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Thomas JG, Panza E, Goldstein CM, Hayes JF, Benedict N, O’Leary K, Wing RR. Pragmatic Implementation of Online Obesity Treatment and Maintenance Interventions in Primary Care: A Randomized Clinical Trial. JAMA Intern Med 2024; 184:502-509. [PMID: 38466266 PMCID: PMC10928540 DOI: 10.1001/jamainternmed.2023.8438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/18/2023] [Indexed: 03/12/2024]
Abstract
Importance Behavioral weight loss interventions have achieved success in primary care; however, to our knowledge, pragmatic implementation of a fully automated treatment that requires little researcher oversight has not been tested. Moreover, weight loss maintenance remains a challenge. Objective To evaluate the long-term effectiveness of an automated, online, behavioral obesity treatment program (Rx Weight Loss [RxWL]) at 12 months (primary end point) and 24 months when delivered pragmatically in primary care and to compare the effectiveness of 3 weight loss maintenance approaches. Design, Setting, and Participants This randomized clinical trial of RxWL, an online weight loss program, recruited patients from a Rhode Island primary care network with approximately 60 practices and 100 physicians. Eligible participants were primary care patients aged 18 to 75 years with overweight or obesity who were referred by their nurse care manager and enrolled between 2018 and 2020. All participants were included in the intention-to-treat analysis, whereas only those who engaged with maintenance intervention were included in the per-protocol analysis. Data were analyzed from August 2022 to September 2023. Interventions All participants were offered the same 3-month weight loss program, with randomization to one of three 9-month maintenance programs: control intervention (monthly online newsletters), monthly intervention (9 monthly video lessons and 1 week of self-monitoring per month), or refresher intervention (an introductory session and two 4-week periods of lessons and self-monitoring at 7 and 10 months). Main Outcomes and Measures The primary outcome was weight change at 12 months using height and weight data collected from electronic medical records through 24 months. Results Among the 540 participants (mean [SD] age, 52.8 [13.4] years; 384 females [71.1%]) in the intention-to-treat analysis, mean estimated 3-month weight loss was 3.60 (95% CI, -4.32 to -2.88) kg. At the 12-month primary end point, the amount of weight regained in the monthly (0.37 [95% CI, -0.06 to 0.81] kg) and refresher (0.45 [95% CI, 0.27 to 0.87] kg) maintenance groups was significantly less than that in the newsletter control maintenance group (1.28 [95% CI, 0.85 to 1.71] kg; P = .004). The difference in weight regain between the monthly and refresher maintenance groups was not statistically significant. This pattern persisted at 24 months. In the per-protocol analysis of 253 participants, mean weight loss at the end of the initial 3-month intervention was 6.19 (95% CI, -7.25 to -5.13) kg. Similarly, at 12 months there was less weight regain in the monthly (0.61 kg) and refresher (0.96 kg) maintenance groups than in the newsletter control maintenance group (1.86 kg). Conclusions and Relevance Results of this randomized clinical trial indicate that pragmatic implementation of a 12-month automated, online, behavioral obesity treatment that includes 9 months of active maintenance produces clinically significant weight loss over 2 years in primary care patients with overweight or obesity. These findings underscore the importance of providing ongoing maintenance intervention to prevent weight regain. Trial Registration ClinicalTrials.gov Identifier: NCT03488212.
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Affiliation(s)
- J. Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Emily Panza
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Carly M. Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jacqueline F. Hayes
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Noah Benedict
- Rhode Island Primary Care Physicians Corporation, Cranston
| | - Kevin O’Leary
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rena R. Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Han Y, Sung H, Kim G, Ryu Y, Yoon J, Kim YS. Effects of a Web-based Weight Management Education Program on Various Factors for Overweight and Obese Women: Randomized Controlled Trial. JMIR Cardio 2024; 8:e42402. [PMID: 38635975 PMCID: PMC11066746 DOI: 10.2196/42402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/22/2023] [Accepted: 03/23/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Mediated diet and exercise methods yield effective short-term weight loss but are costly and hard to manage. However, web-based programs can serve many participants, offering ease of access and cost-efficiency. OBJECTIVE This study aimed to compare the effectiveness of a web-based weight management program through web-based education alone (MINE) or combined with tailored video feedback (MINE Plus) with a control (CO) group. METHODS This intervention included 60 Korean women with overweight and obesity (BMI≥23 kg/m2) aged 19 years to 39 years old. We randomly allocated 60 participants to each of 3 groups: (1) MINE group (web-based education video and self-monitoring app), (2) MINE Plus group (web-based education video, self-monitoring app, and 1:1 tailored video feedback), and (3) CO group (only self-monitoring app). Web-based education included nutrition, physical activity, psychological factors, medical knowledge for weight loss, goal setting, and cognitive and behavioral strategies. Tailored feedback aimed to motivate and provide solutions via weekly 10-minute real-time video sessions. The intervention lasted 6 weeks, followed by a 6-week observation period to assess the education's lasting effects, with evaluations at baseline, 6 weeks, and 12 weeks. A generalized linear mixed model was used to evaluate time and group interactions. RESULTS In the intention-to-treat analysis including all 60 participants, there were significant differences in weight change at 6 weeks in the MINE and MINE Plus groups, with mean weight changes of -0.74 (SD 1.96) kg (P=.03) and -1.87 (SD 1.8) kg (P<.001), respectively, while no significant change was observed in the CO group, who had a mean weight increase of 0.03 (SD 1.68) kg (P=.91). After 12 weeks, changes in body weight were -1.65 (SD 2.64) kg in the MINE group, -1.59 (SD 2.79) kg in the MINE Plus group, and 0.43 (SD 1.42) kg in the CO group. There was a significant difference between the MINE and MINE Plus groups (P<.001). Significant group × time effects were found for body weight in the MINE and CO groups (P<.001) and in the MINE Plus and CO groups (P<.001), comparing baseline and 12 weeks. Regarding physical activity and psychological factors, only body shape satisfaction and health self-efficacy were associated with improvements in the MINE and MINE Plus groups (P<.001). CONCLUSIONS This study found that the group receiving education and tailored feedback showed significant weight loss and improvements in several psychological factors, though there were differences in the sustainability of the effects. TRIAL REGISTRATION Korea Disease Control and Prevention Agency (KDCA) KCT0007780: https://cris.nih.go.kr/cris/search/detailSearch.do/22861.
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Affiliation(s)
- Yunmin Han
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
| | - Hoyong Sung
- Department of Military Kinesiology, Korea Military Academy, Seoul, Republic of Korea
| | - Geonhui Kim
- Department of Aviation Sports, Korea Air Force Academy, Cheongju, Republic of Korea
| | - Yeun Ryu
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
| | - Jiyeon Yoon
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Yeon Soo Kim
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
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Jiang S, Ng JYY, Chong KH, Peng B, Ha AS. Effects of eHealth Interventions on 24-Hour Movement Behaviors Among Preschoolers: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e52905. [PMID: 38381514 PMCID: PMC10918543 DOI: 10.2196/52905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/04/2023] [Accepted: 01/18/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The high prevalence of unhealthy movement behaviors among young children remains a global public health issue. eHealth is considered a cost-effective approach that holds great promise for enhancing health and related behaviors. However, previous research on eHealth interventions aimed at promoting behavior change has primarily focused on adolescents and adults, leaving a limited body of evidence specifically pertaining to preschoolers. OBJECTIVE This review aims to examine the effectiveness of eHealth interventions in promoting 24-hour movement behaviors, specifically focusing on improving physical activity (PA) and sleep duration and reducing sedentary behavior among preschoolers. In addition, we assessed the moderating effects of various study characteristics on intervention effectiveness. METHODS We searched 6 electronic databases (PubMed, Ovid, SPORTDiscus, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) for experimental studies with a randomization procedure that examined the effectiveness of eHealth interventions on 24-hour movement behaviors among preschoolers aged 2 to 6 years in February 2023. The study outcomes included PA, sleep duration, and sedentary time. A meta-analysis was conducted to assess the pooled effect using a random-effects model, and subgroup analyses were conducted to explore the potential effects of moderating factors such as intervention duration, intervention type, and risk of bias (ROB). The included studies underwent a rigorous ROB assessment using the Cochrane ROB tool. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment. RESULTS Of the 7191 identified records, 19 (0.26%) were included in the systematic review. The meta-analysis comprised a sample of 2971 preschoolers, which was derived from 13 included studies. Compared with the control group, eHealth interventions significantly increased moderate to vigorous PA (Hedges g=0.16, 95% CI 0.03-0.30; P=.02) and total PA (Hedges g=0.37, 95% CI 0.02-0.72; P=.04). In addition, eHealth interventions significantly reduced sedentary time (Hedges g=-0.15, 95% CI -0.27 to -0.02; P=.02) and increased sleep duration (Hedges g=0.47, 95% CI 0.18-0.75; P=.002) immediately after the intervention. However, no significant moderating effects were observed for any of the variables assessed (P>.05). The quality of evidence was rated as "moderate" for moderate to vigorous intensity PA and sedentary time outcomes and "low" for sleep outcomes. CONCLUSIONS eHealth interventions may be a promising strategy to increase PA, improve sleep, and reduce sedentary time among preschoolers. To effectively promote healthy behaviors in early childhood, it is imperative for future studies to prioritize the development of rigorous comparative trials with larger sample sizes. In addition, researchers should thoroughly examine the effects of potential moderators. There is also a pressing need to comprehensively explore the long-term effects resulting from these interventions. TRIAL REGISTRATION PROSPERO CRD42022365003; http://tinyurl.com/3nnfdwh3.
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Affiliation(s)
- Shan Jiang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Johan Y Y Ng
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Kar Hau Chong
- School of Health and Society and Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Bo Peng
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Amy S Ha
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
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Chew HSJ, Achananuparp P, Dalakoti M, Chew NWS, Chin YH, Gao Y, So BYJ, Shabbir A, Peng LE, Ngiam KY. Public acceptance of using artificial intelligence-assisted weight management apps in high-income southeast Asian adults with overweight and obesity: a cross-sectional study. Front Nutr 2024; 11:1287156. [PMID: 38385011 PMCID: PMC10879329 DOI: 10.3389/fnut.2024.1287156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction With in increase in interest to incorporate artificial intelligence (AI) into weight management programs, we aimed to examine user perceptions of AI-based mobile apps for weight management in adults with overweight and obesity. Methods 280 participants were recruited between May and November 2022. Participants completed a questionnaire on sociodemographic profiles, Unified Theory of Acceptance and Use of Technology 2 (UTAUT2), and Self-Regulation of Eating Behavior Questionnaire. Structural equation modeling was performed using R. Model fit was tested using maximum-likelihood generalized unweighted least squares. Associations between influencing factors were analyzed using correlation and linear regression. Results 271 participant responses were analyzed, representing participants with a mean age of 31.56 ± 10.75 years, median (interquartile range) BMI, and waist circumference of 27.2 kg/m2 (24.2-28.4 kg/m2) and 86.4 (80.0-94.0) cm, respectively. In total, 188 (69.4%) participants intended to use AI-assisted weight loss apps. UTAUT2 explained 63.3% of the variance in our intention of the sample to use AI-assisted weight management apps with satisfactory model fit: CMIN/df = 1.932, GFI = 0.966, AGFI = 0.954, NFI = 0.909, CFI = 0.954, RMSEA = 0.059, SRMR = 0.050. Only performance expectancy, hedonic motivation, and the habit of using AI-assisted apps were significant predictors of intention. Comparison with existing literature revealed vast variabilities in the determinants of AI- and non-AI weight loss app acceptability in adults with and without overweight and obesity. UTAUT2 produced a good fit in explaining the acceptability of AI-assisted apps among a multi-ethnic, developed, southeast Asian sample with overweight and obesity. Conclusion UTAUT2 model is recommended to guide the development of AI-assisted weight management apps among people with overweight and obesity.
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Affiliation(s)
- Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Palakorn Achananuparp
- School of Computing and Information Systems, Singapore Management University, Singapore, Singapore
| | - Mayank Dalakoti
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Nicholas W. S. Chew
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yujia Gao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
| | - Bok Yan Jimmy So
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
| | - Asim Shabbir
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
| | - Lim Ee Peng
- School of Computing and Information Systems, Singapore Management University, Singapore, Singapore
| | - Kee Yuan Ngiam
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
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Oginni J, Otinwa G, Gao Z. Physical Impact of Traditional and Virtual Physical Exercise Programs on Health Outcomes among Corporate Employees. J Clin Med 2024; 13:694. [PMID: 38337388 PMCID: PMC10856341 DOI: 10.3390/jcm13030694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Technology-based exercise programs have the potential to reduce chronic disease prevalence and obesity-related risks. This research focuses on the impact of both traditional and virtual exercise programs on the health metrics of corporate employees. Methods: The study involved 30 corporate employees (16 females, average age ± SD = 37.8 ± 8.8 years) from Nigeria, who were divided into two experimental groups (one experiencing traditional exercises with an on-site trainer, and the other participating in live, virtual classes via Zoom) and a control group continuing usual practices. The 6-week intervention measured several health outcomes, including resting heart rate, blood pressure (both diastolic and systolic), body mass index (BMI), waist circumference, and waist-hip ratio, both before and after the intervention. Results: One-way analysis of covariance yielded significantly greater decreases in the diastolic blood pressure, F(2,27) = 3.7, p < 0.04; systolic blood pressure F(2,27) = 3.5, p < 0.04, body mass index, F(2,26) = 7.8, p < 0.01, and waist circumference, F(2,27) = 39.1, p < 0.01. Conclusions: The study concludes that virtual-based exercise programs are as effective as traditional ones. Offering a virtual exercise option provides flexibility, potentially increasing adherence to exercise routines among corporate workers.
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Affiliation(s)
- John Oginni
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN 37996, USA;
| | - Grace Otinwa
- Department of Human Kinetics and Health Education, University of Lagos, Lagos 101017, Nigeria;
| | - Zan Gao
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN 37996, USA;
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Geurts KAM, Ozcan B, van Hoek M, van de Laar R, van Teeffelen J, van Rosmalen J, van Rossum EFC, Berk KA. The (cost) effectiveness of a very low-energy diet intervention with the use of eHealth in patients with type 2 diabetes and obesity: study protocol for a randomised controlled non-inferiority trial (E-diet trial). Trials 2023; 24:642. [PMID: 37798620 PMCID: PMC10557281 DOI: 10.1186/s13063-023-07620-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Despite preventive measures, the number of people with type 2 diabetes and obesity is increasing. Obesity increases morbidity and mortality in people with type 2 diabetes, making weight loss a cornerstone of treatment. We previously developed a very low energy diet (VLED) intervention that effectively reduced weight in people with type 2 diabetes in the long term. However, this intervention requires considerable time and manpower, which reduces the number of people who can benefit from it. eHealth offers more efficient solutions but has proven to be less effective than face-to-face interventions. Therefore, we want to investigate whether a blended version of our VLED intervention (in which face-to-face contact is partly replaced by an eHealth (mobile) application (E-VLED)) would be more cost-effective than the current face-to-face intervention. METHODS We will conduct a randomised, controlled trial with non-inferiority design in patients with type 2 diabetes and obesity (BMI > 30 kg/m2), aged 18-75 years. The control group will receive the usual care VLED intervention, while the intervention group will receive the E-VLED intervention for 1 year, where face-to-face contact will be partly replaced by an eHealth (mobile) application. The main study endpoint is the difference in weight (% change) between the control and intervention group after 1 year, plus the difference between the total costs (euro) of the treatment in the control and intervention groups. The secondary aims are to investigate the effectiveness of the E-VLED diet intervention regarding cardiovascular risk factors, quality of life, patient satisfaction, compliance, and to study whether there is a difference in effectiveness in pre-specified subgroups. General linear models for repeated measurements will be applied for the statistical analysis of the data. DISCUSSION We hypothesise that the E-VLED intervention will be equally effective compared to the usual care VLED but lower in costs due to less time invested by the dietician. This will enable to help more people with type 2 diabetes and obesity to effectively lose weight and improve their health-related quality of life. TRIAL REGISTRATION Netherlands Trial Register, NL7832, registered on 26 June 2019.
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Affiliation(s)
- Karlijn A M Geurts
- Department of Internal Medicine, Division of Dietetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Behiye Ozcan
- Department of Internal Medicine, Division of Diabetology and Division of Vascular Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Mandy van Hoek
- Department of Internal Medicine, Division of Diabetology and Division of Vascular Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Roel van de Laar
- Department of Internal Medicine, Ikazia Hospital, Montessoriweg 1, 3083 AN, Rotterdam, The Netherlands
| | - Jolande van Teeffelen
- Dietician Practice Health Risk Control, Henk Speksnijderstraat 27, 3067 AC, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Division of Endocrinology, Obesity Center CGG, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Kirsten A Berk
- Department of Internal Medicine, Division of Dietetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Sweeney AM, Wilson DK, Resnicow K, Van Horn ML, Kitzman H. Engagement With Tailored Physical Activity Content: Secondary Findings From the Families Improving Together for Weight Loss Randomized Controlled Trial. J Med Internet Res 2023; 25:e42581. [PMID: 37043271 PMCID: PMC10134014 DOI: 10.2196/42581] [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: 09/09/2022] [Revised: 01/29/2023] [Accepted: 02/24/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Web-based tailored interventions offer rich opportunities for improved access to and personalization of behavioral interventions. However, despite the promise of this approach, the engagement and underrepresentation of minority groups remain major issues. OBJECTIVE This study evaluated whether engagement (log-in status and log-in duration) with different types of tailored behavioral content from the Families Improving Together for weight loss web-based intervention was associated with changes in moderate to vigorous physical activity (MVPA) among African American families with overweight or obesity. METHODS Parent-adolescent dyads were randomized to a web-based tailored intervention or web-based health education comparison program. The web-based intervention (N=119) was completed by parents and targeted 6 weight-related behaviors to support their adolescent children's weight loss goals (session contents included energy balance, fast food, fruits and vegetables, physical activity [PA], sedentary behavior, and sweetened beverages). MVPA was measured using accelerometers at baseline and after the intervention. RESULTS Using a hierarchical approach, the log-in status and duration for each web-based session were used to evaluate the additive effects of engagement with different types of tailored behavioral content on MVPA after the web-based intervention. Among parents, logging in to the PA session was not associated with greater MVPA (B=-12.561, 95% CI -18.759 to -6.367), but MVPA increased with greater log-in duration for the PA (B=0.008, 95% CI 0.004-0.012) and sedentary behavior (B= 0.008, 95% CI 0.004-0.012) sessions. These results suggest that parents who logged in to the PA session had lower MVPA, but MVPA increased with greater log-in duration for the PA and sedentary behavior sessions. These associations remained even after accounting for engagement with other content sessions. However, these engagement effects did not translate to the adolescents. CONCLUSIONS The results of this study highlight the need to disentangle the impact of engagement with different tailored content to improve the efficacy of tailored web-based interventions, especially for promoting PA in African American families. TRIAL REGISTRATION ClinicalTrials.gov NCT01796067; https://clinicaltrials.gov/ct2/show/NCT01796067.
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Affiliation(s)
- Allison M Sweeney
- Department of Biobehavioral Health & Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, United States
| | - Kenneth Resnicow
- Department of Health Behavior & Health Education, University of Michigan, Ann Arbor, MI, United States
| | - M Lee Van Horn
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, NM, United States
| | - Heather Kitzman
- Baylor Scott and White Health, Baylor Scott & White Health and Wellness Center, Dallas, TX, United States
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Bricker JB, Mull KE, Sullivan BM, Forman EM, Lillis J, McTiernan A, Santiago-Torres M. Telehealth acceptance and commitment therapy for weight loss: Protocol of the WeLNES full scale randomized controlled trial. Contemp Clin Trials 2023; 126:107091. [PMID: 36682490 PMCID: PMC9998365 DOI: 10.1016/j.cct.2023.107091] [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: 10/06/2022] [Revised: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Behavioral interventions delivered via one-on-one telephone coaching (hereafter referred to as telehealth) for weight loss have had great population-level reach but to date limited efficacy. Acceptance and Commitment Therapy (ACT) has promise to improve behavioral weight loss treatment efficacy by addressing the fundamental challenges of weight loss and maintenance: overeating in response to internal (e.g., stress) and external (e.g., high calorie foods) cues. Here we describe the Weight Loss, Nutrition, and Exercise Study (WeLNES) randomized controlled trial that is testing the efficacy of an ACT-based telehealth coaching intervention for weight loss in comparison to a Standard Behavioral Therapy (SBT)-based telehealth coaching intervention. A total of 398 adults with overweight or obesity are being recruited and randomized to either ACT or SBT telehealth coaching. Participants in both arms are offered twenty-five telehealth coaching sessions in year one and nine booster sessions in year two. All participants receive a Bluetooth-enabled scale to self-monitor weight and a Fitbit Inspire + Fitbit app for tracking diet and physical activity. The primary aim is to determine whether a greater proportion of ACT participants will achieve a clinically significant weight loss of ≥10% compared with SBT participants at 12-months. Secondary outcomes include change in weight from baseline to 6, 12, and 24-months. Whether the effect of ACT on weight loss is mediated by ACT processes and is moderated by baseline factors will also be examined. If ACT proves efficacious, ACT telehealth coaching will offer an effective, broadly scalable weight loss treatment-thereby making a high public health impact.
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Affiliation(s)
- Jonathan B Bricker
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington, Department of Psychology, Seattle, WA, USA
| | - Kristin E Mull
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Brianna M Sullivan
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Evan M Forman
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA, USA
| | - Jason Lillis
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA; College of Psychology, California Northstate University, Elk Grove, CA, USA
| | - Anne McTiernan
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington School of Public Health, Department of Epidemiology, USA; University of Washington School of Medicine, Department of Medicine, USA
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The role of childhood trauma, obesity and inflammatory biomarkers in the adherence to a digital intervention among bipolar disorder outpatients: A cluster analyses. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Oliveira ACN, Guariente SMM, Zazula R, Mesas AE, Oliveira CEC, Reiche EMV, Nunes SOV. Hybrid and Remote Psychosocial Interventions Focused on Weight and Sedentary Behavior Management Among Patients with Severe Mental Illnesses: a Systematic Review. Psychiatr Q 2022; 93:813-840. [PMID: 35739407 PMCID: PMC9225878 DOI: 10.1007/s11126-022-09994-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 11/29/2022]
Abstract
Severe mental illness could be defined through its diagnosis, disability, and duration, and one of their main characteristics is the high prevalence of some clinical conditions such as obesity and metabolic syndrome. Although the promotion of a healthier lifestyle has been demonstrated as an effective strategy to reduce both body mass index and abdominal circumference in this population, there is a lack of studies focusing on digital intervention in this population. The aim of this systematic review was to evaluate the efficacy of studies that used digital technologies to reduce weight, body mass index (BMI) and abdominal circumference in individuals with severe mental illness. This current review also compared remote and hybrid interventions, the effects of those interventions in metabolic biomarkers as well as in the development of a healthier lifestyle. The main findings included the following: (a) the use of digital devices or strategies might be feasible and useful to reduce sedentary behavior among individuals with severe mental illnesses, 2) most interventions used digital pedometers and mobile phone communication (either text messages or phone calls) as main strategies, 3) all remote interventions and six of nine hybrid interventions found significant outcomes in favor of their interventions. In conclusion, even with a limited number of studies promoting healthier lifestyle through digital interventions among individuals with severe mental illnesses, evidence from studies included in this review showed that they might be useful to improve a healthier lifestyle and increase the frequency of physical activity behavior.
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Affiliation(s)
- Ana Cecília Novaes Oliveira
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | | | - Robson Zazula
- School of Medicine, Federal University of Latin American Integration, Foz do Iguacu, Parana, 85870-901, Brazil.
| | | | | | - Edna Maria Vissosi Reiche
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
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11
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Mobile health plus community health worker support for weight management among public housing residents (Path to Health): A randomized controlled trial protocol. Contemp Clin Trials 2022; 119:106836. [PMID: 35724842 PMCID: PMC9673759 DOI: 10.1016/j.cct.2022.106836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 05/04/2022] [Accepted: 06/13/2022] [Indexed: 11/21/2022]
Abstract
Interventions delivered by mobile devices (mHealth interventions) have the potential to increase access to weight management treatment in low-income populations. However, little prior research has examined effects of mHealth programming plus phone-based community health worker (CHW) support for weight management among public housing residents. For our intervention, we first interacted with a community advisory board to collect feedback on proposed intervention components. Transcripts from 5 advisory board meetings were coded and qualitative data was organized into themes. We used these data to inform our ongoing trial, in which public housing residents are randomized to one of three different groups: phone text messaging and digital self-weighing (mHealth only); mHealth intervention plus CHW behavioral phone counseling (mHealth+CHW); or assessment only to evaluate their differential effects on weight loss at 6- and 12-month follow-up. We will examine changes in diet and physical activity behaviors as well as potential mediating and moderating factors. Results of this trial could provide support for technology-based weight management interventions which may have greater potential for scalability and long-term dissemination than face-to-face programming. Clinical Trial Registration Number: NCT04852042.
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12
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Patton SR, Coffman MJ, De Haven MJ, Miller C, Krinner LM. Text Message Intervention for Latino Adults to Improve Diabetes Outcomes. HISPANIC HEALTH CARE INTERNATIONAL 2022; 20:248-255. [PMID: 35274994 DOI: 10.1177/15404153221084610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Determine the effectiveness of a diabetes text message intervention to improve diabetes outcomes in Latino adults at a free clinic in the southeastern United States. Methods: A pre-post, one-group design was used with a convenience sample (n = 24) of Latino adults with type 2 diabetes and A1C ≥ 7 who consented to participate. Over 8 weeks, participants were sent 23 educational and motivational text messages that were based on the American Association of Diabetes Educators (AADE) 7 self-care tasks and the American Diabetes Association (ADA) Standards of Medical Care in Diabetes Mellitus (DM). Diabetes knowledge, self-efficacy, self-care, and A1C were measured. Results: Diabetes knowledge, self-efficacy, self-care, and A1C improved after 8 weeks. Statistically significant results (p < .05) were seen in two of the four evaluation instruments administered (Spoken Knowledge in Low Literacy in Diabetes Scale [SKILLD], p = .001, Diabetes Self-Efficacy Scale [DSES], p = .000). A1C improvements were significant (0.86 or 10 mmol/mol) from the pre-intervention (M = 9.06 [76 mmol/mol], SD = 1.49) to the post-intervention (M = 8.20 [66 mmol/mol], SD = 1.27, t [23] = 3.02, p = .006). Conclusion: Personalized communication, education, and follow-up via text messages improved diabetes knowledge, self-efficacy, self-care, and A1C among pilot project participants. Text messages are a useful tool for diabetes management.
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Affiliation(s)
- Sharon R Patton
- Hunt School of Nursing, 15621Gardner-Webb University, Boiling Springs, NC, USA.,Nursing Administration, 587822Atrium Health Cabarrus, Concord, NC, USA.,School of Nursing, Adjunct Faculty Catawba College, Salisbury, NC, USA
| | | | - Mark J De Haven
- College of Health and Human Services, The University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Cindy Miller
- Hunt School of Nursing, 15621Gardner-Webb University, Boiling Springs, NC, USA
| | - Lisa M Krinner
- Department of Public Health Sciences, The University of North Carolina at Charlotte, Charlotte, NC, USA
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13
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Evans EW, Redmond EC. Assessing Existing Food Safety Resources with United Kingdom-Based Chemotherapy Patients and Family Caregivers for Future Learning Purposes. J Food Prot 2022; 85:287-310. [PMID: 34648623 DOI: 10.4315/jfp-21-311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/12/2021] [Indexed: 11/11/2022]
Abstract
ABSTRACT Because the incidence of foodborne infection is more prevalent among cancer patients and the domestic kitchen is a contributor to foodborne infection, appropriate domestic food safety practices are needed to safeguard this at-risk population. Although patients are aware of the increased risk of infection, previous self-reported data indicate potential food safety malpractices among patients and family caregivers, thus suggesting the need for targeted food safety information. However, existing United Kingdom resources provide inconsistent and insufficient food safety information. Involvement of intended end users in the cocreation of interventions increases potential effectiveness. Qualitative data were collated from in-depth interviews and a focus group with United Kingdom chemotherapy patients and family caregivers (n = 35) to determine perceptions and preferences for food safety information by evaluating existing food safety resources from international providers (n = 12). Although participants liked digital interventions (e.g., Web sites and videos), traditional paper-based leaflets were perceived as the most beneficial because they could be referred to on repeated occasions. Despite the drawbacks associated with some resources, combining approaches in a multiresource intervention was favored by patients and family caregivers. Ensuring patients are not overwhelmed with excessive information was important. Short, logical, engaging, educational, and entertaining information to evoke an interest in the topic was preferred. Utilization of graphics to supplement descriptive information may enhance comprehensibility. Interventions need to be appropriate for patients and caregivers, and delivery by trusted health care professionals may enhance the credibility of the message. Preferred approaches to facilitate targeted food safety communication were identified, and these findings can be utilized to cocreate targeted food safety interventions for chemotherapy patients and family caregivers. HIGHLIGHTS
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Affiliation(s)
- Ellen W Evans
- ZERO2FIVE Food Industry Centre, Cardiff Metropolitan University, 200 Western Avenue, Llandaff, Cardiff, Wales CF5 2YB
| | - Elizabeth C Redmond
- ZERO2FIVE Food Industry Centre, Cardiff Metropolitan University, 200 Western Avenue, Llandaff, Cardiff, Wales CF5 2YB
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14
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Lugones-Sanchez C, Recio-Rodriguez JI, Agudo-Conde C, Repiso-Gento I, G Adalia E, Ramirez-Manent JI, Sanchez-Calavera MA, Rodriguez-Sanchez E, Gomez-Marcos MA, Garcia-Ortiz L. Long-term Effectiveness of a Smartphone App Combined With a Smart Band on Weight Loss, Physical Activity, and Caloric Intake in a Population With Overweight and Obesity (Evident 3 Study): Randomized Controlled Trial. J Med Internet Res 2022; 24:e30416. [PMID: 35103609 PMCID: PMC8848250 DOI: 10.2196/30416] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/18/2021] [Accepted: 11/30/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Multicomponent mobile health approaches can improve lifestyle intervention results, although little is known about their long-term effectiveness. OBJECTIVE This study aims to evaluate the long-term effectiveness (12 months) of a multicomponent mobile health intervention-combining a smartphone app, an activity tracker wristband, and brief counseling, compared with a brief counseling group only-on weight loss and improving body composition, physical activity, and caloric intake in Spanish sedentary adults with overweight or obesity. METHODS We conducted a randomized controlled, multicenter clinical trial (Evident 3). A total of 650 participants were recruited from 5 primary care centers, with 318 participants in the intervention group (IG) and 332 in the control group (CG). All participants were briefly counseled about a healthy diet and physical activity at the baseline visit. For the 3-month intervention period, the IG received training to use the app to promote healthy lifestyles and the smart band (Mi Band 2, Xiaomi). All measurements were performed at baseline and at 3 and 12 months. Physical activity was measured using the International Physical Activity Questionnaire-Short Form. Nutritional habits were assessed using the Food Frequency Questionnaire and Adherence to Mediterranean diet questionnaire. RESULTS Of the 650 participants included, 563 (86.6%) completed the 3-month visit and 443 (68.2%) completed the 12-month visit. After 12 months, the IG showed net differences in weight (-0.26, 95% CI -1.21 to 0.70 kg; P=.02), BMI (-0.06, 95% CI -0.41 to 0.28 points; P=.01), waist-height ratio (-0.25, 95% CI -0.94 to 0.44; P=.03), body adiposity index (-0.33, 95% CI -0.77 to 0.11; P=.03), waist circumference (-0.48, 95% CI -1.62 to 0.66 cm, P=.04) and hip circumference (-0.69, 95% CI -1.62 to 0.25 cm; P=.03). Both groups lowered daily caloric intake and increased adherence to the Mediterranean diet, with no differences between the groups. The IG increased light physical activity time (32.6, 95% CI -30.3 to 95.04 min/week; P=.02) compared with the CG. Analyses by subgroup showed changes in body composition variables in women, people aged >50 years, and married people. CONCLUSIONS The low-intensity intervention of the Evident 3 study showed, in the IG, benefits in weight loss, some body composition variables, and time spent in light physical activity compared with the CG at 3 months, but once the devices were collected, the downward trend was not maintained at the 12-month follow-up. No differences in nutritional outcomes were observed between the groups. TRIAL REGISTRATION ClinicalTrials.gov NCT03175614; https://clinicaltrials.gov/ct2/show/NCT03175614. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1097/MD.0000000000009633.
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Affiliation(s)
- Cristina Lugones-Sanchez
- Primary Care Research Unit of Salamanca (APISAL), Institute of Biomedical Research of Salamanca, Health Service of Castilla y León, Salamanca, Spain
| | - Jose I Recio-Rodriguez
- Primary Care Research Unit of Salamanca (APISAL), Institute of Biomedical Research of Salamanca, Health Service of Castilla y León, Salamanca, Spain.,Department of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
| | - Cristina Agudo-Conde
- Primary Care Research Unit of Salamanca (APISAL), Institute of Biomedical Research of Salamanca, Health Service of Castilla y León, Salamanca, Spain
| | - Irene Repiso-Gento
- Renedo de Esgueva Health Center, Health Service of Castilla y León, Valladolid, Spain
| | - Esther G Adalia
- Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain
| | - José Ignacio Ramirez-Manent
- Calvià Primary Care Center, The Health Research Institute of the Balearic Islands, Health Service of Balearic Islands, Palma de Mallorca, Spain.,Department of Medicine, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Maria Antonia Sanchez-Calavera
- Las Fuentes Norte Health Center, Aragonese Group of Primary Care Research (GAIAP), Aragon Health Research Institute (IISA), Aragon Health Service, Zaragoza, Spain.,Department of Internal Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Emiliano Rodriguez-Sanchez
- Primary Care Research Unit of Salamanca (APISAL), Institute of Biomedical Research of Salamanca, Health Service of Castilla y León, Salamanca, Spain.,Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Manuel A Gomez-Marcos
- Primary Care Research Unit of Salamanca (APISAL), Institute of Biomedical Research of Salamanca, Health Service of Castilla y León, Salamanca, Spain.,Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Luis Garcia-Ortiz
- Primary Care Research Unit of Salamanca (APISAL), Institute of Biomedical Research of Salamanca, Health Service of Castilla y León, Salamanca, Spain.,Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
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- See Acknowledgements, Barcelona, Spain
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15
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Swindle T, Poosala AB, Zeng N, Børsheim E, Andres A, Bellows LL. Digital Intervention Strategies for Increasing Physical Activity Among Preschoolers: Systematic Review. J Med Internet Res 2022; 24:e28230. [PMID: 35014962 PMCID: PMC8790686 DOI: 10.2196/28230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/27/2021] [Accepted: 10/05/2021] [Indexed: 01/11/2023] Open
Abstract
Background Digital interventions are increasingly used to improve health behaviors. Improved access and lower costs (relative to in-person interventions) make such interventions appealing. Specifically, digital platforms may be a promising approach for increasing physical activity (PA) in young children. Objective The goal of this systematic review was three-pronged: (1) to determine the quality of studies using digital PA intervention strategies with preschool-aged children (ie, 3 to 5 years old); (2) to assess the efficacy of digital interventions and approaches designed to improve PA in preschool-aged children; and (3) to examine theoretical application and implementation outcomes with current approaches to digital PA interventions. Methods This review identified and summarized studies on digitally supported interventions for promoting PA in preschool-aged children. We generated 3 lists of relevant search terms that included technology-related terms, PA-related terms, and weight-related terms. The search included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Study selection was led by a single author and verified by a second; the same 2 authors assessed study quality using a standardized tool, and 3 authors completed data extraction on PA outcomes, theory application, and implementation outcomes. Results In total, 601 studies were identified; 8 met the inclusion criteria. For study quality, only 2 studies received an overall rating of strong quality and low risk of bias. All but 1 study had a small sample size (<100). Positive and significant changes in child PA outcomes were reported in only 2 studies with weak overall quality, both of which used child-directed approaches. In total, 5 studies applied a behavioral theory for designing the intervention; no patterns of effectiveness were identified based on the application of theory. Finally, no studies reported on the implementation outcomes of adoption, cost, penetration, or sustainability; 1 study did not assess any implementation outcomes, and no single study reported on more than 2 implementation outcomes. Studies measured the implementation outcome of acceptability most frequently (n=4), and researchers assessed fidelity in 3 studies. Conclusions The interventions with a significant effect on PA used child-centered activities; parent-directed digital interventions alone were ineffective for improving PA. Future research with rigorous designs, monitoring of implementation outcomes, and testing of the contributions of digital components will advance understanding of the effectiveness of digital interventions for increasing PA in children.
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Affiliation(s)
- Taren Swindle
- Department of Pediatrics, University of Arkansas Medical Sciences, Little Rock, AR, United States
| | | | - Nan Zeng
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
| | - Elisabet Børsheim
- Department of Pediatrics, University of Arkansas Medical Sciences, Little Rock, AR, United States.,Arkansas Children's Nutrition Center, Little Rock, AR, United States.,Arkansas Children's Research Institute, Little Rock, AR, United States
| | - Aline Andres
- Department of Pediatrics, University of Arkansas Medical Sciences, Little Rock, AR, United States.,Arkansas Children's Nutrition Center, Little Rock, AR, United States.,Arkansas Children's Research Institute, Little Rock, AR, United States
| | - Laura L Bellows
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
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16
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Mattila E, Hansen S, Bundgaard L, Ramsey L, Dunning A, Silva MN, Harjumaa M, Ermes M, Marques MM, Matos M, Larsen SC, Encantado J, Santos I, Horgan G, O'Driscoll R, Turicchi J, Duarte C, Palmeira AL, Stubbs RJ, Heitmann BL, Lähteenmäki L. Users' Experiences With the NoHoW Web-Based Toolkit With Weight and Activity Tracking in Weight Loss Maintenance: Long-term Randomized Controlled Trial. J Med Internet Res 2022; 24:e29302. [PMID: 35006081 PMCID: PMC8787666 DOI: 10.2196/29302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/19/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background Digital behavior change interventions (DBCIs) offer a promising channel for providing health promotion services. However, user experience largely determines whether they are used, which is a precondition for effectiveness. Objective The primary aim of this study is to evaluate user experiences with the NoHoW Toolkit (TK)—a DBCI that targets weight loss maintenance—over a 12-month period by using a mixed methods approach and to identify the main strengths and weaknesses of the TK and the external factors affecting its adoption. The secondary aim is to objectively describe the measured use of the TK and its association with user experience. Methods An 18-month, 2×2 factorial randomized controlled trial was conducted. The trial included 3 intervention arms receiving an 18-week active intervention and a control arm. The user experience of the TK was assessed quantitatively through electronic questionnaires after 1, 3, 6, and 12 months of use. The questionnaires also included open-ended items that were thematically analyzed. Focus group interviews were conducted after 6 months of use and thematically analyzed to gain deeper insight into the user experience. Log files of the TK were used to evaluate the number of visits to the TK, the total duration of time spent in the TK, and information on intervention completion. Results The usability level of the TK was rated as satisfactory. User acceptance was rated as modest; this declined during the trial in all the arms, as did the objectively measured use of the TK. The most appreciated features were weekly emails, graphs, goal setting, and interactive exercises. The following 4 themes were identified in the qualitative data: engagement with features, decline in use, external factors affecting user experience, and suggestions for improvements. Conclusions The long-term user experience of the TK highlighted the need to optimize the technical functioning, appearance, and content of the DBCI before and during the trial, similar to how a commercial app would be optimized. In a trial setting, the users should be made aware of how to use the intervention and what its requirements are, especially when there is more intensive intervention content. Trial Registration ISRCTN Registry ISRCTN88405328; https://www.isrctn.com/ISRCTN88405328 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2019-029425
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Affiliation(s)
- Elina Mattila
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | | | | | - Lauren Ramsey
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Alice Dunning
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Marlene N Silva
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde, Faculdade de Educação Física e Desporto, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Miikka Ermes
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Marta M Marques
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Marcela Matos
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Sofus C Larsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Denmark
| | - Jorge Encantado
- Centro Interdisciplinar De Estudo Da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal.,Applied Psychology Research Center Capabilities & Inclusion, ISPA - Instituto Universitário, Lisbon, Portugal
| | - Inês Santos
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde, Faculdade de Educação Física e Desporto, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal.,Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - 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
| | - Jake Turicchi
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Cristiana Duarte
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.,Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - António L Palmeira
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde, Faculdade de Educação Física e Desporto, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal
| | - R James Stubbs
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Denmark.,Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark
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17
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O'Boyle J, Davidson P. The Effects of mHealth Versus eHealth on Weight Loss in Adults. TOP CLIN NUTR 2022. [DOI: 10.1097/tin.0000000000000268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Chatterjee A, Prinz A, Gerdes M, Martinez S. Digital Interventions on Healthy Lifestyle Management: Systematic Review. J Med Internet Res 2021; 23:e26931. [PMID: 34787575 PMCID: PMC8663673 DOI: 10.2196/26931] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/07/2021] [Accepted: 08/10/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Digital interventions have tremendous potential to improve well-being and health care conveyance by improving adequacy, proficiency, availability, and personalization. They have gained acknowledgment in interventions for the management of a healthy lifestyle. Therefore, we are reviewing existing conceptual frameworks, digital intervention approaches, and associated methods to identify the impact of digital intervention on adopting a healthier lifestyle. OBJECTIVE This study aims to evaluate the impact of digital interventions on weight management in maintaining a healthy lifestyle (eg, regular physical activity, healthy habits, and proper dietary patterns). METHODS We conducted a systematic literature review to search the scientific databases (Nature, SpringerLink, Elsevier, IEEE Xplore, and PubMed) that included digital interventions on healthy lifestyle, focusing on preventing obesity and being overweight as a prime objective. Peer-reviewed articles published between 2015 and 2020 were included. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and a framework for an evidence-based systematic review. Furthermore, we improved the review process by adopting the Rayyan tool and the Scale for the Assessment of Narrative Review Articles. RESULTS Our initial searches identified 780 potential studies through electronic and manual searches; however, 107 articles in the final stage were cited following the specified inclusion and exclusion criteria. The identified methods for a successful digital intervention to promote a healthy lifestyle are self-monitoring, self-motivation, goal setting, personalized feedback, participant engagement, psychological empowerment, persuasion, digital literacy, efficacy, and credibility. In this study, we identified existing conceptual frameworks for digital interventions, different approaches to provide digital interventions, associated methods, and execution challenges and their impact on the promotion of healthy lifestyle management. CONCLUSIONS This systematic literature review selected intervention principles (rules), theories, design features, ways to determine efficient interventions, and weaknesses in healthy lifestyle management from established digital intervention approaches. The results help us understand how digital interventions influence lifestyle management and overcome the existing shortcomings. It serves as a basis for further research with a focus on designing, developing, testing, and evaluating the generation of personalized lifestyle recommendations as a part of digital health interventions.
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Affiliation(s)
- Ayan Chatterjee
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Andreas Prinz
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Martin Gerdes
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Santiago Martinez
- Department of Health and Nursing Science, Centre for e-Health, University of Agder, Grimstad, Norway
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19
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Berry R, Kassavou A, Sutton S. Does self-monitoring diet and physical activity behaviors using digital technology support adults with obesity or overweight to lose weight? A systematic literature review with meta-analysis. Obes Rev 2021; 22:e13306. [PMID: 34192411 DOI: 10.1111/obr.13306] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 01/30/2023]
Abstract
Establish whether digital self-monitoring of diet and physical activity is effective at supporting weight loss, increasing physical activity and improving eating behavior in adults with obesity or overweight, and determine the intervention components that might explain variations in its effectiveness. A systematic search of MEDLINE, Embase, PsycINFO, Web of Science, Scopus, Cinahl, and CENTRAL identified 4068 studies, of which 12 randomized controlled trials were eligible and included in the review. A random-effect meta-analysis evaluated intervention effectiveness and subgroup analyses tested for effective intervention content. Twelve studies were included in the review and meta-analysis. Digital self-monitoring of both diet and physical activity had a statistically significant effect at supporting weight loss (mean difference [MD] = -2.87 [95% CI -3.78, -1.96], P < 0.001, I2 = 69%), improving moderate physical activity (standardized mean difference [SMD] = 0.44 [95% CI 0.26, 0.62], P < 0.001, I2 = 0%), and reducing calorie intake (MD = -181.71 [95% CI -304.72, -58.70], P < 0.01, I2 = 0%). Tailored interventions were significantly more effective than nontailored interventions (x2 = 12.92, P < 0.001). Digital self-monitoring of physical activity and diet is an effective intervention to support weight loss in adults with obesity or overweight. This effect is significantly associated with tailored advice. Future studies should use rigorous designs to explore intervention effectiveness to support weight loss as an adjunct to weight management services.
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Affiliation(s)
- Rhiannon Berry
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| | - Aikaterini Kassavou
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| | - Stephen Sutton
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
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20
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Bricker JB, Mull KE, Sullivan BM, Forman EM. Efficacy of telehealth acceptance and commitment therapy for weight loss: a pilot randomized clinical trial. Transl Behav Med 2021; 11:1527-1536. [PMID: 33787926 DOI: 10.1093/tbm/ibab012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Telehealth coaching for weight loss has high population-level reach but limited efficacy. To potentially improve on this limitation, the purpose of this study was to determine the preliminary efficacy of the first known telephone coaching acceptance and commitment therapy (ACT) intervention for weight loss. A two-arm, stratified, individually randomized pilot trial comparing ACT (n = 53) with standard behavioral therapy (SBT; n = 52) was used for this study. Both interventions were delivered in 25 telephone coaching calls (15-20 min each) over a 12 month period. Weight was measured at baseline and 3, 6, and 12 month postrandomization follow-ups. Recruited from 32 U.S. states, participants were of mean age 40.7, 42% male, 34% racial/ethnic minority, and mean baseline body mass index of 34.3. Fractions of 10% or more scale-reported weight loss: 15% for ACT versus 4% for SBT at 3 month follow-up (N = 86; odds ratio [OR] = 4.61; 95% confidence interval [CI]: 0.79, 26.83), 24% for ACT versus 13% for SBT at 6 month follow-up (N = 72; OR = 2.45; 95% CI: 0.65, 9.23), 30% for ACT versus 30% for SBT at 12 month follow-up (N = 57; OR = 0.93; 95% CI: 0.28, 3.09). Fractions of 10% or more self-reported weight loss at 12 month follow-up: 25% for ACT versus 15% for SBT (N = 75; OR = 2.38; 95% CI: 0.68, 8.34). The conclusion of the study was the preliminary evidence that telephone coaching ACT may be efficacious for weight loss.
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Affiliation(s)
- Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.,Department of Psychology, University of Washington, Seattle, WA 98195, USA
| | - Kristin E Mull
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Brianna M Sullivan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Evan M Forman
- Department of Psychology, and Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA 19104, USA
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21
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Lillis J, Dunsiger S, Thomas JG, Ross KM, Wing RR. Novel behavioral interventions to improve long-term weight loss: A randomized trial of acceptance and commitment therapy or self-regulation for weight loss maintenance. J Behav Med 2021; 44:527-540. [PMID: 33772702 DOI: 10.1007/s10865-021-00215-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
Maintenance of weight loss is hard to achieve, and novel interventions are needed to improve long-term outcomes. In this pilot randomized controlled trial, N = 188 participants received an online, 12-week weight loss intervention and N = 102 who lost ≥ 5% were then randomly assigned to a 1-day, 5-h workshop based on Acceptance and Commitment Therapy (ACT), Self-Regulation (SR), or no workshop (Control) with 3 months of limited email follow-up. Assessments were conducted at baseline, 3, 6, 12, 18, and 24 months. The primary outcome was percent weight change; secondary outcomes were weight-related experiential avoidance and health values-consistent behavior. ACT had greater overall weight loss (-7.18%, SE = 1.33) when compared to Control (-1.15%, SE = 1.50; p = .03). Post hoc analyses showed that ACT had significantly greater weight losses than Control (6.11%, β = -2.03, p = .048) among those with lower initial weight loss (5-7%), and significantly greater weight loss than SR (6.19%, β = -1.77, p = .05) among those with the highest initial weight losses (10% +). There is potential for continuing to develop ACT in a limited interventionist-contact format with modifications. This pilot study represents an innovative model for behavioral weight loss by reversing the typical treatment intensity model with the aim of providing interventionist support during a critical period after initial weight loss. REGISTRATION: Clinicaltrials.org #NCT02156752 https://www.clinicaltrials.gov/ct2/show/NCT02156752 .
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Affiliation(s)
- J Lillis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 20903, USA.
| | - S Dunsiger
- Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI, USA
| | - J G Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 20903, USA
| | - K M Ross
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - R R Wing
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 20903, USA
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22
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Lillis J, Schumacher L, Thomas JG, Levin ME, Dunsiger S, Unick JL, Evans E, Hayes JF, Wing RR. Study protocol for a randomized controlled trial comparing two low-intensity weight loss maintenance interventions based on acceptance and commitment therapy or self-regulation. Contemp Clin Trials 2021; 103:106327. [PMID: 33631360 DOI: 10.1016/j.cct.2021.106327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Weight regain is common following behavioral obesity treatment and attenuates many of the benefits of initial weight loss. This paper describes a randomized controlled trial that will evaluate the efficacy of two low-contact weight loss maintenance interventions based on Acceptance and Commitment Therapy (ACT) and self-regulation (SR). Potential mechanisms of action and moderators of treatment effects will also be evaluated. METHODS Adults (anticipated N = 480) with overweight or obesity will complete an initial 3-month online weight loss program (Phase 1). Participants who achieve ≥4 kg weight loss (anticipated N = 288) will then be randomized to an ACT or SR weight loss maintenance intervention. Both interventions will entail four 2.5 h, face-to-face, group-based workshop sessions and 6 months of email contact. Assessments will be conducted at phase 1 baseline, phase 1 completion/pre-randomization, and 6, 12, 18, 24, and 30 months post-randomization. The primary outcome will be weight change for the period from randomization to 30 months. Potential process measures including ACT-based constructs (e.g., psychological acceptance, values-consistent behavior), self-weighing frequency, and motivation will be also be assessed, as will potential moderators (e.g., initial weight loss). CONCLUSIONS This study will compare the efficacy of two intervention approaches (ACT and SR) delivered in a scalable workshop format for long-term weight loss maintenance. Future research could examine efficacy and cost-effectiveness of these approaches in real world settings.
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Affiliation(s)
- Jason Lillis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA.
| | - Leah Schumacher
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Michael E Levin
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Brown University, School of Public Health, Providence, RI, USA
| | - Jessica L Unick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Erin Evans
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Jacqueline F Hayes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
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23
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Fisher L, Glasgow RE, Huebschmann A. A Scoping Review and General User's Guide for Facilitating the Successful Use of eHealth Programs for Diabetes in Clinical Care. Diabetes Technol Ther 2021; 23:133-145. [PMID: 32865431 PMCID: PMC8020562 DOI: 10.1089/dia.2020.0383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The vast eHealth literature in diabetes can provide a useful foundation to aid in the selection, adoption, and implementation of eHealth methodologies in clinical care. Despite clear potential to enhance reach, efficiency, and clinical effectiveness, research has yielded mixed and often contradictory results, and wide-spread adoption and maintenance of eHealth programs in clinical care has been limited. Furthermore, few reports have identified the unique challenges that clinicians and health systems face when attempting to incorporate eHealth systems into clinical care. To address these gaps, we address two goals in this report: first, to summarize and integrate the major findings of the diabetes-related eHealth literature based on currently available systematic and narrative reviews; and second, based on the review, to provide practical guidelines to assist clinicians and health systems in selecting and implementing eHealth programs into diabetes care using dissemination and implementation science principles and perspectives.
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Affiliation(s)
- Lawrence Fisher
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Russell E. Glasgow
- Department of Family Medicine, and Adult and Child Consortium for Research in Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amy Huebschmann
- Virtual Diabetes Center, Division of General Internal Medicine, Center for Women's Health Research, and ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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24
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Food reward sensitivity, impulsivity, and weight change during and after a 3-month weight loss program. PLoS One 2020; 15:e0243530. [PMID: 33306690 PMCID: PMC7732120 DOI: 10.1371/journal.pone.0243530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/22/2020] [Indexed: 01/19/2023] Open
Abstract
Background Greater sensitivity to food rewards and higher levels of impulsivity (and an interaction between these variables, termed “reinforcement pathology”) have been associated with obesity in cross-sectional studies. Less is known regarding how these constructs may impact attempts at weight loss or longer-term weight loss maintenance. Methods We provided 75 adults (69%Female, 84%White, age = 50.8y, BMI = 31.2kg/m2) with a 3-month Internet-based weight loss program and assessed weight, food reward sensitivity (via the Power of Food Scale [PFS]), and impulsivity (via Go No-Go [GNG] and Delay Discounting [DD] computer tasks) at baseline and at Months 3, 6, 9, and 12. No additional intervention was provided Months 3–12. Multi-level mixed-effect models were used to examine changes in PFS, GNG, and DD over time and associations between these measures and weight loss/regain. Results Participants lost 6.0±1.1kg Months 0–3 and regained 2.4±1.1kg Months 3–12. Across time points, higher PFS scores were associated with higher weight, p = .007; however, there were no significant associations between GNG or DD and weight nor between the interactions of PFS and GNG or DD and weight, ps>.05. There were significant decreases from Months 0–3 in PFS, GNG, and DD, ps < .05; however, neither baseline values nor changes were significantly associated with weight change and there were no significant associations between the interactions of PFS and GNG or DD and weight change, ps>.05. Conclusion Results demonstrated an association between food reward sensitivity and weight. Further, decreases in both food reward sensitivity and impulsivity were observed during an initial weight loss program, but neither baseline levels nor improvements were associated with weight change. Taken together, results suggest that the constructs of food reward sensitivity, impulsivity, and reinforcement pathology may have limited clinical utility within behavioral weight management interventions. Future intervention studies should examine whether food-related impulsivity tasks lead to a similar pattern of results.
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25
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Rosas LG, Lv N, Xiao L, Lewis MA, Venditti EMJ, Zavella P, Azar K, Ma J. Effect of a Culturally Adapted Behavioral Intervention for Latino Adults on Weight Loss Over 2 Years: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2027744. [PMID: 33337491 PMCID: PMC7749441 DOI: 10.1001/jamanetworkopen.2020.27744] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/04/2020] [Indexed: 12/14/2022] Open
Abstract
Importance Identifying effective weight loss interventions for Latino adults at risk of diabetes is of critical public health importance. Objective To determine whether a culturally adapted behavioral intervention for Latino adults was more effective than usual care for weight loss over 24 months. Design, Setting, and Participants In this randomized clinical trial, Latino adults with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 24 or greater and a high risk for type 2 diabetes were recruited in primary care practices in the San Francisco, California, area, randomized to receive the Vida Sana intervention or usual care, and followed up for 24 months. The study was conducted from November 2015 to May 2019, and data were analyzed from July 2019 to Septmeber 2020. Interventions The treatment group received Vida Sana, a culturally adapted lifestyle intervention that included a family-based orientation session and 22 group sessions over 12 months. Participants were encouraged to use a wearable activity tracker and mobile applications to track their physical activity and dietary intake. Participants received monthly email messages for an additional 12 months. The control group received usual care. Main Outcomes and Measures The primary outcome was weight loss at 24 months. Secondary outcomes included weight loss at 12 months and achieving at least 5% weight loss at 12 and 24 months. Associations of baseline characteristics and intervention adherence with weight loss outcomes were also examined. Results Among 191 participants (mean [SD] age, 50.2 [12.2] years; 118 [61.8%] women; 107 participants [57.2%] of Mexican origin; mean [SD] baseline BMI, 32.4 [5.7]) randomized, 92 participants were randomized to the intervention and 99 participants were randomized to usual care. Of these, 185 participants (96.9%) completed 24-month follow-up. Mean (SD) weight loss did not differ significantly by group at 24 months (intervention: -1.1 [5.7] kg; control: -1.1 [7.1] kg; P = .93). However, mean (SD) weight loss was significantly greater in the intervention group (-2.6 [6.0] kg) than the control group (-0.3 [4.2] kg) at 12 months (mean difference, -2.1 [95% CI, -3.6 to -0.7] kg; P = .005). Intervention participants were more likely to achieve at least 5% weight loss than control participants at 12 months (22 participants [25.9%] vs 9 participants [9.2%]; P = .003), and participants who achieved at least 5% weight loss attended more intervention sessions than those who did not (mean [SD], 16.6 [7.6] sessions vs 12.4 [7.5] sessions; P = .03). Conclusions and Relevance These findings suggest that among Latino adults with high diabetes risk, a culturally adapted behavioral lifestyle intervention was effective for weight loss over 12 months but not 24 months. Trial Registration ClinicalTrials.gov Identifier: NCT02459691.
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Affiliation(s)
- Lisa G. Rosas
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Nan Lv
- Vitoux Program on Aging and Prevention, Department of Medicine, University of Illinois at Chicago, Chicago
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Megan A. Lewis
- Center for Communications Science, RTI International, Seattle, Washington
| | | | - Patricia Zavella
- Department of Latin American and Latino Studies, University of California, Santa Cruz
| | - Kristen Azar
- Sutter Health Center for Health Systems Research, Walnut Creek, California
| | - Jun Ma
- Vitoux Program on Aging and Prevention, Department of Medicine, University of Illinois at Chicago, Chicago
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26
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Reproductive Health Knowledge About Miscarriage: A Cross-Sectional Study of University Students. Matern Child Health J 2020; 25:282-292. [PMID: 33190195 DOI: 10.1007/s10995-020-03017-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess university students' knowledge of reproductive health information about miscarriage. METHODS A single-centre, cross-sectional study was carried out using an online survey at a higher education institution in the Republic of Ireland between April and May of 2016. A total of 746 university students' responses were analysed. RESULTS Approximately 60% and 70% of college students correctly identified features of first and second trimester miscarriage. After adjusting for confounders, male students were two times more likely to have a poor knowledge of features of miscarriage compared to females (aOR 2.0, 95% CI 1.3-3.0 and aOR 1.7, 95% CI 1.1-2.6 for first and second trimester respectively). Poor knowledge of features of first trimester miscarriage was less common among older students and students who were married, cohabiting or in a relationship (aOR 0.4, 95% CI 0.2-0.6 and aOR 0.4, 95% CI 0.3-0.8 respectively). Students who studied Medicine and Health were more likely to identify any type of treatment for miscarriage compared to students who studied other disciplines. Students who studied Arts and Social Science were more likely to overestimate the percentage of miscarriages with an identified cause compared to students who studied Medicine and Health. CONCLUSION Our results provide additional information about the gap of knowledge in regards to reproductive health information about miscarriage, specifically among university students.
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27
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Spring B, Pfammatter AF, Marchese SH, Stump T, Pellegrini C, McFadden HG, Hedeker D, Siddique J, Jordan N, Collins LM. A Factorial Experiment to Optimize Remotely Delivered Behavioral Treatment for Obesity: Results of the Opt-IN Study. Obesity (Silver Spring) 2020; 28:1652-1662. [PMID: 32656994 PMCID: PMC8045468 DOI: 10.1002/oby.22915] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Intensive behavioral obesity treatments face scalability challenges, but evidence is lacking about which treatment components could be cut back without reducing weight loss. The Optimization of Remotely Delivered Intensive Lifestyle Treatment for Obesity (Opt-IN) study applied the Multiphase Optimization Strategy to develop an entirely remotely delivered, technology-supported weight-loss package to maximize the amount of weight loss attainable for ≤$500. METHODS Six-month weight loss was examined among adults (N = 562) with BMI ≥ 25 who were randomly assigned to conditions in a factorial experiment crossing five dichotomous treatment components set to either low/high (12 vs. 24 coaching calls) or off/on (primary care provider reports, text messaging, meal replacements, and buddy training). RESULTS About 84.3% of participants completed the final assessment. The treatment package yielding maximum weight loss for ≤$500 included 12 coaching calls, buddy training, and primary care provider progress reports; produced average weight loss of 6.1 kg, with 57.1% losing ≥5% and 51.8% losing ≥7%; and cost $427 per person. The most expensive candidate-treatment component (24 vs. 12 coaching calls) was screened out of the optimized treatment package because it did not increase weight loss. CONCLUSIONS Systematically testing each treatment component's effect on weight loss made it possible to eliminate more expensive but less impactful components, yielding an optimized, resource-efficient obesity treatment for evaluation in a randomized controlled trial.
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Affiliation(s)
- Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Angela F. Pfammatter
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sara H. Marchese
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tammy Stump
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - H. Gene McFadden
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Donald Hedeker
- Department of Public Health Sciences, The University of Chicago, Chicago, IL
| | - Juned Siddique
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Neil Jordan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center of Innovation for Complex Chronic Healthcare, Edward J Hines VA Hospital, Hines, IL
| | - Linda M. Collins
- The Methodology Center and Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA
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28
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Bonn SE, Hult M, Spetz K, Löf M, Andersson E, Wiren M, Trolle Lagerros Y. App Technology to Support Physical Activity and Intake of Vitamins and Minerals After Bariatric Surgery (the PromMera Study): Protocol of a Randomized Controlled Clinical Trial. JMIR Res Protoc 2020; 9:e19624. [PMID: 32795990 PMCID: PMC7455871 DOI: 10.2196/19624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 01/24/2023] Open
Abstract
Background To optimize postoperative outcomes after bariatric surgery, lifestyle changes including increased physical activity are needed. Micronutrient deficiency after surgery is also common and daily supplementation is recommended. Objective The aim of the PromMera study is to evaluate the effects of a 12-week smartphone app intervention on promotion of physical activity (primary outcome) and adherence to postsurgery vitamin and mineral supplementation, as well as on other lifestyle factors and overall health in patients undergoing bariatric surgery. Methods The PromMera study is a two-arm, randomized controlled trial comprising patients undergoing bariatric surgery. Participants are randomized postsurgery 1:1 to either the intervention group (ie, use of the PromMera app for 12 weeks) or the control group receiving only standard care. Clinical and lifestyle variables are assessed pre- and postsurgery after 18 weeks (postintervention assessment), 6 months, 1 year, and 2 years. Assessments include body composition using Tanita or BOD POD analyzers, muscle function using handgrip, biomarkers in blood, and an extensive questionnaire on lifestyle factors. Physical activity is objectively measured using the ActiGraph wGT3X-BT triaxial accelerometer. Results A total of 154 participants have been enrolled in the study. The last study participant was recruited in May 2019. Data collection will be complete in May 2021. Conclusions Implementing lifestyle changes are crucial after bariatric surgery and new ways to reach patients and support such changes are needed. An app-based intervention is easily delivered at any time and can be a key factor in the adoption of healthier behavioral patterns in this rapidly growing group of patients. Trial Registration ClinicalTrials.gov NCT03480464; https://clinicaltrials.gov/ct2/show/NCT03480464 International Registered Report Identifier (IRRID) DERR1-10.2196/19624
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Affiliation(s)
- Stephanie Erika Bonn
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Mari Hult
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.,Division of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Spetz
- Department of Surgery, Linköping University, Norrköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Ellen Andersson
- Department of Surgery, Linköping University, Norrköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
| | - Mikael Wiren
- Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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29
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Bramante CT, Lee G, Amsili SS, Linde JA, Phelan SM, Appel LJ, Bennett WL, Clark JM, Gudzune KA. Minority and low-income patients are less likely to have a scale for self-weighing in their home: A survey in primary care. Clin Obes 2020; 10:e12363. [PMID: 32383356 PMCID: PMC7382396 DOI: 10.1111/cob.12363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/28/2020] [Accepted: 03/13/2020] [Indexed: 01/07/2023]
Abstract
Daily self-weighing is a weight management behaviour that requires a scale; however, scale ownership may be cost-prohibitive for some patients. Our objective was to understand the proportion of primary care patients with a scale at home, and factors associated with home scale access, to potentially inform future interventions that facilitate scale access. Cross sectional survey of 216 adult patients from three primary care clinics: mixed-income urban/suburban (n = 68); mixed-income urban (n = 70); low-income urban (n = 74). The dependent variable was presence of a home scale; bivariate associations were conducted with variables including demographics, insurance type, clinic setting and self-reported height/weight. Mean age was 53 years; 71% women; 71% racial minority; mean body mass index 32 kg/m2 . Overall, 56% had a home scale. Most (79%) white patients owned a scale, compared to 46% of racial minority patients (P < .01); 33% of low-income patients owned scale, compared to over 66% of patients at the clinics serving mixed-income populations (P < .01). Most low-income urban clinic patients do not own a home scale. Because self-weighing is an effective weight-management behaviour, clinicians could consider assessing scale access, and future research should assess the health impact of providing scales to patients with overweight/obesity who desire weight loss or maintenance.
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Affiliation(s)
- Carolyn T Bramante
- University of Minnesota Medical School, Division of General Internal Medicine, Minneapolis, Minnesota, USA
| | - Grace Lee
- Johns Hopkins University, Homewood Campus, Baltimore, Maryland, USA
| | - Safira S Amsili
- Johns Hopkins University, Homewood Campus, Baltimore, Maryland, USA
| | - Jennifer A Linde
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota, USA
| | - Sean M Phelan
- Mayo Clinic, Division of Health Care Policy and Research, Rochester, Minnesota, USA
| | - Lawrence J Appel
- Johns Hopkins School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
| | - Wendy L Bennett
- Johns Hopkins School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
| | - Jeanne M Clark
- Johns Hopkins School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
| | - Kimberly A Gudzune
- Johns Hopkins School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
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30
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Chhabria K, Ross KM, Sacco SJ, Leahey TM. The Assessment of Supportive Accountability in Adults Seeking Obesity Treatment: Psychometric Validation Study. J Med Internet Res 2020; 22:e17967. [PMID: 32720911 PMCID: PMC7420735 DOI: 10.2196/17967] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/01/2020] [Accepted: 04/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Technology-mediated obesity treatments are commonly affected by poor long-term adherence. Supportive Accountability Theory suggests that the provision of social support and oversight toward goals may help to maintain adherence in technology-mediated treatments. However, no tool exists to measure the construct of supportive accountability. OBJECTIVE This study aimed to develop and psychometrically validate a supportive accountability measure (SAM) by examining its performance in technology-mediated obesity treatment. METHODS Secondary data analyses were conducted in 2 obesity treatment studies to validate the SAM (20 items). Study 1 examined reliability, criterion validity, and construct validity using an exploratory factor analysis in individuals seeking obesity treatment. Study 2 examined the construct validity of SAM in technology-mediated interventions involving different self-monitoring tools and varying amounts of phone-based interventionist support. Participants received traditional self-monitoring tools (standard, in-home self-monitoring scale [SC group]), newer, technology-based self-monitoring tools (TECH group), or these newer technology tools plus additional phone-based support (TECH+PHONE group). Given that the TECH+PHONE group involves more interventionist support, we hypothesized that this group would have greater supportive accountability than the other 2 arms. RESULTS In Study 1 (n=353), the SAM showed strong reliability (Cronbach α=.92). A factor analysis revealed a 3-factor solution (representing Support for Healthy Eating Habits, Support for Exercise Habits, and Perceptions of Accountability) that explained 69% of the variance. Convergent validity was established using items from the motivation for weight loss scale, specifically the social regulation subscale (r=0.33; P<.001) and social pressure for weight loss subscale (r=0.23; P<.001). In Study 2 (n=80), the TECH+PHONE group reported significantly higher SAM scores at 6 months compared with the SC and TECH groups (r2=0.45; P<.001). Higher SAM scores were associated with higher adherence to weight management behaviors, including higher scores on subscales representing healthy dietary choices, the use of self-monitoring strategies, and positive psychological coping with weight management challenges. The association between total SAM scores and percent weight change was in the expected direction but not statistically significant (r=-0.26; P=.06). CONCLUSIONS The SAM has strong reliability and validity across the 2 studies. Future studies may consider using the SAM in technology-mediated weight loss treatment to better understand whether support and accountability are adequately represented and how supportive accountability impacts treatment adherence and outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT01999244; https://clinicaltrials.gov/ct2/show/NCT01999244.
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Affiliation(s)
- Karishma Chhabria
- The Center for Health Care Data, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Kathryn M Ross
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Shane J Sacco
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Tricia M Leahey
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
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Effect of Behavioral Weight Management Interventions Using Lifestyle mHealth Self-Monitoring on Weight Loss: A Systematic Review and Meta-Analysis. Nutrients 2020; 12:nu12071977. [PMID: 32635174 PMCID: PMC7400167 DOI: 10.3390/nu12071977] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 01/04/2023] Open
Abstract
Alongside an increase in obesity, society is experiencing the development of substantial technological advances. Interventions that are easily scalable, such as lifestyle (including diet and physical activity) mobile health (mHealth) self-monitoring, may be highly valuable in the prevention and treatment of excess weight. Thus, the aims of this systematic review and meta-analysis were to estimate the following: (i) the effect of behavioral weight management interventions using lifestyle mHealth self-monitoring on weight loss and (ii) the adherence to behavioral weight management interventions using lifestyle mHealth self-monitoring. MEDLINE via PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and the Web of Science databases were systematically searched. The DerSimonian and Laird method was used to estimate the effect of and adherence to behavioral weight management interventions using lifestyle mHealth self-monitoring on weight loss. Twenty studies were included in the systematic review and meta-analysis, yielding a moderate decrease in weight and higher adherence to intervention of behavioral weight management interventions using lifestyle mHealth self-monitoring, which was greater than other interventions. Subgroup analyses showed that smartphones were the most effective mHealth approach to achieve weight management and the effect of behavioral weight management interventions using lifestyle mHealth self-monitoring was more pronounced when compared to usual care and in the short-term (less than six months). Furthermore, behavioral weight management interventions using lifestyle mHealth self-monitoring showed a higher adherence than: (i) recording on paper at any time and (ii) any other intervention at six and twelve months.
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Parretti HM, Ives NJ, Tearne S, Vince A, Greenfield SM, Jolly K, Jebb SA, Frew E, Yardley L, Little P, Pritchett RV, Daley A. Protocol for the feasibility and acceptability of a brief routine weight management intervention for postnatal women embedded within the national child immunisation programme: randomised controlled cluster feasibility trial with nested qualitative study (PIMMS-WL). BMJ Open 2020; 10:e033027. [PMID: 32066605 PMCID: PMC7045221 DOI: 10.1136/bmjopen-2019-033027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/16/2019] [Accepted: 01/07/2020] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION On average women retain 5 to 9 kg 1 year after giving birth which can increase the risk of later obesity and chronic diseases. Some previous trials in this population have been effective in reducing weight, but are too intensive and costly to deliver at scale. There is a need for low-cost interventions to facilitate weight loss in this population. METHODS AND ANALYSIS The primary aim is to assess the feasibility of delivering a weight management intervention for overweight/obese postnatal women within child immunisation appointments. We will conduct a randomised controlled cluster feasibility trial with a nested qualitative study to assess study recruitment and acceptability of the intervention. General practitioner practice (cluster) will be the unit of randomisation, with practices randomised to offer usual care plus the intervention or usual care only. Eighty women will be recruited. The intervention group will be offered brief support that encourages self-management of weight when attending child immunisation appointments. Practice nurses will encourage women to weigh themselves weekly and record this, and to make healthy lifestyle choices through using an online weight management programme. Women will be advised to aim for 0.5 to 1 kg/week weight loss. At each child immunisation the nurse will assess progress by weighing women. The comparator group will receive a healthy lifestyle leaflet. Data on weight, body fat, depression, anxiety, body image, eating behaviours and physical activity will be collected at baseline and follow-up. Women and nurses will be interviewed to ascertain their views about the intervention. The decision to proceed to the phase III trial will be based on prespecified stop-go criteria. ETHICS AND DISSEMINATION Data will be stored securely at the University of Birmingham. Results will be disseminated through academic publications and presentations and will inform a possible phase III trial. The National Research Ethics Committee approved the study protocol. TRIAL REGISTRATION NUMBER ISRCTN12209332.
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Affiliation(s)
- Helen M Parretti
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Natalie J Ives
- Birmingham Clinical Trials Unit, Public Health Building, University of Birmingham, Birmingham, UK
| | - Sarah Tearne
- Birmingham Clinical Trials Unit, Public Health Building, University of Birmingham, Birmingham, UK
| | - Alexandra Vince
- Birmingham Clinical Trials Unit, Public Health Building, University of Birmingham, Birmingham, UK
| | - Sheila M Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
- Primary Care and Population Sciences, Aldermoor Health Centre, Aldermoor Close, Southampton, UK
| | - Paul Little
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Ruth V Pritchett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amanda Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Zarnowiecki D, Mauch CE, Middleton G, Matwiejczyk L, Watson WL, Dibbs J, Dessaix A, Golley RK. A systematic evaluation of digital nutrition promotion websites and apps for supporting parents to influence children's nutrition. Int J Behav Nutr Phys Act 2020; 17:17. [PMID: 32041640 PMCID: PMC7011240 DOI: 10.1186/s12966-020-0915-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background Globally children’s diet quality is poor. Parents are primary gatekeepers to children’s food intake; however, reaching and engaging parents in nutrition promotion can be challenging. With growth in internet and smartphone use, digital platforms provide potential to disseminate information rapidly to many people. The objectives of this review were to conduct a comprehensive and systematic evaluation of nutrition promotion via websites and apps supporting parents to influence children’s nutrition, from three different perspectives: 1) current evidence base, 2) end user (parent) experience and 3) current commercial offerings. Methods Three systematic reviews were undertaken of (1) studies evaluating the effectiveness for digital platforms for improving nutrition in children and parents, (2) studies conducting user-testing of digital tools with parents, (3) websites and apps providing lunch-provision information to parents. Searches were conducted in five databases for reviews one and two, and systematic search of Google and App Store for review three. Randomised controlled trials, cohort and cross-sectional and qualitative studies (study two only) were included if published in English, from 2013, with the intervention targeted at parents and at least 50% of intervention content focused on nutrition. Search results were double screened, with data extracted into standardised spreadsheets and quality appraisal of included search results. Results Studies evaluating digital nutrition interventions targeting parents (n = 11) demonstrated effectiveness for improving nutrition outcomes, self-efficacy and knowledge. Six of the included randomised controlled trials reported digital interventions to be equal to, or better than comparison groups. User-testing studies (n = 9) identified that digital platforms should include both informative content and interactive features. Parents wanted evidence-based information from credible sources, practical tools, engaging content and connection with other users and health professionals. Websites targeting lunch provision (n = 15) were developed primarily by credible sources and included information-based content consistent with dietary guidelines and limited interactive features. Lunchbox apps (n = 6), developed mostly by commercial organisations, were more interactive but provided less credible information. Conclusions Digital nutrition promotion interventions targeting parents can be effective for improving nutrition-related outcomes in children and parents. As demonstrated from the lunchbox context and user-testing with parents, they need to go beyond just providing information about positive dietary changes, to include the user-desired features supporting interactivity and personalisation.
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Affiliation(s)
- Dorota Zarnowiecki
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia.
| | - Chelsea E Mauch
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Georgia Middleton
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Louisa Matwiejczyk
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Wendy L Watson
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia
| | - Jane Dibbs
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia
| | - Anita Dessaix
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia
| | - Rebecca K Golley
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia
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Abstract
PURPOSE OF REVIEW This review synthesizes recent research on remotely delivered interventions for obesity treatment, including summarizing outcomes and challenges to implementing these treatments as well as outlining recommendations for clinical implementation and future research. RECENT FINDINGS There are a wide range of technologies used for delivering obesity treatment remotely. Generally, these treatments appear to be acceptable and feasible, though weight loss outcomes are mixed. Engagement in these interventions, particularly in the long term, is a significant challenge. Newer technologies are rapidly developing and enable tailored and adaptable interventions, though research in this area is in its infancy. Further research is required to optimize potential benefits of remotely delivered interventions for obesity.
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Affiliation(s)
- Lauren E Bradley
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd. Suite 400, Chicago, IL, 60612, USA.
| | - Christine E Smith-Mason
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd. Suite 400, Chicago, IL, 60612, USA
| | - Joyce A Corsica
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd. Suite 400, Chicago, IL, 60612, USA
| | - Mackenzie C Kelly
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd. Suite 400, Chicago, IL, 60612, USA
| | - Megan M Hood
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd. Suite 400, Chicago, IL, 60612, USA
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Cueto V, Wang CJ, Sanders LM. Impact of a Mobile App-Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study. JMIR Mhealth Uhealth 2019; 7:e14458. [PMID: 31730041 PMCID: PMC6884716 DOI: 10.2196/14458] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/12/2019] [Accepted: 08/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background Effective treatment of obesity in children and adolescents traditionally requires frequent in-person contact, and it is often limited by low participant engagement. Mobile health tools may offer alternative models that enhance participant engagement. Objective The aim of this study was to assess child engagement over time, with a mobile app–based health coaching and behavior change program for weight management, and to examine the association between engagement and change in weight status. Methods This was a retrospective cohort study of user data from Kurbo, a commercial program that provides weekly individual coaching via video chat and supports self-monitoring of health behaviors through a mobile app. Study participants included users of Kurbo between March 2015 and March 2017, who were 5 to 18 years old and who were overweight or obese (body mass index; BMI ≥ 85th percentile or ≥ 95th percentile) at baseline. The primary outcome, engagement, was defined as the total number of health coaching sessions received. The secondary outcome was change in weight status, defined as the change in BMI as a percentage of the 95th percentile (%BMIp95). Analyses of outcome measures were compared across three initial commitment period groups: 4 weeks, 12 to 16 weeks, or 24 weeks. Multivariable linear regression models were constructed to adjust outcomes for the independent variables of sex, age group (5-11 years, 12-14 years, and 15-18 years), and commitment period. A sensitivity analysis was conducted, excluding a subset of participants involuntarily assigned to the 12- to 16-week commitment period by an employer or health plan. Results A total of 1120 participants were included in analyses. At baseline, participants had a mean age of 12 years (SD 2.5), mean BMI percentile of 96.6 (SD 3.1), mean %BMIp95 of 114.5 (SD 16.5), and they were predominantly female 68.04% (762/1120). Participant distribution across commitment periods was 26.07% (292/1120) for 4 weeks, 61.61% (690/1120) for 12-16 weeks, and 12.32% (138/1120) for 24 weeks. The median coaching sessions (interquartile range) received were 8 (3-16) for the 4-week group, 9 (5-12) for the 12- to 16-week group, and 19 (11-25) for the 24-week group (P<.001). Adjusted for sex and age group, participants in the 4- and 12-week groups participated in –8.03 (95% CI –10.19 to –5.87) and –9.34 (95% CI –11.31 to –7.39) fewer coaching sessions, compared with those in the 24-week group (P<.001). Adjusted for commitment period, sex, and age group, the overall mean change in %BMIp95 was –0.21 (95% CI –0.25 to –0.17) per additional coaching session (P<.001). Conclusions Among overweight and obese children using a mobile app–based health coaching and behavior change program, increased engagement was associated with longer voluntary commitment periods, and increased number of coaching sessions was associated with decreased weight status.
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Affiliation(s)
- Victor Cueto
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States.,Division of General Internal Medicine, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - C Jason Wang
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States.,Center for Policy, Outcomes, and Prevention, Stanford University, Stanford, CA, United States
| | - Lee Michael Sanders
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
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Bell LK, Golley R, Moores CJ, Perry R, Hartley J, Miller M, Matwiejczyk L, Miller J, Magarey AM. Feasibility of a Group-Based, Facilitator-Directed Online Family Lifestyle Program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:1194-1201. [PMID: 31471067 DOI: 10.1016/j.jneb.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study aimed to overcome barriers to access and attendance, and improve recruitment and engagement, through delivery and evaluation of the Parenting, Eating and Activity for Child Health (PEACH) child weight management program, as a facilitated group-based online healthy lifestyle program, PEACH Lifestyle. METHODS Pre-post feasibility study of an online intervention comprising a website with 10 self-directed learning modules and 6 facilitated group-based video conferencing sessions with parents (n = 79) of children (7.9 ± 2.9 years, 25% healthy weight, 23% obese). RESULTS Three enrollees were from remote locations. Half of the parents (n = 38) attended ≥1 video conferencing session (median = 3 participants per session [Range, 0-7]). Thirty percent (n = 7 of 21) completed all 10 online modules. Technical issues, time, and family commitments were barriers to engagement. CONCLUSIONS AND IMPLICATIONS Reframing and delivering a weight management program as a healthy lifestyle program online in real-time did not address barriers to engagement in PEACH Lifestyle.
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Affiliation(s)
- Lucinda K Bell
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.
| | - Rebecca Golley
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Carly J Moores
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Rebecca Perry
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Jo Hartley
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Micelle Miller
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Louisa Matwiejczyk
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Jacqueline Miller
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia; Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Anthea M Magarey
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
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Moores CJ, Maeder A, Miller J, Prichard I, Lewis LK, Bell LK, Macoustra A, Miller MD. A Digital Intervention for Australian Adolescents Above a Healthy Weight (Health Online for Teens): Protocol for an Implementation and User Experience Study. JMIR Res Protoc 2019; 8:e13340. [PMID: 31603435 PMCID: PMC6913688 DOI: 10.2196/13340] [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: 01/10/2019] [Revised: 04/24/2019] [Accepted: 05/05/2019] [Indexed: 01/16/2023] Open
Abstract
Background More than one-fourth of Australian adolescents are overweight or obese, with obesity in adolescents strongly persisting into adulthood. Recent evidence suggests that the mid-teen years present a final window of opportunity to prevent irreversible damage to the cardiovascular system. As lifestyle behaviors may change with increased autonomy during adolescence, this life stage is an ideal time to intervene and promote healthy eating and physical activity behaviors, well-being, and self-esteem. As teenagers are prolific users and innate adopters of new technologies, app-based programs may be suitable for the promotion of healthy lifestyle behaviors and goal setting training. Objective This study aims to explore the reach, engagement, user experience, and satisfaction of the new app-based and Web-based Health Online for Teens (HOT) program in a sample of Australian adolescents above a healthy weight (ie, overweight or obese) and their parents. Methods HOT is a 14-week program for adolescents and their parents. The program is delivered online through the Moodle app–based and website-based learning environment and aims to promote adolescents’ lifestyle behavior change in line with Australian Dietary Guidelines and Australia’s Physical Activity and Sedentary Behaviour Guidelines for Young People (aged 13-17 years). HOT aims to build parental and peer support during the program to support adolescents with healthy lifestyle behavior change. Results Data collection for this study is ongoing. To date, 35 adolescents and their parents have participated in one of 3 groups. Conclusions HOT is a new online-only program for Australian adolescents and their parents that aims to reduce cardiovascular disease risk factors. This protocol paper describes the HOT program in detail, along with the methods to measure reach, outcomes, engagement, user experiences, and program satisfaction. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12618000465257; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374771 International Registered Report Identifier (IRRID) DERR1-10.2196/13340
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Affiliation(s)
- Carly Jane Moores
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Anthony Maeder
- Digital Health Research Centre, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Jacqueline Miller
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Healthy Mothers Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Ivanka Prichard
- Health Sciences, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Sport, Health, Activity, Performance and Exercise Research Centre, Flinders University, Adelaide, Australia
| | - Lucy Kate Lewis
- Physiotherapy, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lucinda Kate Bell
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Aimee Macoustra
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Michelle D Miller
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Bramante CT, McTigue KM, Lehmann HP, Clark JM, Rothenberger S, Kraschnewski J, Lent MR, Herring SJ, Conroy MB, McCullough J, Bennett WL. Understanding Primary Care Patients' Self-weighing Habits: Cohort Analysis from the PaTH Clinical Data Research Network. J Gen Intern Med 2019; 34:1775-1781. [PMID: 31313111 PMCID: PMC6712152 DOI: 10.1007/s11606-019-05153-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/05/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Greater than 60% of adults have overweight or obesity. Self-weighing is an effective weight loss and weight maintenance tool. However, little is known about self-weighing habits among the primary care patient population. Our objective was to examine the frequency of patient-reported self-weighing, and to evaluate the associations of self-weighing with demographic characteristics and self-monitoring behaviors. METHODS We conducted an analysis of survey data collected as part of the PaTH Clinical Data Research Network, which recruited a cohort of 1,021 primary care patients at 4 academic medical centers. Patients of all body mass index (BMI) categories were included. RESULTS Response rate of 6-month survey was 727 (71%). The mean age was 56 years, and most were female (68%), White (78%), college graduates (66%), and employed/retired (85%). The mean BMI was 30.2 kg/m2, 80% of participants had a BMI ≧ 25 kg/m2. Of patients with BMI ≧ 25 kg/m2, 35% of participants self-weighed weekly and 23% daily. Participants who reported self-weighing at least weekly were more likely to be older (59 vs 54 years, p < 0.01), married (p = 0.01), college graduates (p = 0.03), White (p < 0.01), and employed vs disabled/unemployed (p < 0.01). Patients who self-weighed daily had a lower BMI (29 kg/m2 vs 31 kg/m2, p = 0.04). Patients who tracked exercise or food intake were more likely to self-weigh daily (p < 0.01), as were patients wanting to lose or maintain weight (p < 0.01). CONCLUSIONS Despite its potential for primary and secondary obesity prevention, only 35% of primary care patients with overweight or obesity engage in self-weighing weekly and less than a quarter (23%) self-weigh daily. Socioeconomic status appears to be a factor influencing regular self-weighing in this population, potentially contributing to greater health disparities in obesity rates. Patients who self-weighed daily had a lower BMI, suggesting that it may play a role in primary prevention of obesity. More work is needed to explore self-weighing among patients.
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Affiliation(s)
- Carolyn T Bramante
- Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA.,Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Kathleen M McTigue
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Harold P Lehmann
- Division of Health Informatics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Scott Rothenberger
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Sharon J Herring
- Center for Obesity Research and Education, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Molly B Conroy
- Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jody McCullough
- Department of Medicine, Penn State University, State College, PA, USA
| | - Wendy L Bennett
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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39
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Patel ML, Brooks TL, Bennett GG. Consistent self-monitoring in a commercial app-based intervention for weight loss: results from a randomized trial. J Behav Med 2019; 43:391-401. [PMID: 31396820 DOI: 10.1007/s10865-019-00091-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 08/04/2019] [Indexed: 01/18/2023]
Abstract
Self-monitoring is the strongest predictor of success in lifestyle interventions for obesity. In this secondary analysis of the GoalTracker trial, we describe outcomes of consistently self-monitoring in a standalone weight loss intervention. The 12-week intervention focused on daily self-monitoring of diet and/or body weight in a commercial app (MyFitnessPal). Participants (N = 100; 21-65 years; BMI 25-45 kg/m2) were categorized as Consistent Trackers if they tracked ≥ 6 out of 7 days for at least 75% of the targeted weeks. One-fourth of participants were Consistent Trackers. This subset was more likely to be married or living with a partner, be non-Hispanic White, and have higher health literacy than Inconsistent Trackers (ps < .05). Consistent tracking was associated with greater weight change than inconsistent tracking at 1 month (mean difference [95% CI] - 1.11 kg [- 2.12, - 0.10]), 3 months (- 2.42 kg [- 3.80, - 1.04]), and 6 months (- 2.13 kg [- 3.99, - 0.27]). Over 3 times as many Consistent Trackers as Inconsistent Trackers achieved ≥ 5% weight loss at 3 months (48 vs. 13%) and at 6 months (54 vs. 15%; ps < .001). Though causality cannot be determined by the present study, tracking weight and/or diet nearly every day per week for 12 weeks in a commercial app may serve as an effective strategy for weight loss. Strategies are needed to promote greater consistency in tracking.
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Affiliation(s)
- Michele L Patel
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA. .,Duke Digital Health Science Center, Duke Global Health Institute, Durham, NC, USA. .,Stanford Prevention Research Center, Stanford University School of Medicine, 1070 Arastradero Road, Suite 100, Palo Alto, CA, 94304-1334, USA.
| | - Taylor L Brooks
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.,Duke Digital Health Science Center, Duke Global Health Institute, Durham, NC, USA
| | - Gary G Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.,Duke Digital Health Science Center, Duke Global Health Institute, Durham, NC, USA
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Unick JL, Ross KM, Wing RR. Factors associated with early non-response within an Internet-based behavioural weight loss program. Obes Sci Pract 2019; 5:324-332. [PMID: 31452917 PMCID: PMC6700509 DOI: 10.1002/osp4.341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/21/2019] [Accepted: 04/10/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE While behavioural weight loss interventions are effective overall, many individuals fail to achieve a clinically significant weight loss. Given that 4-week weight loss has been shown to predict longer term outcomes, one potential strategy for improving rates of success is to provide additional support to early non-responders. To inform these early rescue efforts, it is important to first identify how they may differ from their more successful peers. METHODS At week 4 of a 12-week Internet-delivered weight loss program, 130 adults (age: 49.8 ± 9.8 years, body mass index: 31.2 ± 4.6 kg m-2) were asked to complete an 11-item survey assessing mood and weight-related cognitions and behaviours. Participants were then categorized as early non-responders (4-week weight loss <2%) or initial responders (4-week weight loss ≥2%), and groups were compared on intervention adherence during weeks 1-4 and week 4 survey question responses. RESULTS Early non-responders and initial responders did not differ on any intervention adherence variables (ps > 0.05). Compared to initial responders, early non-responders reported less positive mood (p = 0.011), greater boredom with weight loss efforts (p = 0.036), greater temptation to eat foods not consistent with their goals (p = 0.023), and that their eating choices were less consistent with their goals (p < 0.001). CONCLUSIONS These findings identify important differences between early non-responders and initial responders, offering potential intervention targets for rescuing early non-responders (i.e. making it easier for individuals to choose healthier foods, reducing boredom in Internet-delivered weight loss programs and providing strategies to limit exposure to dietary temptations).
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Affiliation(s)
- J. L. Unick
- The Miriam Hospital's Weight Control and Diabetes Research Center, Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - K. M. Ross
- Department of Clinical & Health Psychology, College of Public Health ProfessionsUniversity of FloridaGainesvilleFLUSA
| | - R. R. Wing
- The Miriam Hospital's Weight Control and Diabetes Research Center, Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
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Alnasser A, Kyle J, Aloumi N, Al-Khalifa A, Marais D. The Twazon Arabic Weight Loss App: App-Based Intervention for Saudi Women With Obesity. JMIR Mhealth Uhealth 2019; 7:e10923. [PMID: 31140444 PMCID: PMC6658271 DOI: 10.2196/10923] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 11/02/2018] [Accepted: 02/10/2019] [Indexed: 12/29/2022] Open
Abstract
Background By 2022, it is estimated that the rate of female obesity (78%) in Saudi Arabia will almost double that of males (41%). Despite being mainly attributed to poor diet, sedentary lifestyle, and a lack of health awareness, behavioral modification interventions are relatively new to the population; bariatric surgery continues to be the treatment of choice for comorbidities. However, neither pre nor postoperative diet and exercise are promoted. Evidence-informed mobile health (mHealth) weight loss apps and interventions may be an effective tool for delivering a culturally relevant intervention. Objective This study aimed to determine the feasibility of a weight loss intervention that tests the effectiveness of Twazon, an originally designed Arabic weight-loss app that promotes lifestyle modification specific to Arab populations. Methods A pre-post single‐arm pilot study was carried out among a sample of 240 overweight volunteer Saudi women residing in Riyadh, Saudi Arabia who used the Twazon app over a 4-month period. Anthropometric, diet, and physical activity measures were assessed 3 times: baseline, 2-months and 4-months; frequency of app use and system usability were evaluated during the 2 latter data collection periods. Repeated measures analysis of variance was used to identify changes over time. Results A total of 40 participants completed the 4-month intervention with an attrition rate of 83%. An evaluation of the frequency of app use fostered 2 groups: engaged users (65%) and unengaged users (35%). At 4 months, the engaged users experienced more successful outcomes; body weight was lowered on average by 1.3 (SD 0.6) kg (P=.18), waist circumference (WC) was reduced by 4.9 (SD 1.1) cm (P<.001), and daily energy consumption was decreased by >600 calories (P=.002). Unengaged users experienced minor changes in body weight, WC, and reduced energy intake. Conclusions The findings have demonstrated that engagement with the Twazon app renders positive changes in body weight, WC, and energy intake. mHealth weight loss apps and interventions have the potential to be effective in promoting weight loss and healthy lifestyle modification in Saudi Arabia and similar populations.
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Affiliation(s)
- Aroub Alnasser
- Food Science and Nutrition Dept, King Saud University, Riyadh, Saudi Arabia.,Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Janet Kyle
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Najla Aloumi
- Food Science and Nutrition Dept, King Saud University, Riyadh, Saudi Arabia
| | | | - Debbi Marais
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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42
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van Beurden SB, Smith JR, Lawrence NS, Abraham C, Greaves CJ. Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App-Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults. JMIR Form Res 2019; 3:e11586. [PMID: 31038464 PMCID: PMC6658245 DOI: 10.2196/11586] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/03/2019] [Accepted: 01/27/2019] [Indexed: 12/19/2022] Open
Abstract
Background ImpulsePal is a theory-driven (dual-process), evidence-informed, and person-centered smartphone app intervention designed to help people manage impulsive processes that prompt unhealthy eating to facilitate dietary change and weight loss. Objective The aims of this study were to (1) assess the feasibility of trial procedures for evaluation of the ImpulsePal intervention, (2) estimate standard deviations of outcomes, and (3) assess usability of, and satisfaction with, ImpulsePal. Methods We conducted an individually randomized parallel two-arm nonblinded feasibility trial. The eligibility criteria included being aged ≥16 years, having a body mass index of ≥25 kg/m2, and having access to an Android-based device. Weight was measured (as the proposed primary outcome for a full-scale trial) at baseline, 1 month, and 3 months of follow-up. Participants were randomized in a 2:1 allocation ratio to the ImpulsePal intervention or a waiting list control group. A nested action-research study allowed for data-driven refinement of the intervention across 2 cycles of feedback. Results We screened 179 participants for eligibility, and 58 were randomized to the intervention group and 30 to the control group. Data were available for 74 (84%, 74/88) participants at 1 month and 67 (76%, 67/88) participants at 3 months. The intervention group (n=43) lost 1.03 kg (95% CI 0.33 to 1.74) more than controls (n=26) at 1 month and 1.01 kg (95% CI −0.45 to 2.47) more than controls (n=43 and n=24, respectively) at 3 months. Feedback suggested changes to intervention design were required to (1) improve receipt and understanding of instructions and (2) facilitate further engagement with the app and its strategies. Conclusions The evaluation methods and delivery of the ImpulsePal app intervention are feasible, and the trial procedures, measures, and intervention are acceptable and satisfactory to the participants. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 14886370; http://www.isrctn.com/ISRCTN14886370 (Archived by WebCite at http://www.webcitation.org/76WcEpZ51)
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Affiliation(s)
| | - Jane R Smith
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | | | - Charles Abraham
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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43
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Levine DI. Measure, Record, Share: Weight Loss, Biometrics, and Self-Tracking in the U.S. Am J Prev Med 2018; 55:e147-e151. [PMID: 30262147 DOI: 10.1016/j.amepre.2018.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/10/2018] [Accepted: 05/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Deborah I Levine
- Department of Health Policy and Management, ProvidenceCollege, Providence, Rhode Island.
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44
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Description, utilisation and results from a telehealth primary care weight management intervention for adults with obesity in South Carolina. J Telemed Telecare 2018; 26:28-35. [DOI: 10.1177/1357633x18789562] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction In the US, obesity rates are higher in rural areas than in urban areas. Rural access to treatment of obesity is limited by a lack of qualified clinicians and by transportation and financial barriers. We describe a telemedicine weight management programme, Wellness Connect, developed through a partnership of academic clinicians and rural primary care providers in South Carolina, and present utilisation and weight outcomes from seven patient cohorts. Methods Eight bi-weekly sessions were provided via telemedicine videoconferencing for groups of patients at these rural primary care clinics. Protocol-based sessions were led by registered dietitians, exercise physiologists and clinical psychologists at a central urban location. Results Of 138 patients who started the programme, 62% ( N = 86) of patients met the criteria for completion. Completers lost an average of 3.5% (standard deviation (SD) = 3.9%) body weight, which was statistically significant ( p < .001) and corresponded with an average loss of 3.8 kg (SD = 4.5 kg). There were no differences in weight change among clinics ( p = .972). Overall, patients and providers reported satisfaction with the programme and identified several challenges to sustainability. Discussion The use of innovative telemedicine interventions continues to be necessary to alleviate barriers to accessing evidence-based services to reduce chronic diseases and decrease obesity rates among rural populations.
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45
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Tanaka K, Sasai H, Wakaba K, Murakami S, Ueda M, Yamagata F, Sawada M, Takekoshi K. Professional dietary coaching within a group chat using a smartphone application for weight loss: a randomized controlled trial. J Multidiscip Healthc 2018; 11:339-347. [PMID: 30038502 PMCID: PMC6052929 DOI: 10.2147/jmdh.s165422] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose To test the effectiveness of professional dietary coaching via group chat using a smartphone application (app) for weight loss. Methods This study was a 12-week, assessor-blind, parallel-group, waitlist-controlled randomized trial that included a 4-week follow-up period (trial registration, UMIN000025340). Data were collected between October 2016 and May 2017 and were analyzed between July 2017 and January 2018. Participants were 112 overweight, obese, or abdominally obese Japanese adults, aged 20 to 64 years, with at least one cardiometabolic risk factor. Participants were randomized to the coaching group (n=75) or control group (n=37), with a ratio of 2:1. The coaching group received a commercial weight loss program characterizing dietary coaching by a certified nutrition professional via group chat delivered on a smartphone app. Participants posted photos of every meal into the group chat, and the certified professional gave immediate direct feedback and encouragement. The primary outcome was an 8-week weight change. Secondary outcomes included 8-week changes in cardiometabolic risk factors. The frequency of meal photo uploads was recorded as a measure of adherence. Results Of the 112 randomized participants, 93 (83.0%) and 81 (72.3%) completed 8-week and 12-week visits, respectively. Intention-to-treat analysis demonstrated significantly larger 8-week weight loss in the coaching group (−1.4 kg; 95% confidence interval [CI]: −2.0, −0.8 kg) than that in the control group (−0.1 kg; 95% CI: −0.6, 0.4 kg). Significantly larger improvements in triglyceride and glycated hemoglobin A1c levels were also obtained in the coaching group. These benefits, except for the triglyceride level, were maintained until week 12. The frequent upload of meal photos was associated with a larger 8-week weight loss in a dose–response fashion (P-value for trend <0.001). Conclusion This smartphone-delivered commercial weight loss program characterized as dietary coaching via group chat resulted in modest but significant weight loss. Facilitating participants’ active involvement in the program is necessary to achieve greater health benefits.
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Affiliation(s)
- Kiyoji Tanaka
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan, .,THF Co., Ltd, Tsukuba, Japan,
| | - Hiroyuki Sasai
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Kyohsuke Wakaba
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Shin Murakami
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.,Life Science Department, FiNC Inc., Tokyo, Japan
| | - Miyuki Ueda
- Life Science Department, FiNC Inc., Tokyo, Japan
| | - Fumio Yamagata
- Genki Plaza Medical Center for Health Care, Tokyo, Japan
| | - Masao Sawada
- Genki Plaza Medical Center for Health Care, Tokyo, Japan
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46
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Walton A, Nahum-Shani I, Crosby L, Klasnja P, Murphy S. Optimizing Digital Integrated Care via Micro-Randomized Trials. Clin Pharmacol Ther 2018; 104:53-58. [PMID: 29604043 PMCID: PMC5995647 DOI: 10.1002/cpt.1079] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 01/02/2023]
Abstract
Mobile health (mHealth) interventions are a promising tool in providing digitally mediated integrative care. They can extend care outside of the clinic by providing reminders to take medications, assisting in managing symptoms, and supporting healthy behaviors including physical activity, healthy eating, and stress management. mHealth interventions can adapt the delivery of care across time in order to optimize treatment effectiveness. Yet there exists limited empirical evidence useful to the development of adaptive mHealth interventions. This article describes a new randomized trial design, the Micro-Randomized Trial (MRT), for informing the development of mHealth interventions. We provide examples of scientific questions important to the development of an mHealth intervention, and describe how these questions can be answered using an MRT.
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Affiliation(s)
- Ashley Walton
- Harvard University, Department of Statistics, Boston, MA
| | - Inbal Nahum-Shani
- University of Michigan, Institute for Social Research, Ann Arbor, MI
| | - Lori Crosby
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- University of Cincinnati, Department of Psychology, Cincinnati, OH
| | - Predrag Klasnja
- University of Michigan, School of Information, Ann Arbor, MI
| | - Susan Murphy
- Harvard University, Department of Statistics, Boston, MA
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Bardus M, Hamadeh G, Hayek B, Al Kherfan R. A Self-Directed Mobile Intervention (WaznApp) to Promote Weight Control Among Employees at a Lebanese University: Protocol for a Feasibility Pilot Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e133. [PMID: 29769174 PMCID: PMC5981057 DOI: 10.2196/resprot.9793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/18/2018] [Accepted: 03/31/2018] [Indexed: 01/04/2023] Open
Abstract
Background Overweight and obesity have become major health problems globally with more than 1.9 billion overweight adults. In Lebanon, the prevalence of obesity and overweight is 65.4% combined. Risk factors of obesity and overweight are preventable and can be addressed by modifications in the environment and in an individual’s lifestyle. Mobile technologies are increasingly used in behavioral, self-directed weight management interventions, providing users with additional opportunities to attain weight control (weight loss, weight gain prevention, etc). Mobile apps may allow for the delivery of Just-in-Time Adaptive Interventions (JITAIs), which provide support through skill building, emotional support, and instrumental support, following the participants’ progress. A few commercially available apps offer JITAI features, but no studies have tested their efficacy. Objective The primary objective of this study is to examine the feasibility of a self-directed weight loss intervention, targeting employees of an academic institution, using a virtual coaching app with JITAI features (Lark) and a self-help calorie-counting app (MyFitnessPal). The secondary objective is to estimate the effects of the intervention on main study outcomes. Methods This study is a single-center, parallel, randomized controlled trial with 2 study arms (intervention and control). Participants will be randomly allocated in equal proportions to the intervention (Lark) and control groups (MyFitnessPal). To be eligible for this study, participants must be employed full- or part-time at the university or its medical center, able to read English, have a smartphone, and be interested in controlling their weight. Recruitment strategies entail email invitations, printed posters, and social media postings. We will assess quantitative rates of recruitment, adherence, and retention, self-reported app quality using the user version of the Mobile App Rating Scale. We will also assess changes in weight-related outcomes (absolute weight and waist circumference), behavioral outcomes (physical activity and diet), and cognitive factors (motivation to participate in the trial and to manage weight). Results WaznApp was funded in June 2017, and recruitment started in March 2018. Conclusions This study will provide information as to whether the selected mobile apps offer a feasible solution for promoting weight management in an academic workplace. The results will inform a larger trial whose results might be replicated in similar workplaces in Lebanon and the Middle East and North Africa region, and will be used as a benchmark for further investigations in other settings and similar target groups. Trial Registration ClinicalTrials.gov NCT03321331; https://clinicaltrials.gov/ct2/show/NCT03321331 (Archived by WebCite at http://www.webcitation.org/6ys9NOLo5) Registered Report Identifier RR1-10.2196/9793
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Affiliation(s)
- Marco Bardus
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ghassan Hamadeh
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Bouchra Hayek
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rawan Al Kherfan
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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48
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Alnasser A, Kyle J, Alkhalifah A, Marais D. Relationship Between Evidence Requirements, User Expectations, and Actual Experiences: Usability Evaluation of the Twazon Arabic Weight Loss App. JMIR Hum Factors 2018; 5:e16. [PMID: 29666042 PMCID: PMC5930174 DOI: 10.2196/humanfactors.9765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/03/2018] [Accepted: 03/19/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Saudi Arabia has faced a steady growth in the prevalence of obesity. The concurrent and ubiquitous use of mobile technology, such as smartphones and apps, provides an opportunity for the implementation of mHealth technology, a method for delivering behavioral interventions. Despite their effectiveness in promoting lifestyle and diet modification, culturally adapted weight loss apps and related interventions are lacking in Gulf Cooperation Council countries. OBJECTIVE The objective of our study was to identify the relationship between adherence to evidence-informed practices, potential user expectations, and actual user experiences in order to enhance the understanding of the overall usability of the Twazon Arabic weight loss app. METHODS In 2 previous studies, 39 Saudi women were recruited for focus group discussions and 240 Saudi women were recruited for an app-based weight loss intervention. Usability of the Twazon Arabic weight loss app was evaluated by analyzing the opinions and experiences of 26 participants who engaged with the Twazon app for 4 months; the System Usability Scale (SUS) and word clouds were used. The results were triangulated with potential user expectations obtained in the focus group discussion and with the findings from an Arabic app screening for evidence-informed practices. RESULTS The average reported SUS score was 69.3. The most favored features were the calorie counter, step counter, and physical activity calorie counter. The features in need of improvement were the social network, notifications, and the Twazon Saudi Food Database. Twazon users preferred and found useful 7 of the 13 evidence-informed weight loss practices that were integrated into the features of the app. CONCLUSIONS Triangulation identified the most notable relationship to be the disparity between user experience and 2 of the evidence-informed practices, namely a minimum weight loss goal of 0.5 to 1 kg/week and social support; no relationship was found between user expectations and evidence-informed weight loss practices. The overall usability of the Twazon Arabic weight loss app ranged between high marginal and acceptable, indicating that some improvements to the app should be considered for implementation in future app-based weight loss interventions of this kind.
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Affiliation(s)
- Aroub Alnasser
- Food Science and Nutrition Department, College of Food and Agriculture Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Janet Kyle
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Abdulrahman Alkhalifah
- Food Science and Nutrition Department, College of Food and Agriculture Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Debbi Marais
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Grady A, Yoong S, Sutherland R, Lee H, Nathan N, Wolfenden L. Improving the public health impact of eHealth and mHealth interventions. Aust N Z J Public Health 2018; 42:118-119. [PMID: 29384248 DOI: 10.1111/1753-6405.12771] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Alice Grady
- Hunter New England Population Health, Wallsend, New South Wales.,School of Medicine and Public Health, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton Heights, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Serene Yoong
- Hunter New England Population Health, Wallsend, New South Wales.,School of Medicine and Public Health, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton Heights, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Rachel Sutherland
- Hunter New England Population Health, Wallsend, New South Wales.,School of Medicine and Public Health, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton Heights, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Hopin Lee
- School of Medicine and Public Health, University of Newcastle, New South Wales.,Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, New South Wales.,School of Medicine and Public Health, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton Heights, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, New South Wales.,School of Medicine and Public Health, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton Heights, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
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50
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Rushing J, Wing R, Wadden TA, Knowler WC, Lawlor M, Evans M, Killean T, Montez M, Espeland MA, Zhang P. Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial. Obes Sci Pract 2017; 3:15-24. [PMID: 28392928 PMCID: PMC5358076 DOI: 10.1002/osp4.92] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/16/2016] [Accepted: 11/19/2016] [Indexed: 12/12/2022] Open
Abstract
Objective The Action for Health in Diabetes (Look AHEAD) trial was a randomized controlled clinical trial to compare the effects of 10 years of intensive lifestyle intervention (ILI) with a control condition of diabetes support and education (DSE) on health outcomes in over 5,000 participants with type 2 diabetes. The ILI had significantly greater weight losses than DSE throughout the trial. The goal of this analysis is to describe the cost of delivering the intervention. Methods The ILI was designed to promote weight loss and increase physical activity. It involved a combination of group plus individual intervention sessions, with decreasing frequency of contact over the 10 years. The intervention incorporated a variety of strategies, including meal replacement products, to improve weight loss outcomes. The costs of intervention delivery were derived from staff surveys of effort and from records of intervention materials from the 16 US academic clinical trial sites. Costs were calculated from the payer perspective and presented in 2012 dollars. Results During the first year, when intervention delivery was most intensive, the annual cost of intervention delivery, averaged (standard deviation) across clinical sites, was $2,864.6 ($513.3) per ILI participant compared with $202.4 ($76.6) per DSE participant. As intervention intensity declined, costs decreased, such that from years 5 to 9 of the trial, the annual cost of intervention was $1,119.8 ($227.7) per ILI participant and $102.9 ($33.0) per DSE participant. Staffing accounted for the majority of costs throughout the trial, with meal replacements and materials to promote adherence accounting for smaller shares. Conclusions The sustained weight losses produced by the Look AHEAD intervention were supported by intervention costs that were within the range of other weight loss programmes. Future work will include an evaluation of the cost‐effectiveness of the ILI and will contain additional follow‐up data.
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Affiliation(s)
- J Rushing
- Department of Biostatistical Sciences Wake Forest School of Medicine Winston-Salem NC USA
| | - R Wing
- Weight Control and Diabetes Research Center Brown Medical School/The Miriam Hospital Providence RI USA
| | - T A Wadden
- Center for Weight and Eating Disorders University of Pennsylvania Philadelphia PA USA
| | - W C Knowler
- Diabetes Epidemiology and Clinical Research Section National Institute of Diabetes and Digestive and Kidney Diseases Phoenix AZ USA
| | - M Lawlor
- Department of Economics Wake Forest University Winston-Salem NC USA
| | - M Evans
- National Institute of Diabetes and Digestive and Kidney Diseases Bethesda MD USA
| | - T Killean
- Southwest American Indian Center National Institute of Diabetes and Digestive and Kidney Diseases Phoenix AZ USA; Southwest American Indian Center National Institute of Diabetes and Digestive and Kidney Diseases Shiprock NM USA
| | - M Montez
- University of Texas Health Science Center at San Antonio San Antonio TX USA
| | - M A Espeland
- Department of Biostatistical Sciences Wake Forest School of Medicine Winston-Salem NC USA
| | - P Zhang
- DDT Health Economics Workgroup Centers for Disease Control and Prevention Atlanta GA USA
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