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Individualised approach to weight-loss

NIH group reports on long-term weight loss strategies

Report recommends an individualised approach to weight-loss treatments and maintenance, and the integration of physiology and behavioural psychology to identify effective and sustainable interventions

A report combining perspectives from a range of obesity experts identifies genetic, epigenetic and neuro-hormonal differences between individuals as one of the key challenges associated with weight loss and long-term weight control. The report, NIH working group report: Innovative research to improve maintenance of weight loss, published in the journal Obesity recommends a number of novel approaches to improve obesity therapeutics, including more emphasis on an individualised approach to weight-loss treatments and maintenance, and the integration of physiology and behavioural psychology to identify effective and sustainable interventions.

“Despite advancements in our understanding of obesity, weight regain after weight loss remains the most substantial problem in obesity treatment – with both the body and the mind conspiring against individual efforts to maintain weight loss,” said Dr Paul MacLean, co-chair of the National Institutes of Health (NIH) working group who authored the report. “There are many differences in individuals ranging from genetic to behavioural that lead some to do well on one approach, whereas others do not. Therefore, what works for a friend or co-worker may be very different from a weight-loss program that’s most effective and sustainable for you over the long term.”

The NIH Working Group report summarizes the results from a recent conference and includes various perspectives from experts in integrative physiology, genetics, endocrinology, and behavioural and cognitive sciences.

Bariatric surgery

The paper also discusses the mechanisms of weight loss and weight regain following bariatric surgery and states that helping to identify targets for pharmacotherapy could be achieved by interrogating the mechanisms for weight loss and weight regain following surgery.

“Moreover, many of the same guiding principles that the working group identified to be important for weight loss maintenance and prevention of weight regain following lifestyle interventions can most certainly be applied to patients post bariatric surgery,” the report states.

“The overwhelming conclusion from this meeting was that greater collaboration and cross-talk between physiological and behavioural researchers is needed. The development of intervention strategies to improve maintenance of weight loss must be informed by an understanding of the physiological changes that occur with weight loss and promote weight regain,” the authors conclude. “Including ancillary studies in intervention trials to examine physiological questions and behavioural measures in human physiological studies is critical. Training in both areas for early-stage obesity researchers may lead to a more sophisticated understanding of factors that influence relapse and development of methods to enhance long-term maintenance.”

The report is accompanied by a commentary in Obesity by research and treatment pioneers and TOS past presidents, Dr George Bray of Pennington Biomedical Research Center and Dr Thomas Wadden of the University of Pennsylvania. In their commentary, they call individualized weight-loss strategies “promising,” highlighting it as the most important issue identified by the working group to bridge the divide between basic and clinical sciences and better target obesity treatments.

“In all weight loss trials, whether behavioural, dietary, exercise or pharmacological, some individuals lose a great deal of weight, others an average amount, and some even gain weight,” they write.

The NIH working group report in full seeks to identify barriers to successful weight loss, review strategies that have been previously employed to improve success, and recommend novel solutions that could be investigated in future long-term weight control studies. In addition to more personalized weight-loss strategies, the authors recommend further exploration into the following areas to improve weight-loss maintenance:

  • Pharmacological strategies to counter the physiological changes that occur after weight loss, which require adjustments to the drug development process (e.g. pairing different medications or combining medication and behavioural approaches).
  • New ways to improve adherence to physical activity programmes.
  • Foods engineered to maximize palatability and satiation to improve long-term adherence to a lower-calorie diet.
  • Strategies to decrease the perceived reward value of foods and increase impulse control.
  • Technologies (e.g. smart phones, tablets, GPS) and social networking to keep individuals engaged and goal-oriented.

To access this paper, please click here

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