An epigenetic aging analysis of randomized metformin and weight loss interventions in overweight postmenopausal breast cancer survivors.

Metformin and weight loss relationships with epigenetic age measures-biological aging biomarkers-remain understudied. We performed a post-hoc analysis of a randomized controlled trial among overweight/obese breast cancer survivors (N = 192) assigned to metformin, placebo, weight loss with metformin, or weight loss with placebo interventions for 6 months. Epigenetic age was correlated with chronological age (r = 0.20-0.86; P < 0.005). However, no significant epigenetic aging associations were observed by intervention arms. Consistent with published reports in non-cancer patients, 6 months of metformin therapy may be inadequate to observe expected epigenetic age deceleration. Longer duration studies are needed to better characterize these relationships.Trial Registration: Registry Name: ClincialTrials.Gov.Registration Number: NCT01302379.Date of Registration: February 2011.URL: https://clinicaltrials.gov/ct2/show/NCT01302379.

Clinical usefulness of brief screening tool for activating weight management discussions in primary cARE (AWARE): A nationwide mixed methods pilot study.

OBJECTIVE: The Edmonton Obesity Staging System (EOSS) is based on weight related health complications among individuals with overweight and obesity requiring clinical intervention. We aimed to assess the clinical usefulness of a new screening tool based on the EOSS for activating weight management discussions in general practice. METHODS: We enrolled five General Practitioners (GPs) and 25 of their patients located nationwide in metropolitan areas of Australia to test the feasibility, acceptability, and accuracy of the new 'EOSS-2 Risk Tool', using cross-sectional and qualitative study designs. Diagnostic accuracy of the tool for the presence of EOSS ≥2 criteria was based on clinical information collected prospectively. To assess feasibility and applicability, we explored the views of GP and patient participants by thematic analysis of transcribed verbatim and de-identified data collected by semi-structured telephone interviews. RESULTS: Nineteen (76%) patients were aged ≥45 years, five (20%) were male, and 20 (80%) were classified with obesity. All 25 patients screened positive for EOSS ≥2 criteria by the tool. Interviews with patients continued until data saturation was reached resulting in a total of 23 interviews. Our thematic analysis revealed five themes: GP recognition of obesity as a health priority (GPs expressed strong interest in and understanding of its importance as a health priority); obesity stigma (GPs reported the tool helped them initiate health based and non-judgmental conversations with their patients); patient health literacy (GPs and patients reported increased awareness and understanding of weight related health risks), patient motivation for self-management (GPs and patients reported the tool helped focus on self-management of weight related complications), and applicability and scalability (GPs stated it was easy to use, relevant to a range of their patient groups, and scalable if integrated into existing patient management systems). CONCLUSION: The EOSS-2 Risk Tool is potentially clinically useful for activating weight management discussions in general practice. Further research is required to assess feasibility and applicability.

A staged approach to address youth unresponsive to initial obesity intervention: a randomized clinical trial.

BACKGROUND/OBJECTIVE: Maintenance interventions inherently require BMI improvement to maintain. This overlooks individuals initially unresponsive to obesity interventions. Staged pediatric clinical treatment guidelines were adapted to the school setting to develop an escalated treatment option for individuals initially unresponsive. This staged randomized controlled trial examined differences between escalated treatment (Take CHARGE!) and a maintenance program (PE Planners). Take CHARGE was hypothesized to have greater improvements in BMI as a percentage of the 95th BMI Percentile (%BMIp95) than PE Planners. SUBJECTS/METHODS: From 2018 to 2020, 171 middle and high schoolers (BMI Percentile ≥ 85) were recruited from a Houston school district to participate in a staged obesity intervention in their physical education (PE) class. After receiving a semester-long intensive lifestyle intervention (ILI) with established efficacy, all participants were randomized to Take CHARGE (n = 85) or PE Planners (n = 86). Take CHARGE escalated the behavioral treatment of obesity received in ILI with more frequent individual sessions, additional opportunities for parental and school staff involvement, and increased mentorship from trained college students. PE Planners allowed participants to decide how they wanted to be active in PE class. Mixed linear modeling examined %BMIp95 overtime between groups. This trial was registered at ClinicalTrials.gov (#NCT04362280). RESULTS: Participants were 13.63 ± 1.32 years old; 59% were female, and 85% were Hispanic. Among those initially unresponsive to ILI, Take CHARGE had significantly greater decreases in %BMIp95 than PE Planners (ß = -0.01, p < 0.01). Conversely, among those initially responsive, Take CHARGE had significantly smaller decreases in %BMIp95 than PE Planners (ß = 0.02, p < 0.05). Intention-to-treat analysis had similar results. CONCLUSIONS: Participant outcomes in semester two differed based on initial response. Individuals responsive to initial intervention were most likely to benefit from a maintenance intervention and those initially unresponsive benefited more from escalated treatment. This indicates the need for staged intervention protocols to better address obesity in the school setting.

Factors associated with patient weight loss and prescribed diet during hospitalization / Factores asociados a la pérdida de peso de los pacientes y la dieta prescrita durante la hospitalización

Objective: the aim of this study was to assess weight loss, diet prescribed, and nutritional status in hospitalized patients, as well as their associated factors. Methods: weight loss during hospitalization, nutritional status, disease type, and prescribed diet were investigated in a retrospective study in 621 hospitalized patients. The chi-squared, Fisher's, Mann-Whitney, and Kruskal-Wallis tests were used for statistical analysis. To identify factors associated with weight loss a logistic regression analysis was performed. The significance level adopted for statistical tests was 5 %. Results: patients who experienced weight loss during hospitalization were associated with longer hospital stays (p < 0.0001; OR = 1.052; 95 % CI = 1.030 to 1.073), malnourishment according to the subjective global assessment (p = 0.0358; OR = 1.520; 95 % CI = 1,028 to 2,248), digestive disorders (p = 0.0081; OR = 3.177; 95 % CI = 1.351 to 7.469), and digestive neoplasms (p = 0.0407; OR = 2.410; 95 % CI = 1.038 to 5.597). Conclusion: weight loss during hospitalization was associated with neoplasms, digestive diseases, malnutrition, and length of stay. (AU)

Objetivo: el objetivo de este estudio fue evaluar la pérdida de peso, la dieta prescrita y el estado nutricional de pacientes hospitalizados y sus factores asociados. Métodos: se investigó la pérdida de peso durante la hospitalización, el estado nutricional, el tipo de enfermedad y la dieta prescrita en un estudio retrospectivo de 621 pacientes hospitalizados. Las pruebas del chi cuadrado, Fisher, Mann-Whitney y Kruskal-Wallis se utilizaron para el análisis estadístico. Para identificar los factores asociados con la pérdida de peso se utilizó la regresión logística. El nivel de significación adoptado para las pruebas estadísticas fue del 5 %. Resultados: los casos de pérdida de peso durante la hospitalización se asociaron a las estancias hospitalarias más largas (p < 0,0001; OR = 1,052; IC 95 % = 1,030; 1,073), la desnutrición según la evaluación global subjetiva (p = 0,0358; OR = 1,520; IC 95 % = 1,028; 2,248) los trastornos digestivos (p = 0,0081; OR = 3,177; IC 95 % = 1,351; 7,469) y las neoplasias digestivas (p = 0,0407; OR = 2,410; IC 95 % = 1,038; 5,597). Conclusión: la pérdida de peso durante la hospitalización se asoció con las neoplasias y las enfermedades digestivas, la desnutrición y la duración de la estancia. (AU)

The Doctor Will "Friend" You Now: A Qualitative Study on Adolescents' Preferences for Weight Management App Features.

OBJECTIVES: Primary care providers report a lack of resources as a barrier to managing adolescent obesity. Mobile health applications (apps) may be helpful in weight management; however, adolescents' preferences for weight management app features are unknown. Our objectives were to provide insight into adolescents' preferred weight management app features and elicit facilitators and barriers to app use. METHODS: Using the qualitative content analysis method, 14 interviews with adolescents with overweight/obesity were conducted in rural and urban pediatric offices in South Carolina. Eligibility criteria included being 13 to 17 years old, having a body mass index at or above the 85th percentile for age and sex, and having access to a smartphone or tablet. Semistructured key informant interviews were conducted from May to October 2017. Participants were presented with three popular mobile health apps and asked to complete tasks and comment on their various features and usability. Summative content analysis coding was performed on interview transcripts, and interviews were conducted until thematic saturation was reached. RESULTS: Seventy-one percent of participants were from a rural practice, 64% were White, and 86% had a body mass index higher than the 95th percentile. Familiarity with similar apps and accessibility of apps on their smartphones promoted app use. The need for wireless Internet, operating difficulties, or privacy concerns were barriers. Nutritional education, physical activity tracking, and social connection were desirable app features. CONCLUSIONS: Adolescents have expressed preferred app features to help them manage weight; however, further work is needed to see whether these features are effective.

Extended follow-up of a short total diet replacement programme: results of the Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET) randomised controlled trial at 3 years.

OBJECTIVES: To test the long-term effectiveness of a total diet replacement programme (TDR) for routine treatment of obesity in a primary care setting. METHODS: This study was a pragmatic, two-arm, parallel-group, open-label, individually randomised controlled trial in adults with obesity. The outcomes were change in weight and biomarkers of diabetes and cardiovascular disease risk from baseline to 3 years, analysed as intention-to-treat with mixed effects models. INTERVENTIONS: The intervention was TDR for 8 weeks, followed by food-reintroduction over 4 weeks. Behavioural support was provided weekly for 8 weeks, bi-weekly for the next 4 weeks, then monthly for 3 months after which no further support was provided. The usual care (UC) group received dietary advice and behavioural support from a practice nurse for up to 3 months. RESULTS: Outcome measures were collected from 179 (66%) participants. Compared with baseline, at 3 years the TDR group lost -6.2 kg (SD 9.1) and usual care -2.7 kg (SD 7.7); adjusted mean difference -3.3 kg (95% CI: -5.2, -1.5), p < 0.0001. Regain from programme end (6 months) to 3 years was greater in TDR group +8.9 kg (SD 9.4) than UC + 1.2, (SD 9.1); adjusted mean difference +6.9 kg (95% CI 4.2, 9.5) P < 0.001. At 3 years TDR led to greater reductions than UC in diastolic blood pressure (mean difference -3.3 mmHg (95% CI:-6.2; -0.4) P = 0.024), and systolic blood pressure (mean differences -3.7 mmHg (95% CI: -7.4; 0.1) P = 0.057). There was no evidence of differences between groups in the change from baseline to 3 years HbA1c (-1.9 mmol/mol (95% CI: -0.7; 4.5; P = 0.15), LDL cholesterol concentrations (0.2 mmol/L (95% CI -0.3, 0.7) P = 0.39), cardiovascular risk score (QRISK2) (-0.37 (95% CI -0.96; 0.22); P = 0.22). CONCLUSIONS: Treatment of people with obesity with a TDR programme compared with support from a practice nurse leads to greater weight loss which persists to at least 3 years, but there was only evidence of sustained improvements in BP and not in other aspects of cardiometabolic risk.

Temporal patterns of physical activity in successful weight loss maintainers.

BACKGROUND/OBJECTIVES: Individuals successful at weight loss maintenance engage in high amounts of physical activity (PA). Understanding how and when weight loss maintainers accumulate PA within a day and across the week may inform PA promotion strategies and recommendations for weight management. METHODS: We compared patterns of PA in a cohort of weight loss maintainers (WLM, n = 28, maintaining ≥13.6 kg weight loss for ≥1 year, BMI 23.6 ± 2.3 kg/m2), controls without obesity (NC, n = 30, BMI similar to current BMI of WLM, BMI 22.8 ± 1.9 kg/m2), and controls with overweight/obesity (OC, n = 26, BMI similar to pre-weight loss BMI of WLM, 33.6 ± 5.1 kg/m2). PA was assessed during 7 consecutive days using the activPALTM activity monitor. The following variables were quantified; sleep duration, sedentary time (SED), light-intensity PA (LPA), moderate-to-vigorous intensity PA (MVPA), and steps. Data were examined to determine differences in patterns of PA across the week and across the day using mixed effect models. RESULTS: Across the week, WLM engaged in ≥60 min of MVPA on 73% of days, significantly more than OC (36%, p < 0.001) and similar to NC (59%, p = 0.10). Across the day, WLM accumulated more MVPA in the morning (i.e., within 3 h of waking) compared to both NC and OC (p < 0.01). WLM engaged in significantly more MVPA accumulated in bouts ≥10 min compared to NC and OC (p < 0.05). Specifically, WLM engaged in more MVPA accumulated in bouts of ≥60 min compared to NC and OC (p < 0.05). CONCLUSIONS: WLM engage in high amounts of MVPA (≥60 min/d) on more days of the week, accumulate more MVPA in sustained bouts, and accumulate more MVPA in the morning compared to controls. Future research should investigate if these distinct patterns of PA help to promote weight loss maintenance.

Factors associated with patient weight loss and prescribed diet during hospitalization.

INTRODUCTION: Objective: the aim of this study was to assess weight loss, diet prescribed, and nutritional status in hospitalized patients, as well as their associated factors. Methods: weight loss during hospitalization, nutritional status, disease type, and prescribed diet were investigated in a retrospective study in 621 hospitalized patients. The chi-squared, Fisher's, Mann-Whitney, and Kruskal-Wallis tests were used for statistical analysis. To identify factors associated with weight loss a logistic regression analysis was performed. The significance level adopted for statistical tests was 5 %. Results: patients who experienced weight loss during hospitalization were associated with longer hospital stays (p < 0.0001; OR = 1.052; 95 % CI = 1.030 to 1.073), malnourishment according to the subjective global assessment (p = 0.0358; OR = 1.520; 95 % CI = 1,028 to 2,248), digestive disorders (p = 0.0081; OR = 3.177; 95 % CI = 1.351 to 7.469), and digestive neoplasms (p = 0.0407; OR = 2.410; 95 % CI = 1.038 to 5.597). Conclusion: weight loss during hospitalization was associated with neoplasms, digestive diseases, malnutrition, and length of stay.

INTRODUCCIÓN: Objetivo: el objetivo de este estudio fue evaluar la pérdida de peso, la dieta prescrita y el estado nutricional de pacientes hospitalizados y sus factores asociados. Métodos: se investigó la pérdida de peso durante la hospitalización, el estado nutricional, el tipo de enfermedad y la dieta prescrita en un estudio retrospectivo de 621 pacientes hospitalizados. Las pruebas del chi cuadrado, Fisher, Mann-Whitney y Kruskal-Wallis se utilizaron para el análisis estadístico. Para identificar los factores asociados con la pérdida de peso se utilizó la regresión logística. El nivel de significación adoptado para las pruebas estadísticas fue del 5 %. Resultados: los casos de pérdida de peso durante la hospitalización se asociaron a las estancias hospitalarias más largas (p < 0,0001; OR = 1,052; IC 95 % = 1,030; 1,073), la desnutrición según la evaluación global subjetiva (p = 0,0358; OR = 1,520; IC 95 % = 1,028; 2,248) los trastornos digestivos (p = 0,0081; OR = 3,177; IC 95 % = 1,351; 7,469) y las neoplasias digestivas (p = 0,0407; OR = 2,410; IC 95 % = 1,038; 5,597). Conclusión: la pérdida de peso durante la hospitalización se asoció con las neoplasias y las enfermedades digestivas, la desnutrición y la duración de la estancia.

Patients Desire Personalized, Specific, and Continuous Advice on Weight Management.

OBJECTIVE: To deliver effective care, healthcare systems should understand patients' preferences for weight management across a spectrum of needs. Our objective was to describe patients' perceptions of what helps or hinders weight loss and maintenance. METHODS: Semistructured interviews were conducted with patients who accessed weight management services at a large integrated health system in 2018. The interview guide was developed and iteratively refined through a literature search and by consulting experts. Questions included the respondent's weight history, interactions with the health system, and current health status. The analysis used a grounded theory approach, and each transcript was double-coded in 2019. Codes were sorted into themes. All discrepancies were resolved through team discussion. RESULTS: Fifteen patients were interviewed. The majority of respondents (87%) reported multiple weight loss attempts. Three themes were identified. First, advice should be matched to a patient's knowledge and prior experience (eg, using bariatric deck cards). As patients progressed, clinician advice also needed to advance (eg, explaining how to expand food options instead of defining a healthy diet). Second, respondents had a variety of motivating factors, and understanding where motivation is generated from can inform how to design a weight management approach. Third, patients need continual and long-term advice. Some respondents feared becoming ineligible for services if their weight dropped too much. CONCLUSIONS: Health systems can support patients by developing processes for identifying the extent of a patient's knowledge and giving personalized advice based on the patient's preferences and experiences. Reassessing needs at defined intervals may help patients attain and sustain their goals.

Changes in the Prevalence and Correlates of Weight-Control Behaviors and Weight Perception in Adolescents in the UK, 1986-2015.

Importance: In the context of the growing prevalence of childhood obesity, behaviors aimed at weight loss and their psychological burden might be increasing. Objective: To investigate whether the prevalence of weight-control behaviors and weight perception, including their association with depressive symptoms, has changed in the 3 decades between 1986 and 2015. Design, Setting, and Participants: This study used data from repeated cross-sections from successive longitudinal birth cohort studies. These included general population samples of UK adolescents aged 14 to 16 years from 3 ongoing birth cohorts: the British Cohort Study 1970 (children born between April 5 and 11, 1970; data collected in 1986), the Avon Longitudinal Study of Parents and Children (mothers with expected delivery between April 1, 1991, and December 21, 1992; data collected in 2005), and the Millennium Cohort Study (children born between September 1, 2000, and January 11, 2002; data collected in 2015). A total of 22 503 adolescents with data available on at least 1 weight-control or weight-perception variable in midadolescence were included in the study. Data were analyzed from August 1, 2019, to January 15, 2020. Main Outcomes and Measures: Self-reported lifetime dieting and exercise for weight loss, current intentions about weight (doing nothing, lose weight, stay the same, gain weight), and weight perception (underweight, about the right weight, overweight) adjusted for body mass index. The secondary outcome was depressive symptoms. Exposures: The main exposure was time (ie, cohort); secondary exposures were weight-change behaviors and weight perception. Results: The study cohort included 22 503 adolescents (mean [SD] age, 14.8 [0.3] years; 12 061 girls [53.6%]; and 19 942 White individuals [89.9%]). A total of 5878 participants were from the British Cohort Study, 5832 were from the Avon Longitudinal Study of Parents and Children, and 10 793 were from the Millennium Cohort Study. In 2015, 4809 participants (44.4%) had dieted and 6514 (60.5%) had exercised to lose weight compared with 1952 (37.7%) and 344 (6.8%) in 1986. Furthermore, 4539 (42.2%) were trying to lose weight in 2015 compared with 1767 (28.6%) in 2005. Although girls were more likely to report these behaviors in all years, their prevalence increased more in boys over time (lifetime dieting in boys: odds ratio [OR], 1.79; 95% CI, 1.24-2.59; in girls: OR, 1.23; 95% CI, 0.91-1.66; currently trying to lose weight in boys: OR, 2.75; 95% CI, 2.38-3.19; in girls: OR, 1.70; 95% CI, 1.50-1.92). Adolescents also became more likely to overestimate their weight (boys describing themselves as overweight adjusting for body mass index, 2005 vs 1985 OR, 1.60; 95% CI, 1.17-2.19; 2015 vs 1985 OR, 1.36; 95% CI, 1.04-1.80; girls describing themselves as underweight, after adjusting for body mass index, 2015 vs 1986 OR, 0.51; 95% CI, 0.28-0.91). Girls who described themselves as overweight experienced increasingly greater depressive symptoms over time compared to girls who described their weight as about right (mean difference 1986, 0.32; 95% CI, 0.22-0.41; mean difference 2005, 0.33; 95% CI, 0.24-0.42; mean difference 2015, 0.56; 95% CI, 0.49-0.62). Conclusions and Relevance: These findings suggest that the growing focus on obesity prevention might have had unintended consequences related to weight-control behaviors and poor mental health. Public health campaigns addressing obesity should include prevention of disordered eating behaviors and be sensitive to negative impact on mental health.

Analysing Credibility of UK Social Media Influencers' Weight-Management Blogs: A Pilot Study.

Social media influencers (SMI) are individuals with large follower engagement, who can shape the thoughts and dietary behaviours of their audience. Concerns exist surrounding the spread of dietary misinformation by SMI, which may impact negatively on public health, yet no standards currently exist to assess the credibility of their information. This study aimed to evaluate the credibility of key SMI weight management (WM) blogs (n = 9), piloting a pre-prepared credibility checklist. SMI were included if they had a blue-tick verification on ≥2 social media (SM) and an active WM blog. A sample of blog posts were systematically evaluated against thirteen credibility indicators under four themes: 'transparency', 'use of other resources', 'trustworthiness and adherence to nutritional criteria' and 'bias'. Indicators were yes/no questions to determine an overall credibility percentage for each SMI. The ten most recent meal recipes from each blog were evaluated against Public Health England's (PHE) calorie targets and the UK 'traffic light' food labelling scheme to assess nutritional quality. Percentages ranged from 23-85%, the highest gained by a Registered Nutritionist. SMI blogs may not be credible as WM resources. Given the popularity and impact of SM in the context of overweight, obesity and WM, this study may inform the methodological approach for future research.

Qualitative study on the key elements of obesity counseling in Korean Medicine.

INTRODUCTION: The increasing prevalence of obesity worldwide necessitates the provision of support for many patients. Patients with obesity appreciate receiving advice from doctors. Previous studies have qualitatively explored clinicians' counseling for weight loss; however, this is limited to primary physicians or general practitioners working in community health centers. In contrast, Korean Medicine Doctors (KMDs) have treated patients with obesity using a holistic approach with a multicomponent approach on counseling. However, there is currently no data regarding KMDs' consulting practices for weight loss. Therefore, the present study will explore KMDs' experience in counseling for weight loss and describe the constituents of counseling for weight loss in Korean medicine practice. METHODS: This qualitative study utilizes a phenomenological framework. The KMDs who have worked >1 year as practitioners in treating patients with obesity will be invited to describe their lived experiences of counseling patients for weight loss. Purposive and snowball sampling will be undertaken to ensure that the sample provides information-rich cases that are representative of KMDs' experiences of counseling for weight loss. Face-to-face, individual, and semi-structured interviews will be conducted with the participants, which will be analyzed using a phenomenological method. ETHICS AND DISSEMINATION: Ethical approval was granted by the Human Research Ethics Committee of the Korea Institute of Oriental Medicine (I-1908/006-001). The results will be disseminated via journal articles and conference presentations. TRIAL REGISTRATION NUMBER: Korean Clinical Trial Registry, KCT0004985.

Effectiveness of a Primary Care-Based Pediatric Weight Management Program.

BACKGROUND: Childhood obesity is a growing epidemic of great concern for our nation, including pediatric populations treated at military treatment facilities. OBJECTIVE: This study aims to retrospectively evaluate the effectiveness of a primary care-based structured weight management program in a sample of pediatric patients with obesity at a military treatment facility. METHODS: This study was a retrospective chart review of patients enrolled in the All About Me Program (AAMP) from August 1, 2011, through July 10, 2012. Baseline demographics, 5-2-1-0 behavioral targets, and anthropometric measures were obtained from 54 enrollees. Pre- and post-program weight, body mass index (BMI) percentile, and 5-2-1-0 behavioral targets were compared for 20 patients who completed the program which consisted of a total of five visits over 3 months. RESULTS: Participants showed a significant reduction in their BMI, improvement in daily servings of fruits and vegetables, reduction in recreational screen time from baseline, improvement in daily physical activity, and reduction in consumption of sugary beverages. CONCLUSIONS: These preliminary findings are a promising indicator that primary care-based obesity interventions may be effective for the management and treatment of pediatric obesity. IMPLICATIONS FOR NURSING: This evidence-based toolkit provides a practical point-of-care guidance on the prevention, assessment, and treatment of childhood obesity and can be easily implemented in other primary care settings.

Management of inadequate weight loss or weight regain in post-bariatric surgical patients.

Nurse practitioners play a key role in the front-line treatment of obesity in primary care practice settings. National guidelines for the management of obesity are provided by a majority of national organizations, yet little guidance is provided for the management of post-bariatric surgical patients who experience inadequate weight loss or early weight regain. As the number of surgical procedures increases, guidelines and interventions for managing this complex outcome are needed.

Using targeting to recruit men and women of color into a behavioral weight loss trial.

BACKGROUND: The majority of participants in weight loss trials are non-Hispanic White women, while men and women of color are underrepresented. This study presents data obtained from non-targeted and targeted recruitment approaches in a trial of behavioral weight loss programs to (1) describe the yields from each approach and (2) compare the demographics, weight control histories, and study involvement of samples recruited by each approach. METHODS: Data for this observational study include source of recruitment, demographic information, weight loss experiences (e.g., lifetime weight loss, current weight loss behaviors), and completion of the 6-month assessment visit. RESULTS: Men comprised 14.2% of participants who responded to non-targeted recruitment efforts, while targeted efforts yielded 50.4% men. Similarly, people of color comprised 12.8% of those who responded to non-targeted approaches, whereas targeted recruitment methods yielded 47.2% people of color. Men recruited through targeted methods were younger (p = 0.01) than men recruited through non-targeted means but were otherwise similar. Women of color recruited through targeted methods reported use of fewer weight loss strategies relative to women of color recruited through non-targeted means (p = 0.006) but were otherwise similar. There were no differences by recruitment method on retention to the study. CONCLUSIONS: Using targeted recruitment methods increased the ethnic and gender diversity of the recruited sample without reducing study retention. This targeting also increased the enrollment of women with less weight loss experience who may not have otherwise sought out a weight loss program. Developing and implementing a targeted recruitment plan should be considered early in the clinical trial development process. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02368002. Registered on 20 February 2015.

The NEW Keiki Program Reduces BMI z-scores Among Overweight and Obese Children and BMI Among Their Adult Caregivers in Hawai'i.

The high prevalence of childhood obesity highlights the need for effective weight management interventions. This study evaluated a family-based weight management program (Nutrition+Exercise+Weight Management; NEW Keiki) in overweight and obese children and their adult caregivers. Data were collected on overweight (body mass index, BMI = 85th-94th percentile) and obese (BMI > 95th percentile) children (n = 75, 5-14 years) and their adult caregivers (n = 104). Seventy-one percent of the enrolled children identified as Native Hawaiian, Pacific Islander, and/or Filipino (NHPI+F). Families participated weekly in a multidisciplinary lifestyle program for 8-9 weeks (intervention phase); follow-up visits occurred at 6-months and 12-months post-intervention. Long-term data (14-50 months post intervention) were collected by chart review for the children. Change in children's BMI z-score and adult BMI were analyzed. The effects of ethnicity, acceptance of government assistance, and program attendance were evaluated. Participants identifying as NHPI+F and/or receiving government assistance had higher baseline BMI z-scores and BMIs. In children, BMI z-score decreased from baseline at all evaluation visits (-0.05 at 2 months [P < .001], -0.07 at 6-month follow-up [P < .001], -0.04 at 12-month follow-up [P = .05], -0.06 at long-term follow-up [P = .01]). At the 2 month visit BMI decreased from baseline for adults (-0.39 [P < .001]). Decreases in BMI z-score and BMI were independent of program attendance, ethnicity, and acceptance of government assistance. This study, unique in its inclusion of both adults and overweight children, supports the effectiveness of a community-developed program to address weight management in an ethnically diverse population.

A comparison of diet versus diet + exercise programs for health improvement in middle-aged overweight women.

BACKGROUND: Obesity is an independent risk factor for many diseases. Many studies have investigated the benefits of losing weight as well as the best methods for weight loss. This research evaluated the impact of various weight loss programs on health enhancement among overweight women aged 40-60 years. METHODS: This was a retrospective observational study that analyzed data from 145 overweight women in weight loss programs. Each woman joined one of four programs: 8 weeks of exercise plus diet (exe + nutr), 8 weeks of diet only (nutrition), 8 weeks of exercise only, or a control group. Women completed a psychological questionnaire and also underwent anthropometric tests, blood pressure checks, a predicted maximal oxygen consumption (VO2 max) test on an ergometer bicycle, a one-leg balance test, straight leg test, and a sit and reach test, both before and after the program. Participants also provided a blood sample. RESULTS: All of the measured variables improved in the exe + nutr and nutrition programs when compared with the control group; the exe + nutr group improved the most: body mass index, -1.3 kg/m2; body fat, -2.9%; lean body mass, +1.1; VO2 max, +4.8; body image, +1.02; and p < 0.01. CONCLUSION: The hypothesis-generating findings showed that weight loss programs improved anthropometric, biochemical, physiological, physical, and psychological variables in women aged 40-60 years. The program that included diet restriction with exercise, guidance, and regular counseling showed the best results.