Initial Weight Loss Response as an Indicator for Providing Early Rescue Efforts to Improve Long-term Treatment Outcomes.

PURPOSE OF REVIEW: There is a large variability in response to behavioral weight loss (WL) programs. Reducing rates of obesity and diabetes may require more individuals to achieve clinically significant WL post-treatment. Given that WL within the first 1-2 months of a WL program is associated with long-term WL, it may be possible to improve treatment outcomes by identifying and providing additional intervention to those with poor initial success (i.e., "early non-responders"). We review the current literature regarding early non-response to WL programs and discuss how adaptive interventions can be leveraged as a strategy to "rescue" early non-responders. RECENT FINDINGS: Preliminary findings suggest that adaptive interventions, specifically stepped care approaches, offer promise for improving outcomes among early non-responders. Future studies need to determine the optimal time point and threshold for intervening and the type of early intervention to employ. Clinicians and researchers should consider the discussed factors when making treatment decisions.

A preliminary investigation into whether early intervention can improve weight loss among those initially non-responsive to an internet-based behavioral program.

This study examined whether providing additional support to individuals with poor initial weight loss improves 12-week outcomes. Participants were randomized to a 12-week internet-delivered behavioral weight loss program (IBWL; n = 50) or the identical internet program plus the possibility of extra support (IBWL + ES; n = 50). IBWL + ES participants losing <2.3% at Week 4 (early non-responders; n = 12) received one individual meeting and two follow-up phone calls with an interventionist, and were compared to IBWL 'early non-responders' who did not receive extra support (n = 21), and to 'early responders' in both treatment arms (i.e., 4-week weight loss ≥2.3%; n = 59). IBWL + ES early non-responders had greater program adherence (p's < 0.055) and lost twice as much weight (p = 0.036) compared to IBWL early non-responders. Program adherence did not differ between early responders and IBWL + ES early non-responders. However, 12-week weight loss was greater in the early responders compared to both early non-responder groups (p's > 0.05). Providing additional intervention to early non-responders in an Internet program improves treatment outcomes.

Consistency in compensatory eating responses following acute exercise in inactive, overweight and obese women.

It is often assumed that some individuals reliably increase energy intake (EI) post-exercise ('compensators') and some do not ('non-compensators'), leading researchers to examine the characteristics that distinguish these two groups. However, it is unclear whether EI post-exercise is stable over time. The present study examined whether compensatory eating responses to a single exercise bout are consistent within individuals across three pairs of trials. Physically inactive, overweight/obese women (n 28, BMI 30·3 (SD 2·9) kg/m²) participated in three pairs of testing sessions, with each pair consisting of an exercise (30 min of moderate-intensity walking) and resting testing day. EI was measured using a buffet meal 1 h post-exercise/rest. For each pair, the difference in EI (EIdiff = EIex - EIrest) was calculated, where EIex is the EI of the exercise session and EIrest is the EI of the resting session, and women were classified as a 'compensator' (EIex > EIrest) or 'non-compensator' (EIex ≤ EIrest). The average EI on exercise days (3328·0 (SD 1686·2) kJ) was similar to those on resting days (3269·4 (SD 1582·4) kJ) (P= 0·67). Although EI was reliable within individuals across the three resting days (intraclass correlation coefficient (ICC) 0·75, 95 % CI 0·60, 0·87; P< 0·001) and three exercise days (ICC 0·83, 95 % CI 0·70, 0·91; P< 0·001), the ICC for EIdiff across the three pairs of trials was low (ICC 0·20, 95 % CI -0·02, 0·45; P= 0·04), suggesting that compensatory eating post-exercise is not a stable construct. Moreover, the classification of 'compensators'/'non-compensators' was not reliable (κ = -0·048; P= 0·66). The results were unaltered when 'relative' EI was used, which considers the energy expenditure of the exercise/resting sessions. Acute compensatory EI following an exercise bout is not reliable in overweight women. Seeking to understand what distinguishes 'compensators' from 'non-compensators' based on a single eating episode post-exercise is not justified.

Examination of the Consistency in Affective Response to Acute Exercise in Overweight and Obese Women.

This study examined whether inactive, overweight/obese women experience consistent affective responses to moderate-intensity exercise. Twenty-eight women participated in 3 identical (same treadmill grade and speed within a subject) 30-min exercise sessions. The Feeling Scale (FS), Positive and Negative Affect Schedule and Subjective Exercise Experience Scale were administered pre- and postexercise and FS was also administered every 5 min during exercise. All measures exhibited less than optimal agreement in pre-to-postexercise change within an individual across the 3 sessions (ICCs = 0.02-0.60), even after controlling for within-subject variations in heart rate. Only FS exhibited "good" consistency when controlling for preexercise values (ICC = 0.72). However, the mean FS score during exercise was highly consistent within an individual (ICC = 0.83). Thus, an individual's affective response to an exercise session does not provide reliable information about how they will respond to subsequent exercise sessions. Taking the average of FS measurements during exercise may yield more consistent findings.

The effects of myofascial release with foam rolling on performance.

In the last decade, self-myofascial release has become an increasingly common modality to supplement traditional methods of massage, so a masseuse is not necessary. However, there are limited clinical data demonstrating the efficacy or mechanism of this treatment on athletic performance. The purpose of this study was to determine whether the use of myofascial rollers before athletic tests can enhance performance. Twenty-six (13 men and 13 women) healthy college-aged individuals (21.56 ± 2.04 years, 23.97 ± 3.98 body mass index, 20.57 ± 12.21 percent body fat) were recruited. The study design was a randomized crossover design in which subject performed a series of planking exercises or foam rolling exercises and then performed a series of athletic performance tests (vertical jump height and power, isometric force, and agility). Fatigue, soreness, and exertion were also measured. A 2 × 2 (trial × gender) analysis of variance with repeated measures and appropriate post hoc was used to analyze the data. There were no significant differences between foam rolling and planking for all 4 of the athletic tests. However, there was a significant difference between genders on all the athletic tests (p ≤ 0.001). As expected, there were significant increases from pre to post exercise during both trials for fatigue, soreness, and exertion (p ≤ 0.01). Postexercise fatigue after foam rolling was significantly less than after the subjects performed planking (p ≤ 0.05). The reduced feeling of fatigue may allow participants to extend acute workout time and volume, which can lead to chronic performance enhancements. However, foam rolling had no effect on performance.

A randomized trial of an acceptance-based behavioral intervention for weight loss in people with high internal disinhibition.

OBJECTIVE: To determine whether an acceptance-based behavioral intervention (ABBI) produces better weight losses than standard behavioral treatment (SBT) among individuals reporting high internal disinhibition. METHODS: Participants were 162 adults with overweight or obesity (mean BMI 37.6 kg/m2 ) randomly assigned to ABBI or SBT. Both interventions provided the same calorie intake target, exercise goal, and self-monitoring skills training. SBT incorporated current best practice interventions for addressing problematic thoughts and emotions. ABBI utilized acceptance-based techniques based on Acceptance and Commitment Therapy. ABBI and SBT were compared on weight change and internal disinhibition change over 24 months. RESULTS: Mixed models analysis showed mean weight loss at 24 months was -4.1% (SE = 0.88) for ABBI and -2.4% (SE = 0.87) for SBT (P = 0.204). Secondary analyses showed that the ABBI group regained less weight from the end of treatment to the final follow-up (4.6 vs. 7.1 kg; P = 0.005), and that a significantly higher proportion of ABBI participants achieved a 5% weight loss (38% vs. 25%; P = 0.038) at 24 months. CONCLUSIONS: Results suggest that ABBI could be helpful for improving the maintenance of weight loss for individuals who report high internal disinhibition.

Systematic review of interventions to reduce problematic alcohol use in men who have sex with men.

ISSUES: Rates of heavy drinking, alcohol problems and alcohol-related disorders are high among men who have sex with men (MSM) and are an important public health issue. Associations between heavy drinking and human immunodeficiency virus (HIV) acquisition among MSM also suggest that drinking may have more severe and chronic consequences for this population relative to others. Consequently, effective interventions to reduce heavy drinking and alcohol-related risk factors among MSM are needed. APPROACH: We conducted a systematic review of randomised controlled trials of interventions to reduce heavy drinking and/or alcohol-related problems among MSM. We searched five electronic databases, screened 3722 records and identified 5 studies involving 1022 participants that satisfied inclusion criteria, which included having: (i) incorporated a comparison condition; (ii) randomised participants to groups; and (iii) reported quantitative outcomes. KEY FINDINGS: The methodological quality of studies varied, and meta-analysis was not conducted because of heterogeneity in intervention approaches and outcomes. Studies provided preliminary support for the use of motivational interviewing/motivational enhancement-based interventions (MI) and hybrid MI and cognitive behavioural therapy treatments for heavy drinking among MSM over no treatment. Perhaps the most important conclusion of this review, however, is that well-designed, theoretically informed research focused on establishing the efficacy of interventions for hazardous drinking and alcohol use disorders among MSM is alarmingly scarce. CONCLUSIONS: Effective interventions to reduce hazardous drinking among MSM and prevent key alcohol-related outcomes, including risk for HIV transmission and health problems among HIV-positive MSM, are needed to mitigate health disparities in this population.

Effects of resistance training and dietary changes on physical function and body composition in overweight and obese older adults.

BACKGROUND: Community-based interventions that incorporate resistance training (RT) and dietary changes have not been extensively studied in overweight and obese older adults. The purpose of this investigation was to determine the effects of a community-based RT and dietary intervention on physical function and body composition in overweight and obese older adults. METHODS: Ninety-five overweight and obese (BMI=33.4±4.0 kg/m2) older adults aged 55-80 years completed an 8-week RT and dietary intervention at 4 Rhode Island senior centers. Participants performed RT twice-weekly using resistance tubing, dumbbells, and ankle weights. Participants also attended 1 weekly dietary counseling session on a modified Dietary Approaches to Stop Hypertension diet. Outcome measurements included anthropometrics, body composition, and physical function. RESULTS: There were small changes in body mass (-1.0±1.8 kg, P<.001), waist circumference (-5.2±3.8 cm, P<.001), and percent body fat (-0.5±1.4%, P<.001). In addition, significant improvements were observed in knee extensor torque (+7.9±19.1 N-m, P<.001), handgrip strength (+1.2±2.5 kg, P<.001), and 8-foot up-and-go test time (-0.56±0.89 s, P<.001). CONCLUSION: Community-based RT and dietary modifications can improve body composition, muscle strength, and physical function in overweight and obese older adults. Future investigations should determine if this intervention is effective for long-term changes.