The past, present, and future of behavioral obesity treatment.

Over the last century, hundreds of evaluations have been conducted to examine weight-management interventions related to diet, physical activity, and behavior therapy. These investigations have contributed to a growing body of knowledge that has consistently advanced the field of obesity treatment, while also revealing some persistent challenges. This narrative review summarizes key findings from randomized controlled trials conducted in adults that have combined diet, physical activity, and behavior therapy, an approach variously referred to as behavioral treatment, comprehensive lifestyle modification, or intensive lifestyle intervention. The review shows that current behavioral approaches induce average reductions in baseline body weight of 5 to 10% at 6 to 12 months. Such losses have proven effective in reducing the risk of type 2 diabetes in persons with impaired glucose tolerance and in improving other obesity-related complications. These benefits have also been associated with reductions in healthcare costs. Despite these advances, behavioral treatment is challenged by the need for larger losses to achieve optimal improvements in health, by difficulties associated with maintaining weight loss, and by barriers limiting access to treatment. New anti-obesity medications, when combined with behavioral obesity treatment, hold promise of addressing the first two issues.

Neural Responses to Auditory Food Stimuli Following Cognitive Behavioral Therapy for Binge-Eating Disorder.

OBJECTIVE: Adults with binge-eating disorder (BED), compared with those without BED, demonstrate higher blood-oxygen-level-dependent (BOLD) response to food cues in reward-related regions of the brain. It is not known whether cognitive behavioral therapy (CBT) can reverse this reward system hyperactivation. This randomized controlled trial (RCT) assessed changes in BOLD response to binge-eating cues following CBT versus wait-list control (WLC). METHOD: Females with BED (N = 40) were randomized to CBT or WLC. Participants completed assessments at baseline and 16 weeks including measures of eating and appetite and functional magnetic resonance imaging (fMRI) to measure BOLD response while listening to personalized scripts of binge-eating and neutral-relaxing cues. Data were analyzed using general linear models with mixed effects. RESULTS: Overall retention rate was 87.5%. CBT achieved significantly greater reductions in binge-eating episodes than WLC (mean ± standard error decline of 14.6 ± 2.7 vs. 5.7 ± 2.8 episodes in the past 28 days, respectively; p = 0.03). CBT and WLC did not differ significantly in changes in neural responses to binge-eating stimuli during the fMRI sessions. Compared with WLC, CBT had significantly greater improvements in reward-based eating drive, disinhibition, and hunger as assessed by questionnaires (ps < 0.05). DISCUSSION: CBT was effective in reducing binge eating, but, contrary to our hypothesis, CBT did not improve BOLD response to auditory binge-eating stimuli in reward regions of the brain. Further studies are needed to assess mechanisms underlying improvements with CBT for BED. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03604172.

Randomized Controlled Trial of Effects of Behavioral Weight Loss Treatment on Food Cue Reactivity.

BACKGROUND: It is not known whether behavioral weight loss can attenuate blood oxygen level-dependent responses to food stimuli. OBJECTIVES: This randomized controlled trial assessed the effects of a commercially available behavioral weight loss program (WW, WeightWatchers) compared to a wait-list control on blood oxygen level-dependent response to food cues. METHODS: Females with obesity ( N = 61) were randomized to behavioral weight loss or wait-list control. At baseline and follow-up, participants completed assessments that included functional magnetic resonance imaging scans to assess response to images of high-calorie foods (HCF) or low-calorie foods (LCF), and neutral objects. RESULTS: There were no significant between-group differences in change from baseline to follow-up in any regions of the brain in response to viewing HCF or LCF. From baseline to follow-up, participants in behavioral weight loss, compared with wait-list control, reported significantly greater increases in desire for LCF. Changes in liking and palatability of LCF and liking, palatability, and desire for HCF did not differ between groups. DISCUSSION: Behavioral weight loss was associated with increased desire for LCF without changes in neural reactivity to food cues. These results suggest that alteration of neurological processes underlying responsiveness to food is difficult to achieve through behavioral weight management alone.

Correction: Effectiveness of an Artificial Intelligence-Assisted App for Improving Eating Behaviors: Mixed Methods Evaluation.

[This corrects the article DOI: 10.2196/46036.].

Effectiveness of an Artificial Intelligence-Assisted App for Improving Eating Behaviors: Mixed Methods Evaluation.

BACKGROUND: A plethora of weight management apps are available, but many individuals, especially those living with overweight and obesity, still struggle to achieve adequate weight loss. An emerging area in weight management is the support for one's self-regulation over momentary eating impulses. OBJECTIVE: This study aims to examine the feasibility and effectiveness of a novel artificial intelligence-assisted weight management app in improving eating behaviors in a Southeast Asian cohort. METHODS: A single-group pretest-posttest study was conducted. Participants completed the 1-week run-in period of a 12-week app-based weight management program called the Eating Trigger-Response Inhibition Program (eTRIP). This self-monitoring system was built upon 3 main components, namely, (1) chatbot-based check-ins on eating lapse triggers, (2) food-based computer vision image recognition (system built based on local food items), and (3) automated time-based nudges and meal stopwatch. At every mealtime, participants were prompted to take a picture of their food items, which were identified by a computer vision image recognition technology, thereby triggering a set of chatbot-initiated questions on eating triggers such as who the users were eating with. Paired 2-sided t tests were used to compare the differences in the psychobehavioral constructs before and after the 7-day program, including overeating habits, snacking habits, consideration of future consequences, self-regulation of eating behaviors, anxiety, depression, and physical activity. Qualitative feedback were analyzed by content analysis according to 4 steps, namely, decontextualization, recontextualization, categorization, and compilation. RESULTS: The mean age, self-reported BMI, and waist circumference of the participants were 31.25 (SD 9.98) years, 28.86 (SD 7.02) kg/m2, and 92.60 (SD 18.24) cm, respectively. There were significant improvements in all the 7 psychobehavioral constructs, except for anxiety. After adjusting for multiple comparisons, statistically significant improvements were found for overeating habits (mean -0.32, SD 1.16; P<.001), snacking habits (mean -0.22, SD 1.12; P<.002), self-regulation of eating behavior (mean 0.08, SD 0.49; P=.007), depression (mean -0.12, SD 0.74; P=.007), and physical activity (mean 1288.60, SD 3055.20 metabolic equivalent task-min/day; P<.001). Forty-one participants reported skipping at least 1 meal (ie, breakfast, lunch, or dinner), summing to 578 (67.1%) of the 862 meals skipped. Of the 230 participants, 80 (34.8%) provided textual feedback that indicated satisfactory user experience with eTRIP. Four themes emerged, namely, (1) becoming more mindful of self-monitoring, (2) personalized reminders with prompts and chatbot, (3) food logging with image recognition, and (4) engaging with a simple, easy, and appealing user interface. The attrition rate was 8.4% (21/251). CONCLUSIONS: eTRIP is a feasible and effective weight management program to be tested in a larger population for its effectiveness and sustainability as a personalized weight management program for people with overweight and obesity. TRIAL REGISTRATION: ClinicalTrials.gov NCT04833803; https://classic.clinicaltrials.gov/ct2/show/NCT04833803.

Food insecurity and binge eating: A systematic review and meta-analysis.

OBJECTIVE: This review synthesized literature on the relationship between food insecurity and binge eating. METHODS: Relevant studies were identified by searching PubMed, CINAHL, PsycINFO, and gray literature from inception to October 2022. Eligible studies included primary research that assessed the relationship between food insecurity and binge eating. Data extraction was performed independently by two reviewers. Pooled odds ratios and 95% confidence intervals (CI) were obtained from random effect models with the R package meta. Analyses were stratified by binge eating versus binge-eating disorder (BED), study type (cross-sectional vs. longitudinal), and age (adults vs. adolescents). RESULTS: We included 24 articles that reported on 20 studies, and 13 articles were included in the meta-analysis. Based on the random effects meta-analysis, the odds of adults in the food insecure group having binge eating were 1.66 (95% CI = 1.42, 1.93) times the odds of adults in the food secure group having binge eating. The odds of adults in the food insecure group having BED were 2.70 (95% CI = 1.47, 4.96) times the odds of adults in the food secure group having BED. Insufficient data were available for a meta-analysis on adolescents or longitudinal relationships. CONCLUSIONS: These findings support that food insecurity is associated with binge eating in adults. There is a need for research to investigate the mechanisms underlying this relationship. Results highlight the importance of screening participants with food insecurity for disordered eating behaviors and vice versa. Future research is needed to examine whether interventions targeting food insecurity may help to mitigate disordered eating behaviors. PUBLIC SIGNIFICANCE: Food insecurity is a common but under-recognized contributor to binge eating. In this article, we systematically reviewed research that has been published on the relationship between food insecurity and binge eating. We found support that food insecurity should be considered in the prevention and treatment of binge eating.

OBJETIVO: Esta revisión sintetizó la literatura sobre la relación entre la inseguridad alimentaria y comer en atracones. MÉTODOS: Los estudios relevantes se identificaron mediante búsquedas en PubMed, CINAHL, PsycINFO y literatura gris desde su inicio hasta octubre de 2022. Los estudios elegibles incluyeron estudios primarios que evaluaron la relación entre la inseguridad alimentaria y los atracones. La extracción de datos fue realizada de forma independiente por 2 revisores. Los odds ratios agrupados y los intervalos de confianza (IC) del 95% se obtuvieron de modelos de efectos aleatorios con el paquete R meta. Los análisis se estratificaron por comer en atracones versus trastorno por atracón (TpA), tipo de estudio (transversal vs longitudinal) y edad (adultos vs adolescentes). RESULTADOS: Se incluyeron 24 artículos que informaron sobre 20 estudios y 13 artículos se incluyeron en el metaanálisis. Según el metaanálisis de efectos aleatorios, las probabilidades de que los adultos en el grupo de inseguridad alimentaria comieran en atracones fue de 1,66 (IC del 95% = 1,42, 1,93) veces las probabilidades de que los adultos en el grupo de seguridad alimentaria comieran en atracones. Las probabilidades de que los adultos en el grupo de inseguridad alimentaria tuvieran TpA fue 2.70 (IC del 95% = 1.47, 4.96) veces las probabilidades de que los adultos en el grupo de seguridad alimentaria tuvieran TpA. No hubo datos suficientes disponibles para un metaanálisis sobre adolescentes o relaciones longitudinales. CONCLUSIONES: Estos hallazgos apoyan que la inseguridad alimentaria está asociada con comer en atracones en adultos. Existe la necesidad de desarrollar investigación para investigar los mecanismos subyacentes a esta relación. Los resultados resaltan la importancia de evaluar a los participantes con inseguridad alimentaria para detectar conductas alimentarias disfuncionales y viceversa. Se necesitan estudios de investigación futuros para examinar si las intervenciones dirigidas a la inseguridad alimentaria pueden ayudar a mitigar los comportamientos alimentarios disfuncionales.

A Systematic Review of Interventions for Obesity Among Adults With Food Insecurity.

OBJECTIVE: Food insecurity is associated with reduced dietary quality and excess weight gain. However, interventions that are effective for obesity among individuals with food insecurity are unclear. The purpose of this systematic review was to synthesize studies in which authors examined interventions for obesity among adults with food insecurity. METHODS: PubMed, PsycINFO, CINAHL, and EMBASE were searched from inception to October 2022. Studies were included if their authors reported on nonpharmacological and nonsurgical interventions that focused on adults with food insecurity and overweight/obesity and reported weight loss. RESULTS: A total of 1360 titles were reviewed during the electronic search, and only 5 studies met inclusion criteria. There were 2 primary types of interventions that have been tested: first, behavioral weight loss counseling with or without tailoring for individuals with food insecurity and, second, subsidies for food. Findings of the benefits of one type of intervention over another are mixed. CONCLUSIONS: This systematic review highlights that the current evidence for interventions that address food insecurity and obesity is mixed and limited in scope. There is a need for rigorous controlled trials to examine the effectiveness and cost-effectiveness of interventions for weight management among individuals with food insecurity and obesity while considering sustainability.

Psychosocial Factors, Technology Use, and Disordered Eating in College Students During the COVID-19 Pandemic.

The current cross-sectional study aimed to evaluate the effects of psychosocial factors and technology use on disordered eating in college students (aged 18 to 23 years) during the coronavirus disease 2019 (COVID-19) pandemic. An online survey was distributed between February and April 2021. Participants completed questionnaires on eating disorder behaviors and cognitions, depressive symptoms, anxiety, impacts of the pandemic across personal and social domains, social media use, and screen time. Of all participants (N = 202), 40.1% of students reported moderate or greater depressive symptoms and 34.7% endorsed moderate or greater anxiety symptoms. Higher depressive symptoms were associated with increased odds of bulimia nervosa (BN) (p = 0.03) and binge eating disorder (p = 0.02). People with higher COVID-19 infection scores were at increased odds of reporting BN (p = 0.01). Mood disturbances and COVID-19 infection history were associated with increased eating disorder psychopathology in college students during the pandemic. [Journal of Psychosocial Nursing and Mental Health Services, 61(10), 29-38.].

Binge-Spectrum Eating Disorders, Mood, and Food Insecurity in Young Adults With Obesity.

BACKGROUND: Disordered eating is common but underrecognized in people with obesity and the relationship of food insecurity, mood, and binge-spectrum eating disorders has not been well addressed in samples with higher weight. Young adults are particularly vulnerable to developing disordered eating. OBJECTIVE: The purpose of this study was to compare the prevalence of food insecurity, depressive symptoms, anxiety, and loneliness among young adults (aged 18-35 years) who screened positive for binge-spectrum eating disorders (i.e., binge eating disorder and bulimia nervosa), those with subthreshold forms of these disorders, and individuals who did not screen positive for these conditions. METHOD: This was a cross-sectional study of young adults with a self-reported body mass index ≥30 kg/m2 from the United States who were recruited online. Participants (N = 1,331; M ± SD age = 28.0 ± 3.4 years; body mass index [BMI] = 36.5 ± 6.2 kg/m2; 73.9% male; 56.3% White) completed surveys that evaluated disordered eating behaviors, food insecurity, mood, and lifestyle factors. RESULTS: In the sample, 8.0% of participants screened positive for binge-spectrum eating disorder and 16.0% had probable subthreshold symptoms. Higher depressive symptoms (odds ratio [OR] = 1.11, 95% confidence interval [CI] = [1.03, 1.20], p = .01), perceived stress (OR = 1.13, 95% CI = [1.07, 1.19], p < .001), and food insecurity scores (OR = 1.12, 95% CI = [1.03, 1.21], p = .01) were associated with an increased likelihood of threshold binge-spectrum eating disorders. CONCLUSION: People with disordered eating should also be evaluated for mood disorders and food insecurity and vice versa. Further research is needed to evaluate interventions that address food insecurity and mood disorders, which may help to decrease disordered eating.

Relationships among Alcohol Drinking Patterns, Macronutrient Composition, and Caloric Intake: National Health and Nutrition Examination Survey 2017-2018.

BACKGROUND: Excessive alcohol consumption is associated with poor diet. Mixed reports in literature, so far, emphasize on the detailed understanding of relationships between diet composition and binge drinking at different drinking thresholds. OBJECTIVE: We examined the association of alcohol consumption thresholds with macronutrient composition, caloric intake and anthropometric measures from the NHANES 2017-2018 dataset. METHODS: A total of 2320 participants' data were analyzed. Energy and nutrient content from daily food and beverage intake were assessed via two dietary recall interviews. Physical examination and Alcohol Use Questionnaire including details about lifetime and current usage patterns were obtained. Correlations were evaluated using the Rao-Scott F Adjusted Chi-square statistic and Wald F-test. Sample-weighted multiple linear regression models were built to analyze the associations among volume of alcohol consumed, weight history and macronutrient intake. RESULTS: Waist circumference was significantly higher in 0- < 4 drinks/episode (low-quantity) drinkers than 4-7 drinks/episode (medium-quantity) and 8-11 drinks/episode (high-quantity) drinkers. High-quantity drinkers consumed significantly more kilocalories (2569.91) compared with low-quantity drinkers (2106.73). Low-quantity drinkers consumed more energy from carbohydrate and fat than medium and high-quantity drinkers. Very high-quantity drinkers (12+ drinks/episode) consumed less fiber (12.81 g) than low-quantity drinkers (16.67 g). CONCLUSIONS: We observed an association between high alcohol intake and differences in eating habits and body composition. The findings suggest a need to compare more specific drinking patterns and their impact on nutrient intake. Although some results conflicted with previous studies, the mechanisms underlying alcohol's effect on ingestive and digestive metabolic pathways are still unclear and require further investigation.

Binge size and loss of control as correlates of eating behavior and psychopathology among individuals with binge eating disorder and higher weight.

Studies comparing individuals with loss of control (LOC) eating who do and do not have objectively large binge episodes have found that degree of LOC is more important than binge size to psychological and behavioral outcomes. However, the relative importance of these characteristics has not been investigated in a population with binge eating disorder (BED), who by definition all have objectively large binge episodes. Persons with BED and higher weight (N = 34) were enrolled in a BED treatment trial and completed the Loss of Control Over Eating Scale, the Eating Disorder Examination, and measures of eating behavior, mood, and quality of life. Body mass index (BMI) was calculated from measured height and weight. The size of the largest binge episode (measured in kilocalories) and degree of LOC were entered into multiple regression equations to determine their relationships with disordered eating symptoms, depression, quality of life, and BMI in this pilot study. Greater LOC had a stronger independent association than binge size with higher total eating psychopathology, shape dissatisfaction, hunger, food cravings and food addiction symptoms. Larger binge size had a stronger independent association than LOC with higher weight concern and lower general and social quality of life. Both characteristics were associated with higher eating concern and neither were associated with depression or BMI. Both binge size and degree of LOC are associated with important psychosocial treatment targets in patients with BED. Future research should validate the largest binge episode measurement method and replicate the present findings in a larger sample.

Associations of Taste Perception with Tobacco Smoking, Marijuana Use, and Weight Status in the National Health and Nutrition Examination Survey.

Habitual smoking of tobacco and marijuana can lead to weight changes and poor diet quality. These effects may be caused by taste changes related to smoking and marijuana use. This study examined the associations among taste perceptions of a bitterant (quinine) and salt, tobacco and marijuana use, and weight status. We conducted a cross-sectional analysis of adults who responded to the National Health and Nutrition Examination Survey in 2013-2014. Participants (n = 2808; female = 51.7%) were adults ≥40 years with an average body mass index (BMI) of 29.6 kg/m2. Participants completed whole mouth and tongue tip assessments of bitter (quinine) and salty (NaCl) tastes, and questionnaires on demographics, cigarette, tobacco, and drug use. Measured height and weight were used to calculate BMI. Compared with never smokers, current smokers reported increased bitter ratings. Smoking status was not associated with salty taste intensity ratings after adjustment for demographic variables. Current marijuana users reported lower tongue tip quine ratings than never users. Among current smokers, current marijuana users had lower whole mouth quinine ratings than never users. Taste perception for salt and quinine for current and former smokers as well as marijuana smokers varied in whole mouth and tongue tip assessment. Changes in taste perception among cigarette smokers and marijuana consumers may be clinically relevant to address to improve diet and weight status.

Factors associated with readmission in patients with eating disorders.

PURPOSE: This study examined predictors of readmission to inpatient/residential settings in patients with eating disorders. We hypothesized that readmitted patients would report worse transitional care and continuity of care compared to those who were not readmitted. METHODS: We conducted a cross-sectional, online survey of 80 individuals from the US who reported that they were diagnosed with an eating disorder requiring inpatient/residential treatment. Participants completed questionnaires on demographic and clinical characteristics, the Care Transition Model-15, and the Continuity of Care Questionnaire. We analyzed data using univariate statistics and a series of logistic regression models. RESULTS: Participants who reported better transitional care (adjusted OR (AOR) = 1.14; p < 0.001), continuity of care during their inpatient or residential stay, including greater transfer of information (AOR = 6.39, p = 0.002), relationships in the hospital (AOR = 6.83, p = 0.003), management of follow-up (AOR = 3.41, p = 0.02), management of communication (AOR = 8.74, p = 0.001), and management of forms (AOR = 9.61, p = 0.002), reported increased odds of being readmitted to an inpatient or residential treatment facility. Use of nasogastric (NG) tube feedings was significantly associated with being readmitted. CONCLUSIONS: Contrary to our hypotheses, we found that better transitional care and continuity of care were associated with higher odds of readmission. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Effects of liraglutide on appetite, food preoccupation, and food liking: results of a randomized controlled trial.

BACKGROUND: Some weight loss medications, including liraglutide 3.0 mg, are thought to facilitate weight loss by improving appetite control. However, no studies have evaluated their long-term appetitive effects. SUBJECTS/METHODS: This study examined changes in appetite in a subsample of 113 adults with obesity (76.1% female, 55.8% white, BMI = 38.8 ± 4.8 kg/m2) who participated in a 52-week trial. Participants were randomized to intensive behavioral therapy alone (IBT-alone), IBT with liraglutide 3.0 mg/day (IBT-liraglutide), or IBT-liraglutide combined with a 12-week meal replacement diet (Multi-component). Participants rated their hunger, fullness after meals, liking of meals, and food preoccupation (all as experienced over the past week) using visual analogue scales (0-100 mm). Ratings were completed at baseline and eight subsequent visits over the year. RESULTS: At week 52, participants treated by IBT-alone lost 6.2 ± 1.6% of baseline weight, compared with 11.8 ± 1.6% and 12.1 ± 1.5% in the IBT-liraglutide and Multi-component groups, respectively. Compared to IBT-alone, IBT-liraglutide participants reported larger reductions at week 6 in hunger (-0.3 ± 4.2 vs -16.8 ± 4.0 mm, p = .005) and food preoccupation (+0.2 ± 3.7 vs -16.3 ± 3.6 mm, p = .002) and larger increases in fullness (-5.1 ± 3.2 vs +9.8 ± 3.0 mm, p = .001). These significant differences persisted at all assessments through week 24. There were no differences between IBT-alone and IBT-liraglutide in meal liking. IBT-alone and Multi-component participants differed in hunger at week 6, and in food preoccupation at all assessments through week 24. Multi-component participants reported reduced liking of meals relative to the IBT-alone and IBT-liraglutide groups through weeks 40 and 52, respectively. There were no other differences among any groups at week 52. CONCLUSIONS: Consistent with short-term studies, IBT-liraglutide participants reported greater improvements in hunger, fullness, and food preoccupation than those assigned to IBT-alone. Differences in appetite persisted for 24 weeks but were not maintained at week 52, despite the relatively greater weight losses in the liraglutide-treated participants at the trial's end.

Associations between causal attributions for obesity and long-term weight loss.

Obesity is a complex disease caused by a wide array of behavioral, biological, and environmental factors. However, obesity is often attributed to oversimplified and stigmatizing causal factors such as laziness, lack of willpower, and failure to take personal responsibility for one's health. Understanding of the causal factors that contribute to obesity among people with obesity may affect their weight management efforts. The current study explored associations between causal attributions for obesity and long-term weight loss, as well as examined potential changes in attributions with weight reduction. The 16-item Causal Attributions for Obesity scale (rated 1-7) was administered to 178 patients seeking behavioral/pharmacological weight-loss treatment. Causal attributions and weight were assessed at baseline, after 14 weeks of a low-calorie diet, and again at weeks 24 and 52 of a subsequent randomized trial (i.e., 66 weeks total). Logistic and linear regression examined effects of baseline causal attribution ratings on weight loss. Higher baseline ratings of personal responsibility attributions predicted 38% reduced odds of achieving ≥10% weight loss at week 52 (p = 0.02). Causal attribution ratings did not change over time or correlate continuously with weight change. Thus, attributing obesity to a failure of personal responsibility may impair long-term weight management efforts for individuals seeking ≥10% weight loss. Targeted techniques are needed to reduce patients' stigmatizing beliefs about the causes of obesity.

Early Weight Loss in Behavioral Treatment Predicts Later Rate of Weight Loss and Response to Pharmacotherapy.

BACKGROUND: Early weight loss (EWL) in the first 1-2 months of behavioral treatment is a strong predictor of later total weight loss. It is not clear whether participants with lower early losses lose less in ongoing treatment or simply fail to overcome the smaller initial loss. Furthermore, no study has tested whether EWL in behavioral treatment predicts response to a different treatment modality, such as pharmacotherapy. METHODS: Data were from 170 participants with obesity (baseline BMI = 40.8 ± 5.8 kg/m2, 87.6% female; 71.3% Black) enrolled in a two-phase trial. Data from the weight loss phase, which provided weekly lifestyle counseling and a meal replacement diet, were used to examine the relationship between 4-week EWL and subsequent rate of weight loss in behavioral treatment. Data from the maintenance phase, in which 137 participants who had lost ≥5% of initial weight were randomized to 52 weeks of maintenance counseling with lorcaserin or placebo, were used to determine whether EWL with behavioral treatment affects the benefit of pharmacotherapy. RESULTS: EWL in the first 4 weeks of behavioral treatment (3.6 ± 1.7%) predicted greater total losses at Week 14 (r2 = 0.61, p < .001) and a faster rate of weight loss in the subsequent 9 weeks of the program (p < .001). During the maintenance phase, lower EWL in behavioral treatment predicted a greater benefit of lorcaserin, in comparison with placebo, for the maintenance of a ≥5% loss at Weeks 24 and 52. CONCLUSIONS: These findings support recommendations to modify treatment for individuals with low EWL.

Weight Bias Internalization and Long-Term Weight Loss in Patients With Obesity.

BACKGROUND: The relationship between weight bias internalization (WBI) and long-term weight loss is largely unknown. PURPOSE: To determine the effects of weight loss on WBI and assess whether WBI impairs long-term weight loss. METHODS: One hundred thirty-three adults with obesity completed the Weight Bias Internalization Scale (WBIS) at baseline, after a 14-week lifestyle intervention in which they lost ≥5 per cent of initial weight, and at weeks 24 and 52 of a subsequent randomized controlled trial (RCT) for weight-loss maintenance (66 weeks total). Linear mixed models were used to examine the effects of weight loss on WBIS scores and the effects of baseline WBIS scores on weight change over time. Logistic regression was used to determine the effects of baseline WBIS scores on achieving ≥5 and ≥10 per cent weight loss. RESULTS: Changes in weight did not predict changes in WBIS scores. Baseline WBIS scores predicted reduced odds of achieving ≥5 and ≥10 per cent weight loss at week 24 of the RCT (p values < .05). At week 52, the interaction between participant race and WBIS scores predicted weight loss (p = .046) such that nonblack (but not black) participants with higher baseline WBIS scores had lower odds of achieving ≥10 per cent weight loss (OR = 0.38, p = .01). Baseline WBIS scores did not significantly predict rate of weight change over time. CONCLUSIONS: Among participants in a weight loss maintenance trial, WBI did not change in relation to changes in weight. More research is needed to clarify the effects of WBI on long-term weight loss and maintenance across race/ethnicity. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identifier NCT02388568.

Obesity in Adolescents with Psychiatric Disorders.

PURPOSE OF REVIEW: This narrative review synthesized recent research related to obesity in adolescents with psychiatric disorders, with a focus on epidemiology, mechanisms, and weight management approaches. The paper reviews literature on depressive and anxiety disorders, bipolar disorder, and schizophrenia spectrum and other psychotic disorders. RECENT FINDINGS: Depression has a bidirectional relationship with obesity. Bipolar disorder and schizophrenia spectrum disorders, and their treatments, increase the risk of developing obesity. Mechanisms underlying this weight gain include lifestyle and environmental factors and psychiatric medications, though emerging evidence has also suggested the role of genetic and neuroendocrine processes. Evidence about the most effective treatments for obesity in adolescents with psychiatric disorders remains limited. Adolescents with psychiatric disorders are at high risk for obesity. Close monitoring for increases in weight and cardiometabolic risk factors with use of antipsychotic and mood-stabilizing medications is recommended. Clinical trials are needed that test the efficacy of weight management strategies for this population.

Perceptions of a large amount of food based on binge-eating disorder diagnosis.

OBJECTIVE: This study examined what adults with binge-eating disorder (BED) and obesity perceived as the threshold for a large amount of food and how their evaluations compared to ratings by participants with obesity but without BED. METHOD: This was a cross-sectional study of 150 participants with obesity. BED was assessed using the Questionnaire on Eating and Weight Patterns and confirmed via interview. Participants completed the Eating Patterns Questionnaire and Eating Inventory. RESULTS: Participants with BED had significantly higher thresholds for a large amount of food relative to those without BED. Compared to participants without BED, those with BED had significantly higher thresholds on 13 of the 22 food items. In the overall sample, being male and having higher hunger scores were associated with greater thresholds. DISCUSSION: Individuals with obesity and BED had larger portion standards than participants without BED. Individuals with BED may benefit from interventions targeted toward decreasing perceptions of portion sizes.

Effects of addictive-like eating behaviors on weight loss with behavioral obesity treatment.

To examine the relationship between food cravings and food addiction as defined by the Yale Food Addiction Scale (YFAS) and to assess the effects of these variables on weight loss during a 14-week group lifestyle modification program. Data were from 178 participants who were prescribed a 1000-1200 kcal/day portion-controlled diet and provided with weekly group lifestyle modification sessions. Participants completed the Food Craving Inventory and YFAS pre- and post-treatment. Weight was measured weekly. Participants with YFAS-defined food addiction (6.7%) reported more frequent overall food cravings relative to those without food addiction. More frequent food cravings at baseline were associated with less weight loss over the 14 weeks. Analyzed categorically, participants in the highest tertile of baseline food cravings lost 7.6 ± 0.5% of initial weight, which was significantly less compared to those in the lowest tertile who lost 9.1 ± 0.5%. Percent weight loss did not differ significantly between participants with YFAS-defined food addiction (6.5 ± 1.2%) and those who did not meet criteria (8.6 ± 0.3%). Addictive-like eating behaviors significantly declined from pre- to post-treatment. Participants with frequent food cravings lost less weight than their peers. Targeted interventions for food cravings could improve weight loss in these individuals. Few participants met YFAS-defined criteria for food addiction. Addictive-like eating behaviors tended to decline during behavioral weight loss, but neither baseline nor change in YFAS scores predicted weight loss.