Suzanne Phelan Copyright (c) 2011 All rights reserved. http://works.bepress.com/sphelan Recent documents in Suzanne Phelan en-us Sat, 27 Aug 2011 02:20:19 PDT 3600 Physical Activity Patterns Using Accelerometry in the National Weight Control Registry http://works.bepress.com/sphelan/35 http://works.bepress.com/sphelan/35 Thu, 25 Aug 2011 15:15:42 PDT The National Weight Control Registry (NWCR) was established in 1993 to examine characteristics of successful weight-loss maintainers. This group consistently self-reports high levels of physical activity. The aims of this study were to obtain objective assessments of physical activity in NWCR subjects and compare this to physical activity in both normal-weight and overweight controls. Individuals from the NWCR (n = 26) were compared to a never‑obese normal-weight control group matched to the NWCR group’s current BMI (n = 30), and an overweight control group matched to the NWCR group’s self-reported pre-weight-loss BMI (n = 34). Objective assessment of physical activity was obtained for a 1-week period using a triaxial accelerometer. Bouts of moderate-to-vigorous physical activity (MVPA) ≥10 min in duration, as well as nonbout MVPA (bouts of MVPA 1–9 min in duration) were summed and characterized. NWCR subjects spent significantly (P = 0.004) more time per day in sustained bouts of MVPA than overweight controls (41.5 ± 35.1 min/day vs. 19.2 ± 18.6 min/day) and marginally (P = 0.080) more than normal controls (25.8 ± 23.4). There were no significant differences between the three groups in the amount of nonbout MVPA. These results provide further evidence that physical activity is important for long-term maintenance of weight loss and suggest that sustained volitional activity (i.e., ≥10 min in duration) may play an important role. Interventions targeting increases in structured exercise may be needed to improve long-term weight-loss maintenance.

]]> Victoria A. Catenacci et al. Articles Practitioner Advice and Gestational Weight Gain http://works.bepress.com/sphelan/34 http://works.bepress.com/sphelan/34 Thu, 25 Aug 2011 15:15:37 PDT Background: The purpose of this study was to investigate receipt of gestational weight gain advice in prenatal care and ideal and expected gestational weight gain outcomes for normal weight and overweight/obese women.

Methods: This was a cross-sectional study of normal weight (n=203) and overweight/obese (n=198) women in early (<16 >weeks) pregnancy.

Results: Less than half of participants (41.7%) reported receiving weight gain advice from a practitioner. In multivariate models, pregravid weight status was not significantly related to receiving advice. However, women with lower income (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.13-0.77, p=0.01), younger age (OR 0.93, 95% CI 0.87-0.99, p=0.02), and multiparity (OR 0.49, 95% CI 0.28-0.87, p=0.02) were least likely to report receiving advice. Among those receiving advice, most (85%) received accurate advice; however, overweight/obese women were more likely to be advised to overgain compared with normal weight women (22.2% vs. 2.3%, p=0.0001). Overweight/obese women were also more likely than normal weight women to report ideal (OR 7.2, 95% CI 2.3-22.7, p=0.001) and expected (OR 4.7, 95% CI 2.6-8.4, p=0.0001) pregnancy weight gains above Institute of Medicine guidelines. Further, a consistent relationship was observed between higher ideal and expected weight gains and greater first trimester weight gain ( p<0.03).

Conclusions: Clinicians should be encouraged to provide timely and accurate advice to women about gestational weight gain. Interventions to promote healthy gestational weight gain may benefit from targeting women’s beliefs about ideal and expected gestational weight gain.

]]> Suzanne Phelan et al. Articles Dietary energy density and successful weight loss maintenance http://works.bepress.com/sphelan/33 http://works.bepress.com/sphelan/33 Thu, 14 Jul 2011 10:55:52 PDT Research shows a positive relationship between dietary energy density (ED) and body mass index (BMI), but dietary ED of weight loss maintainers is unknown. This preliminary investigation was a secondary data analysis that compared self-reported dietary ED and food group servings consumed in overweight adults (OW: BMI=27–45 kg/m2), normal weight adults (NW: BMI=19–24.9 kg/m2), and weight loss maintainers (WLM: current BMI=19–24.9 kg/m2 [lost≥10% of maximum body weight and maintained loss for ≥5 years]) participating in 2 studies, with data collected from July 2006 to March 2007. Three 24-h phone dietary recalls from 287 participants (OW=97, NW=85, WLM=105) assessed self-reported dietary intake. ED (kcal/g) was calculated by three methods (food+all beverages except water [F+AB], food+caloric beverages [F+CB], and food only [FO]). Differences in self-reported consumption of dietary ED, food group servings, energy, grams of food/beverages, fat, and fiber were assessed using one-way MANCOVA, adjusting for age, sex, and weekly energy expenditure from self-reported physical activity. ED, calculated by all three methods, was significantly lower in WLM than in NW or OW (FO: WLM=1.39±0.45 kcal/g; NW=1.60± 0.43 kcal/g; OW=1.83±0.42 kcal/g). Self-reported daily servings of vegetables and whole grains consumed were significantly higher in WLM compared to NW and OW (vegetables: WLM=4.9±3.1 servings/day; NW=3.9±2.0 servings/day; OW=3.4±1.7 servings/day; whole grains: WLM=2.2±1.8 servings/day; NW=1.4±1.2 servings/day; OW=1.3±1.3 servings/day). WLM self-reported consuming significantly less energy from fat and more fiber than the other two groups. Self-reported energy intake per day was significantly lower in WLM than OW, and WLM self-reported consuming significantly more grams of food/ beverages per day than OW. These preliminary findings suggest that consuming a diet lower in ED, characterized by greater intake of vegetables and whole grains, may aid with weight loss maintenance and should be further tested in prospective randomized controlled trials.

]]> Hollie A. Raynor et al. Articles What Type of Weight Loss Program Do Postpartum Women Want? Treatment Preferences of Postpartum Women in Two Community Settings http://works.bepress.com/sphelan/32 http://works.bepress.com/sphelan/32 Tue, 19 Apr 2011 16:07:41 PDT Approximately 25% of women experience major weight gain after pregnancy, retaining more than 4.5 kg. Preliminary efforts to promote postpartum weight loss have encountered some success, but little is known about the types of programs of greatest interest to postpartum women. The purpose of this study was to better understand the weight control needs and preferences of postpartum women in the Women, Infants and Children (WIC) Nutrition program (N = 100) and an Adult Education Parenting (AEP) program (N = 75). A self-report questionnaire was used to collect participants’ demographic and weight history information as well as participants’ degree of interest in various weight loss treatment modalities. Results indicated that, independent of weeks postpartum and breastfeeding status, women in both groups (WIC and AEO) experienced high postpartum weight retention, and greater weight retention was reported in WIC than AEP (7.6 ± 7.7 kg vs. 3.2 ± 6.9 kg, respectively; p = .0001). When asked about types of weight control treatments, women in both setting expressed greatest interest in weekly face-to-face group meetings, but 66.2% of AEP and 60.6% of WIC reported needing childcare to attend such meetings. Women in both settings reported interest in an Internet-based program, particularly one that integrated monthly face-to-face meetings. Future randomized controlled trials are needed to examine the efficacy of Internet-based treatment in reducing postpartum weight retention in diverse patient populations.

]]> Suzanne Phelan et al. Articles Cognitive Interference From Food Cues in Weight Loss Maintainers, Normal Weight, and Obese Individuals http://works.bepress.com/sphelan/31 http://works.bepress.com/sphelan/31 Wed, 09 Feb 2011 09:02:09 PST Much attention has been paid to the behavioral characteristics of successful weight loss maintenance, but less is known about the cognitive processes that underlie this process. The purpose of this study was to investigate cognitive interference from food-related cues in long-term weight loss maintainers (WLM; N = 15) as compared with normal weight (NW; N = 19) and obese (OB; N = 14) controls. A Food Stroop paradigm was used to determine whether successful WLM differed from controls in both the speed and accuracy of color naming words for low-calorie and high-calorie foods. A significant group × condition interaction for reaction time was observed (P = 0.04). In post hoc analyses, no significant differences in reaction time across the three groups were observed for the low-calorie foods (P = 0.66). However, for the high-calorie foods, WLM showed a significantly slower reaction time than the NW (0.04) and OB (0.009) groups (885 ± 17.6, 834 ± 15.8, 816 ± 18.3 ms, respectively). No significant group differences were seen for number of correct trials in 45 s (P = 0.12). The differential interference among WLM did not appear to generalize to other types of distracters (i.e., nonfood). Overall, findings from this study suggest that WLM differ from OB and NW controls in their cognitive responses to high-calorie food cues. Future research is needed to better understand why this bias exists and whether and how interventions can change cognitive processes to better facilitate long-term weight control.

]]> Suzanne Phelan et al. Articles Prevalence and Predictors of Weight-Loss Maintenance in a Biracial Cohort: Results from the Coronary Artery Risk Development in Young Adults Study http://works.bepress.com/sphelan/30 http://works.bepress.com/sphelan/30 Fri, 14 Jan 2011 09:34:26 PST Background: Few population-based studies have examined the behavioral and psychosocial predictors of long-term weight-loss maintenance.
Purpose: The goal of this study was to determine the prevalence and predictors of weight-loss maintenance in a biracial cohort of younger adults.
Methods: This study examined a population-based sample of overweight/obese African-American and white men and women who had 5% weight loss between 1995 and 2000. Subsequent changes in weight, physical activity, and behavioral and psychosocial factors were examined between 2000 and 2005. Analyses were conducted in 2008 –2009.
Results: Among the 1869 overweight/obese individuals without major disease in 1995, a total of 536 (29%) lost 5% between 1995 and 2000. Among those who lost weight, 34% (n=180) maintained at least 75% of their weight loss between 2000 and 2005, whereas 66% subsequently regained. Higher odds of successful weight-loss maintenance were related to African-American race (OR=1.7, p=0.03); smoking (OR=3.4, p=0.0001); history of diabetes (OR=2.2, p=0.04); increases in moderate physical activity between 2000 and 2005 (OR=1.4, p=0.005); increases in emotional support over the same period (OR=1.6, p=0.01); and less sugar-sweetened soft drink consumption in 2005 (OR=0.8, p=0.006).
Conclusions: One third of overweight men and women who lost weight were able to maintain 75% or more of their weight loss over 5 years. Interventions to promote weight-loss maintenance may benefıt from targeting increased physical activity and emotional support and decreased sugarsweetened soft drink consumption.

]]> Suzanne Phelan et al. Articles Pregnancy: A "Teachable Moment" for Weight Control and Obesity Prevention http://works.bepress.com/sphelan/29 http://works.bepress.com/sphelan/29 Fri, 14 May 2010 10:50:34 PDT Excessive gestational weight gain has been shown to relate to high-postpartum weight retention and the development of overweight and obesity later in life. Because many women are concerned about the health of their babies during pregnancy and are in frequent contact with their healthcare providers, pregnancy may be an especially powerful "teachable moment" for the promotion of healthy eating and physical activity behaviors among women. Initial research suggests that helping women gain the recommended amount during pregnancy through healthy eating and physical activity could make a major contribution to the prevention of postpartum weight retention. However, more randomized controlled trials with larger sample sizes are needed to identify the most effective and disseminable intervention. Providers have the potential to prevent high postpartum weight retention and future obesity by monitoring weight gain during pregnancy and giving appropriate advice about recommended amounts of gestational weight gain.

]]> Suzanne Phelan Articles Clinical Research in Diabetes and Urinary Incontinence: What We Know and Need to Know http://works.bepress.com/sphelan/28 http://works.bepress.com/sphelan/28 Thu, 18 Mar 2010 11:25:51 PDT Purpose: We discuss epidemiological and clinical trial research in women with urinary incontinence and diabetes, and provide directions for future research.
Materials and Methods: Published epidemiological and clinical trial literature examining diabetes and incontinence is presented.
Results: Multiple studies have now confirmed that the prevalence and incidence of incontinence is increased in women with type 2 diabetes. Emerging evidence also suggests higher incontinence rates in women with type 1 diabetes or prediabetes. Clinical trial research suggests that weight loss can decrease incontinence in women with prediabetes. An ongoing multicenter trial will examine the effects of weight loss on incontinence in women with type 2 diabetes. Limited trial data in those with type 1 diabetes suggest that intensive glycemic control does not appear to decrease the long-term risk of incontinence in women with type 1 diabetes.
Conclusions: Future research is needed to identify the risk factors, mechanisms, and most effective treatment and prevention strategies to decrease urinary incontinence in women with type 1 or 2 diabetes, or prediabetes. Physicians should be alert for urinary incontinence because it is often not reported and, therefore, it is under treated in women with diabetes and prediabetes.

]]> Suzanne Phelan et al. Articles Use of artificial sweeteners and fat-modified foods in weight loss maintainers and always-normal weight individuals http://works.bepress.com/sphelan/27 http://works.bepress.com/sphelan/27 Wed, 06 Jan 2010 13:57:36 PST Objective: The purpose of this study was to compare the dietary strategies, and use of fat- and sugar-modified foods and beverages in a weight loss maintainer group (WLM) and an always-normal weight group (NW).
Subjects: WLM (N=172) had maintained ≥10% weight loss for 11.5 years, and had a body mass index (BMI) of 22.0 kg m-2. NW (N=131) had a BMI of 21.3 kg m-2 and no history of being overweight. Three, 24-h recalls on random, non-consecutive days were used to assess dietary intake.
Results: WLM reported consuming a diet that was lower in fat (28.7 vs 32.6%, P<0.0001) and used more fat-modification strategies than NW. WLM also consumed a significantly greater percentage of modified dairy (60 vs 49%; P=0.002) and modified dressings and sauces (55 vs 44%; P=0.006) than NW. WLM reported consuming three times more daily servings of artificially sweetened soft drinks (0.91 vs 0.37; P=0.003), significantly fewer daily servings of sugar-sweetened soft drinks (0.07 vs 0.16; P=0.03) and more daily servings of water (4.72 vs 3.48; P=0.002) than NW.
Conclusions: These findings suggest that WLM use more dietary strategies to accomplish their weight loss maintenance, including greater restriction on fat intake, use of fat- and sugar-modified foods, reduced consumption of sugar-sweetened beverages and increased consumption of artificially sweetened beverages. Ways to promote the use of fat-modified foods and artificial sweeteners merits further research in both prevention- and treatment-controlled trials.

]]> Suzanne Phelan et al. Articles What Distinguishes Weight-Loss Maintainers from the Treatment-Seeking Obese? Analysis of Environmental, Behavioral, and Psychosocial Variables in Diverse Populations http://works.bepress.com/sphelan/26 http://works.bepress.com/sphelan/26 Wed, 04 Nov 2009 13:22:18 PST Background Understanding the factors that influence successful weight control is critical for developing interventions.
Purpose The purpose of the study was to provide a comprehensive understanding of the role of psychosocial, environmental, and behavioral variables in distinguishing weight-loss maintainers (WLM) from treatment-seeking obese (TSO).
Methods WLM (n=167) had lost ≥10% of their maximum body weight, had kept the weight off for ≥5 years, and were now of normal weight. TSO-1 and TSO-2 had a history of dieting and body mass index ≥25. TSO-1 was predominantly Caucasian; TSO-2 was predominantly African-American. Bayesian model averaging was used to identify the variables that distinguished WLM from TSO-1 and TSO-2.
Results The variables that most consistently discriminated WLM from TSO were more physical activity (ORs = 3.95 and 2.85), more dietary restraint (ORs = 1.63 and 1.41), and less dietary disinhibition (ORs = 0.69 and 0.83). Environmental variables, including the availability of physical activity equipment, TVs, and high-fat foods in the home, also distinguished WLM from TSO.
Conclusions Obesity treatment should focus on increasing conscious control over eating, engaging in physical activity, and reducing disinhibition. Changes in the home environment may help facilitate these behavioral changes.

]]> Suzanne Phelan et al. Articles Impact of Weight Loss on the Metabolic Syndrome http://works.bepress.com/sphelan/25 http://works.bepress.com/sphelan/25 Fri, 10 Apr 2009 13:02:59 PDT Objective:
To evaluate the effects of weight loss on the risk of having metabolic syndrome after 1 year of treatment with lifestyle modification alone, pharmacotherapy alone (sibutramine) or the combination of the two.

Design:
Randomized, controlled, 1-year clinical trial.

Patients:
One hundred and eighty women and 44 men, 18–65 years of age, with a body mass index of 30–45 kg/m2, free of uncontrolled hypertension or type 1 or 2 diabetes.

Intervention:
Fifteen milligrams of sibutramine per day alone, lifestyle modification counseling alone, sibutramine plus lifestyle modification counseling or sibutramine plus brief lifestyle modification counseling.

Measurements:
The metabolic syndrome, as defined by the Adult Treatment Panel III.

Results:
Before treatment, 34.8% of the participants had the metabolic syndrome. Metabolic syndrome was more prevalent in Caucasians than African Americans (42.5 vs 20.3%; P<0.03), in males than females (65.1 vs 34.9%; P<0.002) and in older (>44 years) than younger (less than or equal to44 years) participants (47.5 vs 20.8%; P<0.0001). After 1 year of treatment, a moderate decrease in weight (8.0plusminus8.7 kg) resulted in significant reductions in the prevalence of metabolic syndrome from 34.8 to 27.2% of all participants (P<0.02). Logistic regression analyses indicated that for each 1 kg of weight lost, the odds of metabolic syndrome were reduced by 8% (CI=0.89–0.97; P<0.003). Lifestyle modification either alone (P<0.04), or in combination with sibutramine (P<0.05), significantly reduced the prevalence of metabolic syndrome compared with sibutramine alone. The group effect was removed after controlling for weight loss.

Conclusions:
The metabolic syndrome was prevalent in over one-third of obese individuals who sought weight loss treatment, and the prevalence differed by age, sex and ethnicity. Moderate weight loss markedly reduced the odds of metabolic syndrome in this sample.

]]> Suzanne Phelan et al. Articles Empirical Evaluation of Physical Activity Recommendations for Weight Control in Women http://works.bepress.com/sphelan/24 http://works.bepress.com/sphelan/24 Mon, 06 Apr 2009 14:42:19 PDT Purpose: Recent recommendations advise 30-60 min of physical activity per day to prevent weight gain and 60-90 min to prevent weight regain. No studies have used objective measures of physical activity to verify these public health recommendations. The purpose of this study was to use objective measures to quantify the amount and intensity of physical activity in a weight-loss-maintainer group and an always-normal-weight group, and, thus, empirically evaluate the recommendations for prevention of weight gain versus regain.

Methods: The weight-loss-maintainer group (N= 135) lost ≥ 30.6 kg, maintained ≥ 10% weight loss for 14.2 yr, and had a BMI of 22.0 kg•m-2. The always-normal-weight group (N = 102) had a BMI of 21.1 kg•m-2 and no history of overweight. Accelerometry was used to assess the amount and intensity of physical activity.

Results: The weight-loss-maintainer group spent significantly more minutes per day than the always-normal-weight group in physical activity (58.6 vs 52.1; P = 0.0001), largely because of more time spent in higher-intensity activities (24.4 vs 16.9; P = 0.02). The majority of individuals in the always-normal-weight group engaged in 30-60 min•d-1 of physical activity, whereas a greater proportion of individuals in the weight-loss-maintainer group engaged in > 60 min (P = 0.002).

Conclusions: Findings support current recommendations that more activity may be needed to prevent weight regain than to prevent weight gain. Including some higher-intensity activity may also be advisable for weight-loss maintenance.

]]> Suzanne Phelan et al. Articles Holiday weight management by successful weight losers and normal weight individuals http://works.bepress.com/sphelan/22 http://works.bepress.com/sphelan/22 Fri, 03 Apr 2009 15:42:38 PDT This study compared weight control strategies during the winter holidays among successful weight losers (SWL) in the National Weight Control Registry and normal weight individuals (NW) with no history of obesity. SWL (n = 178) had lost a mean of 34.9 kg and had kept =13.6 kg off for a mean of 5.9 years. NW (n = 101) had a body mass index of 18.5-24.9 kg/m². More SWL than NW reported plans to be extremely strict in maintaining their usual dietary routine (27.3% vs. 0%) and exercise routine (59.1% vs. 14.3%) over the holidays. Main effects for group indicated that SWL maintained greater exercise, greater attention to weight and eating, greater stimulus control, and greater dietary restraint, both before and during the holidays. A Group × Time interaction indicated that, over the holidays, attention to weight and eating declined significantly more in SW than in NW. More SWL (38.9%) than NW (16.7%) gained =1 kg over the holidays, and this effect persisted 1 month later (28.3% and 10.7%, respectively). SWL worked harder than NW did to manage their weight, but they appeared more vulnerable to weight gain during the holidays.

]]> Suzanne Phelan et al. Articles Involving Support Partners in Obesity Treatment http://works.bepress.com/sphelan/23 http://works.bepress.com/sphelan/23 Fri, 03 Apr 2009 15:42:38 PDT In this study, the authors examined whether the number or success of weight loss partners influences participants' outcomes in behavioral weight loss treatment. Overweight participants (n = 109) assigned to an exercise intensive group in a larger trial were encouraged to invite up to 3 partners to attend treatment. Weight losses at 6, 12, and 18 months were not associated with the number of partners (0-3) but were associated with the weight loss success of the partners. Participants with at least 1 successful partner (weight loss ≥10% at 6 months) lost significantly (p = .004) more weight at 6, 12, and 18 months than those with no successful partners and those without partners. Interclass correlations of weight change between participants and their partner(s) were strong at all time points (ps < .01). Support partners appear to only be beneficial in obesity treatment when partners themselves lose weight.

]]> Amy Gorin et al. Articles Maintaining Large Weight Losses: The Role of Behavioral and Psychological Factors http://works.bepress.com/sphelan/21 http://works.bepress.com/sphelan/21 Fri, 03 Apr 2009 15:42:37 PDT Few studies have examined predictors of weight regain after significant weight losses. This prospective study examined behavioral and psychological predictors of weight regain in 261 successful weight losers who completed an 18-month trial of weight regain prevention that compared a control condition with self-regulation interventions delivered face-to-face or via the Internet. Linear mixed effect models were used to examine behavioral and psychological predictors of weight regain, both as main effects and as interactions with treatment group. Decreases in physical activity were related to weight regain across all 3 groups, and increased frequency of self-weighing was equally protective in the 2 intervention groups but not in the control group. Increases in depressive symptoms, disinhibition, and hunger were also related to weight regain in all groups. Although the impact of changes in restraint was greatest in the Internet group and weakest in the face-to-face group, the latter was the only group with increases in restraint over time and consequent decreases in magnitude of weight regain. Future programs should focus on maintaining physical activity, dietary restraints, and frequent self-weighing and should include stronger components to modify psychological parameters.

]]> Rena R. Wing et al. Articles The National Weight Control Registry: Is it Useful in Helping Deal with Our Obesity Epidemic? http://works.bepress.com/sphelan/20 http://works.bepress.com/sphelan/20 Thu, 02 Apr 2009 16:56:48 PDT The National Weight Control Registry (NWCR) consists of over 4800 individuals who have been successful in long-term weight loss maintenance. The purpose of establishing the NWCR was to identify the common characteristics of those who succeed in long-term weight loss maintenance. We found very little similarity in how these individuals lost weight but some common behaviors in how they are keeping their weight off. To maintain their weight loss NWCR participants report eating a relatively low-fat diet, eating breakfast almost every day, weighing themselves regularly, and engaging in high levels (about 1 hour/day) of physical activity. Because this is not a random sample of those who attempt weight loss, the results have limited generalizability to the entire population of overweight and obese individuals. The value of this project lies in identifying potential strategies that may help others be more successful in keeping weight off.

]]> James O. Hill et al. Articles What Do Physicians Recommend To Their Overweight and Obese Patients? http://works.bepress.com/sphelan/19 http://works.bepress.com/sphelan/19 Thu, 02 Apr 2009 16:56:47 PDT Background: It is recognized that physicians play an important role in responding to the nation's obesity epidemic. Little is known, however, about what physicians say to their obese patients to help them lose weight.

Objective: This cross-sectional survey examined weight loss recommendations of family physicians and internists. Surveys were mailed to 188 physicians and 54% (n = 101) responded. The survey assessed physicians’ weight loss recommendations, the basis for recommendations, and their expected weight loss outcomes for a hypothetical patient. Physicians rated the extent to which they recommended various weight control strategies to their obese patients. They also rated the extent to which clinical experience, personal experience, and the medical literature were important in formulating their recommendations.

Results: The most common strategies recommended were increasing physical activity, reducing consumption of fast foods, reducing portion sizes, and reducing soda consumption. Physicians were less likely to recommended regular self-weighing, recording food intake, and decreasing television viewing. Meal replacements and weight loss medications were rarely advised. Physicians reported that they based their weight loss recommendations more on clinical experience than on the medical literature or personal experience; these latter 2 were rated as equally important. Physicians reported that, from their perspective, the equivalent of a 21.5% weight loss would be an "acceptable" outcome for a hypothetical obese patient; a 10.6% weight loss "disappointing."

Conclusions: Physicians, like patients, need to be educated about the benefits of modest weight loss and the weight loss strategies empirically proven to be most effective, including self-monitoring. Further research is needed to understand the barriers to recommending and implementing these effective strategies.

]]> Suzanne Phelan et al. Articles Weight-Loss Maintenance in Successful Weight Losers: Surgical vs. Non-Surgical Methods http://works.bepress.com/sphelan/18 http://works.bepress.com/sphelan/18 Thu, 12 Feb 2009 14:20:58 PST Objective: As large weight losses are rarely achieved through any method except bariatric surgery, there have been no studies comparing individuals who initially lost large amounts of weight through bariatric surgery or non-surgical means. The National Weight Control Registry (NWCR) provides a resource for making such unique comparisons. This study compared the amount of weight regain, behaviors and psychological characteristics in NWCR participants who were equally successful in losing and maintaining large amounts of weight through either bariatric surgery or non-surgical methods.
Design: Surgical participants (n=105) were matched with two non-surgical participants (n=210) on gender, entry weight, maximum weight loss and weight-maintenance duration, and compared prospectively over 1 year.
Results: Participants in the surgical and non-surgical groups reported having lost approximately 56 kg and keeping ≥ 13.6 kg off for 5.5 ± 7.1 years. Both groups gained small but significant amounts of weight from registry entry to 1 year (P=0.034), but did not significantly differ in magnitude of weight regain (1.8 ± 7.5 and 1.7 ± 7.0 kg for surgical and non-surgical groups, respectively; P=0.369). Surgical participants reported less physical activity, more fast food and fat consumption, less dietary restraint, and higher depression and stress at entry and 1 year. Higher levels of disinhibition at entry and increased disinhibition over 1 year were related to weight regain in both groups.
Conclusions: Despite marked behavioral differences between the groups, significant differences in weight regain were not observed. The findings suggest that weight-loss maintenance comparable with that after bariatric surgery can be accomplished through non-surgical methods with more intensive behavioral efforts. Increased susceptibility to cues that trigger overeating may increase risk of weight regain regardless of initial weight-loss method.

]]> D. S. Bond et al. Articles Promoting More Modest Weight Losses: A Pilot Study http://works.bepress.com/sphelan/16 http://works.bepress.com/sphelan/16 Wed, 11 Feb 2009 15:40:58 PST Objective: This pilot study assessed the short- and long-term effects of a modified cognitive behavioral treatment designed to facilitate obese patients' acceptance of a 5% to 10% reduction in initial weight.
Research Methods and Procedures: Participants were 17 women with a mean age of 46.5 ± 9.7 years and BMI of 34.7 ± 2.9 kg/m2. They participated in a 40-week program that included four phases. The first discussed the benefits of modest weight losses and the potential adverse effects of unrealistic expectations. Phase II provided instruction in traditional cognitive behavioral methods of weight control Phase III focused on methods to improve body image and self-esteem. Phase IV addressed skills for weight maintenance. Changes in weight, self-esteem, body image, and quality of life were assessed at the end of treatment and 1 year later (week 92).
Results: At week 40, participants lost an average of 5.7 ± 5.3% of initial weight, which was associated with significant improvements in body image, self-esteem, and quality of life. Improvements in psychosocial status were maintained at week 92, although mean weight loss at this time had declined to 2.9 ± 5.6% of initial weight. Increased satisfaction with body weight at week 40 was associated with significantly better maintenance of weight loss at follow-up (r = -0.70; p = 0.02).
Discussion: Having participants seek only modest initial weight losses does not appear to facilitate weight maintenance. However, increasing patients' satisfaction with their body weight at the end of treatment may help improve weight maintenance. More research is needed on the relation between satisfaction with initial weight loss and long-term success.

]]> Gary D. Foster et al. Articles Promoting Long-Term Weight Control: Does Dieting Consistency Matter? http://works.bepress.com/sphelan/17 http://works.bepress.com/sphelan/17 Wed, 11 Feb 2009 15:40:58 PST OBJECTIVE: The present study examined whether long-term weight loss maintenance is enhanced by maintaining the same diet regimen across the week and year or by dieting more strictly on weekdays and nonholiday periods than at other times.
METHOD: National Weight Control Registry participants (N¼1429) indicated on an eight-point scale whether they dieted more strictly on weekends than weekdays, adhered to the same diet regimen throughout the week, or dieted more strictly on weekdays. Participants responded to a similar question about holiday and vacation eating. Participants were then followed prospectively to determine whether scores on these questions were related to self-reported weight regain over the subsequent 12 months.
RESULTS: There was a linear relationship between scores on the dieting consistency questions and weight change over the 1-y period (P’s o0.01), with smaller weight gains in those who reported more consistency. Participants who reported a consistent diet across the week were 1.5 times more likely to maintain their weight within 5 pounds over the subsequent year (OR¼1.58, 95% CI: 1.2–2.2) than participants who dieted more strictly on weekdays. A similar relationship emerged between dieting consistency across the year and subsequent weight regain.
CONCLUSION: Dieting consistency appears to be a behavioral strategy that predicts subsequent long-term weight loss maintenance.

]]> Amy A. Gorin et al. Articles