Eating Disorders In weight-related Therapy (EDIT): Protocol for a systematic review with individual participant data meta-analysis of eating disorder risk in behavioural weight management
Hiba JebeileNatalie B. ListerSol LibesmanKylie E HunterCaitlin M. McMasterBrittany J. JohnsonLouise A. BaurSusan J. PaxtonSarah P. GarnettAmy L. AhernDenise E. WilfleySarah MaguireAmanda SainsburyKatharine SteinbeckLisa AskieCaroline BraetAndrew J. HillDasha NichollsRebecca A. JonesGenevieve DammeryAlicia GrunseitKelly CooperTheodore K. KyleFaith A. NewsomeFiona QuigleyRachel D. BarnesMelanie K. BeanKristine BeaulieuMaxine P. BonhamKerri N. BoutelleBráulio Henrique Magnani BrancoSimona CalugiMichelle I. CardelKelly CarpenterHoi Lun ChengRiccardo Dalle GraveYngvild S. DanielsenMarcelo DemarzoAimee L. DordevicDawn M. EichenAndrea B. GoldschmidtAnja HilbertKatrijn HoubenMara Cristina Lofrano-PradoCorby K. MartinAnne McTiernanJanell L. MensingerCarly R. PacanowskiWagner Luiz do PradoSofia RamalhoHollie A. RaynorElizabeth RiegerEric RobinsonVera SalvoNancy E. SherwoodSharon SimpsonHanna F. SkjåkødegårdEvelyn SmithStephanie R. PartridgeMarian Tanofsky‐KraffRachael W. TaylorAnnelies Van EyckKrista A VaradyAlaina P. VidmarVictoria WhitelockJack A. YanovskiAnna Lene Seidler
2
Citation
62
Reference
10
Related Paper
Citation Trend
Abstract:
ABSTRACT The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12-months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk.Keywords:
Weight management
Weight change
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.
Weight change
Dyslipidemia
Cite
Citations (0)
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.
Weight change
Weight control
Cite
Citations (26)
Weight management
Odds
Best practice
Cite
Citations (0)
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.
Weight change
Attendance
Cite
Citations (40)
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.
Weight change
Attendance
Weight management
Cite
Citations (1)
Weigh Forward was a prospective clinical audit, aimed to assess the use and efficacy of 12-week weight management program in general practice. Twenty-eight practitioners participated in the audit, with a total of 258 patients observed. Of these, 147 (57%) were retained to 24 weeks. Practices were asked to implement a structured 12-week weight loss program, and encouraged to utilize relevant weight management guidelines as necessary. Patients were followed up regularly, and comprehensively assessed at baseline, 12 and 24 weeks. Evaluations were made of patient weight loss, practitioner willingness to utilize available weight loss interventions, practitioner set weight loss goals and the appropriateness of such goals. Overall, the 57% of completing patients lost an average of 6.1% ± 0.5% body weight, with 27.2% losing ≥10% body weight. Practitioners were hesitant to intensify treatment, and those with comorbidities were less likely (odds ratio 1.8; 95% CI 1.4-2.4) to receive intensified treatment than those without. Practitioners also tended to set high weight loss goals, with a mean goal of 17.3% body-weight loss. The clinically significant mean weight loss demonstrates that practitioners are able to generate meaningful weight loss in primary care settings, however, could benefit from increased use of available interventions.
Weight management
Odds
Best practice
Clinical Practice
Cite
Citations (2)
Weight change
Weight management
Cite
Citations (17)
Weight change
Weight management
Cite
Citations (21)
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
Weight change
Cite
Citations (0)