Introduction Gestational diabetes mellitus (GDM) significantly increases maternal and fetal health risks, but factors predictive of GDM are poorly understood. Objectives Plasma metabolomics analyses were conducted in early pregnancy to identify potential metabolites associated with prediction of Gestational Diabetes Mellitus (GDM). Methods Sixty-eight pregnant women with overweight/obesity from a clinical trial of a lifestyle intervention were included. Participants who developed GDM (n=34; GDM group) were matched on treatment group, age, body mass index, and ethnicity with those who did not develop GDM (n=34; Non-GDM group). Blood draws were completed early in pregnancy (10-16 weeks). Plasma samples were analyzed by UPLC-MS using three metabolomics assays. Results One hundred thirty moieties were identified. Thirteen metabolites including pyrimidine/purine derivatives involved in uric acid metabolism, carboxylic acids, fatty acylcarnitines, and sphingomyelins (SM) were different when comparing the GDM vs. the Non-GDM groups (p<0.05). The most significant differences were elevations in the metabolites’ hypoxanthine, xanthine and alpha-hydroxybutyrate (p<0.002, adjusted p<0.02) in GDM patients. A panel consisting of four metabolites: SM 14:0, hypoxanthine, alpha-hydroxybutyrate, and xanthine presented the highest diagnostic accuracy with an AUC= 0.833 (95% CI: 0.572686-0.893946), classifying as a “very good panel”. Conclusion: Plasma metabolites mainly involved in purine degradation, insulin resistance, and fatty acid oxidation, were altered in early pregnancy in connection with subsequent GDM development.

Objective This study aimed to investigate sitting time, the home sedentary environment, and physical activity among weight‐loss maintainers in WW (formerly Weight Watchers). Methods Participants were 4,305 weight‐loss maintainers who had maintained ≥9.1 kg of weight loss (24.7 kg on average) for 3.3 years and had an average current BMI of 27.6 kg/m2. A control group of weight‐stable individuals with obesity (n = 619) had an average BMI of 38.9 kg/m2. The Multicontext Sitting Time Questionnaire and Paffenbarger physical activity questionnaire were administered. Results Weight‐loss maintainers versus controls spent 3 hours less per day sitting during the week (10.9 vs. 13.9; ηp2 = 0.039; P = 0.0001) and weekends (9.7 vs. 12.6; ηp2 = 0.038). Weight‐loss maintainers versus controls spent 1 hour less per day in non–work‐related sitting using a computer or video games during the week (1.4 vs. 2.3; ηp2 = 0.03; P = 0.0001) and weekends (1.5 vs. 2.5; ηp2 = 0.03; P = 0.0001). Weight‐loss maintainers versus controls had similar numbers of sedentary‐promoting devices (15.8 vs. 14.8) and expended significantly more calories per week in physical activity (1,835 vs. 785; ηp2 = 0.036; P = 0.0001). Conclusions Weight‐loss maintainers reported less time sitting than weight‐stable individuals with obesity. Future research should test the efficacy of targeting sitting time to help promote long‐term weight‐loss maintenance.

Objective This study aimed to identify major themes of a large cohort experiencing long‐term weight‐loss maintenance who answered open‐ended questions about weight‐loss triggers, current motivations, strategies, and experiences. Methods Machine learning and topic modeling were used to analyze responses to six open‐ended questions among 6,139 WW International, Inc., (formerly Weight Watchers) members with weight‐loss maintenance; inclusion criteria included ≥9.1‐kg loss with weight‐loss maintenance for ≥1 year. Results Participants (mean age = 53.6 years; 94.3% White; mean BMI = 27.8 kg/m2) had lost 24.5 kg and maintained the loss for 3.4 years. Descriptions of factors triggering weight loss coalesced into five topics: medical status, appearance, mobility, social prompts, and change needed. Factors currently motivating weight‐loss maintenance yielded two topics: looking back at experiences at higher weight and health/appearance concerns. Advice for others to succeed in weight‐loss maintenance coalesced on two recommendations: perseverance in the face of setbacks and consistency in tracking. Rewards for weight management included improved confidence, pain, mobility, fitness, body image, medical status, and affect. Two thematic negative consequences were clothing costs and sagging skin. Conclusions Future weight‐maintenance research should include more diverse populations and investigate weight‐loss maintenance as a journey with highs and lows, perseverance in the face of setbacks, sustained tracking, and making changes in medical status more salient during the weight‐maintenance journey.

Background The present study aimed to examine motivations for food choice among long‐term weight loss maintainers (WLM) in a widely used commercial weight management program. Methods A cross‐sectional study was employed where determinants of food choice were measured in the USA using validated scales: Food Choice Questionnaire, Consideration of Future Consequences, and Eating in the Absence of Hunger. Participants were 3806 WLM following a commercial weight management program (WW International, Inc.) who had maintained a weight loss ≥ 9.1 kg (mean 24.7 kg) for 3.3 years and had a body mass index (BMI) of 27.6 kg m2. A control group of weight stable individuals with obesity (controls; n = 519) had a BMI of 38.9 kg m2 and a weight change < 2.3 kg over the previous 5 years. Results WLM vs. controls made food decisions more based on health (18.9 vs. 16.3; ηp2 = 0.052) and weight control (9.9 vs. 7.5; ηp2 = 0.16) and less based on price (8.4 vs. 9.1; ηp2 = 0.10). WLM also scored higher than controls with respect to considering future consequences of behaviours (44.3 vs. 38.4; ηp2 = 0.060) and reported less external eating in the absence of hunger (7.1 vs. 7.5; ηp2 = 0.058). Standard canonical coefficients indicated that making food choices based on weight (0.717) with less value placed on price (−0.33) and greater consideration of future consequences (0.262) contributed independently and most (overall r = 0.593; p = 0.0001) to discriminating WLM from controls. Conclusions In a widely used commercial weight management program, successful WLM reported food decisions based more on weight and less on price and considered future consequences of current behaviours.

Background/Objectives We previously reported results from a randomized trial showing that a behavioral intervention during pregnancy reduced excess gestational weight gain but did not impact maternal weight at 12 months. We now examine the longer-term effects of this prenatal intervention on maternal postpartum weight retention and toddler body-mass-index z scores (BMIz) over 36 months. Subjects/Methods Pregnant women (N = 264; 13.7 weeks’ gestation; 41.6% Hispanic) with overweight or obesity were randomized into usual care or prenatal intervention. Anthropometric assessments in mothers and toddlers occurred at baseline, 35 weeks’ gestation and after delivery at 6, 12, 18, 24, and 36 months. Results At 36 months, prenatal intervention vs. usual care had no significant effect on the proportion of participants who returned to their early pregnancy weight or below (33.3% vs. 39.5%; p = 0.12) and had no effect on the magnitude of weight retained (2.8 [0.8, 4.8] vs 3.0 kg [1.0, 4.9], respectively; mean difference = 0.14 [−3.0, 2.7]). There was also no statistically significant intervention vs. usual care effect on infant BMIz or skinfold changes over time; toddler BMIz increased by 1.4 [−1.7, 1.0] units in the intervention group and 1.6 [−1.2, 1.8] units in the usual care group from delivery to 36 months (difference = 0.16 [−0.32. 0.63]). The proportion of toddlers at risk for obesity at 36 months was similar in intervention and usual care groups (28/77 [36.4%] vs 30/80 [37.5%]; p = 0.77). Conclusions Compared with usual care, lifestyle intervention during pregnancy resulted in similar maternal and toddler anthropometric outcomes at 36-months postpartum in a diverse US sample of women with overweight and obesity. To sustain improved maternal weight management initiated during pregnancy, continued intervention during the postpartum years may be needed.