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Background: Metabolic and behavioral adaptations to caloric restriction (CR) in free-living conditions have not yet been objectively measured. Methodology and Principal Findings: Forty-eight (36.8+/-1.0 y), overweight (BMI 27.8+/-0.7 kg/m2) participants were randomized to four groups for 6-months; Control: energy intake at 100% of energy requirements; CR: 25% calorie restriction; CR+EX: 12.5% CR plus 12.5% increase in energy expenditure by structured exercise; LCD: low calorie diet (890 kcal/d) until 15% weight reduction followed by weight maintenance. Body composition (DXA) and total daily energy expenditure (TDEE) over 14-days by doubly labeled water (DLW) and activity related energy activity (AREE) were measured after 3 (M3) and 6 (M6) months of intervention. Weight changes at M6 were −1.0+/-1.1% (Control), −10.4+/-0.9% (CR), −10.0+/-0.8% (CR+EX) and −13.9+/-0.8% (LCD). At M3, absolute TDEE was significantly reduced in CR (−454+/-76 kcal/d) and LCD (−633+/-66 kcal/d) but not in CR+EX or controls. At M6 the reduction in TDEE remained lower than baseline in CR (−316+/-118 kcal/d) and LCD (−389+/-124 kcal/d) but reached significance only when CR and LCD were combined (−351+/-83 kcal/d). In response to caloric restriction (CR/LCD combined), TDEE adjusted for body composition, was significantly lower by −431+/-51 and −240+/-83 kcal/d at M3 and M6, respectively, indicating a metabolic adaptation. Likewise, physical activity (TDEE adjusted for sleeping metabolic rate) was significantly reduced from baseline at both time points. For control and CR+EX, adjusted TDEE (body composition or sleeping metabolic rate) was not changed at either M3 or M6. Conclusions: For the first time we show that in free-living conditions, CR results in a metabolic adaptation and a behavioral adaptation with decreased physical activity levels. These data also suggest potential mechanisms by which CR causes large inter-individual variability in the rates of weight loss and how exercise may influence weight loss and weight loss maintenance. Trial Registration: ClinicalTrials.gov NCT00099151.

Précis:In the 2-year randomized weight-loss intervention, dietary fat significantly interacted with genetic variations of circulating adiponectin on long-term changes in appetite and adiponectin levels.AbstractContext:Adiponectin plays key roles in regulating appetite and food intake.Objective:To investigate interactions between the genetic risk score (GRS) for adiponectin levels and weight-loss diets varying in macronutrient intake on long-term changes in appetite and adiponectin levels.Design, Setting, and Participants:A GRS was calculated based on 5 adiponectin-associated variants in 692 overweight adults from the 2-year Preventing Overweight Using Novel Dietary Strategies trial.Main Outcome Measures:Repeated measurements of plasma adiponectin levels and appetite-related traits, including cravings, fullness, prospective consumption, and hunger.Results:Dietary fat showed nominally significant interactions with the adiponectin GRS on changes in appetite score and prospective consumption from baseline to 6 months (P for interaction = 0.014 and 0.017, respectively) after adjusting for age, sex, ethnicity, baseline body mass index, and baseline respective outcome values. The GRS for lower adiponectin levels was associated with a greater decrease in appetite (P < 0.001) and prospective consumption (P = 0.008) among participants consuming a high-fat diet, whereas no significant associations were observed in the low-fat group. Additionally, a significant interaction was observed between the GRS and dietary fat on 6-month changes in adiponectin levels (P for interaction = 0.021). The lower GRS was associated with a greater increase in adiponectin in the low-fat group (P = 0.02), but it was not associated with adiponectin changes in the high-fat group (P = 0.31).Conclusions:Our findings suggest that individuals with varying genetic architecture of circulating adiponectin may respond divergently in appetite and adiponectin levels to weight-loss diets varying in fat intake.

The origins of theories specifying dietary restraint as a cause of eating disorders can be traced to the 1970s. This paper will present an overview of the origins of dietary restraint theories and a brief historical review of evidence will be summarized. Recent research will be presented, including the results from the CALERIE Phase 1 study, as well as CALERIE Phase 2, which were NIH-sponsored randomized controlled trials. CALERIE 2 provided a test of the effect of two years of caloric restriction (CR) on the development of eating disorder syndromes and symptoms in comparison to a control group that did not alter eating behavior or body weight. The intervention was effective for inducing a chronic (two-year) reduction in total energy expenditure and increased dietary restraint but did not increase symptoms of eating disorders. The results of this recent investigation and other studies have not provided experimental support for conventional dietary restraint theories of eating disorders. These findings are discussed in terms of potential revisions of dietary restraint theory, as well as the implications for a paradigm shift in public health messaging related to dieting.

Psychological and Behavioral Correlates of Baseline BMI in the Diabetes Prevention Program (DPP) Linda M. Delahanty , MS, RD 1 , James B. Meigs , MD, MPH 2 , Doug Hayden , MA 3 , Donald A. Williamson , PHD 4 , David M. Nathan , MD 1 and the DPP Research Group 1 Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts 2 General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts 3 Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts 4 Pennington Biomedical Research Center, Baton Rouge, Louisiana Abstract OBJECTIVE —To determine psychological and behavioral correlates of baseline BMI in the Diabetes Prevention Program (DPP). RESEARCH DESIGN AND METHODS —Of 1,079 DPP lifestyle intervention participants, 274 completed validated questionnaires at baseline assessing weight loss history, stage of change, self-efficacy, dietary restraint, emotional eating, binge eating, perceived stress, depression, and anxiety. RESULTS —The mean age of subjects was 52.5 years, 65% were women, and their mean BMI was 33.9 kg/m 2 . Higher BMI correlated with more frequent weight cycling ( r = 0.50, P < 0.0001) and efforts at weight loss ( r = 0.34, P < 0.0001); younger age when first overweight ( r = −0.42, P < 0.0001); lower exercise efficacy ( r = −0.15, P = 0.015); lower weight loss efficacy ( r = −0.21, P < 0.001); a less advanced stage of change for weight loss ( r = −0.12, P = 0.04); more perceived stress ( r = 0.14, P = 0.02); emotional eating ( r = 0.19, P = 0.001); poor dietary restraint ( r = −0.14, P = 0.02); binge eating frequency ( r = 0.18, P = 0.004) and severity ( r = 0.30, P < 0.0001); feeling deprived, angry, or upset while dieting ( r = 0.27, P ≤ 0.0001); and food cravings while dieting ( r = 0.31, P < 0.0001). Correlations did not differ as a function of sex; however, correlations of BMI with anxiety and low-fat diet and weight loss self-efficacy differed as a function of ethnicity. In multivariate models, binge eating severity, poor dietary restraint, and food craving were independent correlates of baseline BMI. CONCLUSIONS —Many psychological and behavioral factors are associated with higher BMI in this ethnically diverse group of men and women. Whether strategies that help patients increase levels of dietary restraint and reduce binge eating and food craving lead to long-term weight loss maintenance needs longitudinal study. BES, Binge Eating Scale DPP, Diabetes Prevention Program Footnotes Address correspondence and reprint requests to Linda M. Delahanty, MS, RD, Massachusetts General Hospital, Diabetes Center, 50 Staniford St., Suite 340, Boston, MA 02114. E-mail: ldelahanty{at}partners.org . Received for publication 2 April 2002 and accepted in revised form 7 August 2002. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. DIABETES CARE

This randomized trial compared the effect of reduced-calorie diets with various compositions of fat, protein, and carbohydrates on weight loss over a 2-year period. Compliance with the diets was not high. No significant differences in weight loss were observed among the various diets. Reduced-calorie diets appear to have similar effects on weight loss regardless of their particular compositions. This randomized trial compared the effect of reduced-calorie diets with various compositions of fat, protein, and carbohydrates on weight loss over a 2-year period. No significant differences in weight loss were observed among the various diets. There is intense debate about what types of diet are most effective for treating overweight — those that emphasize protein, those that emphasize carbohydrates, or those that emphasize fat. 1 – 3 Several trials showed that low-carbohydrate, high-protein diets resulted in more weight loss over the course of 3 to 6 months than conventional high-carbohydrate, low-fat diets, 4 – 12 but other studies did not show this effect. 13 – 17 A smaller group of studies that extended the follow-up to 1 year did not show that low-carbohydrate, high-protein diets were superior to high-carbohydrate, low-fat diets. 6 , 10 , 16 , 18 – 21 In contrast, other researchers found that . . .

To identify the most important pretreatment characteristics and changes in psychological and behavioral factors that predict weight outcomes in the Diabetes Prevention Program (DPP). Approximately 25% of DPP lifestyle intervention participants (n = 274) completed questionnaires to assess weight history and psychological and behavioral factors at baseline and 6 months after completion of the 16-session core curriculum. The change in variables from baseline to 6 months was assessed with t tests. Multivariate models using hierarchical logistic regression assessed the association of weight outcomes at end of study with each demographic, weight loss history, psychological, and behavioral factor. At end of study, 40.5% had achieved the DPP 7% weight loss goal. Several baseline measures (older age, race, older age when first overweight, fewer self-implemented weight loss attempts, greater exercise self-efficacy, greater dietary restraint, fewer fat-related dietary behaviors, more sedentary activity level) were independent predictors of successful end-of-study weight loss with the DPP lifestyle program. The DPP core curriculum resulted in significant improvements in many psychological and behavioral targets. Changes in low-fat diet self-efficacy and dietary restraint skills predicted better long-term weight loss, and the association of low-fat diet self-efficacy with weight outcomes was explained by dietary behaviors. Health care providers who translate the DPP lifestyle intervention should be aware of pretreatment characteristics that may hamper or enhance weight loss, consider prioritizing strategies to improve low-fat diet self-efficacy and dietary restraint skills, and examine whether taking these actions improves weight loss outcomes.

Abstract Context Eating habits and food craving are strongly correlated with weight status. It is currently not well understood how psychological and behavioral factors influence both weight loss and weight regain. Objective To examine the associations between psychological and behavioral predictors with weight changes and energy intake in a randomized controlled trial on weight loss. Design and setting The Prevention of Obesity Using Novel Dietary Strategies is a dietary intervention trial that examined the efficacy of 4 diets on weight loss over 2 years. Participants were 811 overweight (body mass index, 25-40.9 kg/m2; age, 30-70 years) otherwise healthy adults. Results Every 1-point increase in craving score for high-fat foods at baseline was associated with greater weight loss (-1.62 kg, P = .0004) and a decrease in energy intake (r = -0.10, P = .01) and fat intake (r = -0.16, P < .0001) during the weight loss period. In contrast, craving for carbohydrates/starches was associated with both less weight loss (P < .0001) and more weight regain (P = .04). Greater cognitive restraint of eating at baseline was associated with both less weight loss (0.23 kg, P < .0001) and more weight regain (0.14 kg, P = .0027), whereas greater disinhibition of eating was only associated with more weight regain (0.12 kg, P = .01). Conclusions Craving for high-fat foods is predictive of greater weight loss, whereas craving for carbohydrates is predictive of less weight loss. Cognitive restraint is predictive of less weight loss and more weight regain. Interventions targeting different psychological and behavioral factors can lead to greater success in weight loss.

[This corrects the article on p. 13 in vol. 4, PMID: 22685430.].

BackgroundDecreasing selection and consumption of sodium and added sugars in the school cafeteria setting is important to provide optimal nutrition to children.ObjectiveThe ofjective of this study is to determine whether Louisiana (LA) Health, a school-based obesity prevention intervention, could successfully reduce children’s selection and consumption of sodium and added sugars during school lunches vs. the control group.DesignFood selection, consumption, and plate waste from student lunches (3 consecutive days) in 33 public schools in rural Louisiana were collected and analyzed using the digital photography of foods method at baseline and after a 28-month obesity prevention intervention (LA Health) beginning in 4th–6th grade (87% of children received free or reduced cost lunch). Selection and consumption of energy, added sugar, and sodium was objectively measured using digital photography of foods. Mixed models, including Race and BMI, were used to determine whether change in selection and consumption differed by group.ResultsSodium decreased for selection (− 233.1 ± 89.4 mg/lunch, p = 0.04) and consumption (− 206.3 ± 65.9, mg/lunch) in the intervention (vs. control) by month 18, and in consumption by month 28 (− 153.5 ± 66.9 mg/lunch, p = 0.03). Change in added sugar consumption decreased in the intervention (vs. control) at month 18 (− 3.7 ± 1.6, p = 0.05) and at month 28 (− 3.5 ± 1.6 tsp/lunch, p = 0.05).ConclusionsLA Health decreased the amount of added sugar and sodium selected and consumed, but not plate waste, by month 28. Results highlight the importance of long-term interventions and policies targeting provision and selection to improve dietary patterns in children, with less focus on plate waste.

The obesity epidemic had spawned considerable interest in understanding peoples' responses to palatable food cues that are plentiful in obesogenic environments. In this paper we examine how trait mindfulness of older, obese adults may moderate brain networks that arise from exposure to such cues. Nineteen older, obese adults came to our laboratory on two different occasions. Both times they ate a controlled breakfast meal and then were restricted from eating for 2.5 h. After this brief period of food restriction, they had an fMRI scan in which they were exposed to food cues and then underwent a 5 min recovery period to evaluate brain networks at rest. On one day they consumed a BOOST® liquid meal prior to scanning, whereas on the other day they only consumed water (NO BOOST® condition). We found that adults high in trait mindfulness were able to return to their default mode network (DMN), as indicated by greater global efficiency in the precuneus, during the post-exposure rest period. This effect was stronger for the BOOST® than NO BOOST® treatment condition. Older adults low in trait mindfulness did not exhibit this pattern in the DMN. In fact, the brain networks of those low on the MAAS suggests that they continued to be pre-occupied with the elaboration of food cues even after cue exposure had ended. Further work is needed to examine whether mindfulness-based therapies alter brain networks to food cues and whether these changes are related to eating behavior.