Predictors of Attrition in a Large Clinic‐Based Weight‐Loss Program

Objective: Identifying client factors that predict dropout is critical for the development of effective weight‐loss programs. Although demographic predictors are studied, there are few consistent findings. The purpose of this study was to identify predictors of dropout in a large clinic‐based weight‐loss program using readily attainable demographic variables. Research Methods and Procedures: All 866 weight‐loss patients in a clinic‐based weight‐loss program enrolled during 1998 to 1999 were followed. Attrition and retention rates were measured at 8 and 16 weeks. Six variables (sex, race, marital status, age, BMI, and treatment protocol) were evaluated using bivariate and multivariable statistics for relative association with dropout. Results: The overall attrition rate for the 16‐week program was 31%. The retention rate was 69%. Significant risk for dropout, measured as bivariate relative risk (95% confidence interval), was found among patients who were: females, 1.32 (1.01 to 1.73); divorced, 1.54 (1.13 to 2.09); African Americans, 1.68 (1.26 to 2.23); age < 40, 1.66 (1.27 to 2.18); and ages 40 to 50, 1.33 (1.01 to 1.76). There were no significant differences in retention rates by BMI group or program protocol. After logistic regression analysis to control for all variables, young age < 50 years had the only significant association with dropout [odds ratio = 1.39 (1.02 to 1.90)]. Discussion: Multivariable modeling was helpful for prioritizing risk factors for program dropout. These findings have important implications for improving weight‐loss program effectiveness and reducing attrition. By knowing the groups at risk for dropout, we can improve or target program treatments to these populations.     

Men Gain Additional Psychological Benefits by Adding Exercise to a Weight‐Loss Program

Objective: Adding exercise to a comprehensive weight‐loss program might not only attenuate any psychological distress associated with weight‐loss attempts but also may provide psychological benefits. This study examined whether a diet‐plus‐exercise weight‐loss program improved psychological outcomes more than a diet‐only weight‐loss program or an assessment‐only control group. Research Methods and Procedures: This study was part of a larger 1‐year randomized weight‐loss trial examining the effects of diet and exercise on cardiovascular disease risk factors in 264 overweight adults. Psychological measures specific to weight control (e.g., cognitive restraint, disinhibition, hunger, and body dissatisfaction) as well as traditional measures of psychological distress (e.g., symptoms of depression, anxiety, and stress) were obtained at baseline and 1 year. Results: Men and women in either weight‐loss program reported greater restraint, less disinhibition, and less hunger at 1 year than those in no program. Men in the diet‐plus‐exercise program experienced additional increases in restraint and decreases in hunger than did men in the diet‐only program. Women in the diet‐plus‐exercise program did not experience additional psychological benefits specific to weight control than those in the diet‐only program, despite increases in aerobic capacity. Discussion: The pattern seen for overweight men in the diet‐plus‐exercise program at 1 year—greater restraint, less disinhibition, and less hunger—is similar to the pattern seen in successful weight maintainers. These results underscore the need for innovative strategies that will enhance and sustain the pattern of psychological benefits specific to weight control associated with successful weight loss, especially for overweight women.     

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.     

Vegetarian and Weight‐Loss Diets among Young Adults

Objective: Young adults frequently experiment with vegetarian and weight‐loss diets. Comparisons of their experiences on these two different diets may help in the development of approaches to improve long‐term adherence to weight‐loss regimens. In the current study vegetarian and weight‐loss diets were compared on how long and how strictly they were followed, and reasons why they were initiated and discontinued. Research Methods and Procedures: From 428 college students surveyed, four groups were delineated: 1) 59 participants had been following a vegetarian diet but not a weight‐loss diet (Vegetarian), 2) 117 participants had tried a weight‐loss diet but not a vegetarian diet (Weight Loss), 3) 133 participants had followed both a vegetarian and a weight‐loss diet (Both), and 4) 119 participants had not tried either diet (Neither). Results: Differences were examined by comparing the Vegetarian and Weight‐Loss groups as well as by comparing the two diets within the Both group. Duration of the vegetarian diet was much greater than the weight‐loss diet; most participants in the Vegetarian group (62%) remained on their diet for more than 1 year, whereas the majority of the Weight‐Loss participants (61%) followed their diet for 1 to 3 months. Similar results were found when comparing the two diets within the Both group. How strictly the two diets were followed, however, did not differ. Analyses revealed that reasons for discontinuing a diet varied; participants were more likely to cite boredom as a reason for discontinuing a weight‐loss diet than a vegetarian diet (53% vs. 5% between groups and 30% vs. 10% within the Both group). Discussion: The longer duration of the vegetarian diet relative to the weight‐loss diet warrants further investigation. Results could possibly be applied to behavioral weight‐loss treatment to improve long‐term maintenance.     

Center‐Size as a Predictor of Weight‐Loss Outcome in Multicenter Trials Including a Low‐Calorie Diet

It has not been studied yet whether factors such as the number of subjects recruited by specialized centers for multicenter trials may influence weight loss during a low‐calorie diet (LCD). This study aimed at determining whether the number of recruited subjects per center might predict relative weight loss. This is a post hoc analysis of an existing database: 701 obese subjects (77% women, 23% men, mean BMI: 38.9 kg/m²) were enrolled at 22 sites (4–85 subjects/site) in five countries to follow a LCD providing 800–1,000 kcal/day during 8 weeks. The main outcome measure was the percentage weight loss after the 8‐week LCD. Mean weight loss differed significantly between participating centers (5.8–11.8% of the initial weight; P < 0.001). There was a significant positive correlation between relative weight loss and the number of recruited subjects per center (r = 0.38; P < 0.001). In a multiple stepwise regression analysis, the number of recruited subjects per center appeared to be the main predictive factor of weight loss (R² = 0.07; P < 0.001). As the number of participants within each center is clustered, we applied a hierarchical model to model the average weight loss vs. the number of participants included at each center. This model allows to predict that for 10 extra patients in a center, the average weight loss would increase by 0.5%. This is the first study suggesting that the number of recruited subjects per center may impact weight loss, and could therefore be considered as a new predictor for weight loss that is independent from the individual.     

Development and Evaluation of Patient‐Centered Software for a Weight‐Management Clinic

Objective: To describe a weight‐management clinic software system and to report on its preliminary evaluation. Research Methods and Procedures: The software system standardizes the collection of relevant patient information from an initial medical assessment, weekly clinic visits, and laboratory testing protocol of a medically supervised proprietary meal‐replacement program in a university‐based referral clinic. It then generates monthly patient feedback reports with graphs of clinical and laboratory parameters to support a patient‐centered approach to weight management. After patients and clinic physicians review the data to ensure accuracy, the database is used for subsequent patient feedback reports, reports to referring physicians, quality assurance, and research. Clinic physicians and referring physicians were asked to rate their acceptance of the system. In addition, in a retrospective analysis of data generated by the system, outcomes for patients who received system‐generated feedback (n = 620) were compared with those who participated in the program before the introduction of feedback (n = 130). Results: Clinic and referring physicians reported that they had high overall satisfaction with the software and that the system saved them time, and the latter group reported that it decreased laboratory use. Regarding patients, the feedback group had lower dropout rates in the latter half of the program, better rates of attendance, completion of laboratory tests, and weight loss after 8 weeks. Discussion: The software seems to facilitate the effectiveness of the treatment protocol for obesity and generates a high‐quality database for patient care, clinic administration, quality assurance, and research purposes.     

Randomized Trial of a Behavioral Weight Loss Intervention for Low‐income Women: The Weight Wise Program

Low‐income women in the United States have the highest rates of obesity, yet they are seldom included in weight loss trials. To address this research gap, components of two evidence‐based weight loss interventions were adapted to create a 16‐week intervention for low‐income women (Weight Wise Program), which was evaluated in a randomized trial with the primary outcome of weight loss at 5‐month follow‐up. Participants were low‐income women (40–64 years) with a BMI of 25–45. Of 143 participants, 72 were randomized to the Weight Wise Program (WWP) and 71 to the Control Group (CG). Five‐month follow‐up data were obtained from 64 (89%) WWP and 62 (87%) CG participants. With baseline values carried forward for missing data, WWP participants had a weight change of ?3.7 kg compared to 0.7 kg in the CG (4.4 kg difference, 95% confidence interval (CI), 3.2–5.5, P < 0.001). For systolic blood pressure (SBP), change in the WWP was ?6.5 mm Hg compared to ?0.4 mm Hg among controls (6.2 mm Hg difference, 95% CI, 1.7–10.6, P = 0.007); for diastolic BP (DBP), changes were ?4.1 mm Hg for WWP compared to ?1.3 mm Hg for controls (2.8 mm Hg difference, 95% CI, 0.0–5.5, P = 0.05). Of the 72 WWP participants, 64, 47, and 19% lost at least 3, 5, and 7% of their initial body weight, respectively. In conclusion, the WWP was associated with statistically significant and clinically important short‐term weight loss.     

Resistance Training Reduces Skeletal Muscle Work Efficiency in Weight‐Reduced and Non–Weight‐Reduced Subjects

Objective

The objective of this study is to determine whether resistance training is similarly effective in reducing skeletal muscle efficiency and increasing strength in weight‐reduced and maximal weight subjects.

Methods

This study examined the effects of supervised resistance exercise on skeletal muscle in 14 individuals with overweight and obesity sustaining a 10% or greater weight loss for over 6 months and a phenotypically similar group of 15 subjects who had not reduced weight and were weight stable at their maximal lifetime body weight. We assessed skeletal muscle work efficiency and fuel utilization (bicycle ergometry), strength (dynamometry), body composition (dual energy x‐ray absorptiometry), and resting energy expenditure (indirect calorimetry) before and after 12 weeks of thrice‐weekly resistance training.

Results

Non–weight‐reduced subjects were significantly (10%‐20%) stronger before and after the intervention than reduced‐weight subjects and gained significantly more fat‐free mass with a greater decline in percentage of body fat than weight‐reduced subjects. Resistance training resulted in similar significant decreases (~10%) in skeletal muscle work efficiency at low‐level exercise and ~10% to 20% increases in leg strength in both weight‐reduced and non–weight‐reduced subjects.

Conclusions

Resistance training similarly increases muscle strength and decreases efficiency regardless of weight loss history. Increased resistance training could be an effective adjunct to reduced‐weight maintenance therapy.

     

The SHED‐IT Randomized Controlled Trial: Evaluation of an Internet‐based Weight‐loss Program for Men

The aim of this study was to evaluate the efficacy of an Internet‐based weight‐loss program for men in an assessor blinded randomized controlled trial. In total, 65 overweight/obese male staff and students at the University of Newcastle (mean (s.d.) age = 35.9 (11.1) years; BMI = 30.6 (2.8)) were randomly assigned to either (i) Internet group (n = 34) or (ii) control group (information only) (n = 31). Both groups received one face‐to‐face information session and a program booklet. Internet group participants used the study website to self‐monitor diet and activity with feedback provided based on participants' online entries on seven occasions over 3 months. Participants were assessed at baseline, 3‐, and 6‐month follow‐up for weight, waist circumference, BMI, blood pressure, resting heart rate, objectively measured physical activity, and self‐reported total daily kilojoules. Intention‐to‐treat analysis revealed significant weight loss of 5.3 kg (95% confidence interval (CI): ?7.3, ?3.3) at 6 months for the Internet group and 3.5 kg (95% CI: ?5.5, ?1.4) for the control group. A significant time effect was found for all outcomes but no between‐group differences. Per‐protocol analysis revealed a significant group‐by‐time interaction (P < 0.001), with compliers losing more weight at 6 months (?9.1 kg; 95% CI ?11.8, ?6.5) than noncompliers (?2.7 kg; 95% CI ?5.3, ?0.01) and the control group (?4.2 kg; 95% CI ?6.2, ?2.2). Simple weight‐loss interventions can be effective in achieving statistically and clinically significant weight loss in men. The Internet is a feasible and effective medium for weight loss in men but strategies need to be explored to improve engagement in online programs.     

Meeting Report on the Conference on Fathers’ Role in Children’s Weight‐Related Behaviors and Outcomes

On September 22, 2017, “Engaging the Forgotten Parent: Conference of Experts on Fathers’ Role in Children’s Weight‐Related Behaviours and Outcomes” brought researchers, students, health professionals, community stakeholders, and knowledge users from Canada, Australia, and the United States together to Toronto, Ontario, for a 1‐day gathering focused on furthering scientific understanding of effective strategies to recruit, engage, and retain fathers in family‐based obesity research. Furthermore this conference focused on identifying key knowledge gaps and opportunities for collaborative research to further our understanding of fathers’ roles in the development of their children’s behaviors and weight outcomes. The following four themes emerged from the conference: (1) underrepresentation of fathers in family‐based obesity research, (2) fathers’ engagement in children’s weight‐related behaviors and desire to participate in research, (3) best practices in recruiting, engaging, and retaining fathers in research, and (4) key lessons learned from fatherhood research in developmental science.