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Mess F, Blaschke S, Schick TS, Friedrich J. Precision prevention in worksite health-A scoping review on research trends and gaps. PLoS One 2024; 19:e0304951. [PMID: 38857277 PMCID: PMC11164362 DOI: 10.1371/journal.pone.0304951] [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: 11/30/2023] [Accepted: 05/22/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES To map the current state of precision prevention research in the workplace setting, specifically to study contexts and characteristics, and to analyze the precision prevention approach in the stages of risk assessment/data monitoring, data analytics, and the health promotion interventions implemented. METHODS Six international databases were searched for studies published between January 2010 and May 2023, using the term "precision prevention" or its synonyms in the context of worksite health promotion. RESULTS After screening 3,249 articles, 129 studies were reviewed. Around three-quarters of the studies addressed an intervention (95/129, 74%). Only 14% (18/129) of the articles primarily focused on risk assessment and data monitoring, and 12% of the articles (16/129) mainly included data analytics studies. Most of the studies focused on behavioral outcomes (61/160, 38%), followed by psychological (37/160, 23%) and physiological (31/160, 19%) outcomes of health (multiple answers were possible). In terms of study designs, randomized controlled trials were used in more than a third of all studies (39%), followed by cross-sectional studies (18%), while newer designs (e.g., just-in-time-adaptive-interventions) are currently rarely used. The main data analyses of all studies were regression analyses (44% with analyses of variance or linear mixed models), whereas machine learning methods (e.g., Algorithms, Markov Models) were conducted only in 8% of the articles. DISCUSSION Although there is a growing number of precision prevention studies in the workplace, there are still research gaps in applying new data analysis methods (e.g., machine learning) and implementing innovative study designs. In the future, it is desirable to take a holistic approach to precision prevention in the workplace that encompasses all the stages of precision prevention (risk assessment/data monitoring, data analytics and interventions) and links them together as a cycle.
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Affiliation(s)
- Filip Mess
- Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
| | - Simon Blaschke
- Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
| | - Teresa S. Schick
- Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
| | - Julian Friedrich
- Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
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2
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Seiferth C, Fiedler J, Färber T, Pape M, Schroeder S, Herpertz S, Steins-Loeber S, Wolstein J. Bi-directional associations of core affect and physical activity in adults with higher body weight: An ecological momentary assessment study. J Health Psychol 2024:13591053241228202. [PMID: 38284358 DOI: 10.1177/13591053241228202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024] Open
Abstract
Affect is known to be predictive of and enhanced by higher physical activity (PA) levels in the general population. This secondary analysis aimed to increase the understanding of the bi-directional relationship between PA and core affect (i.e. valence, energetic arousal, and calmness) among adults with higher body weight. Affect and PA were assessed in naturalistic settings via ecological momentary assessment using a mixed sampling scheme from 157 participants (body mass index: 32.99 ± 3.78 kg/m2). Multilevel models revealed that being more physically active in the 15 minutes prior to the assessment predicted an increase in energetic arousal and a decrease in calmness. Subsequently, feeling more energetic and agitated was associated with increased PA within the following 15 minutes. Valence (i.e. pleasure-displeasure) was not associated with PA nor predictive of subsequent PA. Digital PA interventions may target the enhancement of feelings of energy and present psychoeducation about these distinct psychological benefits.
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Affiliation(s)
| | | | | | - Magdalena Pape
- LWL-University Hospital, Ruhr University Bochum, Germany
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3
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Smith PJ, Whitson HE, Merwin RM, O’Hayer CV, Strauman TJ. Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW). Front Aging Neurosci 2023; 15:1256430. [PMID: 38076541 PMCID: PMC10702760 DOI: 10.3389/fnagi.2023.1256430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/20/2023] [Indexed: 02/12/2024] Open
Abstract
Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.
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Affiliation(s)
- Patrick J. Smith
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Heather E. Whitson
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
- Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC, United States
| | - Rhonda M. Merwin
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States
| | - C. Virginia O’Hayer
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA, United States
| | - Timothy J. Strauman
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
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4
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Koning E, Vorstman J, McIntyre RS, Brietzke E. Characterizing eating behavioral phenotypes in mood disorders: a narrative review. Psychol Med 2022; 52:2885-2898. [PMID: 36004528 PMCID: PMC9693712 DOI: 10.1017/s0033291722002446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 01/05/2023]
Abstract
Mood disorders, including depressive and bipolar disorders, represent a multidimensional and prevalent group of psychiatric illnesses characterized by disturbances in emotion, cognition and metabolism. Maladaptive eating behaviors in mood disorders are diverse and warrant characterization in order to increase the precision of diagnostic criteria, identify subtypes and improve treatment strategies. The current narrative review synthesizes evidence for Eating Behavioral Phenotypes (EBP) in mood disorders as well as advancements in pathophysiological conceptual frameworks relevant to each phenotype. Phenotypes include maladaptive eating behaviors related to appetite, emotion, reward, impulsivity, diet style and circadian rhythm disruption. Potential treatment strategies for each phenotype are also discussed, including psychotherapeutic, pharmacological and nutritional interventions. Maladaptive eating behaviors related to mood disorders are relevant from both clinical and research perspectives, yet have been somewhat overlooked thus far. A better understanding of this aspect of mood disorders holds promise to improve clinical care in this patient group and contribute to the subtyping of these currently subjectively diagnosed and treated disorders.
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Affiliation(s)
- Elena Koning
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Jacob Vorstman
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Elisa Brietzke
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
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5
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Burgermaster M, Rodriguez VA. Psychosocial-Behavioral Phenotyping: A Novel Precision Health Approach to Modeling Behavioral, Psychological, and Social Determinants of Health Using Machine Learning. Ann Behav Med 2022; 56:1258-1271. [PMID: 35445699 DOI: 10.1093/abm/kaac012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The context in which a behavioral intervention is delivered is an important source of variability and systematic approaches are needed to identify and quantify contextual factors that may influence intervention efficacy. Machine learning-based phenotyping methods can contribute to a new precision health paradigm by informing personalized behavior interventions. Two primary goals of precision health, identifying population subgroups and highlighting behavioral intervention targets, can be addressed with psychosocial-behavioral phenotypes. We propose a method for psychosocial-behavioral phenotyping that models social determinants of health in addition to individual-level psychological and behavioral factors. PURPOSE To demonstrate a novel application of machine learning for psychosocial-behavioral phenotyping, the identification of subgroups with similar combinations of psychosocial characteristics. METHODS In this secondary analysis of psychosocial and behavioral data from a community cohort (n = 5,883), we optimized a multichannel mixed membership model (MC3M) using Bayesian inference to identify psychosocial-behavioral phenotypes and used logistic regression to determine which phenotypes were associated with elevated weight status (BMI ≥ 25kg/m2). RESULTS We identified 20 psychosocial-behavioral phenotypes. Phenotypes were conceptually consistent as well as discriminative; most participants had only one active phenotype. Two phenotypes were significantly positively associated with elevated weight status; four phenotypes were significantly negatively associated. Each phenotype suggested different contextual considerations for intervention design. CONCLUSIONS By depicting the complexity of psychological and social determinants of health while also providing actionable insight about similarities and differences among members of the same community, psychosocial-behavioral phenotypes can identify potential intervention targets in context.
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Affiliation(s)
- Marissa Burgermaster
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA.,Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Victor A Rodriguez
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.,College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
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Stevens CJ, Gillman AS, Giordano GR, Bryan AD. Modeling longitudinal variation in affective response to exercise across a 16-week randomized control trial (RCT). Health Psychol 2021; 40:928-939. [PMID: 32969699 PMCID: PMC7987890 DOI: 10.1037/hea0001023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: Consistent with the Science of Behavior Change (SOBC) experimental medicine approach, this early phase intervention development study examines the influence of an intervention strategy (exercise training) on a behavioral health outcome (exercise engagement) in the service of addressing a widespread threat to public health (physical inactivity). Method: Physically inactive participants (N = 201) were randomly assigned to one of four exercise training conditions fully crossed on intensity (moderate, vigorous) and duration (short, long). Training occurred over 16-weeks and in-bout assessments of affective response (valence) and ratings of perceived exertion (RPE) were collected during Weeks 1, 4, 8, and 16. Cardiorespiratory fitness (VO₂max) was assessed pre- or postintervention and exercise behavior was assessed at 6-months postintervention follow-up. Results: Across conditions, affective response to exercise did not change, on average, over 16-weeks. Conversely, RPE decreased slightly, on average, over time. Participants completing vigorous intensity exercise reported more negatively valenced affective response and higher RPE, on average, across weeks. Greater total exercise volume completed and greater change in VO₂max were associated with more negatively valenced affective response, on average. Baseline affective response scores were positively associated with exercise minutes at follow-up; however, average affective response scores across the intervention were not associated with minutes of exercise at follow-up. Conclusions: Affective response to exercise did not become more positive in valence over time as a function of training volume or change in VO₂max. Implications for translating these findings to inform future intervention development efforts are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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7
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Kushner RF, Hammond MM. Using psycho‐behavioral phenotyping for overweight and obesity: Confirmation of the 6 factor questionnaire. Obes Sci Pract 2021; 8:185-189. [PMID: 35388347 PMCID: PMC8976542 DOI: 10.1002/osp4.555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/09/2021] [Accepted: 08/14/2021] [Indexed: 12/30/2022] Open
Abstract
Objective Methods Results Conclusions
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Affiliation(s)
- Robert F. Kushner
- Department of Medicine and Medical Education Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Michael M. Hammond
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA
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8
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Moxley E, Webber-Ritchey KJ, Hayman LL. Global impact of physical inactivity and implications for public health nursing. Public Health Nurs 2021; 39:180-188. [PMID: 34387002 DOI: 10.1111/phn.12958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/03/2021] [Accepted: 07/25/2021] [Indexed: 01/22/2023]
Abstract
Physicalinactivity has been a public health problem worldwide for more than a decade. Of those who are physically active, a substantial percentage engage solely in low or very low physical activity (PA) levels. In the last 3 decades, the prevalence of PA in the United States has decreased with approximately 80% of adults not meeting the recommended guidelines for aerobic and muscle strengthening PA. The PA levels of youth have dramatically decreased with 85% of adolescents reporting no PA. Regular PA participation can aid in preventing chronic diseases. A strong inverse dose-response relationship exists between PA and the incidence of cardiovascular disease, all-cause and cardiovascular mortality. Moreover, low cardiorespiratory fitness levels are a risk factor for cardiovascular diseases: the leading cause of death and disability globally. Conversely, high amounts of moderate-to-vigorous intensity PA at levels 3-5 times recommended in guidelines reduce risk for all cause mortality. Socio-ecological determinants of PA are essential considerations for promoting across the life course. In health care and community settings, public health nurses have opportunities to promote PA through a socio-ecological approach across the life course of individuals and diverse populations.
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Affiliation(s)
- Elizabeth Moxley
- School of Nursing, Northern Illinois University, DeKalb, Illinois
| | | | - Laura L Hayman
- Department of Nursing, College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
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9
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Davis AS, Wilson KE, Ellis R. An observation of the impact of tailored messages on participant non-compliance during Desire2Move. Transl Behav Med 2021; 11:2127-2135. [PMID: 34283893 DOI: 10.1093/tbm/ibab092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We assessed the impact of tailored versus targeted messages on program non-compliance during Desire2Move (D2M), an 8-week eHealth program that promotes physical activity (PA). Participants recorded minutes of PA using MapMyFitness, which counted toward their departments' PA total. Departments were randomized into the targeted messaging (TM) or tailored messaging (TM+) group based on participant-reported goals. Participants who did not provide a goal were assigned to the control group (CG). Eligible participants were employees from invited departments who were non-compliant for at least 1 week of D2M. Upon initial non-compliance, participants across groups received a targeted email message prompting program resumption. For subsequent non-compliance, the TM group continued to receive the same targeted message. The TM+ group received a message tailored to the participant's program goal. The CG group did not receive additional messages. Participants (n = 149) were mostly female (68.5%), staff (44.3%), with an average age of 43.7 (SD = 11.1). Analyses revealed significant group differences in non-compliance between TM+ (M = 2.6, SD = 1.9) and TM (M = 4.0, SD = 2.1), F(16,88) = 3.4, p < .01; d = .64, and between TM+ (M = 2.6, SD = 1.9) and CG (M = 3.8, SD = 2.1), F(1,74) = 13.3, p < .01; d = .56. There was no significant group difference between TM and CG, F(1,80) = 0.1, p = .75; d = .02. Tailored messages improved individual program compliance. More research is needed to assess the relationship between program compliance and PA behavior change.
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Affiliation(s)
- Ashlee S Davis
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA
| | - Kathryn E Wilson
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA
| | - Rebecca Ellis
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA
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10
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Goldstein SP, Thomas JG, Brick LA, Zhang F, Forman EM. Identifying behavioral types of dietary lapse from a mobile weight loss program: Preliminary investigation from a secondary data analysis. Appetite 2021; 166:105440. [PMID: 34098003 DOI: 10.1016/j.appet.2021.105440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/23/2021] [Accepted: 05/18/2021] [Indexed: 12/22/2022]
Abstract
Success in behavioral weight loss (BWL) programs depends on adherence to the recommended diet to reduce caloric intake. Dietary lapses (i.e., deviations from the BWL diet) occur frequently and can adversely affect weight loss outcomes. Research indicates that lapse behavior is heterogenous; there are many eating behaviors that could constitute a dietary lapse, but they are rarely studied as distinct contributors to weight outcomes. This secondary analysis aims to evaluate six behavioral lapse types during a 10-week mobile BWL program (eating a large portion, eating when not intended, eating an off-plan food, planned lapse, being unaware of caloric content, and endorsing multiple types of lapse). Associations between weekly behavioral lapse type frequency and weekly weight loss were investigated, and predictive contextual characteristics (psychological, behavioral, and environmental triggers for lapse) and individual difference (e.g., age, gender) factors were examined across lapse types. Participants (N = 121) with overweight/obesity (MBMI = 34.51; 84.3% female; 69.4% White) used a mobile BWL program for 10 weeks, self-weighed weekly using Bluetooth scales, completed daily ecological momentary assessment of lapse behavior and contextual characteristics, and completed a baseline demographics questionnaire. Linear mixed models revealed significant negative associations between unplanned lapses and percent weight loss. Unplanned lapses from eating a large portion, eating when not intended, and having multiple "types" were significantly negatively associated with weekly percent weight loss. A lasso regression showed that behavioral lapse types share many similar stable factors, with other factors being unique to specific lapse types. Results add to the prior literature on lapses and weight loss in BWL and provide preliminary evidence that behavioral lapse types could aid in understanding adherence behavior and developing precision medicine tools to improve dietary adherence.
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Affiliation(s)
- Stephanie P Goldstein
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University & the Miriam Hospital/Weight Control and Diabetes Research Center, United States.
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University & the Miriam Hospital/Weight Control and Diabetes Research Center, United States
| | - Leslie A Brick
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, United States
| | - Fengqing Zhang
- Department of Psychology, College of Arts and Sciences, Drexel University, United States
| | - Evan M Forman
- Department of Psychology, College of Arts and Sciences, Drexel University, United States; Center for Weight, Eating, And Lifestyle Sciences (WELL Center), Drexel University, United States
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11
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Psychological Factors Predicting Sedentary Behavior of Older Adults: A Cross-Sectional Study in Brazil. J Aging Phys Act 2021; 29:280-287. [DOI: 10.1123/japa.2020-0051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/23/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022]
Abstract
This cross-sectional study aimed to investigate the psychological factors that might predict the sedentary behavior of 654 older adults from the South Region of Brazil. The participants were evaluated by the International Physical Activity Questionnaire; Mini-Mental State Exam; Geriatric Anxiety Scale; and the scales Geriatric Depression, Purpose in Life, Perceived Stress, Rosenberg Self-Esteem, and Satisfaction with Life. Data analysis was conducted through Pearson correlation and multiple regression analysis (p < .05). No significant (p > .05) correlation was found between the sedentary behavior variables with self-esteem. Multiple regression analysis revealed that psychological variables explained 6% of the variance of sitting time during the week (R2 = .06; F = 11.546; p < .01). Depression showed a positive prediction (β = −0.10; p = .040), while life satisfaction (β = −0.16; p = .001) and purpose in life (β = −0.10; p = .026) showed negative prediction. Psychological variables predicted only 3% of the variance of sitting time during the weekend (R2 = .03; F = 5.629; p < .01), showing that life satisfaction had significant (p = .007) and negative (β = −0.13) association. Life satisfaction and purpose in life can be considered protector factors to sedentary behavior, while depression is a potentiating factor.
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12
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Kim MT, Radhakrishnan K, Heitkemper EM, Choi E, Burgermaster M. Psychosocial phenotyping as a personalization strategy for chronic disease self-management interventions. Am J Transl Res 2021; 13:1617-1635. [PMID: 33841684 PMCID: PMC8014371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND As the U.S. population grows older and more diverse, self-management needs are increasingly complicated. In order to deliver effective personalized interventions to those suffer from chronic conditions social determinants of health must be considered. Therefore, psychosocial phenotyping holds strong promise as a tool for tailoring interventions based on precision health principles. PURPOSE To define psychosocial phenotyping and develop a research agenda that promotes its integration into chronic disease management as a tool for precision self-management interventions. METHODS Since psychosocial phenotyping is not yet used in interventions for self-management support, we conducted a literature review to identify potential phenotypes for chronic disease self-management. We also reviewed policy intervention case reports from the Centers for Medicare and Medicaid Services to examine factors related to social determinants of health in people with chronic illnesses. Finally, we reviewed methodological approaches for identifying patient profiles or phenotypes. RESULTS The literature review revealed areas within which to collect data for psychosocial phenotyping that can inform personalized interventions. The findings of our exemplar cases revealed that several environmental or key SDOH such as factors realted with economic stability and neighborhood environment have been closely linked with the success of chronic disease management interventions. We elucidated theory, definitions, and pragmatic conceptual boundaries related to psychosocial phenotyping for precision health. CONCLUSIONS Our literature review with case example analysis demonstrates the potential usefulness of psychosocial phenotyping as a tool to enhance personalized self-management interventions for people with chronic diseases, with implications for future research.
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Affiliation(s)
- Miyong T Kim
- School of Nursing, The University of Texas at AustinAustin, TX 78712, USA
| | | | | | - Eunju Choi
- School of Nursing, The University of Texas at AustinAustin, TX 78712, USA
| | - Marissa Burgermaster
- School of Natural Science and Dell medical School, The University of Texas at AustinAustin, TX 78712, USA
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13
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Mason TB, Do B, Dunton G. Interactions of approach motivation and self-regulation in relation to obesity in children. Eat Weight Disord 2021; 26:85-92. [PMID: 31784947 PMCID: PMC7255926 DOI: 10.1007/s40519-019-00817-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/11/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Motivation and self-regulation are two psychological systems that have been shown to be related to childhood obesity. OBJECTIVE This study evaluated independent and interactive associations of approach-oriented motivation (i.e., drive and reward responsiveness) and self-regulation (i.e., self-control and behavioral regulation) in relation to age- and sex-adjusted body mass index-z scores (BMI-z) in children. METHODS Children (55% female; Mage = 12.5 years ± .93) completed questionnaires assessing motivation and self-regulation, and anthropometric measurements were taken by research staff cross-sectionally. RESULTS Regressions revealed no independent associations of approach motivation or self-regulation and BMI-z. There were interactions between the drive facet of approach motivation, which assesses motivation to follow goals, and self-regulation in relation to BMI-z. Children with lower motivation to follow goals and lower self-regulation had higher BMI-z, and children with lower motivation to follow goals and higher self-regulation had lower BMI-z. Children with higher motivation to follow goals had similar BMI-z at all levels of self-regulation. CONCLUSION For children with low motivation to follow goals, self-regulation may be an important buffer of high BMI-z. LEVEL OF EVIDENCE Level V: cross-sectional descriptive study.
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Affiliation(s)
- Tyler B Mason
- Department of Preventive Medicine, University of Southern California, 2001 Soto St., Los Angeles, CA, 90032, USA.
| | - Bridgette Do
- Department of Preventive Medicine, University of Southern California, 2001 Soto St., Los Angeles, CA, 90032, USA
| | - Genevieve Dunton
- Department of Preventive Medicine, University of Southern California, 2001 Soto St., Los Angeles, CA, 90032, USA.,Department of Psychology, University of Southern California, Los Angeles, CA, USA
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Lee HH, Emerson JA, Bohlen LC, Williams DM. Affective response to physical activity as an intermediate phenotype. Soc Sci Med 2021; 271:112038. [PMID: 30502097 PMCID: PMC6510653 DOI: 10.1016/j.socscimed.2018.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 11/02/2018] [Accepted: 11/08/2018] [Indexed: 12/12/2022]
Abstract
Over the past seventy years, biomedical and epidemiological research has shown that regular physical activity (PA) is critical for physical and mental health. Despite this knowledge, physical inactivity is the fourth leading risk factor for global mortality, accounting for 9% (5.3 million) of premature deaths annually. We suggest this mismatch between knowing about the risks of PA and engaging in regular PA can be reconciled by focusing less on expected health benefits of PA and more on how people feel during PA. Specifically, in this position paper, we argue that affective response (feeling good versus bad) to PA is an intermediate phenotype that can explain significant variance in PA behavior and is, in turn, a function of genetic variability. In making this argument, we first review empirical evidence showing that affective response to PA predicts future physical activity behavior. Second, we systematically review research on single nucleotide morphisms (SNPs) that are associated with affective response to PA. Investigating affective response to PA as an intermediate phenotype will allow future researchers to move beyond asking "What SNPs are associated with PA?", and begin asking "How do these SNPs influence PA?", thus ultimately optimizing the translation of knowledge gained from genomic data to intervention development.
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Affiliation(s)
- Harold H Lee
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Jessica A Emerson
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | | | - David M Williams
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Stevens CJ, Baldwin AS, Bryan AD, Conner M, Rhodes RE, Williams DM. Affective Determinants of Physical Activity: A Conceptual Framework and Narrative Review. Front Psychol 2020; 11:568331. [PMID: 33335497 PMCID: PMC7735992 DOI: 10.3389/fpsyg.2020.568331] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022] Open
Abstract
The literature on affective determinants of physical activity (PA) is growing rapidly. The present paper aims to provide greater clarity regarding the definition and distinctions among the various affect-related constructs that have been examined in relation to PA. Affective constructs are organized according to the Affect and Health Behavior Framework (AHBF), including: (1) affective response (e.g., how one feels in response to PA behavior) to PA; (2) incidental affect (e.g., how one feels throughout the day, unrelated to the target behavior); (3) affect processing (e.g., affective associations, implicit attitudes, remembered affect, anticipated affective response, and affective judgments); and (4) affectively charged motivational states (e.g., intrinsic motivation, fear, and hedonic motivation). After defining each category of affective construct, we provide examples of relevant research showing how each construct may relate to PA behavior. We conclude each section with a discussion of future directions for research.
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Affiliation(s)
- Courtney J. Stevens
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Austin S. Baldwin
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Angela D. Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Ryan E. Rhodes
- School of Exercise Science, Physical & Health Education, University of Victoria, Victoria, BC, Canada
| | - David M. Williams
- Department of Behavioral and Social Sciences, Department of Psychiatry and Human Behavior, School of Public Health, Brown University, Providence, RI, United States
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Jeffers AJ, Mason TB, Benotsch EG. Psychological eating factors, affect, and ecological momentary assessed diet quality. Eat Weight Disord 2020; 25:1151-1159. [PMID: 31388844 DOI: 10.1007/s40519-019-00743-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 07/01/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Eating behaviors are a contributor to obesity, yet more research is needed examining time varying and time-invariant factors associated with food consumption. Psychological eating factors (e.g., restraint, disinhibition, and susceptibility to hunger) and affect have been associated with obesity and diet. However, less is known about how psychological eating factors and affect are associated with food consumption assessed in daily life. The purpose of this study was to examine associations among psychological eating factors, affect, and food consumption using ecological momentary assessment (EMA) in a non-clinical sample of college students. METHOD Young adults (N = 30; Mage = 21) completed traditional self-report measures of psychological eating factors and usual dietary intake and EMA measures of food consumption and affect. RESULTS Momentary negative affect was associated with greater sugary beverage consumption, and sugary food consumption in the past 2.5 h was associated with report of higher current negative affect. Susceptibility to hunger, disinhibited and emotional eating, and baseline unhealthy eating were positively related to sugary food consumption. Lower susceptibility to hunger was associated with more sugary beverage intake. Finally, increased aggregate EMA negative affect and positive affect were related to increased fruit consumption, and lower susceptibility to hunger and baseline unhealthy eating were associated with vegetable consumption. CONCLUSIONS Results provide support for the role of time varying and invariant factors in predicting eating behaviors in daily life; both may be important to consider in obesity prevention and intervention. Particularly, ecological momentary interventions targeting affective states in individuals' daily lives may be useful for changing food intake. LEVEL OF EVIDENCE Level IV, multiple time series.
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17
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Bates CR, Bohnert AM, Buscemi J, Vandell DL, Lee KTH, Bryant FB. Family entropy: understanding the organization of the family home environment and impact on child health behaviors and weight. Transl Behav Med 2020; 9:413-421. [PMID: 31094439 DOI: 10.1093/tbm/ibz042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Child obesity is a major public health issue with a high disease burden. Although numerous contributing factors have been identified, the family home environment is a central context of influence that requires deeper understanding. The level of organization in the family home environment may influence obesity and obesogenic behaviors, but the literature has suffered from the lack of a strong overarching construct and model to guide this area of research. Family entropy is a conceptual framework that fills this gap by representing the level of organization across the home environment. The current study empirically assesses family entropy using factor analysis in a longitudinal sample of 968 children measured yearly from Grades 3 to 6 as part of the NICHD Study of Early Child Care and Youth Development. Mixed modeling using MPLUS examined the influence of family entropy on child weight both directly and indirectly through weight-related health behaviors (i.e., sleep and physical activity), and considered the moderating role of socioeconomic status (SES). Results suggest that family entropy is comprised of distinct elements of household organization and disorganization, which are moderately related. Household disorganization may be particularly detrimental to child sleeping behavior both concurrently and over time in families of both high and low SES. The study concludes with recommendations for advancing understanding of the home environment by using nuanced measurement strategies, and incorporating support for household organization within child obesity prevention and intervention efforts.
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Affiliation(s)
- Carolyn R Bates
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Amy M Bohnert
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Deborah L Vandell
- School of Education, University of California, Irvine, Irvine, CA, USA
| | - Kenneth T H Lee
- School of Education, University of California, Irvine, Irvine, CA, USA
| | - Fred B Bryant
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
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18
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Sedentary Behavior and Chronic Disease: Mechanisms and Future Directions. J Phys Act Health 2020; 17:52-61. [DOI: 10.1123/jpah.2019-0377] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 11/18/2022]
Abstract
Background: Recent updates to physical activity guidelines highlight the importance of reducing sedentary time. However, at present, only general recommendations are possible (ie, “Sit less, move more”). There remains a need to investigate the strength, temporality, specificity, and dose–response nature of sedentary behavior associations with chronic disease, along with potential underlying mechanisms. Methods: Stemming from a recent research workshop organized by the Sedentary Behavior Council themed “Sedentary behaviour mechanisms—biological and behavioural pathways linking sitting to adverse health outcomes,” this paper (1) discusses existing challenges and scientific discussions within this advancing area of science, (2) highlights and discusses emerging areas of interest, and (3) points to potential future directions. Results: A brief knowledge update is provided, reflecting upon current and evolving thinking/discussions, and the rapid accumulation of new evidence linking sedentary behavior to chronic disease. Research “action points” are made at the end of each section—spanning from measurement systems and analytic methods, genetic epidemiology, causal mediation, and experimental studies to biological and behavioral determinants and mechanisms. Conclusion: A better understanding of whether and how sedentary behavior is causally related to chronic disease will allow for more meaningful conclusions in the future and assist in refining clinical and public health policies/recommendations.
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Arteaga SS, Esposito L, Osganian SK, Pratt CA, Reedy J, Young-Hyman D. Childhood obesity research at the NIH: Efforts, gaps, and opportunities. Transl Behav Med 2018; 8:962-967. [PMID: 30329138 PMCID: PMC6454453 DOI: 10.1093/tbm/iby090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Childhood obesity is a major public health challenge. This article describes an overview of the National Institutes of Health (NIH) behavioral and social sciences childhood obesity research efforts. The overview will highlight five areas of childhood obesity research supported by the NIH: (a) basic behavioral and social sciences; (b) early childhood; (c) policies, programs, and environmental strategies; (d) health disparities; and (e) transagency and public-private collaboration. The article also describes potential gaps and opportunities in the areas of childhood obesity and severe obesity, measurement, and sleep.
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Affiliation(s)
- S Sonia Arteaga
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Layla Esposito
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stavroula K Osganian
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Charlotte A Pratt
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jill Reedy
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Deborah Young-Hyman
- Office of Behavioral and Social Science Research, National Institutes of Health, Bethesda, MD, USA
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Kelly AS, Marcus MD, Yanovski JA, Yanovski SZ, Osganian SK. Working toward precision medicine approaches to treat severe obesity in adolescents: report of an NIH workshop. Int J Obes (Lond) 2018; 42:1834-1844. [PMID: 30283078 PMCID: PMC6461397 DOI: 10.1038/s41366-018-0231-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/16/2018] [Accepted: 09/11/2018] [Indexed: 02/06/2023]
Abstract
Adolescent severe obesity is a prevalent, chronic, and serious disease with few effective and safe treatment options. To address this issue, a National Institutes of Health-sponsored workshop entitled "Developing Precision Medicine Approaches to the Treatment of Severe Obesity in Adolescents," was convened, bringing together a multidisciplinary group of experts to review the current state of the science and identify (1) what is known regarding the epidemiology and biopsychosocial determinants of severe obesity in adolescents, (2) what is known regarding effectiveness of treatments for severe obesity in adolescents and predictors of response, and (3) gaps and opportunities for future research to develop more effective and targeted treatments for adolescents with severe obesity. Major topical areas discussed at the workshop included: appropriate BMI metrics, valid measures of phenotypes and predictors, mechanisms associated with the development of severe obesity, novel treatments informed by biologically and psychosocially plausible mechanisms, biopsychosocial phenotypes predicting treatment response, standardization of outcome measures and results reporting in research, and improving clinical care. Substantial gaps in knowledge were identified regarding the basic behavioral, psychosocial, and biological mechanisms driving the development of severe obesity and the influence of these factors on treatment response. Additional exploratory and observational studies are needed to better understand the heterogeneous etiology of severe obesity and explain the high degree of variability observed with interventions. Tailored treatment strategies that may be developed by achieving a better understanding of individual differences in genetic endowment, clinical, metabolic, psychological, and behavioral phenotypes, and response to environmental exposures need to be tested. It is anticipated that these recommendations for future research, including strategies to enhance methodological rigor, will advance precision medicine approaches to treat severe obesity in adolescents more effectively.
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Affiliation(s)
- Aaron S Kelly
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jack A Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Susan Z Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Stavroula K Osganian
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
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21
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Muñoz-Prieto A, Nielsen LR, Dąbrowski R, Bjørnvad CR, Söder J, Lamy E, Monkeviciene I, Ljubić BB, Vasiu I, Savic S, Busato F, Yilmaz Z, Bravo-Cantero AF, Öhlund M, Lucena S, Zelvyte R, Aladrović J, Lopez-Jornet P, Caldin M, Lavrador C, Karveliene B, Mrljak V, Mazeikiene J, Tvarijonaviciute A. European dog owner perceptions of obesity and factors associated with human and canine obesity. Sci Rep 2018; 8:13353. [PMID: 30190536 PMCID: PMC6127309 DOI: 10.1038/s41598-018-31532-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 08/21/2018] [Indexed: 01/12/2023] Open
Abstract
Obesity is a common nutrition-related disorder leading to reduced life expectancy in both humans and dogs. With the aim of identifying new prevention and control options, the study objectives were (1) to investigate dog-owner perceptions about obesity in terms of themselves and their dogs, and (2) to identify factors associated with obesity and possible social, environmental and economic drivers for its development in dog owners and their pets. A cross-sectional questionnaire-based study was performed across multiple countries. The questionnaire focused on human and canine obesity, associated factors and potential drivers, and was distributed online and in the form of hard copies among dog owners in 11 European countries. In total, 3,185 responses from ten countries were included in multivariable analyses. Between 19.1% and 48.8% of the dog owners reported to be overweight/obese. Owner-reported overweight/obesity in dogs ranged from 6.0% to 31.3% based on body condition score charts, and 31.8% to 69.4% based on body fat index charts. Common factors associated with obesity in owners and their dogs were age, gender and owners' attitudes to diet and physical activity. Dog owners who did not consider obesity to be a disease were more likely to have obese dogs.
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Affiliation(s)
- Alberto Muñoz-Prieto
- Interlab-UMU, Regional Campus of International Excellence "Mare Nostrum", University of Murcia, Ed.16, 4a planta, Espinardo, Murcia, 30100, Spain
| | - Liza Rosenbaum Nielsen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Grønnegårdsvej 8, 1870, Frederiksberg C, Denmark
| | - Roman Dąbrowski
- Department and Clinic of Animal Reproduction, Faculty of Veterinary Medicine, University of Life Sciences, Gleboka 30 St, 20-612, Lublin, Poland
| | - Charlotte Reinhard Bjørnvad
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej16, 1870, Frederiksberg C, Denmark
| | - Josefin Söder
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, SE_750 07, Uppsala, Sweden
| | - Elsa Lamy
- Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), Escola de Ciências e Tecnologia, Universidade de Évora, Núcleo da Mitra, Apartado 94, 7006-554, Évora, Portugal
| | - Ingrida Monkeviciene
- Department of Anatomy and Physiology, Research Center of Digestive Physiology and Pathology, Veterinary Academy, Lithuanian University of Health Sciences, Tilzes 18, LT-47181, Kaunas, Lithuania
| | - Blanka Beer Ljubić
- Clinic for Internal Diseases, Faculty of Veterinary Medicine, Heinzelova 55, 10000, Zagreb, Croatia
| | - Iosif Vasiu
- Small Animal Emergency Hospital, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Calea Mănăştur 3-5, Cluj-Napoca, 400372, Romania
| | - Sara Savic
- Scientific Veterinary Institute "Novi Sad", Novi Sad, Serbia
| | | | - Zeki Yilmaz
- Department of Internal Medicine, Faculty of Veterinary Medicine, Uludag University, 16059, Nilufer, Bursa, Turkey
| | | | - Malin Öhlund
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Box 7054, 750 07, Uppsala, Sweden
| | - Sónia Lucena
- Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), Escola de Ciências e Tecnologia, Universidade de Évora, Núcleo da Mitra, Apartado 94, 7006-554, Évora, Portugal
| | - Rasa Zelvyte
- Department of Anatomy and Physiology, Research Center of Digestive Physiology and Pathology, Veterinary Academy, Lithuanian University of Health Sciences, Tilzes 18, LT-47181, Kaunas, Lithuania
| | - Jasna Aladrović
- Department of Physiology and Radiobiology, Faculty of Veterinary Medicine, Heinzelova 55, 10000, Zagreb, Croatia
| | - Pia Lopez-Jornet
- Department of Oral Medicine, Faculty of Medicine, University of Murcia, 30100, Espinardo, Spain
| | | | - Catarina Lavrador
- Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), Escola de Ciências e Tecnologia, Universidade de Évora, Núcleo da Mitra, Apartado 94, 7006-554, Évora, Portugal
| | - Birute Karveliene
- Veterinary faculty, Dr. L Kriaučeliūnas Small Animal Clinic (teaching hospital), Veterinary Academy, Lithuanian University of Health Sciences, Tilzes 18, LT-47181, Kaunas, Lithuania
| | - Vladimir Mrljak
- Clinic for Internal Diseases, Faculty of Veterinary Medicine, Heinzelova 55, 10000, Zagreb, Croatia
| | - Jovita Mazeikiene
- InMedica Vilnius - Alfa Clinic, Baltrusaicio 3, 06120, Vilnius, Lithuania
| | - Asta Tvarijonaviciute
- Interlab-UMU, Regional Campus of International Excellence "Mare Nostrum", University of Murcia, Ed.16, 4a planta, Espinardo, Murcia, 30100, Spain.
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Arguello LE, Mauldin K, Goyal D. Atypical Eating Disinhibition Genotype. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2018.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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