Differences in 5-year weight change between younger and older US firefighters
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Abstract Background Research consistently finds that, on average, firefighters gain weight over time and some data indicate that younger firefighters are more likely to gain weight than older firefighters. The purpose of this study was to estimate the 5-year weight change among younger and older US firefighters. Methods Data from two occupational medical exams separated by 5 years (2009–2016) were examined from a cohort of US career firefighters in Virginia (males, n = 589; females, n = 67). The cohort was grouped into two age categories (< 45 years and ≥ 45 years). Weight change subgroups were Loss (decrease of > 3% body weight), Stable (within ±3% body weight) and Gain (increase of > 3% body weight). Multinomial logistic regression models and linear regression models were conducted to examine differences in the probability of being in a particular weight change category, weight change overall and by weight change category between younger and older firefighters. Results At baseline, 25 and 35% of younger (< 45 years) and older (≥ 45 years) were obese, respectively. Younger firefighters gained significantly ( P < 0.05) more weight (3.0 ± 0.2 kg) than older firefighters (0.8 ± 0.5 kg). Younger firefighters were more likely to gain weight (53% versus 39%) and less likely (10% versus 20%) to lose weight as compared to older firefighters. Smaller weight gains were associated with age and BMI with the smallest increases observed in overweight and obese firefighters ≥45 years of age. Conclusions Health care providers should be attentive to weight gain, even among young non-obese firefighters, and counsel firefighters to avoid the additive risks of being older and heavier. In addition, weight loss/management programs should be promoted in the fire service to encourage healthy body weight and to prevent unhealthy weight gain among both young and old firefighters alike.Keywords:
Weight change
Biostatistics
In the present issue of The Journal of Clinical Hypertension, Tyson and colleagues1 evaluated, through secondary analysis of the Weight Loss Maintenance Randomized Controlled Trial,2 the relationship between weight and blood pressure (BP) changes in a cohort of overweight or obese patients with hypertension and/or dyslipidemia. All studied patients before inclusion in the analysis experienced a weight reduction of ≥4 kg through behavioral weight loss intervention during a 6-month period (phase 1). Subsequently, patients were followed for 5 years and were divided into 3 groups according to an additional change in weight of >3% observed at the end follow-up: positive (weight gain), negative (weight loss), and no weight change (weight stable). During this 5-year period they were randomized 2 times (at baseline and after 2.5 years from baseline) according to the implemented strategy for sustaining weight loss. The first randomization (phase 2) was made through a personal contact maintenance weight loss program, an internet-based interactive technology maintenance weight loss program or no further treatment, while the second randomization (phase 3) was made through a personal contact maintenance weight loss program or no further treatment. Tyson and colleagues1 demonstrated a modest positive association between body weight and BP change over a period of 5 years and that after an initial weight loss of ≥4 kg, regain of body weight compared with body weight maintenance was associated with the same extent of systolic BP increase; by contrast, weight loss was not accompanied by systolic BP changes. The authors also suggested that advancing age might be a potential promoter of BP increase beyond weight changes in the stable-weight group. Since an increase in pulse pressure can partially reflect a vascular aging process, throughout phase 3 it can be observed that the weight-loss group demonstrated a mean change in pulse pressure of 0.4 mm Hg, the stable-weight group of 0.7 mm Hg, and the weight-gain group of 1.6 mm Hg. Thus, we can identify an almost 2- and 4-fold increased change in pulse pressure over a 2.5-year period when comparing the weight-loss group with both the stable-weight and the weight-gain groups, respectively. This observation raises the hypothesis that vascular aging would be more attenuated in the weight-loss group compared with the others. However, it is unclear whether this phenomenon would be more or less evident at different ages. An analysis of the results in young, middle-aged, and older patients would be of importance to clarify this issue. With respect to crude BP changes, we should underline the following issues. First, BP was not measured at the beginning of phase 1 and thus the extent of BP lowering with body weight reduction during the intensive weight–lowering strategy (phase 1) remains unknown. As pointed out by the authors,1 a plateau effect possibly took place for BP during this investigational period. Second, BP was curiously measured by an automated device not validated for clinic BP use.3 However, since the outcome was “changes in BP” along with the changes of body weight, we feel that this shortcoming did not affect the results in a meaningful way. Third, the duration of hypertension at baseline might be important to modulate BP changes through lifestyle interventions, because patients with an onset of hypertension close to baseline and mild vascular damage may be more responsive to BP reduction compared with those with long-lasting hypertension and more pronounced vascular damage. This is also the case for patients with and without overt cardiovascular disease, as well as for patients with hyperlipidaemia alone compared with those with hypertension or with the combined phenotype of hyperlipidemia and hypertension. Additional important confounders that could entail significant consequences on the investigating dynamic relationship are related to sodium intake and sleep habits. Indeed, sleep disruption associated with underlying sleep apnea4 and time asleep5 both promote weight and BP changes beyond daytime attitudes including exaggerated sodium consumption and increased salt sensitivity, especially in postmenopausal women.6 Finally, we should point out that the implemented strategies for lifestyle modification were assessed “on top” of ongoing pharmacologic treatment. Thus, the type and changes in antihypertensive agents might also contribute to different changes in body weight. Beyond the previous comments, the study by Tyson and colleagues1 provides enough evidence that weight-loss strategies associated with continued reduction of body size may be beneficial for BP stability over long periods. It could also be hypothesized that continued weight reduction may delay the aging-related hemodynamic deterioration. However, more studies are needed to clarify this complex issue at different ages, possibly complemented by measurement of arterial stiffness and further controlling for hidden confounders that modulate this relationship.
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Objective The Swedish Obese Subjects (SOS) study was designed to compare outcomes in patients with obesity treated by bariatric surgery and a matched control group given usual care. The aim of this study was to analyze self‐reported weight‐loss methods and weight changes over 10 years in the SOS control group. Methods Self‐reported weight‐loss methods in the control group ( n = 2,037; 71% women; 48.7 ± 6.3 years; BMI 40.1 ± 4.7 kg/m 2 ) were analyzed at baseline and after 0.5, 1, 2, 3, 4, 6, 8, and 10 years of follow‐up and studied in relation to weight changes. Results The average 10‐year weight change was +2.1% (95% CI: 1.4%‐2.8%). At every follow‐up, 82.7% (95% CI: 81.3%‐84.1%) of participants reported weight‐loss attempts. At 10 years, 12.5% of the participants had ≥ 10% weight loss and 22.3% had ≥ 10% weight gain. Participants who lost or gained weight reported similar usage of weight‐loss methods. Conclusions Over 10 years, the majority of the participants of the SOS control group reported continuous efforts to lose weight. These results illustrate the constant struggle individuals with severe obesity are facing and that, on average, the results of long‐term weight loss and weight maintenance were discouraging.
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Little is known about the transition in behaviors from short-term weight loss to maintenance of weight loss. We wanted to determine how short-term and long-term weight loss and patterns of weight change were associated with intervention behavioral targets. This analysis includes overweight/obese participants in active treatment (n = 507) from the previously published PREMIER trial, an 18-month, multicomponent lifestyle intervention for blood pressure reduction, including 33 intervention sessions and recommendations to self-monitor food intake and physical activity daily. Associations between behaviors (attendance, recorded days/week of physical activity, food records/week) and weight loss of ≥5% at 6 and 18 months were examined using logistic regression. We characterized the sample using 5 weight change categories (weight gained, weight stable, weight loss then relapse, late weight loss, and weight loss then maintenance) and analyzed adherence to the behaviors for each category, comparing means with ANOVA. Participants lost an average of 5.3 ± 5.6 kg at 6 months and 4.0 ± 6.7 kg (4.96% of body weight) by 18 months. Higher levels of attendance, food record completion, and recorded days/week of physical activity were associated with increasing odds of achieving 5% weight loss. All weight change groups had declines in the behaviors over time; however, compared to the other four groups, the weight loss/maintenance group (n = 154) had statistically less significant decline in number of food records/week (48%), recorded days/week of physical activity (41.7%), and intervention sessions attended (12.8%) through 18 months. Behaviors associated with short-term weight loss continue to be associated with long-term weight loss, albeit at lower frequencies. Minimizing the decline in these behaviors may be important in achieving long-term weight loss.
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Objectives: In this study, we examined compliance and progress factors associated with weight loss and maintenance, individual patterns of weight trends following weight loss, and impact of early weight loss on longer-term weight change. Methods: We conducted secondary analysis of pre-post data. Participants were 8769 persons (mean age = 47.63 ± 13.78 years; 77.74% women; mean weight = 97.20 ± 22.82 kilograms; BMI = 34.09 ± 6.84) in a commercial weight management program. We carried out multiple regression analyses on weight change and percentage, and used ANOVA and the Pearson chi-square test to examine participant characteristics, weight change patterns, and early weight loss success. Results: Participants were active in the program for 222 ± 158 days, completed 15 ± 13 appointments, achieving -8.53 ± 7.87 kilograms lost (-8.61% ± 7.64%). Greater weight loss was associated with appointment frequency (β = -0.46) and total spending (β = -2.89) (p < .01). We identified 5 weight change patterns (F = 37.56, p < .001) (total weight loss for each group was: Stable = -10.4% [N=2036]; Minimal Regain = -10.5% [N=3766]; Modest Regain = -8.8% [N=1476]; Large Regain = -7.3% [N=753]; No Loss/Gain = +3.7% [N=737]; all p < .05). Over 5000 participants achieved early weight loss (losing > 5%) within the first 2 months resulting in significantly greater final weight loss (-8.43% to -14.56% vs -1.18% to -3.15%). Conclusions: We identified several weight patterns; increased health coaching attendance was associated with greater weight loss.
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This study examined factors associated with weight change in 535 residents in 32 long term care homes where 3-month weight records were available. Trained researchers and standardized measures (e.g., nutrition status, food intake, home characteristics) were used to collect data; weight change was defined as ±2.5%. Just over 25% of the sample lost and 21% gained weight. Weight stability was compared to loss or gain. Weight loss was associated with being male, malnourished (MNA-SF or BMI <25), energy and protein intake and oral nutritional supplement use, while weight gain was associated with being female, and a physically (e.g., less noise) and socially supportive dining room. Weight stability was associated with better cognition. A high proportion of residents had a significant weight change in 3 months. Modifiable factors associated with weight stability or gain suggest focusing interventions that promote food intake and improve the mealtime environment.
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This article provides an assessment of the associations that weight-loss patterns during the first year of an intensive lifestyle intervention have with 4-year maintenance and health outcomes. Two components described patterns of weight change during the first year of intervention: one reflected the typical pattern of weight loss over the 12 months, but distinguished those who lost larger amounts across the monthly intervals from those who lost less. The second component reflected the weight change trajectory, and distinguished a pattern of initial weight loss followed by regain vs. a more sustained pattern of weight loss. Two thousand four hundred and thirty eight individuals aged 45-76 years with type 2 diabetes mellitus, who enrolled in the weight-loss intervention of a randomized clinical trial, were assigned scores according to how their weight losses reflected these patterns. Relationships these scores had with weight losses and health outcomes (glycosolated hemoglobin--hemoglobin A1c (HbA1c); systolic blood pressure, high-density lipoprotein (HDL)-cholesterol, and triglycerides) over 4 years were described. When compared to those with lower scores on the two components, both individuals who had larger month-to-month weight losses in year 1 and whose weight loss was more sustained during the first year had better maintenance of weight loss over 4 years, independent of characteristics traditionally linked to weight loss success (P < 0.001). While relationships with year 4 weight loss were stronger, the pattern of larger monthly weight loss during year 1 was also independently predictive of year 4 levels of HbA1c, HDL-cholesterol, and systolic blood pressure.
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Background: Weight loss, though difficult to attain and sustain over time, remains the cornerstone of non-alcoholic fatty liver disease (NAFLD) treatment. We aimed to describe weight changes among NAFLD patients. Methods: This was a retrospective, cohort study of consecutively-identified NAFLD patients with >2 clinic visits from March2007–April2018. Weight changes from baseline were categorized into weight gain, weight loss, and no change. Baseline liver and metabolic biochemistries and non-invasive liver fibrosis tests were correlated with the final weight changes. Succeeding weight changes after the initial follow-up visits were used to determine sustainability of weight loss. Results: Of the 240 patients included, 123 (51.2%), 93 (38.8%), and 24 (10%) had weight gain, weight loss, and no change, respectively. Only 12.5% had >5% weight loss. Duration of follow-up was significantly longer for patients with weight loss (p<0.001). None of the baseline demographic and laboratory data were associated with weight loss. Patients with weight loss also did not have significant changes to their biochemistries and non-invasive liver fibrosis tests compared to patients with weight gain/no change. Compared to patients with weight gain after the initial follow-up, where only 11.8% were able to lose weight on the final visit, 73.1% of patients who lost weight after the initial follow-up were able to sustain their weight loss on the final visit. Conclusions: Weight loss is achieved in only a third of NAFLD patients. Although 73% of patients who lost weight initially were able to sustain it, patients who gained weight after the 1st follow-up were unlikely to lose weight on further follow-up. Key words: Non-alcoholic fatty liver disease, weight loss, sustainability
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