Background Exercise is recommended for weight management, yet exercise produces less weight loss than expected, which is called weight compensation. The mechanisms for weight compensation are unclear. Objective The aim of this study was to identify the mechanisms responsible for compensation. Methods In a randomized controlled trial conducted at an academic research center, adults (n = 198) with overweight or obesity were randomized for 24 wk to a no-exercise control group or 1 of 2 supervised exercise groups: 8 kcal/kg of body weight/wk (KKW) or 20 KKW. Outcome assessment occurred at weeks 0 and 24. Energy intake, activity, and resting metabolic rate (RMR) were measured with doubly labeled water (DLW; with and without adjustments for change in RMR), armband accelerometers, and indirect calorimetry, respectively. Appetite and compensatory health beliefs were measured by self-report. Results A per-protocol analysis included 171 participants (72.5% women; mean ± SD baseline body mass index: 31.5 ± 4.7 kg/m2). Significant (P < 0.01) compensation occurred in the 8 KKW (mean: 1.5 kg; 95% CI: 0.9, 2.2 kg) and 20 KKW (mean: 2.7 kg; 95% CI: 2.0, 3.5 kg) groups, and compensation differed significantly between the exercise groups (P = 0.01). Energy intake by adjusted DLW increased significantly (P < 0.05) in the 8 KKW (mean: 90.7 kcal/d; 95% CI: 35.1, 146.4 kcal/d) and 20 KKW (mean: 123.6 kcal/d; 95% CI: 64.5, 182.7 kcal/d) groups compared with control (mean: −2.3 kcal/d; 95% CI: −58.0, 53.5 kcal/d). Results were similar without DLW adjustment. RMR and physical activity (excluding structured exercise) did not differentially change among the 3 groups. Participants with higher compared with lower compensation reported increased appetite ratings and beliefs that healthy behaviors can compensate for unhealthy behaviors. Furthermore, they increased craving for sweet foods, increased sleep disturbance, and had worsening bodily pain. Conclusions Compensation resulted from increased energy intake and concomitant increases in appetite, which can be treated with dietary or pharmacological interventions. Compensation was not due to activity or metabolic changes. This trial was registered at clinicaltrials.gov as NCT01264406.

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Background: Identifying reliable predictors of long-term weight loss could lead to improved weight management. Objective: To identify predictors. Design: The Diabetes Prevention Program (DPP) was a randomized controlled trial that compared weight loss using placebo, intensive lifestyle intervention, or metformin, and its Outcomes Study (DPPOS) observed patients after the masked treatment phase ended. Setting: 27 DPP/DPPOS clinics. Participants: Of the 3234 randomized participants, 1066 lost ≥ 5% of their baseline weight during the first year and have been followed for 15 years. Measurements: Treatment assignment, personal characteristics, and weight. Results: After 1 year, 289 (28.5%) metformin participants, 640 (62.6%) intensive lifestyle participants, and 137 (13.4%) placebo participants, achieved ≥ 5% weight loss. After the masked treatment phase ended, the mean (95% CI) amount of weight loss relative to baseline that was maintained between years 6 and 15 was 6.2% (5.2, 7.2) for metformin participants, 3.7% (3.1, 4.4) for intensive lifestyle participants, and 2.8% (1.3, 4.4) for placebo participants. Independent predictors of long-term weight loss included greater weight loss during the first year in all study groups, older age and continued use of metformin in the metformin group, older age and not having diabetes or a family history of diabetes in the intensive lifestyle group, and higher baseline fasting plasma glucose in the placebo group. Limitation: Post-hoc analysis. Nonrandomized subsets of randomized groups examined after year 1. Conclusion: Among those with ≥ 5% 1-year weight loss, the group originally randomized to metformin had the greatest success with weight loss during years 6–15. Older age and the amount of initial weight loss were the most consistent predictors for maintaining long-term weight loss. Primary Funding Source: National Institutes of Health. Trial Registration: ClinicalTrials.gov and .

BackgroundTwo-thirds of pregnant women exceed gestational weight gain (GWG) recommendations. Because excess GWG is associated with adverse outcomes for mother and child, development of scalable and cost-effective approaches to deliver intensive lifestyle programs during pregnancy is urgent.ObjectiveThe aim of this study was to decrease the proportion of women who exceed the Institute of Medicine (IOM) 2009 GWG guidelines.MethodsIn a parallel-arm randomized controlled trial, 54 pregnant women (age 18-40 years) who were overweight (n=25) or obese (n=29) were enrolled to test whether an intensive lifestyle intervention (called SmartMoms) decreased the proportion of women with excess GWG, defined as exceeding the 2009 IOM guidelines, compared to no intervention (usual care group). The SmartMoms intervention was delivered through mobile phone (remote group) or in a traditional in-person, clinic-based setting (in-person group), and included a personalized dietary intake prescription, self-monitoring weight against a personalized weight graph, activity tracking with a pedometer, receipt of health information, and continuous personalized feedback from counselors.ResultsA significantly smaller proportion of women exceeded the IOM 2009 GWG guidelines in the SmartMoms intervention groups (in-person: 56%, 10/18; remote: 58%, 11/19) compared to usual care (85%, 11/13; P=.02). The remote intervention was a lower cost to participants (mean US $97, SD $6 vs mean US $347, SD $40 per participant; P<.001) and clinics (US $215 vs US $419 per participant) and with increased intervention adherence (76.5% vs 60.8%; P=.049).ConclusionsAn intensive lifestyle intervention for GWG can be effectively delivered via a mobile phone, which is both cost-effective and scalable.Trial RegistrationClinicaltrials.gov NCT01610752; https://clinicaltrials.gov/ct2/show/NCT01610752 (Archived by WebCite at http://www.webcitation.org/6sarNB4iW)