Changes in self-efficacy for exercise and improved nutrition fostered by increased self-regulation among adults with obesity

Association between nutrition self-efficacy, health locus of control and food choice motives in consumers in nine European countries

We investigated associations between food choice motives and psychological determinants of dietary health behaviour change (nutrition self-efficacy, NS-E, and health locus of control, HLoC) among 9381 participants (18-65 years, 49.4% females) from nine European countries. Price was the highest rated food choice motive. Higher importance of all motives was associated with higher NS-E and with higher Internal HLoC. Relationships between food choice motives and External HLoC were also in the expected direction in showing negative associations with Health, Natural Content, Weight Control, Mood and Sensory Appeal. Higher External HLoC was also associated with perceived greater importance of 'external' motives Ethical Concern, Familiarity and Convenience. Relationships between External HLoC and food choice motives were not all in the expected direction. Price was unrelated to External HLoC. Females rated the importance of all motives higher than males. People with less education ascribed greater importance to Price in motivating food choices. Together, these findings imply that self-efficacy and health locus of control should be considered along with motivations for food choice in dietary health promotion.

Interest and Perseverance Are Not Enough to Be Physically Active: The Importance of Self-Efficacy toward Healthy Eating and Healthy Weight to Move More in Adolescents

(1) Background: Insufficient physical activity in adolescents remains an important issue for health promotion. Given the current relevance of understanding the adoption and maintenance of moderate and vigorous physical activity (MVPA), the aim of this study was to analyze, in a sample of adolescents, the role of grit personality as an antecedent of healthy eating and healthy weight (HEW) self-efficacy and its implications for the practice of MVPA. (2) Methods: Participants were 987 adolescents (597 girls, 390 boys) aged between 15 and 19 years from Mexico and Spain. The Spanish versions of the grit personality scale, the healthy eating and weight self-efficacy scale and the global physical activity questionnaire were used to measure the variables of interest. (3) Results: Mediated regression analysis showed that grit personality was not directly related to MVPA practice. However, the results indicate the significant relationship between grit personality and HEW self-efficacy, as well as the positive and significant relationship of this self-efficacy on MVPA practice. HEW self-efficacy totally mediated the relationship between grit personality and MVPA in both boys and girls. (4) Conclusions: These results suggest that having a grit personality (i.e., having interest and perseverance) is not enough for adolescents to be physically active, but that perceiving oneself as effective in having a healthy diet and healthy weight may be the key for adolescents to move more. At the intervention level, we suggest targeting an enhancement of young people's competence to eat healthily and regulate their weight as a strategy to enhance the performance of more MVPA, with a possible transfer between healthy behaviors (spill over).

California's Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Be Better social marketing campaign: mothers' fruit and vegetable consumption and facilitation of children's healthy behaviours

OBJECTIVE

Evaluation of California Department of Public Health's three-year social marketing campaign (Be Better) to encourage healthy eating and water consumption among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) California mothers. Andreasen's social marketing framework was used to outline the development and evaluation of the campaign.

DESIGN

Quantitative, pre-post cross-sectional study with three cohorts nested within survey years. Generalised estimating equation modeling was used to obtain population estimates of campaign reach and changes in mothers' fruit and vegetable (FV) consumption and facilitative actions towards their children's health behaviours.

SETTING

CalFresh Healthy Living (California's SNAP-Ed).

PARTICIPANTS

Three separate cohorts of SNAP mothers were surveyed (pre, post) between 2016 and 2018 inclusive. A total of 2229 mothers (ages 18-59) self-identified as White, Latina, African American or Asian/Pacific Islander participated.

RESULTS

Approximately 82 percent of surveyed mothers were aware of the campaign as assessed by measures of recall and recognition. Ad awareness was positively associated with mothers' FV consumption (R2 = 0·45), with the proportion of FV on plates and with behaviours that facilitate children's FV consumption and limit unhealthy snacks and sugary drinks (βs ranged from 0·1 to 0·7).

CONCLUSIONS

The campaign successfully reached 82 percent of surveyed mothers. Positive associations between California's Be Better campaign and targeted health behaviours were observed, although the associations varied by year and media channel (i.e. television, radio, billboards and digital). Most associations between ad awareness and outcomes were noted in years two and three of the campaign, suggesting that more than 1 year of campaign exposure was necessary for associations to emerge.

Nightly Variation in Sleep Influences Self-efficacy for Adhering to a Healthy Lifestyle: A Prospective Study

BACKGROUND

Self-efficacy, or the perceived capability to engage in a behavior, has been shown to play an important role in adhering to weight loss treatment. Given that adherence is extremely important for successful weight loss outcomes and that sleep and self-efficacy are modifiable factors in this relationship, we examined the association between sleep and self-efficacy for adhering to the daily plan. Investigators examined whether various dimensions of sleep were associated with self-efficacy for adhering to the daily recommended lifestyle plan among participants (N = 150) in a 12-month weight loss study.

METHOD

This study was a secondary analysis of data from a 12-month prospective observational study that included a standard behavioral weight loss intervention. Daily assessments at the beginning of day (BOD) of self-efficacy and the previous night's sleep were collected in real-time using ecological momentary assessment.

RESULTS

The analysis included 44,613 BOD assessments. On average, participants reported sleeping for 6.93 ± 1.28 h, reported 1.56 ± 3.54 awakenings, and gave low ratings for trouble sleeping (3.11 ± 2.58; 0: no trouble; 10: a lot of trouble) and mid-high ratings for sleep quality (6.45 ± 2.09; 0: poor; 10: excellent). Participants woke up feeling tired 41.7% of the time. Using linear mixed effects modeling, a better rating in each sleep dimension was associated with higher self-efficacy the following day (all p values < .001).

CONCLUSION

Our findings supported the hypothesis that better sleep would be associated with higher levels of reported self-efficacy for adhering to the healthy lifestyle plan.

The EVO study protocol for a randomized controlled evaluation trial of an optimized weight management intervention

BACKGROUND

Obesity is a substantial public health concern; however, gold-standard behavioral treatments for obesity are costly and burdensome. Existing adaptations to the efficacious Diabetes Prevention Program (DPP) demonstrate mixed results. Our prior research applying the Multiphase Optimization Strategy (MOST) to DPP identifies a more parsimonious, less costly intervention (EVO) resulting in significant weight loss.

OBJECTIVE

The aim of the remotely conducted EVO trial is to test the non-inferiority of EVO against DPP. We will conduct economic evaluations alongside the trial to estimate delivery and patient costs, cost-effectiveness, and lifetime healthcare costs of EVO as compared to DPP. Exploratory analyses will examine maintenance, moderators, and mediators of the treatment effect.

STUDY DESIGN

The EVO trial will recruit nationally to randomize 524 participants with obesity. Participants will receive either EVO or DPP over a 6 month period. EVO participants will be provided online lessons, a smartphone application to self-monitor diet, physical activity, and weight, and attend 12 brief calls with a Health Promotionist. DPP participants will receive the first 6 months of the Center for Disease Control's T2D materials and attend 16 one-hour video call sessions with staff certified in DPP delivery. Weight will be measured at baseline, 3-, 6-, and 12-months. Itemized delivery cost will be collected. Staff and participants will also provide information to estimate costs for intervention-related activities.

SIGNIFICANCE

The EVO trial could establish evidence supporting dissemination of a scalable, cost-effective behavioral treatment with potential to shift clinical practice guidelines, inform policy, and reduce the prevalence of obesity.

The impact of COVID-19 lockdown on physical activity and weight gain among active adult population in Israel: a cross-sectional study

BACKGROUND

The COVID-19 outbreak holds public health concerns. The stay-at-home increases sedentary behavior, with unintended adverse outcomes. Since organized recreation and sports facilities were closed, we aimed to study how the crisis of closure affected exercise habits and weight gain among the trainee population in Israel. We examined differences in weight gain among individuals with different PA activities and assessed their ability to adapt to digital media as an alternative training structure.

METHODS

A cross-sectional survey consisted of a multiple-choice questionnaire obtained using a web-based survey application. Trainees (1202) who exercised steadily anonymously answered the questionnaire sent by their coaches regarding their activity and weight gain during lockdown times.

RESULTS

Results confirmed that 70% of Israelis trained less than their usual routine, 60% used digital media for training, 55% gained weight. Half of the respondents gained more than 2 kg, with an average increase of 1.2 kg. However, those who exhibited a higher physical activity level gained less weight. Using digital media for training was associated with higher physical activity levels. The aged population was less likely to use digital media.

CONCLUSIONS

Since increased sedentary behavior could increase the risk for potential worsening of health conditions, health agencies should look for strategies, including digital remote media training to promote physical activity and subsequently, preventing the increased burden of future comorbidities worsening by a sedentary lifestyle. Approval: by the Helsinki ethics committee of Sheba Medical Center (6504-19-SMC).

A systematic review of weight-related communication trainings for physicians

Obesity is a leading cause of preventable death in the USA. Given the high number of adults seeking routine health care services, physicians have an opportunity to address weight loss during routine clinical encounters. It's often reported that physicians lack the training to address weight. Training programs are implemented in medical settings to prepare physicians to have conversations with patients. Yet, the degree of consistency among training programs and factors associated with better outcomes is unclear. The purpose of this study is to systematically review literature in physician communication trainings related to weight-to compare the content, outcomes, and implementation of existing studies examining weight-related communication training programs for physicians and determine factors associated with physician and patient outcomes. Articles were extracted from PubMed, Proquest, and Embase. Search terms included: health communication, physician training, weight, and obesity. Studies implementing a training program addressing weight among physicians were included. Trainings using either motivational interviewing (MI) or 5 As (Ask, Advise, Assess, Assist, and Arrange) framework found improvements in physicians' communication skills. A small number of trainings including experiential components were also associated with improvements in positive physician outcomes. Findings suggest trainings based in MI or 5 As framework improve physicians' communication skills, but few programs affected patient outcomes. Gaps remain with trainings that can demonstrate weight loss in patients. While work is needed to enhance the effects of these trainings on patient outcomes, data suggest that trainings should be longer in duration and include an experiential component.

The SMARTER Trial: Design of a trial testing tailored mHealth feedback to impact self-monitoring of diet, physical activity, and weight

BACKGROUND

Self-monitoring food intake and physical activity (PA) is positively related to weight loss and the addition of feedback (FB) messages has been shown to reinforce behavior change. Moreover, the more immediate the delivery of reinforcing FB messages, the more likely they will promote the desired behaviors.

PURPOSE

Describe design and rationale of SMARTER, a National Institute of Heart, Lung, and Blood (NHLBI)-sponsored randomized, controlled trial, which compares the differential efficacy of two weight loss treatments among 530 adults, ages 18 and older.

METHODS

Single-site, 2-group design trial with subjects randomized 1:1 to either: 1) self-monitoring (SM), where participants self-monitor diet, PA, and weight using a commercial smartphone application (app); or 2) SM + FB, where participants self-monitor and receive real-time, tailored feedback (FB) as pop-up messages up to 3 times/day for 12 months. Daily FB messages address diet and PA behaviors and a weekly FB message addresses self-weighing. We hypothesize that subjects assigned to SM + FB will show greater weight loss at 6 and 12 months and greater sustained engagement in the program than the SM group, measured by adherence to the study's lifestyle and SM protocol. We will explore temporal relationships of the frequency, timing, and type of FB delivered and subsequent lifestyle behaviors through examination of serially collected real-time SM (diet, PA, weight) data over 12 months.

CONCLUSIONS

If efficacious, this fully scalable intervention could be efficiently translated and disseminated to reach large numbers of individuals through commercial apps at lower cost than existing in-person weight loss programs.

Coaction Between Physical Activity and Fruit and Vegetable Intake in Racially Diverse, Obese Adults

PURPOSE

There is minimal understanding of the potential for coaction, defined as action on one behavior increasing the likelihood of taking action on another behavior, between physical activity (PA) and fruit and vegetable (FV) intake. The purpose of this study was to assess the bidirectional coaction between FV intake and PA, as well as self-efficacy for these behaviors, in a racially diverse sample of obese adults.

DESIGN

This is a secondary analysis using data collected from the Path to Health study, a randomized controlled trial. ClinicalTrials.gov Identifier: NCT03674229.

SAMPLE

Obese adults who completed baseline and 6-month follow-up assessments.

MEASURES

For this study, data on FV intake, leisure time PA, and 7-day accelerometer data were analyzed at baseline and 6-month follow-up.

ANALYSIS

We interchanged modeling the FV intake and PA change variables as the independent and dependent variables. We conducted multiple imputation and both linear and multinomial regression.

RESULTS

The sample (n = 168) was 59% female and mainly split between white (42%) and African American (42%). Change in self-efficacy for PA was predictive of change in self-efficacy for FV intake and vice versa. When compared with participants with no change in FV intake, someone with a positive change in FV intake was more likely to have a positive change in self-reported PA (adjusted risk ratio [RR] = 6.72, 95% confidence interval [CI] = 1.69-26.68). Likewise, when compared with no change, participants with a positive change in self-reported PA were more likely to report a positive change in FV intake (adjusted RR = 6.79, 95% CI = 1.70-27.17).

CONCLUSION

Findings suggest coaction between self-efficacy for FV intake and PA as well as between FV intake and PA. Coaction could be capitalized on to more effectively promote both energy-balance behaviors.

Diet and physical activity changes among low-income families: perspectives of mothers and their children

Purpose: The current study explored how mothers and their children influence each other's diet and physical activity. Methods: We conducted semi-structured interviews with women with diabetes and their children (N = 18) from eight low-income families. Results: Two approaches to changes emerged: collaborative and non-collaborative. Families using collaborative approaches believed they could sustain positive changes through accepting family changes, encouragement, abstaining from buying certain foods, modelling and compromise. Within families using non-collaborative approaches, some challenges included using more individualistic approaches and poor communication. Lack of information and resource constraints challenged all families. Conclusion: Interventions should reinforce family collaborative approaches and teach skills for families to work together towards a healthier lifestyle.

Eating behaviors and weight loss outcomes in a 12-month randomized trial of diet and/or exercise intervention in postmenopausal women

Background

Certain eating behaviors are common among women with obesity. Whether these behaviors influence outcomes in weight loss programs, and whether such programs affect eating behaviors, is unclear.

Methods

Our aim was to examine the effect of baseline eating behaviors on intervention adherence and weight among postmenopausal women with overweight or obesity, and to assess intervention effects on eating behaviors.

Four hundred and 39 women (BMI ≥25 kg/m²) were randomized to 12 months of: i) dietary weight loss with a 10% weight loss goal (‘diet’; n = 118); ii) moderate-to-vigorous intensity aerobic exercise for 225 mins/week (‘exercise’; n = 117); iii) combined dietary weight loss and exercise (‘diet + exercise’; n = 117); or iv) no-lifestyle change control (n = 87). At baseline and 12 months, restrained eating, uncontrolled eating, emotional eating and binge eating were measured by questionnaire; weight and body composition were assessed. The mean change in eating behavior scores and weight between baseline and 12 months in the diet, exercise, and diet + exercise arms were each compared to controls using the generalized estimating equation (GEE) modification of linear regression adjusted for age, baseline BMI, and race/ethnicity.

Results

Baseline restrained eating was positively associated with change in total calories and calories from fat during the dietary intervention but not with other measures of adherence. Higher baseline restrained eating was associated with greater 12-month reductions in weight, waist circumference, body fat and lean mass. Women randomized to dietary intervention had significant reductions in binge eating (− 23.7%, p = 0.005 vs. control), uncontrolled eating (− 24.3%, p < 0.001 vs. control), and emotional eating (− 31.7%, p < 0.001 vs. control) scores, and a significant increase in restrained eating (+ 60.6%, p < 0.001 vs. control); women randomized to diet + exercise reported less uncontrolled eating (− 26.0%, p < 0.001 vs. control) and emotional eating (− 22.0%, p = 0.004 vs. control), and increased restrained eating (+ 41.4%, p < 0.001 vs. control). Women randomized to exercise alone had no significant change in eating behavior scores compared to controls.

Conclusions

A dietary weight loss intervention helped women modify eating behaviors. Future research should investigate optimal behavioral weight loss interventions for women with both disordered eating and obesity.

Trial registration

NCT00470119 (https://clinicaltrials.gov). Retrospectively registered May 7, 2007.

Translating a "Stand Up and Move More" intervention by state aging units to older adults in underserved communities: Protocol for a randomized controlled trial

INTRODUCTION

As aging is associated with functional decline, preventing functional limitations and maintaining independence throughout later life has emerged as an important public health goal. Research indicates that sedentary behavior (prolonged sitting) is associated with functional loss and diminished ability to carry out activities of daily living. Despite many efforts to increase physical activity, which can be effective in countering functional loss, only an estimated 8% of older adults meet national physical activity guidelines. Thus, shifting the focus to reducing sitting time is emerging as a potential new intervention strategy but little research has been conducted in this area. With community support and funding, we developed and pilot tested a 4-week "Stand Up and Move More" intervention and found decreases in sedentary behavior, increases in physical activity, and improvements in mobility and vitality in a small sample of older adults. The purpose of this project is to expand upon these pilot results and examine the effectiveness and feasibility of translating a "Stand Up and Move More" intervention by State Aging Units to older adults in underserved communities. Eighty older adults from 4 counties across Wisconsin predominantly made up of rural older adults and older African American adults are randomly assigned to intervention (n = 40) or wait-list control (n = 40) groups. The intervention consists of 4 weekly sessions plus a refresher session at 8 weeks, and is delivered by community partners in each county. The sessions are designed to elicit ideas from older adults regarding how they can reduce their sitting time, help them set practical goals, develop action plans to reach their goals, and refine their plans across sessions to promote behavior change. Sedentary behavior, physical activity levels, functional performance, and health-related quality of life are assessed before and after the intervention to examine the effectiveness of the program. Feasibility of implementing the program by our community partners is assessed via semi-structured interviews. Strengths of this project include strong community collaborations and a high need given that the older adult population is projected to increase substantially in the next 15 years.

CONCLUSION

This project will provide an important step in developing effective strategies for maintaining independence in older adults through determining the feasibility and impact of a community-based intervention to break up sitting time.

Effects of a Group Protocol on Physical Activity and Associated Changes in Mood and Health Locus of Control in Adults with Parkinson Disease and Reduced Mobility

BACKGROUND

Parkinson disease (PD) is a degenerative nervous disorder that affects motor functioning. Although physical activity is beneficial, it often is reduced, and psychosocial issues persist such as low mood and perceptions of loss of control over health.

OBJECTIVE

To determine the extent to which a community-based physical activity/self-regulatory skills intervention affects overall physical activity and changes in psychosocial factors in adults with PD and in adults with reduced mobility without PD.

METHODS

Existing participants (N = 45, mean age = 71 years) of community-based PD group movement classes, who also participated in an individualized 6-session protocol for exercise support that emphasized self-regulation through barriers, completed validated self-report surveys. Participants' mean length of movement class participation was 11.8 months at the time of survey administration.

RESULTS

Mixed-model repeated-measures analysis of variance indicated significant improvements in physical activity, self-regulation, exercise self-efficacy, negative mood, and task social cohesion but not internal health locus of control. Improvement in social cohesion was significantly greater in the PD group (n = 27) than in the non-PD (n = 18) group. Changes in exercise self-efficacy mediated a significant relationship between changes in self-regulation and physical activity. Changes in social cohesion mediated a significant relationship between changes in physical activity and mood. Changes in mood and social cohesion had a reciprocal, mutually reinforcing relationship. For the PD group, length of program involvement predicted vigor change (r = 0.52, p = 0.006).

CONCLUSION

The intervention demonstrated positive effects on physical activity and psychosocial factors in adults with PD and with reduced mobility. Effects on social cohesion were important. Such programming should be considered as an adjunct to traditional medical treatment.

Resistance training is associated with spontaneous changes in aerobic physical activity but not overall diet quality in adults with prediabetes

BACKGROUND

Aerobic exercise interventions have been shown to result in alterations to dietary intake and non-exercise physical activity (PA). To date, the ability for resistance training (RT) to influence other health-related behaviors has not been examined. This study aimed to determine if initiation and maintenance of RT is associated with spontaneous changes in dietary quality and non-RT PA in adults with prediabetes.

METHODS

Overweight/obese adults (n=170, BMI=32.9±3.8kg·m², age=59.5±5.5years, 73% female) with prediabetes were enrolled in the 15-month Resist Diabetes trial. Participants completed a supervised 3-month RT initiation phase followed by a 6-month maintenance phase and a 6-month no-contact phase. Participants were not encouraged to change eating or non-RT PA behaviors. At baseline, and months 3, 9, and 15, three 24-hour diet recalls were collected to evaluate dietary intake and quality, the Aerobics Institute Longitudinal Study Questionnaire was completed to evaluate non-RT PA, and body mass, body composition (DXA), and muscular strength were measured. At months 3, 9, and 15 social cognitive theory (SCT) constructs were assessed with a RT Health Beliefs Questionnaire. Mixed effects models were used to assess changes in dietary intake and non-RT PA over the 15-month study period.

RESULTS

Energy and carbohydrate intake decreased with RT initiation and maintenance phases (baseline to month 9: β=-87.9, p=0.015 and β=-16.3, p<0.001, respectively). No change in overall dietary quality (Healthy Eating Index [HEI]-2010 score: β=-0.13, p=0.722) occurred, but alterations in HEI-2010 sub-scores were detected. Maintenance of RT was accompanied by an increase in MET-min/week of total non-RT PA (month 3 to month 9: β=146.2, p=0.01), which was predicted by increased self-regulation and decreased negative outcome expectancies for RT (β=83.7, p=0.014 and β=-70.0, p=0.038, respectively).

CONCLUSIONS

Initiation and maintenance of RT may be a gateway behavior leading to improvements in other health-related behaviors. These results provide rationale for single-component lifestyle interventions as an alternative to multi-component interventions, when resources are limited.

Weight Loss and the Prevention of Weight Regain: Evaluation of a Treatment Model of Exercise Self-Regulation Generalizing to Controlled Eating

CONTEXT

For decades, behavioral weight-loss treatments have been unsuccessful beyond the short term. Development and testing of innovative, theoretically based methods that depart from current failed practices is a priority for behavioral medicine.

OBJECTIVE

To evaluate a new, theory-based protocol in which exercise support methods are employed to facilitate improvements in psychosocial predictors of controlled eating and sustained weight loss.

METHODS

Women with obesity were randomized into either a comparison treatment that incorporated a print manual plus telephone follow-ups (n = 55) or an experimental treatment of The Coach Approach exercise-support protocol followed after 2 months by group nutrition sessions focused on generalizing self-regulatory skills from an exercise support to a controlled eating context (n = 55). Repeated-measures analysis of variance contrasted group changes in weight, physical activity, fruit and vegetable intake, mood, and exercise- and eating-related self-regulation and self-efficacy over 24 months. Regression analyses determined salient interrelations of change scores over both the weight-loss phase (baseline-month 6) and weight-loss maintenance phase (month 6-month 24).

RESULTS

Improvements in all psychological measures, physical activity, and fruit and vegetable intake were significantly greater in the experimental group where a mean weight loss of 5.7 kg (6.1% of initial body weight) occurred at month 6, and was largely maintained at a loss of 5.1 kg (5.4%) through the full 24 months of the study. After establishing temporal intervals for changes in self-regulation, self-efficacy, and mood that best predicted improvements in physical activity and eating, a consolidated multiple mediation model suggested that change in self-regulation best predicted weight loss, whereas change in self-efficacy best predicted maintenance of lost weight.

CONCLUSIONS

Because for most participants loss of weight remained greater than that required for health benefits, and costs for treatment administration were comparatively low, the experimental protocol was considered successful. After sufficient replication, physician referral and applications within health promotion and wellness settings should be considered.