The 7 types of weight loss surgery are gastric sleeve, gastric bypass, gastric band, duodenal switch, gastric balloon, vBloc Therapy, and AspireAssist. There's a growing movement of surgery centers and specialists that list their prices and don't take insurance. Weight Loss deals in San Antonio, TX: 50 to 90% off deals in San Antonio. Two or Four Lipo-Laser Treatments and Whole-Body Vibration-Platform Sessions at Mind Body. Green Tea Weight Loss - Ten Scientific Facts To Know. What is the scientific basis for green tea weight loss? What are the misleading marketing claims to watch out for? In the Green Tea Diet article, I cover many practical aspects of drinking green tea to lose weight. It should answer many of the questions you have, such as: Which tea to drink? How many cups a day? Best time for drinking? This article covers the science aspect i. Although. I have drunk green tea for many years, and am aware of its slimming effect, I still can't helped being impressed. You can read how she did it here.. Green Tea Burns Calories - How I Lost 2. Pounds In 6 Months. Doesn’t that sound too easy? Or was it just a one off success? In-Depth From A.D.A.M. To understand what occurs in heart failure, it helps to be familiar with the anatomy of the heart and how it works. This randomized clinical trial compares the effects of a technology-enhanced vs a standard behavioral weight loss intervention on achieving weight loss over 24.I was. skeptical at first. So I delved into it, reading all the scientific. I could lay my hands on. Here are my findings. Enjoy. Green Tea Weight Loss Fact #1: Scientifically Proven? Fast forward 1,3. For those of you who are skeptical, I highly recommend you read Swen Wolfram's excellent review paper Anti- obesity effects of green tea. In his peer review of 7. Wolfram, 9 human studies have been conducted, with . This reduces your metabolism. In. addition, your body begins to feed on itself. Although some fat may be. Most diets fail because they help you lose the wrong kind of. Green Tea Weight Loss Fact #3: Why Does A Green Tea Diet Work? Green tea weight loss works because it does not require you to eat a very low calorie diet. Scientific studies have discovered that the main ingredients responsible for green tea slimming effects are caffeine and EGCG (epigallocatechin gallate). There are at least 5 proven ways they can help you lose weight: Increase metabolism. Burn fat. Block conversion of energy into fat. Help your body absorb less dietary fat. Regulate your blood sugar levels and reduce food cravings. To learn more, read Green Tea Lose Weight - 6- Way Magic. Green Tea Weight Loss Fact #4: Suppresses Appetite? Some green tea fat burner products claim that they can help to suppress your appetite. This is highly misleading. A 2. 00. 0 study conducted by University of Chicago found that rats consumed less food only when they were injected with green tea extract, but not when they drank green tea. Therefore, for green tea to act as an. Beware of companies making misleading claims on green tea's appetite suppressing effect. Some weight loss products can make you feel less hungry because they contain chromium, not because of the green tea extract. Green Tea Weight Loss Fact #5: Exercise Longer. Doing exercise can help you lose weight in three different ways: Burns calories. Your burn extra calories when you engage in physical activities. Boosts metabolism. Your energy level stays high for a period of time after you finish exercising. Increases. muscle mass. When you exercise, you develop lean muscle mass. Your. metabolism rate is determined largely by how much muscle you carry. So. having more muscle makes it easier for you to keep slim. Getting into an exercise routine is hard work. The good news is that drinking green tea can increase your endurance level by up to 2. When is 1+1=3? Researchers found that mice that exercised regularly lost 2. Mice that drank. green tea lost 4. Mice that exercised AND drank green tea lost 8. It was found that mice that exercised and drank green tea burned the. Mice that drank green. Surprisingly, the study found that drinking green tea alone helps lose more fat and weight than exercising alone would for mice. Green. tea Diet and Exercise - Visceral Fat Burning and Stamina. Green Tea Weight Loss Fact #6: Water, Muscle or Fat Loss? The American College of Sports Medicine (ACSM), the largest. They. recommend a weight loss goal of one to two pounds per week. According to Tom Venuto, author of the excellent book Burn the Fat. When you lose water weight, you will gain it back immediately as soon as you rehydrate yourself. When you lose muscle, your metabolic rate slows down, making you more likely to regain the lost weight later. Green. tea weight loss is no exception! Permanent weight loss is slow because. And green tea is. Green Tea Burn Fat - How Does It Work. Green Tea Weight Loss Fact #7: Lose Weight Fast? How Soon Can You See Results? Don't let anyone fool you into thinking that green tea acts fast! Studies by. Dulloo and Rumpler used a state- of- the- art metabolic chamber to measure the energy. They found that green tea increases metabolism by 2. Green Tea. Thermogenesis - Metabolism Booster. If you burn 2,0. 00 calories a day, this translates to a savings. After a few years, each little cup adds up to a. How quickly you lose weight depends on your diet and lifestyle. No one can guarantee how many pounds you can shed in a week! Green Tea Weight Loss Fact #8: Dosage Versus Duration. More green tea will help you lose more weight, but only up. So far scientists have not found evidence that. The longer you drink it, the more fat it burns. A Taiwanese population study found that 1. This is significantly lower than the non tea drinkers with 2. Green Tea Burn. Fat - A Population Study. In other words, develop the good habit of drinking high quality green tea, and you will stand a much better chance of staying healthy and slim in the years to come. Green Tea Weight Loss Fact #9: Ideal For Weight Control. After you have successfully regained your curvy shape, what comes next? The beauty of green tea is that, unlike other herbs and supplements. Together with its other powerful health. A study conducted by Mastic University in United States found that green. EGCG) and caffeine. Green Tea. and Weight Control - Weight Maintenance Aid. Green Tea Weight Loss Fact #1. High Caffeine Consumers Beware! If you are a heavy coffee drinker and are hooked on caffeine, you may want consider switching over to green tea for two reasons: Green tea contains less caffeine. A widely accepted. Green tea also contains a natural relaxant called theanine, which is known to promote a feeling of well- being. If you are at work, it will improve your concentration and productivity. But there is a catch. Although you will reap the many health. In the same study quoted above, participants maintained their weight by drinking a caffeinated green tea. EGCG and 1. 50 milligrams of caffeine). High caffeine consumers did not benefit from the green tea. But. low caffeine consumers continued to lose weight in the weight maintenance phase. So by all means drink more green tea for its health and fat burning. For practical tips about effective tea dieting, read Green Tea Diet - How To Be A Successful Loser. New! Comments: Like This Story? Leave A Comment! References. Wolfram S, Wang Y, Thielecke F (2. Anti- obesity effects of green tea. Feb; 5. 0(2): 1. 76- 8. Shutsung Liao, Ph. D, Yung- hsi Kao, Ph. D, research associate in the Ben. May Institute for Cancer Research, and Richard Hiipakka, Ph. D Published. March 2. Endocrinology The University of Chicago Medical. Center Office of Medical Center Communications 8. E. 5. 8th Street, Room. MC6. 06. 3 Chicago, IL 6. Also In This Section.. Does Tea. Weight Loss Work? Much has been said about tea weight loss property, but do green tea and. Green Tea Increase Weight Loss. Can drinking green tea increase weight loss? What's the best form of tea to take? Green Tea Fat. Metabolism - Visceral Fat Benefits. Green tea fat metabolism includes visceral fat burning. We cut. out the hype and examine the scientific evidence. White. Tea Weight Loss. Does white tea weight loss work? What are its advantages and. Back to Top of Green Tea Weight Loss. Back to Amazing Green Tea Home. Amazing Green Tea Newsletter - Solving problems every tea drinker faces. Every issue is packed with solid research and useful tips to address your concerns. Subscribe today and receive four free ebooks worth $6. And - you save $5 as first- time buyer of world- class teas. PS: I respect your privacy and never sell or rent my subscriber lists. Subscribing will not result in more spam! How To Low Carb: 1. Common Weight Loss Mistakes. Studies have proven that low- carb diets are the most effective tool for losing excess body fat. Despite that, it's not uncommon for many people to hit a weight loss plateau. By weight loss plateau, I don't mean a short term fluctuation but a long- lasting stall. No matter what you do, the extra pounds of body fat are just not coming off. Specific diet plans such as fat fast has helped many people break through long- lasting plateaus but fat fast shouldn't be used as a quick fix every time your weight is stalling. In the long term, you need to focus on getting your diet right and avoid some of the common mistakes listed below. Not Knowing Your Macros. As you may know, calories do count, even on a low- carb, ketogenic diet. When you eat nutritious foods low in carbs, moderate in protein and high in fat, you will naturally eat less. For this reason, most of you won't need to count calories on a keto diet. However, just following a low- carb diet doesn't guarantee weight loss. It helps to keep an eye on your fat intake. The closer you get to your target weight, the more important that becomes. Additionally, you need to ensure that you're eating sufficient amount of protein to stay satiated and prevent muscle loss. You can find out your ideal macronutrients by using our keto calculator. Only Focusing on Carbs. Most of you know that when following a ketogenic diet, you have to reduce the amount of carbohydrates you are eating. However, this doesn't mean that the less carbs you eat, the more weight you are going to lose. In fact, I've seen many people following a close to zero- carb diet who were plateauing or even gaining weight. A very low- carb diet will simply not ensure fat loss! Some people do well on a moderate carbohydrate diet while others see better results with a greater carb restriction. There is simply no one way for all and that's why we need to embrace personalised nutrition in order to determine the best method for each individual. I use non- starchy vegetables, nuts, seeds and berries, which are all high in fibre, thus total carbs. If you want to learn more about my approach, have a look at this post: Total Carbs or Net Carbs: What Really Counts? Not Eating Adequate Protein. Eating sufficient protein is important, especially for those who are trying to lose weight. Adding some protein within the recommended limits may help you break through a long- lasting plateau. When you eat a high- protein meal, you body releases glucagon which counterbalances insulin and plays a significant role in satiety. This doesn't mean that you should overeat protein. Protein is not a particularly efficient fuel source and too much of it may raise your insulin levels. As you may know, high insulin levels will block fat burning. Also, not all protein sources are equal and some amino acids may cause greater insulin spikes. You don't need to worry about a few extra grams of protein. Eating slightly more protein will not kick you out of ketosis because not all excess protein converts into glucose via gluconeogenesis. Make sure you also include quality protein sources such fatty fish high in omega 3s. You can read more about protein intake in this post. Not Eating Adequate Fat. When following a ketogenic diet, you regulate your energy intake via fat, as protein and carbs remain more or less constant. It's simple: if you want to lose body fat, you need to stay in calorie deficit. You should get most of your fats from omega- 3 rich foods like fatty fish, and foods high in monounsaturated fatty acids such as avocados and extra virgin olive oil. Also, make sure you get enough vitamin D. Chances are that even if you eat fatty fish and other foods high in vitamin D, you may be deficient in this vital micronutrient. I eat fish at least 3- 4 times a week and I'm also taking cod liver oil. To learn more about counting macros, types of fat and your ideal fat intake on a ketogenic diet, read this post. Avoiding Vegetables and Fiber. Non- starchy vegetables have their place in a healthy low- carb diet. There is no reason to avoid vegetables like broccoli, cauliflower, zucchini, bell peppers or fruits like avocado or berries. These foods are very high in micronutrients, low in carbs and won't impair your weight loss efforts. So unless you have food sensitivities to nightshades or other vegetables, you should include them in your diet. Obsessing Over Your Ketone Levels. Just like many others, I don't believe that a very low- carb ketogenic diet with high ketone levels is the best way to lose weight. Nutritional ketosis is achieved when your blood ketones are between 0. M. Values higher than that have no additional benefits. I have high ketone readings, so why am I not losing weight? Many people don't eat enough protein and overeat fat simply because they've been given the wrong advice. Too Much Stress. Stress is a significant factor when it comes to weight loss. I know, it's easy to say and difficult to do but try and have less stress. Here are a few tricks you can try: Try the Headspace App to relax and decrease your stress levels in just a few minutes a day. I've been using it myself! Too much exercise, especially chronic cardio, increases stress hormone cortisol. Increased cortisol is linked to increased fat storage, especially the unhealthy visceral fat round your belly. Try strength training and yoga instead of some of your cardio sessions. Try supplements such as melatonin, magnesium (Natural Calm) and B- complex, that will help you reduce your stress levels and improve circadian rhythms. Don't spend too much time on the Internet. It's no secret that social media and constant checking of your inbox are significant stress factors. Read books, meet friends or go for a walk instead. Not Enough Sleep. Lack of sleep or a circadian rhythm disorder may be one of the factors. With less energy, it will be more difficult to lose weight. Sleep deprived individuals produce less growth hormone, have impaired glucose metabolism and show a decreased level of leptin - the hormone that signals satiety. Lack of sleep also leads to an increased level of ghrelin - the hormone that tells the brain when we are hungry. People who are sleep deprived are more likely to store body fat. Here are some tips: Try to get 7- 9 hours of sleep every day. Don't eat heavy meals before bed. Your body needs to rest, not spend the whole night digesting your dinner. Don't exercise 3- 4 hours before bed. Don't use your computer before bed and try blue light blockers. Sleep in complete darkness. If possible, don't keep your laptop, tablet or phone in the bedroom. Eating Too Many Nuts. One of the common mistakes people make is to overeat nuts. You may experience weight stalling or even weight gain not because nuts will kick you out of ketosis but because they are calorie- dense and easy to overeat. This doesn't mean you have to exclude nuts altogether. Nuts are particularly high in insoluble fibre which has zero effect on blood sugar. That's why you shouldn't worry about their relatively high total carb count. How About Peanuts? Peanuts are legumes which are avoided on a keto & primal/paleo diet for two reasons. Firstly, although they are relatively low in carbs, peanuts contain lectins and phytates which makes them hard to digest. Also, legumes in general have been linked to leaky gut syndrome, PCOS, IBS and Hashimoto's. Eating Too Much Dairy. Full- fat dairy commonly eaten on a ketogenic diet is high in calories and easy to overeat. Also, dairy contains a specific type of protein that can lead to greater insulin spikes than meat. If dairy makes your insulin spike, cut back on high- protein dairy products like cheese and yogurt. You can keep butter and cream, as these are relatively low in protein. If you have to avoid dairy altogether, try my free paleo diet plan! Eating Too Many Low- Carb Treats. Although we all love low- carb treats, they are not suitable for weight loss, especially if you just started following a low- carb diet and need to get over your sugar addiction. Keto treats and low- carb sweeteners can all increase cravings and your appetite levels and you should minimise or even completely avoid eating them when you are trying to lose weight. If you have a sweet tooth, go for a piece of dark chocolate or a fat bomb. Eating Products Labeled . Avoid prepared meals full of additives and deceptive labelling. It's no secret that low- carb products are often higher in carbs than they claim to be or contain unwanted additives. A common practice is to exclude all sugar alcohols and other sweeteners from the carb count. This is wrong as not all sugar alcohols and other sweeteners have zero effect on blood sugar. There are a few decent products you can use even on a keto diet but you have to be extra careful. I like the taste and drink it occasionally, usually instead of breakfast - not as part of it. BPC is mostly fat and very low in other nutrients. While for some people it seems to suppress hunger, I wouldn't personally drink it every day. While BPC may be a good addition to your diet, you should get your calories from real nutritious foods together with protein, vitamins and minerals. Some of my readers have been experiencing weight stalling and once they ditched their bulletproof coffee in the morning, they started losing weight again. You can try my keto egg coffee that is more nutritious and satiating - it will keep hunger at bay. Drinking Alcohol. Alcohol is a no- no for those who are trying shed extra pounds. Apart from adding calories, alcohol has other disadvantages when it comes to weight loss. Even if there is no sugar in it, your body can't store alcohol as fat - it has to metabolise it first. As a result, the fat- burning advantage of the ketogenic diet is diminished. Alcohol also increases appetite, dehydration and suppresses self- control - none of these are good for weight loss. Celebrity Weight Loss: John Goodman It's been constant. It's always been in the back of my mind. It just ate at me the whole time. That may be part of the reason I shoved food in my mouth so much. But what clicked was three years ago I did a Santa Clause movie. I looked at it and I was really unhappy about the way I looked. For years, at Christmas- time I'd get fed up and make a resolution, and I'd lose 6. And then I was off to the races again in the summer. I'd just eat whatever I want, and the big key was drinking. So I went to a man named Mackie Shilstone in New Orleans, who is our own fitness guru. He trains Serena Williams. He's trained many boxers. He brought Ozzy Smith back- -gave him a few more years in his career. I set up a program with him, medically, first. This was three years ago, before the Santa Clause movie? I was living in New Orleans, and I thought, I might as well try this guy because he's the best, and we worked out a good program. I lost about 7. 0 pounds and went to Germany to do a movie, and I was still drinking. I was working out during this time. I've got arthritic knees and I need to replace both of them. So I get on an elliptical machine and a recumbent bike. I was working out, but I was still drinking and everything that goes along with that, which is the food and everything else. Right after I got back from Germany, I got sober. And that was the final key you needed to complete this- - Yeah. I had to clear out my own house first. It was built on a bad foundation. Can you tell me a little about this trainer? He's a pretty solid guy, probably the smallest football player who ever played for Tulane. Maybe 1. 00- -hell, I'm not good at guessing weight. Or I'd be in a carnival. Hell, I am in a carnival anyway. But, man, he's just a walking encyclopedia. I don't know why he doesn't have a doctorate because he's up on everything to do with medical advancements, vitamins, nutrition. It's like talking to a computer when you talk to him. So he does all the work for you and he just kicks your ass? He doesn't do it, but he's got a system there in New Orleans in association with East Jefferson Hospital, where we have doctors at our disposal, a nutritionist and trainers. So he hooked me up with a trainer and this time I did a lot of cardio at home. Forty minutes of cardio in the morning and 4. What kind of cardio? I can only do the elliptical and the recumbent bike. But the knees kicked in. I loved to walk, but.. So all cardio? This time we mixed in strength training with resistance bands. They're great for me because I can contract and release slower, and that builds up better muscle for me. And a key thing was boxing twice a week. I was doing a job in New Orleans twice a week called Treme. I was only working a couple days a week. I wanted to treat this other thing (exercise) like a job- -to get healthy. I trained with a man named Axel Murillo for boxing, and what we do is like 1. Right now I'm built up to 2 minutes and 1. But doing that twice a week I think really helped me with the twisting, the turning and the throwing, and it gets my heart up to about 1. Read on to find out what John Goodman eats to keep the pounds off.. It's interesting that not only did you have to lose this weight, but it seems like you can repair the damage that had been done from years of being overweight. But it's a labor of love. And I think the key to the cardio was finding the rate my heart should be at to burn the most fat- -which for me is 1. Do you like it, or is this grueling? I'm still a sucker for highs, and I get those endorphins. It's just a feeling of well- being. I'm where I'm supposed to be. I'm doing what I should be doing. I'm hopefully extending my life. Before, I didn't care. Can you explain a little about the relationship you had between stress and these food and alcohol binges? I would drink no matter what. That's just part of being an alcoholic- -you find any excuse. But as for the stress, I've lived a stressful life. I've made it more stressful by drinking and using drugs, and the business I have chosen is always a nail- biter. You bitch when you're not working, and when you work you bitch about the people you're working with. It was really hairy for a long time, and there was the constant threat of unemployment. For some reason I just denied what I was doing to myself. It's a miracle anyone would hire me at all, looking at me. I looked like a walking heart attack. Why did you break those Christmas promises you made yourself every year? It was all alcohol- related. The alcohol would enter the picture, and food would follow? It took a lot of work to maintain my physique. A lot of fudgy- wudgies and krispy- krispies. What kind of food are you eating now? What I enjoy doing is making smoothies for myself after a workout. With some protein powder and whey powder and fruits. And I'm lactose intolerant, so I eat soy yogurt and soy milk. But also fresh vegetables, lean protein. Fourth of July I'm going to treat myself to a kosher hot dog. I'm not a real hard- on about keeping strict calorie counts. I know what's in my wheelhouse, what I can eat and what I can't. And I'm satisfied eating it. I cannot tolerate sugar. I crossed over to the diabetic side, but I can't tolerate it anyway because it creates hunger. Do you have a total goal for this? How much weight have you lost since you started? I'm pushing 1. 00- -I haven't weighed myself in a couple of weeks. My goal is reducing my body- fat percentage- -to what's healthy- -and waistline, and to see if I can get into stores where real people shop for clothes. At your max you were about how much, would you estimate? I would say I was hanging around 3. I started this time I was at 3. John, has this always been a problem for you? It started when I was a kid. I'd lock myself in the house and sneak food. It gave me great pleasure to eat- -it's part of an alcoholism personality. And then I grew up and found football. My brother sent me to the YMCA when I was probably in 7th grade. And that helped a lot, the organized stuff and swimming. And then I kind of grew out of it. After I stopped playing football I kept eating like I was playing football. When I was playing football I couldn't gain any weight. I tried everything. Weight to some extent is a part of your persona. Your character in The Big Lebowski is a very domineering man. I don't know if the same ferocity could have come from a skinny man. Are you at all worried about losing this weight and having people perceive you differently in the acting realm? I'll scream and cry when I'm in the unemployment line, but that's really secondary. I can act at different weights. It's a miracle I was hired at all for a lot of these jobs. Did you ever look to other actors around you who had similar weight issues? John Candy with his heart attack and the like- -did those deaths affect your mentality? I was in a world of denial- -. It's in the back of your mind. Subconsciously you try to block it out. So when you look in the mirror now as opposed to three years ago, what's going through your head? I try not to look in the mirror. And I'm not that reflective- -no pun intended. I am where I am now and I don't dwell on the past or pat myself on the back too much. Because this could all go away tomorrow. Monitoring and Feedback for Long- term Weight Loss . Numerous wearable technologies specific to physical activity and diet are available, but it is unclear if these are effective at improving weight loss. Objective. At 6 months, the interventions added telephone counseling sessions, text message prompts, and access to study materials on a website. At 6 months, participants randomized to the standard intervention group initiated self- monitoring of diet and physical activity using a website, and those randomized to the enhanced intervention group were provided with a wearable device and accompanying web interface to monitor diet and physical activity. Main Outcomes and Measures. Secondary outcomes included body composition, fitness, physical activity, and dietary intake. Results. For the enhanced intervention group, mean baseline weight was 9. CI, 9. 4. 2- 9. 8. CI, 9. 0. 6- 9. 5. For the standard intervention group, mean baseline weight was 9. CI, 9. 3. 0- 9. 7. CI, 8. 7. 1- 9. 1. Weight change at 2. Both groups had significant improvements in body composition, fitness, physical activity, and diet, with no significant difference between groups. Conclusions and Relevance. Devices that monitor and provide feedback on physical activity may not offer an advantage over standard behavioral weight loss approaches. Trial Registration. Short- term studies have shown these technologies to result in modest improvements in weight loss when added to a behavioral intervention. These technologies may provide a method to improve longer- term weight loss; however, there are limited data on the effectiveness of such technologies for modifying health behaviors long term. This randomized trial examined whether adding wearable technology to a behavioral intervention would improve weight loss across 2. Additional outcomes included body composition, fitness, physical activity, and dietary intake. Key Points. Question Is the addition of a wearable device to monitor and provide feedback on physical activity effective for improving weight loss within the context of a behavioral weight loss intervention? Findings In this randomized trial that included 4. Meaning Devices that monitor and provide feedback on physical activity may not offer an advantage over standard behavioral weight loss approaches. Participants were randomized to 1 of 2 groups. Both groups received a behavioral weight loss intervention for 6 months; at 6 months, both interventions added telephone counseling sessions, text message prompts, and access to study materials on a website. However, after the initial 6 months, participants randomized to the standard behavioral weight loss intervention (standard intervention) group initiated self- monitoring of diet and physical activity behaviors, and those in the technology- enhanced weight loss intervention (enhanced intervention) group used the study website to access education materials only, and wearable technology was provided along with a web- based interface to monitor physical activity and diet. Randomization was stratified by sex and race (white or nonwhite) using a computer program that applied randomly selected block sizes of 2 and 4 with the sequence of randomization kept confidential to the other investigators. The primary outcome was weight change at 2. Eligibility was assessed based on self- reported medical history, and clearance from the participant. Procedures were approved by the University of Pittsburgh institutional review board, and all participants provided informed consent. Eligibility criteria included age between 1. BMI) of 2. 5. 0 to less than 4. Exclusion criteria have been published. Intervention. . Intervention Contact. Both the standard intervention group and the enhanced intervention group received regular intervention contact. Group- based sessions were scheduled weekly for the initial 6 months and monthly between months 7 to 2. If a participant was unable to attend a scheduled group session, attempts were made to engage the participant in a makeup session. Theory- based strategies were used to promote adherence to weight loss behaviors. Beginning with month 7, these materials were posted on the study website, along with a weekly behavioral tip. During months 7 to 2. The telephone contacts were conducted by intervention staff and followed a standard script. Text messages were provided once or twice per week and were used to prompt engagement in weight loss behaviors or to remind participants of upcoming intervention sessions. Participants were compensated $5 per month to offset the cost of receiving text messages. If weight loss exceeded 6% during each 4- week period or if BMI was 2. Dietary fat was prescribed at 2. During months 1 to 6, participants were instructed to self- monitor dietary intake in a diary that was returned to the interventionists at the conclusion of each week, and the intervention staff provided feedback prior to returning diaries to the participants. During months 7 to 2. Participants in the enhanced intervention group self- monitored their dietary patterns using the technology described below. Participants were instructed to engage in structured forms of MVPA that were 1. During months 1 to 6, participants were instructed to self- monitor their MVPA in a diary returned to the interventionists at the conclusion of each week. The intervention staff provided feedback on these diaries. During months 7 to 2. MVPA using a website designed for this study, and this information was available to the staff during the intervention telephone contacts. Participants in the enhanced intervention group self- monitored their MVPA using the technology described below. This system included a multisensor device worn on the upper arm that provided feedback to the participant on energy expenditure and physical activity through a small display or through web- based software developed by the manufacturer. While the display provided information about total MVPA, the web- based software also provided feedback on MVPA performed in durations of 1. The web- based software also allowed for self- monitoring of dietary intake. Intervention staff had access to this information during the scheduled telephone contacts. Participants received $1. Assessment staff were masked to prior data at each assessment to minimize potential bias. Weight was assessed to the nearest 0. Height was measured only at baseline to the nearest 0. Body composition was assessed using dual- energy x- ray absorptiometry from a total body scan. Prior to this scan, women had a urine pregnancy test; a positive result excluded the participant from further study participation. Cardiorespiratory fitness was assessed with a submaximal graded exercise test performed on a motorized treadmill. Oxygen consumption was assessed using a metabolic cart. Physical activity was assessed using a portable device worn for 1 week. Data were considered valid if the participant wore the device for 1. Minute- by- minute data were used to identify minutes and metabolic equivalent (MET). Percent sedentary time was calculated as sedentary time identified by the activity monitor divided by the monitor wear time. Diet over the past month was assessed using the web- based version of the Diet History Questionnaire. Diet. Calc software (version 1. Percent weight loss was included as a post hoc outcome. For safety, depressive symptoms were assessed using the 1. Center for Epidemiology Studies questionnaire. Participants with a score of 1. Resting blood pressure was assessed following a 5- minute seated resting period using an automated system; participants with systolic blood pressure of 1. Hg or greater or diastolic blood pressure of 9. Hg or greater were referred to their primary care physician. Participants were queried regarding the occurrence of overnight hospitalizations and conditions to assess for adverse and serious adverse events. Sex, education, income, employment status, smoking status, alcohol consumption, and depressive symptoms. Race and ethnicity, measures included in the early trials consortium, were assessed by self- report using questionnaires with fixed categories. This would allow participants in the enhanced intervention group to maintain a clinically meaningful weight loss of at least 5%. Using a standard deviation of 6. Based on an expected attrition rate of 2. Statistical significance of group differences in distributions was tested using Wilcoxon test for continuous variables and Pearson . Thus, the primary hypothesis of participants in the enhanced intervention group achieving weight loss different from those in the standard intervention group was tested by fitting a linear mixed- effects model via maximum likelihood with weight over time as the outcome, including race, sex, time (assessment, treated as discrete, at baseline and at 6, 1. Weights measured during or after pregnancy were excluded from the analyses. Significance of the difference in distributions of weight was tested with a likelihood ratio test of the null hypothesis H0: . The mean change at each time point, estimated using the least- square means, are presented by intervention along with the corresponding 9. P values were adjusted by the Holm method for multiplicity when the differences were tested at multiple time points. No adjustments for multiple comparisons were made for the primary outcome. P values for all other secondary outcome analyses were adjusted for multiplicity using the Holm method. Multiple imputation was used for sensitivity analysis. Specifically, 1. 0 Monte Carlo Markov Chain imputations based on the observed variables (intervention group, sex, race, ethnicity, education, income, employment status, waist circumference, smoking status, alcohol consumption, depression, and weight) at previous assessments were used to impute the missing weights for the sensitivity analysis. The estimates from the imputed data sets were averaged to see if they were similar to the likelihood- based estimates from the primary analysis.
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