Dataset Information

Physical activity changes during behavioral weight loss treatment by Latinx patients with obesity with and without binge eating disorder.

ABSTRACT:

Objective

This secondary analysis examined physical activity (PA) changes and their prognostic significance among Latinx patients with obesity, with and without binge eating disorder (BED), who participated in a randomized, placebo-controlled trial testing the addition of orlistat to behavioral weight-loss (BWL) treatment in a "real-world" clinical setting.

Methods

In this randomized controlled trial at a community mental health center serving economically disadvantaged Spanish-speaking-only Latinx patients, 79 patients with obesity (40 with BED and 39 without BED) received BWL treatment and were randomized to orlistat or placebo. PA, weight, depression, and binge eating were assessed at baseline, posttreatment (end of treatment [4 months]), and the 6-month follow-up (10 months after baseline).

Results

PA was low at baseline (9.3% categorized as "active"), increased during treatment (32.9% categorized as "active" at posttreatment), and declined from posttreatment to the 6-month follow-up (28.2% classified as "active"). At baseline, PA was lower among patients with BED than those without BED. Changes in PA during and after treatment did not differ by BED status or medication condition. PA change was associated with reduced depression but not weight loss.

Conclusions

Latinx patients with obesity receiving BWL treatment achieved significant, albeit modest, increases in PA. Although PA changes were not associated with weight loss, they were associated with reduced depression. Identifying methods to increase PA further is necessary.

SUBMITTER: Grilo CM

PROVIDER: S-EPMC8612949 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Publications

Physical activity changes during behavioral weight loss treatment by Latinx patients with obesity with and without binge eating disorder.

Grilo Carlos M CM Kerrigan Stephanie G SG Lydecker Janet A JA White Marney A MA

Obesity (Silver Spring, Md.) 20210928 12

<h4>Objective</h4>This secondary analysis examined physical activity (PA) changes and their prognostic significance among Latinx patients with obesity, with and without binge eating disorder (BED), who participated in a randomized, placebo-controlled trial testing the addition of orlistat to behavioral weight-loss (BWL) treatment in a "real-world" clinical setting.<h4>Methods</h4>In this randomized controlled trial at a community mental health center serving economically disadvantaged Spanish-sp ...[more]

PMID: 34582624

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Project description:ObjectiveThis study was a randomized placebo-controlled trial testing the addition of orlistat to behavioral weight loss for obesity in Spanish-speaking-only Latino/as with versus without binge eating disorder (BED) performed at a community mental health center serving educationally- and economically-disadvantaged patients. Latino/as have high rates of obesity but are under-represented in obesity treatment studies and despite comparable-to-or-higher rates of BED than Whites, Latino/as are under-represented in BED treatment studies. BED is associated with obesity but whether it predicts/moderates treatment outcomes remains uncertain. Thus, this study also tested whether BED prospectively predicts/moderates outcomes.MethodsSeventy-nine obese Spanish-speaking-only Latino/as with BED (N=40) versus without BED (N=39) at a community mental health center were randomly assigned to four-months of orlistat-plus-BWL or placebo-plus-BWL. BWL was culturally-enhanced modification of Diabetes-Prevention-Program delivered in weekly sessions in Spanish. Orlistat (120 mg tid) and matching-placebo delivered with standard clinical-management. Participants were assessed independently throughout treatment, post-treatment, and six-month follow-up.Results78% completed treatments; completion rates did not differ significantly by medication or BED. Intent-to-treat mixed-models analyses revealed significant improvements in binge eating, eating-psychopathology, and depression, and significant--albeit modest--weight-loss. Overall, the addition of orlistat to BWL was not associated with greater improvements; however, BED moderated weight-loss: orlistat-plus-BWL produced significantly greater weight-loss in non-BED group but not in BED. Improvements were maintained through 6-month follow-up; BED significantly predicted/moderated increases in eating concerns and depression following treatment. Within BED-group, binge-eating remission rates were 65% (post-treatment) and 50% (follow-up).ConclusionsIn this controlled trial performed at community mental health center serving educationally- and economically-disadvantaged Spanish-speaking-only Latino/as with co-morbid psychiatric needs, we observed outcomes for the BWL plus orlistat/placebo medication that approximate or are slightly dampened relative to the literature for efficacy trials with much more restrictive obese and BED samples. In this complex patient group, adding orlistat to BWL produced greater weight-loss than adding placebo among obese patients without BED but not among those with BED. Although 50% of BED patients maintained abstinence from binge-eating following these specific obesity treatments (BWL plus orlistat/placebo), BED was a negative prognostic indicator for some outcome variables.Trial registrationclinicaltrials.gov Identifier: NCT00516919.

Project description:Depressive symptoms and binge eating are both prevalent in weight management populations and may be associated with reduced benefit from behavioral weight loss, including higher attrition, more perceived barriers, lower weight loss, and increased weight regain. These two potential risk factors for poor behavioral weight loss outcomes may also be associated with each other as depressive symptoms may trigger binge eating, and binge eating-related distress could increase depressive symptoms. The depressive symptom-binge eating link has not been well studied in weight management samples, and psychological processes involved in this relationship have not yet been elucidated. Psychological flexibility, an individual's ability to be connected with and conscious of the present moment and to engage in values-consistent behavior even in the presence of difficult internal experiences, may be one psychological process that changes the depressive symptom-binge eating relationship. High psychological flexibility may be a protective factor in the association of depressive symptoms with binge eating. This study examined the relationship between depressive symptom and binge eating and a potential interactive role of psychological flexibility. Participants (N = 468, 76% female) completed self-report questionnaires of binge eating, depressive symptoms, and psychological flexibility at baseline prior to initiating behavioral weight loss. Depressive symptoms were positively associated with binge eating (B = 1.00, p < 0.001). Psychological flexibility had an interactive role (B = -0.03, p = 0.005). Among participants with minimal to mild depressive symptoms, those with higher psychological flexibility had less severe binge eating. Findings suggest that psychological flexibility may be a protective factor in the association between depressive symptoms and binge eating in the majority of individuals initiating behavioral weight loss. Psychological flexibility is a psychological process to consider targeting for enhancing efficacy of weight loss treatment, especially among individuals with minimal to mild depressive symptoms and binge eating behavior.

Project description:BackgroundModest weight losses may be associated with improvements in cardiovascular disease risk factors (CVDRF) in patients with obesity. The effects of weight losses on CVDRF in persons with binge-eating disorder (BED) are unknown. This study prospectively examined changes in CVDRF among patients receiving behaviorally-based weight-loss treatment (BBWLT) who attained modest weight losses (≥5 to <10% and ≥10%).MethodOf 191 participants, CVDRF variables were re-assessed in 168 participants at posttreatment and in 151 at 12-month follow-up. Participants who attained ≥5 to <10% weight loss were compared to those who did not on CVDRFs (total cholesterol, HDL, LDL, triglycerides, HbA1C, mean plasma glucose, heart rate, and systolic/diastolic blood pressure); similar comparisons were completed for those who attained ≥10% weight loss.ResultsAt posttreatment, ≥5 to <10% weight loss (N = 42; 25.0%) was associated with significant improvements in HbA1c and mean plasma glucose, whereas ≥10% weight loss (N = 40, 23.8%) was associated with significant improvements in total cholesterol, triglycerides, HbA1c, mean plasma glucose, and heart rate. At 12-month follow-up, ≥5 to <10% weight loss (N = 17; 11.1%) was related to significant improvements on HDL, triglycerides, HbA1c, and mean plasma glucose, whereas ≥10% weight loss (N = 40, 26.0%) was associated with significant improvements on all the CVDRF variables (except blood pressure).ConclusionsModest weight loss is associated with significant improvements in CVDRFs in patients with BED and obesity following treatment and at 12-month follow-up. Future work should examine whether improvements in CVDRF are attributable to weight loss per se and/or to other related lifestyle changes.Public significance statementIndividuals with binge-eating disorder and obesity who attain modest weight loss following treatment exhibit improvements in various measures of cardiovascular disease risk compared to those who do not. While weight loss has been challenging for individuals with binge-eating disorder, clinicians should inform patients of the potential health benefits of modest weight loss. Future research should investigate whether weight loss itself and/or related behavioral lifestyle changes drive improved cardiovascular disease risk factors.

Dataset Information

Physical activity changes during behavioral weight loss treatment by Latinx patients with obesity with and without binge eating disorder.

Objective

Methods

Results

Conclusions

Publications

Physical activity changes during behavioral weight loss treatment by Latinx patients with obesity with and without binge eating disorder.

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