Current Diabetes Reports

, 17:69 | Cite as

Initial Weight Loss Response as an Indicator for Providing Early Rescue Efforts to Improve Long-term Treatment Outcomes

  • Jessica L. Unick
  • Christine A. Pellegrini
  • Kathryn E. Demos
  • Leah Dorfman
Obesity (J McCaffery, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Obesity

Abstract

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.

Keywords

Behavioral weight loss Stepped care Adaptive intervention Non-responder Lifestyle intervention 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Morgan CL, Currie CJ, Peters JR. Relationship between diabetes and mortality: a population study using record linkage. Diabetes Care. 2000;23(8):1103–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4–14. doi:10.1016/j.diabres.2009.10.007.CrossRefPubMedGoogle Scholar
  4. 4.
    Diabetes Prevention Program Research G, Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, et al. 10-year follow-up of diabetes incidence and weight loss in the diabetes prevention program outcomes study. Lancet. 2009;374(9702):1677–86. doi:10.1016/S0140-6736(09)61457-4.CrossRefGoogle Scholar
  5. 5.
    Gregg EW, Chen H, Wagenknecht LE, Clark JM, Delahanty LM, Bantle J, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308(23):2489–96. doi:10.1001/jama.2012.67929.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Wadden TA, West DS, Delahanty L, Jakicic J, Rejeski J, Williamson D, et al. The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring). 2006;14(5):737–52. doi:10.1038/oby.2006.84.CrossRefGoogle Scholar
  7. 7.
    Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity. Psychiatr Clin North Am. 2011;34(4):841–59. doi:10.1016/j.psc.2011.08.006.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Wadden TA, Butryn ML, Wilson C. Lifestyle modification for the management of obesity. Gastroenterology. 2007;132(6):2226–38. doi:10.1053/j.gastro.2007.03.051.CrossRefPubMedGoogle Scholar
  9. 9.
    Wadden TA, West DS, Neiberg RH, Wing RR, Ryan DH, Johnson KC, et al. One-year weight losses in the Look AHEAD study: factors associated with success. Obesity (Silver Spring). 2009;17(4):713–22. doi:10.1038/oby.2008.637.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Diabetes Prevention Program Research G. The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS. Diabetes Care. 2012;35(4):723–30. doi:10.2337/dc11-1468.CrossRefGoogle Scholar
  11. 11.
    Carels RA, Darby L, Cacciapaglia HM, Douglass OM, Harper J, Kaplar ME, et al. Applying a stepped-care approach to the treatment of obesity. J Psychosom Res. 2005;59(6):375–83. doi:10.1016/j.jpsychores.2005.06.060.CrossRefPubMedGoogle Scholar
  12. 12.
    Haaga DA. Introduction to the special section on stepped care models in psychotherapy. J Consult Clin Psychol. 2000;68(4):547–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Unick JL, Hogan PE, Neiberg RH, Cheskin LJ, Dutton GR, Evans-Hudnall G, et al. Evaluation of early weight loss thresholds for identifying nonresponders to an intensive lifestyle intervention. Obesity (Silver Spring). 2014;22(7):1608–16. doi:10.1002/oby.20777.CrossRefGoogle Scholar
  14. 14.
    • Unick JL, Neiberg RH, Hogan PE, Cheskin LJ, Dutton GR, Jeffery R, et al. Weight change in the first 2 months of a lifestyle intervention predicts weight changes 8 years later. Obesity (Silver Spring). 2015;23(7):1353–6. doi:10.1002/oby.21112. Demonstrates that a 1-month weight loss predicts weight loss outcomes at 4 and 8 years. CrossRefGoogle Scholar
  15. 15.
    Nackers LM, Ross KM, Perri MG. The association between rate of initial weight loss and long-term success in obesity treatment: does slow and steady win the race? Int J Behav Med. 2010;17(3):161–7. doi:10.1007/s12529-010-9092-y.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Carels RA, Cacciapaglia HM, Douglass OM, Rydin S, O'Brien WH. The early identification of poor treatment outcome in a women’s weight loss program. Eat Behav. 2003;4(3):265–82. doi:10.1016/S1471-0153(03)00029-1.CrossRefPubMedGoogle Scholar
  17. 17.
    Kong W, Langlois MF, Kamga-Ngande C, Gagnon C, Brown C, Baillargeon JP. Predictors of success to weight-loss intervention program in individuals at high risk for type 2 diabetes. Diabetes Res Clin Pract. 2010;90(2):147–53. doi:10.1016/j.diabres.2010.06.031.CrossRefPubMedGoogle Scholar
  18. 18.
    Elfhag K, Rossner S. Initial weight loss is the best predictor for success in obesity treatment and sociodemographic liabilities increase risk for drop-out. Patient Educ Couns. 2010;79(3):361–6. doi:10.1016/j.pec.2010.02.006.CrossRefPubMedGoogle Scholar
  19. 19.
    Waring ME, Schneider KL, Appelhans BM, Busch AM, Whited MC, Rodrigues S, et al. Early-treatment weight loss predicts 6-month weight loss in women with obesity and depression: implications for stepped care. J Psychosom Res. 2014;76(5):394–9. doi:10.1016/j.jpsychores.2014.03.004.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Unick JL, Leahey T, Kent K, Wing RR. Examination of whether early weight loss predicts 1-year weight loss among those enrolled in an Internet-based weight loss program. Int J Obes. 2015;39(10):1558–60. doi:10.1038/ijo.2015.89.CrossRefGoogle Scholar
  21. 21.
    Miller CK, Nagaraja HN, Weinhold KR. Early weight-loss success identifies nonresponders after a lifestyle intervention in a worksite diabetes prevention trial. J Acad Nutr Diet. 2015;115(9):1464–71. doi:10.1016/j.jand.2015.04.022.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Batterham M, Tapsell L, Charlton K, O'Shea J, Thorne R. Using data mining to predict success in a weight loss trial. J Hum Nutr Diet. 2017; doi:10.1111/jhn.12448.
  23. 23.
    Stotland SC, Larocque M. Early treatment response as a predictor of ongoing weight loss in obesity treatment. Br J Health Psychol. 2005;10(Pt 4):601–14. doi:10.1348/135910705X43750.CrossRefPubMedGoogle Scholar
  24. 24.
    Handjieva-Darlenska T, Handjiev S, Larsen TM, van Baak MA, Jebb S, Papadaki A, et al. Initial weight loss on an 800-kcal diet as a predictor of weight loss success after 8 weeks: the Diogenes study. Eur J Clin Nutr. 2010;64(9):994–9. doi:10.1038/ejcn.2010.110.CrossRefPubMedGoogle Scholar
  25. 25.
    Garvin JT, Hardy D, Xu H. Initial response to program, program participation, and weight reduction among 375 MOVE! participants, Augusta, Georgia, 2008–2010. Prev Chronic Dis. 2016;13:E55. doi:10.5888/pcd13.150598.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Burke LE, Wang J, Sevick MA. Self-monitoring in weight loss: a systematic review of the literature. J Am Diet Assoc. 2011;111(1):92–102. doi:10.1016/j.jada.2010.10.008.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    US Food and Drug Administration. Medications target long-term weight control: consumer health information. Silver Spring: US Food and Drug Administration; 2012.Google Scholar
  28. 28.
    Centers for Medicare and Medicaid Services. Final coverage decision memorandum for intensive behavioral therapy for obesity. 2011.Google Scholar
  29. 29.
    Carels RA, Young KM, Coit CB, Darby LA, Clayton AM, Spencer AC, et al. The failure of therapist assistance and stepped-care to improve weight loss outcomes. Obesity (Silver Spring). 2008;16(6):1460–2. doi:10.1038/oby.2008.49.CrossRefGoogle Scholar
  30. 30.
    Carels RA, Wott CB, Young KM, Gumble A, Darby LA, Oehlhof MW, et al. Successful weight loss with self-help: a stepped-care approach. J Behav Med. 2009;32(6):503–9. doi:10.1007/s10865-009-9221-8.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    •• Unick JL, Dorfman L, Leahey TM, Wing RR. A preliminary investigation into whether early intervention can improve weight loss among those initially non-responsive to an internet-based behavioral program. J Behav Med. 2016;39(2):254–61. doi:10.1007/s10865-015-9691-9. Randomized trial examining early intervention for early non-responders within Internet-based program. CrossRefPubMedGoogle Scholar
  32. 32.
    Carels RA, Darby L, Cacciapaglia HM, Konrad K, Coit C, Harper J, et al. Using motivational interviewing as a supplement to obesity treatment: a stepped-care approach. Health Psychol. 2007;26(3):369–74. doi:10.1037/0278-6133.26.3.369.CrossRefPubMedGoogle Scholar
  33. 33.
    Jakicic JM, Tate DF, Lang W, Davis KK, Polzien K, Rickman AD, et al. Effect of a stepped-care intervention approach on weight loss in adults: a randomized clinical trial. JAMA. 2012;307(24):2617–26. doi:10.1001/jama.2012.6866.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Carpeggiani C, Emdin M, Bonaguidi F, Landi P, Michelassi C, Trivella MG, et al. Personality traits and heart rate variability predict long-term cardiac mortality after myocardial infarction. Eur Heart J. 2005;26(16):1612–7. doi:10.1093/eurheartj/ehi252.CrossRefPubMedGoogle Scholar
  35. 35.
    Lei H, Nahum-Shani I, Lynch K, Oslin D, Murphy SA. A “SMART” design for building individualized treatment sequences. Annu Rev Clin Psychol. 2012;8:21–48. doi:10.1146/annurev-clinpsy-032511-143152.CrossRefPubMedGoogle Scholar
  36. 36.
    Almirall D, Nahum-Shani I, Sherwood NE, Murphy SA. Introduction to SMART designs for the development of adaptive interventions: with application to weight loss research. Transl Behav Med. 2014;4(3):260–74. doi:10.1007/s13142-014-0265-0.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    •• Sherwood NE, Butryn ML, Forman EM, Almirall D, Seburg EM, Lauren Crain A, et al. The BestFIT trial: a SMART approach to developing individualized weight loss treatments. Contemp Clin Trials. 2016;47:209–16. doi:10.1016/j.cct.2016.01.011. First SMART weight loss trial comparing early intervention approaches. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Jessica L. Unick
    • 1
  • Christine A. Pellegrini
    • 2
  • Kathryn E. Demos
    • 1
  • Leah Dorfman
    • 1
  1. 1.The Miriam Hospital’s Weight Control and Diabetes Research CenterWarren Alpert Medical School at Brown UniversityProvidenceUSA
  2. 2.Technology Center to Promote Healthy Lifestyles, Department of Exercise Science, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA

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