Saudi Cultural Missions Theses & Dissertations
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Item Restricted Assessing Community Pharmacist Knowledge, Perceptions and attitudes toward trizepatide as a weight mangment medication in Saudi Arabia(Saudi Digital Library, 2026) Alhazmi, Saja; Gomaa, BasmaObesity is a complex, chronic disease and a major public health challenge world-wide, with particularly high prevalence in Saudi Arabia. Effective obesity management typ-ically involves a combination of lifestyle modification and pharmacological treatment. Tir-zepatide is one of the newer emerging medications approved for the treatment of type 2 dia-betes mellitus; however, it has recently been used for weight management. Previous studies have demonstrated that tirzepatide is an effective and safe treatment option for obesity. Nevertheless, the successful integration of such therapies into clinical practice largely de-pends on healthcare providers’ knowledge, attitudes, and perceptions, particularly among community pharmacists who play an essential role in patient counseling and medication management. This study aimed to measure the association between these factors and phar-macists’ confidence levels by applying the Knowledge, Attitudes, and Perceptions on Con-fidence Level framework. A cross-sectional survey design was used to assess the relation-ship between knowledge, attitudes, and perceptions, and community pharmacists' confi-dence in counseling patients on the use of tirzepatide for weight management. The results demonstrated that community pharmacists had a relatively high level of knowledge (76.1%) and generally positive attitudes toward tirzepatide as a weight management medication. These findings suggest that pharmacists are aware of the therapeutic value of tirzepatide and are open to its role in obesity management. However, perceptions were not significantly associated with confidence level. In addition, most pharmacists (58%) reported low to moderate confidence in counseling patients about tirzepatide. This finding may be explained by the relatively recent introduction of tirzepatide, limited practical experience, and the need for further training and clinical guidance. In conclusion, although community pharmacists showed satisfactory knowledge and positive attitudes toward tirzepatide, their confidence in counseling patients remained limited. These findings highlight the importance of targeted educational interventions and professional development programs to improve pharmacists’ confidence and support the safe and effective use of tirzepatide in obesity management.15 0Item Restricted Fast-Food Consumption Frequency and Adiposity Among U.S. Adults: NHANES 2017–March 2020(Saudi Digital Library, 2026) Amuhathab, Hanan; Amie, Hufton; Amy, FerketichObjective: To examine the association between fast-food consumption frequency and adiposity among U.S. adults using NHANES 2017–March 2020 data, and to assess whether poverty-to-income ratio (PIR) modifies the associations with body mass index (BMI) and obesity. Methods: This cross-sectional study used pre-pandemic NHANES 2017–March 2020 data. The analytic sample included nonpregnant adults aged 20 years and older with complete data on BMI, fast-food consumption frequency, PIR, covariates, and survey design variables (N = 5,644). Fast-food consumption was categorized as 0–1, 2–3, and ≥4 meals per week. Outcomes were BMI and obesity (BMI ≥30 kg/m²). Survey weighted linear regression was used for BMI, and survey-weighted logistic regression was used for obesity. Adjusted models included demographic, socioeconomic, and behavioral covariates, and effect modification by PIR was examined using interaction terms and predictive margins. Results: Higher fast-food consumption frequency was associated with higher adiposity. In adjusted analyses, compared with adults reporting 0–1 fast-food meals per week, those reporting 2–3 meals per week had higher BMI (beta = 0.72; 95% CI: 0.19–1.25; p = 0.010), and those reporting ≥4 meals per week had a larger increase in BMI (beta = 1.68; 95% CI: 0.50–2.87; p = 0.007). For obesity, adults reporting 2–3 meals per week had higher but not statistically significant odds of obesity (OR = 1.18; 95% CI: 0.98,1.43; p = 0.079), whereas adults reporting ≥4 meals per week had significantly higher odds of obesity (OR = 1.59; 95% CI: 1.15–2.21; p = 0.007). The association between fast-food consumption and BMI varied marginally by PIR, and the interaction with PIR was statistically significant for obesity, with the strongest gradient observed in the highest income group. Conclusion: More frequent fast-food consumption was associated with higher BMI and, at the highest level of intake, with higher odds of obesity among U.S. adults. These findings support fast-food consumption frequency as a relevant behavioral exposure for adiposity and suggest that its association with obesity may differ across income groups, with the strongest gradient observed in the highest income group.9 0Item Restricted The role of stigma on inflammation in depressed and non-depressed bariatric patients(Saudi Digital Library, 2025) Mubarak, Yousef; Zuzanna, ZajkowskaBackground. Depression is prevalent among post-bariatric surgery patients, yet its psychosocial determinants remain underexplored. Weight stigma, both perceived and internalized, is linked to depression and systemic inflammation. Very few studies have examined these associations using validated clinical depression scales alongside inflammatory biomarkers, limiting understanding of their combined impact and informing the need for targeted interventions in bariatric patients. Method. This observational study included 37 post-bariatric surgery patients after three years of follow-up, comprising 15 cases with depression and 22 controls. Before and after 3 years of surgery, depression was evaluated by clinical interview, Weight stigma was assessed using self report questionnaires, and measured serum inflammatory cytokines, including Tumor Necrosis Factor-alpha (TNF-α) and Interleukin-6 (IL-6). Results. After surgery, inflammatory cytokines TNF-α and IL-6 were significantly elevated in depressed patients. All stigma scales correlated with depression, with SSI-B showing the strongest associations: HAM-D-17 (r = .546, p < .001), atypical depression (r = .396, p = .019), and SIGH-ADS (r = .554, p < .001). TNF-α and IL-6 correlated only with BMI. In regression analyses, SSI-B independently predicted HAM-D-17 (B = 0.230, p = .004) and SIGH-ADS (B = 0.312, p = .005), while WBIS predicted atypical depression (B = 0.159, p = .031). WCS and cytokines were not independent predictors. Conclusions. Weight stigma showed stronger associations with depression than inflammatory cytokines beyond the effect of BMI and other confounders. highlighting psychosocial factors as key targets. Interventions addressing weight stigma may be critical for improving mental health outcomes among bariatric patients.7 0Item Restricted The Role of RIPK1 Pathways in Obesity and Circadian Rhythm Regulation(Saudi Digital Library, 2025) Alammar, Abdulaziz Mohammed A; Denuja, Karunakaran; Masaaki, SatoRIPK1 and MLKL are best known for executing necroptosis, yet emerging evidence implicates them in metabolic control. We tested whether modulating these proteins reshapes adipose biology and glucose regulation through non-lethal signalling. Using complementary in vivo and in vitro approaches, we combined adipose-targeted genetic manipulation with longitudinal metabolic phenotyping, depot-level endpoints, 3T3-L1 adipogenesis assays, and circadian profiling of hepatic clock-linked transcripts. Attenuating RIPK1 signalling aligned with reduced inflammatory tone in adipose tissue and indices consistent with improved insulin sensitivity, in keeping with RIPK1’s scaffolding of NF-κB pathways that antagonise insulin signalling. Effects on fat distribution favoured a relative reduction in visceral depots rather than a simple fall in total adiposity, suggesting qualitative remodelling of adipose function. MLKL influenced adipocyte programs beyond cell death: loss of MLKL impaired differentiation in vitro and pointed to altered lipid-handling pathways in vivo. Rhythmic analyses supported genotype-dependent modulation of hepatic transcripts, compatible with feedback between lipid status and clock-controlled transcription. Together, these data support a model in which RIPK1 and MLKL shape immunometabolic signalling and insulin sensitivity via context-dependent, non-necroptotic functions. The findings motivate depot-aware and time-of-day interventions and prioritise follow-up experiments coupling RIPK1 inhibition or MLKL manipulation with direct measures of PPARγ targets, adiponectin multimers, and responses to inflammatory challenge.27 0Item Restricted Metabolic and Molecular Changes in Visceral Obesity(Saudi Digital Library, 2025) Alotaibi, Mohammed I; Murphy, David; Greenwood, MichaelRodent models have played a crucial role in obesity research, particularly for understanding polygenic obesity, which mirrors human obesity more closely than monogenic forms. The genetically diverse outbred Crl:CD SD rats provide a relevant system for studying obesity-related metabolic changes. This study categorized male Crl:CD SD rats into overweight, average-weight, and underweight groups based on body weight percentiles. Without intervention, the overweight rats exhibited increased food intake, adiposity, hyperinsulinemia, hyperglycemia, and hyperleptinemia, reinforcing their suitability for studying polygenic obesity. Expanding on these findings, a multi-omics approach was employed to investigate molecular differences in epididymal white adipose tissue (EWAT). Proteomics, phospho-proteomics, and kinase activity assays revealed significant alterations in adipogenesis pathways, cell cycle regulation, inflammatory markers, and insulin signaling. Notably, overweight rats demonstrated increased activity of the dual specificity mitogen activated protein kinase 7 (MKK7) and the never in mitosis gene A (NEK2), alongside hyperphosphorylation of O-GlcNAcase (OGA) at serine 364. To further assess the functional roles of these proteins, gene knockdown experiments were conducted in 3T3-L1 adipocytes. While Mkk7 knockdown did not impair adipogenesis, it influenced cytokine production, suggesting a role in adipose tissue inflammation. Conversely, Oga knockdown resulted in reduced cell viability and impaired adipogenesis, highlighting its importance in adipocyte differentiation. Taken together, these findings establish Crl:CD SD rats as a valuable model for studying polygenic visceral obesity and its molecular underpinnings. Additionally, MKK7 and OGA emerge as potential therapeutic targets for mitigating adipose tissue inflammation and visceral adiposity, though further in vivo studies are required to elucidate their specific mechanisms.13 0Item Restricted Development of a home based resistance exercise programme for muscle strength and function during weight loss(Saudi Digital Library, 2025) Binmahfoz, Ahmad; Gray, StuartThesis abstract Background The prevalence of obesity continues to increase, representing a major public health concern across the globe. While dietary interventions can reduce body mass, the concurrent loss of fat free mass and muscle strength is a potentially deleterious consequence. Resistance exercise may help preserve muscle mass and function during weight loss, yet its implementation remains challenging. This thesis investigated the potential of home-based resistance exercise to attenuate these deleterious effects of weight loss through three research studies. Methods Study 1 included a systematic review and meta-analysis examining the effects of resistance exercise on body composition, muscle strength, and cardiometabolic health during dietary weight loss. Study 2 employed qualitative methods to explore experiences and perceptions of resistance exercise among people living with overweight or obesity (n=11), informing a theory of change for intervention development. Study 3 evaluated the effects of a 12-week home-based resistance exercise intervention, during dietary weight loss, through a randomised controlled pilot trial (n=48). Results The systematic review and meta-analysis (25 RCTs) demonstrated that supervised resistance exercise during dietary weight loss preserved fat free mass (SMD: 0.40, p<0.001), increased fat mass loss (SMD: -0.36, p<0.001), and improved muscle strength (SMD: 2.36, p<0.001) relative to a no exercise control. The qualitative study identified multiple barriers, including pandemic-related limits, access to facilities and financial constraints to traditional gym-based resistance exercise, and indicated strong preferences for home-based alternatives. The pilot trial showed that, during weight loss, home-based resistance training improved grip strength (p=0.046), knee extensor maximal voluntary contraction force (p=0.019) and sit-to-stand performance (p<0.001), but did not have any effects on body composition (body mass index, total body mass, fat mass, fat free mass, muscle thickness) compared to dietary weight loss alone. Conclusions The current thesis demonstrates that supervised resistance exercise enhances the benefits of diet induced weight loss by preserving muscle mass and improving muscle function. The development and evaluation of a home-based programme showed promising results for overcoming traditional barriers to resistance exercise participation and improving muscle strength and function, but not muscle mass. These findings support the implementation of accessible resistance exercise interventions during weight loss for people living with overweight or obesity.49 0Item Restricted Obesity is linked to remodelling of mitochondrial dynamics and the inflammasome in the heart(The University of Manchester, 2025) Albalawi, Zainab; Kitmitto, AshrafBackground: Obesity affects 890 million adults worldwide, with the number of obese people predicted to rise to 1 billion by 2030. Obesity is a common precursor to type 2 diabetes (T2DM) both of which are driving the prevalence of Heart Failure with preserved Ejection Fraction (HFpEF). HFpEF has few treatment options in part due to a limited understanding of the pathophysiological processes. This thesis took a combined in-vivo and in-vitro approach to characterise the intersection between changes to cardiac function, mitochondrial dynamics and the inflammasome resulting from diet-induced obesity (DIO) (a longitudinal study), and the effects of associated stressors. The experimental findings additionally led to investigations of the protein MIRO1 (a regulator of mitochondrial motility in neuronal cells), as little is known about the role of this protein in heart health. Methods and Results: 8-week-old C57BL/6J male mice were fed either a 60% High Fat Diet (HFD) or normal chow diet for 16 or 19 weeks. After 16 weeks, the HFD mice developed hyperglycaemia and hyperinsulinemia. Cardiac structure and function, as assessed by echocardiography and electrocardiography (ECG), revealed mild impairment of systolic function, associated with eccentric hypertrophy with no changes to the ECG. Western blotting and RT-qPCR showed a shift towards fission, with a reduction in mitochondrial fusion proteins MFN1 and MFN 2 (~0.6-fold, p = 0.04 and p = 0.05, respectively). Levels of MIRO1 also fell ~2-fold (p=0.0005). In contrast to expectations, extending the HFD protocol to 19-weeks did not affect cardiac function relative to control mice. Furthermore, at 19 weeks there was a shift towards increased fusion (up-regulation of the fusion proteins MFN1 and OPA1 and down-regulation of the fission protein DRP1). Interestingly, the mitophagy proteins PINK1 and PARKIN mirrored changes detected in the 16 week model (up and down-regulation respectively). Protein levels for the NLRP3 inflammasome components increased. Proteomics analysis of isolated cardiac mitochondria (19 weeks) identified increased expression of proteins regulating ketogenic activity. In-vitro (H9C2) cytokine treatments had mixed effects on cardiomyocytes. IL-1β treatment did not affect the mitochondrial and inflammasome proteins, whereas IL-6 and TNF-ɑ affected expression level changes to inflammasome related proteins (NLRP3 and Caspase 1) and proteins linked to mitophagy (PARKIN) and mitochondrial motility (MIRO1 and MIRO2). A cardiac specific MIRO1 knockout mouse (Cre-loxP) was next developed. Partial deletion of MIRO1, Cre+Het (heterozygous), mice exhibited mild diastolic dysfunction, which was exacerbated in the MIRO1cKO (homozygous) model. Mitochondrial function of MIRO1cKO mice was assessed using a high-resolution respirometer (Oxygraph) and displayed impaired oxidative phosphorylation and increased levels of mitochondrial reactive oxygen species (ROS) relative to wild type (WT) mice. Tissue from the apex of MIRO1cKO hearts was fixed for Transmission electron microscopy (EM) revealing more interfibrillar (IFM) and subsarcolemma (SSM) mitochondria with disrupted cristae, consistent with increased Cytochrome C expression compared to WT mice. Cre+Het mice when given a combination of a 60% HFD and L-NAME, when compared to control mice, exhibited a rapid onset of cardiac dysfunction consistent with HFpEF pathophysiology. Conclusion: This Thesis work developed and characterised a DIO mouse model that reiterated features of HFrEF, identifying a shift towards mitochondrial fission. Surprisingly, extending the HFD duration resulted in a reversion of the cardiac dysfunction to a healthy cardiac phenotype. This finding afforded the opportunity to compare the 16 and 19 week models at the molecular level to identify mitochondrial proteins that exhibited plasticity and thus may be linked to the pathogenesis of HF. For example, the shift from fission to fusion could suggest that promoting fusion improves cardiac outcomes. Additionally, upregulation of the ketogenesis pathway proteins was also identified at 19 weeks, suggesting HMGCS2 and BDH1 linked processes may represent intervention pathways. The link between obesity and inflammation status emerged as complex and further studies are required for clear stratification to HFrEF progression. This thesis also generated novel data revealing that the protein MIRO1 plays a crucial role in cardiac function and loss of MIRO1 leads to cardiac and mitochondrial dysfunction and altered the mitochondrial morphology. When combined, the novel results from this Thesis research have identified potential new target candidates/directions for developing novel approaches to preventing/delaying obesity-linked HF and serve as a platform for future investigation.26 0Item Restricted Benefits of Supplementation with LCn-3 PUFA during Diet-Induced Body Mass Loss and Maintenance Phases on Body Composition, Muscle Function, and Appetite(University Of Glasgow, 2025) Alblaji, Mansour Ghazi; Malkova, Dalia; Gray, StuartObesity is a complex medical condition that is associated with a range of comorbidities, including hypertension, type 2 diabetes, dyslipidaemia, gastrointestinal disorders, joint pain, and musculoskeletal complications. Current treatment approaches for obesity primarily involve lifestyle modifications, including diet-induced weight loss and physical exercise. However, evidence from previous research highlights a concern regarding diet-induced body mass loss: approximately 25–30% of the total body mass lost is derived from fat-free mass (FFM). This decline in FFM is associated with diminished muscle mass and function, reduced metabolic rate, and an elevated risk of body mass regain. Attenuating FFM loss during body mass loss is therefore critical for healthy body mass loss. Long-chain n-3 polyunsaturated fatty acids (LCn-3 PUFA) have been proposed as a potential strategy to mitigate these effects by influencing body composition, muscle mass and function, and inflammation during energy balance. Evidence suggests that LCn-3 PUFA can reduce fat mass while enhancing FFM, improving muscle mass, strength, and function, and mitigating inflammation. However, despite these potential benefits, the evidence supporting the efficacy of LCn-3 PUFA supplementation during diet-induced body mass loss on body composition, muscle function, and inflammatory markers remains limited and requires further exploration. The first aim of this thesis was to systematically investigate the effects of supplementation with LCn-3 PUFA during caloric restriction (CR) on body mass, fat mass and FFM loss (Chapter 2). Eleven studies were included in this systematic review and meta-analysis as they met the inclusion criteria of the systematic review, with a total of 637 participants. The participants’ age ranged between 18 and 61 years, with a mean BMI ranging between 27 and 36 kg/m2 . Pooled analyses showed that LCn-3 PUFA supplementation during CR had no additional effect on changes in body mass (SMD = -0.05: 95% CI -0.22 to 0.13; p = 0.62; I2 : 10%), BMI (SMD = -0.06, 95% CI -0.25 to 0.13; p = 0.55; I2 : 18%), fat mass (SMD = - 0.01; 95% CI -0.25 to 0.24; p = 0.96; I2 : 46%), or FFM (SMD = 0.12, 95%CI -0.14 to 0.37, p = 0.36; I2 :35%). The lack of impact of LCn-3 PUFA on body mass and composition observed in this systematic review (Chapter 2) may be attributed to some limitations in the iii included studies. Most of the studies assessed body composition using bioelectrical impedance analysis (BIA), applied low doses of LCn-3 PUFA, and also did not evaluate muscle strength during diet-induced body mass loss. To address the gaps identified in our systematic review, a double-blind, randomised, placebo-controlled trial (RCT) was conducted, including a 4-week preparation phase, an 8-week alternate-day fasting (ADF) phase, and an 8-week body mass maintenance phase, with participants taking 4 capsules/day of krill oil as a source of LCn-3 PUFA throughout (Chapter 4). Body composition was evaluated via the deuterium water (D2O) dilution method, and parameters of muscle function, and fasting blood samples were measured at the pre- and post body mass loss phase. Forty-one healthy adults completed this RCT. The two-way ANOVA revealed significant time and time*group interaction effects on FFM, handgrip strength, chair rising test, TNF-α, CRP, and systolic blood pressure (all p < 0.05). Post-intervention, there was a small, non-significant reduction in FFM (- 0.2 ± 0.9 kg, p > 0.05) and handgrip strength (-0.2 ± 0.5 kg, p > 0.05) in the krill oil group, whereas the placebo group experienced significant reductions in FFM (- 1.2 ± 2.0 kg, p < 0.05) and handgrip strength (-0.9 ± 0.7 kg, p < 0.05). The time to conduct the chair rising test decreased significantly in the krill oil group (-1.8 ± 0.9 s, p < 0.05), whereas the reduction in the placebo group was not significant (- 0.3 ± 1.2 s, p > 0.05). TNF-α levels decreased significantly in both groups (all p < 0.05), with a greater reduction in the krill oil group (-1.4 ± 0.2 pg/ml) compared to the placebo group (-0.9 ± 0.5 pg/ml). Similarly, CRP levels were significantly reduced in both groups (all p < 0.05), with a greater reduction in the krill oil group (-51.4 ± 25 ng/ml) than in the placebo group (-33.5 ± 12.6 ng/ml). Systolic blood pressure decreased significantly in both groups (all p < 0.05), with a greater reduction observed in the krill oil group (-9 ± 6 mmHg) compared to the placebo group (-4 ± 4 mmHg). No significant difference was observed in changes between groups in body mass, body fat, insulin, glucose HOMA-IR, TAG, or diastolic blood pressure (all p > 0.05). Therefore, from this RCT, it was concluded that supplementation with krill oil during diet-induced body mass loss via ADF helps to attenuate the associated decline of FFM and muscle function, improve functional capacity, and reduce TNF-α and CRP levels. Supplementation with LCn-3 PUFA, in the absence of CR, has been associated with appetite reduction and enhanced sensations of fullness and satiety in individuals iv living with overweight or obesity. However, the effects of LCn-3 PUFA supplementation during diet-induced body mass loss on appetite and gastrointestinal appetite hormones remain underexplored. In Chapter 5, the impact of LCn-3 PUFA during diet-induced body mass loss on changes in appetite and gastrointestinal appetite hormones was examined in a subset of the participants of the RCT (Chapter 4). This exploratory study included 28 adults (mean age: 39.4 ± 11.7 years; BMI: 27.9 ± 3.2 kg/m²) who participated in the RCT (Chapter 4). Body mass, body fat, and FFM were measured at baseline (week 4), at the end of the body mass loss phase (week 12), and at the end of the body mass maintenance phase (week 20). Fasting and postprandial subjective appetite scores, along with plasma concentrations of acylated ghrelin, Glucagon-Like Peptide-1 (GLP-1), and Peptide YY (PYY), were assessed before and after the body mass loss phase. The ANOVA revealed a significant time (p<0.05), but not group (p>0.05) or time*group interaction (p>0.05) effects for body mass, fat mass or FFM during the body mass loss phase. During the maintenance phase, no significant (p>0.05) time, group, or time*group interaction effects were found for body mass and FFM, but for fat mass, a significant time*group interaction effect was observed (p<0.05). During the maintenance phase, in the krill oil group, fat mass remained unchanged (p>0.05) but increased significantly (p< 0.05) in the placebo group. This coincided with the body mass loss-induced significant reduction (p<0.05) in the composite appetite score (CAS) in the krill oil but not the placebo group (p> 0.05). There was no significant (p>0.05) time, group, or time*group interaction effects for acylated ghrelin, GLP-1, and PYY during the body mass loss phase. Changes in body mass during the body mass loss and body mass maintenance phases were not correlated with acylated ghrelin, PYY, or GLP-1 (all p > 0.05). Body mass changes during the body mass loss phase showed a tendency toward a significant positive correlation with changes in CAS (r=0.36, p = 0.06). Therefore, krill oil supplementation during body mass maintenance may induce favourable changes in subjective appetite and prevent short-term fat mass regain. Overall, the current thesis demonstrates that supplementing with LCn-3 PUFA during diet-induced body mass loss is a promising strategy to attenuate the loss of FFM and muscle function. Beyond these benefits, LCn-3 PUFA supplementation also reduces inflammation and lowers blood pressure, underscoring its potential to enhance body composition, preserve muscle mass, and promote overall well- v being during body mass loss. Furthermore, LCn-3 PUFA supplementation may reduce subjective appetite and might help to prevent fat mass regain during the body mass maintenance phase, further supporting its role in long-term body mass management.40 0Item Restricted Age-Varying Associations Between Childhood Abuse and The Risk of Obesity Across Adulthood: Examining Data from The National Longitudinal Study of Adolescents to Adult Health(Claremont Graduate University, 2025) Abudawood, Mohammed; Xie, BinChildhood abuse is a significant early-life stressor linked to adverse health outcomes such as obesity across adulthood. This study examines how the association between childhood abuse (physical, emotional, and sexual) and obesity risk varies with age, using data from Waves I–V of the National Longitudinal Study of Adolescents to Adult Health (Add Health). Utilizing Time-Varying Effect Modeling (TVEM), the study identifies specific developmental periods during which the relationship between childhood abuse and obesity risk is strongest and investigates the moderating role of gender. The study found that all forms of childhood abuse are associated with elevated obesity risk across the life course, with distinct patterns over time. Physical abuse showed a stronger impact on obesity risk during late adolescence and early adulthood, with a resurgence of influence in later adulthood. Emotional abuse had a positive and long-lasting association with obesity risk from young adulthood into established adulthood. Sexual abuse was linked to increased obesity risk emerging in late adolescence, early adulthood, and established adulthood, with females experiencing particularly pronounced effects in early adulthood. These results highlight the temporal dynamics of childhood abuse on obesity risk across adulthood, offering critical insights for the timing and tailoring of prevention and intervention strategies. The study underscores the need for trauma-informed public health policies that address childhood abuse as a risk factor for obesity across adulthood, particularly at high-risk age windows. By identifying when and for whom the abuse-obesity link is strongest, this study informs more effective prevention strategies and health policies to mitigate long-term obesity risk among survivors of childhood abuse.25 0Item Restricted UNDERSTANDING THE RELATIONSHIP BETWEEN WEIGHT MANAGEMENT SUCCESS AND FOOD CRAVINGS: INVESTIGATING STRATEGIES(University of Illinois Urbana-Champaign, 2027-12-20) Alfouzan, Nouf; Nakamura, ManabuIntroduction: Obesity and its related comorbidities have become one of the significant threats to public health. While sustained weight loss can mitigate these comorbidities, achieving and maintaining weight loss remains challenging. One of the significant challenges in sustaining weight loss is managing food cravings, as uncontrolled cravings are associated with increased intake of calorie-dense foods and subsequent weight regain. The goals were to determine the impact of weight loss and maintenance on food cravings and identify effective strategies for managing food cravings that could prevent weight regain. The objective of study 1 was to determine the associations of factors such as food cravings and eating habits with large variations in weight loss and maintenance outcomes. The objective of study 2 was to evaluate the long-term change in food cravings, whether food cravings changes persist during weight maintenance, and explore the relationship between food cravings changes and weight loss outcomes. The objective of the final study was to determine whether an avoidance strategy or an inclusion strategy is more effective in reducing food cravings and achieving a greater magnitude of weight loss. Methods: Study 1 was a one-year follow-up study conducted after completing a one-year dietary weight loss program. Twenty-two participants entered the follow-up phase and weighed themselves daily using Wi-Fi scales. Self-reported questionnaires assessing food cravings and eating habits were collected at 12 and 24 months. In study 2, thirty participants with a BMI of 25 kg/m² enrolled in a one-year weight loss dietary program, EMPOWER, followed by one year of weight maintenance. Self-reported food craving questionnaires were completed at baseline, 6, 12, 18, and 24 months. At 12 months, participants reported their experience using the "inclusion strategy" for managing food cravings and rated its frequency and effectiveness in supporting weight loss goals and controlling food cravings. Daily self-weighing was recorded using Wi-Fi scales. In the final study, sixty-three adults with a BMI of 28 kg/m², who reported moderate food cravings and the consumption of craved foods a few times a week, participated in a 3-month EMPOWER program. Participants were randomized into one of two food craving management strategies: avoidance or inclusion. The avoidance strategy involves completely avoiding craved foods by reducing their availability and accessibility, while the inclusion strategy incorporates small portions of craved foods within well-balanced meals and avoids their consumption between meals. Self-reported food craving questionnaires were completed at baseline and 3 months, along with bi-weekly self-reported treatment adherence. Daily self-weighing was reported using Wi-Fi scales. Body composition and anthropometric measurements were taken at baseline and 3 months. Monthly self-reported dietary intake was assessed, and weekly feedback messages from nutrition coaches were provided to monitor progress in weight loss and food craving management. Results: In study 1, 19 out of 22 (86.3%) completed the questionnaires at 12 and 24 months. Control food cravings at 12 and 24 months was significantly associated with weight loss outcomes; those in the >5% weight loss group had higher food craving control compared to the <5% group (3.23 vs. 2.72, p = 0.03; 3.48 vs. 2.72, p = 0.01, respectively). Self-perceived implementation of maintaining consistent portion sizes significantly correlates with weight loss outcomes at 24 months (r=0.76, p=0.0001). In study 2, out of 30 participants, 24 (80%) remained in the program at 12 months with an average (SD) weight loss of -7.9 (7.2 %) and 20 (66.7%) completed the program at 24 months with a mean weight loss of -6.7 (7.5 %). The frequency of general food cravings and cravings for specific foods and craving traits decreased significantly at 12 and 24 months from baseline and remained stable from 12 to 24 months. Changes in food cravings at 6 months predict concurrent and subsequent weight changes at 12, 18, and 24 months. Participants who implemented the inclusion strategy (n = 16) experienced significantly greater weight loss (-9.9% vs. -3.7%, p = 0.04), reduced cravings for high-fat foods (-0.50 vs. -0.09, p = 0.02), and sweet foods (-1.02 vs. -0.38, p = 0.028) compared to non-strategy users (n = 8) at 12 months. In the final study, 56 of 63 participants (88.9 %) completed the 3-month EMPOWER program, with a mean weight loss of -3.55(3.21 %). There was no significant difference in weight loss between the groups (p=0.67), with the avoidance group's average weight loss of -3.73 (3.34 %) (n=28) and the inclusion group's average weight loss of -3.36(3.34 %) (n=28). Compared to the avoidance group, the inclusion group showed greater reductions in cravings for carbohydrates (p = 0.01), high-fat foods (p = 0.03), and general food cravings (p = 0.05). The inclusion group also had significant improvements in global trait scores (p = 0.04) and specific traits such as "anticipation of relief from the negative state" (p = 0.03), "craving as a physiological state" (p = 0.04), and "guilt from cravings" (p = 0.04). In the inclusion group, craving frequency and strength steadily decreased from Week 2 to Week 12, whereas in the avoidance group, cravings initially decreased from Week 2 to Week 4 but then increased. Conclusion: In study 1, reduced food cravings were correlated with successful weight maintenance. In study 2, food cravings and cravings for specific foods decreased during weight loss, and remained stable during weight maintenance, with craving reduction demonstrating a strong correlation to successful weight loss and maintenance. In the final study, the inclusion strategies resulted in a greater reduction in food cravings and cravings for specific foods compared to the avoidance strategy.25 0
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