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Höchsmann C, Dorling JL, Lavie CJ, Katzmarzyk PT. Healthy Lifestyle and Cardiac Rehabilitation for Weight Loss. Curr Cardiol Rep 2024:10.1007/s11886-024-02130-6. [PMID: 39230618 DOI: 10.1007/s11886-024-02130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2024] [Indexed: 09/05/2024]
Abstract
PURPOSE OF REVIEW Considerable current interest is directed at pharmacological agents for producing significant weight loss. However, healthy lifestyle choices can also lead to clinically meaningful weight loss and improvements in cardiovascular disease (CVD) risk factors. RECENT FINDINGS In this review, we summarize the recent research from our PROmoting Successful Weight Loss in Primary CarE in Louisiana (PROPEL) randomized controlled trial and review previous data on the potential benefits of cardiac rehabilitation and exercise training (CRET) programs to produce weight loss and improvements in CVD risk factors. Although obesity medications are becoming extremely attractive for secondary and even primary CVD prevention, high-intensity non-pharmacological therapies with healthy lifestyle choices reviewed herein can also lead to substantial health improvements in patients with obesity, including improvements in body weight and other body composition parameters as well as overall CVD risk.
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Affiliation(s)
- Christoph Höchsmann
- Department of Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, 80809, Munich, Germany.
| | - James L Dorling
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, New Orleans, LA, USA
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Staiano AE, Button AM, Baker A, Beyl R, Conn AM, Lima A, Lindros J, Newton RL, Stein RI, Welch RR, Cook S, Wilfley DE. A pragmatic trial of a family-centered approach to childhood obesity treatment: Rationale and study design. Contemp Clin Trials 2024; 138:107459. [PMID: 38278478 PMCID: PMC10922779 DOI: 10.1016/j.cct.2024.107459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Family-based behavioral treatment (FBT) is an effective intensive health behavior and lifestyle treatment for obesity reduction in children and adolescents, but families have limited access. The purpose of this randomized, pragmatic, comparative effectiveness trial was to examine changes in child relative weight in a 12-month, enhanced standard of care (eSOC) intervention combined with FBT (eSOC+FBT) vs. eSOC alone. METHODS Children aged 6 to 15 years with obesity, and their primary caregiver, were recruited from primary care clinics. Families were randomized 1:1 to eSOC, a staged approach led by the primary care provider that gradually intensified dependent on a child's response to care and aligns with the American Medical Association guidelines, or the eSOC+FBT arm, which included regular meetings with a health coach for healthy eating, physical activity, positive parenting strategies, and managing social and environmental cues. Both treatments align with the 2023 American Academy of Pediatrics clinical practice guidelines. Assessments occurred at baseline, midpoint (month 6), end-of-intervention (month 12), and follow-up (month 18). Primary outcome was change from baseline to 12 months in child percent overweight (percentage above the median body mass index in the general US population normalized for age and sex). Secondary outcomes were parent weight, child psychosocial factors, heterogeneity of treatment effects, and cardiometabolic risk factors. Exploratory outcomes assessed reach, effectiveness, adoption, implementation, and maintenance. CONCLUSION This pragmatic trial will generate evidence for the comparative effectiveness of implementing two guidelines-based approaches in primary care for obesity reduction in children and adolescents. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03843424.
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Affiliation(s)
- Amanda E Staiano
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America.
| | - Alyssa M Button
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America
| | - Alison Baker
- American Academy of Pediatrics, 345 Park Blvd., Itasca, IL 60143, United States of America
| | - Robbie Beyl
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America
| | - Anne-Marie Conn
- University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, United States of America
| | - Angela Lima
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
| | - Jeanne Lindros
- American Academy of Pediatrics, 345 Park Blvd., Itasca, IL 60143, United States of America
| | - Robert L Newton
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America
| | - Richard I Stein
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
| | - R Robinson Welch
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
| | - Stephen Cook
- University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, United States of America
| | - Denise E Wilfley
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
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Newton RL, Zhang D, Johnson WD, Martin CK, Apolzan JW, Denstel KD, Brantley PJ, Davis TC, Arnold C, Sarpong DF, Price-Haywood EG, Lavie CJ, Thethi TK, Katzmarzyk PT. Predictors of racial differences in weight loss: the PROPEL trial. Obesity (Silver Spring) 2024; 32:476-485. [PMID: 38058232 PMCID: PMC10922207 DOI: 10.1002/oby.23936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Studies have consistently shown that African American individuals lose less weight in response to behavioral interventions, but the mechanisms leading to this result have been understudied. METHODS Data were derived from the PROmoting Successful Weight Loss in Primary CarE in Louisiana (PROPEL) study, which was a cluster-randomized, two-arm trial conducted in primary care clinics. In the PROPEL trial, African American individuals lost less weight compared with patients who belonged to other racial groups after 24 months. In the current study, counterfactual mediation analyses among 445 patients in the intervention arm of PROPEL were used to determine which variables mediated the relationship between race and weight loss. The mediators included treatment engagement, psychosocial, and lifestyle factors. RESULTS At 6 months, daily weighing mediated 33% (p = 0.008) of the racial differences in weight loss. At 24 months, session attendance and daily weighing mediated 35% (p = 0.027) and 66% (p = 0.005) of the racial differences in weight loss, respectively. None of the psychosocial or lifestyle variables mediated the race-weight loss association. CONCLUSIONS Strategies specifically targeting engagement, such as improving session attendance and self-weighing behaviors, among African American individuals are needed to support more equitable weight losses over extended time periods.
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Affiliation(s)
| | - Dachaun Zhang
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | | | | | | | | | - Terry C. Davis
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Connie Arnold
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Daniel F. Sarpong
- Office of Health Equity Research, Yale University School of Medicine, New Haven, CT, USA
| | | | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School- the UQ School of Medicine, New Orleans, LA, USA
| | - Tina K. Thethi
- AdventHealth Translational Research Institute, Orlando, FL, USA
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Holmen H, Flølo T, Tørris C, Løyland B, Almendingen K, Bjørnnes AK, Albertini Früh E, Grov EK, Helseth S, Kvarme LG, Malambo R, Misvær N, Rasalingam A, Riiser K, Sandbekken IH, Schippert AC, Sparboe-Nilsen B, Sundar TKB, Sæterstrand T, Utne I, Valla L, Winger A, Torbjørnsen A. Unpacking the Public Health Triad of Social Inequality in Health, Health Literacy, and Quality of Life-A Scoping Review of Research Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:36. [PMID: 38248501 PMCID: PMC10815593 DOI: 10.3390/ijerph21010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
Social inequalities in health, health literacy, and quality of life serve as distinct public health indicators, but it remains unclear how and to what extent they are applied and combined in the literature. Thus, the characteristics of the research have yet to be established, and we aim to identify and describe the characteristics of research that intersects social inequality in health, health literacy, and quality of life. We conducted a scoping review with systematic searches in ten databases. Studies applying any design in any population were eligible if social inequality in health, health literacy, and quality of life were combined. Citations were independently screened using Covidence. The search yielded 4111 citations, with 73 eligible reports. The reviewed research was mostly quantitative and aimed at patient populations in a community setting, with a scarcity of reports specifically defining and assessing social inequality in health, health literacy, and quality of life, and with only 2/73 citations providing a definition for all three. The published research combining social inequality in health, health literacy, and quality of life is heterogeneous regarding research designs, populations, contexts, and geography, where social inequality appears as a contextualizing variable.
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Affiliation(s)
- Heidi Holmen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Intervention Centre, Oslo University Hospital, 4950 Oslo, Norway
| | - Tone Flølo
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Department of Surgery, Voss Hospital, Haukeland University Hospital, 5704 Voss, Norway
| | - Christine Tørris
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Borghild Løyland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Kari Almendingen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Ann Kristin Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Elena Albertini Früh
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Sølvi Helseth
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Rosah Malambo
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Nina Misvær
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Anurajee Rasalingam
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Kirsti Riiser
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Ida Hellum Sandbekken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Ana Carla Schippert
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Bente Sparboe-Nilsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
| | - Turid Kristin Bigum Sundar
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Torill Sæterstrand
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Lisbeth Valla
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), 0484 Oslo, Norway
| | - Anette Winger
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Astrid Torbjørnsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
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Abstract
Lifestyle intervention is an alluring concept. Changing behaviors to reduce food intake and increase energy expenditure will reduce body weight and body fat. Large randomized clinical trials in academic settings demonstrate lifestyle intervention can produce weight loss and significant health benefits. However, they also demonstrate the problems-not all participants are able to lose even 5%, and weight regain is common. Studies conducted in real-world settings achieve modest weight loss, but no reimbursement model supports it. Health care providers need to understand the benefits and limitations of lifestyle intervention delivery in the medical office setting.
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Affiliation(s)
- Donna H Ryan
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
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Katzmarzyk PT. Addressing Obesity: Implementing Evidence-Based Lifestyle Prevention and Treatment Strategies in Clinical Practice. Med Clin North Am 2023; 107:1025-1034. [PMID: 37806722 DOI: 10.1016/j.mcna.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
The prevalence of obesity continues to increase in the United States and globally, placing a large portion of the population at an increased risk of metabolic and cardiovascular diseases. Primary care settings remain the main access point for medical care and preventive medical services for most individuals and thus represent a key environment for treating and managing obesity. Several recent pragmatic trials conducted in primary care have demonstrated clinically significant weight loss and associated reductions in chronic disease risk factors, highlighting the need to translate these programs into mainstream clinical care.
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Affiliation(s)
- Peter T Katzmarzyk
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
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Höchsmann C, Martin CK, Apolzan JW, Dorling JL, Newton RL, Denstel KD, Mire EF, Johnson WD, Zhang D, Arnold CL, Davis TC, Fonseca V, Thethi TK, Lavie CJ, Springgate B, Katzmarzyk PT. Initial weight loss and early intervention adherence predict long-term weight loss during the Promoting Successful Weight Loss in Primary Care in Louisiana lifestyle intervention. Obesity (Silver Spring) 2023; 31:2272-2282. [PMID: 37551762 PMCID: PMC10597572 DOI: 10.1002/oby.23854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE This study tested whether initial weight change (WC), self-weighing, and adherence to the expected WC trajectory predict longer-term WC in an underserved primary-care population with obesity. METHODS Data from the intervention group (n = 452; 88% women; 74% Black; BMI 37.3 kg/m2 [SD: 4.6]) of the Promoting Successful Weight Loss in Primary Care in Louisiana trial were analyzed. Initial (2-, 4-, and 8-week) percentage WC was calculated from baseline clinic weights and daily at-home weights. Weights were considered adherent if they were on the expected WC trajectory (10% at 6 months with lower [7.5%] and upper [12.5%] bounds). Linear mixed-effects models tested whether initial WC and the number of daily and adherent weights predicted WC at 6, 12, and 24 months. RESULTS Percentage WC during the initial 2, 4, and 8 weeks predicted percentage WC at 6 (R2 = 0.15, R2 = 0.28, and R2 = 0.50), 12 (R2 = 0.11, R2 = 0.19, and R2 = 0.32), and 24 (R2 = 0.09, R2 = 0.11, and R2 = 0.16) months (all p < 0.01). Initial daily and adherent weights were significantly associated with WC as individual predictors, but they only marginally improved predictions beyond initial weight loss alone in multivariable models. CONCLUSIONS These results highlight the importance of initial WC for predicting long-term WC and show that self-weighing and adherence to the expected WC trajectory can improve WC prediction.
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Affiliation(s)
- Christoph Höchsmann
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - James L Dorling
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Robert L Newton
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Kara D Denstel
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Emily F Mire
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - Dachuan Zhang
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Connie L Arnold
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Terry C Davis
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Vivian Fonseca
- AdventHealth, Translational Research Institute, Orlando, Florida, USA
| | - Tina K Thethi
- AdventHealth, Translational Research Institute, Orlando, Florida, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, New Orleans, Louisiana, USA
| | - Benjamin Springgate
- Department of Internal Medicine, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
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Apolzan JW, Martin CK, Newton RL, Myers CA, Arnold CL, Davis TC, Johnson WD, Zhang D, Höchsmann C, Fonseca VA, Denstel KD, Mire EF, Springgate BF, Lavie CJ, Katzmarzyk PT. Dietary intake during a pragmatic cluster-randomized weight loss trial in an underserved population in primary care. Nutr J 2023; 22:38. [PMID: 37528391 PMCID: PMC10394871 DOI: 10.1186/s12937-023-00864-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Currently there are limited data as to whether dietary intake can be improved during pragmatic weight loss interventions in primary care in underserved individuals. METHODS Patients with obesity were recruited into the PROPEL trial, which randomized 18 clinics to either an intensive lifestyle intervention (ILI) or usual care (UC). At baseline and months 6, 12, and 24, fruit and vegetable (F/V) intake and fat intake was determined. Outcomes were analyzed by repeated-measures linear mixed-effects multilevel models and regression models, which included random cluster (clinic) effects. Secondary analyses examined the effects of race, sex, age, and food security status. RESULTS A total of 803 patients were recruited. 84.4% were female, 67.2% African American, 26.1% received Medicaid, and 65.5% made less than $40,000. No differences in F/V intake were seen between the ILI and UC groups at months 6, 12, or 24. The ILI group reduced percent fat at months 6, 12, and 24 compared to UC. Change in F/V intake was negatively correlated with weight change at month 6 whereas change in fat intake was positively associated with weight change at months 6, 12, and 24 for the ILI group. CONCLUSIONS The pragmatic weight loss intervention in primary care did not increase F/V intake but did reduce fat intake in an underserved population with obesity. F/V intake was negatively associated with weight loss at month 6 whereas percent fat was positively correlated with weight loss throughout the intervention. Future efforts better targeting both increasing F/V intake and reducing fat intake may promote greater weight loss in similar populations. TRIAL REGISTRATION NCT Registration: NCT02561221.
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Affiliation(s)
- John W Apolzan
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA.
| | - Corby K Martin
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
| | - Robert L Newton
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
| | - Candice A Myers
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
| | - Connie L Arnold
- Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Terry C Davis
- Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - William D Johnson
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
| | - Dachuan Zhang
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
| | - Christoph Höchsmann
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Vivian A Fonseca
- Department of Medicine, Division of Endocrinology and Metabolism, Tulane University Health Sciences Center, School of Medicine, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
| | - Kara D Denstel
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
| | - Emily F Mire
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
| | - Benjamin F Springgate
- Department of Internal Medicine, Section of Community and Population Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA
- Program in Health Policy and Systems Management, School of Public Health, Louisiana State University, New Orleans, LA, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Peter T Katzmarzyk
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA
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9
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Katzmarzyk PT, Mire EF, Martin CK, Newton RL, Apolzan JW, Denstel KD, Johnson WD. Physical activity and weight loss in a pragmatic weight loss trial. Int J Obes (Lond) 2023; 47:244-248. [PMID: 36702913 PMCID: PMC11079994 DOI: 10.1038/s41366-023-01260-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/27/2023]
Abstract
The purpose of this study was to determine the association between changes in physical activity and changes in body weight in a cluster-randomized weight loss trial conducted in an underserved population in Louisiana. This study reports analyses conducted in the intervention group only, which was a 24-month multi-component weight loss program delivered by health coaches embedded in primary care clinics. Physical activity was assessed at baseline and at 6, 12, and 24 months of follow-up and changes in body weight were expressed as percent weight change from baseline. Among the sample of 402 patients, percent changes in body weight (mean ± SE) across increasing tertiles of changes in walking between baseline and 24 months were -3.2 ± 1.0%, -5.5 ± 0.9%, and -7.3 ± 0.9%, respectively (p = 0.001). Changes in body weight across increasing tertiles of changes in moderate-to-vigorous-intensity activity between baseline and 24 months were -4.3 ± 1.0%, -5.0 ± 0.9%, and -7.0 ± 0.9%, respectively (p = 0.04). In conclusion, this multi-component intervention resulted in clinically significant weight loss, and greater increases in physical activity over the intervention period were associated with greater percent reductions in body weight. These results are consistent with those from other studies conducted primarily in non-underserved populations.
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Affiliation(s)
| | - Emily F Mire
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | - John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Kara D Denstel
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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10
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Dorling JL, Martin CK, Yu Q, Cao W, Höchsmann C, Apolzan JW, Newton RL, Denstel KD, Mire EF, Katzmarzyk PT. Mediators of weight change in underserved patients with obesity: exploratory analyses from the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) cluster-randomized trial. Am J Clin Nutr 2022; 116:1112-1122. [PMID: 35762659 PMCID: PMC9535544 DOI: 10.1093/ajcn/nqac179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/26/2022] [Accepted: 06/21/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Intensive lifestyle interventions (ILIs) stimulate weight loss in underserved patients with obesity, but the mediators of weight change are unknown. OBJECTIVES We aimed to identify the mediators of weight change during an ILI compared with usual care (UC) in underserved patients with obesity. METHODS The PROPEL (Promoting Successful Weight Loss in Primary Care in Louisiana) trial randomly assigned 18 clinics (n = 803) to either an ILI or UC for 24 mo. The ILI group received an intensive lifestyle program; the UC group had routine care. Body weight was measured; further, eating behaviors (restraint, disinhibition), dietary intake (percentage fat intake, fruit and vegetable intake), physical activity, and weight- and health-related quality of life constructs were measured through questionnaires. Mediation analyses assessed whether questionnaire variables explained between-group variations in weight change during 2 periods: baseline to month 12 (n = 779) and month 12 to month 24 (n = 767). RESULTS The ILI induced greater weight loss at month 12 compared with UC (between-group difference: -7.19 kg; 95% CI: -8.43, -6.07 kg). Improvements in disinhibition (-0.33 kg; 95% CI: -0.55, -0.10 kg), percentage fat intake (-0.25 kg; 95% CI: -0.50, -0.01 kg), physical activity (-0.26 kg; 95% CI: -0.41, -0.09 kg), and subjective fatigue (-0.28 kg; 95% CI: -0.46, -0.10 kg) at month 6 during the ILI partially explained this between-group difference. Greater weight loss occurred in the ILI at month 24, yet the ILI group gained 2.24 kg (95% CI: 1.32, 3.26 kg) compared with UC from month 12 to month 24. Change in fruit and vegetable intake (0.13 kg; 95% CI: 0.05, 0.21 kg) partially explained this response, and no variables attenuated the weight regain of the ILI group. CONCLUSIONS In an underserved sample, weight change induced by an ILI compared with UC was mediated by several psychological and behavioral variables. These findings could help refine weight management regimens in underserved patients with obesity.This trial was registered at clinicaltrials.gov as NCT02561221.
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Affiliation(s)
- James L Dorling
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Qingzhao Yu
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Wentao Cao
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Christoph Höchsmann
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | - Kara D Denstel
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Emily F Mire
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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11
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Cromer SJ, Meigs J, Wexler DJ. Racial/ethnic and socioeconomic disparities in weight outcomes, cardiovascular events, and mortality in the look AHEAD trial. Diabetes Res Clin Pract 2022; 192:110095. [PMID: 36174779 DOI: 10.1016/j.diabres.2022.110095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 09/02/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intensive lifestyle interventions (ILI) for type 2 diabetes (T2D) improve health outcomes, but participants from different races/ethnicities or socioeconomic status may not benefit equally. METHODS Within the Look AHEAD trial, we examined achievement of the 7% weight loss goal, as well as secondary weight, cardiovascular, and mortality outcomes, by race/ethnicity and educational attainment (EA). RESULTS Among 4,640 participants (31 % Black or Hispanic, 13 % with less than a high school degree), Black and Hispanic participants were less likely than White participants to achieve 7 % weight loss in both the ILI (45.8 % v. 60.7 %, p < 0.001 and 53.0 % v. 60.7 %, p = 0.01, respectively) and diabetes support and education (DSE) arms. Contrastingly, participants with less than a high school degree were more likely in the ILI but less likely in the DSE arm to achieve this goal, with a significant arm by EA interaction. Hispanic participants and those with lowest EA also experienced decreased mortality in the ILI versus the DSE arm. CONCLUSIONS All Look AHEAD participant subgroups achieved greater weight loss from ILI; however, Black and Hispanic participants lost less weight than White participants in both arms, while those with lowest EA benefited disproportionately from the ILI compared to participants with higher EA.
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Affiliation(s)
- Sara J Cromer
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; The Broad Institute of Harvard and MIT, Boston, MA, United States.
| | - James Meigs
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; The Broad Institute of Harvard and MIT, Boston, MA, United States
| | - Deborah J Wexler
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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12
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Katzmarzyk PT, Denstel KD, Martin CK, Newton RL, Apolzan JW, Mire EF, Horswell R, Johnson WD, Brown AW, Zhang D. Intraclass correlation coefficients for weight loss cluster randomized trials in primary care: The PROPEL trial. Clin Obes 2022; 12:e12524. [PMID: 35412010 PMCID: PMC9283264 DOI: 10.1111/cob.12524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
The aim of this study was to compute intra-class correlations (ICCs) for weight-related and patient-reported outcomes in a cluster randomized clinical trial (cRCT) for weight loss. Baseline and follow-up data from the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) cRCT were used in this analysis. ICCs were computed for baseline and follow-up measures, and changes in body weight, cardiometabolic risk factors and health-related and weight-related quality of life at 6, 12, 18 and 24 months. Baseline ICCs ranged from 0 for PROMIS measures of anxiety and fatigue to 0.055 for total cholesterol (median = 0.019). The ICCs were higher for changes and decreased over time during follow-up. The ICCs for changes were highest in the pooled sample (intervention and usual care combined) followed by the intervention and usual care groups, respectively. The results demonstrated significant ICCs for several outcomes in a weight loss cRCT. The ICCs differed in magnitude depending on whether baseline versus longitudinal data were used, whether data were combined across treatment arms or were considered separately, and varied across the follow-up period. All these factors must be considered when choosing an ICC to inform sample size estimates for future weight loss cRCTs conducted in primary care settings.
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Affiliation(s)
| | - Kara D Denstel
- Pennington Biomedical Research Centre, Baton Rouge, LA, USA
| | - Corby K Martin
- Pennington Biomedical Research Centre, Baton Rouge, LA, USA
| | | | - John W Apolzan
- Pennington Biomedical Research Centre, Baton Rouge, LA, USA
| | - Emily F Mire
- Pennington Biomedical Research Centre, Baton Rouge, LA, USA
| | | | | | - Andrew W Brown
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Dachuan Zhang
- Pennington Biomedical Research Centre, Baton Rouge, LA, USA
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13
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Comparison of weight loss data collected by research technicians versus electronic medical records: the PROPEL trial. Int J Obes (Lond) 2022; 46:1456-1462. [PMID: 35523955 PMCID: PMC9329211 DOI: 10.1038/s41366-022-01129-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022]
Abstract
Background/Objectives: Pragmatic trials are increasingly used to study the implementation of weight loss interventions in real-world settings. This study compared researcher-measured body weights versus electronic medical record (EMR)-derived body weights from a pragmatic trial conducted in an underserved patient population. Subjects/Methods: The PROPEL trial randomly allocated 18 clinics to usual care (UC) or to an intensive lifestyle intervention (ILI) designed to promote weight loss. Weight was measured by trained technicians at baseline and at 6, 12, 18, and 24 months. A total of 11 clinics (6 UC/5 ILI) with 577 enrolled patients also provided EMR data (n = 561), which included available body weights over the period of the trial. Results: The total number of assessments were 2 638 and 2 048 for the researcher-measured and EMR-derived body weight values, respectively. The correlation between researcher-measured and EMR-derived body weights was 0.988 (n = 1 939; p<0.0001). The mean difference between the EMR and researcher weights (EMR-researcher) was 0.63 (2.65 SD) kg, and a Bland-Altman graph showed good agreement between the two data collection methods; the upper and lower boundaries of the 95% limits of agreement are −4.65 kg and +5.91 kg, and 71 (3.7%) of the values were outside the limits of agreement. However, at 6 months, percent weight loss in the ILI compared to the UC group was 7.3% using researcher-measured data versus 5.5% using EMR-derived data. At 24 months, the weight loss maintenance was 4.6% using the technician-measured data versus 3.5% using EMR-derived data. Conclusion: At the group level, body weight data derived from researcher assessments and an EMR showed good agreement; however, the weight loss difference between ILI and UC was blunted when using EMR data. This suggests that weight loss studies that rely on EMR data may require larger sample sizes to detect significant effects. Clinical trial registration: ClinicalTrials.gov number NCT02561221
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14
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Katzmarzyk PT, Apolzan JW, Gajewski B, Johnson WD, Martin CK, Newton RL, Perri MG, VanWormer JJ, Befort CA. Weight loss in primary care: A pooled analysis of two pragmatic cluster-randomized trials. Obesity (Silver Spring) 2021; 29:2044-2054. [PMID: 34714976 PMCID: PMC9520994 DOI: 10.1002/oby.23292] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to report the results of five weight-loss interventions in primary care settings in underserved patients and to compare the level of pragmatism across the interventions using the Pragmatic Explanatory Continuum Indicator Summary (PRECIS-2) tool. METHODS Data from 54 primary care clinics (2,210 patients) were pooled from the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) and Rural Engagement in Primary Care for Optimizing Weight Reduction (REPOWER) cluster-randomized trials. Clinics were randomized to one of five comparators: PROPEL usual care, PROPEL combination of in-clinic and telephone visits, REPOWER in-clinic individual visits, REPOWER in-clinic group visits, or REPOWER telephone group visits. RESULTS At 24 months, weight loss (kilograms) was -0.50 (95% CI: -1.77 to 0.76), -3.05 (-4.10 to -2.01), -4.30 (-5.35 to -3.26), -4.79 (-5.83 to -3.75), and -4.80 (-5.96 to -3.64) in the PROPEL usual care, REPOWER in-clinic individual visits, REPOWER telephone group visits, REPOWER in-clinic group visits, and PROPEL in-clinic and telephone visits arms, respectively. At 24 months, percentage of weight loss was -0.360 (-1.60 to 0.88), -3.00 (-4.02 to -1.98), -4.23 (-5.25 to -3.20), -4.67 (-5.69 to -3.65), and -4.69 (-5.82 to -3.56), respectively, in the five arms. The REPOWER in-clinic individual visits intervention was the most pragmatic and reflects the current Centers for Medicare and Medicaid Services funding model, although this intervention produced the least weight loss. CONCLUSIONS Clinically significant weight loss over 6 months in primary care settings is achievable using a variety of lifestyle-based treatment approaches. Longer-term weight-loss maintenance is more difficult to achieve.
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Affiliation(s)
| | - John W. Apolzan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Byron Gajewski
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Corby K. Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Robert L. Newton
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Michael G. Perri
- College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Jeffrey J. VanWormer
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Christie A. Befort
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
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15
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Geyer C. Empathy and Language in the Clinician Patient Relationship: Improving the Translation of Evidence to Practice. Am J Health Promot 2021; 35:590-592. [PMID: 33969709 DOI: 10.1177/08901171211002328b] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For clinicians, effective communication goes beyond the delivery of scientific information to include an understanding of who the patient is and what they value; treating them with respect; and acknowledging their emotional and social realities. Recognizing our own implicit biases and cultivating a more mindful approach to the impact of language, especially around weight and food, and using verbal and nonverbal approaches to convey empathic concern can improve our relationships with our patients. Patients who feel seen and respected are more likely to follow through with recommendations including dietary change, leading to improved health and quality of life.
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16
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Myers CA, Martin CK, Apolzan JW, Arnold CL, Davis TC, Johnson WD, Katzmarzyk PT. Food Insecurity and Weight Loss in an Underserved Primary Care Population: A Post Hoc Analysis of a Cluster Randomized Trial. Ann Intern Med 2021; 174:1032-1034. [PMID: 33683931 PMCID: PMC8292163 DOI: 10.7326/m20-6326] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Candice A Myers
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Connie L Arnold
- Louisiana State University Health Sciences Center, Shreveport, Louisiana
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Chen M, Surbhi S, Bailey JE. Association of Weight Loss With Type 2 Diabetes Remission Among Adults in Medically Underserved Areas: A Retrospective Cohort Study. Am J Health Promot 2021; 36:29-37. [PMID: 34128392 DOI: 10.1177/08901171211024426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the association between weight loss and type 2 diabetes remission among vulnerable populations living in medically underserved areas of the Mid-Southern United States. DESIGN Quantitative, retrospective cohort study. SETTING 114 ambulatory sites and 5 adults' hospitals in the Mid-South participating in a regional diabetes registry. PARTICIPANTS 9,900 adult patients with type 2 diabetes, stratified by remission status, with 1 year of baseline electronic medical record data, and 1 year of follow-up data for the 2015-2018 study period. MEASURES The outcomes were diabetes remissions, categorized as any remission, partial remission, and complete remission based on the guidelines of the American Diabetes Association. The exposure was weight loss, calculated by the change in the Body Mass Index (BMI) as a proxy measure. ANALYSIS χ2 tests, Fisher's exact tests, and the Mann-Whitney U-test were used to examine the differences in patient characteristics by remission status across the 3 remission categories, as appropriate. Multiple multivariable logistic regressions adjusting for confounders were performed to estimate the adjusted odds ratios (aORs) for the associations between weight loss and diabetes remission. RESULTS Among 9,900 patients identified, a reduction of 0.3 kg/m2 (standard deviation: 2.5) in the average BMI from the baseline to the follow-up was observed. 10.8% achieved any type of remission, with 9.8% for partial and 1.0% for complete remissions. Greater weight loss was significantly associated with an increased likelihood of any (aOR = 1.07, 95% confidence interval (CI), 1.06-1.08), partial (aOR 1.06, 95% CI, 1.04-1.07), and complete diabetes remission (aOR 1.10, 95% CI, 1.07-1.13). CONCLUSIONS Weight loss is significantly associated with diabetes remission among patients living in medically underserved areas, but complete remission is rare.
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Affiliation(s)
- Ming Chen
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Institute of Health Outcome and Policy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Satya Surbhi
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Institute of Health Outcome and Policy, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Medicine-General Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James E Bailey
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Institute of Health Outcome and Policy, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Medicine-General Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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18
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Katz DL, Geyer C, Sanchez H, Buettner D. Knowing Well, Being Well: well-being born of understanding: The Homo Sapiens Superpower. Am J Health Promot 2021. [DOI: 10.1177/08901171211002328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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19
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Höchsmann C, Dorling JL, Martin CK, Newton RL, Apolzan JW, Myers CA, Denstel KD, Mire EF, Johnson WD, Zhang D, Arnold CL, Davis TC, Fonseca V, Lavie CJ, Price-Haywood EG, Katzmarzyk PT. Effects of a 2-Year Primary Care Lifestyle Intervention on Cardiometabolic Risk Factors: A Cluster-Randomized Trial. Circulation 2021; 143:1202-1214. [PMID: 33557578 DOI: 10.1161/circulationaha.120.051328] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intensive lifestyle interventions (ILIs) are the first-line approach to effectively treat obesity and manage associated cardiometabolic risk factors. Because few people have access to ILIs in academic health centers, primary care must implement similar approaches for a meaningful effect on obesity and cardiometabolic disease prevalence. To date, however, effective lifestyle-based obesity treatment in primary care is limited. We examined the effectiveness of a pragmatic ILI for weight loss delivered in primary care among a racially diverse, low-income population with obesity for improving cardiometabolic risk factors over 24 months. METHODS The PROPEL trial (Promoting Successful Weight Loss in Primary Care in Louisiana) randomly allocated 18 clinics equally to usual care or an ILI and subsequently enrolled 803 (351 usual care, 452 ILI) adults (67% Black, 84% female) with obesity from participating clinics. The usual care group continued to receive their normal primary care. The ILI group received a 24-month high-intensity lifestyle-based obesity treatment program, embedded in the clinic setting and delivered by health coaches in weekly sessions initially and monthly sessions in months 7 through 24. RESULTS As recently demonstrated, participants receiving the PROPEL ILI lost significantly more weight over 24 months than those receiving usual care (mean difference, -4.51% [95% CI, -5.93 to -3.10]; P<0.01). Fasting glucose decreased more in the ILI group compared with the usual care group at 12 months (mean difference, -7.1 mg/dL [95% CI, -12.0 to -2.1]; P<0.01) but not 24 months (mean difference, -0.8 mg/dL [95% CI, -6.2 to 4.6]; P=0.76). Increases in high-density lipoprotein cholesterol were greater in the ILI than in the usual care group at both time points (mean difference at 24 months, 4.6 mg/dL [95% CI, 2.9-6.3]; P<0.01). Total:high-density lipoprotein cholesterol ratio and metabolic syndrome severity (z score) decreased more in the ILI group than in the usual care group at both time points, with significant mean differences of the change of -0.31 (95% CI, -0.47 to -0.14; P<0.01) and -0.21 (95% CI, -0.36 to -0.06; P=0.01) at 24 months, respectively. Changes in total cholesterol, low-density lipoprotein cholesterol, triglycerides, and blood pressure did not differ significantly between groups at any time point. CONCLUSIONS A pragmatic ILI consistent with national guidelines and delivered by trained health coaches in primary care produced clinically relevant improvements in cardiometabolic health in an underserved population over 24 months. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02561221.
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Affiliation(s)
- Christoph Höchsmann
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - James L Dorling
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - Robert L Newton
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - Candice A Myers
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - Kara D Denstel
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - Emily F Mire
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - William D Johnson
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - Dachuan Zhang
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
| | - Connie L Arnold
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.)
| | - Terry C Davis
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.)
| | - Vivian Fonseca
- Department of Medicine, Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, LA (V.F.)
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, New Orleans, LA (C.J.L.)
| | - Eboni G Price-Haywood
- Ochsner Clinic Foundation, Center for Outcomes and Health Services Research, New Orleans, LA (E.G.P.-H.)
| | - Peter T Katzmarzyk
- Pennington Biomedical Research Center, Baton Rouge, LA (C.H., J.L.D., C.K.M., R.L.N., J.W.A., C.A.M., K.D.D., E.F.M., W.D.J., D.Z., P.T.K.)
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Katzmarzyk PT, Martin CK, Newton RL, Apolzan JW, Arnold CL, Davis TC, Price-Haywood EG, Denstel KD, Mire EF, Thethi TK, Brantley PJ, Johnson WD, Fonseca V, Gugel J, Kennedy KB, Lavie CJ, Sarpong DF, Springgate B. Weight Loss in Underserved Patients - A Cluster-Randomized Trial. N Engl J Med 2020; 383:909-918. [PMID: 32877581 PMCID: PMC7493523 DOI: 10.1056/nejmoa2007448] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Evidence of the effectiveness of treatment for obesity delivered in primary care settings in underserved populations is lacking. METHODS We conducted a cluster-randomized trial to test the effectiveness of a high-intensity, lifestyle-based program for obesity treatment delivered in primary care clinics in which a high percentage of the patients were from low-income populations. We randomly assigned 18 clinics to provide patients with either an intensive lifestyle intervention, which focused on reduced caloric intake and increased physical activity, or usual care. Patients in the intensive-lifestyle group participated in a high-intensity program delivered by health coaches embedded in the clinics. The program consisted of weekly sessions for the first 6 months, followed by monthly sessions for the remaining 18 months. Patients in the usual-care group received standard care from their primary care team. The primary outcome was the percent change from baseline in body weight at 24 months. RESULTS All 18 clinics (9 assigned to the intensive program and 9 assigned to usual care) completed 24 months of participation; a median of 40.5 patients were enrolled at each clinic. A total of 803 adults with obesity were enrolled: 452 were assigned to the intensive-lifestyle group, and 351 were assigned to the usual-care group; 67.2% of the patients were Black, and 65.5% had an annual household income of less than $40,000. Of the enrolled patients, 83.4% completed the 24-month trial. The percent weight loss at 24 months was significantly greater in the intensive-lifestyle group (change in body weight, -4.99%; 95% confidence interval [CI], -6.02 to -3.96) than in the usual-care group (-0.48%; 95% CI, -1.57 to 0.61), with a mean between-group difference of -4.51 percentage points (95% CI, -5.93 to -3.10) (P<0.001). There were no significant between-group differences in serious adverse events. CONCLUSIONS A high-intensity, lifestyle-based treatment program for obesity delivered in an underserved primary care population resulted in clinically significant weight loss at 24 months. (Funded by the Patient-Centered Outcomes Research Institute and others; PROPEL ClinicalTrials.gov number, NCT02561221.).
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Affiliation(s)
- Peter T Katzmarzyk
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Corby K Martin
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Robert L Newton
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - John W Apolzan
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Connie L Arnold
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Terry C Davis
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Eboni G Price-Haywood
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Kara D Denstel
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Emily F Mire
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Tina K Thethi
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Phillip J Brantley
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - William D Johnson
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Vivian Fonseca
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Jonathan Gugel
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Kathleen B Kennedy
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Carl J Lavie
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Daniel F Sarpong
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
| | - Benjamin Springgate
- From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana
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Myers CA, Martin CK, Newton RL, Apolzan JW, Arnold CL, Davis TC, Price-Haywood EG, Katzmarzyk PT. Cardiovascular Health, Adiposity, and Food Insecurity in an Underserved Population. Nutrients 2019; 11:nu11061376. [PMID: 31248113 PMCID: PMC6628173 DOI: 10.3390/nu11061376] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022] Open
Abstract
This study investigated associations between cardiovascular health (CVH), adiposity, and food insecurity by race, sex, and health literacy in a sample of 800 underserved patients with obesity (body mass index [BMI] ≥ 30 kg/m2). CVH was assessed using American Heart Association Life’s Simple 7 (LS7) and adiposity was estimated using BMI and waist circumference (WC). Mixed models including interaction terms between food insecurity and sex, race, and health literacy were analyzed for LS7, BMI, and WC. Stratified models were analyzed as indicated by significant interactions. Mean BMI and WC were 37.3 kg/m2 (4.6 SD) and 113.5 cm (12.4 SD), respectively. Among patients, 31% were food insecure and 31% had low health literacy. There were significant positive associations between food insecurity and BMI (p = 0.03) and WC (p = 0.03) in the overall sample. In sex-stratified models, women who were food insecure had higher BMI (p = 0.02) and WC (p = 0.007) than their food secure counterparts. Further, food insecure patients with better health literacy had greater BMI (p = 0.004) and WC (p = 0.007) than their food secure counterparts. Results suggest that adiposity is a greater burden in food insecure patients, which may be an important consideration for obesity treatment in underserved populations.
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Affiliation(s)
- Candice A Myers
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
| | - Corby K Martin
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
| | - Robert L Newton
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
| | - John W Apolzan
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
| | - Connie L Arnold
- Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Terry C Davis
- Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Eboni G Price-Haywood
- Ochsner Clinic Foundation, Center for Outcomes and Health Services Research, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
- Ochsner Clinical School, University of Queensland, 1401 Jefferson Highway, New Orleans, LA 70121, USA.
| | - Peter T Katzmarzyk
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
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