Individuals who are obese are at increased risk of many diseases, including type 2 diabetes and heart disease.  As 75%-95% of previously obese individuals regain their lost weight, many researchers are interested in developing treatments to help individuals maintain their weight loss.  A new study, by Michael Rosenbaum and colleagues, at Columbia University Medical Center, New York, has provided new insight into the critical interaction between the hormone leptin and the brain’s response to weight loss.

Leptin levels fall as obese individuals lose weight.  So, the authors set out to see whether changes in leptin levels altered activity in the regions of the brain known to have a role in regulating food intake.  They observed that activity in these regions of the brain in response to visual food-related cues changed after an obese individual successfully lost weight.  However, these changes in brain activity were not observed if the obese individual who had successfully lost weight was treated with leptin.  These data are consistent with the idea that the decrease in leptin levels that occurs when an individual loses weight serves to protect the body against the loss of body fat.  Further, both the authors and, in an accompanying commentary, Rexford Ahima, at the University of Pennsylvania School of Medicine, Philadelphia, suggest that leptin therapy after weight loss might improve weight maintenance by overriding this fat-loss defense.

Past research has found that patients enrolled in weight-management programs experience greater success as the frequency they meet with physicians or weight-loss counselors about their progress increases. The U.S. Preventative Services Task Force, an organization that recommends guidelines for primary care in the U.S, classifies two provider contacts with patients as intensive. A study by NiCole Keith, associate professor in the Department of Physical Education at Indiana University-Purdue University in Indianapolis, found that this current recommendation may not be intensive enough for low-income and disadvantaged populations.

Her study was conducted in an urban community health center in Indianapolis that primarily serves low-income and disadvantaged populations. The weight-management program, Take Charge Lite (TCL), was free to patients, funded by the Fairbanks Foundation and available to all patients 18 or older with a body mass index indicating they could be overweight or obese — equal to or above 25. The program was developed for English or Spanish-speaking patients and used input from physicians, administrators and patients of the clinic. If patients qualified, their physician gave them information about TCL and the program coach’s contact information. Once a patient phoned, a first visit was arranged at which the patient chose goals, weighed-in, and discussed different weight-loss strategies with the coach. Program participants could attend support groups, education or exercise classes, meet face-to-face with coaches, or have regular weigh-ins. Each of these activities qualified as a contact.

At the end of the program’s first year, the relationship between weight loss and number of contacts was evaluated. Patients with two or fewer contacts per month gained about a pound. Patients with three or four contacts per month lost about two pounds of weight and patients who had five contacts per month lost just over two pounds. Those with six or more contacts lost about five pounds and patients with more than 11 contacts per month lost about six pounds. Keith said the program will continue and that she’s optimistic about its impact. “TCL coaches helped patients find strategies tailored to patient needs and abilities to help with weight loss,” she said. “Indentifying factors associated with weight loss and program participation may improve weight loss services, maximize contact and lead to increased weight loss in this population.”

After major weight loss, many patients want to further hone their body by having body contouring plastic surgery. This study looked at demographic factors that influence patients’ desires for plastic surgery following massive weight loss. According to the study, the majority of post-bariatric surgery patients want body contouring. In addition, younger, divorced women who had minimally-invasive gastric bypass surgery had the strongest interest. Almost 67,000 body contouring procedures after massive weight loss were performed in 2007, according to the ASPS.