BACKGROUND:Obesity is an urgent public health problem, yet only a few clinical trials have systematically tested the efficacy of long-term weight-loss maintenance interventions. This randomized clinical trial tested the efficacy of a novel mind and body technique for weight-loss maintenance.METHODS:Participants were obese adults who had completed a six-month behavioral weight-loss program prior to randomization. Those who successfully lost weight were randomized into either an experimental weight-loss maintenance intervention, Tapas Acupressure Technique (TAT(R)), or a control intervention comprised of social-support group meetings (SS) led by professional facilitators. TAT combines self-applied light pressure to specific acupressure points accompanied by a prescribed sequence of mental steps. Participants in both maintenance conditions attended eight group sessions over six months of active weight loss maintenance intervention, followed by an additional 6 months of no intervention. The main outcome measure was change in weight from the beginning of the weight loss maintenance intervention to 12 months later. Secondary outcomes were change in depression, stress, insomnia, and quality of life. We used analysis of covariance as the primary analysis method. Missing values were replaced using multiple imputation.RESULTS:Among 285 randomized participants, 79% were female, mean age was 56 (standard deviation (sd) = 11), mean BMI at randomization was 34 (sd = 5), and mean initial weight loss was 9.8 kg (sd = 5). In the primary outcome model, there was no significant difference in weight regain between the two arms (1.72 kg (se 0.85) weight regain for TAT and 2.96 kg (se 0.96) weight regain for SS, p < 0.097) Tests of between- arm differences for secondary outcomes were also not significant. A secondary analysis showed a significant interaction between treatment and initial weight loss (p < .036), with exploratory post hoc tests showing that greater initial weight loss was associated with more weight regain for SS but less weight regain for TAT.CONCLUSIONS:The primary analysis showed no significant difference in weight regain between TAT and SS, while secondary and post hoc analyses indicate direction for future research.TRIAL REGISTRATION:ClinicalTrials.gov: NCT00526565

Within nutrigenomics, clustering using data generated by microarray gene expression profiles can be used to identify sub-populations of subjects that respond differently to a given diet intervention. The use of clustering analyses is promising in obesity-related research as personalized nutrition is gaining popularity. This thesis focuses on clustering a human subcutaneous adipose tissue gene expression data set obtained during a low-calorie diet intervention to aid in the prediction of 6-month weight loss maintenance. The aims of the study were (1) to identify the best performing clustering method for clustering samples, (2) to identify differential responders to the low-calorie diet, and (3) to identify the biological pathways affected during the low-calorie diet by weight maintainers and weight regainers. MCLUST performed the best when clustering samples using relative weight change and either fasting insulin or insulin resistance change. Furthermore, it identified differences in the regulation of pathways between weight maintainers and regainers.

Aim: This study aims to examine the factors that are perceived to contribute to lasting weight loss. To try to understand the psychosocial factors- and what aspects of physical activity and the relationship with food is perceived as supporting and/or inhibiting for lasting weight loss. Method: Participants (n=7) who lost weight and kept it off during a minimum of six months were interviewed about their experience of weight loss maintenance using a semistructured interview. To participate in this study one of the criterias was to have a BMI over 25 from start, but a BMI under 30 after their weight loss. The age varied between 23-48 years old, and they had lost 5-15 % of total body weight. Results: The participants had a strong internal motivation and has enjoyed physical activity since early age. Avoiding fast food, and the sugar and fast carbohydrates it contains, and instead make home cooked food was a success factor for the participants in this study. Emotional eating, injuries interfering with physical activity, lack of motivation to perform certain exercises perceived as boring, difficulties getting started with physical activity and certain living conditions are listed as inhibiting factors. The participants received no or neutral social support, this didn't seem to affect the results but contradicts other research findings. Conclusion: To achieve lasting weight loss, factors of success are strong internal motivation and a healthy relationship to food. Early contact with physical activity, and the enjoyment of performing it are also key aspects. The inhibiting factors for weight loss maintenance consisted in emotional eating, injuries interfering with physical activity, lack of motivation to perform certain exercises perceived as boring, difficulties getting started with physical activity and certain living conditions. / Syfte och frågeställningar: Den här studien syftar till att undersöka vilka faktorer som upplevs bidra till varaktig viktminskning. Frågeställningarna var designade för att försöka förstå de psykosociala faktorerna och vilka aspekter av fysisk aktivitet samt relation till mat som upplevs som främjande och/eller hämmande för varaktig viktminskning. Metod: Individer (n=7) som gått ner i vikt och bibehållit sin viktminskning i minst sex månader deltog i semistrukturerade intervjuer om deras upplevelse av varaktig viktminskning. Inklusionskriterierna var att deltagarna ska ha haft ett BMI över 25 vid viktminskningsfasens start och ett BMI under 30 vid dess slut samt att viktminskningen ska omfatta 5-15 % av deras kroppsvikt. Deltagarnas ålder sträckte sig mellan 23 och 48 år. Resultat: Deltagarna hade en stark inre motivation och har uppskattat fysisk aktivitet sedan tidigt ålder. De försöker undvika snabbmat som består av socker och snabba kolhydrater och gör istället hemlagad mat. Dessa var framgångsfaktorer för deltagarna i denna studie. Känslomässigt ätande, skador som förhindrar fysisk aktivitet, bristande motivation att utföra vissa träningsformer som ansågs svåra/jobbiga/tråkiga, svårt att komma igång, och vissa levnadsförhållanden som exempelvis arbetstid och boendesituation uppges som hämmande faktorer. Deltagarna fick inget eller neutralt socialt stöd, något som inte verkar ha påverkat resultatet, men motsäger de resultat som återfinns i annan forskning. Slutsats: Främjande faktorer för varaktig viktminskning är stark inre motivation, en hälsosam relation till kost, tidig kontakt med fysisk aktivitet samt att se den som ett roligt och avslappnande inslag i livet. De hämmande faktorerna för varaktig viktminskning består av känslomässigt ätande, skador som försvårar fysisk aktivitet, bristande motivation för att utföra aktiviteter som upplevs vara svåra/jobbiga/tråkiga, svårt att komma igång med fysisk aktivitet samt vissa levnadsförhållanden.

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Current literature emphasizes poor long-term weight loss maintenance (WTLM) outcomes, and the need for inexpensive, practical solutions for effective WTLM is evident. Individuals successful at WTLM utilize similar behaviors but in varying amounts and combinations, seemingly choosing behaviors that best fit their preferences. Researchers have attempted to identify characteristics of individuals that may predict successful WTLM in order to develop flexible WTLM treatments based on individuals' lifestyle and preferences. The purpose of this analysis was to examine sex differences in WTLM outcomes and to identify potential behaviors related to WTLM success. In a 12-month study targeting WTLM, weight-reduced middle-aged and older men and women (n=39) were assigned behavioral goals for body weight, fruit and vegetable intake, water consumption, and physical activity and were asked to daily self-monitor body weight and these behaviors. Sex difference in clinically significant WL ≥5% WL) at 12 months was determined. A growth curve model assessed interactions of sex and WTLM predictors, and a crisp set qualitative comparative analysis (QCA) characterized individuals' weight changes and behaviors. No sex difference was found in clinically significant WL or in the interaction of sex and behaviors on weight change; however, QCA evidence suggests men and women may approach WTLM with different behaviors. Additionally, QCA findings suggest weight change in the first 3 months of WTLM may determine success at 12-months. WTLM treatments should provide more intensive support during the transition period from WL to WTLM. Future research in predictors of WTLM, particularly within the context of sex, is essential. / Master of Science

Weight management is problematic among Americans, as the number of overweight adults has risen to two-thirds of the population (1). Without the identification of successful approaches to promote weight stability, it is predicted that 86% of American adults will be overweight or obese by 2030 (2). Body-weight influenced diseases, such as diabetes and cardiovascular disease, are now leading causes of death (3). Annually, adult Americans are thought to increase their body weight by 0.5-0.9 kg (4). Of this gain, 52% is believed to occur during the winter holiday period of mid-late November to early January (5). Unfortunately, obesity research specific to this high-risk period is limited. Older adults and weight-reduced individuals are thought to be highly susceptible to significant holiday body weight gains (1, 6). To date, little research has investigated effective interventions that may be used to assist in successful body weight maintenance during the winter holiday period. Therefore, our purpose was to determine if daily self-monitoring of body weight, physical activity, and step counts is a feasible and effective tool to prevent weight gain in older, weight-reduced adults during the winter holiday period. This intervention represents a holiday weight maintenance approach that may be translatable to larger, more diverse populations. / Master of Science

Objective: This study’s purpose was to examine dietary quality, macronutrient intake, and micronutrient adequacy among long term weight loss maintainers (WLM) in a commercial weight management program. Methods: Participants were 1,207 WLM in WW (formerly Weight Watchers) who had maintained a 9.1 kg or greater weight loss (29.7 kg on average) for 3.4 years, and had an average BMI of 28.3 kg/m2. A control group of weight stable adults with obesity (Controls; N=102) had a BMI of 41.1 kg/m2 and 2.3 kg or less weight change over the previous five years. Results: WLM vs. Controls had a 10.1 point higher HEI-2015 score (70.2 [69.7 - 70.7] vs 60.1 [58.4 - 61.8], respectively; p=0.0001) in analyses that adjusted for group difference in demographic factors. WLM versus Controls had a significantly higher average percentage of calories from carbohydrates (50.3% [49.7 - 50.8] vs 46.7% [44.8 - 48.7], respectively; p=0.0001) and protein (18.2% [18.0-18.5] vs 15.9% [15.1-16.6], respectively; p=0.0001) and lower percentage of calories from fat (32.3% [31.9-32.8] vs 37.4% [35.8-38.9], respectively; p=0.0001). Examining micronutrients, WLM had significantly higher odds for meeting the EAR for copper (OR=5.8 [2.6-13.1]; p=0.0001), magnesium (OR=2.9 [1.8-4.7]; p=0.0001), potassium (OR=4.7 [1.4-16.5]; p=0.015), vitamin A (OR=2.8 [1.7-4.8]; p=0.0001), thiamin (OR=2.3 [1.3-4.1]; p=0.003), riboflavin (OR=6.5 [2.2-19.3]; p=0.001), vitamin B6 (OR=2.91 [1.6-5.2]; p=0.0001), vitamin C (OR=5.0 [2.8-8.8]; p=0.0001), folate (OR=2.2 [1.3-3.7]; p=0.003), and vitamin E (OR=1.8 [1.1-2.8]; p=0.014) and didn’t differ in calcium (OR=1.15 [0.7-1.7]; p=0.823), iron (OR=1.9 [0.8-4.6]; p=0.151), phosphorus (OR=2.0 [0.9-4.5]; p=0.101), selenium (OR=1.6 [0.6-3.8]; p=0.332), zinc (OR=1.7 [0.9-3.0]; p=0.095), niacin (B3) (OR=1.9 [0.8-4.1]; p=0.136), vitamin B12 (OR=1.2 [0.5-2.8]; p=0.625), and vitamin D (OR=1.5 [0.9-2.4]; p=0.09). Conclusions In a widely available commercial program, WLM consumed a healthier and more micronutrient rich diet than adults who were weight stable with obesity. Future research is needed to examine whether improved micronutrient status among WLM reduces risk of chronic disease.

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Weight loss maintenance is essential for the reduction of obesity-related health impairments. However, only a minority of individuals successfully maintain reduced weight in the long term. Research has provided initial evidence for associations between weight-related teasing (WRT) and greater non-normative eating behaviors. Further, first evidence was found for associations between non-normative eating behaviors and weight loss maintenance. Hence, the present study aimed to examine the predictive value of WRT for weight loss maintenance and the role of non-normative eating behaviors as possible mediators of this relationship. The study was part of the German Weight Control Registry that prospectively followed individuals who had intentionally lost at least 10% of their maximum weight and had maintained this reduced weight for at least one year. In N = 381 participants, retrospective WRT during childhood and adolescence, current non-normative eating behaviors (i.e., restrained, external, emotional eating), and change in body mass index (BMI, kg/m2) over two years were examined using self-report assessments. Structural equation modeling was used to analyze the assumed mediational relationship. As a result, a greater effect of retrospective WRT during childhood and adolescence predicted less successful adult weight loss maintenance over two years. Current emotional eating fully mediated this relationship while current restrained and external eating yielded no mediational effects. Hence, a greater effect of WRT predicted greater current emotional eating, which in turn predicted a smaller decrease or a greater increase in BMI. Our findings suggest that suffering from WRT during childhood and adolescence might lead to emotional eating which in turn impairs long-term weight loss maintenance. Thus, our results highlight the need for interventions aiming at reducing weight stigmatization and targeting emotional eating for successful long-term weight loss maintenance.