The Role of Choice in Weight Loss Strategies: A Systematic Review and Meta-Analysis

Effective strategies to achieve weight loss and long-term weight loss maintenance have proved to be elusive. This systematic review and meta-analysis aims to explore whether the choice of weight loss strategy is associated with greater weight loss. An electronic search was conducted using the MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online), EMBASE (Excerpta Medica database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO (Database of Abstracts of Literature in the Field of Psychology, produced by the American Psychological Association and distributed on the association’s APA PsycNET) databases for clinical trials and randomized controlled trials, investigating the role of choice in weight loss strategies. A total of nine studies were identified as meeting the pre-specified criteria. All of the studies included a ‘Choice’ or preference arm and a ‘No Choice’ arm or group who did not receive their preference as a control. A total of 1804 subjects were enrolled in these studies, with weight loss observed in both experimental and control groups of all studies, irrespective of dietary intervention, study duration, or follow-up length. Twelve interventions in nine trials were used for the meta-analysis, with results indicating a greater weight loss in the control groups, 1.09 ± 0.28 (overall mean difference in weight loss between groups ± standard error; p = 0). There was no significant effect of duration or attrition. In this meta-analysis, the choice of weight loss strategy did not confer a weight loss benefit. © 2018 by the authors. Licensee MDPI, Basel, Switzerland

Clinical Study Meal Replacements for Weight Loss in Type 2 Diabetes in a Community Setting

Background. There is limited information on the effectiveness of meal replacements (MRs) as a weight-loss strategy in an unsupervised community setting. Aim. To evaluate the use of MR compared with a diet book for 6 months. Subjects and Methods. Obese subjects (n = 120) with type 2 diabetes mellitus were recruited from the community in Adelaide, South Australia, and randomised to intervention or control. Subjects in the intervention were advised to consume 2 MR/day for 3 months and 1 MR/day for 3 months and follow the manufacturers' instructions from printed material and the website. Subjects in the control arm were given a commercially available diet book. Results. Consumption of 2 MR for 3 months and 1 MR for the subsequent 3 months led to weight loss of 5.5 kg (5%) and a 0.26% decrease in HbA1c while the diet book group had a weight loss of 3 kg (3%) (P = 0.027 for difference between groups) and a decrease in HbA1c of 0.15% (between group ns) in those who completed the 6-month study. On intention-to-treat (last observation carried forward) weight loss at 6 months was 3.4 kg in MR and 1.8 kg in control (P = 0.07). Decreases in HbA1c were 0.22% and 0.12%, respectively (P = ns). HDL cholesterol increased by 4% in MR and decreased by 1% in control (P = 0.004). Blood pressure decreased equally in both groups. There were reductions in fasting glucose in both groups at 6 months with no changes in LDL-cholesterol or triglyceride concentrations. Conclusion. MR confers benefits in HbA1C reduction and weight loss at 6 months in those who completed the study

Long-term weight maintenance and cardiovascular risk factors are not different following weight loss on carbohydrate-restricted diets high in either monounsaturated fat or protein in obese hyperinsulinaemic men and women

The aim of this study was to determine after 52 weeks whether advice to follow a lower carbohydrate diet, either high in monounsaturated fat or low fat, high in protein had differential effects in a free-living community setting. Following weight loss on either a high monounsaturated fat, standard protein (HMF; 50 % fat, 20 % protein (67 g/d), 30 % carbohydrate) or a high protein, moderate fat (HP) (40 % protein (136 g/d), 30 % fat, 30 % carbohydrate) energy-restricted diet (6000 kJ/d) subjects were asked to maintain the same dietary pattern without intensive dietary counselling for the following 36 weeks. Overall weight loss was 6·2 (sd 7·3) kg (P < 0·01 for time with no diet effect, 7·6 (sd 8·1) kg, HMF v. 4·8 (sd 6·6) kg, HP). In a multivariate regression model predictors of weight loss at the end of the study were sex, age and reported percentage energy from protein (R2 0·22, P < 0·05 for the whole model). Fasting plasma insulin decreased (P < 0·01, with no difference between diets), 13·9 (sd 4·6) to 10·2 (sd 5·2) mIU/l, but fasting plasma glucose was not reduced. Neither total cholesterol nor LDL-cholesterol were different but HDL was higher, 1·19 (sd 0·26) v. 1·04 (sd 0·29) (P < 0·001 for time, no diet effect), while TAG was lower, 1·87 (sd 1·23) v. 2·22 (sd 1·15) mmol/l (P < 0·05 for time, no diet effect). C-reactive protein decreased (3·97 (sd 2·84) to 2·43 (sd 2·29) mg/l, P < 0·01). Food records showed that compliance to the prescribed dietary patterns was poor. After 1 year there remained a clinically significant weight loss and improvement in cardiovascular risk factors with no adverse effects of a high monounsaturated fat diet.Jennifer B. Keogh, Natalie D. Luscombe-Marsh, Manny Noakes, Gary A. Wittert and Peter M. Clifto

Comparison of isocaloric very low carbohydrate/high saturated fat and high carbohydrate/low saturated fat diets on body composition and cardiovascular risk

BACKGROUND: It is speculated that high saturated fat very low carbohydrate diets (VLCARB) have adverse effects on cardiovascular risk but evidence for this in controlled studies is lacking. The objective of this study was to compare, under isocaloric conditions, the effects of a VLCARB to 2 low saturated fat high carbohydrate diets on body composition and cardiovascular risk. METHODS: Eighty three subjects, 48 ± 8 y, total cholesterol 5.9 ± 1.0 mmol/L, BMI 33 ± 3 kg/m(2 )were randomly allocated to one of 3 isocaloric weight loss diets (6 MJ) for 8 weeks and on the same diets in energy balance for 4 weeks: Very Low Fat (VLF) (CHO:Fat:Protein; %SF = 70:10:20; 3%), High Unsaturated Fat (HUF) = (50:30:20; 6%), VLCARB (4:61:35; 20%) RESULTS: Percent fat mass loss was not different between diets VLCARB -4.5 ± 0.5, VLF-4.0 ± 0.5, HUF -4.4 ± 0.6 kg). Lean mass loss was 32-31% on VLCARB and VLF compared to HUF (21%) (P < 0.05). LDL-C increased significantly only on VLCARB by 7% (p < 0.001 compared with the other diets) but apoB was unchanged on this diet and HDL-C increased relative to the other 2 diets. Triacylglycerol was lowered by 0.73 ± 0.12 mmol/L on VLCARB compared to -0.15 ± 0.07 mmol/L on HUF and -0.06 ± 0.13 mmol/L on VLF (P < 0.001). Plasma homocysteine increased 6.6% only on VLCARB (P = 0.026). VLCARB lowered fasting insulin 33% compared to a 19% fall on HUF and no change on VLF (P < 0.001). The VLCARB meal also provoked significantly lower post prandial glucose and insulin responses than the VLF and HUF meals. All diets decreased fasting glucose, blood pressure and CRP (P < 0.05). CONCLUSION: Isocaloric VLCARB results in similar fat loss than diets low in saturated fat, but are more effective in improving triacylglycerols, HDL-C, fasting and post prandial glucose and insulin concentrations. VLCARB may be useful in the short-term management of subjects with insulin resistance and hypertriacylglycerolemia

Women’s Barriers to Weight Loss, Perception of Future Diabetes Risk and Opinions of Diet Strategies Following Gestational Diabetes: An Online Survey

Weight loss after gestational diabetes (GDM) reduces the risk of type 2 diabetes (T2DM); however, weight loss remains challenging in this population. In order to explore perceptions of T2DM risk, barriers to weight loss, and views of diet strategies in women with previous GDM, a cross-sectional online survey of n = 429 women in Australia aged ≥18 years with previous GDM was conducted. Opinions of intermittent energy restriction (IER) were of interest. Seventy-five percent of responders (n = 322) had overweight or obesity, and 34% (n = 144) believed they had a high risk of developing T2DM. Within the Theoretical Domains Framework, barriers to weight loss were prominently related to Environmental Context and Resources, Beliefs about Capabilities, and Behavioural Regulation. Exercising was the most tried method of weight loss over other diet strategies (71%, n = 234) and weight loss support by a dietician was appealing as individual appointments (65%, n = 242) or an online program (54%, n = 200). Most women (73%, n = 284) had heard of IER (the “5:2 diet”), but only 12% (n = 34) had tried it. Open comments (n = 100) revealed mixed views of IER. Women in Australia with previous GDM were found to lack a self-perceived high risk of developing T2DM and expressed barriers to weight loss related to their family environment, beliefs about their capabilities and behavioural regulation. IER is appealing for some women with previous GDM; however, views vary

Development and Validation of an Online Survey to Assess Perception of Diabetes Risk and Barriers and Facilitators to Weight Loss Following Gestational Diabetes

Our objective was to describe the development and validation of a survey investigating barriers to weight loss, perception of diabetes risk, and views of diet strategies following gestational diabetes (GDM). The survey underwent three stages of development: generation of items, expert evaluation, and pilot testing. A content validation index (CVI) was calculated from expert responses regarding item relevance, coherence, clarity, and response options. Experts also responded to the domain fit of questions linked to the Theoretical Domains Framework (TDF). Pilot responders answered the survey and responded to review questions. Six experts in the field of nutrition, midwifery, psychology, or other health or medical research completed the expert review stage of the survey. In the pilot test, there were 20 responders who were women with previous GDM and who were living in Australia. The overall CVI from the expert review was 0.91. All questions except one received an I-CVI of >0.78 for relevance (n = 35). Fourteen of the 27 items linked to the TDF received an agreement ratio of <1.0. Twenty-seven of the 31 pilot questions were completed by ≥90% of responders. Pilot review questions revealed an agreement percentage of ≥86% (n = 12) regarding the survey’s ease to complete, understand, importance, length, and interest level. The final survey tool consists of 30 items and achieved content validation through expert evaluation and pilot testing

Effect of a Low–Resource-Intensive Lifestyle Modification Program Incorporating Gymnasium-Based and Home-Based Resistance Training on Type 2 Diabetes Risk in Australian Adults

OBJECTIVE—The purpose of this study was to assess the effectiveness of a low–resource-intensive lifestyle modification program incorporating resistance training and to compare a gymnasium-based with a home-based resistance training program on diabetes diagnosis status and risk

Effects of weight loss on a low-carbohydrate diet on flow-mediated dilatation, adhesion molecules and adiponectin

Our aim was to determine whether short-term weight loss on a low-carbohydrate/low-saturated fat diet improved endothelial function compared with a conventional high-carbohydrate diet, as this diet is expected to lower both blood glucose and LDL-cholesterol. In a randomised parallel design of two energy-restricted diets in an outpatient setting, thirty-six subjects (BMI 33 (sem 4) kg/m2) were randomised to a low- or high-carbohydrate diet both low in saturated fat. Flow-mediated dilatation (FMD), fasting glucose, insulin, lipids, adiponectin and adhesion molecules were measured at baseline, during weight loss and at 52 weeks. FMD did not change with either diet (5·2 (sem 0·6) to 5·5 (sem 0·6) %) despite weight loss of 5 % and significant reductions in glucose and insulin and LDL-cholesterol and was not different after sustained weight loss of 5 % at 52 weeks. Adiponectin fell by 6 % at 12 weeks (P = 0·1) with weight loss but rose by 17 % at 12 months (P < 0·05) with 5 % weight loss. There were no effects of diet. In contradistinction, adhesion molecules fell at 12 weeks, vascular cell adhesion molecule-1 by 14 % and intracellular adhesion molecule-1 by 13 % (both P < 0·05). There were correlations between change in adiponectin at 12 months and change in HDL (r 0·778, P < 0·01) and glucose (r − 0·563, P = 0·057). In summary, weight loss does not improve FMD. Novel cardiovascular risk factors improved at 12 weeks but the improvement in adiponectin was delayed.Jennifer B. Keogh, Grant D. Brinkworth and Peter M. Clifto

Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomised controlled trial

Background Many inpatients receive little or no rehabilitation on weekends. Our aim was to determine what effect providing additional Saturday rehabilitation during inpatient rehabilitation had on functional independence, quality of life and length of stay compared to 5 days per week of rehabilitation.MethodsThis was a multicenter, single-blind (assessors) randomized controlled trial with concealed allocation and 12-month follow-up conducted in two publically funded metropolitan inpatient rehabilitation facilities in Melbourne, Australia. Patients were eligible if they were adults (aged &ge;18 years) admitted for rehabilitation for any orthopedic, neurological or other disabling conditions excluding those admitted for slow stream rehabilitation/geriatric evaluation and management. Participants were randomly allocated to usual care Monday to Friday rehabilitation (control) or to Monday to Saturday rehabilitation (intervention). The additional Saturday rehabilitation comprised physiotherapy and occupational therapy. The primary outcomes were functional independence (functional independence measure (FIM); measured on an 18 to 126 point scale), health-related quality of life (EQ-5D utility index; measured on a 0 to 1 scale, and EQ-5D visual analog scale; measured on a 0 to 100 scale), and patient length of stay. Outcome measures were assessed on admission, discharge (primary endpoint), and at 6 and 12 months post discharge.ResultsWe randomly assigned 996 adults (mean (SD) age 74 (13) years) to Monday to Saturday rehabilitation (n&thinsp;=&thinsp;496) or usual care Monday to Friday rehabilitation (n&thinsp;=&thinsp;500). Relative to admission scores, intervention group participants had higher functional independence (mean difference (MD) 2.3, 95% confidence interval (CI) 0.5 to 4.1, P&thinsp;=&thinsp;0.01) and health-related quality of life (MD 0.04, 95% CI 0.01 to 0.07, P&thinsp;=&thinsp;0.009) on discharge and may have had a shorter length of stay by 2 days (95% CI 0 to 4, P&thinsp;=&thinsp;0.1) when compared to control group participants. Intervention group participants were 17% more likely to have achieved a clinically significant change in functional independence of 22 FIM points or more (risk ratio (RR) 1.17, 95% CI 1.03 to 1.34) and 18% more likely to have achieved a clinically significant change in health-related quality of life (RR 1.18, 95% CI 1.04 to 1.34) on discharge compared to the control group. There was some maintenance of effect for functional independence and health-related quality of life at 6-month follow-up but not at 12-month follow-up. There was no difference in the number of adverse events between the groups (incidence rate ratio&thinsp;=&thinsp;0.81, 95% CI 0.61 to 1.08).ConclusionsProviding an additional day of rehabilitation improved functional independence and health-related quality of life at discharge and may have reduced length of stay for patients receiving inpatient rehabilitation.&nbsp;</p