Factors Associated with Weight Loss Maintenance and Weight Regain Among African American and White Adults Initially Successful at Weight Loss

Kinsey, Amber W.; Phillips, James; Desmond, Reneé A.; Gowey, Marissa A.; Jones, C. Danielle; Ard, Jamy D.; Clark, Jeanne M.; Lewis, Cora E.; Dutton, Gareth R.

doi:10.1007/s40615-021-00985-x

Cited by 7 publications

(6 citation statements)

References 58 publications

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“…Even after adjustment for various other sociodemographic and clinical factors, non‐Hispanic White participants were almost twice as likely as Hispanic participants, 2.5 times as likely as non‐Hispanic Asian participants, and almost 3 times as likely as non‐Hispanic Black participants to experience positive weight‐loss outcomes despite low session attendance. Studies have previously documented lower success at weight‐loss goal achievement through LMIs for non‐Hispanic Black participants specifically, and there is increasing study regarding how socio‐cultural factors and longstanding societal inequities, including the daily stress of discrimination, could be contributing to worse health outcomes for people from historically marginalized communities 39–42 . However, our study contributes to the new finding that non‐Hispanic White participants are more likely to achieve weight loss goals despite low engagement, which could suggest that non‐Hispanic White patients experience better healthcare overall (access, racial concordance, quality of care) and societal privileges than racially and ethnically minoritized people.…”

Section: Discussionmentioning

confidence: 67%

Examining paradoxical session attendance and weight loss relationships in a clinic based lifestyle modification intervention

Azar

Sudat

Huang

et al. 2023

Obesity Science & Practice

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ObjectiveEvaluations of lifestyle modification interventions (LMIs), modeled after the Diabetes Prevention Program, have repeatedly shown a dose‐response relationship between session attendance and weight loss. Despite this, not all participants had “average” weight loss experiences. Nearly one‐third of LMI participants experienced unexpected, paradoxical outcomes (i.e., high attendance with little weight loss, and low attendance with clinically significant weight loss). Paradoxical weight‐loss outcomes were characterized based on session attendance among participants in a group‐based LMI in a real‐world healthcare setting. This group‐based LMI was delivered over 1 year to participants with the possibility of attending up to 25 sessions total.MethodsLMI participants identified in 2010–2017 from electronic health records were characterized as having low (<75%) or high (≥75%) session attendance. Weight‐loss outcomes were defined as expected (≥5%, high‐attendance; <5%, low‐attendance) or paradoxical (≥5%, low‐attendance; <5%, high‐attendance). Paradoxical‐outcome‐associated characteristics were identified using logistic regression.ResultsAmong 1813 LMI participants, 1498 (82.6%) had low and 315 (17.4%) high session attendance; 555 (30.6%) had paradoxical outcomes, comprising 415 (74.8%) responders (≥5% weight‐loss) and 140 (25.2%) non‐responders (<5% weight‐loss). Among participants with high session attendance, paradoxical non‐responders were more likely to be female (odds ratio [OR]: 2.76; 95% confidence interval [CI]: 1.32, 5.77) and have type 2 diabetes (OR: 3.32; 95% CI: 1.01, 10.95). Among low‐attendance participants, paradoxical responders were more likely to be non‐Hispanic White and less likely to be non‐Hispanic Black (OR: 0.35; 95% CI: 0.18, 0.69), non‐Hispanic Asian (OR: 0.40; 95% CI: 0.22, 0.73), or Hispanic (OR: 0.53; 95% CI: 0.35, 0.80).ConclusionsIn a healthcare setting, nearly one‐third of LMI participants experienced paradoxical outcomes. More research is needed to understand the facilitators and barriers to weight loss above and beyond session attendance.

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Section: Discussionmentioning

confidence: 67%

Examining paradoxical session attendance and weight loss relationships in a clinic based lifestyle modification intervention

Azar

Sudat

Huang

et al. 2023

Obesity Science & Practice

View full text Add to dashboard Cite

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“…Finally, the sample included in this trial was primarily White and female. Thus, we cannot generalize these findings to other groups, and recent evidence indicates that preferences for weight loss maintenance interventions may differ by race (24).…”

Section: Discussionmentioning

confidence: 77%

“…In addition, participants in the coaching group received personalized coaching via their patient portal account in the EHR. Participants were contacted regularly (weekly for month 1, biweekly for months 2-5, monthly for months 6-12, and quarterly for months [13][14][15][16][17][18][19][20][21][22][23][24] by trained health coaches. The trained health coaches in this trial had backgrounds in nursing, nutrition, and exercise physiology.…”

Section: Study Overviewmentioning

confidence: 99%

Lifestyle Strategies after Intentional Weight Loss: Results from the MAINTAIN-pc Randomized Trial

et al. 2023

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Introduction/PurposeWeight maintenance after intentional weight loss is challenging and often unsuccessful. Physical activity and self-monitoring are strategies associated with successful weight loss maintenance. However, less is known about the type and number of lifestyle strategies used after intentional weight loss. The purpose of this study was to determine the types and amounts of strategies associated with successful long-term weight loss maintenance.MethodsData from the 24-month Maintaining Activity and Nutrition Through Technology-Assisted Innovation in Primary Care (MAINTAIN-pc) trial were analyzed. MAINTAIN-pc recruited adults (n = 194; 53.4 ± 12.2 yr of age; body mass index, 30.4 ± 5.9 kg·m−2; 74% female) with recent intentional weight loss of ≥5%, randomized to tracking tools plus coaching (i.e., coaching group) or tracking tools without coaching (i.e., tracking-only group). At baseline and at 6, 12, and 24 months, participants reported lifestyle strategies used in the past 6 months, including self-monitoring, group support, behavioral skills, and professional support. General linear models evaluated changes in the number of strategies over time between groups and the consistency of strategies used over the 24-month intervention.ResultsAt baseline, 100% used behavioral skills, 73% used group support, 69% used self-monitoring, and 68% used professional support in the past 6 months; at 24 months, these rates were 98%, 60%, 75%, and 61%, respectively. Although the number of participants utilizing individual strategies did not change significantly over time, the overall number of strategies participants reported decreased. More strategies were used at baseline and 6 months compared with 12- and 24-month follow-ups. The coaching group used more strategies at months 6 and 12 than the tracking-only group. Consistent use of professional support strategies over the 24-month study period was associated with less weight regain.ConclusionWeight loss maintenance interventions that incorporate continued follow-up and support from healthcare professionals are likely to prevent weight regain after intentional weight loss.

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“…In a survey of general internal medicine clinic patients with obesity, Blixen and colleagues 9 found that African American women rated self‐monitoring of dietary intake as significantly less important for weight loss success compared to White women. Looking at weight loss maintenance, Kinsey and colleagues 10 asked former participants of behavioral weight management programs to rank facilitators and barriers to maintenance and found that, among successful weight loss maintainers, White participants ranked self‐monitoring of weight and caloric intake as equal (both tied for rank 2) whereas African American participants ranked self‐monitoring of caloric intake higher in the list of facilitators compared to self‐monitoring of weight (rank 4 vs. 7, respectively).…”

Section: Introductionmentioning

confidence: 99%

“…Despite differences in the perceived effectiveness of self‐monitoring, 9 , 10 few studies have examined differences in the associations between self‐monitoring and weight change by demographic characteristics. One recent study examined the relative contribution of various treatment components within Look AHEAD's intensive lifestyle intervention to weight loss within racial/ethnic and sex subgroups 11 and found no statistically significant differences between groups in associations between self‐reported adherence to daily self‐weighing (captured via a 28‐item checklist administered at major assessment points) and weight loss at 1, 4, or 8 years after intervention enrollment.…”

Section: Introductionmentioning

confidence: 99%

Characterising individual variability in associations between self‐monitoring and weight change during and after a behavioral weight management program

Arroyo

Ross

2023

Obesity Science & Practice

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ObjectiveGreater self‐monitoring of caloric intake and weight has been associated with success at both initial weight loss and long‐term maintenance. Given the existence of wide variability in weight loss outcomes and the key role of self‐monitoring within behavioral weight management interventions, this study examined individual variability in associations between self‐monitoring and weight change and whether demographic factors could predict who may best benefit from self‐monitoring.MethodsParticipants were 72 adults with overweight or obesity (mean ± SD, age = 50.6 ± 10.3; body mass index = 31.2 ± 4.5 kg/m2; 71%Female; 83%White) enrolled in a 12‐week weight loss program followed by a 40‐week observational maintenance period. Participants were encouraged to self‐monitor caloric intake and weight daily and to report these data via a study website each week. Multilevel mixed models were used to estimate week‐to‐week associations between self‐monitoring and weight change, by individual and linear regressions and ANOVAs were used to explore demographic differences in these associations.ResultsMost participants (68%) demonstrated statistically significant negative associations between self‐monitoring of either caloric intake or weight and weight change. Of these, 76% benefited from self‐monitoring both caloric intake and weight, 18% from self‐monitoring caloric intake only, and 6% from self‐weighing only. The magnitude of associations between self‐monitoring and weight change did not significantly differ by age, gender, race/ethnicity, education, or income, all ps > 0.05.ConclusionsDifferences in the effectiveness of self‐monitoring for weight loss were not observed by demographic characteristics. Future research should examine if other factors may predict the effectiveness of self‐monitoring.

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Factors Associated with Weight Loss Maintenance and Weight Regain Among African American and White Adults Initially Successful at Weight Loss

Cited by 7 publications

References 58 publications

Examining paradoxical session attendance and weight loss relationships in a clinic based lifestyle modification intervention

Examining paradoxical session attendance and weight loss relationships in a clinic based lifestyle modification intervention

Lifestyle Strategies after Intentional Weight Loss: Results from the MAINTAIN-pc Randomized Trial

Characterising individual variability in associations between self‐monitoring and weight change during and after a behavioral weight management program

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