Long-term Weight Loss Maintenance

It is not easy to maintain long-term weight loss even though it is the ultimate goal of obesity management. The Look AHEAD study in which 50% of participants in the intervention arm maintained a weight loss at least 5% below their initial weight after 8 years of intensive lifestyle intervention confirms a crucial role of continuous and constant application of lifestyle changes. Alteration of appetite-related hormones, energy homeostasis, nutrient metabolism, and subjective appetite are involved in biological pathways responsible for balance between energy utilization and storage following weight loss. Previous studies have shown that some appetite-related hormones and metabolites are potential predictors of weight-regain after weight loss, and specific diet pattern and physical activity could oppose weight loss regain.

Sucesso na manutencao do peso perdido em Portugal: o Registo Nacional de Controlo do Peso / Success in maintaining weight loss in Portugal: The Portuguese Weight Control Registry

O objetivo deste trabalho é descrever a metodologia do Registo Nacional de Controlo do Peso e descrever os participantes quanto à sua história individual e familiar relacionada com o peso, tentativas anteriores de redução deste e caraterização psicossocial. A amostra inclui 198 adultos (idade: 39,7 ± 11,1anos; IMC: 26,0 ± 3,9kg/m2), 59% mulheres, que completaram um questionário abordando questões demográficas, motivações e atitudes, e estratégias de perda e de manutenção do peso. Os participantes reportaram uma perda do peso média de 17,4kg e uma duração média de manutenção do peso perdido de 29 meses. Relativamente ao número de tentativas de redução do peso reportadas, 73% indicou ter iniciado uma dieta no máximo por três vezes e 34% reportou ter tentado perder peso apenas uma vez no passado. Este estudo irá permitir conhecer com mais detalhe e representatividade as caraterísticas e as estratégias adoptadas por estas pessoas bem sucedidas na manutenção do peso perdido no longo prazo e contribuir para identificar variáveis preditoras da gestão bem sucedida do peso a longo prazo. .

The scope of this article is to describe the Portuguese Weight Control Registry (PWCR) methodology and the participants currently enrolled specifically with respect to their individual and family weight history, previous weight loss attempts, and psychosocial characteristics. One hundred and ninety-eight adults (age: 39.7±11.1 years; BMI: 26.0±3.9 kg/m2), 59% women, filled out a questionnaire about demographics, health-related behaviors and motivation, and methods and strategies used to lose and/or maintain weight loss. Participants reported an average weight loss of 17.4 kg for an average of 29 months. Concerning the number of weight loss attempts, 73% of participants reported a maximum of three attempts of going on a diet, and 34% indicated only one attempt to lose weight in the past. The PWCR now features a considerable number of successful long-term weight loss maintainers in Portugal. Participants will be followed over the next years to learn about their characteristics and weight loss strategies in further detail, as well as to identify predictors of continued weight loss maintenance. .

Intervenções para tratamento da obesidade: revisão sistemática / Interventions in obesity treatments: a systematic review / Intervenciones para el tratamiento de la obesidad: una revisión sistemática

Objetivo: fazer uma revisão sistemática para avaliar a efetividade e segurança dos métodos para redução de peso, sendo eles: cirúrgico, farmacológico e mudanças do estilo de vida (MEV), que incluem exercícios físicos e dietas. Os resultados clínicos de interesse foram a perda de peso e sua manutenção pelo prazo mínimo de 1 ano. Método: foi feita uma busca de artigos nas bases de dados PUBMED, Scielo e Biblioteca do Cochrane, com as palavras-chave weight loss maintenance e obesity treatment. A busca incluiu artigos em português, inglês e espanhol publicados até outubro de 2011. Foram incluídos revisões sistemáticas, metanálises e ensaios clínicos randomizados que tivessem um período de seguimento maior ou igual a um ano. Os estudos deveriam ter como participantes: adultos obesos (maior que 18 anos e com índice de massa corpórea ­ IMC maior que 30) e que comparassem intervenções distintas para o tratamento da obesidade. Resultados: foram selecionados 5 artigos que contemplaram os critérios de inclusão, sendo que cada um desses estudaram isoladamente, comparados com MEV, a eficácia do Orlistat, Sibutramina, Pramlintide e gastroplastia. A gastroplastia teve um resultado significativo (p < 0,05) para evitar o total reganho de peso. O Orlistat produziu uma perda de peso significativa durante o primeiro ano de tratamento e o ganho de peso foi diminuído com seu uso no segundo ano de tratamento (p < 0,001). A Sibutramina se mostrou eficaz na manutenção do peso após um período de perda com dieta de grande restrição calórica. O Pramlintide mostrou efetividade na perda de peso e redução da circunferência abdominal. Conclusões: As intervenções farmacológicas e cirúrgicas se mostraram mais efetivas quando comparadas à MEV em relação à perda de peso e a sua manutenção a longo prazo, porém é necessária a realização de mais estudos que analisem a comparação entre as diferentes intervenções disponíveis para o tratamento da obesidade.

Objective: to make a systematic review to evaluate the effectiveness and safety of methods to reduce weight, as follows: surgical, pharmacological and changes in lifestyle, which include exercise and diet. Clinical outcomes of interest were weight loss and long-term loss maintenance. Methods: a search for the keywords "weight loss maintenance" and "obesity treatment" in articles from PubMed, Scielo and Cochrane Library database was performed. The search included articles in English, Portuguese and Spanish published until October 2011. Systematic reviews, meta-analysis and randomized clinical trials that had a follow-up period greater or equal to one year were included. The studies should have obese adults (over 18 years with body mass index greater than 30) as participants and compare different interventions to the treatment of obesity. Results: five articles that fulfill the inclusion criteria were selected, and each of these articles separately studied the effectiveness of Orlistat, Sibutramine, Pramlintide and gastroplasty, in comparison to changes in lifestyle. Gastroplasty presented significant results (p < 0.05) to avoid the total weight regain. Orlistat produced significant weight loss during the first year of treatment and weight gain was reduced with its use in the second year of treatment (p < 0.001). Sibutramine was effective in maintaining weight loss after a weight loss diet with high caloric restriction. Pramlintide showed effectiveness in weight loss and reduction in waist circumference. Conclusions: Pharmacological and surgical interventions were more effective compared to changes in lifestyle regarding weight loss and maintenance in the long term, but further studies need to be carried out to examine the comparison between the different interventions available for the treatment of obesity.

Objetivo: Realizar una revisión sistemática para evaluar la eficacia y la seguridad de los siguientes métodos para reducción de peso: cirugía, medicación y cambio de estilo de vida (CEV), incluyendo el ejercicio y la dieta. Los resultados clínicos evaluados fueron la pérdida de peso y su manutención por el plazo mínimo de un año. Métodos: Se buscaron artículos en las base de datos PubMed, Scielo y en la Biblioteca Cochrane con las palabras-clave "mantenimiento de la pérdida de peso" y "tratamiento de la obesidad". La búsqueda incluyó artículos en Inglés, Portugués y Español publicados hasta octubre de 2011. Se incluyeron revisiones sistemáticas, meta-análisis y ensayos clínicos aleatorizados que tuviesen un período de seguimiento mayor o igual a un año. Los estudios debían tener como participantes: adultos obesos (mayores de 18 años y con índice de masa corporal mayor que 30) y que comparasen diferentes intervenciones para el tratamiento de la obesidad. Resultados: Se seleccionaron cinco artículos que contemplaron los criterios de inclusión, cada uno de ellos fue estudiado por separado con relación al CEV, la eficacia del Orlistat, la Sibutramina, la Pramlintida, y la gastroplastia. La gastroplastia tuvo un resultado significativo (p < 0,05) para evitar la recuperación del peso total. El Orlistat produjo una pérdida significativa de peso durante el primer año de tratamiento y su uso disminuyó el aumento de peso en el segundo año de tratamiento (p < 0,001). La Sibutramina fue eficaz en el mantenimiento de peso después de un período de pérdida con una dieta de gran restricción calórica. La Pramlintida mostró eficacia en la pérdida de peso y reducción de la circunferencia abdominal. Conclusiones: Las intervenciones farmacológicas y quirúrgicas fueron más efectivas en comparación con el CEV en relación con la pérdida de peso y su mantenimiento a largo plazo, pero es necesario llevar a cabo más estudios que analicen la comparación entre las diferentes intervenciones disponibles para el tratamiento de la obesidad.

Factors associated with Weight Loss Maintenance

BACKGROUND: In general, long-term weight loss maintenance is difficult. Thus we have attempted to examine the factors associated with weight loss maintenance after weight reduction to appropriate level in obese people. METHODS: The study subjects were 170 obese adults who visited the Yeung Nam University Medical Center Obesity Clinic from January 2002 to April 2004. Selected individuals for this study were those who have intentionally lost at least 5% of their body weight and have kept it off for at least 1 year and considered to be "weight loss maintainers" and the factors that are associated with weight loss maintenance were obsened and assessed by telephone survey. RESULTS: Among all study subjects, the successful weight loss maintainers were 61 (35.9%) subjects (males: 23, females: 38) and re-gainers were 109 (64.1%) subjects (males: 42, females: 67). The difference between maintainers and re-gainers according to sex, age and basal body weight was not statistically significant. The difference between maintainers and regainers were statistically significant in those with regular exercise more than 3 times per week (P=0.001), no alcohol intake (P=0.001), physical activity more than moderate level (P<0.001), TV viewing (internet using) times less than 2 hours (P<0.001), dietary control (P<0.001), and no overeating (P<0.001). According to multiple regression analysis, obesity treatment medication use during the weight loss maintenance period had the greatest influence (R2=0.336, P=0.000), and the following were TV (internet) viewing time, smoking, exercise, and physical activity in order. CONCLUSION: By using, medications, reducing TV viewing (internet using) times, smoking cessation, diet control exercise weight loss were maintained significantly.