Yoga targets psychological processes which may be important for long-term weight loss (WL). This study is the first to examine the feasibility, acceptability, and preliminary efficacy of yoga within ...a weight management program following WL treatment.
60 women with overweight or obesity (34.3±3.9 kg/m2, 48.1±10.1 years) were randomized to receive a 12-week yoga intervention (2x/week; YOGA) or a structurally equivalent control (cooking/nutrition classes; CON), following a 3-month behavioral WL program. Feasibility (attendance, adherence, retention) and acceptability (program satisfaction ratings) were assessed. Treatment groups were compared on weight change, mindfulness, distress tolerance, stress, affect, and self-compassion at 6 months. Initial WL (3-mo WL) was evaluated as a potential moderator.
Attendance, retention, and program satisfaction ratings of yoga were high. Treatment groups did not differ on WL or psychological constructs (with exception of one mindfulness subscale) at 6 months. However, among those with high initial WL (≥5%), YOGA lost significantly more weight (-9.0kg vs. -6.7kg) at 6 months and resulted in greater distress tolerance, mindfulness, and self-compassion and lower negative affect, compared to CON.
Study findings provide preliminary support for yoga as a potential strategy for improving long-term WL among those losing ≥5% in standard behavioral treatment.
Objective
Examine the relationship between 1‐ and 2‐month weight loss (WL) and 8‐year WL among participants enrolled in a lifestyle intervention.
Methods
2,290 Look AHEAD participants (BMI: 35.65 ± ...5.93 kg/m2) with type 2 diabetes received an intensive behavioral WL intervention.
Results
1‐ and 2‐month WL were associated with yearly WL through Year 8 (P's < 0.0001). At Month 1, participants losing 2‐4% and >4% had 1.62 (95% CI: 1.32, 1.98) and 2.79 (95% CI: 2.21, 3.52) times higher odds of achieving ≥5% WL at Year 4 and 1.28 (95% CI: 1.05,1.58) and 1.77 (95% CI: 1.40, 2.24) times higher odds of achieving ≥5% WL at Year 8, compared to those losing <2% initially. At Month 2, 3‐6% WL resulted in greater odds of achieving ≥5% WL at Year 4 (OR = 1.85; CI: 1.48, 2.32), and >6% WL resulted in the greatest odds of achieving ≥5% WL at Year 4 (OR = 3.85; CI: 3.05, 4.88) and Year 8 (OR = 2.28; CI: 1.81, 2.89), compared to those losing <3%. Differences in adherence between WL categories were observed as early as Month 2.
Conclusions
1‐ and 2‐month WL was associated with 8‐year WL. Future studies should examine whether alternative treatment strategies can be employed to improve treatment outcomes among those with low initial WL.
While previous research has utilized remote delivery of yoga interventions, no research has specifically interrogated the effectiveness of remote yoga intervention delivery. In this secondary ...analysis of weight-maintenance trial data, we examined participant perceptions of essential yoga properties across in-person and remote formats, hypothesizing that perceptions would not differ following remote delivery.
24 women with overweight or obesity (34.6±4.1 kg/m2, 48.2±9.9 years) received a 12-week Iyengar yoga intervention (2x/week) following a 3-month behavioral weight loss program. Of 23 participants who completed follow-up questionnaires, 12 received the planned in-person intervention and 11 received a remote intervention (delivered live) due to the COVID-19 pandemic. The Essential Properties of Yoga Questionnaire (EPYQ) was completed online by participants and by the instructors to measure the perceptions of the relative emphasis placed on the essential components of the yoga intervention via 14 subscales. Linear regression models were used to compare perceptions of each EPYQ dimension across in-person and remote delivery methods, as well as between participants and instructors, independent of delivery method.
13 of the 14 subscales did not differ between delivery modalities (p>0.05). Participants perceived more individual attention within in-person yoga (p = 0.003). For both delivery methods, instructors perceived breathwork, restorative postures, and body locks to be incorporated to a lesser degree compared to participants (β = -1.28, p = 0.003; β = -1.57, p = 0.019; β = -1.39, p = 0.036; respectively). No other significant differences across the participant and instructor scores were observed.
Findings provide preliminary support for the use of live remote delivery of yoga, effectively communicating most essential yoga properties when compared to in-person classes. However, participants perceived more individual attention with in-person versus remote delivery; thus, future remote-based yoga interventions may benefit from providing additional individualized feedback.
Abstract Objective Severe obesity (body mass index BMI ≥40 kg/m2 ) is a serious public health concern. Although bariatric surgery is an efficacious treatment approach, it is limited in reach; thus, ...nonsurgical treatment alternatives are needed. We examined the 4-year effects of an intensive lifestyle intervention on body weight and cardiovascular disease risk factors among severely obese, compared with overweight (25 ≤BMI <30), class I (30 ≤BMI <35), and class II obese (35 ≤BMI <40) participants. Methods There were 5145 individuals with type 2 diabetes (45-76 years, BMI ≥25 kg/m2 ) randomized to an intensive lifestyle intervention or diabetes support and education. The lifestyle intervention group received a behavioral weight loss program that included group and individual meetings, a ≥10% weight loss goal, calorie restriction, and increased physical activity. Diabetes support and education received a less intense educational intervention. Four-year changes in body weight and cardiovascular disease risk factors were assessed. Results Across BMI categories, 4-year changes in body weight were significantly greater in lifestyle participants compared with diabetes support and education ( P s <.05). At year 4, severely obese lifestyle participants lost 4.9% ± 8.5%, which was similar to class I (4.8% ± 7.2%) and class II obese participants (4.4% ± 7.6%), and significantly greater than overweight participants (3.4% ± 7.0%; P <.05). Four-year changes in low-density-lipoprotein cholesterol, triglycerides, diastolic blood pressure, HbA1c , and blood glucose were similar across BMI categories in lifestyle participants; however, the severely obese had less favorable improvements in high-density-lipoprotein cholesterol (3.1 ± 0.4 mg/dL) and systolic blood pressure (−1.4 ± 0.7 mm Hg) compared with the less obese ( P s <.05). Conclusion Lifestyle interventions can result in important long-term weight losses and improvements in cardiovascular disease risk factors among a significant proportion of severely obese individuals.
Objective: Little is known about week-to-week recovery from regains following a behavioral weight loss intervention (BWLI). This study examined changes in behaviors, cognitions, and moods associated ...with transitioning from weight regain to weight loss during the nine-month weight loss maintenance period after a three-month Internet-based BWLI. Method: Participants (n = 68) self-weighed daily via "smart" scales and answered 40 weekly questionnaires about their weight-related behaviors and psychological states. Mixed models were used to (a) determine whether weight gain in a given week predicted changes in weight, behaviors (e.g., self-monitoring), and psychological states (e.g., mood, temptation) the following week and to (b) compare back-to-back weeks when individuals recovered from weight gain (gained in the first week and lost in the second) versus those in which they gained both weeks. Results: Weight gain in a given week predicted greater weight gain and greater report of behaviors and psychological states associated with weight gain the following week. Back-to-back weeks when individuals switched from gaining to losing were few (5%) compared with weeks when individuals continued gaining (60%). Switching from gaining to losing was associated with greater physical activity during the initial weight gain week and greater self-reported behaviors/cognitions consistent with weight loss (e.g., greater calorie self-monitoring, greater importance of "staying on track") during the following week. Conclusions: Engagement in more weight loss consistent behaviors and more favorable ratings of key psychological variables were associated with the rare shifts from gaining to losing. Future research should investigate interventions to help individuals quickly recover from weight regain.
OBJECTIVE: Rates of severe obesity (BMI ≥40 kg/m2) are on the rise, and effective treatment options are needed. We examined the effect of an intensive lifestyle intervention (ILI) on weight loss, ...cardiovascular disease (CVD) risk, and program adherence in participants with type 2 diabetes who were severely obese compared with overweight (BMI 25 to <30 kg/m2), class I (BMI 30 to <35 kg/m2), and class II (BMI 35 to <40 kg/m2) obese participants. RESEARCH DESIGN AND METHODS: Participants in the Action for Health in Diabetes (Look AHEAD) trial were randomly assigned to ILI or diabetes support and education (DSE). DSE participants received a less intense educational intervention, whereas ILI participants received an intensive behavioral treatment to increase physical activity (PA) and reduce caloric intake. This article focuses on the 2,503 ILI participants (age 58.6 ± 6.8 years). RESULTS: At 1 year, severely obese participants in the ILI group lost –9.04 ± 7.6% of initial body weight, which was significantly greater (P < 0.05) than ILI participants who were overweight (–7.43 ± 5.6%) and comparable to class I (–8.72 ± 6.4%) and class II obese (–8.64 ± 7.4%) participants. All BMI groups had comparable improvements in fitness, PA, LDL cholesterol, triglycerides, blood pressure, fasting glucose, and HbA1c at 1 year. ILI treatment session attendance was excellent and did not differ among weight categories (severe obese 80% vs. others 83%; P = 0.43). CONCLUSIONS: Severely obese participants in the ILI group had similar adherence, percentage of weight loss, and improvement in CVD risk compared with less obese participants. Behavioral weight loss programs should be considered an effective option for this population.
Purpose of Review
There is a large variability in response to behavioral weight loss (WL) programs. Reducing rates of obesity and diabetes may require more individuals to achieve clinically ...significant WL post-treatment. Given that WL within the first 1–2 months of a WL program is associated with long-term WL, it may be possible to improve treatment outcomes by identifying and providing additional intervention to those with poor initial success (i.e., “early non-responders”). We review the current literature regarding early non-response to WL programs and discuss how adaptive interventions can be leveraged as a strategy to “rescue” early non-responders.
Recent Findings
Preliminary findings suggest that adaptive interventions, specifically stepped care approaches, offer promise for improving outcomes among early non-responders.
Summary
Future studies need to determine the optimal time point and threshold for intervening and the type of early intervention to employ. Clinicians and researchers should consider the discussed factors when making treatment decisions.
Objective
To examine the relationship between objectively assessed moderate‐to‐vigorous intensity physical activity (MVPA) and 4‐year weight loss (WL) and WL maintenance among individuals with ...diabetes enrolled in the Look AHEAD trial.
Methods
MVPA was measured in a subgroup of lifestyle intervention participants with accelerometry data at baseline and at 1 and 4 years (n = 553; age: 59.7 ± 6.8 y; BMI: 35.5 ± 5.9 kg/m2). Minutes per week of bout‐related MVPA were calculated (≥ 3 metabolic equivalents, ≥ 10‐min bouts), and adherence to the national physical activity (PA) recommendation for WL maintenance (≥ 250 min/wk) was assessed.
Results
Independent of 1‐year WL, 4‐year MVPA (β = −0.003, SE = 0.002, P = 0.006), but not 1‐year MVPA (β = 0.0001, SE = 0.001, P = 0.50), was significantly associated with 4‐year WL. Compared with “nonmaintainers” (≥ 10% WL at year 1, but < 10% at year 4; n = 132), WL maintainers (≥ 10% WL at years 1 and 4; n = 103) had higher MVPA at year 1 (253.4 ± 251.8 vs. 163.9 ± 158.2 min/wk, P = 0.002) and year 4 (155.3 ± 180.6 vs. 111.4 ± 154.5 min/wk, P = 0.046). Although 38.8% and 22.3% of WL maintainers engaged in ≥ 250 min/wk at years 1 and 4, respectively, many engaged in < 150 min/wk (year 1: 41%, year 4: 61%).
Conclusions
Higher weekly MVPA is associated with greater long‐term WL and weight maintenance; however, many individuals are able to maintain ≥ 10% WL while engaging in little MVPA.
Background: We examined the association of time-of-day bout-related moderate-to-vigorous physical activity (bMVPA) with changes in glycemic measures and use of antidiabetic medications in adults with ...type 2 diabetes.
Methods: Look AHEAD participants were randomly assigned to a lifestyle intervention or a control group, in which the most intensive intervention occurred in Year 1. Among 1755 participants (age, mean ± SD 60 ± 7 years; 57% women) with 7-day waist-worn accelerometry data at Year 1, we grouped them by the timing of bMVPA (≥3 METs in ≥min bouts) : ≥50% of bMVPA during the same time period (Morning, Midday, Afternoon, or Evening; N=191-258) , <50% of bMVPA in any time period (Mixed; N=379) , and ≤1 day with bMVPA per week (Inactive; N=485) . Analyses were adjusted for covariates including socio-demographic factors, randomization arm, and clinics; then further adjusted for weekly bMVPA volume and intensity.
Findings: Timing of bMVPA was associated with changes in HbA1c across Year 1 (P=0.01) , independent of weekly bMVPA volume and intensity. Participants in the afternoon group as compared to the inactive group had a greater HbA1c reduction (mean: -0.16%; 95%CI: -0.33% to 0%) . Among non-insulin users the odds of discontinuation vs. maintaining or initiating antidiabetic medications across Year 1 trended to differ between the bMVPA timing groups (P=0.09) , with the afternoon group having the highest odds of discontinuation (OR vs. inactive group: 1.86; 1.14 to 3.02) .
Interpretation: Timing of bMVPA may be linked with improvements in glycemic control in adults with type 2 diabetes. While regular physical activity remains to be the cornerstone for blood glucose management in diabetes, our findings suggested that exercise interventions aimed to increase glycemic control in patients with diabetes can be enhanced by engaging in physical activity at specific times of the day. Experimental protocols are needed to test the causality.
Disclosure
J.Qian: None. R.Middelbeek: Research Support; Novo Nordisk. Q.Xiao: None. M.P.Walkup: None. M.Coday: None. M.Erickson: None. J.L.Unick: None. J.M.Jakicic: Advisory Panel; Spark360, Wondr Health, WW International, Inc. K.Hu: None. F.A.Scheer: None.
Funding
National Institutes of Health (K99HL148500, DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, DK56992, R01HL140574, RF1AG059867, RF1AG064312)
Background
The COVID‐19 pandemic resulted in mandated stay‐at‐home orders, potentially resulting in changes in mental health (e.g., stress, anxiety) and challenges maintaining healthy dietary and ...physical activity behaviors.
Objective
This study examined how stress was associated with mental well‐being and weight loss behaviors during the COVID‐19 pandemic among adults enrolled in an internet‐based weight loss program.
Methods
Participants enrolled in a weight‐loss program residing in Rhode Island or Massachusetts, USA, completed a brief survey on their mental health and current weight‐loss behaviors during the COVID‐19 pandemic. Surveys were completed between 14 April 2020 and 21 April 2020, approximately one month after stay‐at‐home orders were mandated. Linear regression was used to examine associations between stress, mental health, and weight‐loss behaviors.
Results
A total of 99 participants completed the survey (79% female, 91% white, 52.2 ± 9.8 years, 34.0 ± 5.2 kg/m2, 77% reported moderate to extreme stress). Greater stress was associated with higher BMI (p = 0.04), higher education (p = 0.04), working more hours (p = 0.003), and having school‐age children at home (p = 0.002). Greater stress was also associated with higher levels of anxiety, worry, and concern regarding COVID‐19 (p's < 0.001) and having less time to spend on weight‐loss efforts (p < 0.001), after controlling for BMI and education.
Conclusions
Many individuals enrolled in a weight‐loss program experienced more stress during COVID‐19 compared to before the pandemic. This stress was related to more mental health challenges as well as more difficulties finding time for weight management efforts.
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