Group dynamics are associated with weight loss in the behavioral treatment of obesity.

OBJECTIVE: To assess whether group dynamics are associated with weight loss, session attendance, and self-monitoring adherence after 6 months of lifestyle intervention for obesity. METHODS: Women with obesity (N = 125; mean ± SD BMI = 37.84 ± 3.94 kg/m(2) ; age = 51.99 ± 10.81 years) participated in a 24-week group-based lifestyle weight loss intervention and achieved a weight loss of 9.13 ± 7.15 kg after 6 months. Participants reported their perceptions of group conflict, avoidance, engagement, social support, and attraction at the end of treatment. Multiple regression with forward selection assessed which group dynamic variables were associated with weight loss, attendance, and adherence. RESULTS: Greater perceived group conflict was associated with smaller weight losses (ß = 1.833, P = 0.044) and lower attendance (ß = -2.313, P = 0.002) and adherence rates (ß = -2.261, P = 0.030). Higher group attraction was associated with higher attendance rates (ß = 0.051, P = 0.039). The association between perceived conflict and weight change was mediated by attendance and adherence (P = 0.019). CONCLUSIONS: Findings demonstrate that group dynamics associate with weight loss outcomes, attendance, and adherence. Addressing conflicts and fostering acceptance among group members may promote success in group-based lifestyle interventions for obesity.

Associations between body mass index and sexual functioning in midlife women: the Study of Women's Health Across the Nation.

OBJECTIVE: This study aims to examine baseline and longitudinal associations between body mass index (BMI) and sexual functioning in midlife women. METHODS: Midlife women (N = 2,528) from the Study of Women's Health Across the Nation reported on sexual functioning and underwent measurements of BMI annually beginning in 1995-1997, with follow-up spanning 13.8 years. Associations between baseline levels and longitudinal changes in BMI and sexual desire, arousal, intercourse frequency, and ability to climax were assessed with generalized linear mixed-effects models. Models were adjusted for demographic variables, depressive symptoms, hormone therapy use, alcohol intake, menopause status, smoking status, and health status. RESULTS: Mean BMI increased from 27.7 to 29.1 kg/m2, whereas all sexual functioning variables declined across time (P values ≤ 0.001). Higher baseline BMI was associated with less frequent intercourse (P = 0.003; 95% CI, -0.059 to -0.012). Although overall change in BMI was not associated with changes in sexual functioning, years of greater-than-expected BMI increases relative to women's overall BMI change trajectory were characterized by less frequent intercourse (P < 0.001; 95% CI, -0.106 to -0.029) and reduced sexual desire (P = 0.020; 95% CI, -0.078 to -0.007). CONCLUSIONS: Although women's overall BMI change across 13.8 years of follow-up was not associated with overall changes in sexual functioning, sexual desire and intercourse frequency diminished with years of greater-than-expected weight gain. Results suggest that adiposity and sexual functioning change concurrently from year to year. Further research should explore the impact of weight management interventions as a strategy for preserving sexual functioning in midlife women.

Meal preparation and cleanup time and cardiometabolic risk over 14 years in the Study of Women's Health Across the Nation (SWAN).

OBJECTIVE: To determine whether baseline levels and longitudinal changes in meal preparation and cleanup time are associated with changes in cardiometabolic risk factors in midlife women. METHODS: Subjects were 2755 midlife women enrolled in the Study of Women's Health Across the Nation, a multi-ethnic, longitudinal cohort study in the United States. The five diagnostic components of the metabolic syndrome and meal preparation/cleanup time were assessed repeatedly across 14 years of follow-up (spanning 1996-2011) at seven U.S. sites. Mixed-effects logistic and ordered logistic models tested associations between meal preparation/cleanup time and odds of meeting criteria for metabolic syndrome and its individual diagnostic components. RESULTS: Women who spent more time preparing and cleaning up meals at baseline, or demonstrated greater increases in this activity, had greater increases over time in their odds of having metabolic syndrome and in the number of metabolic syndrome components for which they met criteria. Adjusted associations were observed between meal preparation/cleanup time and hypertension, impaired fasting glucose, hypertriglyceridemia, and low high-density lipoprotein cholesterol, but not abdominal obesity. CONCLUSIONS: In midlife women, greater meal preparation/cleanup time is associated with the development of an adverse cardiometabolic risk profile. Public health interventions should place greater emphasis on cooking healthfully, not just cooking frequently.

A randomized trial comparing weight loss treatment delivered in large versus small groups.

BACKGROUND: Behavioral interventions for obesity are commonly delivered in groups, although the effect of group size on weight loss has not been empirically evaluated. This behavioral weight loss trial compared the 6- and 12-month weight changes associated with interventions delivered in a large group (LG) or small groups (SG). METHODS: Obese adults (N = 66; mean age = 50 years; mean BMI = 36.5 kg/m2; 47% African American; 86% women) recruited from a health maintenance organization were randomly assigned to: (1) LG treatment (30 members/group), or (2) SG treatment (12 members/group). Conditions were comparable in frequency and duration of treatment, which included 24 weekly group sessions (months 1-6) followed by six monthly extended care contacts (months 7-12). A mixed effects model with unstructured covariance matrix was applied to analyze the primary outcome of weight change while accounting for baseline weight and dependence among participants' measurements over time. RESULTS: SG participants lost significantly more weight than LG participants at Month 6 (-6.5 vs. -3.2 kg; p = 0.03) and Month 12 (-7.0 vs. -1.7 kg; p < 0.002). SG participants reported better treatment engagement and self-monitoring adherence at Months 6 and 12, ps < 0.04, with adherence fully mediating the relationship between group size and weight loss. CONCLUSIONS: Receiving obesity treatment in smaller groups may promote greater weight loss and weight loss maintenance. This effect may be due to improved adherence facilitated by SG interactions. These novel findings suggest that the perceived efficiency of delivering behavioral weight loss treatment to LGs should be balanced against the potentially better outcomes achieved by a SG approach.

Dietary self-monitoring and long-term success with weight management.

OBJECTIVE: To examine the contributions of frequency, consistency, and comprehensiveness of dietary self-monitoring to long-term weight change. METHODS: Participants included 220 obese women (mean ± SD, age = 59.3 ± 6.1 years; BMI = 36.8 ± 4.9 kg/m(2) ) who achieved a mean weight loss of -10.39 ± 5.28% from baseline during 6 months of behavioral treatment and regained 2.30 ± 7.28% during a 12-month extended-care period. The contributions of cumulative frequency of self-monitoring (total number of food records), consistency across time (number of weeks with ≥3 records), and comprehensiveness of information recorded were examined as predictors of weight regain in a hierarchical linear regression analysis. The mediating role of adherence to daily caloric intake goals was tested using a bootstrapping analysis. RESULTS: The association between high total frequency of self-monitoring and reduced weight regain was moderated by weekly consistency of self-monitoring, P = 0.004; increased frequency produced beneficial effects on weight change only when coupled with high consistency (>3 days/week). There was no impact of comprehensiveness on weight change, P > 0.05. The favorable effect of high frequency/high consistency self-monitoring on weight change was partially mediated by participants' success in meeting daily caloric intake goals (P < 0.001). CONCLUSION: The combination of high frequency plus high consistency of dietary self-monitoring improves long-term success in weight management.

Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: a systematic review.

Mindfulness-based approaches are growing in popularity as interventions for disordered eating and weight loss. Initial research suggests that mindfulness meditation may be an effective intervention for binge eating; however, no systematic review has examined interventions where mindfulness meditation was the primary intervention and no review has examined its effect on subclinical disordered eating or weight. Using the PRISMA method for systematic reviews, we reviewed 14 studies that investigated mindfulness meditation as the primary intervention and assessed binge eating, emotional eating, and/or weight change. Results suggest that mindfulness meditation effectively decreases binge eating and emotional eating in populations engaging in this behavior; evidence for its effect on weight is mixed. Additional research is warranted to determine comparative effectiveness and long-term effects of mindfulness training.

Dietary self-monitoring in patients with obstructive sleep apnea.

Self-monitoring of food intake is a cornerstone of behavioral weight loss interventions, but its use has not been evaluated in the treatment of obese patients with obstructive sleep apnea (OSA). This pilot study described patterns of adherence to dietary self-monitoring in obese patients with OSA and determined associations between self-monitoring and weight loss, psychosocial functioning, and adherence to continuous positive airway pressure treatment. Participants completed a 6-week behavioral weight loss intervention focused on dietary self-monitoring. Approximately one-third of participants were adherent to self-monitoring throughout the course of the intervention and experienced more weight loss than those who did not self-monitor regularly. More frequent dietary self-monitoring also appeared to be associated with adherence to other health behaviors. These preliminary data suggest that use of dietary self-monitoring may be beneficial for promoting weight loss and adherence to other important health behaviors in OSA patients.

Beverages contribute extra calories to meals and daily energy intake in overweight and obese women.

Caloric beverages may promote obesity by yielding energy without producing satiety, but prior laboratory and intervention studies are inconclusive. This study examined whether the diets of free-living overweight and obese women show evidence that calories from beverages are offset by reductions in solid food within individual eating occasions and across entire days. Eighty-two women weighed and recorded all consumed foods and beverages for seven days. Beverages were coded as high-calorie (≥ 0.165 kcal/g) or low-calorie (<0.165 kcal/g), and total energy intake and energy intake from solid food were calculated for each eating occasion and day. In covariate-adjusted models, energy intake from solid food did not differ between eating occasions that included high-calorie or low-calorie beverages and those with no reported beverage. Energy intake from solid food was also unrelated to the number of high-calorie or low-calorie beverages consumed per day. On average, eating occasions that included a high-calorie beverage were 169 kcal higher in total energy than those with no reported beverage, and 195 kcal higher in total energy than those that included a low-calorie beverage. Each high-calorie beverage consumed per day contributed an additional 147 kcal to women's daily energy intake, whereas low-calorie beverage intake was unrelated to daily energy intake. Beverages contributed to total energy intake in a near-additive fashion among free-living overweight and obese women, suggesting a need to develop more effective interventions to reduce caloric beverage intake in the context of weight management, and to potentially reexamine dietary guidelines.

Food insecurity is linked to a food environment promoting obesity in households with children.

OBJECTIVE: To determine the extent to which the presence and accessibility of healthful and less healthful foods in children's homes vary with level of food security. METHODS: A total of 41 parents or primary caregivers who had at least 1 child ages 2-13 and resided in a low-income area with limited food access completed a home food inventory and a validated measure assessing household food security. RESULTS: Compared with food-secure participants, marginal or low/very low food-secure caregivers reported significantly more obesity-promoting foods in the home, more microwavable or quick-cook frozen foods, and greater access to less healthful foods in the kitchen (all Ps < .05). CONCLUSIONS AND IMPLICATIONS: Given the greater presence and accessibility of less healthful foods, targeting home food environment may improve diet quality and health status in children of low-income, food insecure households.

Feasibility and acceptability of Internet grocery service in an urban food desert, Chicago, 2011-2012.

We explored the feasibility and acceptability of an Internet grocery service (IGS) as an approach to improving food access in urban neighborhoods. In our pilot study, caregivers residing in a documented Chicago food desert (N = 34, 79% ethnic minority) received a voucher to use a commercial IGS to purchase groceries for their household. Caregivers most frequently purchased fruits, vegetables, meats, and caloric beverages, and endorsed 4 factors as potentially important determinants of future IGS use. IGS programs could have a role in improving urban food access if they have competitive prices, provide rapid delivery, and incorporate strategies to discourage purchasing of discretionary caloric beverages.

Effects of prescribing 1,000 versus 1,500 kilocalories per day in the behavioral treatment of obesity: a randomized trial.

OBJECTIVE: Controversy exists regarding the optimal energy prescription to promote successful long-term behavioral management of obesity. Prescribing intake of 1,000 (vs. 1,500) kcal/day may produce larger initial weight reduction, but long-term advantage remains unclear. The effects of prescribing 1,000 versus 1,500 kcal/day on 6- and 12-month weight changes within behavioral treatment of obesity were examined. DESIGN AND METHODS: Participants were 125 obese women (mean ± SD; BMI = 37.84 ± 3.94 kg/m(2) ) randomly assigned goals of 1,000 or 1,500 kcal/day. RESULTS: From months 0 to 6, participants prescribed 1,000 kcal/day lost more weight than those prescribed 1,500 kcal/day (mean ± SE = -10.03 ± 0.92g vs. -6.23 ± 0.94 kg, P = 0.045); however, from months 7 through 12, only the 1,000 kcal/day condition experienced a significant weight regain (1.51 ± 0.77 kg, P = 0.025). Baseline caloric consumption moderated the effect of treatment on regain; participants with baseline intakes ≧2,000 kcal/day who were assigned 1,000 kcal/day were significantly more susceptible to weight regain than those assigned 1,500 kcal/day (P = 0.049). At month 12, a significantly greater percentage of 1,000 kcal/day participants achieved weight reductions of 5% or more than those prescribed 1,500 kcal/day. CONCLUSION: Encouraging obese individuals in behavioral treatment to adhere to a 1,000 kcal/day intake may increase their likelihood of achieving clinically meaningful weight losses.

Confirmatory factor analysis of the Beck Depression Inventory-II in bariatric surgery candidates.

Screening for depression is an integral part of psychological evaluations conducted prior to bariatric surgery. The Beck Depression Inventory-II (BDI-II) is the most commonly used measure of depression in these treatment evaluations. The reliability and validity of the BDI-II has not yet been evaluated within bariatric surgery-seeking samples, evidencing a significant gap in the present literature. The purpose of the present study is to evaluate the structural validity of the BDI-II and to examine the reliability and convergent and criterion validity of this instrument within a bariatric surgery-seeking sample. The study population consisted of 505 ethnically diverse bariatric surgery candidates presenting for presurgical psychological evaluations in a midwestern urban academic medical center. Confirmatory factor analytic results indicated that a 3-factor model consisting of affective, cognitive, and somatic factors was the best fitting model of depression within this sample. Internal consistency reliability was satisfactory for each subscale, ranging from .72 to .82. Moderate to large correlations were observed between each BDI-II subscale and a measure of depression previously validated with bariatric surgery candidates indicating adequate convergent validity. On the basis of clinical interview, 14% of the sample was diagnosed with current major depression. Significant mean differences were observed between depressed and nondepressed patients with respect to each BDI-II subscale score, demonstrating criterion-related validity. The BDI-II is a reliable and valid measure of depression for bariatric surgery candidates. Understanding the factor structure of the BDI-II can be useful for planning potential presurgical psychological interventions.

The association between rate of initial weight loss and long-term success in obesity treatment: does slow and steady win the race?

BACKGROUND: Controversy exists regarding the optimal rate of weight loss for long-term weight management success. PURPOSE: This study examined whether gradual initial weight loss was associated with greater long-term weight reduction than rapid initial loss. METHODS: Groups were drawn from participants in the TOURS trial, which included a sample of middle-aged (mean = 59.3 years) obese women (mean BMI = 36.8) who received a 6-month lifestyle intervention followed by a 1-year extended care program. Participants were encouraged to reduce caloric intake to achieve weight losses of 0.45 kg/week. Groups were categorized as "FAST" (> or =0.68 kg/week, n = 69), "MODERATE" (> or =0.23 and <0.68 kg/week, n = 104), and "SLOW" (<0.23 kg/week, n = 89) based on rate of weight loss during first month of treatment. RESULTS: The FAST, MODERATE, and SLOW groups differed significantly in mean weight changes at 6 months (-13.5, -8.9, and -5.1 kg, respectively, ps < 0.001), and the FAST and SLOW groups differed significantly at 18 months (-10.9, -7.1, and -3.7 kg, respectively, ps < 0.001). No significant group differences were found in weight regain between 6 and 18 months (2.6, 1.8, and 1.3 kg, respectively, ps < 0.9). The FAST and MODERATE groups were 5.1 and 2.7 times more likely to achieve 10% weight losses at 18 months than the SLOW group. CONCLUSION: Collectively, findings indicate both short- and long-term advantages to fast initial weight loss. Fast weight losers obtained greater weight reduction and long-term maintenance, and were not more susceptible to weight regain than gradual weight losers.

Alternative Gnas gene products have opposite effects on glucose and lipid metabolism.

Gnas is an imprinted gene with multiple gene products resulting from alternative splicing of different first exons onto a common exon 2. These products include stimulatory G protein alpha-subunit (G(s)alpha), the G protein required for receptor-stimulated cAMP production; extralarge G(s)alpha (XLalphas), a paternally expressed G(s)alpha isoform; and neuroendocrine-specific protein (NESP55), a maternally expressed chromogranin-like protein. G(s)alpha undergoes tissue-specific imprinting, being expressed primarily from the maternal allele in certain tissues. Heterozygous mutation of exon 2 on the maternal (E2m-/+) or paternal (E2+/p-) allele results in opposite effects on energy metabolism. E2m-/+ mice are obese and hypometabolic, whereas E2+/p- mice are lean and hypermetabolic. We now studied the effects of G(s)alpha deficiency without disrupting other Gnas gene products by deleting G(s)alpha exon 1 (E1). E1+/p- mice lacked the E2+/p- phenotype and developed obesity and insulin resistance. The lean, hypermetabolic, and insulin-sensitive E2+/p- phenotype appears to result from XLalphas deficiency, whereas loss of paternal-specific G(s)alpha expression in E1+/p- mice leads to an opposite metabolic phenotype. Thus, alternative Gnas gene products have opposing effects on glucose and lipid metabolism. Like E2m-/+ mice, E1m-/+ mice had s.c. edema at birth, presumably due to loss of maternal G(s)alpha expression. However, E1m-/+ mice differed from E2m-/+ mice in other respects, raising the possibility for the presence of other maternal-specific gene products. E1m-/+ mice had more severe obesity and insulin resistance and lower metabolic rate relative to E1+/p- mice. Differences between E1m-/+ and E1+/p- mice presumably result from differential effects on G(s)alpha expression in tissues where G(s)alpha is normally imprinted.