Dataset Information

Chronic pain and weight regain in a lifestyle modification trial.

ABSTRACT:

Objective

Obesity and chronic pain often co-occur and exert bidirectional influences on one another. How patients with obesity and chronic pain respond to weight loss treatments, however, remains unclear. This study evaluated body weight, physical activity, and diet outcomes in participants with and without chronic pain in a 2-year behavioral weight loss trial.

Methods

An analytical cohort of 397 adults was assembled from a Midwestern healthcare system that participated in the larger trial. Participants with chronic pain 1 year prior to, or during, the trial were identified using a validated medical records algorithm. Mixed models were used to estimate changes in outcomes over 24 months.

Results

One-third of participants (n = 130) had chronic pain. After adjustment for age, sex, body mass index, and trial arm, weight loss was similar in both groups at 6-months (-7.0 ± 0.8 kg with chronic pain vs. -7.7 ± 0.6 kg without). Participants with chronic pain had significantly less weight loss at 24-months relative to those without (-3.6 ± 0.5 vs. -5.2 ± 0.4 kg; p = 0.007). Physical activity, screen time, dietary fat, fruit/vegetable consumption, and sugar-sweetened beverage intake improved similarly in both groups over time.

Conclusions

Participants with chronic pain lost ∼33% less weight over 2 years, which was driven by greater weight regain after the first 6 months. Future research should test tailored weight loss maintenance strategies for individuals with chronic pain.

SUBMITTER: Goessl CL

PROVIDER: S-EPMC8019281 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThough long-term weight loss maintenance is the treatment goal for obesity, weight regain is typical and few studies have evaluated lifestyle habits associated with weight regain.ObjectiveTo identify dietary and physical activity habits associated with 6- and 24-month weight regain among participants in a weight loss maintenance clinical trial.DesignSecondary analysis of randomized clinical trial data.ParticipantsAdult primary care patients with recent, intentional weight loss of at least 5%.Main measuresLifestyle habits included consumption of low-fat foods, fish, desserts, sugary beverages, fruits, and vegetables and eating at restaurants from the Connor Diet Habit Survey; moderate-vigorous physical activity by self-report; steps recorded by a pedometer; and sedentary behavior by self-report. The outcome variable was weight change at 6 and 24 months. Linear regression models estimated adjusted associations between changes in weight and changes in dietary and physical activity habits.Key resultsOverall, participants (mean (SD): 53.4 (12.2) years old; 26% male; 88% white) maintained weight loss at 6 months (n = 178, mean (SD): - 0.02 (5.70)% change) but began to regain weight by 24 months (n = 157, mean (SD): 4.22 (9.15)% increase). When considered all together, more eating at restaurants, reduced fish consumption, and less physical activity were most consistently associated with weight regain in fully adjusted models at both 6 and 24 months of follow-up. In addition, more sedentary behavior was associated with weight regain at 6 months while reduced consumption of low-fat foods, and more desserts and sugary beverages were associated with weight regain at 24 months.ConclusionsConsuming less fish, fewer steps per day, and more frequent restaurant eating were most consistently associated with weight regain in primary care patients. Primary care providers may consider addressing specific lifestyle behaviors when counseling patients after successful weight loss.Trial registrationClinicalTrials.gov Identifier: NCT01946191.

Project description:Obesity is a major global health problem and predisposes individuals to several comorbidities that can affect life expectancy. Interventions based on lifestyle modification (for example, improved diet and exercise) are integral components in the management of obesity. However, although weight loss can be achieved through dietary restriction and/or increased physical activity, over the long term many individuals regain weight. The aim of this article is to review the research into the processes and mechanisms that underpin weight regain after weight loss and comment on future strategies to address them. Maintenance of body weight is regulated by the interaction of a number of processes, encompassing homoeostatic, environmental and behavioural factors. In homoeostatic regulation, the hypothalamus has a central role in integrating signals regarding food intake, energy balance and body weight, while an 'obesogenic' environment and behavioural patterns exert effects on the amount and type of food intake and physical activity. The roles of other environmental factors are also now being considered, including sleep debt and iatrogenic effects of medications, many of which warrant further investigation. Unfortunately, physiological adaptations to weight loss favour weight regain. These changes include perturbations in the levels of circulating appetite-related hormones and energy homoeostasis, in addition to alterations in nutrient metabolism and subjective appetite. To maintain weight loss, individuals must adhere to behaviours that counteract physiological adaptations and other factors favouring weight regain. It is difficult to overcome physiology with behaviour. Weight loss medications and surgery change the physiology of body weight regulation and are the best chance for long-term success. An increased understanding of the physiology of weight loss and regain will underpin the development of future strategies to support overweight and obese individuals in their efforts to achieve and maintain weight loss.