Weight-Gain Reduction Among 2-Year College Students: The CHOICES RCT

mHealth Intervention for Elevated Blood Pressure Among College Students: Single-Arm Intervention Study

BACKGROUND

Current evidence reveals a growing pattern of hypertension among young adults, significantly increasing their risk for cardiovascular disease later in life. Young adults, particularly those of college age, often develop risk factors related to lifestyle choices in diet, exercise, and alcohol consumption. Developing useful interventions that can assist with screening and possible behavioral modifications that are suitable and appealing to college-aged young adults could help with early identification and intervention for hypertension. Recent studies indicate mobile health (mHealth) apps are acceptable and effective for communication and message delivery among this population.

OBJECTIVE

The purpose of this study was to examine the feasibility of using a mobile smartphone delivery system that provides tailored messages based on participant self-measured blood pressure (BP) with college-aged young adults.

METHODS

Using a single-arm intervention, pilot study design, the mHealth to Optimize BP Improvement (MOBILE) intervention was implemented with college students aged 18 years to 39 years who had systolic BP >120 mm Hg and diastolic BP ≥80 mm Hg. Participants were required to measure their BP daily for 28 days, submit the readings to the app, and receive preset educational text messages tailored to their BP value and related to encouraging healthy lifestyle modifications. Changes in a participant's BP was evaluated using a mixed regression model, and a postintervention survey evaluated their perspectives on the mHealth intervention.

RESULTS

The participants' (N=9) mean age was 22.64 (SD 4.54) years; 56% (5/9) were overweight, and 11% (1/9) were obese. The average daily participation rate was 86%. Of the 9 participants, 8 completed the survey, and all indicated the intervention was easy to use, found it increased awareness of their individual BP levels, indicated the text messages were helpful, and reported making lifestyle changes based on the study intervention. They also provided suggestions for future implementation of the intervention and program. Overall, no significant changes were noted in BP over the 28 days.

CONCLUSIONS

The mHealth-supported MOBILE intervention for BP monitoring and tailored text messaging was feasible to implement, as our study indicated high rates of participation and acceptability. These encouraging findings support further development and testing in a larger sample over a longer time frame and hold the potential for early identification and intervention among college-aged adults, filling a gap in current research.

Black Young Adult Superwomen in the Face of Gendered Racial Microaggressions: Contextualizing Challenges With Acceptance and Avoidance and Emotional Eating

BACKGROUND

Black young adult women (ages 18-35) are at disproportionate risk for obesity and emotional eating. Emotional eating interventions target psychological flexibility, such as reducing experiential avoidance and increasing acceptance of food-related thoughts. Yet Black women face gendered racism, and some endorse roles that reduce psychological flexibility, such as the superwoman schema role. Culturally centered stress and coping has often been overlooked, leading to an incomplete understanding of processes that engender emotional eating and the implications for appropriate and effective interventions for Black young adult women.

PURPOSE

We investigated direct and indirect pathways of associations between stress from gendered racial microaggressions to emotional eating through the endorsement of superwoman schema and two aspects of psychological flexibility.

METHODS

Black young adult women (N = 504; Mage = 24.72; 75.2% African American; 98.4% cisgender) participated in an online survey wherein they reported demographics, stress from gendered racial microaggressions, superwoman schema, experiential avoidance, acceptance of food-related thoughts, and emotional eating. Path analysis was conducted to examine direct and indirect effects.

RESULTS

Results provided evidence for indirect associations between more stress from gendered racial microaggressions and more emotional eating. More stress was associated with greater endorsement of the superwoman schema which was associated with more experiential avoidance and less acceptance of food-related thoughts, which were each associated with more emotional eating.

CONCLUSIONS

Endorsement of superwoman schema and concomitant avoidance and less acceptance may be one way that gendered racial stress propels emotional eating. Future research could test intervention components that disrupt this path.

Influences of cognitive load on center of pressure trajectory of young male adults with excess weight during gait initiation

Introduction: Falls and fall-related injuries in young male adults with excess weight are closely related to an increased cognitive load. Previous research mainly focuses on analyzing the postural control status of these populations performing cognitive tasks while stabilized walking progress but overlooked a specific period of walking known as gait initiation (GI). It is yet unknown the influences of cognitive load on this population's postural control status during GI. Objective: This study aimed to determine the influences of cognitive load on the center of pressure (CoP) trajectory of young male adults with excess weight during GI. Design: A controlled laboratory study. Methods: Thirty-six male undergraduate students were recruited and divided into normal-weight, overweight, and obese groups based on their body mass index (BMI). Participants' CoP parameters during GI under single and dual-task conditions were collected by two force platforms. A mixed ANOVA was utilized to detect significant differences. Results: Compared with the normal-weight group, the obese group showed significant changes in the duration and CoP parameters during sub-phases of GI, mainly reflecting prolonged duration, increased CoP path length, higher mediolateral CoP displacement amplitude, and decreased velocity of anteroposterior CoP displacement. During GI with 1-back task, significantly increased mediolateral CoP displacement amplitude occurred in the obese group. During GI with 2-back task, the obese group had increased CoP path length, higher mediolateral CoP displacement amplitude, as well as a decreased velocity of CoP displacement. Conclusion: Based on the changes in CoP parameters during GI with cognitive tasks, young male adults with excess weight, mainly obese ones, have compromised postural stability. During GI with a difficult cognitive task, obese young male adults are more susceptible to deterioration in their lateral postural balance. These findings indicate that the increased cognitive load could exacerbate obese young male adults' postural control difficulty during GI under dual-task conditions, putting them at a higher risk of experiencing incidents of falls. Based on these findings, we offer suggestions for therapists to intervene with these young male adults to ensure their safety of GI.

Behavioral Sleep Interventions and Cardiovascular Risk Factors: Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND/OBJECTIVES

Chronic sleep disturbance has been consistently associated with cardiovascular disease. We sought to determine whether behavioral interventions to improve sleep have been associated with improvements in 4 common cardiovascular disease risk factors: hypertension, diabetes mellitus (DM), obesity, and smoking.

METHODS

Randomized controlled trials evaluating the prospective effect of behavioral sleep interventions on (a) blood pressure in participants with hypertension/prehypertension, (b) glycemic control in participants with DM/pre-DM, (c) anthropometrics in participants who were overweight/obese, and (d) smoking status in smokers were eligible. Where feasible, we undertook random-effects meta-analyses of standardized mean differences in cardiovascular disease risk factor change.

RESULTS

Overall, 3 trials met the inclusion criteria for blood pressure, 4 for glycemic control, 9 for overweight/obesity, and 2 for smoking. On meta-analysis, interventions with sleep as the sole behavioral target were associated with a significant reduction in hemoglobin A1c% (-0.84; 95% confidence interval [CI], -1.34 to -0.34), but not a significant reduction in systolic blood pressure (-0.18; 95% CI, -0.55 to 0.20) versus controls. In addition, any interventions with sleep as a behavioral target were associated with significant reductions in hemoglobin A1c% (-0.71; 95% CI, -1.01 to -0.42) and weight (-0.78; 95% CI, -1.11 to -0.45), but not systolic blood pressure (-0.72; 95% CI, -1.82 to 0.37). Trials evaluating smoking status were not amenable to meta-analysis.

CONCLUSION

Behavioral interventions to improve sleep were associated with improved glycemic control in patients with DM. It is also possible that these interventions improve weight in individuals who were overweight/obese. A low number of trials and small sample sizes indicate that further large, well-designed randomized controlled trials of interventions are warranted.

Health, health behaviors, and medical care utilization among college students with obesity

Objective: The study assessed perceived health, health behaviors and conditions, and medical care utilization among students of different weight categories. Participants: Participants were college students (n = 37,583) from 58 institutions who responded to a national survey of student health behaviors. Methods: Chi-squared and mixed model analyses were completed. Results: Compared to healthy weight students, those with obesity were less likely to report excellent health and meet dietary and physical activity recommendations, and more likely to have obesity-related chronic conditions and to have attended a medical appointment in the prior 12 months. Students with obesity (84%) and overweight (70%) were more likely to be attempting weight loss compared to students of healthy weight (35%). Conclusions: Students with obesity have poorer health and health behaviors relative to students of healthy weight; students with overweight were in between. Adapting and implementing evidence-based weight management programs within colleges/universities may be beneficial for student health.

Social media-based interventions for adults with obesity and overweight: a meta-analysis and meta-regression

Social isolation and loneliness are growing public health concerns in adults with obesity and overweight. Social media-based interventions may be a promising approach. This systematic review aims to (1) evaluate the effectiveness of social media-based interventions on weight, body mass index, waist circumference, fat, energy intake and physical activity among adults with obesity and overweight and (2) explore potential covariates on treatment effect. Eight databases, namely, PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus PsycINFO and ProQuest, were searched from inception until December 31, 2021. The Cochrane Collaboration Risk of Bias Tool and Grading of Recommendations, Assessment, Development and Evaluation criteria evaluated the evidence quality. Twenty-eight randomised controlled trials were identified. Meta-analyses found that social media-based interventions had small-to-medium significant effects on weight, BMI, waist circumference, body fat mass and daily steps. Subgroup analysis found greater effect in interventions without published protocol or not registered in trial registries than their counterparts. Meta-regression analysis showed that duration of intervention was a significant covariate. The certainty of evidence quality of all outcomes was very low or low. Social media-based interventions can be considered an adjunct intervention for weight management. Future trials with large sample sizes and follow-up assessment are needed.

A randomized controlled trial for reduction of risk factors for cardiovascular disease in young adults: Methods of the Aspire study

BACKGROUND

Being overweight or obese is a large public health problem, especially in the African American/Black and Hispanic communities. Having a body mass index (BMI) > 25 can lead to chronic health conditions, such as heart disease, stroke, and type 2 diabetes. The transition into adulthood may be an excellent time to intervene due to young adults gaining independence; however, little research has focused on community college students and weight change. The purpose of this randomized controlled trial is to test the efficacy of an intervention tool that is personalized for weight loss through healthy eating and increased physical activity in Black and Hispanic community college students.

METHODS

Community college students who identify as Black or Hispanic (N = 256) will be recruited and randomized 1:1 to a 12-month, health coach and smartphone application (app) driven intervention or an attention-control condition. The intervention is implemented by health coaches, trained in a health coach specialty program at a university. The intervention includes a Smartphone app for tracking dietary intake, a Fitbit Inspire 2 for tracking physical activity, and daily personalized text messages from a health coach. The main outcome is percent weight loss at 6- and 12-month follow-up assessments. Secondary outcomes include self-efficacy for eating and physical activity, adherence to self-monitoring, Healthy Eating Index scores, and physical activity levels.

DISCUSSION

If the intervention is demonstrated to be efficacious, broader dissemination across college/university campuses to assist young adults to develop sustainable healthy habits may be possible.

CLINICALTRIALS

gov Identifier: NCT04412954 R01 Trial Number: 1R01NR018699-02.

Identifying the behavior change techniques used in obesity interventions: AN EXAMPLE FROM THE EARLY TRIALS

Objective

The dissemination of effective obesity interventions requires the documentation of key elements of the intervention. But outcome papers and other published manuscripts often lack detail that allow the replication of the intervention. The Behavior Change Technique (BCT) Taxonomy (BCTTv1) is a widely used approach to identify key elements of an intervention study. This study compares the extent to which BCTs and domains identified in studies' intervention protocol are concordant with detail from corresponding intervention design and study outcome papers.

Methods

Data come from four obesity interventions with complete intervention protocols as well as published intervention design and outcome papers. The number of domains and BCTs was calculated for each treatment arm and stratified by coding source. Emphasis of domains and BCTs was determined using an Analytical Hierarchy Process (AHP).

Results

A review of each study's intervention protocol showed the mean number of domains and BCTs used in treatment arms as 11.8 and 26.7, respectively. Primary outcome papers had a mean loss of 34% of the reported domains and 43% of BCTS as compared with intervention protocl. Design papers showed a loss of 11% and 21% of domains and BCTs, respectively.

Conclusions

The results confirm the limitations of using the BCTTv1 coding of outcome papers to describe obesity-related interventions. The results also highlight the need for mechanisms that allow for a full description of intervention content such as inclusion in a supplemental section of an online journal or the use of intervention-focused consort guidelines.

Exercise preferences among emerging adults: Do men and women want different things?

The purpose of this study was to examine exercise preferences of college students (CS), and explore potential gender differences to inform interventions. Participants (N = 187, 18-25 years) completed an online survey. Descriptive statistics were conducted to characterize preferences for exercise type and mode of delivery, followed by χ² tests to assess potential gender differences. CS preferred a combination of moderate intensity cardio and strength training. Most CS preferred exercising on their own with guidance from a program. Men preferred intense strength training at higher rates than women (p < .001). Findings can inform tailored recruitment messaging and lifestyle interventions for this high-risk population.

A brief whole-body vibration intervention to avoid weight gain in college students: A randomized controlled pilot trial

ObjectiveOver one-third of college students are overweight or obese and rates are rising. Whole body vibration (WBV) training could prevent weight gain but has not been tested in college students. Methods: Randomized controlled trial comparing thrice weekly WBV for 6 months to controls (CON) in undergraduate students. Feasibility included retention, adherence and safety and outcomes included changes in weight, body mass index (BMI) and fat mass. Results: 77 students enrolled in the trial (WBV: n = 40, CON: n = 37), 81% completed the study. Adherence to WBV averaged 59%. Average group differences were 1% body fat (p = 0.049) and 1 kg fat mass (p < 0.01), favoring WBV. Among students completing >80% of prescribed WBV sessions significant group differences widened, while group differences in BMI (p = 0.026) and weight (p = 0.02) change became significant. Conclusions: WBV may be a feasible, safe and effective approach to weight management in college students, though strategies to optimize adherence should continue.

Associations between college/university campus characteristics and student body mass index

Background

Campus environments are associated with undergraduate weight. However, few studies have examined campus type and geographic location in relation to student weight. This article aimed to identify college/university students with elevated BMIs by campus type and region.

Methods

Linear mixed effects regression models were fit to data from the American College Health Association-National College Health Assessment II. Analyses tested associations between campus type/region and student self-reported BMI.

Results

The sample included 404,987 students from 445 schools with mean BMI 24.9 ± 5.8. Across all school types/regions, BMI confidence intervals included overweight values. Two-year and public school students had higher BMIs compared to four-year and private school students, respectively. Students in the Midwest had higher BMIs compared to students in the Northeast. In the South only, Minority Serving Institution (MSI) students had higher BMIs compared to non-MSI students.

Conclusion

Healthy weight maintenance programs should be made available to undergraduate students.

Preventing weight gain in adults: A systematic review and meta-analysis of randomized controlled trials

Weight gain prevention is a global public health priority to address escalating adiposity in adults. This review evaluates the efficacy of weight gain prevention trials targeting adults aged 18-50 years and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Trials of any duration from inception to May 2020 that evaluated a weight gain prevention intervention (using either prescriptive diet, prescriptive physical activity, prescriptive diet, and/or physical activity or non-prescriptive lifestyle) and included weight or body mass index (weight [kg]/height [m² ]) were eligible. Twenty-nine trials across 34 publications (participants n = 37,407) were included. Intervention resulted in less weight gain compared with controls (-1.15 kg [95% CI -1.50, -0.80 kg] p < 0.001). Subgroup analysis demonstrated greater effectiveness with prescriptive (-1.60 kg [95% CI -2.00, -1.19] p < 0.001) compared with non-prescriptive (-0.81 kg [95% CI 1.10, -0.53] p < 0.001) intervention types. Interventions had greatest impact in healthy weight (18.5-24.9 kg/m² ) (-0.82 kg [95% CI -1.5, -0.50] p < 0.001) or overweight (25.0-29.9 kg/m² ) (-1.48 kg [95% CI -1.85, -1.12] p < 0.001) compared with obese populations (≥30.0 kg/m² ) (-0.56 kg [95% CI -1.40, 0.27] p = 0.19). These findings demonstrate that lifestyle intervention prevents cumulative weight gain in non-obese adults, with future research required to inform cost-effectiveness and implementation feasibility.

Behavioural interventions delivered through interactive social media for health behaviour change, health outcomes, and health equity in the adult population

BACKGROUND

Social networking platforms offer a wide reach for public health interventions allowing communication with broad audiences using tools that are generally free and straightforward to use and may be combined with other components, such as public health policies. We define interactive social media as activities, practices, or behaviours among communities of people who have gathered online to interactively share information, knowledge, and opinions.

OBJECTIVES

We aimed to assess the effectiveness of interactive social media interventions, in which adults are able to communicate directly with each other, on changing health behaviours, body functions, psychological health, well-being, and adverse effects. Our secondary objective was to assess the effects of these interventions on the health of populations who experience health inequity as defined by PROGRESS-Plus. We assessed whether there is evidence about PROGRESS-Plus populations being included in studies and whether results are analysed across any of these characteristics.

SEARCH METHODS

We searched CENTRAL, CINAHL, Embase, MEDLINE (including trial registries) and PsycINFO. We used Google, Web of Science, and relevant web sites to identify additional studies and searched reference lists of included studies. We searched for published and unpublished studies from 2001 until June 1, 2020. We did not limit results by language.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), controlled before-and-after (CBAs) and interrupted time series studies (ITSs). We included studies in which the intervention website, app, or social media platform described a goal of changing a health behaviour, or included a behaviour change technique. The social media intervention had to be delivered to adults via a commonly-used social media platform or one that mimicked a commonly-used platform. We included studies comparing an interactive social media intervention alone or as a component of a multi-component intervention with either a non-interactive social media control or an active but less-interactive social media comparator (e.g. a moderated versus an unmoderated discussion group). Our main outcomes were health behaviours (e.g. physical activity), body function outcomes (e.g. blood glucose), psychological health outcomes (e.g. depression), well-being, and adverse events. Our secondary outcomes were process outcomes important for behaviour change and included knowledge, attitudes, intention and motivation, perceived susceptibility, self-efficacy, and social support.

DATA COLLECTION AND ANALYSIS

We used a pre-tested data extraction form and collected data independently, in duplicate. Because we aimed to assess broad outcomes, we extracted only one outcome per main and secondary outcome categories prioritised by those that were the primary outcome as reported by the study authors, used in a sample size calculation, and patient-important.

MAIN RESULTS

We included 88 studies (871,378 participants), of which 84 were RCTs, three were CBAs and one was an ITS. The majority of the studies were conducted in the USA (54%). In total, 86% were conducted in high-income countries and the remaining 14% in upper middle-income countries. The most commonly used social media platform was Facebook (39%) with few studies utilising other platforms such as WeChat, Twitter, WhatsApp, and Google Hangouts. Many studies (48%) used web-based communities or apps that mimic functions of these well-known social media platforms. We compared studies assessing interactive social media interventions with non-interactive social media interventions, which included paper-based or in-person interventions or no intervention. We only reported the RCT results in our 'Summary of findings' table. We found a range of effects on health behaviours, such as breastfeeding, condom use, diet quality, medication adherence, medical screening and testing, physical activity, tobacco use, and vaccination. For example, these interventions may increase physical activity and medical screening tests but there was little to no effect for other health behaviours, such as improved diet or reduced tobacco use (20,139 participants in 54 RCTs). For body function outcomes, interactive social media interventions may result in small but important positive effects, such as a small but important positive effect on weight loss and a small but important reduction in resting heart rate (4521 participants in 30 RCTs). Interactive social media may improve overall well-being (standardised mean difference (SMD) 0.46, 95% confidence interval (CI) 0.14 to 0.79, moderate effect, low-certainty evidence) demonstrated by an increase of 3.77 points on a general well-being scale (from 1.15 to 6.48 points higher) where scores range from 14 to 70 (3792 participants in 16 studies). We found no difference in effect on psychological outcomes (depression and distress) representing a difference of 0.1 points on a standard scale in which scores range from 0 to 63 points (SMD -0.01, 95% CI -0.14 to 0.12, low-certainty evidence, 2070 participants in 12 RCTs). We also compared studies assessing interactive social media interventions with those with an active but less interactive social media control (11 studies). Four RCTs (1523 participants) that reported on physical activity found an improvement demonstrated by an increase of 28 minutes of moderate-to-vigorous physical activity per week (from 10 to 47 minutes more, SMD 0.35, 95% CI 0.12 to 0.59, small effect, very low-certainty evidence). Two studies found little to no difference in well-being for those in the intervention and control groups (SMD 0.02, 95% CI -0.08 to 0.13, small effect, low-certainty evidence), demonstrated by a mean change of 0.4 points on a scale with a range of 0 to 100. Adverse events related to the social media component of the interventions, such as privacy issues, were not reported in any of our included studies. We were unable to conduct planned subgroup analyses related to health equity as only four studies reported relevant data.

AUTHORS' CONCLUSIONS

This review combined data for a variety of outcomes and found that social media interventions that aim to increase physical activity may be effective and social media interventions may improve well-being. While we assessed many other outcomes, there were too few studies to compare or, where there were studies, the evidence was uncertain. None of our included studies reported adverse effects related to the social media component of the intervention. Future studies should assess adverse events related to the interactive social media component and should report on population characteristics to increase our understanding of the potential effect of these interventions on reducing health inequities.

Applying RE-AIM to Evaluate the External Validity of Weight Gain Prevention Interventions in Young Adults: A Systematic Review

OBJECTIVES

The purpose of this review was to use RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) to assess the extent to which weight gain prevention studies targeting young adults reported on elements of external validity.

DESIGN

Systematic review.

ELIGIBILITY CRITERIA

Articles of interest included a lifestyle/behavioral intervention targeting weight gain prevention. Eligibility criteria included the following: study design of randomized controlled trials, quasi-randomized control trials, or natural experiments; average participant age between 18 and 35 years; study duration of at least 12 months; and published in English between January 2008 and May 2018. Studies had to report weight or body mass index as a measured outcome and were excluded if they were paired with smoking cessation programs, were conducted in specific groups (ie, pregnant women, breast cancer survivors), or were follow-ups to weight loss studies.

STUDY SELECTION

After removing duplicates, the search yielded 11426 articles. Titles and abstracts were screened by 1 reviewer; 144 articles were assessed in a full-text review by 2 reviewers. Discrepancies were resolved by consensus. Nine studies (13 articles) were included in the review.

MAIN OUTCOMES MEASURES

Reported elements of the RE-AIM framework.

RESULTS

A total of 9 studies met the selection criteria. All studies lacked full reporting on external validity elements. Of the total of 60 RE-AIM reporting criteria, 8 were reported by all 9 studies, 26 criteria were reported by fewer than 4 studies, and 22 criteria were not reported by any of the studies.

DISCUSSION

There remains inadequate reporting of elements of external validity and generalizability in weight gain prevention studies. This is a significant scientific constraint that limits the information required to disseminate and implement prevention of weight gain interventions for population impact. Standardized reporting may be needed to ensure results that demonstrate not only internal validity but also external validity and generalizability are needed to promote public health impact.

Changes in Cardiovascular Risk Factors Over 6 Years in Young Adults in a Randomized Trial of Weight Gain Prevention

OBJECTIVE

This study aimed to determine the impact of weight gain prevention interventions on changes in cardiovascular risk factors over 6 years.

METHODS

The Study of Novel Approaches to Weight Gain Prevention (SNAP) randomized 599 participants (ages 18-35; 46% with BMI 21-25; 54% with BMI 25-30) to Large Changes (produce buffer by losing 5-10 pounds initially), Small Changes (daily small changes in intake and activity) or Control and followed 355 participants with ongoing intervention and assessments through 6 years.

RESULTS

There were no significant differences among interventions for changes in weight or cardiovascular disease (CVD) risk factors from baseline to 6 years. However, 44% of participants gained ≥5%, and only 14% lost ≥5% over 6 years. Weight changes, from baseline to year 6, were significantly associated with changes in risk factors, especially insulin and high-density lipoprotein cholesterol. Earlier weight changes (e.g., weight cycling) had no beneficial or adverse effect on changes in CVD risk factors at 6 years, independent of 6-year weight changes.

CONCLUSIONS

Despite participation in a weight gain prevention trial, almost half of these young adults gained ≥5% or more over 6 years, with significant worsening in CVD risk factors. Greater attention to long-term weight gain prevention in young adults is needed.

Using Social Media to Understand Online Social Factors Concerning Obesity: A Systematic Review (Preprint)

Background

Evidence in the literature surrounding obesity suggests that social factors play a substantial role in the spread of obesity. Although social ties with a friend who is obese increase the probability of becoming obese, the role of social media in this dynamic remains underexplored in obesity research. Given the rapid proliferation of social media in recent years, individuals socialize through social media and share their health-related daily routines, including dieting and exercising. Thus, it is timely and imperative to review previous studies focused on social factors in social media and obesity.

Objective

This study aims to examine web-based social factors in relation to obesity research.

Methods

We conducted a systematic review. We searched PubMed, Association for Computing Machinery, and ScienceDirect for articles published by July 5, 2019. Web-based social factors that are related to obesity behaviors were studied and analyzed.

Results

In total, 1608 studies were identified from the selected databases. Of these 1608 studies, 50 (3.11%) studies met the eligibility criteria. In total, 10 types of web-based social factors were identified, and a socioecological model was adopted to explain their potential impact on an individual from varying levels of web-based social structure to social media users’ connection to the real world.

Conclusions

We found 4 levels of interaction in social media. Gender was the only factor found at the individual level, and it affects user’s web-based obesity-related behaviors. Social support was the predominant factor identified, which benefits users in their weight loss journey at the interpersonal level. Some factors, such as stigma were also found to be associated with a healthy web-based social environment. Understanding the effectiveness of these factors is essential to help users create and maintain a healthy lifestyle.

Challenges and Opportunities for the Prevention and Treatment of Cardiovascular Disease Among Young Adults: Report From a National Heart, Lung, and Blood Institute Working Group

Improvements in cardiovascular disease (CVD) rates among young adults in the past 2 decades have been offset by increasing racial/ethnic and gender disparities, persistence of unhealthy lifestyle habits, overweight and obesity, and other CVD risk factors. To enhance the promotion of cardiovascular health among young adults 18 to 39 years old, the medical and broader public health community must understand the biological, interpersonal, and behavioral features of this life stage. Therefore, the National Heart, Lung, and Blood Institute, with support from the Office of Behavioral and Social Science Research, convened a 2-day workshop in Bethesda, Maryland, in September 2017 to identify research challenges and opportunities related to the cardiovascular health of young adults. The current generation of young adults live in an environment undergoing substantial economic, social, and technological transformations, differentiating them from prior research cohorts of young adults. Although the accumulation of clinical and behavioral risk factors for CVD begins early in life, and research suggests early risk is an important determinant of future events, few trials have studied prevention and treatment of CVD in participants <40 years old. Building an evidence base for CVD prevention in this population will require the engagement of young adults, who are often disconnected from the healthcare system and may not prioritize long-term health. These changes demand a repositioning of existing evidence-based treatments to accommodate new sociotechnical contexts. In this article, the authors review the recent literature and current research opportunities to advance the cardiovascular health of today's young adults.

Review of the Scientific Literature on Young Adults Related to Cardiovascular Disease Intervention

Many young adults are at risk for cardiovascular disease related to their behavioral choices. Irresponsible alcohol consumption, tobacco smoking, sedentary lifestyle, poor dietary habits, and excessive weight gain are some of the behaviors that put young adults at risk. The Centers for Disease Control and Prevention identified that 15% of young adults are diagnosed with chronic illnesses related to their behavioral choices. The purpose of this review is to identify, in the literature, interventions that are currently available to young adults and evaluate the adequacy and effectiveness of those interventions. An extensive electronic search was conducted using CINAHL, EBSCOhost, Cochrane, PubMed, and Google Scholar. A total of 130 articles were identified and 28 articles met the inclusion criteria. Three main interventions were identified for young adults: personalized interventions, technology-based interventions, and educational/behavioral interventions. The interventions were all effective to different degrees and interventions were most effective when they were combined. This review impacts in what manner nurses and health care providers deliver health promotion, prevention, and management of cardiovascular risk factors in young adults; in particular, nurses play a key role in lifestyle modifications including diet and exercise.

Using motivational interviewing to enhance emerging adults' engagement in weight loss: The Live Well RVA pilot randomized clinical trial

Background

Emerging adults (ages 18–25) are at high risk for overweight/obesity, yet traditional adult behavioural weight loss (BWL) interventions do not meet the needs of individuals at this developmental stage. Motivational interviewing (MI) is an evidence‐based approach to promote behaviour change but has not been tested for weight loss in this population. The study aimed to test the feasibility and preliminary efficacy of an MI‐enhanced weight loss programme to promote engagement, retention and weight loss in emerging adults.

Methods

Emerging adults with overweight/obesity (N = 47, 81% female, 47% racial/ethnic minority, body mass index [BMI] = 33.2 ± 4.6 kg/m²) were randomized to either standard BWL or MI‐enhanced BWL (MIBWL). Weight was assessed objectively at baseline and posttreatment (3 months). Engagement (in‐person session attendance [weeks 1 and 2], online self‐monitoring [weeks 3–12] and online content viewing [weeks 3–12]) was tracked throughout the program.

Results

Though results did not reach the level of statistical significance, participants in MIBWL demonstrated greater programme engagement (77% vs. 61.0%, p = .11; Cohen d = .48), retention (71% vs. 48.0%, p = .10; Cohen h = .47) and intent‐to‐treat weight loss (−3.3% vs. −2.2%, p = .37; Cohen d = .26) compared with those in BWL.

Conclusions

Effect sizes suggest that MI might be a viable approach to enhance engagement and retention in weight loss programmes targeting emerging adults. This finding is meaningful, given the documented challenges with engagement and retention in this vulnerable population and the relationship between engagement and better weight loss outcomes. The results of this small pilot study support efforts to replicate these findings within the context of a fully powered trial.

Behavior Change Techniques Included in Reports of Social Media Interventions for Promoting Health Behaviors in Adults: Content Analysis Within a Systematic Review

BACKGROUND

Social media are an increasingly commonly used platform for delivering health promotion interventions. Although recent research has focused on the effectiveness of social media interventions for health promotion, very little is known about the optimal content within such interventions, and the active ingredients to promote health behavior change using social media are not clear. Identifying which behavior change techniques (BCTs) are reported may help to clarify the content of interventions using a generalizable terminology that may facilitate future intervention development.

OBJECTIVE

This study aimed to identify which BCTs are reported in social media interventions for promoting health behavior change in adults.

METHODS

We included 71 studies conducted with adult participants (aged ≥18 years) and for which social media intervention was considered interactive in a Cochrane review of the effectiveness of such interventions. We developed a coding manual informed by the Behavior Change Technique Taxonomy version 1 (BCTTv1) to identify BCTs in the included studies. We identified BCTs in all study arms (including control) and described BCTs in the group and self-directed components of studies. We characterized the dose of delivery for each BCT by low and high intensity. We used descriptive analyses to characterize the reported BCTs.

RESULTS

Our data consisted of 71 studies published from 2001 to 2017, mainly conducted in high-income countries (n=65). Most studies (n=31) used tailored, interactive websites to deliver the intervention; Facebook was the most used mainstream platform. In developing our coding manual, we adapted some BCTTv1 instructions to better capture unique nuances of how BCTs were operationalized in social media with respect to likes, retweets, smiles, congratulations, and badges. Social support (unspecified), instruction on how to perform the behavior, and credible source were most frequently identified BCTs in intervention arms of studies and group-delivery settings, whereas instruction on how to perform the behavior was most commonly applied in self-directed components of studies, control arms, and individual participant settings. Instruction on how to perform the behavior was also the most frequently reported BCT in both intervention and control arms simultaneously. Instruction on how to perform the behavior, social support (unspecified), self-monitoring of behavior, information about health consequences, and credible source were identified in the top 5 BCTs delivered with the highest intensity.

CONCLUSIONS

This study within a review provides a detailed description of the BCTs and their dose to promote behavior change in web-based, interactive social media interventions. Clarifying active ingredients in social media interventions and the intensity of their delivery may help to develop future interventions that can more clearly build upon the existing evidence.

Which behaviour change techniques within interventions to prevent weight gain and/or initiate weight loss improve adiposity outcomes in young adults? A systematic review and meta-analysis of randomized controlled trials

Young adulthood is associated with the highest rate of weight gain compared with any other adult age group. This review evaluates the effectiveness of interventions with adiposity outcomes among young adults and identifies which behaviour change techniques (BCTs) are most effective. BCT utilization was assessed using Michie's 93-item BCT Taxonomy v1. Six electronic databases were searched for randomized controlled trials assessing change in adiposity in young adults (17-35 years) until December 2019; identifying 21,582 articles. Fifty-one studies were included. Meta-analyses for weight (n=19 studies), body mass index (BMI) (n=20 studies), and waist circumference (n=10 studies) demonstrated no significant between-group differences at ≤3 or >3 months. There were no differences between interventions focusing on weight loss or weight-gain prevention. Narrative synthesis showed significant between-group differences in weight change, favouring the intervention in 14/43 (33%) studies. In studies assessing BMI and waist circumference, this was 31% (11/36) and 25% (4/16). Two BCTs had a percentage effectiveness ratio >50% in weight loss interventions; social support (unspecified) and self-monitoring behaviour, and one in weight-gain prevention interventions; and goal-setting (outcome). Findings demonstrate initial potential for these types of BCTs and can help build cumulative evidence towards delivering effective, cost-efficient, and replicable interventions.

The efficacy of electronic health interventions targeting improved sleep for achieving prevention of weight gain in adolescents and young to middle-aged adults: A systematic review

Sleep is emerging as a modifiable risk factor in counteracting harmful weight gain. Electronic and mobile devices offer a channel for wide-reaching intervention delivery. This systematic review aimed to determine the efficacy of interventions that included sleep behaviour as part of health promotion for preventing weight gain. Seven databases were searched from 1 January 2000 until 28 June 2019. Eligible studies were controlled trials of weight gain prevention programs that addressed sleep in healthy participants aged 13 to 44 years of age. The primary outcome was change in measured or self-reported weight. From 824 publications located, only six eligible trials with a total of 3,277 participants were identified and all addressed multiple behaviours. One study demonstrated a decrease in weight for the intervention group, and two other studies showed a decreased prevalence of overweight and obesity. Only one trial showed improved sleep duration but failed to show differences in weight. No definitive conclusions concerning the efficacy of electronic weight gain prevention interventions that include sleep can be made, but future trials should provide more detail about intervention techniques used, employ objective sleep and physical activity measures and undertake mediation analysis to judge the contributions of changes in sleep to study outcomes. PROSPERO REGISTRATION: CRD42019121879.

A Secondary Data Analysis Examining Young Adults' Performance in an Internet Weight Loss Program with Financial Incentives

OBJECTIVE

In traditional behavioral weight loss (BWL) programs, young adults fare worse than older adults with respect to engagement, retention, and weight loss, but money and use of technology have been cited as program factors that might improve outcomes for this population. This study evaluated young adult performance in internet-based BWL (IBWL) offering financial incentives for self-monitoring and weight loss.

METHODS

Participants (N = 180; BMI = 33.2 ± 6.0 kg/m² ) were randomly assigned to a 12-week IBWL or IBWL + incentives (IBWL + $) group. This secondary data analysis compared young adults (ages 18-35) in IBWL (n = 16) with young adults in IBWL + $ (n = 12) on percent weight loss, engagement, and retention. Young adults (n = 28) were also compared with older adults (ages 36-70; n = 152) on these outcomes.

RESULTS

Young adult weight loss was -2.8% ± 5.2% in IBWL and -5.4% ± 5.7% in IBWL + $ (P = 0.23, partial η²  = 0.06). A greater proportion of young adults in IBWL + $ achieved a 10% weight loss compared with IBWL (42% vs. 6%, P = 0.02). Compared with older adults, young adults were less engaged, but there were no differences for retention or weight loss (P values > 0.05).

CONCLUSIONS

Findings suggest that technology-based BWL has the potential to eliminate weight loss disparities observed between young adults and older adults in in-person BWL trials. Moreover, adding financial incentives holds promise for promoting clinically meaningful weight loss for young adults.

Examining Heterogeneity of Outcomes in a Weight Gain Prevention Program for Young Adults

OBJECTIVE

This study aimed to characterize young adults who experienced significant weight gains (> 10%) over 3 years in a weight gain prevention program.

METHODS

Secondary data analysis from the Study of Novel Approaches to Weight Gain Prevention (SNAP), a randomized trial comparing two self-regulation interventions and a control arm in young adults (18-35 years; BMI 21-30.9 kg/m² ), was used. Large Gainers (≥ 10% of their body weight; n = 48), Small Gainers (2.6%-9.9%; n = 149), and Weight Stable participants (± 2.5%; n = 143) were compared on dimensions affecting weight gain.

RESULTS

Differences in weight gain among the three groups were significant by year 1 and subsequently increased. Those who became Large Gainers were heavier at baseline and further below their highest weight, and they reported more weight cycling than Weight Stable, with Small Gainers intermediate. Neither study arm nor pregnancy explained weight change differences among the three groups. Large Gainers reported more depressive symptoms than Weight Stable at years 1 and 2. Large Gainers were less likely to weigh themselves at least weekly at 4 months, before differences in weight gain emerged, and at years 1 and 2.

CONCLUSIONS

Large Gainers (representing almost 10% of participants) could be identified early by greater weight issues at baseline and lower use of weight gain prevention strategies.

Behavioural weight loss treatment preferences of college students with overweight and obesity

The college environment increases risk of weight gain in young adults with overweight/obesity. Behavioural weight loss interventions are proven effective, however, young adults' adherence to such programs is poor. The purpose of the study was to determine weight loss treatment preferences of 2- and 4-year college students for the development of population-specific interventions. Students with a BMI ≥25, between 18 and 24 years of age, and enrolled in one of four institutions were recruited. A questionnaire was developed to assess students' preferences and was administered via Qualtrics. BMI was calculated from objectively assessed height and weight measurements. Descriptive analyses, chi-square, Fisher's Exact Test, Mann-Whitney U test and Cramer's V were performed. Participants (n = 133, age = 20.2 ± 1.8) predominately identified as female (70%), non-Hispanic (68%) and Black/African American (32%) or White (32%). Fifty-five percent met criteria for obesity. Most students preferred session length of ≤1 hour (78%), for meetings to be held on a weekday (70%) and for both a peer and a professional to co-facilitate meetings (61%). Preferences for health outcomes and physical activity monitoring, type of physical activity, frequency of dietary monitoring, physical activity tracking method and interest in financial incentives to promote core treatment components differed between institutions. Heterogeneity in program preferences by college environment should be considered when designing weight loss interventions.

Weight Gain Over 6 Years in Young Adults: The Study of Novel Approaches to Weight Gain Prevention Randomized Trial

OBJECTIVE

The study objective was to determine whether two self-regulation interventions that reduced 3-year weight gain in young adults remain effective at 6 years.

METHODS

A randomized trial was conducted in two academic settings in 599 young adults, aged 18 to 35 years, with normal weight or overweight; 504 (84%) reconsented for a 6-year extension (Study of Novel Approaches to Weight Gain Prevention-Extended [SNAP-E]) with ongoing intervention and assessments. Weight gain over 6 years was compared for all assigned to Control, Large Changes (LC; lose 5-10 pounds initially), and Small Changes (SC; make small daily changes in intake and activity).

RESULTS

Weight change from baseline to 6 years did not differ significantly among the three groups (Control = 3.9 kg, SC = 4.1 kg, and LC = 2.8 kg). However, there was a significant age-by-treatment interaction (P = 0.002). Among those < 25 years old, weight gain from baseline to 6 years averaged 7.3 kg in the Control group and was reduced by almost 50% in LC and SC. LC also significantly reduced mean weight gain (area under the curve) over 6 years compared with Control or SC.

CONCLUSIONS

Although the interventions did not reduce weight gain at 6 years for the full cohort, they were effective in those < 25 years old. Future efforts should focus on young adults aged 18 to 24.9 and test more intensive interventions with more diverse participants.

Deconstructing Weight Management Interventions for Young Adults: Looking Inside the Black Box of the EARLY Consortium Trials

OBJECTIVE

The goal of the present study was to deconstruct the 17 treatment arms used in the Early Adult Reduction of weight through LifestYle (EARLY) weight management trials.

METHODS

Intervention materials were coded to reflect behavioral domains and behavior change techniques (BCTs) within those domains planned for each treatment arm. The analytical hierarchy process was employed to determine an emphasis profile of domains in each intervention.

RESULTS

The intervention arms used BCTs from all of the 16 domains, with an average of 29.3 BCTs per intervention arm. All 12 of the interventions included BCTs from the six domains of Goals and Planning, Feedback and Monitoring, Social Support, Shaping Knowledge, Natural Consequences, and Comparison of Outcomes; 11 of the 12 interventions shared 15 BCTs in common across those six domains.

CONCLUSIONS

Weight management interventions are complex. The shared set of BCTs used in the EARLY trials may represent a core intervention that could be studied to determine the required emphases of BCTs and whether additional BCTs add to or detract from efficacy. Deconstructing interventions will aid in reproducibility and understanding of active ingredients.

Early Engagement is Associated with Better Weight Loss in Emerging Adults

Objectives: Predictors of success among emerging adults (EAs; ages 18-25) within behavioral weight loss (BWL) trials are largely unknown. We examined whether early program engagement predicted overall engagement and weight loss in EAs. Methods: Data were pooled from 2 randomized controlled pilot trials in EAs. Participants (N = 99, 80% female, BMI = 33.7±5.1 kg/m²) received a 3-month BWL intervention. Weight was objectively assessed at 0 and 3 months; engagement was tracked weekly; retention was assessed at 3 months. Results: Greater engagement during the initial 4 weeks of treatment predicted greater weight loss (p = .001). Compared to those who did not engage in all 4 initial weeks, participants meeting this threshold experienced greater overall engagement (9.6 vs 4.2 weeks, p < .001), weight losses (intent-to-treat = -3.8% vs -1.3%, p = .004), and retention (78% vs 53%, p = .012). Conclusions: Early engagement in BWL is associated with better outcomes among EAs. Monitoring engagement in real-time during the initial 4 weeks of treatment may be necessary to intervene effectively. Early engagement did not vary by sex or race; future work should identify characteristics associated with poor early engagement.

Reported theory use in electronic health weight management interventions targeting young adults: a systematic review

This review assesses the extent of reported theory use in electronic health weight management interventions targeting young adults aged 18-35 years. Twenty-four eligible studies were identified. Two independent reviewers extracted data and coded for theory use using the Theory Coding Scheme. Overall, the mean total use of theory score was 6/23 (SD = 5; Min. = 0, Max. = 17); 17 studies were classified as having weak application of theory, five as moderate, and two as strong. The majority (N = 18) of studies mentioned theory, however, most (N = 14) did not report how intervention techniques related to theoretical base. No study used theory to select intervention recipients and only four used theory to tailor intervention techniques to recipients. Limited studies reported theory testing (N = 6) and no study used intervention results to build and/or refine theory. Results indicate that weight-related outcomes may be enhanced when at least one or more theoretical constructs are explicitly linked to an intervention technique and when theoretical constructs are included in evaluations. Increases in theory application and reporting are needed to assist the scientific research community in systematically identifying which theories work, for whom, how, why, and when; thereby delivering an advanced understanding of how best to apply theory to enhance intervention outcomes.

Sustaining eHealth engagement in a multi-year weight gain prevention intervention

INTRODUCTION

Digital tools are widely used and effective in weight management interventions; however, usage declines over time. Strategies to promote continued engagement should be explored. We examined the effects of offering additional modes of weight reporting as well as periodic online campaigns to promote engagement, assessed by frequency of weight reporting, in a weight gain prevention study for young adults.

METHODS

Using an observational design, self-reported weights obtained through digital tools were pooled across participants assigned to two interventions (n = 312). Analysis examined the effects before during and after introduction of an additional reporting modality (email) and for three time-limited refresher campaigns over 2 years.

RESULTS

Adding a new modality to the three existing modes (SMS, web, and mobile web) increased weight reporting as well as the number of modalities participants used to report weights. The use of several modes of reporting was associated with more weights submitted (p < 0.01). Refresher campaigns did not increase the proportion of participants reporting; however, the number of weights submitted during the 4-week campaigns increased compared with the 4 weeks before the campaign (p's ≥ 0.45, <0.001, respectively).

CONCLUSION

Using multiple digital modalities and periodic campaigns shows promise for sustaining engagement with weight reporting in a young adult population, and incorporating such strategies may mitigate typical declines in eHealth and mHealth interventions.

Weight Management in Young Adults: Systematic Review of Electronic Health Intervention Components and Outcomes

Background

Young adulthood is a vulnerable period for unhealthy lifestyle adoption and excess weight gain. Scant attention has been focused on developing and evaluating effective weight gain prevention strategies for this age group. Electronic health (eHealth) offers potential as a cost-effective means of delivering convenient, individually-tailored, and contextually-meaningful interventions at scale.

Objective

The primary aim of this systematic review was to locate and synthesize the evidence on eHealth weight management interventions targeting young adults, with a particular focus on (eHealth) intervention components and outcomes.

Methods

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy was executed across the following electronic databases: Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, EBSCO, EMBASE, Emerald, Education Resources Information Center, Medical Literature Analysis and Retrieval System Online, Ovid, ProQuest, PsycINFO, PubMed, Science Direct, Scopus, and Web of Science. Furthermore, 2 reviewers independently assessed records for eligibility: peer-reviewed, published in English, and report evaluations of eHealth weight management interventions targeting healthy young adults (aged 18-35 years). Data were then extracted from studies that met the criteria for inclusion. The methodological quality of studies was independently assessed by 2 reviewers using the Effective Public Health Practice Project’s (EPHPP) quality assessment tool. A comprehensive narrative evidence synthesis was then completed.

Results

Out of the 1301 studies assessed for eligibility, 24 met the criteria for inclusion. According to the EPHPP quality assessment tool, overall, 19 studies were as rated weak, 5 as moderate, and none as strong. The narrative synthesis of intervention outcomes found 8 studies reported positive weight-related outcomes, 4 reported mixed outcomes, and 12 did not report any significant changes in weight-related outcomes. The narrative synthesis of (eHealth) intervention components led to 3 levels of classification. A total of 14 studies were classified as Web-based, 3 as mobile-based, and 7 as multicomponent interventions. Following the narrative synthesis, 5 key strategies were thematically identified: self-regulation (goal setting and self-monitoring), tailored or personalized feedback, contact with an interventionist, social support, and behavioral prompts (nudges and reminders) and booster messages.

Conclusions

Findings highlight the limited evidence base for eHealth weight management interventions targeting young adults. The complex nature of weight management presents an ongoing challenge for interventionists to identify what works, for whom, how, and when. The quality of the evidence in this review was generally assessed as weak; however, assessment tools such as the EPHPP are principally concerned with what should be and this is seldom equivalent to what works. Thus, while sampling, study design and retention rates will remain key determining factors of reliability and validity, further research attention directed toward the development of guiding tools for community trials is warranted.

Findings From a Randomized Trial of Weight Gain Prevention Among Overweight Puerto Rican Young Adults

OBJECTIVE

Assess impact of multimodality weight gain prevention intervention.

METHODS

Randomized clinical trial among 39 overweight young Puerto Rico college students using 10 weekly peer-support sessions promoting dietary, physical activity, and other lifestyle changes enhanced by stress-reduction and mindfulness approaches. Body mass index (BMI) and self-reported behaviors were measured at baseline and at 10 weeks and 6 months after baseline.

RESULTS

At the completion of the intervention, BMIs in the experimental arm were 0.8 units lower than at baseline (z = -3.0; P = .008) and 1.2 lower at 6 months after baseline (z = -4.1; P < .001); BMIs in the control arm were 0.7 higher (z = 2.7; P = .02) at 10 weeks and 0.8 higher at 6 months (z = 3.1; P = .005). Group × time interaction confirmed that BMI differed significantly over time between arms (χ² = 26.9; degrees of freedom = 2; P < .001). Analysis of behavioral changes was mostly inconclusive although the experimental arm reported a considerable increase in walking at 10 weeks. Qualitative data suggested that yoga and mindfulness components were particularly useful for motivating participants to maintain healthier lifestyle patterns.

CONCLUSIONS

Body mass index in the experimental arm decreased at the end of intervention and was maintained at 6 months' follow-up.

Dietary outcomes within the study of novel approaches to weight gain prevention (SNAP) randomized controlled trial

BACKGROUND

Young adults (YA) are at high-risk for unhealthy dietary behaviors and weight gain. The Study of Novel Approaches to Weight Gain Prevention (SNAP) Trial demonstrated that two self-regulation approaches were effective in reducing weight gain over 2 years compared with control. The goal of this analysis was to examine effects of intervention on dietary outcomes and the association of diet changes with weight change.

METHODS

Participants were 599 YA, age 18-35 years, BMI 21.0-30.0 kg/m² (27.4 ± 4.4 years; 25.4 ± 2.6 kg/m²; 22% men; 73% non-Hispanic White), who were recruited in Providence, RI and Chapel Hill, NC and randomized to self-regulation with Small Changes (SC), self-regulation with Large Changes (LC) or Control (C). SC and LC emphasized frequent self-weighing to cue behavior changes (small daily changes vs. periodic large changes) and targeted high-risk dietary behaviors. Diet and weight were assessed at baseline, 4 months and 2 years.

RESULTS

LC and SC had greater decreases in energy intake than C at 4 months but not 2 years. LC had the greatest changes in percent calories from fat at 4 months, but differences were attenuated at 2 years. No differences in diet quality were observed. Across conditions, increased total energy consumption, fast food, meals away from home, and binge drinking, and decreased dietary quality and breakfast consumption were all associated with weight gain at 2 years.

CONCLUSIONS

This study suggests the need to strengthen interventions to produce longer term changes in dietary intake and helps to identify specific behaviors associated with weight gain over time in young adults.

TRIAL REGISTRATION

Clinicaltrials.gov # NCT01183689 , registered August 18, 2010.

Social media use for nutrition outcomes in young adults: a mixed-methods systematic review

BACKGROUND

Social media has been widely adopted by young adults, consequently health researchers are looking for ways to leverage this engagement with social media for the delivery of interventions and health promotion campaigns. Weight gain and sub-optimal dietary choices are common in young adults, and social media may be a potential tool to facilitate and support healthier choices.

METHODS

We conducted a mixed-methods systematic review of studies examining social media use for nutrition-related outcomes in young adults. Seven databases [EBscohost, ERIC, ProQuest Central, PubMed, Ovid, Scopus, and Emerald] were systematically searched; 1225 abstracts were screened, and 47 full-text articles were assessed for eligibility. Study designs included both quantitative, such as experimental and observational studies, and qualitative, such as focus groups and interviews, approaches. Quality was assessed using the Mixed Methods Appraisal Tool. Quantitative and qualitative results were examined separately, and then synthesized.

RESULTS

Twenty-one studies were included although their use of social media was highly variable. The main purpose of social media was to provide information and social support to participants. In the nine randomized controlled trials, social media was used as one aspect of a multi-faceted intervention. Interventions had a positive statistically significant impact on nutritional outcomes in 1/9 trials. Engagement with the social media component of interventions varied, from 3 to 69%. Young adults appear to be open to receiving healthy eating and recipe tips through social media, however, they are reluctant to share personal weight-related information on their online social networks.

CONCLUSIONS

Information-dissemination is now an acceptable use of social media by young adults. Using social media effectively for social support, either via private groups or public pages, requires careful evaluation as its effectiveness is yet to be demonstrated in experimental designs. Concerns about public social media use may be a contributing factor to poor engagement with social media in research intervention studies aimed at influencing weight. Future research should consider how to best engage with young adults using social media, how to more effectively use social media to support young adults and to facilitate social and peer-to-peer support in making healthier choices.

Effectiveness of lifestyle interventions for preventing harmful weight gain among young adults from lower socioeconomic status and ethnically diverse backgrounds: a systematic review

The incidence of overweight and obesity are increasing with each successive generation of young adults. Associated co-morbidities will emerge at an earlier age unless weight gain is prevented. Evidence has demonstrated young adults (aged 18-35 years) from low socioeconomic and ethnically diverse backgrounds are at greater risk of overweight or obesity, yet it is unclear how to effectively intervene in this population. This systematic review aimed to assess the effectiveness of lifestyle interventions conducted in this population. Thirty studies reporting on lifestyle interventions for prevention of weight gain were identified from eight electronic databases searched. Six interventions included subgroup analyses to determine if ethnicity moderated weight change, and two included subgroup analyses to determine if socioeconomic status had an effect on change in weight. Five of these six studies were effective in preventing weight gain, and subgroup analyses showed no differences in effect by ethnicity. Of these five studies, two included a subgroup analysis that showed socioeconomic status to have no effect on weight outcome. Despite the promising results from these five lifestyle interventions utilizing online and mobile components to effectively reach and prevent weight gain in this priority population, the evidence base of high quality trials is limited.

The Transition into Young Adulthood: a Critical Period for Weight Control

PURPOSE OF REVIEW

Emerging adulthood (age 18-25) represents a critical period for weight control: rate of weight gain is greatest during these years and the prevalence of overweight and obesity is estimated to be at least 40% among emerging adults. Unique behavioral, psychosocial, and cognitive risk factors among this population must be specifically addressed within weight management programs. We review extant treatment approaches, including lessons learned from the nascent literature specifically targeting this population. Lastly, we provide suggestions to inform future work in this area.

RECENT FINDINGS

The EARLY consortium comprises seven clinical trials targeting weight control in young adults age 18-35. Though these studies encompass a broader age range, two of the trials enrolled large numbers of 18-25-year-olds. Results from these trials and other recent pilot trials provide a foundation for next steps with respect to developing weight management interventions for emerging adults. The design of targeted weight control approaches for emerging and young adults has contributed to improved outcomes for this high-risk population. However, suboptimal engagement and variability in response pose challenges. Identifying and intervening on individual-level behavioral and psychological variables may enhance the effects of these adapted treatments.