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Jordan OJ, Benitez A, Burnet DL, Quinn MT, Baig AA. The Role of Family in Diabetes Management for Mexican American Adults. HISPANIC HEALTH CARE INTERNATIONAL 2024; 22:109-118. [PMID: 37872697 PMCID: PMC11041087 DOI: 10.1177/15404153231206086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Introduction: The purpose of this study was to characterize how family influences diabetes self-management in Mexican American adults. Methods: Data were analyzed from previously collected data that included 34 semi-structured interviews with Hispanic adults with diabetes and six focus groups with 37 adults with diabetes and family members. Themes related to family and diabetes management were identified and analyzed using a modified template approach. Results: Family-related facilitators to T2DM self-management were (1) provides support, (2) provides motivation, and (3) desire to protect family from diabetes. Family-related challenges were (1) lack of support, (2) family responsibilities, and (3) stress related to family. Diabetes education was shared with family members. Family member perspectives on T2DM included (1) not knowing how to help, (2) effect on emotional wellbeing, (3) diabetes affects the whole family, and (4) family provides support. Conclusion: Most participants with T2DM felt supported by family, but many desired more social support and support surrounding dietary changes from family. Many felt family did not understand what living with diabetes meant for them. Most family members wished to learn more about how to help. Future interventions should include family members and teach them supportive strategies to support beneficial diabetes self-management behaviors.
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Affiliation(s)
- Olivia J. Jordan
- Department of Medicine, Internal Medicine Resident, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Deborah L. Burnet
- University of Chicago, Section of General Internal Medicine, Chicago, IL, USA
| | - Michael T. Quinn
- University of Chicago, Section of General Internal Medicine, Chicago, IL, USA
| | - Arshiya A. Baig
- University of Chicago, Section of General Internal Medicine, Chicago, IL, USA
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Bohler L, Meyer HE, Stigum H, Leirbakk MJ, Cabral D, Wedegren MC, Andersen E, Wieland ML, Madar AA. A controlled weight loss intervention study among women of Somali background in Norway. J Migr Health 2024; 9:100231. [PMID: 38766513 PMCID: PMC11101690 DOI: 10.1016/j.jmh.2024.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/01/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
Background Women of Somali background in Norway have a high prevalence of overweight and obesity, compared with women in the general Norwegian population. For lifestyle interventions to be applicable for immigrants to Norway, it is important to culturally tailor interventions in collaboration with relevant communities. The primary outcome was a difference in weight change between the intervention and control groups. Methods In this interventional study, Somali women living in one borough of Oslo Municipality in Norway with body mass index (BMI) ≥27.0 kg.m-2 received a co-created, culturally tailored 12-month weight loss intervention consisting of 24 interactive sessions during the first three months, and monthly sessions for the next nine months, compared to a control group. Both groups were measured at baseline and 12 months. Results A total of 169 participants were recruited, and 101 participants completed the follow-up. After multiple imputation, the mean difference in weight change adjusted for baseline weight, age, education, employment, marital status, number of children in the household and length of Norwegian residency was -1.6 kg (95 % CI -3.57, 0.43, p = 0.12) in the intervention compared to the control group. Conclusion This culturally tailored intervention study demonstrated a modest non-significant effect on weight change after 12 months, possibly due to the short intervention duration and COVID-19. Further studies of a longer duration and considering the provision of childcare are needed to understand whether this approach can be transferred to other immigrant groups and genders.Trial registration: The study was registered at clinicaltrials.gov NCT04578067, 2020-09-29.
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Affiliation(s)
- Linn Bohler
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, PO Box 1130 Blindern, 0316 Oslo, Norway
| | - Haakon E. Meyer
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, PO Box 1130 Blindern, 0316 Oslo, Norway
- Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - Hein Stigum
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, PO Box 1130 Blindern, 0316 Oslo, Norway
| | - Maria J. Leirbakk
- Oslo Municipality, District Sagene, Vitaminveien 4, 0485 Oslo, Norway
| | - Danielle Cabral
- Oslo Municipality, District Gamle Oslo, Kolstadgata 1, 0652 Oslo, Norway
| | | | - Eivind Andersen
- Faculty of Humanities, Sports and Educational Science, Department of Sports, Physical Education and Outdoor Studies, University of South-Eastern Norway (USN), Post office box 4, 3199 Borre, Norway
| | - Mark L. Wieland
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN 55902, USA
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, Minnesota 55902, USA
| | - Ahmed A. Madar
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, PO Box 1130 Blindern, 0316 Oslo, Norway
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Doumbia L, Findley S, Ba HO, Maiga B, Ba A, Béréthé RK, Sangaré HM, Kachur SP, Besançon S, Doumbia S. Formative research to adapt the 'Diabetes Prevention Program- Power to Prevent' for implementation in Bamako, Mali. BMC Health Serv Res 2024; 24:61. [PMID: 38212794 PMCID: PMC10785539 DOI: 10.1186/s12913-023-10515-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/21/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND There are few community-level behaviors change interventions for reducing diabetes and hypertension risk in Africa, despite increasing cases of type 2 diabetes and cardiovascular diseases. Thus, this study was designed to adapt the United States Centers for Disease Control and Prevention's "Diabetes Prevention Program Power to Prevent" (DPP-P2P) for use in low-income urban communities of Bamako, Mali. METHODS Feedback was elicited on an initial French PowerPoint adaptation of the DPP-P2P session guidelines from stakeholders at the ministry of health, organizational partners, and medical care providers. Two community health centers in districts with high levels of diabetes or hypertension were selected to assist in developing the Malian adaptation. Focus groups were conducted with 19 community health workers (CHWs) of these centers. Based on feedback from these discussions, more graphics, demonstrations, and role plays were added to the PowerPoint presentations. The 19 CHWs piloted the proposed 12 sessions with 45 persons with diabetes or at-risk patients over a one-month period. Feedback discussions were conducted after each session, and changes in dietary and exercise habits were assessed pre and post participation in the program. This feedback contributed to finalization of a 14-session sequence. RESULTS The DPP-P2P session guidelines were adapted for use by low-literacy CHWs, converting the written English guidelines into French PowerPoint presentations with extensive use of pictures, role plays and group discussions to introduce diabetes, diet, and exercise concepts appropriately for the Bamako context. CHWs recommendations for a strong family-oriented program led to expanded sessions on eliciting support from all adults in the household. The 45 participants in the pilot adaptation were enthusiastic about the program. At the end of the program, there were significant increases in the frequency of daily exercise, efforts to limit fat intake, and goals for more healthy diets and exercise levels. CONCLUSION This study documents how an iterative process of developing the DPP-P2P adaptation led to the development of a culturally appropriate set of materials welcomed by participants and having promise for reaching the low-income, low-literacy population with or at risk for diabetes in Bamako, Mali.
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Affiliation(s)
- Lancina Doumbia
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali.
| | - Sally Findley
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Hamidou Oumar Ba
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - Bonkana Maiga
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - Aissata Ba
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - Rokiatou Koné Béréthé
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - Hadja Madjè Sangaré
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - S Patrick Kachur
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Seydou Doumbia
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
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Rodriguez Espinosa P, Xiao L, Ma J, Rosas LG. What matters for weight loss in behavioral trials in the Latinx community: Learnings from three randomized controlled trials. Obes Res Clin Pract 2023; 17:519-528. [PMID: 38071165 PMCID: PMC10810045 DOI: 10.1016/j.orcp.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/29/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Nearly half of Latinx adults in the US are obese, making effective weight loss interventions crucial to prevent associated chronic conditions. OBJECTIVE To identify factors associated with increased session attendance and clinically significant weight loss among Latinx adults. PARTICIPANTS Latinx participants from the Vivamos Activos (n = 207), Vida Sana (n = 191), and HOMBRE (n = 424 Latinx men) randomized clinical trials. DESIGN Post-hoc analysis of randomized controlled trial data. INTERVENTION Culturally-adapted behavioral weight loss interventions based on the Diabetes Prevention Program among Latinx adults over 12 months. MAIN OUTCOME MEASURE Demographic, clinical, and psychosocial predictors of session attendance and 5% weight loss at 12-months. STATISTICAL ANALYSIS PERFORMED Bi-variable associations between baseline characteristics and outcomes were tested with chi-square and t-tests. Those with p-value< 0.15 were then included in stepwise logistic regressions. RESULTS Participants (N = 822) were middle age with diverse socioeconomic backgrounds. Older age in the Vivamos Activos and Vida Sana trials, and lower acculturation in the HOMBRE trial were significant predictors of increased session attendance. Factors associated with 5% weight loss varied by trials. These included younger age (OR 0.96 95% CI 0.92, 0.99) in Vivamos Activos, higher acculturation (OR 1.88 95% CI 1.05, 3.37) in Vida Sana, and higher education (OR 3.20 95% CI 1.3, 7.03) and greater body image dissatisfaction (OR 1.29, 95% CI 1.04, 1.6), and lower acculturation (0.69 95% CI 0.5, 0.96) in HOMBRE. CONCLUSIONS Few and conflicting baseline characteristics were associated with session attendance and clinically significant weight loss, suggesting that alternative approaches to optimizing interventions are needed.
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Affiliation(s)
- Patricia Rodriguez Espinosa
- Department of Epidemiology and Population Health, Stanford University School of Medicine, California, US; Office of Community Engagement, Stanford School of Medicine, California, US
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University School of Medicine, California, US
| | - Jun Ma
- Center for Health Behavior Research, University of Illinois Chicago, US
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University School of Medicine, California, US; Office of Community Engagement, Stanford School of Medicine, California, US.
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Cora-Cruz MS, Wilson EM, Vargas GB, Thompson V, Enenmoh I, Goffe C, Martin-Hammond AM, Purnell TS. Applications of Mobile Health Technologies to Address Cardiometabolic Health Disparities in the United States: A Systematic Review. Ethn Dis 2023; 33:180-193. [PMID: 38854414 PMCID: PMC11155620 DOI: 10.18865/ed.33.4.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Introduction Black and Hispanic adults are disproportionately burdened by cardiometabolic disorders. The aim of this systematic review was to examine the effectiveness of mobile health technologies to promote disease prevention and self-management among US adults in diverse communities. Methods Potential studies were identified using a comprehensive search of the PubMed and EMBASE databases for recent studies published from December 2018 through 2021. Keywords and search strategies were established to focus on health disparity populations and the application of mobile health technology for cardiovascular disease risk reduction. Titles and abstracts were assessed and, if a study was eligible, 2 independent reviewers completed a full-length review with extraction in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results A total of 13 studies met our inclusion criteria. Study sample sizes ranged from 8 to 533 baseline participants. Studies were conducted in diverse communities (eg, North Carolina and California). Most studies used mobile applications (n=11) and a majority used accelerometers or similar technologies (eg, smartwatches) to assess changes in dietary behavior, blood pressure control, and physical activity. Overall, studies reported positive associations between mobile technology use and risk factor reduction actions and behaviors. Long-term adherence varied across studies. Those that prioritized culturally tailored approaches reported more significant impacts than those that did not. Conclusions Evidence suggests that mobile technology may be useful in promoting disease self-management and risk reduction among populations at higher risk of cardiometabolic diseases. The use of mobile health technologies, particularly when tailored to target populations, may be a practical approach to advancing population health equity.
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Affiliation(s)
| | - Elena M. Wilson
- The B.O.L.D. Health Equity Initiative, Johns Hopkins University, Baltimore, MD
| | - Grecia B. Vargas
- The B.O.L.D. Health Equity Initiative, Johns Hopkins University, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD
| | - Valerie Thompson
- The B.O.L.D. Health Equity Initiative, Johns Hopkins University, Baltimore, MD
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Ikechukwu Enenmoh
- The B.O.L.D. Health Equity Initiative, Johns Hopkins University, Baltimore, MD
| | - Chelsea Goffe
- The B.O.L.D. Health Equity Initiative, Johns Hopkins University, Baltimore, MD
| | | | - Tanjala S. Purnell
- The B.O.L.D. Health Equity Initiative, Johns Hopkins University, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD
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Robinson J, Nitschke E, Tovar A, Mattar L, Gottesman K, Hamlett P, Rozga M. Nutrition and Physical Activity Interventions Provided by Nutrition and Exercise Practitioners for the General Population: An Evidence-Based Practice Guideline From the Academy of Nutrition and Dietetics and American Council on Exercise. J Acad Nutr Diet 2023; 123:1215-1237.e5. [PMID: 37061182 DOI: 10.1016/j.jand.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023]
Abstract
A nutritious diet and adequate physical activity vitally contribute to disease prevention, but most adults do not meet population-based dietary and physical activity recommendations. Qualified nutrition and exercise practitioners can address challenges to adopting healthy lifestyle behaviors by providing consistent, individualized, and evidence-based education and programming within their professional scopes of practice to improve client outcomes. The objective of this evidence-based practice guideline is to inform practice decisions for nutrition and exercise practitioners providing nutrition and physical activity interventions for adults who are healthy or have cardiometabolic risk factors, but no diagnosed disease. Evidence from a systematic review was translated to practice recommendations using an evidence-to-decision framework by an interdisciplinary team of nutrition and exercise practitioners and researchers. This evidence-based practice guideline does not provide specific dietary or physical activity recommendations but rather informs nutrition and exercise practitioners how they may utilize existing guidelines for the general population to individualize programming for a range of clients. This evidence-based practice guideline provides widely applicable recommendation statements and a detailed framework to help practitioners implement the recommendations into practice. Common barriers and facilitators encountered when delivering nutrition and physical activity interventions, such as adherence to professional scopes of practice; methods to support behavior change; and methods to support inclusion, diversity, equity, and access, are discussed. Nutrition and exercise practitioners can consistently provide individualized, practical, and evidence-based interventions by seeking to understand their clients' needs, circumstances, and values and by co-creating interventions with the client and their allied health team.
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Affiliation(s)
- Justin Robinson
- Kinesiology Department, Point Loma Nazarene University, San Diego, California
| | - Erin Nitschke
- Department of Exercise Science, Laramie County Community College, Cheyenne, Wyoming
| | | | - Lama Mattar
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Lebanon
| | - Kimberly Gottesman
- Department of Nutrition and Food Science, California State University Los Angeles, Los Angeles, California
| | - Peggy Hamlett
- Department of Kinesiology, Washington State University Pullman, Washington
| | - Mary Rozga
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, Illinois.
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Alemán JO, Almandoz JP, Frias JP, Galindo RJ. Obesity among Latinx people in the United States: A review. Obesity (Silver Spring) 2023; 31:329-337. [PMID: 36695058 PMCID: PMC9937439 DOI: 10.1002/oby.23638] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/11/2022] [Accepted: 10/27/2022] [Indexed: 01/26/2023]
Abstract
Obesity is a serious, chronic disease that is associated with a range of adiposity-based comorbidities, including cardiovascular disease, type 2 diabetes, and nonalcoholic fatty liver disease. In the United States, obesity is a public health crisis, affecting more than 40% of the population. Obesity disproportionately affects Latinx people, who have a higher prevalence of obesity and related comorbidities (such as cardiovascular disease, type 2 diabetes, and nonalcoholic fatty liver disease) compared with the general population. Many factors, including genetic predisposition, environmental factors, traditional calorie-dense Latinx diets, family dynamics, and differences in socioeconomic status, contribute to the increased prevalence and complexity of treating obesity in the Latinx population. Additionally, significant heterogeneity within the Latinx population and disparities in health care access and utilization between Latinx people and the general population add to the challenge of obesity management. Culturally tailored interventions have been successful for managing obesity and related comorbidities in Latinx people. Antiobesity medications and bariatric surgery are also important options for obesity treatment in Latinx people. As highlighted in this review, when managing obesity in the Latinx population, it is critical to consider the impact of genetic, dietary, cultural, and socioeconomic factors, in order to implement an individualized treatment strategy.
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Garcia DO, Valdez LA, Aceves B, Bell ML, Rabe BA, Villavicencio EA, Marrero DG, Melton F, Hooker SP. mHealth-Supported Gender- and Culturally Sensitive Weight Loss Intervention for Hispanic Men With Overweight and Obesity: Single-Arm Pilot Study. JMIR Form Res 2022; 6:e37637. [PMID: 36129735 PMCID: PMC9536522 DOI: 10.2196/37637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hispanic men have disproportionate rates of overweight and obesity compared with other racial and ethnic subpopulations. However, few weight loss interventions have been developed specifically for this high-risk group. Furthermore, the use of mobile health (mHealth) technologies to support lifestyle behavior changes in weight loss interventions for Hispanic men is largely untested. OBJECTIVE This single-arm pilot study examined the feasibility and acceptability of integrating mHealth technology into a 12-week gender- and culturally sensitive weight loss intervention (GCSWLI) for Hispanic men with overweight and obesity. METHODS A total of 18 Hispanic men (mean age 38, SD 10.9 years; mean BMI 34.3, SD 5.5 kg/m²; 10/18, 56% Spanish monolingual) received a GCSWLI, including weekly in-person individual sessions, a daily calorie goal, and prescription of ≥225 minutes of moderate-intensity physical activity per week. mHealth technology support included tailored SMS text messaging, behavior self-monitoring support using Fitbit Charge 2, and weight tracking using a Fitbit Aria Wi-Fi Smart Scale. Changes in weight from baseline to 12 weeks were estimated using a paired 2-tailed t test. Descriptive analyses characterized the use of Fitbit and smart scales. Semistructured interviews were conducted immediately after intervention to assess the participants' weight loss experiences and perspectives on mHealth technologies. RESULTS Of 18 participants, 16 (89%) completed the 12-week assessments; the overall attrition rate was 11.1%. The mean weight loss at week 12 was -4.7 kg (95% CI 7.1 to -2.4 kg; P<.001). Participants wore the Fitbit 71.58% (962/1344) of the intervention days and logged their body weight using the smart scale (410/1344, 30.51% of the intervention days). Participants identified barriers to the use of the technology, such as lack of technological literacy and unreliable internet access for the smart scale. CONCLUSIONS Although clinically significant weight loss was achieved by integrating mHealth technology into the GCSWLI, adherence to the prescribed use of technology was modest. Addressing barriers to the use of such technologies identified in our work may help to refine an mHealth intervention approach for Hispanic men. TRIAL REGISTRATION ClinicalTrials.gov NCT02783521; https://clinicaltrials.gov/ct2/show/NCT02783521.
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Affiliation(s)
- David O Garcia
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Luis A Valdez
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Benjamin Aceves
- School of Public Health, College of Health and Human Services, San Diego State University, San Diego, CA, United States
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Brooke A Rabe
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Edgar A Villavicencio
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - David G Marrero
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Forest Melton
- Department of Clinical and Translational Sciences, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Steven P Hooker
- College of Health and Human Services, San Diego State University, San Diego, CA, United States
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Chew HSJ, Koh WL, Ng JSHY, Tan KK. Sustainability of Weight Loss Through Smartphone Apps: Systematic Review and Meta-analysis on Anthropometric, Metabolic, and Dietary Outcomes. J Med Internet Res 2022; 24:e40141. [PMID: 36129739 PMCID: PMC9536524 DOI: 10.2196/40141] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Evidence on the long-term effects of weight management smartphone apps on various weight-related outcomes remains scarce. Objective In this review, we aimed to examine the effects of smartphone apps on anthropometric, metabolic, and dietary outcomes at various time points. Methods Articles published from database inception to March 10, 2022 were searched, from 7 databases (Embase, CINAHL, PubMed, PsycINFO, Cochrane Library, Scopus, and Web of Science) using forward and backward citation tracking. All randomized controlled trials that reported weight change as an outcome in adults with overweight and obesity were included. We performed separate meta-analyses using random effects models for weight, waist circumference, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, blood glucose level, blood pressure, and total energy intake per day. Methodological quality was assessed using the Cochrane Risk of Bias tool. Results Based on our meta-analyses, weight loss was sustained between 3 and 12 months, with a peak of 2.18 kg at 3 months that tapered down to 1.63 kg at 12 months. We did not find significant benefits of weight loss on the secondary outcomes examined, except for a slight improvement in systolic blood pressure at 3 months. Most of the included studies covered app-based interventions that comprised of components beyond food logging, such as real-time diet and exercise self-monitoring, personalized and remote progress tracking, timely feedback provision, smart devices that synchronized activity and weight data to smartphones, and libraries of diet and physical activity ideas. Conclusions Smartphone weight loss apps are effective in initiating and sustaining weight loss between 3 and 12 months, but their effects are minimal in their current states. Future studies could consider the various aspects of the socioecological model. Conversational and dialectic components that simulate health coaches could be useful to enhance user engagement and outcome effectiveness. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42022329197; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=329197
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Affiliation(s)
- Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wee Ling Koh
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Janelle Shaina Hui Yi Ng
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ker Kan Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Surgery, National University Hospital, Singapore, Singapore
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Valenzuela R, Saadiq S, Cobos S, Salinas JJ. Engagement in Physical Activity Improves after Participation in Pasos Para Prevenir Cancer-An Obesity-Related Cancer Prevention Program in El Paso, Texas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11607. [PMID: 36141878 PMCID: PMC9517185 DOI: 10.3390/ijerph191811607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This present study experimentally evaluated the Pasos Para Prevenir Cancer (PPPC) program to determine whether participation was associated with improved physical activity engagement. Evidence suggests that obesity prevention programs improve physical activity (PA) engagement and lead to healthier weights, which substantially impacts cancer and cardiometabolic disease risk. There is a shortage of knowledge on the effectiveness of programs tailored to populations along the U.S.-Mexico border. METHODS We collected demographic, nutrition, and physical activity data at baseline, 6 months, and 12 months using the Research Electronic Data Capture (REDCap) for 209 participants. We analyzed the average metabolic equivalents (METS) per week for all physical activity levels and types and the achievement of the recommended METS per week to determine the demographic characteristics most associated with a change between baseline, 6 months, and 12 months. RESULTS Light activity was the most common activity at all three points, and it slightly increased at 6 months in work settings. Subjects conducted moderate physical activity primarily at home and work, and moderate physical activity increased more compared to vigorous physical activity. CONCLUSIONS Intervention tailoring might improve PA engagement in Mexican Americans residing on the U.S.-Mexico border; however, larger studies that are more diverse are required.
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Affiliation(s)
- Roy Valenzuela
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Stefan Saadiq
- Francis Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Sandra Cobos
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Jennifer J. Salinas
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
- Francis Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
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Rosas LG, Lv N, Xiao L, Venditti EM, Lewis MA, Azar KMJ, Hooker SP, Zavella P, Ma J. HOMBRE: A Trial Comparing 2 Weight Loss Approaches for Latino Men. Am J Prev Med 2022; 63:341-353. [PMID: 35654660 DOI: 10.1016/j.amepre.2022.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/03/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Latino men have been drastically under-represented in research to identify effective behavioral weight-loss interventions. This trial compared 2 interventions for weight loss: (1) a culturally adapted intervention (HOMBRE) and (2) a minimal-intensity intervention. STUDY DESIGN Randomized controlled trial. SETTING/PARTICIPANTS Latino men with a BMI ≥27 kg/m2 and 1 or more cardiometabolic risk factors (N=424) were recruited (February 15, 2017‒October 2, 2018) from 14 medical centers and randomized to receive 1 of the 2 interventions. INTERVENTION HOMBRE provided men a choice among 3 options: coach-facilitated group sessions using online video conferencing, coach-facilitated group sessions in person, and prerecorded videos of group sessions available online. MAIN OUTCOME MEASURES The primary outcome was the proportion of participants sustaining clinically significant (≥5% of baseline) weight loss at 18 months. Secondary outcomes included weight loss trajectory over time, 3% and 10% weight loss, cardiometabolic risk factors, health behaviors, and psychosocial well-being at baseline and 18 months. Data were analyzed from October 6, 2020 to January 15, 2022. RESULTS Participants were predominantly middle aged (47.0 [SD=11.9] years), were married (74.3%), were with at least some college experience (79.7%), and had middle to upper incomes (72.4% with annual family incomes >$75,000). Their average BMI was 33.1 kg/m2 (SD=5.1). The proportion achieving clinically significant weight loss at 18 months was 27.4% in the HOMBRE intervention and 20.6% in the minimal-intensity intervention (mean difference=7.2%, 95% CI= -1.8, 17.0; p=0.13). Mean difference between the HOMBRE vs the minimal-intensity group was ‒1.25 kg at 6 months (95% CI= -2.28, -0.21; p=0.02) and ‒1.11 kg at 12 months (95% CI= -2.11, -0.10; p=0.03) using weight measurement data abstracted from the Electronic Health Record and by self report. There were no significant differences in secondary outcomes. CONCLUSIONS Among Latino men with overweight and obesity, HOMBRE was not more effective for clinically significant weight loss than a minimal-intensity intervention at 18 months.
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Affiliation(s)
- Lisa G Rosas
- Department of Epidemiology & Population Health, School of Medicine, Stanford University, Palo Alto, California.
| | - Nan Lv
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Institute of Health Research and Policy, University of Illinois Chicago, Chicago, Illinois
| | - Lan Xiao
- Department of Epidemiology & Population Health, School of Medicine, Stanford University, Palo Alto, California
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Megan A Lewis
- RTI Center for Communications Science, RTI International, Seattle, Washington
| | - Kristen M J Azar
- Sutter Health, Sutter Health Center for Health Systems Research, Palo Alto, California
| | - Steven P Hooker
- College of Health and Human Services, San Diego State University, San Diego, California
| | - Patricia Zavella
- Latin American and Latino Studies department, University of California Santa Cruz, Santa Cruz, California
| | - Jun Ma
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Institute of Health Research and Policy, University of Illinois Chicago, Chicago, Illinois
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12
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Nitschke E, Gottesman K, Hamlett P, Mattar L, Robinson J, Tovar A, Rozga M. Impact of Nutrition and Physical Activity Interventions Provided by Nutrition and Exercise Practitioners for the Adult General Population: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14091729. [PMID: 35565696 PMCID: PMC9103154 DOI: 10.3390/nu14091729] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 12/18/2022] Open
Abstract
Healthy dietary intake and physical activity reduce the risk of non-communicable diseases. This systematic review and meta-analysis aimed to examine the effect of interventions including both nutrition and physical activity provided by nutrition and exercise practitioners for adults in the general population (those without diagnosed disease). The MEDLINE, CINAHL, Cochrane Central, Cochrane Database of Systematic Reviews and SportDiscus databases were searched for randomized controlled trials (RCTs) published from 2010 until April 2021. Outcomes included physical activity, fruit and vegetable intake, waist circumference, percent weight loss, quality of life (QoL) and adverse events. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods were used to synthesize and grade evidence. Meta-analyses were stratified according to participant health status. The database search identified 11,205 articles, and 31 RCTs were included. Interventions increased physical activity amount [standardized mean difference (SMD) (95% CI): 0.25 (0.08, 0.43)] (low certainty evidence); increased vegetable intake [SMD (95% CI): 0.14 (0.05, 0.23)] (moderate certainty evidence); reduced waist circumference [MD (95% CI): −2.16 cm (−2.96, −1.36)] (high certainty evidence); and increased likelihood of achieving 5% weight loss for adults with overweight and obesity [relative risk (95% CI): 2.37 (1.76, 3.19)] (high certainty evidence). Very low and low certainty evidence described little-to-no effect on QoL or adverse events. Nutrition and exercise practitioners play key roles in facilitating positive lifestyle behaviors to reduce cardiometabolic disease risk in adults.
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Affiliation(s)
- Erin Nitschke
- Department of Exercise Science, Laramie County Community College, 1400 E College Drive, Cheyenne, WY 82007, USA;
| | - Kimberly Gottesman
- Department of Kinesiology, Nutrition and Food Science, California State University Los Angeles, 5151 South University Drive, Los Angeles, CA 90032, USA;
| | - Peggy Hamlett
- Department of Movement Sciences, University of Idaho, 875 Perimeter Drive, Moscow, ID 83844, USA;
| | - Lama Mattar
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut 10150, Lebanon;
| | - Justin Robinson
- Kinesiology Department, Point Loma Nazarene University, 3900 Lomaland Dr, San Diego, CA 92106, USA;
| | - Ashley Tovar
- Gilead Sciences, 333 Lakeside Dr, Foster City, CA 94404, USA;
| | - Mary Rozga
- Evidence Analysis Center, Academy of Nutrition and Dietetics, 120 S Riverside Plaza, Suite 2190, Chicago, IL 60606, USA
- Correspondence: ; Tel.: +1-(312)-899-1758
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13
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Eisenhauer CM, Brito F, Kupzyk K, Yoder A, Almeida F, Beller RJ, Miller J, Hageman PA. Mobile health assisted self-monitoring is acceptable for supporting weight loss in rural men: a pragmatic randomized controlled feasibility trial. BMC Public Health 2021; 21:1568. [PMID: 34407782 PMCID: PMC8375071 DOI: 10.1186/s12889-021-11618-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background Addressing overweight and obesity among men at-risk for obesity-related diseases and disability in rural communities is a public health issue. Commercial smartphone applications (apps) that promote self-monitoring for weight loss are widely available. Evidence is lacking regarding what support is required to enhance user engagement with and effectiveness of those technologies. Pragmatically comparing these apps effectiveness, including rural men’s desired forms of support when using them, can lead to greater weight loss intervention impact and reach. This study assessed the feasibility and acceptability of a mobile technology application applied differently across two groups for weight loss. Methods In a two-armed, pragmatic pilot feasibility study, 80 overweight and obese men aged 40–69 were randomized using a 1:1 ratio to either an enhanced Mobile Technology Plus (MT+) intervention or a basic Mobile Technology (MT) intervention. The MT+ group had an enhanced smartphone app for self-monitoring (text messaging, discussion group, Wi-Fi scale) whereas the MT group received a basic app that allowed self-monitoring logging only. Assessments were collected at baseline, 3 and 6 months. App logs were analyzed to track engagement and adherence to self-monitoring. Acceptability was assessed via focus groups. Analysis included descriptive statistics and qualitative content analysis. Results Of 80 men recruited, forty were allocated to each arm. All were included in the primary analysis. Recruitment ended after 10 months with a 97.5 and 92.5% (3 month, 6 month) retention rate. Over 90% of men reported via survey and focus groups that Lose-It app and smart scale (MT+) was an acceptable way to self-monitor weight, dietary intake and physical activity. Adherence to daily app self-monitoring of at least 800 dietary calories or more (reported respectively as MT+, MT) was positive with 73.4, 51.6% tracking at least 5 days a week. Adherence to tracking activity via recorded steps four or more days weekly was positive, 87.8, 64.6%. Men also adhered to self-weighing at least once weekly, 64, 46.3%. At 6 months, an observed mean weight loss was 7.03 kg (95% CI: 3.67, 10.39) for MT+ group and 4.14 kg (95% CI: 2.22, 6.06) for MT group, with 42.9 and 34.2% meeting ≥5% weight loss, respectively. No adverse events were reported. Conclusions This National Institutes of Health-funded pilot study using mobile technologies to support behavior change for weight loss was found to be feasible and acceptable among midlife and older rural men. The interventions demonstrated successful reductions in weight, noting differing adherence to lifestyle behaviors of eating, monitoring and activity between groups, with men in the MT+ having more favorable results. These findings will be used to inform the design of a larger scale, clinical trial. Trial registration The trial was prospectively registered with ClinicalTrials NCT03329079. 11/1/2017.
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Affiliation(s)
- Christine M Eisenhauer
- College of Nursing-Northern Division, University of Nebraska Medical Center, 801 East Benjamin Avenue, Norfolk, NE, 68701, USA.
| | - Fabiana Brito
- College of Public Health, University of Nebraska Medical Center, 984355 Medical Center, Omaha, NE, 68198-4355, USA
| | - Kevin Kupzyk
- College of Nursing-Omaha Division, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198-5330, USA
| | - Aaron Yoder
- Department of Environmental, Agricultural & Occupational Health, College of Public Health, University of Nebraska Medical Center, 984388 Nebraska Medical Center, Omaha, NE, 68198-4388, USA
| | - Fabio Almeida
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA
| | - Rebecca Johnson Beller
- College of Nursing-Northern Division, University of Nebraska Medical Center, 801 East Benjamin Avenue, Norfolk, NE, 68701, USA
| | - Jessica Miller
- College of Nursing-Northern Division, University of Nebraska Medical Center, 801 East Benjamin Avenue, Norfolk, NE, 68701, USA
| | - Patricia A Hageman
- Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE, 68198-4420, USA
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Ronneberg CR, Lv N, Xiao L, Rosas LG, Shrestha R, Dosala S, Eckley T, Wittels N, Ma J. Weight loss effects in usual primary care: Findings from 5 behavioral weight loss RCTs. Obes Res Clin Pract 2021; 15:180-183. [PMID: 33589391 DOI: 10.1016/j.orcp.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 11/18/2022]
Abstract
Primary care is an important setting for obesity treatment and behavior therapy is considered the first line. However, current practice often does not meet clinical guidelines and, furthermore, effects of usual care (UC) on weight loss are unclear. This makes it difficult to design sufficiently powered weight loss trials in primary care. This study analyzed data from UC control participants across 5 primary care-based randomized clinical trials of behavioral weight loss interventions to assess UC effects for 4 weight outcomes: body mass index (BMI), weight change (kg and %), and percent of participants achieving clinically significant 5% weight loss. Results indicated modest UC effects, suggesting modest weight loss is possible in usual primary care.
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Affiliation(s)
| | - Nan Lv
- Institute for Health Research and Policy, University of Illinois Chicago, United States.
| | - Lan Xiao
- Stanford University, United States.
| | | | - Rohit Shrestha
- Institute for Health Research and Policy, University of Illinois Chicago, United States.
| | - Sushanth Dosala
- Institute for Health Research and Policy, University of Illinois Chicago, United States.
| | - Tessa Eckley
- Institute for Health Research and Policy, University of Illinois Chicago, United States.
| | - Nancy Wittels
- Institute for Health Research and Policy, University of Illinois Chicago, United States.
| | - Jun Ma
- Department of Medicine, University of Illinois Chicago, United States.
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