P348Motivation of overweight patients with atrial fibrillation to lose weight or to follow a weight loss management program: a cross-sectional study

Funding Acknowledgements none Background Overweight and obesity increase the risk of recurrence and progression of atrial fibrillation (AF). Studies evaluating weight reduction programs in AF patients have shown benefits in AF burden, symptoms and quality of life. Despite this proof, AF patients often lack the will to tackle overweight and they do not commonly participate in cardiac rehabilitation programs. Purpose The objective of this study was to assess the motivation of AF patients with overweight or obesity to lose weight and/or to follow weight reduction programs. Methods A multicenter descriptive cross-sectional study was performed at three Belgian hospitals. A self-developed questionnaire was presented to AF patients with a BMI >27kg/m2 who presented for an outpatient cardiology visit or were hospitalized at the cardiology ward. The questionnaire was validated for its content by an expert panel and it addressed the following topics: knowledge about the relation between weight and AF; patients’ history of weight reduction efforts and its success; current motivation to reduce weight; factors related to motivation; interest in following weight reduction programs. Results A total of 143 patients (mean age 65.7 ± 9.2 years; mean BMI 32.3 ± 4.7kg/m2; 68.5% males; 47.6% hospitalized; mean duration of AF history 5.7 ± 6.0 years) out of 560 screened AF patients completed the questionnaire (figure 1). Only 69.9% of patients was aware of the positive effect of weight reduction on the progression of AF. Prior attempts to reduce weight were made by 76.2% of the patients in which a minority participated in a hospital-based weight reduction program (9.2%) or a structured fitness program (10.1%). Of the study patients, 75.5% were currently motivated to reduce weight, mainly driven by health considerations (78.7%). Univariate analysis showed that a higher educational degree, higher income, living with a partner, and higher BMI were positively correlated with motivation to reduce weight (p < 0.05). Multivariate regression analysis showed that a higher BMI (OR = 1.20; CI = 1.05-1.38; p = 0.010), younger age (0.96 (0.91-1.01); p = 0.108), a college/university degree (5.03 (1.57-16.16); p = 0.007) and living with a partner (4.31 (1.55-11.95); p = 0.005) were associated with greater odds ratio of motivation for weight reduction. A completely home-based program (including tele-rehabilitation) was the preferred approach for 57.9% of the patients, and 57.3% would consider a weight reduction program only if reimbursement was available. Conclusions AF patients with overweight still need to be better informed about overweight as a risk factor for AF. AF patients with a lower degree of education, living alone and a lower BMI need more external motivation to lose weight. A tailored weight reduction program, mainly home based, is the preferred option for patients. This will require further development and validation of tele-coaching programs for this patient group. Abstract Figure 1: Enrollment procedure

Efficacy of a Lifestyle Program Designed to Help Indigent, Obese Adult Patients Lose Weight

Introduction. Modest weight loss (5 to 7%) reduced the incidenceof type II diabetes in the Diabetes Prevention Program (DDP) trial.A DPP-inspired lifestyle intervention requiring minimal patientself-data collection and tailored to low-SES patients throughminimal cost was developed for our indigent, obese patients. Methods. Obese (BMI ≥ 30 kg/m2), indigent (≤ 200% FederalPoverty Level) adults (age 18 - 70) were offered a nocostweight loss intervention as an adjunct to their usual primarycare in a residency outpatient clinic. The interventionprovided options for diet plans and social support. The goalwas to achieve a 5% loss of body weight over six months. Results. The sample (n = 158) was 86% female and 62% white,with a median age of 45 and median BMI of 40.9. Two-thirds ofsubjects chose the 50% diet; YMCA membership was selected byall but one. The 5% weight loss goal was met by 12.8%; another8.7% gained that amount. Subjects who either had pre-existingYMCA membership or used their provided membership weresuccessful, relative to those who received but never used theirmembership (0.6% loss vs 0.9% gain; p < 0.05). Changes in weightover six months were observed in the youngest (gain of 3.9 lbs.,p < 0.05) and the oldest (loss of 4.0 lbs., p < 0.05) age quartiles. Conclusions. A DPP-inspired lifestyle intervention tailoredto low-SES patients did not lead to overall weight loss, reinforcingthat weight reduction programs must provide a significantamount of support for participants to see success.Older age and a behavioral commitment to physical activityimproved the likelihood of success. KS J Med 2016;9(4):83-87.

Diet versus Exercise in Weight Loss and Maintenance: Focus on Tryptophan

An association between mood disturbance, the inability to lose or to stop gaining weight, and a craving for carbohydrates is manifested by many people who are overweight or are becoming so. In a recent study, we observed that low-calorie weight loss diet lowered not only levels of lept in but also levels of essential amino acid tryptophan (TRP) significantly. The disturbed metabolism of TRP might affect biosynthesis of serotonin and could thereby increase the susceptibility for mood disturbances and carbohydrate craving, increasing the cessation probability of weight reduction programs. Alternatively, moderate physical exercise – a potent stimulus to modulate (reduce/normalize) proinflammatory cytokines, which may affect TRP levels – could be helpful in improving mood status and preventing uncontrolled weight gain. In contrast, excessive physical exercise may induce breakdown of TRP when proinflammatory cascades together with TRP-degrading enzyme indoleamine 2,3-dioxygenase-1 are stimulated, which may lead to neuropsychiatric symptoms such as fatigue and low mood.