Objective: The Centers for Medicare and Medicaid Services (CMS) covers intensive behavioral therapy (IBT) for obesity. The efficacy, however, of the specific approach has never been evaluated in a randomized trial, as described here. The 1-year trial also assessed whether the addition to IBT of liraglutide 3.0 mg would significantly increase weight loss and whether the provision of meal replacements would add further benefit. Methods: A total of 150 adults with obesity were randomly assigned to: IBT (IBT-alone), providing 21 counseling visits; IBT combined with liraglutide (IBT-liraglutide); or IBT-liraglutide combined for 12 weeks with a 1,000-to 1,200-kcal/d meal-replacement diet (Multicomponent). All participants received weekly IBT visits in month 1, every-other-week visits in months 2 to 6, and monthly sessions thereafter.Results: Ninety-one percent of participants completed 1 year, at which time mean (± SEM) losses for IBTalone, IBT-liraglutide, and Muticomponent participants were 6.1 ± 1.3%, 11.5 ± 1.3%, and 11.8 ± 1.3% of baseline weight, respectively. Fully 44.0%, 70.0%, and 74.0% of these participants lost ≥ 5% of weight, respectively. The liraglutide-treated groups were superior to IBT-alone on both outcomes. Weight loss in all three groups was associated with clinically meaningful improvements in cardiometabolic risk factors. Conclusions: The findings demonstrate the efficacy of IBT for obesity and the potential benefit of adding pharmacotherapy to this approach.

Objective Weight stigma is a chronic stressor that may increase cardiometabolic risk. Some individuals with obesity self-stigmatize (i.e., weight bias internalization; WBI). No study to date has examined whether WBI is associated with metabolic syndrome. Methods Blood pressure, waist circumference, and fasting glucose, triglycerides, and HDL cholesterol were measured at baseline in 178 adults with obesity enrolled in a weight-loss trial. Medication use for hypertension, dyslipidemia, and pre-diabetes was included in criteria for metabolic syndrome. One hundred fifty-nine participants (88.1% female, 67.3% black, mean BMI=41.1kg/m2) completed the Weight Bias Internalization Scale and Patient Health Questionnaire (PHQ-9, to assess depressive symptoms). Odds ratios and partial correlations were calculated adjusting for demographics, BMI, and PHQ-9 scores. Results Fifty-one participants (32.1%) met criteria for metabolic syndrome. Odds of meeting criteria for metabolic syndrome were greater among participants with higher WBI, but not when controlling for all covariates (OR=1.46, 95% CI=1.00–2.13, P=.052). Higher WBI predicted greater odds of having high triglycerides (OR=1.88, 95% CI=1.14–3.09, P=0.043). Analyzed categorically, high (versus low) WBI predicted greater odds of metabolic syndrome and high triglycerides (Ps<.05). Conclusions Individuals with obesity who self-stigmatize may have heightened cardiometabolic risk. Biological and behavioral pathways linking WBI and metabolic syndrome require further exploration.

The clinical cardiovascular utility of a diet rich in fi sh oils, particularly EPA and DHA, has been debated over the past 50 years ( 1-3 ). Large clinical outcome trials, such as the open-labeled GISSI-Prevenzione ( 4 ) or JELIS ( 5 ) studies, supported the notion that fi sh oil supplements confer therapeutic benefi t on patients with cardiovascular disease. However, an overview analysis of results of more than 50 randomized controlled trials and cohort studies addressing this question yielded equivocal results ( 6, 7 ). Consequently, the adoption of the dietary interventions with fi sh oil into clinical guidelines has been limited ( 8 ). Fish oil supplementation does infl uence a series of cardiovascular biomarkers: it decreases blood levels of triglycerides in patients with hypertriglyceridemia, an effect primarily driven by lowering the production of triglycerides from nonesterifi ed fatty acids ( 9 ); high doses reduce blood pressure in patients with essential hypertension ( 10, 11 ) and modestly inhibit indices of platelet activation ( 12 ). The mechanisms involved are unclear, but may involve a shift in formation of enzymatic and free radical-catalyzed prostanoids, refl ecting utilization of EPA and DHA rather than arachidonic acid (AA) as a substrate. It has been speculated also that cardiovascular benefi t might derive, in part, from anti-infl ammatory actions of fi sh oils: families of bioactive lipids which favor resolution of infl ammation have been suggested to be of particular importance ( 13 ). Synthetic versions of such specialized pro-resolving mediators (SPMs), products of transcellular metabolism of fi sh oils, exert anti-infl ammatory effects in vitro and when administered in vivo in several animal models ( 14-17 ). Quantities Abstract Resolvins, maresins, and protectins can be formed from fi sh oils. These specialized pro-resolving mediators (SPMs) have been implicated in the resolution of infl ammation. Synthetic versions of such SPMs exert anti-infl ammatory effects in vitro and when administered to animal models. However, their importance as endogenous products formed in suffi cient amounts to exert anti-infl ammatory actions in vivo remains speculative. We biased our ability to detect SPMs formed in healthy volunteers by supplementing fi sh oil in doses shown previously to infl uence blood pressure and platelet aggregation under placebo-controlled conditions. Additionally, we sought to determine the relative formation of SPMs during an acute infl ammatory response and its resolution, evoked in healthy volunteers by bacterial lipopolysaccharide (LPS). Bioactive lipids, enzymatic epoxyeicosatrienoic acids (EETs), and free radical-catalyzed prostanoids [isoprostanes (iPs)] formed from arachidonic acid and the fi sh oils, served as comparators. Despite the clear shift from -6 to -3 EETs and iPs, we failed to detect a consistent signal, in most cases, of SPM formation in urine or plasma in response to fi sh oil, and in all cases in response to LPS on a background of fi sh oil. Our results que...

Objective We previously reported that preoperative binge eating disorder (BED) did not attenuate weight loss 12 months after bariatric surgery. This report extends our prior study by examining weight loss at 24 months. Methods We used a modified intention-to-treat (ITT) population to compare 24-month changes in weight among 59 participants treated with bariatric surgery, determined preoperatively to be free of a current eating disorder, with changes in 33 surgically-treated participants with BED. Changes were also compared with 49 individuals with obesity and BED who sought lifestyle modification for weight loss. Analyses included all available data points and were adjusted for covariates. Results At month 24, surgically-treated patients with BED preoperatively lost 18.6% of initial weight, compared with 23.9% for those without BED (p=0.049). (Mean losses at month 12 had been 21.5% and 24.2%, respectively; p=0.23.) Participants with BED who received lifestyle modification lost 5.6% at 24 months, significantly less than both groups of surgically treated patients (p<0.001). Conclusions These results suggest that preoperative BED attenuates long-term weight loss after bariatric surgery. We recommend that patients with this condition, as well as other eating disturbances, receive adjunctive behavioral support, the timing of which remains to be determined.

Background:Some weight loss medications, including liraglutide 3.0 mg, are thought to facilitate weight loss by improving appetite control. However, no studies have evaluated their long-term appetitive effects.Subjects/Methods:This study examined changes in appetite in a subsample of 113 adults with obesity (76.1% female, 55.8% white, BMI = 38.8±4.8 kg/m2) who participated in a 52-week trial. Participants were randomized to intensive behavioral therapy alone (IBT-alone), IBT with liraglutide 3.0 mg/day (IBT-liraglutide), or IBT-liraglutide combined with a 12-week meal replacement diet (Multi-component). Participants rated their hunger, fullness after meals, liking of meals, and food preoccupation (all as experienced over the past week) using visual analogue scales (0-100 mm). Ratings were completed at baseline and 8 subsequent visits over the year.Results:At week 52, participants treated by IBT-alone lost 6.2±1.6% of baseline weight, compared with 11.8±1.6% and 12.1±1.5% in the IBT-liraglutide and Multi-component groups, respectively. Compared to IBT-alone, IBT-liraglutide participants reported larger reductions at week 6 in hunger (−0.3±4.2 vs −16.8±4.0 mm, p=.005) and food preoccupation (+0.2±3.7 vs −16.3±3.6 mm, p=.002) and larger increases in fullness (−5.1±3.2 vs +9.8±3.0 mm, p=.001). These significant differences persisted at all assessments through week 24. There were no differences between IBT-alone and IBT-liraglutide in meal liking. IBT-alone and Multi-component participants differed in hunger at week 6, and in food preoccupation at all assessments through week 24. Multi-component participants reported reduced liking of meals relative to the IBT-alone and IBT-liraglutide groups through weeks 40 and 52, respectively. There were no other differences among any groups at week 52.Conclusions:Consistent with short-term studies, IBT-liraglutide participants reported greater improvements in hunger, fullness, and food preoccupation than those assigned to IBT-alone. Differences in appetite persisted for 24 weeks but were not maintained at week 52, despite the relatively greater weight losses in the liraglutide-treated participants at the trial’s end.

VSG and RYGB both produced substantial weight losses at 18 months. The data suggest a role of gastrointestinal hormones as mediators of weight loss.

Introduction:The COVID-19 pandemic creates a challenge in the provision of care for patients with diabetes. Furthermore, those with uncontrolled diabetes are at a higher risk for complications due to COVID-19. The purpose of this study is to find an innovative method to sustain effective diabetes care services amidst the COVID-19 pandemic.Methods: Outpatient diabetes care was successfully transformed from traditional face-toface encounters in the clinic to an online telemedicine service.Results: 1,972 patients were encountered over a 4-week study period during which we had a low proportion of unreached patients (4%). Some patients were still seen in person because they came as walk-in visits or insisted to be seen in person. Conclusion:Telemedicine has become an essential healthcare service and could be augmented by the use of technology like web-based applications and communication via transfer of data from patients' glucometer, insulin pumps, or sensors. Diabetes care can be transitioned to telemedicine effectively and would be successful in reaching more patients than by traditional face-to-face visits. This model of care is time consuming and unfortunately does not reduce the need for medical staff.

Introduction Food addiction is a controversial concept. The potential influence of food addiction on patients’ psychosocial functioning and well-being has not been well established. The purpose of this study was to examine the relationships between psychosocial functioning (depressive symptoms and health-related quality of life [HRQOL]) and food addiction as measured by the Yale Food Addiction Scale (YFAS). We also explored whether food addiction contributed additional variance in explaining psychosocial functioning, beyond demographic and clinical factors (e.g., binge eating). Methods The sample included 178 participants (mean age=44.2±11.2 years; BMI=40.9±5.9 kg/m2; 88.2% female; 70.8% Black) with obesity seeking treatment for weight loss. Participants completed the Medical Outcomes Study 36-Item Short-Form Health Survey, Impact of Weight on Quality of Life-Lite, Patient Health Questionnaire, YFAS, and Questionnaire on Eating and Weight Patterns-5. Results Twelve (6.7%) participants met criteria for food addiction, with 4 (33.3%) of these participants having co-occurring binge eating disorder. After adjusting for covariates, the number of food addiction symptoms accounted for 6.5% to 16.3% of additional variance in general HRQOL, 5.0% to 21.5% in weight-related HRQOL, and 19.1% in symptoms of depression. Conclusions In this treatment-seeking sample of participants, we found a low prevalence of food addiction, suggesting that additive-like eating is unlikely to be a causal mechanism for most people with obesity. However, individuals who met criteria for food addiction had reduced psychosocial functioning compared to those who did not meet criteria. Individuals with addictive-like eating may require additional psychosocial support.