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Gilder CM, Gorin AA, Huedo-Medina T, Cooksey-Stowers K, McCaffery JM, Denmat Z, Field C, Wyckoff E, LaRose J, O'Connor K, Marfo N, Leahey TM. Impact of social connectedness on weight loss outcomes in an online program. J Behav Med 2024; 47:144-152. [PMID: 37698801 DOI: 10.1007/s10865-023-00447-1] [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: 05/06/2022] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
Obesity is linked to many negative health consequences. While online behavioral weight loss programs (BWL) are an effective treatment for obesity, weight losses are modest. Social connectedness has been found to improve weight loss outcomes and previous findings suggests that it may be especially important for people of color. The present study investigated the impact of social connectedness (structural connectedness, or network size; relationship quality, and functional connectedness, or social support) on weight loss outcomes in an online BWL program and whether Black race or Hispanic ethnicity moderates the relationship between social connectedness and weight loss. Participants (N = 387) enrolled in a 16-week online BWL program and completed measures of social connectedness before treatment and had their weight measured. Individuals with less structural connectedness (smaller social networks) had greater weight losses. Further, higher levels of functional connectedness (affectionate support, positive support, and relationship quality) mediated the relationship between smaller network size and better weight loss outcomes. Black race / Hispanic ethnicity did not moderate the relationship between social connectedness and weight loss. These findings suggest that the quality of one's relationships, not the size of one's social network, is important for weight loss. Future studies may examine whether online BWL programs that build relationship quality and affectionate and positive support in participants' existing social networks improve overall weight loss outcomes.
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Affiliation(s)
- Carnisha M Gilder
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Amy A Gorin
- Institute for Collaboration on Health, Intervention, and Policy, Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Tania Huedo-Medina
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Kristen Cooksey-Stowers
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Jeanne M McCaffery
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Zeely Denmat
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Christiana Field
- Institute for Collaboration on Health, Intervention, and Policy, Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Emily Wyckoff
- Institute for Collaboration on Health, Intervention, and Policy, Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Jessica LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Kayla O'Connor
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Nana Marfo
- Institute for Collaboration on Health, Intervention, and Policy, Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Tricia M Leahey
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA.
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Goessl CL, VanWormer JJ, Pathak RD, Ellerbeck EF, Kurz DL, Befort CA. Weight change and mental health status in a behavioral weight loss trial. J Affect Disord 2023; 334:302-306. [PMID: 37156276 DOI: 10.1016/j.jad.2023.04.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/12/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Obesity, depression, and anxiety often co-occur, but research on weight change and mental health status is limited. This analysis examined how the mental component score (MCS-12) from the Short Form health survey changed over 24 months in weight loss trial participants with vs. without treatment seeking for affective symptoms (TxASx) and by weight change quintiles. METHODS Participants with complete data (n = 1163) were analyzed from enrollees in a cluster-randomized, behavioral weight loss trial in rural U.S. Midwestern primary care practices. Participants received a lifestyle intervention with different delivery models, including in-clinic individual, in-clinic group, or telephone group counseling visits. Participants were stratified by baseline TxASx status and 24-month weight change quintiles. Mixed models were used to estimate MCS-12 scores. RESULTS There was a significant group-by-time interaction at the 24-month follow-up. The largest 0-24 month increase in MCS-12 scores (+5.3 points [12 %]) was observed in participants with TxASx who lost the most weight during the trial, while the largest decrease in MCS-12 scores (-1.8 points [-3 %]) was observed in participants without TxASx who gained the most weight (p < 0.001). LIMITATIONS Notable limitations included self-reported mental health, the observational analytical design, and a largely homogenous source population, as well as the possibility of reverse causation biasing some findings. CONCLUSIONS Mental health status generally improved, particularly among participants with TxASx who experienced significant weight loss. Those without TxASx who gained weight, however, had a decline in mental health status over 24 months. Replication of these findings is warranted.
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Affiliation(s)
- Cody L Goessl
- Marshfield Clinic Research Institute, Center for Clinical Epidemiology & Population Health, Marshfield, WI, USA; Marshfield Clinic-Marshfield Medical Center, Department of Occupational Medicine, Marshfield, WI, USA
| | - Jeffrey J VanWormer
- Marshfield Clinic Research Institute, Center for Clinical Epidemiology & Population Health, Marshfield, WI, USA.
| | - Ram D Pathak
- Marshfield Clinic-Marshfield Medical Center, Department of Endocrinology, Marshfield, WI, USA
| | - Edward F Ellerbeck
- University of Kansas Medical Center, Department of Population Health, Kansas City, KS, USA
| | - Daniel L Kurz
- University of Kansas Medical Center, Department of Population Health, Kansas City, KS, USA
| | - Christie A Befort
- University of Kansas Medical Center, Department of Population Health, Kansas City, KS, USA
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Tham KW, Abdul Ghani R, Cua SC, Deerochanawong C, Fojas M, Hocking S, Lee J, Nam TQ, Pathan F, Saboo B, Soegondo S, Somasundaram N, Yong AML, Ashkenas J, Webster N, Oldfield B. Obesity in South and Southeast Asia-A new consensus on care and management. Obes Rev 2023; 24:e13520. [PMID: 36453081 PMCID: PMC10078503 DOI: 10.1111/obr.13520] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022]
Abstract
Obesity is a chronic disease in which the abnormal or excessive accumulation of body fat leads to impaired health and increased risk of mortality and chronic health complications. Prevalence of obesity is rising rapidly in South and Southeast Asia, with potentially serious consequences for local economies, healthcare systems, and quality of life. Our group of obesity specialists from Bangladesh, Brunei Darussalam, India, Indonesia, Malaysia, Philippines, Singapore, Sri Lanka, Thailand, and Viet Nam undertook to develop consensus recommendations for management and care of adults and children with obesity in South and Southeast Asia. To this end, we identified and researched 12 clinical questions related to obesity. These questions address the optimal approaches for identifying and staging obesity, treatment (lifestyle, behavioral, pharmacologic, and surgical options) and maintenance of reduced weight, as well as issues related to weight stigma and patient engagement in the clinical setting. We achieved consensus on 42 clinical recommendations that address these questions. An algorithm describing obesity care is presented, keyed to the various consensus recommendations.
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Affiliation(s)
- Kwang Wei Tham
- Singapore Association for the Study of Obesity, Singapore
| | | | - Sioksoan C Cua
- Division of Pediatric Endocrinology, Philippine General Hospital, Metro Manila, Philippines.,Department of Pediatrics, Chinese General Hospital, Cardinal Santos Medical Center, Manila Doctors Hospital, Metro Manila, Philippines
| | | | - Mia Fojas
- Department of Biochemistry and Molecular Biology, University of the Philippines College of Medicine, Manila, Philippines
| | - Samantha Hocking
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - June Lee
- Upper Gastrointestinal and Bariatric Surgery, Department of Surgery, Changi General Hospital, Singapore
| | - Tran Quang Nam
- Department of Endocrinology, Ho Chi Minh City University Medical Center, Ho Chi Minh City, Vietnam
| | - Faruque Pathan
- Department of Endocrinology, Ibrahim Memorial Diabetes Center, Dhaka, Bangladesh
| | - Banshi Saboo
- Dia Care Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Sidartawan Soegondo
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.,Diabetes Connection and Care, Eka Hospitals, Jakarta, Indonesia
| | | | - Alice M L Yong
- Department of Internal Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | | | | | - Brian Oldfield
- Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Australia
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Mensah Bonsu I, Myezwa H, Brandt C, Ajidahun AT, Moses MO, Asamoah B. An exploratory study on excess weight gain: Experiences of Postmenopausal Women in Ghana. PLoS One 2023; 18:e0278935. [PMID: 36638076 PMCID: PMC9838829 DOI: 10.1371/journal.pone.0278935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/23/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Excess weight gain is a problem with a significant impact on health and quality of life as well as the consequent economic burden on human populations. While society advocates preference for excess weight gain, limited evidence exists concerning postmenopausal women's experiences in Ghana. AIM The current study explored the experiences regarding excess weight (overweight and obesity) gain among Ghanaian postmenopausal women in Bono East (Techiman) region. METHODS This is a qualitative exploratory descriptive study where anthropometric measurements [body mass index (BMI), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR)] were determined and participants who were identified with excess weight (obesity and overweight) were recruited to participate in a focus group discussion (FGD). Four focus group discussions were held and 24 postmenopausal women (>45 years) in Techiman took part. Discussions were audio-recorded and transcribed for thematic analysis. RESULTS From the qualitative analysis of the FGD, three major themes emerged from the study namely, (i) perception of body weight, (ii) measures to reduce body weight, and (iii) support to adhere to the weight management program. Sub-themes revealed that weight gained was viewed as the presence of diseases and admired by society as a culturally accepted body image. Diet-related changes, a combination of diet modification and physical activity, and weight management supplements emerged as measures to reduce excess weight. Support to adhere to the weight program included health education, access, affordable exercise facilities, and social support. CONCLUSIONS Sociocultural norms influence the image perception and acceptance of weight gain among postmenopausal women in Ghana, but there is an acknowledgment of the perceived negative health implications of such excess weight. Measures for weight reduction and support to adhere to the weight reduction programme require attention in Ghana.
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Affiliation(s)
- Isaac Mensah Bonsu
- Department of Physiotherapy, School of Therapeutic Sciences, University of The Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Hellen Myezwa
- Department of Physiotherapy, School of Therapeutic Sciences, University of The Witwatersrand, Johannesburg, South Africa
| | - Corlia Brandt
- Department of Physiotherapy, School of Therapeutic Sciences, University of The Witwatersrand, Johannesburg, South Africa
| | - Adedayo Tunde Ajidahun
- Department of Physiotherapy, School of Therapeutic Sciences, University of The Witwatersrand, Johannesburg, South Africa
| | - Monday Omoniyi Moses
- Faculty of Allied Health Sciences, Department of Physiotherapy and Sports Science, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Benjamin Asamoah
- Faculty of Allied Health Sciences, Department of Physiotherapy and Sports Science, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Martinez M, Salazar-Collier CL, Pena J, Wilkinson AV, Chavarria EA, Reininger BM. Motivation for weight loss among completers of a free community-based weight loss program in a US-Mexico border region: A self-determination theory perspective. Front Public Health 2022; 10:652271. [PMID: 36203664 PMCID: PMC9530817 DOI: 10.3389/fpubh.2022.652271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/16/2022] [Indexed: 01/21/2023] Open
Abstract
This study explores the perceptions and motivation for weight loss among participants who completed a free community-based weight loss program in a predominantly Hispanic and low-income region along the US-Mexico border using a Self-Determination Theory (SDT) perspective. This manuscript is timely as qualitative research on the effect of motivation as a factor in behavioral interventions to reduce overweight or obesity is currently lacking. Individual semi-structured interviews were conducted with 20 participants (80%, n = 16 female) who completed a community weight-loss intervention to assess motivation for weight loss and participating, and the role of social support and self-efficacy in weight loss. Directed content analysis was used with SDT guiding the questions and subsequent theme analysis. The findings communicate perspectives of participants relevant to 8 prominent themes. The regulation types and constructs related to SDT included: non-regulation, external regulation, introjected regulation, identified regulation, integrated regulation, and intrinsic regulation as well as competence and relatedness. Participants mentioned external sources of motivation, such as wanting to improve their physical appearance, and motivation due to financial incentives. Fewer participants reported intrinsic motivators, which the literature suggests are more likely to create lasting change and improved health behaviors. Understanding the motivation for behavior change and completion of weight loss programs is essential to help participants reach their goals effectively and sustain weight loss. A greater emphasis during weight loss programs on the motives for individuals to lose weight may help improve outcomes in weight-loss interventions. Additionally, increasing strategies targeted at enhancing intrinsic motivation for weight loss may be beneficial.
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Affiliation(s)
- Miriam Martinez
- Texas Tech University Health Science Center, El Paso, TX, United States
| | - Cindy L. Salazar-Collier
- College of Nursing & Health Sciences, Texas A&M International University, Laredo, TX, United States,*Correspondence: Cindy L. Salazar-Collier
| | - Jessica Pena
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Anna V. Wilkinson
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | | | - Belinda M. Reininger
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, United States
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Schmidt K, Faerch K, Zoffmann V, Amadid H, Varming AR. The process of health behaviour change following participation in a randomised controlled trial targeting prediabetes: A qualitative study. Diabet Med 2022; 39:e14748. [PMID: 34806793 DOI: 10.1111/dme.14748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/20/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
AIM To explore how participating in a randomised controlled trial affected motivation, barriers and strategies in the process of health behaviour change among individuals with prediabetes. METHODS An extension to the PRE-D trial, a qualitative study investigated the efficacy of glucose-lowering interventions (metformin, dapagliflozin or exercise) compared with a control group among individuals with prediabetes and overweight/obesity. Data were collected through separate focus group interviews with participants using semi-structured interview guides inspired by health behaviour change theories. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis with an inductive-deductive approach. RESULTS Four interrelated themes were generated from interviews: (1) 'self-construction of prediabetes', on how participants understood the term 'prediabetes', (2) 'altered health image', on how participants' health perceptions were affected, (3) 'personal strategies for health behaviour change', on different ways to attempt to implement behaviour changes and (4) 'the process of health behaviour change', on how participants progressed and relapsed while trying to change behaviour. Themes relate to the health belief model, self-determination theory, self-efficacy and the trans-theoretical model of change. Participants shared their experiences and thoughts during interviews and inspired each other, which led some participants to develop a new perspective on prediabetes severity and increased their motivation for behaviour change. CONCLUSIONS How participants perceived and accepted, rejected or neglected prediabetes appeared to affect their health images and whether they realised a need for behaviour change. Their achievements during interventions, health literacy, self-efficacy and perceived support from their social networks, professionals and technological aids influenced the maintenance of health behaviour changes.
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Affiliation(s)
- Kirstine Schmidt
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kristine Faerch
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Zoffmann
- Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanan Amadid
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Annemarie R Varming
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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7
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Measuring social processes regarding eating, physical activity, and weight in higher-weight people: the weight-related interactions scale (WRIS). Eat Weight Disord 2022; 27:737-749. [PMID: 34041685 DOI: 10.1007/s40519-021-01208-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE This study sought to develop a psychometrically sound measure to assess effective and ineffective forms of input from others regarding eating, physical activity, and weight in higher-weight people, namely, the Weight-Related Interactions Scale (WRIS). METHODS Participants (n = 736) were adults in the overweight/obese weight ranges who completed the WRIS and measures of weight-specific social support, emotional eating, weight stigma, eating-specific self efficacy, and social desirability. RESULTS Exploratory and confirmatory factor analyses of the WRIS supported a three-factor solution of 'Criticism', 'Minimization', and 'Collaboration' as forms of weight-related input from others. Support was found for the reliability and the concurrent, convergent, and divergent validity of the WRIS. CONCLUSIONS The WRIS is a promising new instrument for comprehensively assessing the input of others in relation to eating, physical activity, and weight among higher-weight individuals. LEVEL OF EVIDENCE Level III. Evidence obtained from well-designed cohort or case-control analytic studies.
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8
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Dicker D, Alfadda AA, Coutinho W, Cuevas A, Halford JCG, Hughes CA, Iwabu M, Kang JH, Nawar R, Reynoso R, Rhee N, Rigas G, Salvador J, Sbraccia P, Vázquez-Velázquez V, Caterson ID. Patient motivation to lose weight: Importance of healthcare professional support, goals and self-efficacy. Eur J Intern Med 2021; 91:10-16. [PMID: 33558163 DOI: 10.1016/j.ejim.2021.01.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND People with obesity (PwO) often struggle to achieve and maintain weight loss. This can perpetuate and/or be influenced by feelings of low motivation. This analysis from ACTION-IO data identified factors associated with PwO motivation to lose weight. METHODS PwO completed an online survey in 11 countries. Exploratory multinomial logistic regression analyses identified independent variables associated with self-report of feeling motivated versus not motivated to lose weight. RESULTS Data from 10,854 PwO were included (5,369 motivated; 3,312 neutral; 2,173 not motivated). Variables associated with feeling motivated versus not motivated included (odds ratio [95% confidence interval]): acknowledgement of healthcare professional (HCP) responsibility to contribute to weight loss (2.32 [1.86-2.88]), comfort in talking to their HCP about weight (1.46 [1.24-1.72), agreement that it is easy to lose weight (1.73 [1.30-2.31]), and a goal of reducing risks from excess weight (1.45 [1.22-1.73]). Conversely, if PwO considered obesity less important than other diseases they were less likely to report feeling motivated (0.49 [0.41-0.58]). PwO who reported being motivated to lose weight were more likely to exercise ≥5 times a week versus <1 time a week (2.77 [2.09-3.68]) than those who reported they were not motivated. CONCLUSIONS Positive interactions with HCPs, self-efficacy, setting goals and knowledge of the importance of weight management, in addition to regular exercising, may increase PwO motivation for weight loss. Appropriate HCP support may help PwO who are ready to engage in weight management. CLINICAL TRIAL REGISTRATION NCT03584191.
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Affiliation(s)
- Dror Dicker
- Director, Department of Internal Medicine D, Hasharon Hospital-Rabin Medical Center, Petah-Tikva, Israel; Sackler School Of Medicine, Tel Aviv University Tel Aviv, Israel.
| | - Assim A Alfadda
- Obesity Research Center and the Department of Internal Medicine, College of Medicine, King Saud University, P.O. Box 2925 (98), Riyadh 11461, Saudi Arabia
| | - Walmir Coutinho
- Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Instituto Estadual de Diabetes e Endocrinologia (IEDE), Rio de Janeiro, RJ, Brazil
| | - Ada Cuevas
- Center for Advanced Metabolic Medicine and Nutrition (CAMMYN) Avda Las Condes 9460, office 501, Santiago, Chile
| | - Jason C G Halford
- School of Psychology, University of Leeds, University Road, Woodhouse, Leeds LS2 9JZ, UK
| | - Carly A Hughes
- Weight Management Service, Fakenham Medical Practice, Meditrina House, Trinity Road, Fakenham, NR21 8SY, UK
| | - Masato Iwabu
- Department of Diabetes and Metabolic Diseases, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Jae-Heon Kang
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, South Korea
| | - Rita Nawar
- The Weight Care Clinic, Dubai Healthcare City, Building 64, Block A, 2nd Floor, 2004, P.O. Box: 505042, Dubai, United Arab Emirates
| | - Ricardo Reynoso
- Novo Nordisk Health Care AG, Thurgauerstrasse 36/38, 8050 Zürich, Switzerland
| | - Nicolai Rhee
- Novo Nordisk Health Care AG, Thurgauerstrasse 36/38, 8050 Zürich, Switzerland
| | - Georgia Rigas
- Department of Bariatric Surgery, St George Private Hospital, Suite 3, Level 5, 1 South St, Kogarah, Sydney, Australia
| | - Javier Salvador
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Paolo Sbraccia
- University of Rome Tor Vergata, Department of Systems Medicine, Via Montpellier,1, I-00133 Rome, Rome, Italy
| | - Verónica Vázquez-Velázquez
- Clínica de Obesidad y Trastornos de la Conducta Alimentaria, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, Belisario Domínguez Sección XVI, 14080 Ciudad de México, Mexico
| | - Ian D Caterson
- Boden Collaboration, Charles Perkins Centre, D17, University of Sydney, NSW 2006, Sydney, Australia
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Volz K, Wyckoff E, Medina TH, Denmat Z, Field C, LaRose J, Gorin A, Leahey T. Impact of income and perceived stress on engagement and weight loss outcomes in an online behavioral weight loss program. J Behav Med 2021; 44:853-859. [PMID: 34160724 DOI: 10.1007/s10865-021-00238-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/10/2021] [Indexed: 02/07/2023]
Abstract
Lower income is associated with greater stress, and stress has been shown to undermine treatment engagement and weight loss outcomes in face-to-face interventions. The present study examined whether lower income predicts treatment engagement and weight loss outcomes during an online behavioral weight loss (BWL) intervention. A total of N = 260 participants (79.2% female; 50.7 ± 11.9 years of age; 60.3% non-Hispanic White) were enrolled into an online BWL program and had their income, stress, program engagement, and weight measured. Results showed that stress fully mediated the effect of income on engagement in the online program. Further, lower income predicted poorer weight loss outcomes, and this effect was partially mediated by perceived stress. This is the first study to demonstrate that lower income is associated with poorer engagement and weight loss outcomes in an online weight loss program, underscoring the need for systems-level stress reduction programs and individual level stress management tools, particularly for individuals with lower income.
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Affiliation(s)
| | | | | | | | | | | | - Amy Gorin
- University of Connecticut, Storrs, CT, USA
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A Conceptual Model of Long-Term Weight Loss Maintenance: The Importance of Cognitive, Empirical and Computational Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020635. [PMID: 33451110 PMCID: PMC7828595 DOI: 10.3390/ijerph18020635] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 12/22/2022]
Abstract
Living with obesity is related to numerous negative health outcomes, including various cancers, type II diabetes, and cardiovascular disease. Although much is known about the factors associated with obesity, and a range of weight loss interventions have been established, changing health-related behaviours to positively affect obesity outcomes has proven difficult. In this paper, we first draw together major factors that have emerged within the literature on weight loss to describe a new conceptual framework of long-term weight loss maintenance. Key to this framework is the suggestion that increased positive social support influences a reduction in psychosocial stress, and that this has the effect of promoting better executive functioning which in turn facilitates the development of healthy habits and the breaking of unhealthy habits, leading to improved ongoing maintenance of weight loss. We then outline how the use of computational approaches are an essential next step, to more rigorously test conceptual frameworks, such as the one we propose, and the benefits that a mixture of conceptual, empirical and computational approaches offer to the field of health psychology.
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11
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Chumachenko SY, Cali RJ, Rosal MC, Allison JJ, Person SJ, Ziedonis D, Nephew BC, Moore CM, Zhang N, King JA, Fulwiler C. Keeping weight off: Mindfulness-Based Stress Reduction alters amygdala functional connectivity during weight loss maintenance in a randomized control trial. PLoS One 2021; 16:e0244847. [PMID: 33428638 PMCID: PMC7799782 DOI: 10.1371/journal.pone.0244847] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/15/2020] [Indexed: 12/13/2022] Open
Abstract
Obesity is associated with significant comorbidities and financial costs. While behavioral interventions produce clinically meaningful weight loss, weight loss maintenance is challenging. The objective was to improve understanding of the neural and psychological mechanisms modified by mindfulness that may predict clinical outcomes. Individuals who intentionally recently lost weight were randomized to Mindfulness-Based Stress Reduction (MBSR) or a control healthy living course. Anthropometric and psychological factors were measured at baseline, 8 weeks and 6 months. Functional connectivity (FC) analysis was performed at baseline and 8 weeks to examine FC changes between regions of interest selected a priori, and independent components identified by independent component analysis. The association of pre-post FC changes with 6-month weight and psychometric outcomes was then analyzed. Significant group x time interaction was found for FC between the amygdala and ventromedial prefrontal cortex, such that FC increased in the MBSR group and decreased in controls. Non-significant changes in weight were observed at 6 months, where the mindfulness group maintained their weight while the controls showed a weight increase of 3.4% in BMI. Change in FC at 8-weeks between ventromedial prefrontal cortex and several ROIs was associated with change in depression symptoms but not weight at 6 months. This pilot study provides preliminary evidence of neural mechanisms that may be involved in MBSR’s impact on weight loss maintenance that may be useful for designing future clinical trials and mechanistic studies.
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Affiliation(s)
- Serhiy Y. Chumachenko
- Department of Psychiatry, UMass Medical School, Worcester, Massachusetts, United States of America
| | - Ryan J. Cali
- Department of Psychiatry, UMass Medical School, Worcester, Massachusetts, United States of America
| | - Milagros C. Rosal
- Department of Quantitative Health Sciences, UMass Medical School, Worcester, Massachusetts, United States of America
| | - Jeroan J. Allison
- Department of Quantitative Health Sciences, UMass Medical School, Worcester, Massachusetts, United States of America
| | - Sharina J. Person
- Department of Quantitative Health Sciences, UMass Medical School, Worcester, Massachusetts, United States of America
| | - Douglas Ziedonis
- Department of Psychiatry, University of California San Diego, San Diego, California, United States of America
| | - Benjamin C. Nephew
- Department of Psychiatry, UMass Medical School, Worcester, Massachusetts, United States of America
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, Massachusetts, United States of America
| | - Constance M. Moore
- Department of Psychiatry, UMass Medical School, Worcester, Massachusetts, United States of America
| | - Nanyin Zhang
- Department of Biomedical Engineering, Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Jean A. King
- Department of Psychiatry, UMass Medical School, Worcester, Massachusetts, United States of America
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, Massachusetts, United States of America
| | - Carl Fulwiler
- Department of Psychiatry, UMass Medical School, Worcester, Massachusetts, United States of America
- * E-mail:
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12
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Larsen SC, Turicchi J, Christensen GL, Larsen CS, Jørgensen NR, Mikkelsen MLK, Horgan G, O’Driscoll R, Michalowska J, Duarte C, Scott SE, Santos I, Encantado J, Palmeira AL, Stubbs RJ, Heitmann BL. Hair Cortisol Concentration, Weight Loss Maintenance and Body Weight Variability: A Prospective Study Based on Data From the European NoHoW Trial. Front Endocrinol (Lausanne) 2021; 12:655197. [PMID: 34659105 PMCID: PMC8511813 DOI: 10.3389/fendo.2021.655197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 09/13/2021] [Indexed: 01/23/2023] Open
Abstract
UNLABELLED Several cross-sectional studies have shown hair cortisol concentration to be associated with adiposity, but the relationship between hair cortisol concentration and longitudinal changes in measures of adiposity are largely unknown. We included 786 adults from the NoHoW trial, who had achieved a successful weight loss of ≥5% and had a body mass index of ≥25 kg/m2 prior to losing weight. Hair cortisol concentration (pg/mg hair) was measured at baseline and after 12 months. Body weight and body fat percentage were measured at baseline, 6-month, 12-month and 18-month visits. Participants weighed themselves at home ≥2 weekly using a Wi-Fi scale for the 18-month study duration, from which body weight variability was estimated using linear and non-linear approaches. Regression models were conducted to examine log hair cortisol concentration and change in log hair cortisol concentration as predictors of changes in body weight, change in body fat percentage and body weight variability. After adjustment for lifestyle and demographic factors, no associations between baseline log hair cortisol concentration and outcome measures were observed. Similar results were seen when analysing the association between 12-month concurrent development in log hair cortisol concentration and outcomes. However, an initial 12-month increase in log hair cortisol concentration was associated with a higher subsequent body weight variability between month 12 and 18, based on deviations from a nonlinear trend (β: 0.02% per unit increase in log hair cortisol concentration [95% CI: 0.00, 0.04]; P=0.016). Our data suggest that an association between hair cortisol concentration and subsequent change in body weight or body fat percentage is absent or marginal, but that an increase in hair cortisol concentration during a 12-month weight loss maintenance effort may predict a slightly higher subsequent 6-months body weight variability. CLINICAL TRIAL REGISTRATION ISRCTN registry, identifier ISRCTN88405328.
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Affiliation(s)
- Sofus C. Larsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark
- *Correspondence: Sofus C. Larsen,
| | - Jake Turicchi
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | | | | | - Niklas R. Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie-Louise K. Mikkelsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark
| | - Graham Horgan
- Biomathematics and Statistics Scotland, Aberdeen, United Kingdom
| | - Ruairi O’Driscoll
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Joanna Michalowska
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Cristiana Duarte
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Sarah E. Scott
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Inês Santos
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Centro Interdisciplinar para o Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES), Universidade Lusófona, Lisbon, Portugal
| | - Jorge Encantado
- Centro Interdisciplinar para o Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Applied Psychology Research Center Capabilities & Inclusion (APPsyCI), Instituto Superior de Psicologia Aplicada (ISPA) - Instituto Universitário, Lisbon, Portugal
| | - Antonio L. Palmeira
- Centro Interdisciplinar para o Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES), Universidade Lusófona, Lisbon, Portugal
| | - R. James Stubbs
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Berit L. Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, NSW, Australia
- Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark
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13
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O'Connor EA, Evans CV, Rushkin MC, Redmond N, Lin JS. Behavioral Counseling to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2020; 324:2076-2094. [PMID: 33231669 DOI: 10.1001/jama.2020.17108] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Cardiovascular disease is the leading cause of death in the US, and poor diet and lack of physical activity are major factors contributing to cardiovascular morbidity and mortality. OBJECTIVE To review the benefits and harms of behavioral counseling interventions to improve diet and physical activity in adults with cardiovascular risk factors. DATA SOURCES MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through September 2019; literature surveillance through July 24, 2020. STUDY SELECTION English-language randomized clinical trials (RCTs) of behavioral counseling interventions to help people with elevated blood pressure or lipid levels improve their diet and increase physical activity. DATA EXTRACTION AND SYNTHESIS Data were extracted from studies by one reviewer and checked by a second. Random-effects meta-analysis and qualitative synthesis were used. MAIN OUTCOMES AND MEASURES Cardiovascular events, mortality, subjective well-being, cardiovascular risk factors, diet and physical activity measures (eg, minutes of physical activity, meeting physical activity recommendations), and harms. Interventions were categorized according to estimated contact time as low (≤30 minutes), medium (31-360 minutes), and high (>360 minutes). RESULTS Ninety-four RCTs were included (N = 52 174). Behavioral counseling interventions involved a median of 6 contact hours and 12 sessions over the course of 12 months and varied in format and dietary recommendations; only 5% addressed physical activity alone. Interventions were associated with a lower risk of cardiovascular events (pooled relative risk, 0.80 [95% CI, 0.73-0.87]; 9 RCTs [n = 12 551]; I2 = 0%). Event rates were variable; in the largest trial (Prevención con Dieta Mediterránea [PREDIMED]), 3.6% in the intervention groups experienced a cardiovascular event, compared with 4.4% in the control group. Behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure, low-density lipoprotein cholesterol levels, fasting glucose levels, and adiposity at 12 to 24 months' follow-up. Measurement of diet and physical activity was heterogeneous, and evidence suggested small improvements in diet consistent with the intervention recommendation targets but mixed findings and a more limited evidence base for physical activity. Adverse events were rare, with generally no group differences in serious adverse events, any adverse events, hospitalizations, musculoskeletal injuries, or withdrawals due to adverse events. CONCLUSIONS AND RELEVANCE Medium- and high-contact multisession behavioral counseling interventions to improve diet and increase physical activity for people with elevated blood pressure and lipid levels were effective in reducing cardiovascular events, blood pressure, low-density lipoproteins, and adiposity-related outcomes, with little to no risk of serious harm.
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Affiliation(s)
- Elizabeth A O'Connor
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Corinne V Evans
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan C Rushkin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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14
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Shoneye CL, Mullan B, Begley A, Pollard CM, Jancey J, Kerr DA. Design and Development of a Digital Weight Management Intervention (ToDAy): Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e17919. [PMID: 32641284 PMCID: PMC7511863 DOI: 10.2196/17919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/15/2020] [Accepted: 07/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Tailored Diet and Activity (ToDAy) study aims to build on the campaign by adding a digital intervention with the potential to provide wide-reaching, cost-effective weight management support. OBJECTIVE The ToDAy study aims to build a tailored intervention using mobile technology to improve diet and physical activity behaviours in adults with overweight and obesity. The main objectives were to identify behavior change techniques for diet and physical activity (PA) change for weight loss and explore preferences for digital intervention features that would be effective in changing diet and PA behaviors. METHODS This qualitative study uses the principles of a person-based approach to intervention development; the behavioral intervention technology framework; and the capability, opportunity, motivation, and behavior (COM-B) framework. Focus groups and telephone interviews were conducted with 56 adults in Western Australia. Open-ended questions and example intervention features were used to explore the usability and acceptability of the self-monitoring tools, knowledge about effective weight-loss strategies, and acceptability of tailored feedback. Findings from the focus groups and interviews were analyzed using thematic analysis. RESULTS Qualitative findings revealed an awareness of key public health messages but a lack of confidence in how to perform these behaviors to help manage their weight. A total of 4 major themes were identified and mapped to the domains of the COM-B framework: (1) misinformation, (2) environmental support, (3) social norms, and (4) confidence. CONCLUSIONS This study explores users' capability, opportunity, and motivation to perform the target behaviors for weight loss. The findings suggested that a digital weight management intervention using a mobile food record and activity trackers to inform tailored feedback may be acceptable and feasible. Participants expressed a preference for simple expert advice, digital self-monitoring tools, and visual feedback. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/12782.
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Affiliation(s)
- Charlene L Shoneye
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Barbara Mullan
- Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Andrea Begley
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Christina M Pollard
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,East Metropolitan Health Service, Perth, Western Australia, Australia
| | - Jonine Jancey
- Collaboration for Evidence Research & Impact in Public Health, School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Deborah A Kerr
- School of Public Health, Curtin University, Perth, Western Australia, Australia
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15
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Poltawski L, van Beurden SB, Morgan-Trimmer S, Greaves C. The dynamics of decision-making in weight loss and maintenance: a qualitative enquiry. BMC Public Health 2020; 20:573. [PMID: 32345251 PMCID: PMC7189456 DOI: 10.1186/s12889-020-08664-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/06/2020] [Indexed: 01/08/2023] Open
Abstract
Background Behavioural approaches to weight loss are often initially successful but less so in the longer term, as some people maintain the necessary behaviour changes while others do not. This study aimed to derive possible explanations for this using a qualitative approach with a view to improving intervention effectiveness. Methods Thirty-six participants in a development and feasibility study for a weight loss and maintenance intervention (called SkiM) were interviewed three times over 18 months regarding their experiences before, during and after the intervention. Data were analysed thematically. The accounts of those who were more and less successful in terms of longer term weight loss were compared, and a conceptual model linking the main analytic themes was developed. Results Five interpretative themes were generated: encountering and managing key situations; the impact of emotion; the source of control; personal values; and acquiring knowledge and skills. These themes were linked through a model of decision-making during key situations. In this model, behavioural decisions emerge from a dynamic interplay between several drivers: emotional state and needs, perceived control, personal values, the individual’s knowledge and skills, and their existing habits. The individual’s response in key situations generates experiential learning that can influence decisional dynamics in similar situations in future. These dynamics appeared to differ between participants, and between those who were more and less successful in weight management. Conclusions Our analysis and model of decision-making during weight-management have implications for the development and delivery of behavioural weight management interventions. By helping individuals to identify the drivers of their decision-making in key situations, and equipping them to manage these drivers, programmes may enhance their capacity to sustain the behaviour changes needed for long-term weight loss.
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Affiliation(s)
- Leon Poltawski
- University of Exeter Medical School, St Luke's, Heavitree Rd, Exeter, EX1 2LU, UK.
| | - Samantha Barbara van Beurden
- University of Exeter Medical School, St Luke's, Heavitree Rd, Exeter, EX1 2LU, UK.,School of Psychological Science, University of Bristol, Priory Road Complex, Priory Road, Bristol, BS8 1TU, UK
| | - Sarah Morgan-Trimmer
- University of Exeter Medical School, St Luke's, Heavitree Rd, Exeter, EX1 2LU, UK
| | - Colin Greaves
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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16
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Cruwys T, Norwood R, Chachay VS, Ntontis E, Sheffield J. "An Important Part of Who I am": The Predictors of Dietary Adherence among Weight-Loss, Vegetarian, Vegan, Paleo, and Gluten-Free Dietary Groups. Nutrients 2020; 12:nu12040970. [PMID: 32244576 PMCID: PMC7231009 DOI: 10.3390/nu12040970] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 01/24/2023] Open
Abstract
Weight-loss diets are notorious for their low adherence, which is a barrier to efforts to reduce population rates of overweight and obesity. However, there is some evidence that adherence is better among people on other kinds of diets, such as vegan and gluten free. This study aimed to explore the predictors of dietary adherence across five restrictive dietary patterns (vegan, vegetarian, paleo, gluten free, and weight loss). This study used both qualitative and quantitative methods among 292 adult community members who were following a restrictive dietary pattern. Personality, mental health, and motivational predictors of adherence were examined. Substantial differences in adherence were found between dietary groups, with vegans and vegetarians being particularly high in adherence and gluten-free and weight-loss dieters being comparably low. Four consistent predictors of adherence across different dietary patterns were supported in both the quantitative and qualitative analyses. Self-efficacy and social identification with one's dietary group positively predicted adherence. Conversely, being motivated in one's dietary choices by mood or by weight control negatively predicted adherence. These findings speak to the importance of social and motivational factors in determining adherence. The results also illustrate the utility of looking beyond weight-loss dieters and virtuous individual traits for insights into how adherence may be improved.
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Affiliation(s)
- Tegan Cruwys
- Research School of Psychology, The Australian National University, Canberra ACT 2601, Australia
- Correspondence: ; Tel.: +61-2-6125-5023
| | - Rebecca Norwood
- School of Psychology, The University of Queensland, Brisbane QLD 4072, Australia; (R.N.); (J.S.)
| | - Veronique S. Chachay
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane QLD 4072, Australia;
| | - Evangelos Ntontis
- School of Psychology, Politics, and Sociology, Canterbury Christ Church University, Canterbury CT1 1QU, Kent, UK;
| | - Jeanie Sheffield
- School of Psychology, The University of Queensland, Brisbane QLD 4072, Australia; (R.N.); (J.S.)
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17
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Phelan S, Halfman T, Pinto AM, Foster GD. Behavioral and Psychological Strategies of Long-Term Weight Loss Maintainers in a Widely Available Weight Management Program. Obesity (Silver Spring) 2020; 28:421-428. [PMID: 31970912 PMCID: PMC7003766 DOI: 10.1002/oby.22685] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/02/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study's purpose was to use validated questionnaires to identify novel behavioral and psychological strategies among weight loss maintainers (WLMs) in a commercial weight management program. METHODS Participants were 4,786 WLMs in WW (formerly Weight Watchers, New York, New York) who had maintained weight loss ≥ 9.1 kg (24.7 kg/23.8% weight loss on average) for 3.3 years and had a current mean BMI of 27.6 kg/m2 . A control group of 528 weight-stable individuals with obesity had a mean BMI of 38.9 kg/m2 and weight change < 2.3 kg over the previous 5 years. RESULTS WLMs versus Controls practiced more frequent healthy dietary choices (3.3 vs. 1.9; η p 2 = 0.37), self-monitoring (2.6 vs. 0.7; η p 2 = 0.30), and psychological coping (2.5 vs. 1.1; η p 2 = 0.25) strategies. WLMs also reported more willingness to ignore food cravings (4.4 vs. 3.5; η p 2 = 0.16) and had greater habit strength for healthy eating (5.3 vs. 3.2; η p 2 = 0.21). Standard canonical coefficients indicated that dietary (0.52), self-monitoring (0.40), and psychological (0.14) strategies as well as habit strength for healthy eating (0.15) contributed independently and most (49.5% of variance) to discriminating groups. CONCLUSIONS In a widely available weight management program, more frequent practice of healthy dietary, self-monitoring, and psychological coping strategies as well as development of greater habit strength for healthy eating differentiated long-term WLMs from weight-stable individuals with obesity.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology and Public Health & Center for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Tate Halfman
- Department of Kinesiology and Public Health & Center for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Angela Marinilli Pinto
- WW International, Inc.New YorkNew YorkUSA
- Psychology DepartmentBaruch CollegeCity University of New YorkNew YorkNew YorkUSA
| | - Gary D. Foster
- WW International, Inc.New YorkNew YorkUSA
- Center for Weight and Eating DisordersPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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18
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Nasrallah C, Kimmel L, Khaled SM. Associations between weight loss difficulty, disordered eating behaviors and poor weight loss outcomes in Arab female university students. Eat Behav 2020; 36:101363. [PMID: 31972513 DOI: 10.1016/j.eatbeh.2020.101363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 01/04/2020] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
Little is known about the impact of eating behaviors on weight management efforts among college students in non-Western settings. This study aimed to explore the relationship between eating behaviors, weight loss outcomes, and perceived weight loss difficulties (PWLD) among young Arab women trying to lose weight. A cross-sectional probability sample was used to recruit female university students aged 18 years and older in the state of Qatar. Participants (N = 937) completed an online survey measuring their attitudes and behaviors towards healthy eating, body image, and weight loss. More than two third (67.2%) reported facing difficulties when trying to lose weight and around one-third (31.2%) screened positive for disordered eating. Chi-squared and logistic regression analyses showed a strong and independent association between unsuccessful weight loss including lack of weight loss or maintenance after weight loss attempts, and PWLD (OR 8.6, p = .002). In addition, eating meals a few hours before sleeping (OR 1.98; p = .02) and having disordered eating (OR 2.28; p = .02) were positively associated with PWLD. BMI, weight loss goal and skipping breakfast were not associated with PWLD after adjustment for all covariates. Future studies are needed to develop better tools to comprehensively assess PWLD and validate against short- and long-term measured weight loss outcomes.
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Affiliation(s)
- Catherine Nasrallah
- Social and Economic Survey Research Institute, Qatar University, Doha, Qatar.
| | - Linda Kimmel
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
| | - Salma M Khaled
- Social and Economic Survey Research Institute, Qatar University, Doha, Qatar.
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19
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Kwon YK, Kim SY, Lim YW, Park YB. Review on Predictors of Weight Loss Maintenance after Successful Weight Loss in Obesity Treatment. ACTA ACUST UNITED AC 2019. [DOI: 10.15429/jkomor.2019.19.2.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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20
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Fitzpatrick SL, Brooks N, Bray B, Stevens VJ. Adherence to behavioral recommendations for weight loss and associated psychosocial factors among African American adults. J Behav Med 2019; 43:859-864. [PMID: 31617048 DOI: 10.1007/s10865-019-00108-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 10/03/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify patterns of behavioral adherence among 388 African Americans who participated in the Weight Loss Maintenance trial and examine associated psychosocial factors. METHODS Using repeated measures latent class analysis, we modeled patterns of adherence to recommendations regarding fruit and vegetable, total fat, and saturated fat intake and physical activity at baseline, 6, and 18 months. Latent classes were compared on the SF-36 (mental health composite and vitality subscale), Perceived Stress Scale, and PHQ-8 at each time point. RESULTS Three distinct latent classes emerged: Nutrition Adherers (n = 96); Physical Activity Adherers (n = 61); and Non-Adherers (n = 231). All groups showed initial improvement in psychosocial measures followed by relapse. Non-Adherers had significantly lower mean mental health and vitality scores and higher depression scores than adherers at 6 and 18 months. CONCLUSION Psychological well-being should be addressed with African Americans in weight loss treatment to enhance behavior change and improve weight loss outcomes.
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Affiliation(s)
- Stephanie L Fitzpatrick
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
| | - Neon Brooks
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Bethany Bray
- The Methodology Center, Penn State University, State College, PA, USA
| | - Victor J Stevens
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR, 97227, USA
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21
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Khoo J, Hsiang JC, Taneja R, Koo SH, Soon GH, Kam CJ, Law NM, Ang TL. Randomized trial comparing effects of weight loss by liraglutide with lifestyle modification in non-alcoholic fatty liver disease. Liver Int 2019; 39:941-949. [PMID: 30721572 DOI: 10.1111/liv.14065] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/29/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS We compared the effects of weight loss induced with the glucagon-like peptide-1 agonist liraglutide, with that of lifestyle modification, followed by weight maintenance after discontinuing intervention, in obese adults with non-alcoholic fatty liver disease (NAFLD). METHODS Thirty obese (mean age 40.7 ± 9.1 years, BMI 33.2 ± 3.6 kg/m2 , 90% male) adults with NAFLD defined as liver fat fraction (LFF) > 5% on magnetic resonance imaging without other causes of hepatic steatosis were randomized to a supervised programme of energy restriction plus moderate-intensity exercise to induce ≥ 5% weight loss (DE group, n = 15), or liraglutide 3 mg daily (LI group, n = 15) for 26 weeks, followed by 26 weeks with only advice to prevent weight regain. RESULTS Diet and exercise and LI groups had significant (P < 0.01) and similar reductions in weight (-3.5 ± 3.3 vs -3.0 ± 2.2 kg), LFF (-8.1 ± 13.2 vs -7.0 ± 7.1%), serum alanine aminotransferase (-39 ± 35 vs -26 ± 33 U/L) and caspase-cleaved cytokeratin-18 (cCK-18) (-206 ± 252 vs -130 ± 158 U/L) at 26 weeks. At 52 weeks, the LI group significantly (P < 0.05) regained weight (1.8 ± 2.1 kg), LFF (4.0 ± 5.3%) and cCK-18 (72 ± 126 U/L), whereas these were unchanged in the DE group. CONCLUSIONS Liraglutide was effective for decreasing weight, hepatic steatosis and hepatocellular apoptosis in obese adults with NAFLD, but benefits were not sustained after discontinuation, in contrast with lifestyle modification. Continuing the exercise learned in the structured programme contributed to the maintenance of liver fat reduction.
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Affiliation(s)
- Joan Khoo
- Department of Endocrinology, Changi General Hospital, Singapore
| | - John C Hsiang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Ranu Taneja
- Department of Diagnostic Radiology, Changi General Hospital, Singapore
| | - Seok-Hwee Koo
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Gaik-Hong Soon
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Carmen J Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Ngai-Moh Law
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Tiing-Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
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22
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Norwood R, Cruwys T, Chachay VS, Sheffield J. The psychological characteristics of people consuming vegetarian, vegan, paleo, gluten free and weight loss dietary patterns. Obes Sci Pract 2019; 5:148-158. [PMID: 31019732 PMCID: PMC6469437 DOI: 10.1002/osp4.325] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/30/2018] [Accepted: 12/14/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Previous research has identified several psychological factors associated with dietary restriction but has focused almost exclusively on the subcategory of people following a weight loss diet. Little is known about the psychological factors associated with other kinds of restrictive dietary patterns. Furthermore, it remains unclear whether the identified psychological characteristics of dieters (e.g. elevated disordered eating behaviours, poor well-being) are a cause of dieting, follow from calorie restriction or are the result of cognitive restraint. METHODS This study conducted the first direct comparison of people (N = 393) following five different restrictive dietary patterns (vegetarian, vegan, gluten free, paleo and weight loss) as well as a comparison group who were not following a specific dietary pattern. RESULTS The weight loss group had more negative psychological characteristics than all other groups, reporting the highest levels of eating disorder symptoms (M = 1.50), food cravings (M = 69.39), emotional eating (M = 2.97) and negative affect (M = 19.72). By contrast, several of the other restrictive dietary groups showed a number of psychological strengths, relative to the comparison group. This was particularly apparent among the paleo group, who reported the lowest levels of eating disorder symptoms (M = 0.74), food cravings (M = 47.63), emotional eating (M = 2.30) and negative affect (M = 14.81). By contrast, people following vegetarian and gluten free diets were largely the same as the non-restricted comparison group in their psychological characteristics. CONCLUSIONS People adhering to different dietary patterns showed stark differences in their psychological characteristics. Indeed, some restrictive dietary patterns (paleo and vegan) were associated with more positive psychological characteristics than seen in an unrestricted comparison group. This suggests that the psychological risk factors seen in weight loss dieters are not attributable to a restrictive dietary regimen per se.
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Affiliation(s)
- R. Norwood
- School of PsychologyUniversity of QueenslandBrisbaneAustralia
| | - T. Cruwys
- School of PsychologyUniversity of QueenslandBrisbaneAustralia
- Research School of PsychologyAustralian National UniversityCanberraAustralia
| | - V. S. Chachay
- School of Human Movement and Nutrition SciencesUniversity of QueenslandBrisbaneAustralia
| | - J. Sheffield
- School of PsychologyUniversity of QueenslandBrisbaneAustralia
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23
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Gilbert L, Gross J, Lanzi S, Quansah DY, Puder J, Horsch A. How diet, physical activity and psychosocial well-being interact in women with gestational diabetes mellitus: an integrative review. BMC Pregnancy Childbirth 2019; 19:60. [PMID: 30732571 PMCID: PMC6367798 DOI: 10.1186/s12884-019-2185-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Gestational Diabetes Mellitus (GDM) is associated with future cardio-metabolic risks for the mother and her child. In addition, one-third of women with recent GDM develop postpartum depression. Given these adverse impacts of GDM on the health of the mother and her offspring, it is important to intervene on modifiable factors, such as diet, physical activity, and psychosocial well-being. This integrative review therefore explored evidence on how these modifiable factors interact in women with GDM and their offspring, and how effective combined interventions are on reducing adverse impacts of GDM. Methods A comprehensive search strategy included carefully selected terms that corresponded to the domains of interest (diet, physical activity and psychosocial well-being). The databases searched for articles published between 1980 and February 2018 were: CINAHL, PsycINFO, Embase, Pubmed and Cochrane. Studies that were included in this review were either observational or intervention studies that included at least two domains of interest. Articles had to at least report data on maternal outcomes of women with GDM. Results The search strategies identified 14′419 citations after excluding duplicates. After screening titles and then abstracts, 114 articles were selected for detailed evaluation of their full text, and 16 were included in this review: two observational and 14 intervention studies. Results from observational studies showed that psychosocial well-being (social support and self-efficacy) were positively associated with physical activity and dietary choice. Intervention studies always included diet and physical activity interventions, although none integrated psychosocial well-being in the intervention. These lifestyle interventions mostly led to increased physical activity, improved diet and lower stress perception. Many of these lifestyle interventions also reduced BMI and postpartum diabetes status, improved metabolic outcomes and reduced the risk of preterm deliveries and low birth weight. Conclusion This integrative review showed that psychosocial well-being interacted with diet as well as with physical activity in women with GDM. We recommend that future studies consider integrating psychosocial well-being in their intervention, as observational studies demonstrated that social support and self-efficacy helped with adopting a healthy lifestyle following GDM diagnosis. Electronic supplementary material The online version of this article (10.1186/s12884-019-2185-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leah Gilbert
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland.
| | - Justine Gross
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland.,Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Stefano Lanzi
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland.,Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Dan Yedu Quansah
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Jardena Puder
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010, Lausanne, Switzerland.,Neonatology service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland
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24
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Varkevisser RDM, van Stralen MM, Kroeze W, Ket JCF, Steenhuis IHM. Determinants of weight loss maintenance: a systematic review. Obes Rev 2019; 20:171-211. [PMID: 30324651 PMCID: PMC7416131 DOI: 10.1111/obr.12772] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/21/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Discerning the determinants of weight loss maintenance is important in the planning of future interventions and policies regarding overweight and obesity. We have therefore systematically synthesized recent literature on determinants of weight loss maintenance for individuals with overweight and obesity. METHODS With the use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, prospective studies were identified from searches in PubMed and PsycINFO from 2006 to 2016. We included articles investigating adults with overweight and obesity undergoing weight loss without surgery or medication. Included articles were scored on their methodological quality, and a best-evidence synthesis was applied to summarize the results. RESULTS Our search resulted in 8,222 articles of which 67 articles were selected. In total, 124 determinants were identified of which 5 were demographic, 59 were behavioural, 51 were psychological/cognitive and 9 were social and physical environmental determinants. We found consistent evidence that demographic determinants were not predictive of weight loss maintenance. Behavioural and cognitive determinants that promote a reduction in energy intake, an increase in energy expenditure and monitoring of this balance are predictive determinants. CONCLUSION This review identifies key determinants in weight loss maintenance. However, more research regarding cognitive and environmental determinants of weight loss maintenance is needed to advance our knowledge on determinants of weight loss maintenance.
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Affiliation(s)
- R D M Varkevisser
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M M van Stralen
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - W Kroeze
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - I H M Steenhuis
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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25
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Chad-Friedman E, Pearsall M, Miller KM, Wheeler AE, Denninger JW, Mehta DH, Dossett ML. Total Lifestyle Coaching: A Pilot Study Evaluating the Effectiveness of a Mind-Body and Nutrition Telephone Coaching Program for Obese Adults at a Community Health Center. Glob Adv Health Med 2018; 7:2164956118784902. [PMID: 30013821 PMCID: PMC6043923 DOI: 10.1177/2164956118784902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/25/2018] [Accepted: 05/30/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Stress and obesity are interrelated and common among low-income adults. Mind-body interventions have been shown to reduce psychological distress and have been incorporated into many weight loss interventions. However, few of these programs have incorporated a telephone coaching component. OBJECTIVE We designed and piloted a novel weight loss telephone coaching intervention for this population and examined its effectiveness on weight loss and improvements in health behaviors in obese community health center patients. METHODS This was a 6-month, single-arm, prospective, pre-post pilot study. The study took place at a community health center near Boston, Massachusetts. Participants were 27 overweight and obese community health center patients. The intervention consisted of one in-person intake with the registered dietitian, trained in mind-body approaches, and approximately 1 phone coaching session every 2 weeks for 6 consecutive months. Anthropometric data consisted of weight, body mass index (BMI), and blood pressure. Questionnaires consisted of the Perceived Stress Scale-10 item, the CIGNA Healthy Eating Survey, Section H: Behavioral Eating, a physical activity questionnaire, and a nutritional habits questionnaire. We used paired samples t tests to assess pre-post changes in weight, BMI, blood pressure, perceived stress, behavioral eating, and physical activity. We also conducted semistructured exit interviews to learn about participants' experiences in this program. RESULTS There was a trend toward weight reduction (P < .1, Cohen's d = 0.33) and significant improvements in systolic blood pressure (P = .001, Cohen's d = 0.72), perceived stress (P = .001, Cohen's d = 0.75), and behavioral eating (P = .009, Cohen's d = 0.54). Improvements in weight were sustained 6 months after completion of the intervention. CONCLUSION Results suggest that a telephone nutrition health coaching intervention is feasible and may facilitate weight loss in obese community health center patients. Future randomized-controlled studies are warranted to better understand these improvements. CLINICALTRIALSGOV REGISTRATION NCT03025217.
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Affiliation(s)
- Emma Chad-Friedman
- Benson-Henry Institute for Mind Body
Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Massachusetts
General Hospital, Boston, Massachusetts
| | - Melanie Pearsall
- Department of Nutrition and Food
Services, Ambulatory Nutrition Service, Massachusetts General Hospital, Boston,
Massachusetts
| | - Kathleen M Miller
- Benson-Henry Institute for Mind Body
Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy E Wheeler
- Division of General Internal Medicine,
Massachusetts General Hospital, Boston, Massachusetts
| | - John W Denninger
- Benson-Henry Institute for Mind Body
Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Massachusetts
General Hospital, Boston, Massachusetts
| | - Darshan H Mehta
- Benson-Henry Institute for Mind Body
Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Division of General Internal Medicine,
Massachusetts General Hospital, Boston, Massachusetts
| | - Michelle L Dossett
- Benson-Henry Institute for Mind Body
Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Division of General Internal Medicine,
Massachusetts General Hospital, Boston, Massachusetts
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Obara-Gołębiowska M, Brycz H, Lipowska M, Lipowski M. The Role of Motivation to Reduce Obesity among Elderly People: Response to Priming Temptation in Obese Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020244. [PMID: 29389858 PMCID: PMC5858313 DOI: 10.3390/ijerph15020244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 01/16/2023]
Abstract
The risk of obesity-related disorders is increased among the elderly, so changing eating habits can be an important element of prevention. The main aim of this article is to consider whether looking at pictures that present either fattening food or healthy food may motivate elderly people to change their nutrition habits. Might priming different kinds of food influence the attractiveness of the food for people in late adulthood undergoing obesity therapy? Based on priming theories, we analysed the effects of the conscious processing of stimuli associated with dietary habits in individuals aged with BMI ≥ 30 kg/m². Our experiments confirmed the influence of a higher-priority goal of "slimming" on the perception and internalization of nutrition-related stimuli. In response to such stimuli, individuals who are actively involved in weight reduction and health-oriented programs use strategies for resisting temptation and to effectively "slim". We present our findings in the context of their theoretical background and practical application.
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Affiliation(s)
- Małgorzata Obara-Gołębiowska
- Department of Psychology of Development and Education, University of Warmia and Mazury, Olsztyn Prawocheńskiego 13, 10-447 Olsztyn, Poland.
| | - Hanna Brycz
- Institute of Psychology, University of Gdansk, Bażyńskiego 4, 80-309 Gdansk, Poland.
| | - Małgorzata Lipowska
- Institute of Psychology, University of Gdansk, Bażyńskiego 4, 80-309 Gdansk, Poland.
| | - Mariusz Lipowski
- Department of Health Psychology, Gdansk University of Physical Education and Sport, Górskiego 1, 80-336 Gdansk, Poland.
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27
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Ritten A, LaManna J. Unmet needs in obesity management. J Am Assoc Nurse Pract 2017; 29:S30-S42. [DOI: 10.1002/2327-6924.12507] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 02/05/2023]
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28
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Zhou YE, Jackson CD, Oates VJ, Davis GW, Davis C, Takizala ZM, Akatue RA, Williams K, Liu J, Hébert JR, Patel KA, Buchowski MS, Schlundt DG, Hargreaves MK. Refining a Church-Based Lifestyle Intervention Targeting African-American Adults at Risk for Cardiometabolic Diseases: A Pilot Study. ACTA ACUST UNITED AC 2017; 7:96-114. [PMID: 33457107 DOI: 10.4236/ojepi.2017.72009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective The pilot study was intended to test the feasibility of a multiple-component lifestyle intervention targeting African American adults in a weight control and cardiometabolic risk reduction program on diet, activity, and stress, using community-engagement principles. Methods Applying mixed qualitative and quantitative measures, the intervention had a two-part sequential study design consisting of 12 weekly small group sessions that provided individual and group counseling in nutrition, exercise, and mindfulness, while incorporating focus group and interactive techniques to learn about barriers and acceptable practices for this population. The program was implemented at an African-American church in Nashville, Tennessee. Results Thirty-four participants (aged 56.1 ± 11 years, body mass index (BMI) 36.7 ± 6.6 kg/m2) completed the intervention. Lifestyle changes after the 12 weekly sessions showed some positive trends including reduced sodium intake (from 2725.3 ± 326.5 to 2132 ± 330, mg/day, P = 0.008), increased walking steps (from 4392.1 ± 497.2 to 4895.3 ± 497.9, steps/day, not significant), and slightly decreased Perceived Stress Scale (PSS) scores (from 13.7 ± 1.4 to 12.4 ± 1.5, not significant). Body fat % among male participants decreased significantly (from 33.8 ± 2.6 to 28 ± 2.6, %, P = 0.043). Among cardiometabolic risk biomarkers, hemoglobin A1c (HbA1c) decreased significantly (from 6.6 ± 0.2 to 6.1 ± 0.2, %, P < 0.001). The baseline PSS score was positively associated with baseline adiposity levels (e.g., weight, β = 2.4, P = 0.006). Twenty-one participants took part in focus groups during the program to identify barriers to healthy lifestyle changes. Primary barriers reported were price, time for preparing healthy meals, unfamiliarity with mindfulness activities, their health condition, and daily schedule available for physical activities. Conclusions This church-based pilot intervention was proven feasible by showing modest progress in reducing adiposity and decreasing HbA1c levels. The focus group and interactive methods facilitated program direction. Future full-scale studies are warranted to identify key strategies that provide more personalized approaches and supportive environments to sustain a healthy lifestyle among these at risk minorities with limited resources.
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Affiliation(s)
- Yuan E Zhou
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Cynthia D Jackson
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Veronica J Oates
- Department of Family and Consumer Sciences, Tennessee State University, Nashville, TN, USA
| | - Gerald W Davis
- Ralph H Boston Wellness Center, Tennessee State University, Nashville, TN, USA
| | | | - Zudi-Mwak Takizala
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Richmond A Akatue
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Konya Williams
- Participant and Clinical Interactions Resources, Meharry Medical College, Nashville, TN, USA
| | - Jianguo Liu
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - James R Hébert
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, USA
| | - Kushal A Patel
- Department of Public Health, Tennessee State University, Nashville, USA
| | | | - David G Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
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Puhl RM, Quinn DM, Weisz BM, Suh YJ. The Role of Stigma in Weight Loss Maintenance Among U.S. Adults. Ann Behav Med 2017; 51:754-763. [DOI: 10.1007/s12160-017-9898-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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30
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Trief PM, Cibula D, Delahanty LM, Weinstock RS. Self-determination theory and weight loss in a Diabetes Prevention Program translation trial. J Behav Med 2016; 40:483-493. [DOI: 10.1007/s10865-016-9816-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
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Chang MW, Nitzke S, Brown R, Egan MJB, Bendekgey CM, Buist D. Recruitment Challenges and Enrollment Observations from a Community Based Intervention ( Mothers In Motion) for Low-Income Overweight and Obese Women. Contemp Clin Trials Commun 2016; 5:26-33. [PMID: 28685168 PMCID: PMC5495550 DOI: 10.1016/j.conctc.2016.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Mothers In Motion (MIM), a randomized controlled trial, aimed to help young, low-income overweight and obese mothers prevent weight gain by promoting stress management, healthy eating, and physical activity. This paper describes MIM recruitment challenges and reports demographic characteristics affecting enrollment. METHODS Participants who were African American or Non-Hispanic White were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Michigan. We faced numerous recruitment challenges and learned that several strategies facilitated recruitment. Logistic regression analyses were performed to examine demographic characteristics that affect enrollment. RESULTS Women who had a higher body mass index (BMI, OR 1.06, 95% CI 1.02 - 1.10); were at late postpartum, (OR 1.24, 95% CI 1.10 - 1.40), were breastfeeding (OR 5.0, 95% CI 2.34 -10.65); or were at early postpartum and breastfeeding (OR 0.42, 95% CI 0.22 - 0.81) were more likely to enroll than their counterparts. Compared to African American women, Non-Hispanic White women were more likely to enroll (OR 1.77, 95% CI 1.29 - 2.42). Also, women who were non-smokers (OR 0.54, 95% CI 0.40 - 0.73) or had a higher education were more likely to enroll (OR 1.21, 95% CI 1.04 - 1.42) than those who smoked or had a lower education. CONCLUSION Future lifestyle behavioral intervention studies for similar target audiences may consider tailoring their recruitment messages based on relevant participant demographic characteristics identified as potential determinants of enrollment in this study.
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Affiliation(s)
- Mei-Wei Chang
- The Ohio State University, College of Nursing, 342 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, USA
| | - Susan Nitzke
- University of Wisconsin-Madison, Department of Nutritional Sciences, 1415 Linden Drive, Madison, WI 53706, USA
| | - Roger Brown
- University of Wisconsin-Madison, School of Nursing, 600 Highland Avenue, Madison, WI 53792, USA
| | - M Jean Brancheau Egan
- WIC Michigan Department of Health and Human Services, 320 South Walnut Street, Lansing, MI 48334, USA
| | | | - Diana Buist
- Calhoun County Public Health Department, WIC Program, 190 E. Michigan Avenue, Battle Creek, MI 49014, USA
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Lemstra M, Bird Y, Nwankwo C, Rogers M, Moraros J. Weight loss intervention adherence and factors promoting adherence: a meta-analysis. Patient Prefer Adherence 2016; 10:1547-59. [PMID: 27574404 PMCID: PMC4990387 DOI: 10.2147/ppa.s103649] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adhering to weight loss interventions is difficult for many people. The majority of those who are overweight or obese and attempt to lose weight are simply not successful. The objectives of this study were 1) to quantify overall adherence rates for various weight loss interventions and 2) to provide pooled estimates for factors associated with improved adherence to weight loss interventions. METHODS We performed a systematic literature review and meta-analysis of all studies published between January 2004 and August 2015 that reviewed weight loss intervention adherence. RESULTS After applying inclusion and exclusion criteria and checking the methodological quality, 27 studies were included in the meta-analysis. The overall adherence rate was 60.5% (95% confidence interval [CI] 53.6-67.2). The following three main variables were found to impact adherence: 1) supervised attendance programs had higher adherence rates than those with no supervision (rate ratio [RR] 1.65; 95% CI 1.54-1.77); 2) interventions that offered social support had higher adherence than those without social support (RR 1.29; 95% CI 1.24-1.34); and 3) dietary intervention alone had higher adherence than exercise programs alone (RR 1.27; 95% CI 1.19-1.35). CONCLUSION A substantial proportion of people do not adhere to weight loss interventions. Programs supervising attendance, offering social support, and focusing on dietary modification have better adherence than interventions not supervising attendance, not offering social support, and focusing exclusively on exercise.
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Affiliation(s)
| | | | | | - Marla Rogers
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Karfopoulou E, Anastasiou CA, Avgeraki E, Kosmidis MH, Yannakoulia M. The role of social support in weight loss maintenance: results from the MedWeight study. J Behav Med 2016; 39:511-8. [PMID: 26801339 DOI: 10.1007/s10865-016-9717-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
Abstract
The role of social support in weight management is not fully understood, as more support has been linked to both favorable and unfavorable outcomes. We examined social support in relation to weight loss maintenance, comparing between maintainers and regainers of weight loss. The MedWeight study is a Greek registry of people who have intentionally lost ≥10 % of their weight and are either maintaining this loss for over a year (maintainers), or have regained weight (regainers). Demographics and lifestyle habits questionnaires are completed online. Dietary assessment is carried out by two telephone 24 h recalls. Perceived social support was assessed by validated scales examining support from family and friends regarding healthy eating and exercise. 289 maintainers and 122 regainers participated. Regainers received more support compared to maintainers. However, maintainers reported receiving compliments and active participation, whereas regainers receiving verbal instructions and encouragements. Maintainers who received diet support displayed improved dietary intakes, such as lower energy intake; regainers' diet was unaffected by support. Positive, rather than instructive, support appears beneficial in weight loss maintenance.
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Affiliation(s)
- Eleni Karfopoulou
- Department of Nutrition and Dietetics, Harokopio University, El. Venizelou 70, 17671, Athens, Greece
| | - Costas A Anastasiou
- Department of Nutrition and Dietetics, Harokopio University, El. Venizelou 70, 17671, Athens, Greece
| | - Evangelia Avgeraki
- Department of Nutrition and Dietetics, Harokopio University, El. Venizelou 70, 17671, Athens, Greece
| | - Mary H Kosmidis
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, El. Venizelou 70, 17671, Athens, Greece.
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Green CA, Yarborough BJH, Leo MC, Stumbo SP, Perrin NA, Nichols GA, Stevens VJ. Weight maintenance following the STRIDE lifestyle intervention for individuals taking antipsychotic medications. Obesity (Silver Spring) 2015; 23:1995-2001. [PMID: 26334929 PMCID: PMC4586363 DOI: 10.1002/oby.21205] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 06/09/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Individuals taking antipsychotic medications have increased risk of obesity-related early morbidity/mortality. This report presents weight maintenance results from a successful weight loss and behavioral lifestyle change program developed for people taking antipsychotic medications. METHODS STRIDE was a two-arm randomized controlled trial. Intervention participants attended weekly group meetings for 6 months, then monthly group meetings for 6 months. Assessments were completed at baseline and at 6, 12, and 24 months. RESULTS At 24 months, intervention participants lost 3.7% of baseline weight and control participants 2.1%, a non-significant difference. Fasting glucose results followed a similar pattern. There was a statistically significant difference, however, for fasting insulin-the intervention group's levels decreased between the end of the intensive intervention (at 6 months) and 24 months (10.1-7.91 μU/mL); control participants' levels increased (11.66 to 12.92 μU/mL) during this period. There were also fewer medical hospitalizations among intervention participants (5.7%) than controls (21.1%; χ(2) = 8.47, P = 0.004) during the 12- to 24-month post-intervention maintenance period. CONCLUSIONS Weight change differences between arms diminished following the intervention period, though fasting insulin levels continued to improve. Reduced hospitalizations suggest that weight loss, even with regain, may have long-term positive benefits for people taking antipsychotic medications and may reduce costs.
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Affiliation(s)
- Carla A Green
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | | | - Michael C Leo
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Scott P Stumbo
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Nancy A Perrin
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Gregory A Nichols
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Victor J Stevens
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
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35
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Lemstra M, Rogers MR. The importance of community consultation and social support in adhering to an obesity reduction program: results from the Healthy Weights Initiative. Patient Prefer Adherence 2015; 9:1473-80. [PMID: 26508843 PMCID: PMC4610803 DOI: 10.2147/ppa.s91912] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Few community-based obesity reduction programs have been evaluated. After 153 community consultations, the City of Moose Jaw, SK, Canada, decided to initiate a free comprehensive program. The initiative included 71 letters of support from the Mayor, every family physician, cardiologist, and internist in the city, and every relevant community group including the Heart and Stroke Foundation, the Canadian Cancer Society, and the Public Health Agency of Canada. OBJECTIVE To promote strong adherence while positively influencing a wide range of physical and mental health variables measured through objective assessment or validated surveys. METHODS The only inclusion criterion was that the individuals must be obese adults (body mass index >30 kg/m(2)). Participants were requested to sign up with a "buddy" who was also obese and identify three family members or friends to sign a social support contract. During the initial 12 weeks, each individual received 60 group exercise sessions, 12 group cognitive behavioral therapy sessions, and 12 group dietary sessions with licensed professionals. During the second 12-week period, maintenance therapy included 12 group exercise sessions (24 weeks in total). RESULTS To date, 243 people have been referred with 229 starting. Among those who started, 183 completed the program (79.9%), while 15 quit for medical reasons and 31 quit for personal reasons. Mean objective reductions included the following: 31.0 lbs of body fat, 3.9% body fat, 2.9 in from the waist, 2.3 in from the hip, blood cholesterol by 0.5 mmol/L, systolic blood pressure by 5.9 mmHg, and diastolic blood pressure by 3.2 mmHg (all P<0.000). There were no changes in blood sugar levels. There was also statistically significant differences in aerobic fitness, self-report health, quality of life measured by Short Form-36, and depressed mood measured by Beck Depression Inventory-II (all P<0.000). Independent risk factors for not completing the program were not having a family member or friend sign a social support contract (odds ratio 2.91, 95% confidence interval 1.01-8.34, P=0.047) and lower education (odds ratio 2.90, 95% confidence interval 1.20-7.03, P=0.018). CONCLUSION Comprehensive obesity reduction programs can be effective when there is extensive consultation at the community level and social support at the individual level.
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Affiliation(s)
- Mark Lemstra
- Alliance Wellness and Rehabilitation, Moose Jaw, SK, Canada
- Correspondence: Mark Lemstra, Alliance Wellness and Rehabilitation, B70 500-1st Avenue North West, Moose Jaw, SK, Canada, Tel +1 306 230 3911, Fax +1 306 693 6202, Email
| | - Marla R Rogers
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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