The association between weight maintenance and session-by-session diet adherence, weight loss and weight-loss satisfaction.

OBJECTIVE: The aim of this study was to assess the association between weight-loss maintenance and weight-loss satisfaction, adherence to diet and weight loss, all measured session-by-session during the weight-loss phase of cognitive behavioral therapy. METHODS: The present exploratory study examined a subgroup of fifty-eight patients who participated in a randomized controlled trial and who lost at least the 10% of their baseline weight. Patients were grouped into weight-loss 'Maintainers' (i.e., those who maintained a weight loss of ≥ 10% of baseline body weight at 6 months after the weight-loss phase) and 'Regainers' (i.e., those who did not maintain > 10% weight loss at 6 months after the weight-loss phase). Body weight, adherence to diet and weight-loss satisfaction were measured session-by-session during the weight-loss phase. RESULTS: Thirteen patients (22.4%) were classified as 'Regainers', and 45 (77.6%) as 'Maintainers'. Compared to 'Maintainers', 'Regainers' had a lower adherence to diet after the initial 11 weeks, and a progressively declining weight loss and weight-loss satisfaction from week 15 or 19 of the weight-loss phase. 11-week dietary adherence and 15-week weight loss were significantly associated with weight maintenance. Similar results were obtained using the amount of weight change as dependent variable. CONCLUSIONS: Adherence to diet, weight loss and weight-loss satisfaction, measured during the late weight-loss phase, are associated with weight-loss maintenance. LEVEL OF EVIDENCE: Level III, evidence obtained from well-designed cohort or case-control analytical studies.

The Influence of Weight-Loss Expectations on Weight Loss and of Weight-Loss Satisfaction on Weight Maintenance in Severe Obesity.

BACKGROUND: Conflicting evidence exists as to whether cognitive mechanisms contribute to weight loss and maintenance. OBJECTIVE: To assess the influence of weight-loss expectations on weight loss, and of weight-loss satisfaction on weight maintenance, in individuals with severe obesity. DESIGN: A randomized controlled trial comparing two types of energy-restricted diets (high protein vs high carbohydrate) combined with weight-loss cognitive behavioral therapy, conducted over 51 weeks and divided into two phases: weight-loss phase (3 weeks of inpatient treatment and 24 weeks of outpatient treatment) and weight maintenance phase (24 weeks of outpatient treatment). PARTICIPANTS/SETTING: Eighty-eight participants with severe obesity (mean age=46.7 years and mean body mass index=45.6), referred to an eating and weight disorders clinical service, were studied. MAIN OUTCOME MEASURES: Body weight was assessed at baseline, and after 3, 27 (end of weight-loss phase), and 51 weeks (end of weight maintenance phase). Weight loss expectations were assessed at the time of enrollment, and weight-loss satisfaction was assessed after 27 weeks. STATISTICAL ANALYSES PERFORMED: The relationship between weight-loss expectations and weight loss was assessed using a linear mixed model. The association between weight-loss satisfaction and final outcomes was tested by linear regression. RESULTS: The two groups had similar weight-loss expectations and satisfaction, and their results were therefore pooled. In general, the total amount of expected weight loss (in kilograms), but not the percentage of expected weight loss, predicted weight loss, and both satisfaction with weight loss and the amount of weight lost (in kilograms) were independent predictors of weight maintenance. CONCLUSIONS: Higher expected weight loss improves weight loss, and both the total amount of weight lost and satisfaction with weight loss are associated with weight-loss maintenance at 1-year follow-up.

A randomized trial of energy-restricted high-protein versus high-carbohydrate, low-fat diet in morbid obesity.

OBJECTIVE: Conflicting evidence exists as to weight loss produced by diets with different carbohydrate/protein ratio. The aim was to compare the long-term effects of high-protein vs. high-carbohydrate diet (HPD, HCD), combined with cognitive behavior therapy (CBT). DESIGN AND METHODS: In a randomized trial, 88 obese participants (mean age, 46.7; mean BMI, 45.6 kg m(-2) ) were enrolled in a 3-week inpatient and 48-week outpatient treatment, with continuous CBT during the study period. All subjects consumed a restricted diet (1,200 kcal day(-1) for women, 1,500 for men; 20% energy from fat, <10% saturated fat). HPD derived 34% energy from proteins, 46% from carbohydrates; HCD 17% from proteins, 64% from carbohydrates. The primary outcome was 1-year percent weight loss. Secondary outcomes were attrition rates and changes in cardiovascular risk factors and psychological profile. RESULTS: Attrition rates were similar between groups (25.6%). In the intention-to-treat analysis, weight loss averaged 15.0% in HPD and 13.3% in HCD at 1 year, without any difference throughout the study period. Both diets produced a similar improvement in secondary outcomes. CONCLUSIONS: The relative carbohydrate and protein content of the diet, when combined with intensive CBT, does not significantly affect attrition rate, weight loss and psychosocial outcome in patients with severe obesity.