did not change significantly. Relative changes in leptin with weight loss correlated positively with relative changes in body weight (r = 0.50, p < 0.0001), fat mass (r = 0.38, p < 0.01), subcutaneous fat area (r = 0.52, p < 0.0001), and with baseline values of SHBG (r = 0.38, p < 0.01) and baseline intra‐abdominal fat area (r = ?0.27, p < 0.06). Stepwise multiple regression analysis showed that baseline SHBG levels (r² = 0.24, p < 0.01), relative changes in body weight (cumulative r² = 0.40, p < 0.05), and baseline intra‐abdominal fat area (cumulative r² = 0.48, p < 0.05) were the only independent predictors of the relative change in leptin, accounting for 48% of the variance. Discussion: These results suggest that obese, postmenopausal women with a lower initial SHBG and more visceral obesity have a greater decrease in leptin with weight loss, independent of the amount of weight lost.     

Predictors of Weight Maintenance

PASMAN, WILRIKE J., WIM H.M. SARIS, AND MARGRIET S. WESTERTERP-PLANTENGA. Predictors of weight maintenance. Obes Res. 1999;7:43–50. Objective : To obtain predictors of weight maintenance after a weight-loss intervention. Research Methods and Procedures : An overall analysis of data from two-long intervention studies [n = 67 women; age: 37.9±1.0 years; body weight (BW): 87.0±1.2 kg; body mass index: 32.1±0.5 kg-m^?2; % body fat: 42.4±0.5%]. Subjects were measured before a very low energy diet (month 0), after the very low energy diet of 2 months (month 2) and after a 14-month follow-up phase (at 16 months), in which fiber or a carbohydrate-containing food supplement was supplied. The baseline measurements and the changes in parameters induced by the diet intervention were used to predict the changes in BW in the follow-up phase [ΔBW(2–16)]. Results : Multiple regression analysis revealed that 50% (p<0.71) of the variability in weight regain could be explained by pphysiological and behavioral factors. These were: frequency of previous dieting (r² = 0.27, p<0.05), hunger score (measured with the three-factor eating behavior questionnaire), and change in 24-hour resting metabolic rate (RMR). Frequent dieters showed significantly more weight regain than less frequent dieters (8.8±1.0 kg vs. 5.1 ±0.8 kg, p<0.01). Subjects having parents with obesity regained almost significantly more weight than subjects with lean parents (8.5±0.2 kg vs. 5.1±1.5 kg, respectively; p = 0.06). Discussion : Physiological (ΔRMR-24 hours) and behavioral factors (previous frequency of dieting and hunger score) predicted failure of weight maintenance and, as such, can be used to identify women who are at risk for weight regain.