The Impact of a Clinical Pharmacist in an Interdisciplinary Weight Loss Service: A Follow-Up Study

Background: At an Internal Medicine outpatient clinic, patients are referred to a weight loss service by their primary care physician to be managed by a clinical pharmacist and dietician. Objective: A study was conducted to determine the impact of this established, interdisciplinary, pharmacist-driven weight loss service on percent weight loss from baseline in patients who are obese or overweight compared to those receiving standard weight loss care. Methods: This was a retrospective, single-center, cohort study including adults ≥18 years of age with BMI ≥30 or BMI ≥27 with at least one weight-related comorbidity such as hypertension, dyslipidemia, or type 2 diabetes mellitus, and referred to the clinic’s weight loss service or managed by their primary care physician. The primary outcome was percent weight loss from baseline. Key secondary outcomes included number of patients who had >5% weight loss in 6 months, number of patients who received liraglutide after 6 months, and percent weight loss in patients prescribed liraglutide. Statistical analysis included descriptive statistics, t-test for continuous outcomes, and chi-square test for between-group differences. Results: A total of 86 patients met inclusion criteria with 43 patients in the weight loss service group (intervention) and 43 patients in the primary care group (standard care). The intervention group had a significantly higher baseline weight and BMI than the standard care group (120.44 kg vs. 95.72 kg, p <0.001 and 45.34 kg/m2 vs. 37.62 kg/m2, p <0.001 respectively). The percent change in weight from baseline in the intervention group was a decrease of 3% compared to a decrease of 0.35% in the standard care group (p=0.03). Conclusions: Involvement of clinical pharmacist in interdisciplinary weight loss management through pharmacotherapy and other medication related services, shows considerable improvement in weight loss, when compared to the standard care of weight management. However, prospective randomized studies are warranted to further assess the benefits of a pharmacist-driven, interdisciplinary weight loss service.

Relative resistance of maize varieties against maize weevil, Sitophilus zeamais (Motschulsky), (Coleoptera: Curcolionidae)

The maize weevil, Sitophilus zeamais (Motschulsky) (Coleoptera: Curculionidae), is one of the most damaging pests of stored cereals causing severe damage to stored grains. In current investigation, six open pollinated maize varieties viz. JALAL (white), AZAM (white), SADAF (yellow), ZARD LOCAL (yellow), KASHMIRI (yellow) and PAHARI (white) were screened out in the laboratory of Entomology Department, Faculty of Agriculture, Gomal University, Dera Ismail Khan, Pakistan for their relative susceptibility/resistance to maize weevil. The experiment was laid out following completely randomized design (CRD) with 5 replicates. Results revealed that minimum (23.8) days to adult emergence of maize weevil were recorded when it was reared on variety Azam; whereas; maximum (34.2) days were recorded on variety Sadaf. Total number of F1 adults emerged were maximum (91) in Azam while minimum (62) in variety Sadaf. Percent infestation of maize kernels was maximum (39.01%) in Azam while minimum (25.80%) was recorded in variety Sadaf. Percent weight loss was maximum in Azam i.e. 26.12% while minimum percent weight loss (16.88%) was recorded in Sadaf. Maximum longevity (68.4 days) of adult weevils was recorded on Azam while minimum (53.4 days) was recorded on variety Sadaf. All the tested varieties had no significant effect on the sex ratio of emerged weevils. High germination percentage was recorded in Sadaf (90%) whereas; low germination was found in Azam (57%). The grain hardness test indicated that yellow varieties including Sadaf, Zard local and Kashmiri had maximum hardness having 317, 302.33 and 296 N grain hardness, whereas; white varieties i.e. Pahari, Jalal and Azam had minimum values of grain hardness i.e. 264.33, 251.66 and 238.33 Newton. The present work has shown that Azam is the most susceptible variety and should not be stored for longer periods whereas; Sadaf is the resistant variety against maize weevil.

Abstract MP15: Promoting Lifestyle Change Via Real-time Feedback: Short-term Weight Loss Outcomes In The Smarter Trial

Background: Obesity is a major risk factor for CVD. Standard behavioral treatment (SBT) typically requires face-to-face sessions, is expensive, has limited evidence for sustained weight loss, and critically, is not available to many with obesity. Using innovative mobile technology to provide real-time tailored feedback (FB) to the self-monitoring (SM) of diet, physical activity, and weight can improve lifestyle and weight management habits. It can be accessible to those without access to SBT, or to those not wishing to participate in a structured, in-person program. We report short-term, 6-month weight findings from the SMARTER Trial. Methods: SMARTER tests the efficacy of adding automated FB to smartphone SM compared to SM alone on weight loss. We randomized 502 adults with overweight/obesity to either 1) SM alone (n=251) or 2) SM+FB (n=251). The SM+FB group received up to 3 FB pop-up messages/day on their smartphone which were tailored to data in SM entries and delivered at random times during waking hours. Participants used a smartphone app to self-report diet, a Fitbit Charge 2 to monitor physical activity, and a digital Bluetooth scale for weight tracking. At baseline, all had a 90-min one-on-one session with a dietitian on behavioral changes to target weight loss. Percent weight loss from baseline to 6 months and the percentage of participants having at least a 5% weight loss at 6 months were compared between treatment groups using an intention to treat (ITT) approach with either parametric or non-parametric group comparisons. Missing assessment weights at 6 months were imputed using participants’ weight tracking data. Results: Groups had similar demographic characteristics and anthropometric measures at baseline (all p≥.05). The sample was mostly female (79.5%,399/502) and white (84.3%, 423/502) with mean BMI of 33.10 ± 3.93 kg/m 2 . There was no difference between groups in having weight data available at 6 months (SM: 84.9%, 213/251), SM+FB: 83.7%, 210/251); p=.713). Based on ITT analyses, there was no significant difference between the two groups in mean percent weight loss from baseline to 6 months (SM: Mean= -3.24% [SD=5.27], SM+FB: Mean= -3.16% [SD=5.50]; p=.860). Similar results were obtained using non-parametric methods, further supporting no difference in percent weight loss between the groups (SM: Median= -2.25% [IQR=5.53], SM+FB: Median= -2.45% [IQR=6.88]; p=.962). Overall, 30.1%,151/502) achieved at least 5% weight loss at 6 months, with similar percentages between treatment groups (SM: 28.3%,71/251, SM+FB: 31.9%, 80/251); p=.381). Conclusions: These findings demonstrate excellent 6-month assessment completion rates. We did not support our hypothesis that participants in the SM+FB group would show greater weight loss at 6 months than those in the SM group. It is possible that weight loss outcomes may differ between groups in the second half of the 12-month intervention.

Once-weekly Subcutaneous Semaglutide 2.4 mg Reduces Body Weight in Adults with Overweight or Obesity Regardless of Baseline Characteristics (STEP 1)

Background: Semaglutide is a long-acting, subcutaneous (s.c.), glucagon-like peptide-1 analogue that is currently being investigated for obesity management in adults with overweight or obesity in the phase 3 STEP clinical trial program. Varying degrees of weight loss were observed with once-weekly s.c. semaglutide 2.4 mg in STEP 1, and a post-hoc analysis was conducted to investigate weight loss in subgroups of participants based on their baseline characteristics. Methods: STEP 1 was a randomized, double-blind, placebo-controlled, phase 3 trial (NCT03548935). Adults aged ≥18 years with either body mass index (BMI) ≥27 kg/m2 with ≥1 weight-related comorbidity or BMI ≥30 kg/m2, without type 2 diabetes, were randomized 2:1 to 68 weeks’ treatment with once-weekly s.c. semaglutide 2.4 mg or placebo, as adjunct to lifestyle intervention. A descriptive evaluation of categorical weight loss with semaglutide from baseline to week 68 (≥20%, 15-&lt;20%, 10-&lt;15%, 5-&lt;10%) by baseline characteristics (age, sex, race [White, Asian, Black or African American, other], body weight, BMI, waist circumference, and glycemic status [normo-glycemia, pre-diabetes]) was conducted. Mean percent weight loss with semaglutide from baseline to week 68 was analyzed separately by sex (male, female) and baseline body weight (≥115 kg, 100-&lt;115 kg, 90-&lt;100 kg, &lt;90 kg) using a mixed model for repeated measurements analysis with treatment, subgroup (of sex or baseline body weight), and the interaction between treatment and subgroup as factors, and baseline body weight as a covariate, all nested within visit (based on the trial product estimand [treatment effect assuming treatment adherence and without use of rescue intervention] for the on-treatment period). Results: STEP 1 included 1,961 randomized participants (mean age 46 years, body weight 105.3 kg, BMI 37.9 kg/m2; 74.1% female). For categorical weight loss, the observed proportions of participants with ≥20%, 15-&lt;20%, 10-&lt;15%, and 5-&lt;10% weight loss at week 68 were 34.8%, 19.9%, 20.0%, and 17.5% with semaglutide vs 2.0%, 3.0%, 6.8%, and 21.2% with placebo, respectively. The distribution of participants across weight loss groups did not appear to be affected by any baseline characteristics, except sex and baseline body weight. Mean percent weight loss at week 68 with semaglutide was greater among females than males, and in participants with lower vs higher baseline body weight. Sex and baseline body weight were independently associated with weight loss with semaglutide vs placebo at week 68 (p&lt;0.001 for both tests for subgroup interactions). Conclusion: In STEP 1, weight loss with once-weekly s.c. semaglutide 2.4 mg was seen in all subgroups evaluated, and was generally not influenced by baseline characteristics. The exception was sex and baseline body weight; female sex and a low baseline body weight were associated with a greater response to semaglutide.

Abstract P506: Dietary Self-monitoring Using An App: Are Frequency, Consistency And Completeness Related To Weight Loss?

Background: Approximately 70% of the U.S. adult population has obesity and/or overweight and thus increased risk for heart disease, stroke, and type II diabetes mellitus. Standard obesity treatment includes a behavior modification technique, dietary self-monitoring, which entails recording all foods and beverages consumed with calorie amounts and time of consumption. Greater adherence to dietary self-monitoring using a paper diary is associated with weight loss. Self-monitoring via a mobile phone application (app) is an appealing, convenient alternative to paper-based techniques; however, few studies have examined the relationship between adherence to a dietary self-monitoring app and weight loss. Objectives: The objectives of the study were to 1) examine if there is an association between app-based dietary self-monitoring and weight change and 2) explore the relationships between the frequency, consistency, and completeness of app-based dietary self-monitoring and weight change at 8 weeks among adults with overweight or obesity. Frequency was the percentage of days that any self-monitoring occurred during the study; consistency was the recording of any dietary intake on > 3 days each week; completeness was the recording of 50% or more of the weekly individual calorie goal. Methods: Ninety participants interested in weight loss were recruited to self-monitor dietary intake for 8 weeks using the app Calorie Counter by FatSecret. Participants were assigned a daily calorie goal to achieve a one-pound weight loss per week. Paired sample t-test and linear regression were used to examine the relationships between app-based self-monitoring and weight change as well as the frequency, consistency and completeness of self-monitoring and weight change at 8 weeks. Results: The sample [N = 90, mean ( M ) age = 42 ± 10 years (SD)] was employed (100%), primarily female (96.7%), White (90%), and married (63.3%) with a Bachelor’s or Associate’s degree (60%). Paired-sample t test revealed a significant mean difference [ t (89) = 6.59, p < .001] between baseline and 8-week weight in pounds ( M = -3.26 ± 4.70). Linear regression analysis revealed an association [ F (1, 88) = 7.18, p = .009] between total weeks of consistently self-monitoring ( M = 4.44 ± 2.77) and percent weight loss ( M = -1.54 ± 2.26) as well as an association ( F (1, 88) = 6.42, p = .013] between the frequency of self-monitoring ( M = 50.14 ± 33.0) and percent weight loss. Completeness of self-monitoring was not associated with percent weight loss. Conclusion: Results suggest that consistent ( > 3 days/week) and frequent ( > 50% of days) app-based self-monitoring aids weight loss. Clinicians may wish to emphasize frequent and consistent self-monitoring, rather than complete self-monitoring, when providing weight loss counseling. Future research should examine app-based self-monitoring in men as well as ethnically and racially diverse populations. .

Assessment of Corrosion of Mild Steel Buried In Soils of the Niger Delta, Nigeria

This study determines the corrosion rate and percent weight loss of mild steel buried in soils of the Niger Delta Area of Nigeria. Six geologic zones representing the upland and wetland soils were used for the assessment. The corrosion rates of mild steel in these soils were monitored to assess the extent of corrosion. However, the upland soils (Odagwa, Ogoni, Ahoada and Omoku) were more resistant to corrosion than the wetland (Kaiama and Elebele) soils. The corrosion rate of mild steel at the 24th month was in the following order of corrosivity: Elebele > Kaiama > Omoku > Ahoada > Ogoni > Odagwa. The percent weight loss was higher at the 24th month, with the highest values found at the Meander Belt Deposits of Elebele. Alternately, the Coastal Plain Sands were found to have the least percent weight loss with the lowest value recorded at Odagwa site at the 24th month. The percent weight loss at the 24th month is in the following order: Elebele > Omoku > Kaiama > Ahoada > Ogoni > Odagwa. The variation in corrosion rate and weight loss of mild steel buried in the different soil types is caused by the aquic moisture regime of the soils, anthropogenic activities carried out, microorganisms present in the soils, and also, the physico-chemical properties of the soils.

Egg deposition and weight loss of seeds by pulse beetle, Callosobruchus chinensis L. on different genotypes of pulses

Lentil Lens culinarisMedik., mungbeanVignaradiata L. R. Wilczek, chickpea Cicer arietinum L. and blackgramVigna mungo L. Hepper of different genotypes were tested against pulse beetle, Callosobruchuschinensis L. in the laboratory of the Department of Entomology, Bangladesh Agricultural University (BAU), Mymensingh to evaluate the number of eggs deposition and percent weight loss of seeds. Maximum number of eggs (73.1) was oviposited on chickpea and minimum (19.5) was found on blackgram. The highest (19.9%) weight loss in seed was noted in chickpea and the lowest (7.6%) was recorded in blackgram. On the basis of weight loss of seed, blackgram and mungbean exhibited as tolerant genotype, lentil with moderately susceptible and chickpea as susceptible. Genotypes ML-22 of lentil, MC-21 of mungbean, Hyprosola of chickpea and MAK–1-79 of blackgram were found tolerant as compared to other tested genotypes considering the reduced number of egg deposition and lowest loss of seed weight. Evidently, the percent weight loss was marked as positive correlation with number of eggs deposition in all the genotypes and the regression line resulted in increasing the number of eggs laid with the increase in percent weight loss. Bangladesh J. Agril. Res. 44(3): 513-524, September 2019

Weight Loss Medications in Young Adults after Bariatric Surgery for Weight Regain or Inadequate Weight Loss: A Multi-Center Study

This paper presents a retrospective cohort study of weight loss medications in young adults aged 21 to 30 following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between November 2000 and June 2014. Data were collected from patients who used topiramate, phentermine, and/or metformin postoperatively. Percentage of patients achieving ≥5%, ≥10%, or ≥15% weight loss on medications was determined and percent weight change on each medication was compared to percent weight change of the rest of the cohort. Our results showed that 54.1% of study patients lost ≥5% of their postsurgical weight; 34.3% and 22.9% lost ≥10% and ≥15%, respectively. RYGB had higher median percent weight loss (−8.1%) than SG (−3.3%) (p = 0.0515). No difference was found in median percent weight loss with medications started at weight plateau (−6.0%) versus after weight regain (−5.4%) (p = 0.5304). Patients taking medications at weight loss plateau lost 41.2% of total body weight from before surgery versus 27.1% after weight regain (p = 0.076). Median percent weight change on metformin was −2.9% compared to the rest of the cohort at −7.7% (p = 0.0241). No difference from the rest of the cohort was found for phentermine (p = 0.2018) or topiramate (p = 0.3187). Topiramate, phentermine, and metformin are promising weight loss medications for 21 to 30 year olds. RYGB patients achieve more weight loss on medications but both RYGB and SG benefit. Median total body weight loss from pre-surgical weight may be higher in patients that start medication at postsurgical nadir weight. Participants on metformin lost significantly smaller percentages of weight on medications, which could be the result of underlying medical conditions.

Abstract P377: Multicomponent Workplace Wellness Program Results in Weight Loss and Improved Cardiometabolic Indices

Introduction: Workplace wellness programs offer opportunities for decreasing obesity in adults. The effectiveness of such programs varies and is influenced by key intervention components (e.g. duration, intensity, content). We developed a multicomponent workplace wellness program, MyWay to Health (MW2H), which was adapted from an evidence-based weight loss intervention with demonstrated efficacy and meets the 2013 Guideline for the Management of Overweight and Obesity in adults. The purpose of this one-group pretest-posttest study was to evaluate program acceptability and effectiveness of MW2H on primary and secondary outcomes. Hypotheses: We hypothesized that MW2H would result in 1) clinically meaningful weight loss of ≥5%, and 2) improvements in cardiometabolic indices. Methods: During weeks 1-26, participants met privately with an interventionist for up to 24 weekly, 40-minute sessions, receiving training in eating and physical activity behavior change, self-regulation, and socioenvironmental strategies. During weeks 27-52, participants received maintenance support through phone calls, email, or in-person visits. Our primary outcome was percent weight loss. Secondary outcomes included improvement in BMI, waist circumference, HbA1c, cholesterol, and blood pressure. Outcomes were compared at baseline and 26 weeks; body weight only was measured at 52 weeks. Wilcoxin Signed Rank Tests were used to examine outcomes. Results: Participants (N=154) were mostly female (85%), White (75%), had a median age of 50 (Interquartile Range (IQR): 17) years, a median baseline BMI of 34.7 (IQR: 8.8), a median household income of $70,000 (IQR: $50,000), and 54% had a college degree or higher. Median number of in-person sessions attended was 19 (IQR: 4.0). Percent weight loss at 26 weeks (median [IQR]: 7.5% [6.8%]) was clinically meaningful, with 71% of participants achieving ≥5% weight loss. Statistically significant improvements in BMI, waist circumference, HbA1c, HDL cholesterol, and systolic and diastolic blood pressure (p<0.001 for all) were observed. At week 52, body weight data were available for 106 (69%) participants. Median percent weight loss from baseline was 7.0% (IQR: 9.3%). Of participants who achieved ≥5% weight loss at week 26, 94% maintained this level of weight loss at week 52. Conclusions: The MW2H workplace wellness program was acceptable to participants, evidenced by high program attendance, and resulted in clinically meaningful and statistically significant improvements in body weight and cardiometabolic indices. A majority of participants achieved ≥5% weight loss by 26 weeks, and nearly all participants for whom data was available maintained this level of weight loss at week 52. Additional research is needed to optimize intervention components, identify factors that contribute to weight maintenance, and examine MW2H effectiveness in a more diverse population.