Reductions in Internal Disinhibition During Weight Loss Predict Better Weight Loss Maintenance

The construct of disinhibition, as measured by the Eating Inventory, was recently found to have two factors: internal disinhibition (eating in response to cognitive and emotional cues) and external disinhibition (eating in response to environmental cues). This study examined whether early changes in disinhibition that occurred during a weight loss program predicted later weight loss maintenance. Participants were adults enrolled in a weight loss treatment study (n = 81, 16% men, BMI = 38.4 ± 6.5 kg/m²). Two‐thirds of participants were African Americans. Participants received a uniform, meal‐replacement‐based weight loss program in months 1–3 and one of four nutritionally focused programs for weight loss maintenance in months 4–12. Disinhibition and weight were assessed at clinic visits. Change in internal disinhibition from months 1–3 (i.e., the weight loss period) significantly predicted change in weight from month 4 to 12 (i.e., the weight maintenance period); this remained significant when treatment group, age, gender, ethnicity, baseline weight, baseline depression, baseline internal disinhibition, and initial weight loss were controlled for (P = 0.03). A comparable analysis examining change in external disinhibition found that it was not a significant predictor of weight maintenance (P = 0.43). Participants who experienced the biggest decreases in internal disinhibition during the initial phase of treatment had the most success maintaining their weight loss in the next phase of treatment. Long‐term weight loss outcomes may be improved by spending sufficient treatment time teaching strategies for reducing eating in response to internal cues.     

Maintenance of weight loss in overweight middle-aged women through the Internet

Objective: The purpose of this study was to compare weight regain in a group of perimenopausal women (48.0 ± 4.4 years old), randomized to a 12‐month weight maintenance Internet intervention or to self‐directed weight maintenance after a 4‐month weight loss treatment. Methods and Procedures: After a 4‐month behavioral weight loss program, 135 women were randomized to either Internet or self‐directed groups. The Internet group (n = 66) used a website to gain information and complete logs concerning their weight, diet, and exercise progress over a 12‐month follow‐up. The 69 self‐directed women had no contact with study staff. All women were measured for weight and body composition, and diet intake, and were interviewed using the 7‐day physical activity questionnaires at baseline, 4 months, and 16 months. Results: At the end of the 12‐month follow‐up, the Internet and self‐directed groups had regained on average 0.4 ± 5.0 kg and 0.6 ± 4.0 kg, respectively (P = 0.5). In within‐group analyses, Internet diet‐log entries were correlated with follow‐up weight change (r = ?0.29; P < 0.05) and moderately with change in exercise energy expenditure (EEE; r = 0.44; P < 0.01). Follow‐up weight change was not correlated with change in dietary intake. Discussion: While significant weight loss was maintained over follow‐up by both groups of women, Internet use did not surpass self‐direction in helping to sustain weight loss. Among Internet users, Internet use was related to weight change and EEE.     

Weight Loss Expectations in Obese Patients Seeking Treatment at Medical Centers

Objective: To investigate weight loss expectations (expected 1‐year BMI loss, dream BMI, and maximum acceptable BMI) in obese patients seeking treatment and to examine whether expectations differ by sex, weight, diet and weight history, age, psychological factors, and primary motivations for weight loss. Research Methods and Procedures: 1891 obese patients seeking treatment in 25 Italian medical centers (1473 women; age, 44.7 ± 11.0 years; BMI, 38.2 ± 6.5 kg/m²) were evaluated. Diet and weight history, weight loss expectations, and primary motivation for seeking treatment (health or improving appearance) were systematically recorded. Psychiatric distress, binge eating, and body image dissatisfaction were tested by self‐administered questionnaires (Symptom CheckList‐90, Binge Eating Scale, and Body Uneasiness Test). Results: In 1011 cases (53.4%), 1‐year expected BMI loss was ≥9 kg/m², dream BMI was 26.0 ± 3.4 kg/m² (corresponding to a 32% loss), and maximum acceptable BMI was 29.3 ± 4.4 kg/m² (?23%). BMI and age were the strongest predictors of weight goals. Weight loss necessary to reach the desired targets was largely in excess of weight loss observed during previous dieting. Psychiatric distress, body dissatisfaction, and binge eating did not predict weight loss expectations. The primary motivation for weight loss was concern for future or present health; women seeking treatment to improve appearance had a lower grade of obesity, were younger, and had first attempted weight loss at a younger age. Discussion: Obese Italian patients had unrealistic weight loss expectations. There were significant disparities between patients’ perceptions and physicians’ weight loss recommendations of desirable treatment outcome.     

Cognitive Change in Obese Adolescents Losing Weight

Objectives: To investigate how obese adolescents think about themselves in terms of exercise, eating, and appearance and whether these cognitions change over the course of a residential weight loss camp. Research Methods and Procedures: Obese adolescents [N = 61; age, 14.1 (±0.2) years; BMI, 33.9 (±0.7) kg/m²] completed assessments of body weight and height and self‐esteem and a sentence‐completion test eliciting thoughts and beliefs about exercise, eating, and appearance at the start and end of the camp (mean stay, 26 days). They were compared with a single assessment of 20 normal‐weight adolescents [age, 15.4 (±0.2) years; BMI, 21.8 (±0.5) kg/m²]. Results: The obese adolescents lost 5.7 kg and reduced their BMI SD score by 0.25. Camp residence was associated with a significant reduction in the number of negative automatic thoughts and an increase in positive thoughts, especially related to exercise and appearance. There was no change in conditional beliefs, either functional or dysfunctional. Including BMI SD score change as a covariate took away all the main and interaction effects of time, showing that cognitive change was largely accounted for by the reduction in weight. Despite this improvement, campers remained cognitively more negative and dysfunctional than the normal‐weight comparison adolescents. Discussion: Obese adolescents not only lost weight, but they improved their self‐representation, specifically in terms of automatic thoughts about exercise and appearance. Although these are short‐term cognitive changes, they reflect positively on the camp experience and show the value of psychological improvement in assessing obesity‐treatment outcomes.     

Long‐term Successful Weight Loss Improves Vascular Endothelial Function in Severely Obese Individuals

Obesity is associated with increased cardiovascular risk. Although short‐term weight loss improves vascular endothelial function, longer term outcomes have not been widely investigated. We examined brachial artery endothelium‐dependent vasodilation and metabolic parameters in 29 severely obese subjects who lost ≥10% body weight (age 45 ± 13 years; BMI 48 ± 9 kg/m²) at baseline and after 12 months of dietary and/or surgical intervention. We compared these parameters to 14 obese individuals (age 49 ± 11 years; BMI 39 ± 7 kg/m²) who failed to lose weight. For the entire group, mean brachial artery flow‐mediated dilation (FMD) was impaired at 6.7 ± 4.1%. Following sustained weight loss, FMD increased significantly from 6.8 ± 4.2 to 10.0 ± 4.7%, but remained blunted in patients without weight decline from 6.5 ± 4.0 to 5.7 ± 4.1%, P = 0.013 by ANOVA. Endothelium‐independent, nitroglycerin‐mediated dilation (NMD) was unaltered. BMI fell by 13 ± 7 kg/m² following successful weight intervention and was associated with reduced total and low‐density lipoprotein cholesterol, glucose, hemoglobin A_1c, and high‐sensitivity C‐reactive protein (CRP). Vascular improvement correlated most strongly with glucose levels (r = ?0.51, P = 0.002) and was independent of weight change. In this cohort of severely obese subjects, sustained weight loss at 1 year improved vascular function and metabolic parameters. The findings suggest that reversal of endothelial dysfunction and restoration of arterial homeostasis could potentially reduce cardiovascular risk. The results also demonstrate that metabolic changes in association with weight loss are stronger determinants of vascular phenotype than degree of weight reduction.     

A Pilot Internet‐Based Behavioral Weight Loss Intervention with or without Commercially Available Portion‐Controlled Foods

Objective : To evaluate the short‐term impact of portion‐controlled food provision in combination with an Internet behavioral weight loss program on weight, blood cholesterol, and blood glucose levels. Design and Methods : Fifty participants, mean age 46 ± 10.7 years and mean body mass index 35.1 ± 3.8 kg/m², were randomized to one of two study groups, an Internet behavioral weight loss program (Internet‐alone; n = 25) or an Internet behavioral weight loss program plus a commercially available portion‐controlled diet (Internet + PCD; n = 25) for 12 weeks. Results : An intent‐to‐treat analysis found that the mean weight change in the Internet + PCD group was ?5.7 ± 5.6 kg and in the Internet‐alone group (n = 25) was ?4.1 ± 4.0 kg (P = 0.26). Participants in the Internet + PCD group achieved significantly greater improvements in blood glucose (?2.6 ± 5.7 vs. 1.4 ± 11.0 mg/dl; P = 0.05) and LDL cholesterol (?8.2 ± 18.0 vs. ?0.6 ± 21.0 mg/dl; P = 0.04), compared with Internet‐alone group. Conclusions : These data suggest that there may be short‐term clinical benefit in using a PCD in conjunction with a behavioral Internet‐based weight loss program to enhance weight loss and improve health indicators.     

Sibutramine Treatment in Obesity: Predictors of Weight Loss Including Rorschach Personality Data

Objective: To study personality and clinical factors in weight loss by sibutramine (Meridia and Reductil), an anti‐obesity drug enhancing satiety. Research Methods and Procedures: The subjects were 30 obese patients [43 ± 12 years (mean ± SD), BMI 40 ± 4 kg/m²]. The treatment comprised 15 mg of sibutramine administered daily and monthly dietary advice. Weight loss after 6 months of treatment was evaluated. For psychological assessment, the Rorschach method (Comprehensive System) and the Beck Depression Inventory were used. Results: A multiple linear regression model including the Rorschach predictors’ physical demand states (animal movement, designated as FM) being intrusive or difficult to hold and a dependency orientation (food contents) could explain 47% of 6 months of weight loss. A model including initial weight loss in addition to the Rorschach predictors explained 58% of the 6‐month weight loss. Discussion: The personality factors predicted greater weight loss. In particular, patients with difficulties concerning physical demand states, which would include hunger, could have reduced their eating behavior with enhanced satiety, resulting in greater weight loss. Enhanced satiety could also have helped patients with a dependent need for food to limit food intake. Being enrolled in a treatment program could also have provided essential support for patients with dependency needs. Furthermore, initial weight loss was a predictor of greater weight loss in sibutramine treatment, in accordance with prior research.     

Independent Evolution of Heart Autonomic Function and Insulin Sensitivity During Weight Loss

In order to investigate the improvement of insulin resistance and cardiac autonomic function along massive weight loss, 12 obese women were evaluated before, and 3 and 12 months after Roux‐en‐Y gastric bypass. The 12‐month values were compared to those of BMI‐matched controls. Insulin sensitivity was assessed by euglycemic clamp and the cardiac autonomic function by the analysis of the Heart Rate Variability (HRV). After surgery, glucose uptake progressively increased from 4.3 ± 0.5 mg/kg lean body mass (LBM)/min preoperative (pre‐op) to 4.9 ± 0.5 and 7.0 ± 0.5, 3‐ and 12‐month postoperative (post‐op) (P = 0.04 and P = 0.006 vs. pre‐op), whereas the cardiac autonomic function showed a biphasic pattern. HRV values increased 3 months post‐op, and decreased at 12 months, thus indicating an early sympathetic withdrawal followed by a later reactivation (e.g., the standard deviation of the normal‐to‐normal intervals was 116 ± 7 ms in pre‐op, 161 ± 10 at 3 months, P = 0.008 vs. pre‐op, and 146 ± 15 at 12 months, P = 0.03 vs. pre‐op and P = 0.02 vs. 3 m). Insulin sensitivity was significantly related to body weight (P = 0.02), whereas the cardiac indexes were significantly linked to the profile of energy intake (e.g., HRV triangular index vs. energy intake P = 0.003). No significant relationship linked insulin sensitivity to the cardiac autonomic indexes. Insulin sensitivity and cardiac parameters of the 12‐month post‐op patients were similar to their matched controls. During massive weight loss, the cardiac autonomic deregulation and insulin resistance improved concomitantly but independently from each other. Our results suggest that the extent of the improvement is associated with the final body weight.     

A Primary Care Intervention for Weight Loss: Results of a Randomized Controlled Pilot Study

Most primary care providers (PCPs), constrained by time and resources, cannot provide intensive behavioral counseling for obesity. This study evaluated the effect of using medical assistants (MAs) as weight loss counselors. The study was a randomized controlled trial conducted in two primary care offices at an academic medical center. Patients (n = 50) had a BMI of 27–50 kg/m² and no contraindications to weight loss. They were randomized to quarterly PCP visits and weight loss materials (Control group) or to the same approach combined with eight visits with a MA over 6 months (Brief Counseling). Outcomes included change in weight and cardiovascular risk factors (glucose, lipids, blood pressure, and waist circumference). Patients in the Brief Counseling and Control groups lost 4.4 ± 0.6 kg (5.1 ± 0.7% of initial weight) and 0.9 ± 0.6 kg (1.0 ± 0.7%), respectively, at month 6 (P < 0.001). There were no significant differences between groups for changes in cardiovascular risk factors. Brief Counseling patients regained weight between month 6 and month 12, when MA visits were discontinued. Attrition was 10% after 6 months and 6% after 12 months. Brief Counseling by MAs induced significant weight loss during 6 months. Office‐based obesity treatment should be tested in larger trials and should include weight loss maintenance counseling.     

The Effect of Electronic Self‐Monitoring on Weight Loss and Dietary Intake: A Randomized Behavioral Weight Loss Trial

Technology may improve self‐monitoring adherence and dietary changes in weight loss treatment. Our study aimed to investigate whether using a personal digital assistant (PDA) with dietary and exercise software, with and without a feedback message, compared to using a paper diary/record (PR), results in greater weight loss and improved self‐monitoring adherence. Healthy adults (N = 210) with a mean BMI of 34.01 kg/m² were randomized to one of three self‐monitoring approaches: PR (n = 72), PDA with self‐monitoring software (n = 68), or PDA with self‐monitoring software and daily feedback messages (PDA+FB, n = 70). All participants received standard behavioral treatment. Self‐monitoring adherence and change in body weight, waist circumference, and diet were assessed at 6 months; retention was 91%. All participants had a significant weight loss (P < 0.01) but weight loss did not differ among groups. A higher proportion of PDA+FB participants (63%) achieved ≥5% weight loss in comparison to the PR group (46%) (P < 0.05) and PDA group (49%) (P = 0.09). Median percent self‐monitoring adherence over the 6 months was higher in the PDA groups (PDA 80%; PDA+FB 90%) than in the PR group (55%) (P < 0.01). Waist circumference decreased more in the PDA groups than the PR group (P = 0.02). Similarly, the PDA groups reduced energy and saturated fat intake more than the PR group (P < 0.05). Self‐monitoring adherence was greater in the PDA groups with the greatest weight change observed in the PDA+FB group.     

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.     

Regular Aerobic Exercise,Without Weight Loss,Improves Endothelium‐dependent Vasodilation in Overweight and Obese Adults

Lifestyle modification in the form of weight reduction by caloric restriction alone or in combination with regular aerobic exercise significantly improves endothelium‐dependent vasodilation in overweight and obese adults. We determined whether regular aerobic exercise, independent of weight loss, improves endothelium‐dependent vasodilation in overweight and obese adults. Twenty overweight and obese adults (age 53 ± 1 years; BMI: 30.2 ± 0.8 kg/m²) were studied before and after a 3‐month aerobic exercise training intervention. Forearm blood flow (FBF) responses were determined (via plethysmography) in response to intra‐arterial infusion of acetylcholine and sodium nitroprusside. There were no changes in body mass or composition with the intervention. FBF responses to acetylcholine were ～35% higher (P < 0.01) after (4.1 ± 0.9 to 14.7 ± 4.3 ml/100 ml tissue/min) compared with before (4.2 ± 0.8 to 11.0 ± 3 ml/100 ml tissue/min) exercise training. FBF responses to sodium nitroprusside were unchanged. These results indicate that regular aerobic exercise improves endothelium‐dependent vasodilation in overweight and obese adults, independent of changes in body mass or composition.     

The Effects of Consuming Frequent,Higher Protein Meals on Appetite and Satiety During Weight Loss in Overweight/Obese Men

The purpose of this study was to determine the effects of dietary protein and eating frequency on perceived appetite and satiety during weight loss. A total of 27 overweight/obese men (age 47 ± 3 years; BMI 31.5 ± 0.7 kg/m²) were randomized to groups that consumed an energy‐restriction diet (i.e., 750 kcal/day below daily energy need) as either higher protein (HP, 25% of energy as protein, n = 14) or normal protein (NP, 14% of energy as protein, n = 13) for 12 weeks. Beginning on week 7, the participants consumed their respective diets as either 3 eating occasions/day (3‐EO; every 5 h) or 6 eating occasions/day (6‐EO; every 2 h), in randomized order, for 3 consecutive days. Indexes of appetite and satiety were assessed every waking hour on the third day of each pattern. Daily hunger, desire to eat, and preoccupation with thoughts of food were not different between groups. The HP group experienced greater fullness throughout the day vs. NP (511 ± 56 vs. 243 ± 54 mm · 15 h; P < 0.005). When compared to NP, the HP group experienced lower late‐night desire to eat (13 ± 4 vs. 27 ± 4 mm, P < 0.01) and preoccupation with thoughts of food (8 ± 4 vs. 21 ± 4 mm; P < 0.01). Within groups, the 3 vs. 6‐EO patterns did not influence daily hunger, fullness, desire to eat, or preoccupation with thoughts of food. The 3‐EO pattern led to greater evening and late‐night fullness vs. 6‐EO but only within the HP group (P < 0.005). Collectively, these data support the consumption of HP intake, but not greater eating frequency, for improved appetite control and satiety in overweight/obese men during energy restriction‐induced weight loss.     

Effect of orlistat on eating behavior among participants in a 3-year weight maintenance trial

Objective: To examine the effect of orlistat on dietary restraint, disinhibition, hunger, and binge eating and to understand the relation between changes in eating behavior and weight maintenance. Methods and Procedures: Subjects were 306 women and men (age: 19–45 years; BMI: 37.5 ± 4.1 kg/m²) included in the Scandinavian Multicenter study of Obese subjects with the Metabolic Syndrome, a 3‐year clinical trial of orlistat or placebo following an 8‐week very low energy diet (VLED). Outcomes were changes in weight and in the Three Factor Eating Questionnaire (TFEQ) and Binge Eating Scale (BES) between screening and 17 and 33 months after randomization. As reported previously, weight gain following VLED was lower in subjects treated with orlistat than with placebo. Results: Compared to screening results, dietary restraint was increased and disinhibition, hunger, and binge eating were decreased in both groups. These changes were similar in both groups with the exception of the hunger score at month 33 that was reduced more in the placebo than in the orlistat group (difference between groups ?1.1 (95% CI (?2.0, ?0.2)) P = 0.014). In multivariate analyses, scores for restraint, disinhibition and binge eating were associated with weight loss after adjustment for BMI, gender, age, and treatment (all P ≤ 0.002, model R ² = 0.12–0.17). Discussion: Orlistat did not affect eating behavior differently in any substantial way than the placebo did in this long‐term weight maintenance trial. The results indicate that increased restraint and decreased disinhibition and binge eating are important for sustained weight maintenance in obese subjects with the metabolic syndrome.     

Young Adults' Performance in a Low‐Intensity Weight Loss Campaign

Young adults (YA) are underrepresented in behavioral weight loss programs and achieve poorer outcomes than older adults (OA). There has been a call to develop programs specifically targeting this age group. This study examined the performance of YA enrolled in a low‐intensity, team‐based weight loss campaign and compared their outcomes to OA to determine the utility of such an approach for weight loss in this population. Shape Up Rhode Island (SURI) 2009 was a 12‐week online team‐based weight loss and exercise competition (N = 6,795, 81% female, 94% white, age = 44.7 ± 11.2, BMI = 29.4 ± 5.9). YA was defined as 18–35 years and OA as >35 years; YA and OA were compared on enrollment, retention, weight loss, and change in steps. A total of 1,562 YA enrolled and 715 completed the program. Fewer YA completed compared with OA (46 vs. 62%, P < 0.001). However, among completers, YA achieved greater percent weight loss (‐4.5 ± 4.0 vs. ?3.8 ± 3.2%) and greater daily step change (+1,578.2 ± 3,877.2 vs. +1,342.2 ± 3,645.7) than OA (P's < 0.001). Further, more YA completers achieved a ≥5% weight loss (40 vs. 29%, P < 0.001). Findings were consistent in the overweight/obese (OW/OB) subsample, and using ≤25 years of age as the cut off for YA. Weight losses among YA in this low‐intensity weight loss campaign were quite promising, with over 700 YA completing the program and on average achieving a 4.5% weight loss. Indeed, the potential public health impact of such an approach is substantial; future efforts to develop programs for this age group may benefit from using a low‐intensity, team‐based approach.     

Comparison of Methods to Assess Body Composition Changes during a Period of Weight Loss

Objective: To assess the accuracy of body composition measurements by air displacement plethysmography and bioelectrical impedance analysis (BIA) compared with DXA during weight loss. Research Methods and Procedures: Fifty‐six healthy but overweight participants, 34 women and 22 men (age, 52 ± 8.6 years; weight, 92.2 ± 11.6 kg; BMI, 33.3 ± 2.9 kg/m²) were studied in an outpatient setting before and after 6 months of weight loss (weight loss, 5.6 ± 5.5 kg). Subjects were excluded if they had initiated a new drug therapy within 30 days of randomization, were in a weight loss program, or took a weight loss drug within 90 days of randomization. Subjects were randomly assigned either to a self‐help program, consisting of two 20‐minute sessions with a nutritionist and provision of printed materials and other self‐help resources, or to attendance at meetings of a commercial program (Weight Watchers). Body composition was examined by each of the methods before and after weight loss. Results: BIA (42.4 ± 5.8%) underestimated percentage fat, whereas the BodPod (Siri = 51.7 ± 6.9%; Brozek = 48.5 ± 6.5%) overestimated percentage fat compared with DXA (46.1 ± 7.9%) before weight loss. Correlation coefficients for detecting changes in body composition between DXA and the other methods were relatively high, with Brozek Δfat mass (FM; r² = 0.63), Siri FM (r² = 0.65), tetrapolar BIA percentage fat (r² = 0.57), and Tanita FM (r² = 0.61) being the highest. Discussion: In conclusion, all of the methods were relatively accurate for assessing body composition compared with DXA, although there were biases. Furthermore, each of the methods was sensitive enough to detect changes with weight loss.     

Water Consumption Increases Weight Loss During a Hypocaloric Diet Intervention in Middle‐aged and Older Adults

Water consumption acutely reduces meal energy intake (EI) among middle‐aged and older adults. Our objectives were to determine if premeal water consumption facilitates weight loss among overweight/obese middle‐aged and older adults, and to determine if the ability of premeal water consumption to reduce meal EI is sustained after a 12‐week period of increased water consumption. Adults (n = 48; 55–75 years, BMI 25–40 kg/m²) were assigned to one of two groups: (i) hypocaloric diet + 500 ml water prior to each daily meal (water group), or (ii) hypocaloric diet alone (nonwater group). At baseline and week 12, each participant underwent two ad libitum test meals: (i) no preload (NP), and (ii) 500 ml water preload (WP). Meal EI was assessed at each test meal and body weight was assessed weekly for 12 weeks. Weight loss was ～2 kg greater in the water group than in the nonwater group, and the water group (β = ?0.87, P < 0.001) showed a 44% greater decline in weight over the 12 weeks than the nonwater group (β = ?0.60, P < 0.001). Test meal EI was lower in the WP than NP condition at baseline, but not at week 12 (baseline: WP 498 ± 25 kcal, NP 541 ± 27 kcal, P = 0.009; 12‐week: WP 480 ± 25 kcal, NP 506 ± 25 kcal, P = 0.069). Thus, when combined with a hypocaloric diet, consuming 500 ml water prior to each main meal leads to greater weight loss than a hypocaloric diet alone in middle‐aged and older adults. This may be due in part to an acute reduction in meal EI following water ingestion.     

Predictors of Long‐term Weight Maintenance

Objective: The purpose of this study was to evaluate available variables of a long‐term weight maintenance study to investigate possible factors predisposing to weight regain after a period of weight loss. Research Methods and Procedures: The Maastricht Weight Maintenance Study is an ongoing longitudinal study of healthy men and women (29 men and 62 women; 18 to 65 years of age; BMI = 30.2 ± 3.1 kg/m²). A variety of parameters were measured before and after a very‐low‐energy diet and after a follow‐up of at least 2 years. Results: Mean weight loss was 7.9 ± 3.6 kg, and percent weight regain was 113.8 ± 98.1%. Percent BMI regain was negatively associated with an increase in dietary restraint (r = ?0.47, p < 0.05). Percent weight regain was negatively correlated with baseline resting metabolic rate (r = ?0.38, p = 0.01) and baseline fat mass (r = ?0.24, p = 0.05) and positively correlated with the magnitude of change in body weight (BW) expressed as maximum amplitude of BW (r = 0.21, p < 0.05). In addition, amplitude of BW was positively correlated with the frequency of dieting (r = 0.57, p < 0.01). Discussion: The best predictors for weight maintenance after weight loss were an increase in dietary restraint during weight loss, a high baseline resting metabolic rate, a relatively high baseline fat mass favoring a fat‐free mass–sparing effect during weight loss, a rather stable BW, and a low frequency of dieting. Therefore, BW maintenance after BW loss seems to be a multifactorial issue, including mechanisms that regulate an individuals’ energy expenditure, body composition, and eating behavior in such a way that energy homeostasis is maintained.     

Weight loss on the web: A pilot study comparing a structured behavioral intervention to a commercial program

Objective: Internet weight loss programs have become widely available as alternatives to standard treatment, but few data are available on their efficacy. This study aimed to investigate the effectiveness of a structured behavioral weight loss website (VTrim) vs. a commercial weight loss website ( eDiets.com ). Research Methods and Procedures: A randomized, controlled trial was conducted from February 2003 to March 2005, in 124 overweight and obese subjects ages 18 years and older with a BMI of 25 to 39.9 kg/m² (mean age, 47 ± 9 years; BMI, 32 ± 3 kg/m²; 20% men). Analyses were performed for the 88 subjects who had complete follow‐up data. Participants were randomly assigned to 12‐month VTrim (n = 62) or eDiets.com (n = 62) intervention. VTrim participants had access to a therapist‐led structured behavioral weight loss program delivered on‐line. eDiets.com subjects had access to a self‐help commercial on‐line weight loss program. Body weight, social support, and use of website components were measured at 0, 6, and 12 months. Results: Repeated‐measures analyses showed that the VTrim group lost significantly more weight than the eDiets.com group at 6 months (8.3 ± 7.9 kg vs. 4.1 ± 6.2 kg; p = 0.004) and maintained a greater loss at 12 months (7.8 ± 7.5 kg vs. 3.4 ± 5.8 kg; p = 0.002). More participants in the VTrim group maintained a 5% weight loss goal (65% vs. 37.5%; p = 0.01) at 12 months. Discussion: An on‐line, therapist‐led structured behavioral weight loss website produced greater weight loss than a self‐help commercial website. Because commercial sites have great potential public health impact, future research should investigate the feasibility of incorporating a more structured behavioral program into a commercial application.     

Grazing and loss of control related to eating: two high-risk factors following bariatric surgery

Background: Gastric restrictive surgery induces a marked change in eating behavior. However, the relationship between preoperative and postoperative eating behavior and weight loss outcome has received limited attention. Objective: This study assessed a range of eating behaviors before and 1 year after laparoscopic adjustable gastric banding (LAGB) and explored the nature and extent of change in eating patterns, their clinical associates, and impact on weight loss. Methods and Procedures: A 12‐month observational study assessed presurgical and postsurgical binge eating disorder (BED), uncontrolled eating, night eating syndrome (NES), grazing, nutrient intake and eating‐related behaviors, and markers of psychological distress. A total of 129 subjects (26 male and 103 female, mean age 45.2 ± 11.5 and BMI 44.3 ± 6.8) participated in this study. Results: Presurgical BED, uncontrolled eating, and NES occurred in 14%, 31%, and 17.1% of subjects, which reduced after surgery to 3.1%, 22.5%, and 7.8%, respectively (P = 0.05 for all). Grazing was prevalent before (26.3%) and after surgery (38.0%). Preoperative BED most frequently became grazers (P = 0.029). The average percentage weight loss (%WL) was 20.8 ± 8.5%; range ?0.67 to 50.0% and percentage of excess weight loss (%EWL) 50.0 ± 20.7%; range ?1.44 to 106.9% (P < 0.001). Uncontrolled eating and grazing after surgery showed high overlap and were associated with poorer %WL (P = 0.008 and P < 0.001, respectively) and elevated psychological distress. Discussion: Consistent with recent studies, uncontrolled eating and grazing were identified as two high‐risk eating patterns after surgery. Clearer characterization of favorable and unfavorable postsurgical eating behaviors, reliable methods to assess their presence, and empirically tested postsurgical intervention strategies are required to optimize weight loss outcomes and facilitate psychological well‐being in at‐risk groups.