Obesity is a significant public health concern, with a high prevalence among adults. In Philadelphia, for instance, a substantial percentage of adults are classified as overweight or obese, according to the Centers for Disease Control and Prevention. Recognizing the complex interplay of factors contributing to this epidemic, researchers are actively exploring innovative strategies to promote effective and sustainable weight loss.
Understanding the Psychological Barriers to Weight Loss
While dietary changes and increased physical activity are crucial components of weight loss, psychological factors often present significant challenges. As Evan Forman, PhD, a professor of psychology, points out, many individuals attempting to lose weight through calorie reduction experience setbacks. The constant need for food-related decisions throughout the day can be particularly challenging, especially when faced with tempting, readily available options like sweets.
Forman and his team have investigated methods to enhance mindful decision-making and inhibitory control in habitual snack food eaters. Their study, published in the journal Appetite, involved assigning participants to brief training exercises designed to strengthen these cognitive skills.
DietDash: A Novel Training Game for Inhibitory Control
One of the innovative tools developed by the researchers is DietDash, a training game designed to personalize the weight loss journey. Participants begin by identifying the specific sugary foods they consume most frequently. They are then assigned to one of four versions of the game, tailored to their dietary habits.
The game involves responding to various images, including pictures of both tempting sugary foods and healthy alternatives, by pressing specific keys. As the player's inhibitory control improves, the game's speed increases, providing an ongoing challenge. The researchers are interested in evaluating the long-term effects of this type of training on eating habits over a two-month period.
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Study Participation Criteria
Currently, researchers are seeking participants for the DietDash study, targeting individuals who:
- Are between 25 and 55 years old.
- Are overweight.
- Consume sweets regularly.
The Role of Discomfort Intolerance in Weight Loss
Another area of investigation focuses on the role of physical discomfort intolerance (DI) in weight loss and physical activity outcomes. A study examined DI as a predictor of success in a group-based lifestyle modification program for obesity.
Study Design and Measurements
The study involved measuring DI at baseline and after six months, along with assessing weight and physical activity levels (using accelerometers) at baseline, six months, and twelve months.
Key Findings
Interestingly, baseline DI was not found to be related to weight loss or physical activity at either the six-month or twelve-month mark. However, changes in DI during the initial six months of treatment were predictive of weight loss and physical activity at twelve months. This suggests that monitoring early changes in DI may help identify individuals who may be at risk for less favorable outcomes.
Regional Differences in Weight Loss Intervention Outcomes
Recognizing the potential influence of environmental factors on weight management, researchers have also explored regional differences in the effectiveness of weight loss interventions. A study compared outcomes of a 16-week behavioral weight loss intervention conducted simultaneously in Alabama (AL) and Colorado (CO).
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Environmental Factors and Weight Management
The study acknowledged that the physical or built environment, as well as the social environment, can impact weight management. Factors such as the accessibility of healthy diets and physical activity opportunities, walkability, bike routes, climate, and social norms related to diet and exercise can all play a role.
Study Design and Participants
This study was a secondary analysis of a clinical weight loss trial involving participants with type 2 diabetes (T2D) who were randomized to either a high protein (HP) or normal protein (NP) diet and asked to follow a weight management program. The study included 70 participants (39 in CO, 31 in AL).
Study Procedures
Participants were required to be at least 18 years old, have a BMI ≥27 kg/m2, have a T2D diagnosis within the past 6 years, be weight stable (±3 kg in the past 3 months), and be stable on all medications for the past 3 months. Exclusion criteria were: hemoglobin A1c ≥ 12%, current eating disorder (anorexia or bulimia), dependence on illicit drugs or alcohol, untreated hypothyroidism, currently using insulin or other drugs known to cause weight loss or gain, following a vegetarian or vegan diet, any illness or injury that would make it unsafe to follow a diet and/or exercise up to 70 min at a moderate intensity regularly, and women who were pregnant, lactating, trying to become pregnant, or who had been pregnant or lactating in the last six months.
Dietary Intervention
The HP group was asked to consume four or more servings of lean beef per week and avoid all other red meat, and the NP group was asked to avoid all red meat for the duration of the study. The HP group was designed to have a reduction in carbohydrates and an increase in protein intake when compared with the NP group. Dietary fat was designed to be similar between groups.
Data Collection and Analysis
Body weight was measured at baseline and Week 16. Participants wore an accelerometer at baseline and Week 16 for 7 days at each time point. A series of questionnaires were given to participants at baseline and at Week 16 to measure factors of psychological status.
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Impact of COVID-19 Pandemic
Due to the COVID‐19 pandemic, certain study procedures had to be altered. First, the group classes were switched to online for both AL and CO at Weeks 4-5 and 7-8, respectively. Additionally, the Week 16 study visits became at‐home study visits.
Key Findings
Weight loss did not differ between states, suggesting that factors contributing to higher obesity rates in some regions of the United States may not be barriers to weight loss. Further, participants in AL experienced greater improvements in some factors associated with weight maintenance, indicating the need to study regional differences in weight loss maintenance.
Short-Term Calorie Restriction and Immune Response
In addition to behavioral and environmental approaches, researchers are also investigating the potential of short-term calorie restriction to impact weight loss and immune function.
Fasting-Mimicking Diet (FMD)
Preclinical research has suggested that severe calorie restriction, such as cyclic fasting or a fasting-mimicking diet (FMD), may have anticancer effects when combined with standard pharmacological treatments.
Clinical Trial Results
A clinical trial enrolled 101 patients with various types of cancer who were being treated with standard anticancer therapies. The researchers administered an FMD regimen that consisted of a five-day, low-carbohydrate, low-protein, plant-derived diet.
Study results demonstrated that the FMD regimen was safe, feasible, and well-tolerated by the majority of patients. The investigators also observed a significant decrease of circulating immunosuppressive cells and an increase of activated T cells in an analysis conducted on 38 patients at the end of a five-day FMD cycle.