Predictors of programme adherence and weight loss in women in an obesity programme using meal replacements

Abstract

Objective: To explore predictors of programme adherence and weight loss in patients participating in a weight management programme using meal replacements (MR).Design: 150 healthy obese women, age 48.5(sd=8.3) years; weight, 97.6(13.4) kg; BMI 36.5(3.7), participated in a longitudinal study with a 16-week acute weight loss phase (Phase 1) followed by one year of a trial of weight loss maintenance (Phase 2). Energy intake during Phase 1 totaled 900 kcal (3.7MJ) a day from a diet including two meal replacements (MR). Energy intake during Phase 2 consisted of either MR or a low fat diet with a calculated energy deficit of 600 kcal/day (2.5MJ).Methods: Weight, height and waist circumference were measured and body composition assessed by air plethysmography (Bodpod). Glucose and insulin were measured by standard immunoassays and insulin sensitivity assessed by Homeostatic Model Assessment (HOMA).Results: At the end of 16 weeks, 114 subjects (76%) completed Phase 1 and achieved a mean weight loss of 8.95(3.38) kg. Adherence to Phase 1 was predicted by weight loss over the first two weeks (p<0.001). Weight loss during Phase 1 was predicted by initial weight and initial systolic blood pressure. Adherence to Phase 2 was not predicted by physiological measures. Weight loss maintenance in Phase 2 (not gaining more than 3% of the weight at start of phase 2) was predicted by cholesterol and triglyceride measured at the start of Phase 2 but otherwise was not predicted by the physiological measures. Initial insulin sensitivity did not predict weight loss in either phase.Conclusion: Participants whose weight loss over the first two weeks falls in the bottom third may need additional intervention if they are to continue in this type of programme. A battery of physiological measures at entry to a MR weight loss and maintenance programme explains only a very small proportion of the variation in weight loss.

Predicting dropout in dietary weight loss trials using demographic and early weight change characteristics: Implications for trial design

“…Several researchers have previously demonstrated that initial weight loss is associated with study dropout in dietary based weight loss trials [9][10][11][12][13][14][15][16] , however this finding is not consistent and others have found no relationship 11,17,18 . This is the first study to quantify the amount of initial weight loss which predicts dropout and to investigate and quantify additional easily obtainable subject characteristics such as age which can be used to ensure adequate randomisation.…”

Weight loss resistance: A further consideration for the nutritional management of obese Equidae

“…Although obesity is recognized as a risk factor for insulin resistance (IR) for many mammals, including horses and ponies (Packianathan et al, 2005;Frank et al, 2006), the relationship between IR and the propensity to lose weight during DR has not previously been reported for Equidae. For man, evidence linking IR to a propensity for weight gain or loss has largely been based on the retrospective analysis of observational data and reports are contradictory (Swinburn et al, 1991;Odeleye et al, 1997;Zavaroni et al, 1998).…”

“…Rates of weight loss of $1% of outset BM weekly are considered clinically useful for man and companion animal species (Packianathan et al, 2005;German et al, 2007). Obtaining comparable rates of weight loss in obese ponies of Native breeds, has required relatively severe restriction of forage intake (Welsh Mountain ponies, 1% of BM as daily DMI, $67% of estimated maintenance digestible energy requirements [mDER]; Dugdale et al, 2010; Shetland ponies, $51% of mDER; van Weyenberg et al, 2008).…”

Randomized trial of weight-loss-diets for young adults varying in fish and fish oil content

“…Other studies have shown that weight loss in the beginning of a weight reduction program is an important determinant of further weight loss. [33][34][35] This could also be due to metabolic determinants. 36 The results indicate that the loss of fat-free mass was greater in the diet groups receiving fish.…”