{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T19:48:21Z","timestamp":1787600901787,"version":"build-2736575974"},"reference-count":44,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2019,12,13]],"date-time":"2019-12-13T00:00:00Z","timestamp":1576195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"WW, International","award":["2017"],"award-info":[{"award-number":["2017"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Inadequate vitamin and mineral intake is documented among individuals with obesity, but is unknown among long-term weight loss maintainers (WLM). This study examined dietary quality and micronutrient adequacy among WLMs in a commercial weight management program. Participants were 1207 WLM in Weight Watchers (WW) who had maintained a 9.1 kg or greater weight loss (29.7 kg on average) for 3.4 years and had a body mass index (BMI) of 28.3 kg\/m2. A control group of weight stable adults with obesity (controls; N = 102) had a BMI of 41.1 kg\/m2. Measures included the Diet History Questionnaire-II, Healthy Eating Index-2015 (HEI), and Dietary References Intakes. WLM versus controls had a 10.1 point higher HEI score (70.2 (69.7\u201370.7) vs. 60.1 (58.4\u201361.8); p = 0.0001) and greater odds of meeting recommendations for copper (OR = 5.8 (2.6\u201313.1)), magnesium (OR = 2.9 (1.8\u20134.7)), potassium (OR = 4.7 (1.4\u201316.5)), vitamin A (OR = 2.8 (1.7\u20134.8)), vitamin B6 (OR = 2.9 (1.6\u20135.2)), and vitamin C (OR = 5.0 (2.8\u20138.8)). WLM, compared to controls, also reported higher percentages of calories from carbohydrates (50.3% (49.7\u201350.8) vs. 46.7% (44.8\u201348.7); p = 0.0001) and protein (18.2% (18.0\u201318.5) vs. 15.9% (15.1\u201316.6); p = 0.0001) and lower calories from fat (32.3% (31.9\u201332.8) vs. 37.4% (35.8\u201338.9); p = 0.0001). Long-term weight loss maintenance in a widely used commercial program was associated with a healthier diet pattern, including consuming foods with higher micronutrient density.<\/jats:p>","DOI":"10.3390\/nu11123046","type":"journal-article","created":{"date-parts":[[2019,12,13]],"date-time":"2019-12-13T11:27:22Z","timestamp":1576236442000},"page":"3046","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Diet Quality and Micronutrient Intake among Long-Term Weight Loss Maintainers"],"prefix":"10.3390","volume":"11","author":[{"given":"Rebecca W.","family":"Pascual","sequence":"first","affiliation":[{"name":"Department of Food Science and Nutrition, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA 93407-0386, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2260-0499","authenticated-orcid":false,"given":"Suzanne","family":"Phelan","sequence":"additional","affiliation":[{"name":"Department of Kinesiology &amp; Public Health, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA 93407-0386, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2269-1688","authenticated-orcid":false,"given":"Michael R.","family":"La Frano","sequence":"additional","affiliation":[{"name":"Department of Food Science and Nutrition, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA 93407-0386, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari D.","family":"Pilolla","sequence":"additional","affiliation":[{"name":"Department of Food Science and Nutrition, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA 93407-0386, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Griffiths","sequence":"additional","affiliation":[{"name":"WW International, Inc., New York, NY 10010, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary D.","family":"Foster","sequence":"additional","affiliation":[{"name":"WW International, Inc., New York, NY 10010, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,12,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1038\/s41366-018-0143-9","article-title":"Overfed but undernourished: Recognizing nutritional inadequacies\/deficiencies in patients with overweight or obesity","volume":"43","author":"Astrup","year":"2019","journal-title":"Int. J. Obes. (Lond.)"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1080\/07315724.2014.901196","article-title":"Comparison of prevalence of inadequate nutrient intake based on body weight status of adults in the United States: An analysis of NHANES 2001\u20132008","volume":"34","author":"Agarwal","year":"2015","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"103472","DOI":"10.5402\/2012\/103472","article-title":"The malnutrition of obesity: Micronutrient deficiencies that promote diabetes","volume":"2012","author":"Via","year":"2012","journal-title":"ISRN Endocrinol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s12963-017-0119-3","article-title":"The share of ultra-processed foods and the overall nutritional quality of diets in the US: Evidence from a nationally representative cross-sectional study","volume":"15","author":"Popkin","year":"2017","journal-title":"Popul. Health Metr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1080\/10408391003626223","article-title":"Intake of added sugars and selected nutrients in the United States, National Health and Nutrition Examination Survey (NHANES) 2003\u20132006","volume":"50","author":"Marriott","year":"2010","journal-title":"Crit. Rev. Food. Sci. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1007\/s11695-007-9350-5","article-title":"Nutritional deficiencies in morbidly obese patients: A new form of malnutrition? Part B: Minerals","volume":"18","author":"Person","year":"2008","journal-title":"Obes. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1111\/j.1753-4887.2009.00228.x","article-title":"Impact of micronutrient deficiencies on obesity","volume":"67","author":"Long","year":"2009","journal-title":"Nutr. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s13679-015-0169-4","article-title":"Overweight and Obesity: Prevalence, Consequences, and Causes of a Growing Public Health Problem","volume":"4","author":"Williams","year":"2015","journal-title":"Curr. Obes. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.3945\/jn.111.142257","article-title":"Foods, fortificants, and supplements: Where do Americans get their nutrients?","volume":"141","author":"Fulgoni","year":"2011","journal-title":"J. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Blumberg, J.B., Bailey, R.L., Sesso, H.D., and Ulrich, C.M. (2018). The evolving role of multivitamin\/multimineral supplement use among adults in the age of personalized nutrition. Nutrients, 10.","DOI":"10.3390\/nu10020248"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1111\/j.1365-277X.2011.01159.x","article-title":"The diet quality of adult women participating in a behavioural weight-loss programme","volume":"24","author":"Webber","year":"2011","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"16026","DOI":"10.1038\/npjbcancer.2016.26","article-title":"Changes in diet quality in a randomized weight loss trial in breast cancer survivors: The lifestyle, exercise, and nutrition (LEAN) study","volume":"2","author":"Anderson","year":"2016","journal-title":"NPJ Breast Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1111\/jhn.12296","article-title":"Portion-controlled meals provide increases in diet quality during weight loss and maintenance","volume":"29","author":"Ptomey","year":"2016","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1007\/s12603-017-0892-5","article-title":"Nutrient intake during diet-induced weight loss and exercise interventions in a randomized trial in older overweight and obese adults","volume":"21","author":"Miller","year":"2017","journal-title":"J. Nutr. Health Aging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1016\/j.jada.2003.09.017","article-title":"An ad libitum, very low-fat diet results in weight loss and changes in nutrient intakes in postmenopausal women","volume":"103","author":"Quintana","year":"2003","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1016\/j.jada.2007.07.013","article-title":"dietary quality comparison of popular weight-loss plans","volume":"107","author":"Ma","year":"2007","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/1475-2891-7-25","article-title":"Commercial weight loss diets meet nutrient requirements in free living adults over 8 weeks: A randomised controlled weight loss trial","volume":"7","author":"Truby","year":"2008","journal-title":"Nutr. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E252","DOI":"10.1017\/S002966511100303X","article-title":"Greater improvements in diet quality in participants randomised to a commercial weight loss programme compared with standard care delivered in GP practices","volume":"70","author":"Eberhard","year":"2011","journal-title":"Proc. Nutr. Soc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/S0002-8223(98)00093-5","article-title":"Persons successful at long-term weight loss and maintenance continue to consume a low-energy, low-fat diet","volume":"98","author":"Shick","year":"1998","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"d6500","DOI":"10.1136\/bmj.d6500","article-title":"Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: Lighten Up randomised controlled trial","volume":"343","author":"Jolly","year":"2011","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.1001\/jama.289.14.1792","article-title":"Weight loss with self-help compared with a structured commercial program: A randomized trial","volume":"289","author":"Heshka","year":"2003","journal-title":"JAMA"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"501","DOI":"10.7326\/M14-2238","article-title":"Efficacy of commercial weight-loss programs: An updated systematic review","volume":"162","author":"Gudzune","year":"2015","journal-title":"Ann. Intern. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2214","DOI":"10.1016\/S0140-6736(17)30647-5","article-title":"Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): A randomised controlled trial","volume":"389","author":"Ahern","year":"2017","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2985","DOI":"10.1016\/j.jacc.2013.11.004","article-title":"2013 AHA\/ACC\/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines and The Obesity Society","volume":"63","author":"Jensen","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Look AHEAD Research Group, Pi-Sunyer, X., Blackburn, G., Brancati, F.L., Bray, G.A., Bright, R., Clark, J.M., Curtis, J.M., Espeland, M.A., and Foreyt, J.P. (2007). Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: One-year results of the look AHEAD trial. Diabetes Care, 30, 1374\u20131383.","DOI":"10.2337\/dc07-0048"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1002\/j.1550-8528.1999.tb00416.x","article-title":"Behavioral strategies of individuals who have maintained long-term weight losses","volume":"7","author":"McGuire","year":"1999","journal-title":"Obes. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1093\/ajcn\/66.2.239","article-title":"A descriptive study of individuals successful at long-term maintenance of substantial weight loss","volume":"66","author":"Klem","year":"1997","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1037\/0022-006X.67.2.177","article-title":"What predicts weight regain in a group of successful weight losers?","volume":"67","author":"McGuire","year":"1999","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_29","unstructured":"National Institutes of Health, Epidemiology and Genomics Research Program (2015). Diet History Questionnaire, Version 3.0, National Cancer Institute."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1093\/aje\/154.12.1089","article-title":"Comparative validation of the Block, Willett, and National Cancer Institute food frequency questionnaires: The Eating at America\u2019s Table Study","volume":"154","author":"Subar","year":"2001","journal-title":"Am. J. Epidemiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1016\/j.jand.2018.05.019","article-title":"Evaluation of the Healthy Eating Index-2015","volume":"118","author":"Reedy","year":"2018","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1016\/j.jand.2018.05.021","article-title":"Update of the Healthy Eating Index: HEI-2015","volume":"118","author":"Pannucci","year":"2018","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1079\/PHN2002389","article-title":"Dietary Reference Intakes: Summary of applications in dietary assessment","volume":"5","author":"Murphy","year":"2002","journal-title":"Public Health Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1080\/01635581.2016.1224368","article-title":"Diet Quality of Breast Cancer Survivors after a Six-Month Weight Management Intervention: Improvements and Association with Weight Loss","volume":"68","author":"Christifano","year":"2016","journal-title":"Nutr. Cancer"},{"key":"ref_35","first-page":"59","article-title":"Associations between body mass index and the prevalence of low micronutrient levels among US adults","volume":"8","author":"Kimmons","year":"2006","journal-title":"MedGenMed"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1017\/S0029665119000661","article-title":"Addressing optimal folate and related B-vitamin status through the lifecycle: Health impacts and challenges","volume":"78","author":"McNulty","year":"2019","journal-title":"Proc. Nutr. Soc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1001\/archinternmed.2011.257","article-title":"Sodium and potassium intake and mortality among US adults: Prospective data from the Third National Health and Nutrition Examination Survey","volume":"171","author":"Yang","year":"2011","journal-title":"Arch. Intern. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1436S","DOI":"10.1093\/jn\/nxy093","article-title":"Federal Monitoring of Dietary Supplement Use in the Resident, Civilian, Noninstitutionalized US Population, National Health and Nutrition Examination Survey","volume":"148","author":"Gahche","year":"2018","journal-title":"J. Nutr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1001\/jama.2015.18396","article-title":"Dietary Guidelines for Americans","volume":"315","author":"DeSalvo","year":"2016","journal-title":"JAMA"},{"key":"ref_40","unstructured":"U.S. Department of Health and Human Services and the U.S. Department of Agriculture (2019, March 12). Dietary Guidelines for Americans 2015\u20132020, Available online: https:\/\/health.gov\/dietaryguidelines\/2015\/guidelines\/."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/obr.12772","article-title":"Determinants of weight loss maintenance: A systematic review","volume":"20","author":"Varkevisser","year":"2019","journal-title":"Obes. Rev."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1038\/oby.2006.81","article-title":"Are the eating and exercise habits of successful weight losers changing?","volume":"14","author":"Phelan","year":"2006","journal-title":"Obesity (Silver Spring)"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1093\/aje\/kwg091","article-title":"Structure of dietary measurement error: Results of the OPEN biomarker study","volume":"158","author":"Kipnis","year":"2003","journal-title":"Am. J. Epidemiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/aje\/kwg092","article-title":"Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: The OPEN study","volume":"158","author":"Subar","year":"2003","journal-title":"Am. J. Epidemiol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/12\/3046\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:42:09Z","timestamp":1760190129000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/12\/3046"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,13]]},"references-count":44,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["nu11123046"],"URL":"https:\/\/doi.org\/10.3390\/nu11123046","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12,13]]}}}