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Exploratory analysis of eating- and physical activity-related outcomes from a randomized controlled trial for weight loss maintenance with exercise and liraglutide single or combination treatment.

ABSTRACT: Weight regain after weight loss remains a major challenge in obesity treatment and may involve alteration of eating and sedentary behavior after weight loss. In this randomized, controlled, double-blind trial, adults with obesity were randomized, in a 1:1:1:1 ratio stratified by sex and age group (<40 years and ≥40 years), to one-year weight loss maintenance with exercise, the GLP-1 receptor agonist liraglutide, or the combination, as compared with placebo, after low-calorie diet-induced weight loss. Primary outcome was change in body weight, which has been published. Here, we investigated the effects of weight loss maintenance with exercise, liraglutide, or the combination on weight loss-induced changes in the pre-specified explorative outcomes, eating and sedentary behavior in 130 participants who completed the trial according to the study protocol (exercise (n = 26), liraglutide (n = 36), combination (n = 29), and placebo (n = 39)). One year after weight loss, the placebo group had decreased postprandial appetite suppression score by 14%, and increased sedentary time by 31 min/day and regained weight. Liraglutide prevented the decrease in postprandial appetite suppression score compared with placebo (0% vs. -14%; P = 0.023) and maintained weight loss. Exercise after weight loss did not increase appetite or sedentary behavior compared with placebo, despite increased exercise energy expenditure and maintained weight loss. The combination of exercise and liraglutide increased cognitive restraint score (13% vs. -9%; P = 0.042), reflecting a conscious restriction of food intake, and decreased sedentary time by 41 min/day (-10 vs. 31 min/day; 95%CI, -82.3 to -0.2; P = 0.049) compared with placebo, which may have facilitated the additional weight loss. Targeting both eating and sedentary behavior could be the most effective for preventing weight regain.Trial registration: EudraCT number, 2015-005585-32; clinicaltrials.gov number, NCT04122716.

SUBMITTER: Jensen SBK

PROVIDER: S-EPMC9378667 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Exploratory analysis of eating- and physical activity-related outcomes from a randomized controlled trial for weight loss maintenance with exercise and liraglutide single or combination treatment.

Jensen Simon Birk Kjær SBK Janus Charlotte C Lundgren Julie Rehné JR Juhl Christian Rimer CR Sandsdal Rasmus Michael RM Olsen Lisa Møller LM Andresen Anne A Borg Signe Amalie SA Jacobsen Ida Christine IC Finlayson Graham G Stallknecht Bente Merete BM Holst Jens Juul JJ Madsbad Sten S Torekov Signe Sørensen SS

Nature communications 20220815 1

Weight regain after weight loss remains a major challenge in obesity treatment and may involve alteration of eating and sedentary behavior after weight loss. In this randomized, controlled, double-blind trial, adults with obesity were randomized, in a 1:1:1:1 ratio stratified by sex and age group (<40 years and ≥40 years), to one-year weight loss maintenance with exercise, the GLP-1 receptor agonist liraglutide, or the combination, as compared with placebo, after low-calorie diet-induced weight ...[more]

PMID: 35970829

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Project description:In this secondary analysis of the DiOGenes study, we investigated whether physical activity (PA) contributes to diet-induced weight loss and helps to reduce subsequent regain. We also studied the associations of PA with changes in cardiometabolic variables. Adults with overweight were included and followed an 8-week low-calorie diet (LCD). When successful (>8% weight loss), participants were randomized to different ad libitum diet groups and were advised to maintain their weight loss over the 6-month intervention period. Body weight (BW), body composition, cardiometabolic variables and subjectively-assessed PA were measured at baseline, at the end of weight loss and at the end of the intervention. BW was reduced by the LCD (from 99.8 ± 16.7 to 88.4 ± 14.9 kg; P < 0.001). This reduction was maintained during the weight maintenance period (89.2 ± 16.0 kg). Total PA (sum score of the three subscales of the Baecke questionnaire) increased during the weight loss period (from 8.16 ± 0.83 to 8.39 ± 0.78; P < 0.001) and this increase was subsequently maintained (8.42 ± 0.90). We found no evidence that baseline PA predicted weight loss. However, a higher level of baseline PA predicted a larger weight-loss-induced improvement in total cholesterol, triglycerides, glucose and CRP, and in post-prandial insulin sensitivity (Matsuda index). Subsequent weight and fat mass maintenance were predicted by the post-weight loss level of PA and associated with changes in PA during the weight maintenance phase. In conclusion, despite the fact that higher baseline levels of PA did not predict more weight loss during the LCD, nor that an increase in PA during the LCD was associated with more weight loss, higher PA levels were associated with more improvements in several cardiometabolic variables. The positive effect of higher PA on weight loss maintenance seems in contrast to randomized controlled trials that have not been able to confirm a positive effect of exercise training programmes on weight loss maintenance. This analysis supports the notion that higher self-imposed levels of PA may improve the cardiometabolic risk profile during weight loss and help to maintain weight loss afterwards.

Project description:Biological, genetic, and environmental factors make weight loss very difficult. Acceptance-based behavioral treatment (ABT) supplements standard behavioral treatments (BT) for obesity by teaching skills to accept the discomfort inherent to weight control behaviors and prioritize long-term, values-based goals. Grit, the ability to persevere in goal pursuit, overlaps conceptually with ABT principles and may predict outcomes in ABT. During a randomized controlled trial comparing three weight loss interventions (BT, BT with an emphasis on physical activity [BT+PA], ABT with an emphasis on physical activity [ABT+PA]), this study examined if grit predicted weight loss, intervention engagement (session attendance and dietary self-monitoring), and perceived intervention effectiveness, and whether intervention condition moderated these relationships. Participants (N=309) with overweight/obesity enrolled in an 18-month weight loss intervention completed the Short Grit Scale at baseline. Weight and PA were measured at baseline, during the intervention (12 and 18 months), and at follow-up (24 and 36 months). Session attendance and dietary self-monitoring were assessed throughout the intervention, and perceived intervention effectiveness at end-of-intervention. The relation of grit to several outcomes depended on condition. In ABT+PA, but not BT or BT+PA, lower grit related to higher weight loss at 12 and 24 months, session attendance, and perceived intervention effectiveness. Grit was not related to PA or dietary self-monitoring in any condition. ABT's focus on building skills to facilitate long-term goal pursuit may be unique and beneficial to those with lower grit. Those with higher grit may already possess ABT-consistent skills and benefit less from ABT. Research on trait-level characteristics like grit in relation to weight must be cautious not to reinforce weight bias; rather, this work suggests that an evidence-based intervention (ABT) may be well-suited to those with lower grit levels seeking weight loss.

Project description:BACKGROUND:Certain eating behaviors are common among women with obesity. Whether these behaviors influence outcomes in weight loss programs, and whether such programs affect eating behaviors, is unclear. METHODS:Our aim was to examine the effect of baseline eating behaviors on intervention adherence and weight among postmenopausal women with overweight or obesity, and to assess intervention effects on eating behaviors. Four hundred and 39 women (BMI ≥25 kg/m2) were randomized to 12 months of: i) dietary weight loss with a 10% weight loss goal ('diet'; n = 118); ii) moderate-to-vigorous intensity aerobic exercise for 225 mins/week ('exercise'; n = 117); iii) combined dietary weight loss and exercise ('diet + exercise'; n = 117); or iv) no-lifestyle change control (n = 87). At baseline and 12 months, restrained eating, uncontrolled eating, emotional eating and binge eating were measured by questionnaire; weight and body composition were assessed. The mean change in eating behavior scores and weight between baseline and 12 months in the diet, exercise, and diet + exercise arms were each compared to controls using the generalized estimating equation (GEE) modification of linear regression adjusted for age, baseline BMI, and race/ethnicity. RESULTS:Baseline restrained eating was positively associated with change in total calories and calories from fat during the dietary intervention but not with other measures of adherence. Higher baseline restrained eating was associated with greater 12-month reductions in weight, waist circumference, body fat and lean mass. Women randomized to dietary intervention had significant reductions in binge eating (- 23.7%, p = 0.005 vs. control), uncontrolled eating (- 24.3%, p < 0.001 vs. control), and emotional eating (- 31.7%, p < 0.001 vs. control) scores, and a significant increase in restrained eating (+ 60.6%, p < 0.001 vs. control); women randomized to diet + exercise reported less uncontrolled eating (- 26.0%, p < 0.001 vs. control) and emotional eating (- 22.0%, p = 0.004 vs. control), and increased restrained eating (+ 41.4%, p < 0.001 vs. control). Women randomized to exercise alone had no significant change in eating behavior scores compared to controls. CONCLUSIONS:A dietary weight loss intervention helped women modify eating behaviors. Future research should investigate optimal behavioral weight loss interventions for women with both disordered eating and obesity. TRIAL REGISTRATION:NCT00470119 (https://clinicaltrials.gov). Retrospectively registered May 7, 2007.

Project description:Sympathomimetics are effective, centrally acting drugs that induce weight loss through their potent anorexic and locomotor properties. We reported that sympathomimetics antagonize catecholamine-dependent, alpha-2 adrenergic receptor-dependent signal transduction mediated by chloride/bicarbonate transport. We posit that other drugs that target cellular chloride/bicarbonate antiport would similarly demonstrate anorectic properties, induce locomotion, and diminish weight gain. Male and female inbred mice were housed in groups or stressed by prolonged social isolation. Mice consumed either normal chow or a high fat, high fructose corn syrup, (i.e. "Western") diet. To inhibit chloride/bicarbonate transport, acetazolamide (ACT, 3 mM) was added to the drinking water. Rodents underwent evaluations of exploratory locomotion and learning with the object recognition test. Mice consuming a "Western" diet gain more weight compared to mice given a normal diet. When placed on a "Western" diet, stressed mice gained weight more rapidly than unstressed. The body weight of mice fed a normal diet with ACT was significantly reduced compared to control mice not given ACT (weight, g ± SEM), 23.7 ± 0.8 v. 21.0 ± 0.5, p = 0.02. ACT did not reduce weight gain in animals chronically maintained on a "Western" diet. Compared to unstressed mice, living in social isolation reduced spontaneous exploratory locomotion time, an indicator of anxiety, in male mice (sec +SEM) from 22.8 ± 3.5 to 12.2 ± 2.1 (p < 0.001), and in female mice, from 47 ± 5.7 to 19.6 ± 2.3 (p < 0.001). ACT had no effect on exploration time in unstressed mice, but ACT completely restored the diminished exploratory locomotion time found in stressed mice compared to unstressed mice. The ratio of time spent exploring new objects compared to familiar items (discrimination ratio [DR]) was reduced following social isolation in males from 2.6 ± 0.5 to 1.2 ± 0.2 (p < 0.05) and in females from 3.8 ± 0.6 to 1.5 ± 0.2 (p < 0.01). ACT normalized the DR ratio of the stressed mice. Decreased food consumption and greater locomotor activity induced by ACT may contribute to acute weight loss; this effect is diminished when rodents were maintained on an unhealthful Western diet. Inhibition of chloride/bicarbonate transport through agents such as acetazolamide could offer a safe, new approach to achieving weight loss.

Dataset Information

Exploratory analysis of eating- and physical activity-related outcomes from a randomized controlled trial for weight loss maintenance with exercise and liraglutide single or combination treatment.

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Exploratory analysis of eating- and physical activity-related outcomes from a randomized controlled trial for weight loss maintenance with exercise and liraglutide single or combination treatment.

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