Intention to change dietary habits, and weight loss among Norwegian-Pakistani women participating in a culturally adapted intervention

Effects of the nutrition education intervention on food security, anthropometry, and body composition in women: A randomized controlled trial

BACKGROUND

Food insecurity as a social determinant of health is associated with adverse physical health outcomes such as obesity.

AIM

This study aimed to evaluate the effects of nutrition education intervention based on the transtheoretical model (TTM) on food security, anthropometry, and body composition status.

METHODS

In this randomized controlled trial, an intervention was conducted over months (five weeks) using the TTM among 160 women aged 19-64 years. Food security status, anthropometry, and body composition were determined three times: at baseline, three months, and six months after the intervention.

RESULTS

In the intervention group, food insecurity significantly decreased before, immediately after, and six months after the intervention, these changes were significant in follow-up time and treatment effect. After six months of follow-up, the intervention group significantly decreased weight (-1.29 kg), body mass index (-0.54), and waist circumference (-3.48 cm). Although differences between the two groups were not statistically significant except in the interaction between follow-up time and intervention groups. Also, the mean of fat mass and total body water decreased in the intervention group and differences between the two groups were statistically significant in follow-up time (p < 0.001 and p = 0.01, respectively) and interaction between follow-up time and intervention group (p < 0.001 and p = 0.005, respectively).

CONCLUSION

In the current study, the findings of a six-month TTM-based intervention among women were positive that revealed to be a strategy that may improve anthropometric and nutritional status. Therefore, government programs that offer nutrition counseling should be prioritized to help the population to improve their eating habits.

Mistaken perception of lipid intake and its effects: a randomized trial

Background

Although the Transtheoretical Model (TTM) is promising for behavioral interventions, it may be limited by an inability to understand perceptions of food consumption. The following questions and gaps presented by the scientific community prompted this study: What is the concordance between perceived and actual food consumption? What proportions of individuals are in the pseudo-maintenance (PM) stage (overly optimistic perception of fat consumption)? What is the proportion of individuals in the non-reflective action stages (adequate fat intake but do not recognize it)? Is it necessary to develop specific strategies for individuals in these stages? Therefore, the present study aimed to identify the proportion of “pseudo-respondents,” or those in the PM and non-reflective action stages, and to explore subgroup effects by PM classification.

Methods

In a previously conducted randomized controlled trial, participants in the usual care group (UCG) and the TTM-intervention group (TM-IG) were post-hoc classified as “true respondents” or “pseudo-respondents”; the latter included those in the PM (mistakenly perceived their lipid intake as adequate) or non-reflective action (did not recognize the adequacy of their lipid intake) stage. The 6-month TTM-based intervention for fat consumption was performed with a sample of Public Health Service users.

Results

Seventy-one women completed all of the phases. About half of the participants were in the PM stage (UCG: 14 of 31; TM-IG: 19 of 40), and only two were in the non-reflective action stage. Post-intervention, PM individuals in the TM-IG evolved differently, with greater progression to later stages of change and reduced calorie intake, weight, and body mass index (p < 0.05).

Conclusions

Owing to the high proportion of participants in the PM stage and the differing performance, this stage is important. The intervention had a previously unreported differential effect on the progression of the stage of change and nutritional status by PM classification.

Trial registration

RBR-5TDHZY (retrospectively registered in August 2017 in Brazilian Registry of Clinical Trials).

Electronic supplementary material

The online version of this article (10.1186/s40795-017-0193-8) contains supplementary material, which is available to authorized users.

A randomized controlled trial of an individualized nutrition counseling program matched with a transtheoretical model for overweight and obese females in Thailand

BACKGROUND/OBJECTIVE

Effective weight reduction remains a challenge throughout the world as the prevalence of obesity and its consequences are increasing. This study aimed to determine the effects of an individualized nutrition counseling program (IC) matched with a transtheoretical model (TTM) for overweight and obese subjects.

SUBJECTS/METHODS

Fifty overweight and obese subjects aged 19-60 years with a body mass index ≥ 23 kg/m² were enrolled in the weight reduction study. They were randomized into two groups: Intervention group received an IC matched with a TTM; control group received an educational handbook. Body weight (BW), body fat (BF), waist circumference (WC), waist to height ratio (WHtR), stages of change (SOC), processes of change (POC), food intake, and physical activity (PA) were assessed at baseline and at 4, 8, and 12 weeks after program initiation in both groups. All data were analyzed by intention-to-treat, using SPSS software for hypothesis testing.

RESULTS

Forty-five female subjects were included in the 12-week trial at Ramkhamhaeng Hospital, Bangkok, Thailand. The results showed significant weight loss (1.98 ± 1.75 kg; 3% loss of initial weight) in the intervention group at 12 weeks, compared to a 0.17 ± 1.67 kg loss in the control group. There were significant differences between intervention and control groups in BF mass (-1.68 ± 1.78, -0.04 ± 1.62 kg); percentage BF (-1.54 ± 2.11, 0.08 ± 2.05); WC (-5.35 ± 3.84, 0.13 ± 3.23 cm); WHtR (-0.0336 ± 0.02, -0.0004 ± 0.02), and energy consumption (-405.09 ± 431.31, -74.92 ± 499.54 kcal/day) in the intervention and control groups, respectively. Intragroup SOC was improved in both groups. The POC for the weight management action (WMA) process was significantly different with POC scores increasing by 16.00 ± 11.73 and 7.74 ± 14.97 in the intervention and the control groups, respectively. PA level did not change in either group.

CONCLUSIONS

The IC matched with a TTM resulted in reductions in BW, BF, and WC, thus reducing likely health risks by decreasing energy intake and inducing positive behavior changes while enhancing the WMA process.

Findings from a prospective cohort study evaluating the effects of International Health Advisors' work on recently settled migrants' health

Background

Several interventions have been carried out to tackle health inequalities between migrant groups, especially refugees, and native-born European populations. These initiatives are often address language or cultural barriers. One of them is the International Health Advisors (IHA) in Sweden; a peer education intervention aimed at providing health information for recently settled migrants. It is known that social determinants, such as educational level and access to social capital, affect health. Social determinants may also affect how health information is received and transformed into practice. The aims of this study was to a) assess the impact of the IHA on recently settled migrants’ self-reported health status, and received health information; b) determine the moderating role of educational level and social capital; and c) critically discuss the outcomes and suggest implications for health promotion practice.

Methods

The study was designed as a prospective cohort study. A postal questionnaire translated to Arabic was sent to recently settled Iraqi migrants in eight counties in Sweden, in May 2008 and May 2010. Two of the counties were exposed to the intervention, and six were used as references.

Results

The proportion of individuals who reported that they had received information on healthy diet and physical exercise was higher in the intervention group than in the non-intervention group (OR 2.31, 95% CI 1.02–5.22), after adjustments. Low social participation was negatively associated with deteriorated or unchanged health needs (OR 0.47, 95% CI 0.24–0.92). No other statistically significant differences in health outcomes could be observed between the groups. No signs of effect modification on this association by social capital or educational level could be found.

Conclusions

Health information provided by the IHA increased self-reported level of knowledge on healthy diet and physical exercise. The interpretation of the observed negative association between low social participation and deteriorated or unchanged health needs is that participation was limited to one’s own social group, and therefore had limited positive influence on health seeking behaviour. The lack of measurable improvements in health status could be explained by limitations in the study, in the theoretical assumptions underlying the intervention, and in the implementation of the intervention. Further research is needed to understand success factors in health promoting interventions among recently settled migrants better.

Intervention based on Transtheoretical Model promotes anthropometric and nutritional improvements - a randomized controlled trial

OBJECTIVE

To analyze the effects of an intervention based on the Transtheoretical Model on anthropometric and dietetic profile among women in the Primary Health Care in Brazil.

DESIGN AND METHODS

Randomized controlled trial. The control group participated in physical activity and open group-education regarding nutrition of usual care. The intervention group participated in 10 workshops based on the Transtheoretical Model.

RESULTS

Seventy-one women completed the study, with a mean age of 57.9±11.7years. Participants in the intervention group showed an improved body perception, reduced weight and body mass index post-intervention, and lower consumption of calories and foods high in fat. Significant weight reduction in the intervention group was associated with higher per capita income, reduced consumption of protein, reduced consumption of lipids, and the removal of visible fat from red meat and skin from chicken.

CONCLUSION

An intervention based on the Transtheoretical Model promoted reduction in consumption of foods high in calories and fat, with positive effects on weight and body perception. These results provide evidence of the applicability and benefit of the Transtheoretical Model within primary care.

Diet and physical activity interventions to prevent or treat obesity in South Asian children and adults: a systematic review and meta-analysis

Background and Aims: The metabolic risks associated with obesity are greater for South Asian populations compared with White or other ethnic groups, and levels of obesity in childhood are known to track into adulthood. Tackling obesity in South Asians is therefore a high priority. The rationale for this systematic review is the suggestion that there may be differential effectiveness in diet and physical activity interventions in South Asian populations compared with other ethnicities. The research territory of the present review is an emergent, rather than mature, field of enquiry, but is urgently needed. Thus the aim of this systematic review and meta-analysis was to assess the effectiveness of diet and physical activity interventions to prevent or treat obesity in South Asians living in or outside of South Asia and to describe the characteristics of effective interventions. Methods: Systematic review of any type of lifestyle intervention, of any length of follow-up that reported any anthropometric measure for children or adults of South Asian ethnicity. There was no restriction on the type of comparator; randomised controlled trials, controlled clinical trials, and before-after studies were included. A comprehensive search strategy was implemented in five electronic databases: ASSIA, Cochrane Controlled Trials Register, Embase, Medline and Social Sciences Citation Index. The search was limited to English language abstracts published between January 2006 and January 2014. References were screened; data extraction and quality assessment were carried out by two reviewers. Results are presented in narrative synthesis and meta-analysis. Results: Twenty-nine studies were included, seven children, 21 adult and one mixed age. No studies in children under six were identified. Sixteen studies were conducted in South Asia, ten in Europe and three in USA. Effective or promising trials include physical activity interventions in South Asian men in Norway and South Asian school-children in the UK. A home-based, family-orientated diet and physical activity intervention improved obesity outcomes in South Asian adults in the UK, when adjusted for baseline differences. Meta-analyses of interventions in children showed no significant difference between intervention and control for body mass index or waist circumference. Meta-analyses of adult interventions showed significant improvement in weight in data from two trials adjusted for baseline differences (mean difference −1.82 kgs, 95% confidence interval −2.48 to −1.16) and in unadjusted data from three trials following sensitivity analysis (mean difference −1.20 kgs, 95% confidence interval −2.23 to −0.17). Meta-analyses showed no significant differences in body mass index and waist circumference for adults. Twenty of 24 intervention groups showed improvements in adult body mass index from baseline to follow-up; average change in high quality studies (n = 7) ranged from 0.31 to −0.8 kg/m². There was no evidence that interventions were more or less effective according to whether the intervention was set in South Asia or not, or by socio-economic status. Conclusions: Meta-analysis of a limited number of controlled trials found an unclear picture of the effects of interventions on body mass index for South Asian children. Meta-analyses of a limited number of controlled trials showed significant improvement in weight for adults but no significant differences in body mass index and waist circumference. One high quality study in South Asian children found that a school-based physical activity intervention that was delivered within the normal school day which was culturally sensitive, was effective. There is also evidence of culturally appropriate approaches to, and characteristics of, effective interventions in adults which we believe could be transferred and used to develop effective interventions in children.

The InnvaDiab-DE-PLAN study: a randomised controlled trial with a culturally adapted education programme improved the risk profile for type 2 diabetes in Pakistani immigrant women

The objective of the present study was to explore whether a culturally adapted lifestyle education programme would improve the risk factor profile for type 2 diabetes (T2D) and the metabolic syndrome (MetS) among Pakistani immigrant women in Oslo, Norway. The randomised controlled trial (the InnvaDiab study), lasting 7 ± 1 months, comprised six educational sessions about blood glucose, physical activity and diet. Participants (age 25-62 years) were randomised into either a control (n 97) or an intervention (n 101) group. Primary outcome variables were fasting and 2 h blood glucose, and secondary outcome variables were fasting levels of insulin, C-peptide, lipids, glycated Hb, BMI, waist circumference and blood pressure, measured 1-3 weeks before and after the intervention. During the intervention period, the mean fasting blood glucose decreased by 0·16 (95 % CI -0·27, -0·05) mmol/l in the intervention group, and remained unchanged in the control group (difference between the groups, P=0·022). Glucose concentration 2 h after the oral glucose tolerance test decreased by 0·53 (95 % CI -0·84, -0·21) mmol/l in the intervention group, but not significantly more than in the control group. A larger reduction in fasting insulin was observed in the intervention group than in the control group (between-group difference, P= 0·036). Among the individuals who attended four or more of the educational sessions (n 59), we found a more pronounced decrease in serum TAG (-0·1 (95 % CI -0·24, 0·07) mmol/l) and BMI (-0·48 (95 % CI -0·78, -0·18) kg/m²) compared with the control group. During the intervention period, there was a significant increase in participants having the MetS in the control group (from 41 to 57 %), which was not seen in the intervention group (from 44 to 42 %). Participation in a culturally adapted education programme may improve risk factors for T2D and prevent the development of the MetS in Pakistani immigrant women.