Hensrud, Donald D.

Background/Objectives: A 12-week trial demonstrated that phenotype-tailored lifestyle intervention (PLI) was associated with greater weight loss than standard lifestyle intervention (SLI); however, differences in dietary patterns between groups were not examined. Methods: This secondary analysis evaluated caloric and macronutrient intake at 12 weeks in adults with obesity (BMI ≥ 30 kg/m2), classified into four energy-balance phenotypes (abnormal satiation, reduced postprandial satiety, low energy expenditure, emotional eating) (n = 77) who underwent PLI or SLI. Dietary intake was assessed by 24-h recalls and verified by a blinded registered dietitian. Results: Groups were compared at 12 weeks adjusting for baseline values. PLI was associated with lower total energy intake than SLI (1273 ± 182 vs. 1894 ± 176 kcal/day; p = 0.018), due to lower carbohydrate (464 ± 76 vs. 818 ± 73 kcal/day; p = 0.002) and fat intake (479 ± 76 vs. 697 ± 73 kcal/day; p = 0.036); absolute protein intake did not differ. However, protein comprised a greater proportion of energy intake in PLI (26.8 ± 1.6%) than SLI (19.8 ± 1.5%; p = 0.003), and dairy protein contributed more to total energy in PLI (6.8 ± 0.8% vs. 3.7 ± 0.7%; p = 0.004). Conclusions: PLI was associated with lower energy intake, mainly due to reduced carbohydrate and fat intake, and a higher relative contribution of protein, consistent with phenotype-based recommendations rather than macronutrient prescriptions. These findings suggest a potential role for personalized dietary approaches in obesity management. However, the non-randomized design does not allow causal inferences.

Objectives: To identify patient characteristics, health concerns, and barriers to care based on overweight or obesity. Methods: A 50-question anonymous survey was administered to patients. Data were compared by body mass index (BMI). Results: Among 3976 distributed surveys, 899 were returned and 682 were analyzed. Most respondents were women (60%), White (94%), and married/partnered (65%) and had some college education (80%). Younger and unmarried persons had higher BMI ( P < .001). Concern for quality of life ( P < .001) and importance of lifestyle changes ( P = .006) increased with BMI, but confidence in making changes decreased as BMI increased ( P < .001). Perceived good health decreased with increasing BMI ( P < .001), whereas depression and other comorbid conditions increased. Self-esteem decreased and stigma increased with higher BMI (both P < .001). Weight discussions with clinicians ( P < .001) and belief that clinicians should be involved in weight management ( P = .002) increased with BMI, yet self-perception of being judged by clinicians also increased ( P < .001). As BMI increased, delays in seeking health care increased ( P < .001). Conclusions: This survey study highlights perceived health concerns and barriers to care among persons with overweight and obesity. With higher BMI, self-esteem decreased, and stigma, self-perception of poor health, perception of being judged by clinicians, and delay in seeking medical care increased.

Abstract Satiation is the physiologic process that regulates meal size and termination, and it is quantified by the calories consumed to reach satiation. Given its role in energy intake, changes in satiation contribute to obesity's pathogenesis. Our study employed a protocolized approach to study the components of food intake regulation including a standardized breakfast, a gastric emptying study, appetite sensation testing, and a satiation measurement by an ad libitummeal test. These studies revealed that satiation is highly variable among individuals, and while baseline characteristics, anthropometrics, body composition and hormones, contribute to this variability, these factors do not fully account for it. To address this gap, we explored the role of a germline polygenic risk score, which demonstrated a robust association with satiation. Furthermore, we developed a machine-learning-assisted gene risk score to predict satiation and leveraged this prediction to anticipate responses to anti-obesity medications. Our findings underscore the significance of satiation, its inherent variability, and the potential of a genetic risk score to forecast it, ultimately allowing us to predict responses to different anti-obesity interventions.

Objective: This report describes data regarding the acceptability of delivering a family-based behavioral lifestyle intervention for adolescent obesity in a brief, intensive onsite program (initial 3 sequential days + 1 follow-up day) combined with telephonic wellness coaching (WC). Methods: Four cohorts consisting of 7 adolescents aged 15–17 years (self-identifying as 4 male, 2 female, 1 transgender male; 6 White, 1 African American and White) and thirteen parents participated in a new clinical intervention consisting of 3 days onsite programming, 3-months telephonic wellness coaching, and 1 day onsite follow up. Enrollment, attendance, and retention were recorded. Participants provided quantitative and qualitative feedback regarding acceptability of the program during postintervention interviews. Results: Of 11 families invited, 8 enrolled. Seven families participated, with 1 family lost to follow up. Adolescents completed an average 5.6/9 planned WC sessions. Adolescents rated the program positively overall and liked experiential sessions best. However, participants reported the onsite program was too long, they encountered barriers to sustained engagement during wellness coaching follow up, and parents desired greater guidance and structure for their involvement. Conclusions: Combining in-person sessions with telephonic wellness coaching was acceptable to participants, but intervention refinement is needed. Future program development and research investigating hybrid models should consist of briefer in-person sessions, emphasize skill practice, and include ongoing guidance to parents to provide developmentally appropriate support. Implications for Impact Statement This new clinical program evaluation found that extending onsite family-based behavioral lifestyle intervention for adolescent obesity with telephonic wellness coaching was acceptable to participants, but that program refinement is needed. Feedback highlighted the importance of keeping onsite sessions brief, engaging adolescents with hands-on skill practice, and providing ongoing guidance to parents to support sustained adolescent engagement in behavior change.

Background: Regular exercise is considered a key element to maintain weight loss, but its role to induce weight loss has been controversial. Methods: In this retrospective study of 7237 individuals attending a worksite wellness center from September 2008 to October 2011 to assess predictors of weight loss at 12 months after joining. Upon joining the wellness center, participants completed a survey that assessed for the presence of cardiovascular risk factors, height, weight, self-perceived health behaviors and psychosocial factors using validated 11-point scale items. We limited the sample to 1927 overweight (25 < BMI ≤ 30) and obese (BMI > 30) participants who completed the survey in full at baseline and at 12 months (+/- 90 days). The outcome variable was weight change at 12 months after enrollment. Weight loss was defined as a loss of > 1kg. Results: Of 1927 participants, 998 (52%) were either overweight (n=573; 57%) or obese (n=425; 43%), and 60% were women. Mean (SD) age was 41 (11.5) yr, BMI 30.7 (5.5) kg/m 2 and they visited the wellness center 49 (90) times/year. At 12 months, 416 (42%) of the participants had lost >1 kg and 19% had lost > 5kg. The predictors of weight loss were: baseline BMI, [Odds Ratio (OR)= 1.56 (1.15-2.13); p < .0044] and [OR= 1.75 (1.26-2.44); p < .0010] for BMI between 30-35 and BMI ≥35, vs BMI between 25-29, respectively. In addition, visits/year [OR= 1.60 (1.19-2.16); p < .0010] and [OR= 1.85 (1.37-2.61); p < .0001] for those attending 13-52 sessions and > 52 visits/year, vs ≤ 12 visits/year, respectively. The association persisted after controlling for all covariates (ie, cardiovascular risk factors, self-perceived health behavior and psychosocial factors). The Table shows the results of the multivariate analysis assessing predictors for >1kg weight loss. Neither age, gender, perceived stress, self-perception of being overweight, following a healthy diet, nor history of hypertension, high blood cholesterol or diabetes predicted weight loss. Conclusions: A significant percentage of overweight or obese individuals lose weight after enrolling in a worksite wellness center. Frequency of attendance, baseline BMI, and support for maintaining a healthy living are associated with weight loss. These results suggest interventions to promote usage of wellness centers maybe be beneficial for the obese adult.

Central obesity has been associated with adverse events in patients with cardiovascular disease (CVD). We undertook this study to evaluate predictors of overweight awareness, desire to lose weight and weight loss attempts in patients with CVD and central obesity. Association of physician-rendered diagnosis of overweight with weight loss attempts was also evaluated. Data from National Health and Nutrition Examination Survey (NHANES) 1999 –2004 were used. CVD was defined as self-referred history of coronary artery disease or stroke. Central obesity was determined based on a waist circumference > 102 cm in men and > 88 cm in women. Motivational factors considered as determinant for behavioral change that were evaluated included: participants’ awareness of their overweight status; desire to lose weight; any weight loss attempts in last year. We examined demographic, anthropometric and clinical determinants of each stage of change using multivariate models. Of the 1484 participants with CVD that were identified in NHANES, 824 had central obesity (56%). 76% of centrally obese participants were aware of their overweight status and 79% were desirous of losing weight. Despite this awareness and desire, only 41% of centrally obese had attempted weight loss in the last year. Only 61% reported that they had been informed that they were overweight by physicians. On multivariate analysis, after adjusting for sociodemographic factors and body mass index, physician rendered diagnosis of overweight was a significant predictor of weight loss attempts (OR=2.5, 95% CI 1.3– 4.9, p= 0.006). Awareness of one’s overweight status strongly predicted desire to lose weight in multivariate models (OR=107.6, 95 % CI 42.9 –270.0, p<.0001) and desire to lose weight was linked to recent attempts to lose weight (OR 10.4, 95 % CI 2.8– 39.2, p= 0.0005), confirming that the Transtheoretical Model of behavioral change applies to the study population. In a nationally representative sample of participants with CVD and central obesity, physician-rendered diagnosis of overweight emerged as an important predictor of weight loss attempts. Efforts to promote weight loss should focus on interventions based on Transtheoretical Model of behavioral change.

Objectives: To determine whether meal fatty acid (FA) metabolism differs by sex and obesity phenotypes and to examine how weight loss (WtL) through diet and exercise affects meal FA trafficking. Methods: Before WtL (study 1) 13 obese men (ObM), 9 upper body obese (UbO) and 8 lower body obese (LbO) women consumed a standard meal containing [ 3 H]triolein followed by subcutaneous abdominal and gluteal fat biopsies. Indirect calorimetry was measured by 5 h substrate oxidation. Whole/regional fat distribution was measured using DXA and CT scan. Participants then enrolled in a structured WtL program, after which 23 returned for study 2. Results: There were no differences (p=0.32) in meal FA oxidation between groups. Abdominal uptake of meal FA in LOb was greater than in UOb (p=0.026) and ObM (p<0.001). LOb took up more meal FA in the lower body than ObM (p=0.001). Participants who returned for study 2 lost 14 ± 1.1 kg. After WtL, uptake of meal FA in upper body subcutaneous fat increased (p=0.028) in UOb and ObM (p=0.046) and decreased in lower body fat (p=0.025) in ObM. WtL led to reduced 5 h postprandial total fat oxidation and increased 24 h meal FA oxidation. Conclusion: Changes in uptake of meal FA after WtL followed a pattern indicative of body fat distribution maintenance. These results highlight the potential importance of meal fat uptake in modulating body fat distribution in obesity. Funding: NIH RO1 DK45343, DK50456 and R00585.