Impact of physician BMI on obesity care and beliefs

Using a national cross-sectional survey of 500 primary care physicians conducted between 9 February and 1 March 2011, the objective of this study was to assess the impact of physician BMI on obesity care, physician self-efficacy, perceptions of role-modeling weight-related health behaviors, and perceptions of patient trust in weight loss advice. We found that physicians with normal BMI were more likely to engage their obese patients in weight loss discussions as compared to overweight/obese physicians (30% vs. 18%, P = 0.010). Physicians with normal BMI had greater confidence in their ability to provide diet (53% vs. 37%, P = 0.002) and exercise counseling (56% vs. 38%, P = 0.001) to their obese patients. A higher percentage of normal BMI physicians believed that overweight/obese patients would be less likely to trust weight loss advice from overweight/obese doctors (80% vs. 69%, P = 0.02). Physicians in the normal BMI category were more likely to believe that physicians should model healthy weight-related behaviors-maintaining a healthy weight (72% vs. 56%, P = 0.002) and exercising regularly (73% vs. 57%, P = 0.001). The probability of a physician recording an obesity diagnosis (93% vs. 7%, P < 0.001) or initiating a weight loss conversation (89% vs. 11%, P ≤ 0.001) with their obese patients was higher when the physicians' perception of the patients' body weight met or exceeded their own personal body weight. These results suggest that more normal weight physicians provided recommended obesity care to their patients and felt confident doing so.     

The impact of routine advice on smoking cessation from family physicians.

Cigarette smoking continues to be a major health problem. Therefore, physicians have been asked to advise all their patients on the hazards of smoking. A controlled trial was undertaken to measure the impact of family physicians'' advice to cigarette smokers during a routine office visit. No significant differences were found in the three measures used to determine outcome--desire to stop smoking, an attempt to stop and success in stopping--between the control and intervention groups. These results are discussed in relation to the health belief model, and suggestions are made on how to increase the impact family physicians could have on smoking cessation to their practices.     

Weight‐Loss Practices and Asthma: Findings from the Behavioral Risk Factor Surveillance System

Objective: To describe weight‐control practices and receipt of weight‐loss advice among obese people with asthma. Research Methods and Procedures: We analyzed data from the 2000 Behavioral Risk Factor Surveillance System. Results: Among 13,953 participants with current asthma, 27.3% had a body mass index of ≥30 kg/m2. Overall, 48.1% of participants with asthma reported trying to lose weight (64.1% among overweight or obese participants and 72.9% among obese participants). Among participants with asthma who were trying to lose or maintain weight, 74.7% reported trying to reduce their energy and/or fat intake, and 57.8% reported using physical activity. Approximately 29.7% were using the recommended combination of energy and/or fat intake reduction and physical activity of ≥150 min/wk. During the 12 months before the interview, 16.2% of overweight and 44.9% of obese participants with asthma reported receiving advice to lose weight. Among obese participants receiving weight‐loss advice, 82.9% reported trying to lose weight compared to 63.8% of participants who did not receive such advice. Discussion: Health professionals can play an important role in educating their patients with asthma about the importance of weight control and assisting their overweight and obese patients in setting appropriate weight goals and helping them achieve those goals.     

The impact of primary care resident physician training on patient weight loss at 12 months

Objective:

It is unclear whether training physicians to counsel obese patients leads to weight loss. This study assessed whether a 5‐h multimodal longitudinal obesity curriculum for residents on the basis of the 5As (assess, advise, agree, assist, and arrange) was associated with weight loss in their obese patients.

Design and Methods:

Twenty‐three primary care internal medicine residents were assigned by rotation schedule to intervention (curriculum) or control groups. We then conducted follow‐up chart reviews to determine weight change at up to 12 months following the index visit. 158 obese patients (76 in the intervention group and 82 in the control group) completed exit interviews; 22 patients who presented for acute care at the index visit were excluded. Chart reviews were conducted on the 46 patients in the intervention group and 41 patients in the control group who were seen again within 12 months of the index visit and had follow‐up weight measurements.

Results:

The main outcome of interest was mean change in weight at 12 months compared between the intervention and control groups. Patients of residents in the intervention group had a mean weight loss of ?1.53 kg (s.d. = 3.72) although the patients of those in the control group had a mean weight gain of 0.30 kg (s.d. = 3.60), P = 0.03. Six (15.8%) patients in the intervention group and 2 (5.4%) patients in the control group lost >5% body weight (P = 0.14).

Conclusions:

Although the magnitude of weight loss was small, this study shows that training physicians to counsel patients can produce measurable patient outcomes.

     

Management of Obesity in Primary Care

SIMKIN-SILVERMAN, LAUREY R, RENA R WING. Management of obesity in primary care. Obesity is one of the most common presenting chronic medical conditions in primary care, yet it is not adequately treated. Physicians are often reluctant to counsel patients because of their limited training in treating chronic weight problems and negative attitudes toward obese patients. This study evaluated the feasibility of training physicians to provide weight control counseling to their patients. Eleven physicians were randomly assigned to either an obesity-counseling skills training group or to a control group. Physicians in the counseling skills group received training in behavioral and motivational weight control techniques using a five-step patient-centered model; they were also given patient materials for use in their practice. To evaluate pretraining to posttraining changes in physician counseling behavior, independent samples of patients with obesity were surveyed immediately after their visit to the physician's office. Physicians in both the counseling skills training and the control groups discussed weight with 42% to 47% of their patients at baseline. This increased to 89% in physicians who received training, whereas it remained at 42% in control physicians. Scores on a counseling measure also significantly increased from a mean of 2. 7 to 9. 9 in the counseling group, whereas scores in the control group remained low and stable (2. 3 and 1. 9, respectively). The training program was effective in improving the frequency and quality of counseling that physicians delivered to their patients with obesity. Future research is needed to evaluate the effect of physician counseling on the weight and physical activity level of their patients.     

Impact of changes in relationship status on smoking behavior and body weight

This paper examines whether and how changes in relationship status (i.e., cohabitation, marriage, separation, or divorce) affect individuals’ smoking behavior and body weight. Using German Socio-Economic Panel data, this study accounts for differences between treated (i.e., those affected by a specific family event) and untreated participants since treatment and control groups differ with respect to several characteristics such as age, which may bias the results. Therefore, regression-adjusted matching is employed for each family event separately. This study, thus, takes steps towards disentangling causality from correlation. Overall, changes in family composition (such as moving together with or separating from the partner) impact the probability to start or quit smoking and lead to changes in body weight. In particular, smoking behavior and body weight are predominantly affected by forming or dissolving a household, rather than by marriage or divorce: cohabitation leads to weight gain; separation from a partner leads to weight loss, increased smoking initiation, and decreased smoking cessation.     

Geographic Variation in the Prevalence of Obesity,Diabetes, and Obesity‐Related Behaviors**

Objective: To examine the variation in the prevalences of obesity and type 2 diabetes in weight loss counseling by health providers and in other potential obesity‐related determinants in 100 metropolitan statistical areas in the United States. Research Methods and Procedures: We performed a cross‐sectional study using data from the 2000 Behavioral Risk Factor Surveillance System, the largest telephone survey of health behaviors in the United States, of age‐adjusted prevalence of obesity, type 2 diabetes, intake of ≥five servings of fruits and vegetables per day, participation in 150 minutes of leisure‐time physical activity per week, receipt of weight management advice, and reports of trying to lose or maintain weight among men and women more than 18 years old. Results: The age‐adjusted prevalence of obesity ranged from 13.1% to 30.0% and that of type 2 diabetes from 3.3% to 9.2%. Among participants who had visited a physician for a routine checkup in the previous 12 months, 13.1% to 27.1% of all participants recalled receiving advice from a health professional about their weight, and 11.7% to 34.6% of overweight or obese participants recalled receiving advice to maintain or lose weight. Discussion: Significant differences in the prevalence of obesity and self‐reported type 2 diabetes and in medical practice patterns regarding weight management advice exist among metropolitan statistical areas. These results suggest important opportunities to investigate reasons for these variations that could potentially be used to mitigate the current epidemic of obesity and to identify areas where obesity and diabetes prevention efforts may need to be targeted.     

Avian seed preference and weight loss experiments: the effect of fungal endophyte-infected tall fescue seeds

Summary The impact of endophytic fungus-infected seeds on seed predators is poorly understood. In this multiple trophic level investigation, seed preference experiments were conducted to determine whether five species of passerines (dark-eyed juncos, Junco hyemalis; American tree sparrows, Spizella arborea; song sparrows, Melospiza melodia; chipping sparrows, Spizella pusilla; and house sparrows, Passer domesticus) recognize and preferentially consume noninfected (NI) over infected (I) seeds of tall fescue (Festuca arundinacea). We predicted that the birds would refrain from eating I seeds because those seeds contain high concentrations of fungal alkaloids. When given a choice of NI fescue seeds and control seeds (millet), all bird species showed a significant preference for millet. However, individuals of all species consumed some NI seeds. When given a choice of NI and I fescue seeds, all species except the chippig sparrow ate significatly more NI than I fescue seed and the chipping sparrow showed the same trend. Thus, birds were able to distinguish between the two seed types and preferred NI seeds in choice tests. Additional experiments investigated weight changes in dark-eyed juncos fed diets containing different proportions of millet, NI, and I fescue seed. Significant differences in weight loss were observed for the various diets. Juncos showed greater weight loss when the proportion of fescue seed, especially the proportion of I seed, in their diet was greater. The potential significance of the finding that abundant grass seeds are made unavailable to predators by fungal infection is discussed in relation to foraging and competition in avian communities.     

Impact of bariatric surgery on type 2 diabetes

The management and prevention of diabetes through lifestyle modifications and weight loss should be the mainstay of therapy in appropriate candidates. Although the results from the Diabetes Prevention Trial and the Finnish Prevention Study support this approach, over 95% of patients not participating in a prevention research study are unable to achieve and maintain any significant weight loss over time. Bariatric surgery for weight loss is an emerging option for more sustainable weight loss in the severely obese subject, especially when obesity is complicated by diabetes or other co-morbidities. The two most common types of procedures currently used in the United States are adjustable gastric bands and Roux-en-Y gastric bypass. These procedures can be performed laparoscopically, further reducing the perioperative morbidity and mortality associated with the surgery. While the gastric bypass procedure usually results is greater sustained weight loss (40–50%) than adjustable gastric banding (20–30%), it also carries greater morbidity and nutritional/metabolic issues, such as deficiencies in iron, B12, calcium, and vitamin D. Following bariatric surgery most subjects experience improvements in diabetes control, hypertension, dyslipidemia, and other obesity-related conditions. In patients with impaired glucose tolerance most studies report 99–100% prevention of progression to diabetes, while in subjects with diabetes prior to surgery, resolution of the disease is reported in 64–93% of the cases. While improvements in insulin resistance and beta-cell function are related to surgically induced weight loss, the rapid post-operative improvement in glycemia is possibly due to a combination of decreased nutrient intake and changes in gut hormones as a result of the bypassed intestine. Post-prandial hyperinsulinemic hypoglycemia associated with nesidioblastosis has been described in a series of patients following gastric bypass surgery, and may be related to the described changes in GLP-1 and other gut hormones.     

Detection of risk factors that influence weight loss in patients undergoing radiotherapy

AimTo identify risk factors that influence weight loss in patients receiving radiotherapy.BackgroundIt is a well-known fact that cancer patients can be affected by malnutrition at the onset of the disease and during treatment due to the toxicity. Pretreatment weight loss alone does not predict those who will need nutritional supplementation. Instead, a variety of nutritional and tumor related factors needs to be taken into account.Material and methodsA retrospective study was conducted on 129 patients with different tumor locations. Weight loss was evaluated during radiotherapy and one month after treatment. The impact of age, ECOG, chemotherapy, pretreatment weight loss, tumor location, previous surgery and TNM were analyzed. We aimed to identify a high-risk group of patients before starting treatment.ResultsThe average net weight loss during radiotherapy and one month after treatment for this group of patients was 0.68 kg and 1.6 kg, respectively. Median weight loss during radiotherapy was 2.6 kg for head and neck (HN) patients and 0.27  kg for other tumor sites (p = 0.028). Median weight loss one month after radiotherapy was 3.7 kg for HN patients and 1.1 kg for the rest of the patients (p = 0.034). The median weight loss one month after treatment was 3.2 kg for patients receiving chemotherapy and 0.5 kg for those patients who did not receive chemotherapy (p < 0.001). A regression analysis determined that HN tumor location and the use of chemotherapy were independent risk factors.ConclusionsNutritional status must be monitored and managed before, during and after treatment. A variety of nutritional and tumor-related factors must be considered. According to our results, head and neck tumors and the use of chemotherapy are the only two factors considered statistically significant. Because patients continue to lose weight after treatment, we recommend close surveillance after radiotherapy.     

圈养大熊猫幼仔的早期体重变化

The mortality rates of captive giant panda cubs at 0 and 1 year old was 12.89% and 18.37% respectively,in order to improve survival rate and the nursing level of captive giant panda cubs,145 cubs born in 2000-2017 at the Chengdu Research Base of Giant Panda Breeding were analyzed by grouping primarily body weight(W₀<100,100 ≤ W₀<150,150 ≤ W₀<200,W₀ ≥ 200) and gender.The results indicated that(1) the weight curves of giant panda cubs with different primarily body weights during 180d were cubic functions.(2) Gender and primarily body weight of giant panda cubs had no interaction with the weight and average growth rate during 180 d.Gender did not affect the weight and their average growth rate of cubs,but the primarily body weight had a significant impact on the weight during 98 d and the average growth rate at the ascent stage(3-6 d),high-level stage(7-13 d),decline stage(14-45 d) and stabilization stage(46-180 d). The tokinaga of physiological weight loss was(1.77±0.67) d,and the day-age which weight recovered to primarily body weight was(4.59±1.23) d.(3) The primarily body weight and gender of giant panda cubs had no interaction on the maximum weight loss,the rate of maximum weight loss,the day-age of recovery to primarily body weight,the maximum growth rate and the day-age of maximum growth rate,but affected the day of maximum weight loss together.(4) Although the primarily body weight of giant panda cubs had a significant effect on the maximum weight loss,the day of maximum weight loss,the day-age of recovery to primarily body weight,and the maximum growth rate,it did not affect the rate of maximum weight loss and the day-age of maximum growth rate.Gender of giant panda cubs did not affect the maximum weight loss,the day-age of recovery to primarily body weight,the rate of maximum weight loss,the maximum growth rate and the day-age of maximum growth rate,but it did affect the day-age of maximum weight loss.These results indicated that the lower primarily body weight was,the less weight loss(maximum weight loss) would be,the faster speed with bottoming(the day of maximum weight loss) and recovery to primarily body weight(the day-age of recovery to primarily body weight) would be at early age.In addition,the lower primarily body weight was,the greater growth intensity of unit weight would be during the various stages at increasing growth rate,maintaining a high position,decreasing and tending to stabilize.The study revealed the characteristics of captive giant panda cubs in body weight at early age,and it provided abundant references for the early rearing of giant panda cubs.     

Genetic modulation of the serotonergic pathway: influence on weight reduction and weight maintenance

The serotonergic pathway plays a major role in the development of obesity. Its activity can be modulated by the 5-HT transporter–linked polymorphic region in the SLC6A4 gene and the upstream variable number of tandem repeats polymorphism in the MAOA gene. We studied whether these genetic modulations have an influence on weight reduction and weight maintenance in a one-year weight reduction program (OPTIFAST^®52). The polymorphisms were genotyped by PCR in a sample of 135 female and 67 male subjects with severe obesity (44 ± 13 years, 122.3 ± 22.2 kg, BMI: 41.7 ± 6.7 kg/m²). The program leads to a total weight loss of 19.9 ± 9.8 kg (16.9 ± 8.3 %) in women and 27.4 ± 13.6 kg (20.4 ± 9.9 %) in men. Anthropometric measurements and blood levels were determined at the start of the program (T0), after the weight reduction phase (T1) and after the subsequent weight maintenance phase at the end of the program (T2). Each polymorphism alone did not significantly influence weight loss or weight maintenance neither in men nor in women. However, women carrying both risk genotypes (SS and 3/3) displayed a lower total weight loss during the program (p = 0.05). This effect derived mainly from difficulties in the weight maintenance phase (p = 0.11), while the weight reduction phase was not affected (p = 0.61). No influence was found in men (p = 0.93). Modulation of the serotonergic pathway by carrying both risk alleles seems to influence success of weight loss programs in women with severe obesity due to problems in stabilizing body weight after weight reduction.     

Baseline Predictors of Success When Comparing Two Treatments

Since few medications are equally effective in all patients, physicians can maximize the risk/benefit ratio of therapy for their patients by limiting exposure based on baseline predictors of success. Traditional procedures typically evaluate the response of patients receiving the same treatment regimen without evaluating a comparator. However, when treatments are compared, such as in clinical trials, traditional procedures of identifying predictors must be modified to analyze the treatment effect on the primary outcome variable. We focus on clinical and statistical considerations that arise when developing baseline predictors through models which consider treatment differences. To illustrate an application of this method, we used data from 1,026 patients completing at least 6 months of double-blind therapy in clinical trials comparing fluoxetine (N=522) with placebo (N=504) for weight loss. Stepwise regression procedures were used to identify baseline variables which were predictive of a beneficial fluoxetine treatment effect on last-visit-carried-forward (LVCF) weight change. In this example, age, smoking activity, and uric acid concentration were the best baseline predictors of long-term treatment effect relative to LVCF weight change. Patients were more likely to achieve long-term benefit with fluoxetine if they were older, and/or were nonsmokers, and/or had high concentrations of uric acid at baseline. These predictors, developed through models keying on treatment effect, can be used to identify patients who are more likely to accrue benefits with active therapy beyond those expected with placebo therapy, thus enriching the treatment population so that a higher proportion of treated patients are successful.     

Enzyme replacement therapy for Mucopolysaccharidosis Type I among patients followed within the MPS Brazil Network

Mucopolysaccharidosis type I (MPS I) is a rare lysosomal disorder caused by deficiency of alpha-L-iduronidase. Few clinical trials have assessed the effect of enzyme replacement therapy (ERT) for this condition. We conducted an exploratory, open-label, non-randomized, multicenter cohort study of patients with MPS I. Data were collected from questionnaires completed by attending physicians at the time of diagnosis (T1; n = 34) and at a median time of 2.5 years later (T2; n = 24/34). The 24 patients for whom data were available at T2 were allocated into groups: A, no ERT (9 patients; median age at T1 = 36 months; 6 with severe phenotype); B, on ERT (15 patients; median age at T1 = 33 months; 4 with severe phenotype). For all variables in which there was no between-group difference at baseline, a delta of ≥ ± 20% was considered clinically relevant. The following clinically relevant differences were identified in group B in T2: lower rates of mortality and reported hospitalization for respiratory infection; lower frequency of hepatosplenomegaly; increased reported rates of obstructive sleep apnea syndrome and hearing loss; and stabilization of gibbus deformity. These changes could be due to the effect of ERT or of other therapies which have also been found more frequently in group B. Our findings suggest MPS I patients on ERT also receive a better overall care. ERT may have a positive effect on respiratory morbidity and overall mortality in patients with MPS I. Additional studies focusing on these outcomes and on other therapies should be performed.     

Lifestyle interventions in the management of hypertension: a survey based on the opinion of 105 practitioners

Background Lifestyle interventions in the management of hypertension were beneficial in published studies. ObjectiveTo evaluate (1) which lifestyle recommendations are given by physicians and to what extent the possibility of drug-induced hypertension is addressed; (2) to study the characteristics of the physicians who more often perform lifestyle interventions. MethodsGeneral practitioners in the area of Dordrecht were asked whether or not they included lifestyle advice in the management of their patients' hypertension. ResultsOf the 176 physicians invited, 105 consented to take part. Measures to reduce body weight, stopping smoking, and physical exercise advice were given by 94, 92, and 92% of the physicians, respectively. Advice on psychological relaxation and reducing liquorice (Dutch: drop) intake was only given by 23 and 32%. Rural physicians were more active: they more often recommended quitting smoking (p<0.02), reducing weight (p<0.02), and participating in sporting activities (p<0.02). And so were older physicians: they more often recommended starting low-calorie diets (p<0.05), stopping liquorice consumption (p<0.04) and emphasised drug compliance (p<0.02). Increased blood pressure as a side effect of concomitant medications, other than nonsteroidal anti-inflammatory drugs and oral contraceptives, was virtually never addressed. Conclusions(1) Advice to reduce body weight, stop smoking, and increase physical exercise are the only lifestyle recommendations routinely given, (2) rural physicians and older physicians were more active in giving non-drug treatments, (3) increased blood pressure as a side effect of medications was virtually never addressed. (Neth Heart J 2009;17:9-12.)     

Taking the devil into your mouth: ritualized American weight-loss narratives of morality, pain, and betrayal

Abstract:This article examines narratives of the U.S. Christian weight-loss movement alongside secular U.S. weight-loss narratives and explores how these two movements express similar themes. In particular, I investigate shared themes of sin, the impurity of the body, the body as a temple for the self (a temple that can be defiled), salvation, and the need to prove that one is saved or at least trying to be saved. Through examining stories from individuals who have lost weight and popular dieting advice, I explore how a "spiritual hunger" that is essentially unrelated to physiology but that suggests personal pathology and responsibility is central to mainstream stories of weight loss.     

Carryover and the two-period crossover clinical trial

The use of the two-period crossover trial for comparing two noncurative treatments in patients with a chronic disease is appealing since it eliminates the between-subject variability. However, the possibility of the existence of carryover effect leads many authors to advise that a parallel design be used whenever carryover is suspected. We examine this advice and quantify the degree of carryover required to make the parallel design preferable in terms of the power of the test of treatment effect and precision of the estimate of treatment difference. We conclude that in many situations this amount of carryover is substantial and unlikely to exist.     

Role of the physician in screening for carriers of Tay-Sachs disease.

A screening test for carriers of Tay-Sachs disease has been available in Toronto for more than 6 years. In that time more than 11 000 Jewish residents have been tested. Most had requested testing after hearing about the screening program from friends or the media; few had been advised by their physicians to be tested. To sample the attitudes of physicians in Toronto towards carrier screening, we studied questionnaire responses of 42 physicians whose practices were composed largely of Jewish patients. Only 31% regularly advised their young adult Jewish patients to have a carrier screening test but 76% said they had patients who asked if they should be tested. Of the 14 (33%) who had had one or more patients with Tay-Sachs disease 6 did not advise carrier testing. There was a positive correlation between specialty training and support for the screening program. Methods for increasing physician advocacy of these programs are discussed.     

Diabetes Disease Stage Predicts Weight Loss Outcomes with Long‐Term Appetite Suppressants

Objectives: Characterize degree of weight loss with stage of diabetes and describe its effect on cardiovascular disease risk factors in obese patients with and without diabetes. Research Methods and Procedures: Retrospective cohort analysis from patients participating in a long‐term weight management protocol using diet, exercise, behavioral modification, and appetite‐suppressant therapy. Patient groups, with (n = 19) and without diabetes (n = 19) were matched for age, gender, and weight before weight loss therapy. The effect of 12 months of therapy on weight, blood pressure, glycemic control, lipid profile, and medication requirements were tested. Additionally, patients were grouped or staged based upon therapy required for control of diabetes at the beginning of weight loss intervention. Analysis of covariance described relationships between diabetes disease stage and weight loss at 12 months. Results: Nondiabetic patients had greater mean reduction in BMI than the diabetic group (7.98 kg/m² vs. 4.77 kg/m², p < 0.01). A significant linear trend (p < 0.001) for decreasing weight loss with stage of diabetes was observed. Blood pressure, lipid profile, and glycemia improved significantly. The average daily glyburide‐equivalent dose decreased from 9.4 to 3.0 mg (p < 0.01). Discussion: Patients with diabetes lost less weight than similarly obese patients without diabetes. Regardless of differential weight loss between groups, cardiovascular disease risk factors improved. Hypoglycemic medication requirements decreased with weight loss therapy. A predictive relationship may exist between diabetes disease stage before weight loss therapy and future weight loss potential.     

Aerobic exercise training conserves insulin sensitivity for 1 yr following weight loss in overweight women

The objectives of this study were to 1) identify the independent effects of exercise (aerobic or resistance training) and weight loss on whole body insulin sensitivity and 2) determine if aerobic or resistance training would be more successful for maintaining improved whole body insulin sensitivity 1 yr following weight loss. Subjects were 97 healthy, premenopausal women, body mass index (BMI) 27-30 kg/m(2). Following randomized assignment to one of three groups, diet only, diet + aerobic, or diet + resistance training until a BMI <25 kg/m(2) was achieved, body composition, fat distribution, and whole body insulin sensitivity were determined at baseline, in the weight reduced state, and at 1-yr follow up. The whole body insulin sensitivity index (S(I)) was determined using a frequently sampled intravenous glucose tolerance test. Results of repeated-measures ANOVA indicated a significant improvement in S(I) following weight loss. However, there were no group or group×time interactions. At 1-yr follow up, there were no significant time or group interactions for S(I;) however, there was a significant group×time interaction for S(I). Post hoc analysis revealed that women in the aerobic training group showed a significant increased S(I) from weight reduced to 1-yr follow up (P < 0.05), which was independent of intra-abdominal adipose tissue and %fat. No significant differences in S(I) from weight reduced to 1-yr follow up were observed for diet only or diet + resistance groups. Additionally, multiple linear regression analysis revealed that change in whole body insulin sensitivity from baseline to 1-yr follow up was independently associated with the change in Vo(2max) from baseline to 1-yr follow up (P < 0.05). These results suggest that long-term aerobic exercise training may conserve improvements in S(I) following weight loss and that maintaining cardiovascular fitness following weight loss may be important for maintaining improvements in S(I).