“Last Supper” Predicts Greater Weight Loss Early in Obesity Treatment, but Not Enough to Offset Initial Gains

Abstract

Background: Many participants experience clinically significant fluctuations in weight before beginning a behavioral weight loss program. Pre-treatment weight gain, often referred to as the “last supper” effect, may limit total weight loss from the time of the pre-treatment screening visit and could be an indicator that a participant will respond poorly to behavioral intervention.Methods: Data were from the weight loss phase of a two-phase weight loss maintenance trial, in which 178 participants with obesity (screening BMI = 40.5 ± 6.0 kg/m2, 87.6% female; 71.3% black) were provided with a 14 week lifestyle intervention that included a meal replacement diet. Participants were categorized as having gained >1.15%, remained weight stable, or lost >1.15% of initial weight between the pre-treatment screening visit and the first treatment session (48.7 ± 29.4 days). We first examined whether the weight change groups differed in baseline eating characteristics (e.g., emotional eating, self-regulation, craving frequency) using one-way ANCOVAs. Linear mixed models were then used to compare weight change groups on total weight loss from the screening visit to week 14 and in-treatment weight loss from weeks 1 to 14.Results: Nearly half of the sample (48.9%) gained >1.15% of initial weight during the pre-treatment period (+2.5 ± 1.2%); 41.0% remained weight stable (+0.2 ± 0.6%); and 10.1% lost >1.15% of initial weight (-2.2 ± 0.9%). There were no significant differences between the groups in baseline eating characteristics. As measured from the screening weight, the weight-gain group had a lower total loss of 6.8%, compared to 7.8% in the weight stable group (p = 0.02) and 9.0% in the weight-loss group (p = 0.003). The weight-gain group lost more weight in the first 4 weeks of treatment, but in-treatment losses did not differ among the groups at week 14.Conclusion: Pre-treatment weight gain was not an indicator of a poor response to a behavioral weight loss intervention and was associated with greater weight loss early in treatment. However, weight gain during the pre-treatment period may limit the total weight loss that participants achieve from the time that they first enroll in a weight loss program.

Sociodemographic Characteristics Associated with Pretreatment Weight Change in a Behavioral Weight Loss Intervention

“…Although two other studies failed to find this relationship, pretreatment weight loss was associated with weight loss success when outcomes were compared to screening visit weight rather than baseline weight [1,3]. However, all previous studies observed the relationship between pretreatment weight change and weight loss over relatively short periods (i.e., 14 weeks and six months) [1,2,3]. In addition, previous samples were primarily female [1,2,3] and two were mostly White/Caucasian [1,2].…”

“…Participants identified gender (i.e., male, female), age (i.e., <30 years, 30-40 years, >40 years), ethnicity [i.e., (non-Hispanic/Latino, Hispanic/Latino)], and race [i.e., Caucasian, African American, and Other (i.e., race categories that were infrequently reported)] at SV. From SV to BV, individuals were categorized as those who lost weight (> 1.15% decrease), remained weight stable, and gained weight (> 1.15% increase) similar to previous studies [1,2,3]. This criterion is half of 2.3% used in research defining weight maintenance [7].…”

“…Three previous studies found that many participants experienced significant pretreatment weight change, between the initial screening visit (SV) and first baseline visit (BV), before beginning behavioral weight loss interventions [1,2,3]. Importantly, one study indicated that pretreatment weight change was associated with in-treatment outcomes [2].…”

“…Importantly, one study indicated that pretreatment weight change was associated with in-treatment outcomes [2]. Although two other studies failed to find this relationship, pretreatment weight loss was associated with weight loss success when outcomes were compared to screening visit weight rather than baseline weight [1,3]. However, all previous studies observed the relationship between pretreatment weight change and weight loss over relatively short periods (i.e., 14 weeks and six months) [1,2,3].…”

“…In addition, previous samples were primarily female [1,2,3] and two were mostly White/Caucasian [1,2]. Given that the emerging literature on this topic suggests significant pretreatment weight fluctuations are common [1,2,3], it will be important to explore potential sociodemographic factors that influence the relationship between early weight changes and intervention outcomes among racially and gender diverse samples.…”