1
|
Bauman V, Swanson TN, Eastman AJ, Ross KM, Perri MG. Perceptions of an acceptance-based weight management treatment among adults living in rural areas. Clin Obes 2024:e12662. [PMID: 38613178 DOI: 10.1111/cob.12662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
Obesity and obesity-related comorbidities disproportionately affect rural communities. Research has emerged in support of a novel acceptance-based behavioural weight management treatment (ABT) that integrates the principles and procedures of acceptance-commitment therapy (ACT) with traditional components of standard behavioural treatment (SBT). The current study assessed the perceptions of community stakeholders in rural areas to session materials of a commercially available ABT program. Surveys and focus groups were used to solicit feedback from three former interventionists with experience delivering SBTs in rural counties and from 17 former participants in these programs. Qualitative responses encompassed four overarching themes: (1) recommendations to support participant engagement, (2) comments about preferences for specific ABT and SBT strategies, (3) concerns about specific aspects of treatment delivery, and (4) requests for aesthetic changes to session materials to enhance clarity and engagement. Overall, participants viewed ABT materials and concepts favourably but believed it would be important to begin the intervention with rapport building and training in traditional SBT strategies prior to delving into ACT strategies. Future studies should investigate the efficacy of ABT for weight loss in adults with obesity living in rural communities and continue to solicit feedback from rural community stakeholders.
Collapse
Affiliation(s)
- Viviana Bauman
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Taylor N Swanson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Abraham J Eastman
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Kathryn M Ross
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Michael G Perri
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
2
|
Dixon BN, Hong YR, Perri MG, Allen A, Aufmuth J, Ross KM. Access to Food and Physical Activity Environment Resources in Rural Communities: Impact of Using Driving Time Versus Physical Distance Indicators. JOURNAL OF TRANSPORT & HEALTH 2022; 27:101521. [PMID: 37982034 PMCID: PMC10655550 DOI: 10.1016/j.jth.2022.101521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Brittney N. Dixon
- Department of Health Services Research, Management & Policy, University of Florida, Gainesville, FL
| | - Young-Rock Hong
- Department of Health Services Research, Management & Policy, University of Florida, Gainesville, FL
| | - Michael G. Perri
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Acquel Allen
- Department of Health Services Research, Management & Policy, University of Florida, Gainesville, FL
| | - Joe Aufmuth
- Marston Science Library, University of Florida, Gainesville, FL
| | - Kathryn M. Ross
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| |
Collapse
|
3
|
Befort CA, Ross KM, Janicke DM, Perri MG. Parents of minor children lose less weight during a behavioral weight loss intervention: Findings from the Rural LEAP trial. Obes Sci Pract 2022; 8:728-734. [PMID: 36483125 PMCID: PMC9722455 DOI: 10.1002/osp4.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/11/2022] [Accepted: 03/27/2022] [Indexed: 11/10/2022] Open
Abstract
Objective The transition to parenthood is associated with worsening health behaviors, yet the impact of parental status on successful weight loss has rarely been examined. The purpose of this study was to examine the effect of parental status of minor children on weight loss and behavioral adherence in a rural community-based weight loss intervention. Methods Five hundred and twenty-eight adults (age 21-75 years, body mass index [BMI] 30-45 kg/m2) were enrolled in a group-based weight loss intervention consisting of 16 weekly sessions delivered in face-to-face group sessions at Cooperative Extension Service (CES) offices. Participants who were parents with at least one minor child (≤18 years old) in the home were compared to participants with no minor children in the home. Measures included percent weight loss, session attendance, adherence to self-monitoring, and achieving calorie and physical activity goals. Results Compared to participants without minor children, parents with minor children lost significantly less weight (7.5% vs. 6.2%, respectively; p = 0.01), and were less likely to lose ≥5% of baseline weight (59.2% vs. 70.2%, respectively; p = 0.02). In addition, parents with minor children attended significantly fewer sessions, had lower adherence to self-monitoring, and met calorie and step goals less often (all ps < 0.001). The association between parental status and percent weight loss was not significantly moderated by gender of the parent. Conclusions Parents of minor children had greater difficulty adhering to intervention goals and lost less weight than participants without minor children. Future research should investigate whether tailoring intervention to meet the unique needs of parents can enhance outcomes, especially given the large segment of the population represented by this group.
Collapse
Affiliation(s)
- Christie A. Befort
- Department of Population HealthUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Kathryn M. Ross
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - David M. Janicke
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - Michael G. Perri
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| |
Collapse
|
4
|
Street S, Avenell A. Are individual or group interventions more effective for long-term weight loss in adults with obesity? A systematic review. Clin Obes 2022; 12:e12539. [PMID: 35765718 PMCID: PMC9542282 DOI: 10.1111/cob.12539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 11/15/2022]
Abstract
Guidelines recommend individual and group interventions for weight loss, based on preference. Our 2009 systematic review compared long-term effectiveness of individual or group approaches to the same intervention, but there are new randomized controlled trials (RCTs) of high-quality data. We updated and expanded our previous systematic review. We searched Medline and Embase from 1966 to May 2021, and a clinical trial register from 1966 to 2017. Review Manager (5.4.1) was used to conduct meta-analysis. Ten RCTs were included. The primary outcome, mean weight change at final follow-up, was -1.33 kg (95% confidence interval CI: -2.04, -0.62; 10 trials, 2169 participants), favouring group interventions (p < .001). For the secondary outcomes, attainment of ≥5% body weight loss at final follow-up, the risk ratio (RR) was 1.36 (95% CI 1.05, 1.77; three trials, 1520 participants), favouring group interventions (p = .02); attrition at final follow-up was similar between group and individual arms of trials, RR 0.93 (95% CI 0.82, 1.07) (p = .31). Group interventions can be more effective than individual interventions for long-term weight loss in adults with obesity. However, few studies were included in the clinically relevant, secondary outcome measures. Research on delivering group processes in weight management is needed.
Collapse
Affiliation(s)
- Sarah Street
- Health Services Research Unit, Institute of Applied Health SciencesUniversity of AberdeenAberdeenScotland
| | - Alison Avenell
- Health Services Research Unit, Institute of Applied Health SciencesUniversity of AberdeenAberdeenScotland
| |
Collapse
|
5
|
Kurz D, McCrea-Robertson S, Nelson-Brantley H, Befort C. Rural engagement in primary care for optimizing weight reduction (REPOWER): A mixed methods study of patient perceptions. PATIENT EDUCATION AND COUNSELING 2022; 105:2371-2381. [PMID: 34865892 DOI: 10.1016/j.pec.2021.11.028] [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: 06/17/2021] [Revised: 11/10/2021] [Accepted: 11/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To report on patients' satisfaction and experience of care across three different modes of weight loss counseling. METHODS 1407 patients with obesity in the rural Midwest were enrolled to a 2-year weight management trial through their primary care practice and assigned to one of three treatment conditions: in-clinic individual, in-clinic group, phone group counseling. Patients completed surveys assessing seven domains of satisfaction and experience of care at 6 and 24-months. Post-treatment interviews were conducted to add context to survey responses. RESULTS 1295 (92.0%) and 1230 (87.4%) completed surveys at 6 and 24-months, respectively. Patients in phone group counseling reported lower satisfaction than patients who received in-clinic group or in-clinic individual counseling across all domains at 6-months and five out of seven domains at 24-months. Interviews revealed that patients were more satisfied when they received face-to-face counseling and had meaningful interactions with their primary care provider (PCP) about their weight. CONCLUSION Rural patients with obesity have higher satisfaction and experience of care when weight loss counseling is delivered in a face-to-face environment and when their PCP is involved with their treatment. PRACTICE IMPLICATIONS Primary care practices looking to offer weight loss treatment should consider incorporating some level of face-to-face treatment plans that involves meaningful interaction with the PCP.
Collapse
Affiliation(s)
- Daniel Kurz
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA.
| | - Stacy McCrea-Robertson
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA
| | | | - Christie Befort
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA
| |
Collapse
|
6
|
Differential impact of telehealth extended-care programs for weight-loss maintenance in African American versus white adults. J Behav Med 2022; 45:580-588. [DOI: 10.1007/s10865-022-00291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
|
7
|
Longitudinal Changes in Food Addiction Symptoms and Body Weight among Adults in a Behavioral Weight-Loss Program. Nutrients 2020; 12:nu12123687. [PMID: 33260468 PMCID: PMC7760227 DOI: 10.3390/nu12123687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 12/13/2022] Open
Abstract
Interest in food addiction (FA) has increased, but little is known about its clinical implications or potential treatments. Using secondary analyses from a randomized controlled trial, we evaluated the associations between changes in FA, body weight, and “problem food” consumption during a 22-month behavioral weight-loss program consisting of an initial four-month in-person intervention, 12-month extended-care, and six-month follow-up (n = 182). Food addiction was measured using the Yale Food Addiction Scale. “Problem foods” were identified from the literature and self-reporting. Multilevel modeling was used as the primary method of analysis. We hypothesized that reductions in problem food consumption during the initial treatment phase would be associated with long-term (22-month) FA reductions. As expected, we found that reductions in problem foods were associated with greater initial reductions in FA symptoms; however, they were also associated with a sharper rebound in symptoms over time (p = 0.016), resulting in no significant difference at Month 22 (p = 0.856). Next, we hypothesized that long-term changes in FA would be associated with long-term changes in body weight. Although both FA and weight decreased over time (ps < 0.05), month-to-month changes in FA were not associated with month-to-month changes in weight (p = 0.706). Instead, higher overall FA (i.e., mean scores over the course of the study) were associated with less weight loss (p = 0.008) over time. Finally, we hypothesized that initial reductions in problem food consumption would be associated with long-term reductions in weight, but this relationship was not significant (ps > 0.05). Given the complexity of the findings, more research is needed to identify interventions for long-term changes in FA and to elucidate the associations between problem foods, FA, and weight.
Collapse
|
8
|
Sittig S, McGowan A, Iyengar S. Extensive Review of Persuasive System Design Categories and Principles: Behavioral Obesity Interventions. J Med Syst 2020; 44:128. [PMID: 32500161 DOI: 10.1007/s10916-020-01591-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 05/21/2020] [Indexed: 12/11/2022]
Abstract
In this extensive review of behavioral digital obesity interventions, we reviewed randomized control trials aimed at weight loss or maintaining weight loss and identifying persuasive categories and principles that drive these interventions. The following databases were searched for long-term obesity interventions: Medline, PsycINFO, Academic Search Complete, CINAHL and Scopus. The inclusion criteria included the following search terms: obesity, overweight, weight reduction, weight loss, obesity management, and diet control. Additional criteria included randomized control trial, ≥ 6 months intervention, ≥ 100 participants and must include persuasive technology. Forty-six publications were in the final review. Primary task support was the most frequently utilized persuasive system design (PSD) category and self-monitoring was the most utilized PSD principle. Behavioral obesity interventions that utilized PSD with a behavior change theory more frequently produced statistically significant weight loss findings. Persuasive technology and PSD in digital health play a significant role in the management and improvement of obesity especially when aligned with behavior change theories. Understanding which PSD categories and principles work best for behavioral obesity interventions is critical and future interventions might be more effective if they were based on these specific PSD categories and principles.
Collapse
Affiliation(s)
- Scott Sittig
- School of Computing, University of South Alabama, Mobile, AL, 36688, USA.
| | - Aleise McGowan
- School of Computing, University of South Alabama, Mobile, AL, 36688, USA
| | - Sriram Iyengar
- Department of Medicine, University of Arizona, Tucson, AZ, 85721, USA
| |
Collapse
|
9
|
Perri MG, Shankar MN, Daniels MJ, Durning PE, Ross KM, Limacher MC, Janicke DM, Martin AD, Dhara K, Bobroff LB, Radcliff TA, Befort CA. Effect of Telehealth Extended Care for Maintenance of Weight Loss in Rural US Communities: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e206764. [PMID: 32539150 PMCID: PMC7296388 DOI: 10.1001/jamanetworkopen.2020.6764] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
IMPORTANCE Lifestyle interventions for obesity produce reductions in body weight that can decrease risk for diabetes and cardiovascular disease but are limited by suboptimal maintenance of lost weight and inadequate dissemination in low-resource communities. OBJECTIVE To evaluate the effectiveness of extended care programs for obesity management delivered remotely in rural communities through the US Cooperative Extension System. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from October 21, 2013, to December 21, 2018, in Cooperative Extension Service offices of 14 counties in Florida. A total of 851 individuals were screened for participation; 220 individuals did not meet eligibility criteria, and 103 individuals declined to participate. Of 528 individuals who initiated a 4-month lifestyle intervention, 445 qualified for randomization. Data were analyzed from August 22 to October 21, 2019. INTERVENTIONS Participants were randomly assigned to extended care delivered via individual or group telephone counseling or an education control program delivered via email. All participants received 18 modules with posttreatment recommendations for maintaining lost weight. In the telephone-based interventions, health coaches provided participants with 18 individual or group sessions focused on problem solving for obstacles to the maintenance of weight loss. MAIN OUTCOMES AND MEASURES The primary outcome was change in body weight from the conclusion of initial intervention (month 4) to final follow-up (month 22). An additional outcome was the proportion of participants achieving at least 10% body weight reduction at follow-up. RESULTS Among 445 participants (mean [SD] age, 55.4 [10.2] years; 368 [82.7%] women; 329 [73.9%] white), 149 participants (33.5%) were randomized to individual telephone counseling, 143 participants (32.1%) were randomized to group telephone counseling, and 153 participants (34.4%) were randomized to the email education control. Mean (SD) baseline weight was 99.9 (14.6) kg, and mean (SD) weight loss after the initial intervention was 8.3 (4.9) kg. Mean weight regains at follow-up were 2.3 (95% credible interval [CrI], 1.2-3.4) kg in the individual telephone counseling group, 2.8 (95% CrI, 1.4-4.2) kg for the group telephone counseling group, and 4.1 (95% CrI, 3.1-5.0) kg for the education control group, with a significantly smaller weight regain observed in the individual telephone counseling group vs control group (posterior probability >.99). A larger proportion of participants in the individual telephone counseling group achieved at least 10% weight reductions (31.5% [95% CrI, 24.1%-40.0%]) than in the control group (19.1% [95% CrI, 14.1%-24.9%]) (posterior probability >.99). CONCLUSIONS AND RELEVANCE This randomized clinical trial found that providing extended care for obesity management in rural communities via individual telephone counseling decreased weight regain and increased the proportion of participants who sustained clinically meaningful weight losses. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02054624.
Collapse
Affiliation(s)
- Michael G. Perri
- Department of Clinical and Health Psychology, University of Florida, Gainesville
| | - Meena N. Shankar
- Department of Clinical and Health Psychology, University of Florida, Gainesville
| | | | - Patricia E. Durning
- Department of Clinical and Health Psychology, University of Florida, Gainesville
| | - Kathryn M. Ross
- Department of Clinical and Health Psychology, University of Florida, Gainesville
| | | | - David M. Janicke
- Department of Clinical and Health Psychology, University of Florida, Gainesville
| | - A. Daniel Martin
- Department of Physical Therapy, University of Florida, Gainesville
| | - Kumaresh Dhara
- Department of Statistics, University of Florida, Gainesville
| | - Linda B. Bobroff
- Department of Family, Youth, and Community Sciences, University of Florida, Gainesville
| | - Tiffany A. Radcliff
- Department of Health Policy and Management, Texas A&M University, College Station
| | - Christie A. Befort
- Department of Population Health, University of Kansas Medical Center, Kansas City
| |
Collapse
|
10
|
Batsis JA, McClure AC, Weintraub AB, Kotz DF, Rotenberg S, Cook SB, Gilbert‐Diamond D, Curtis K, Stevens CJ, Sette D, Rothstein RI. Feasibility and acceptability of a rural, pragmatic, telemedicine-delivered healthy lifestyle programme. Obes Sci Pract 2019; 5:521-530. [PMID: 31890242 PMCID: PMC6934425 DOI: 10.1002/osp4.366] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The public health crisis of obesity leads to increasing morbidity that are even more profound in certain populations such as rural adults. Live, two-way video-conferencing is a modality that can potentially surmount geographic barriers and staffing shortages. METHODS Patients from the Dartmouth-Hitchcock Weight and Wellness Center were recruited into a pragmatic, single-arm, nonrandomized study of a remotely delivered 16-week evidence-based healthy lifestyle programme. Patients were provided hardware and appropriate software allowing for remote participation in all sessions, outside of the clinic setting. Our primary outcomes were feasibility and acceptability of the telemedicine intervention, as well as potential effectiveness on anthropometric and functional measures. RESULTS Of 62 participants approached, we enrolled 37, of which 27 completed at least 75% of the 16-week programme sessions (27% attrition). Mean age was 46.9 ± 11.6 years (88.9% female), with a mean body mass index of 41.3 ± 7.1 kg/m2 and mean waist circumference of 120.7 ± 16.8 cm. Mean patient participant satisfaction regarding the telemedicine approach was favourable (4.48 ± 0.58 on 1-5 Likert scale-low to high) and 67.6/75 on standardized questionnaire. Mean weight loss at 16 weeks was 2.22 ± 3.18 kg representing a 2.1% change (P < .001), with a loss in waist circumference of 3.4% (P = .001). Fat mass and visceral fat were significantly lower at 16 weeks (2.9% and 12.5%; both P < .05), with marginal improvement in appendicular skeletal muscle mass (1.7%). In the 30-second sit-to-stand test, a mean improvement of 2.46 stands (P = .005) was observed. CONCLUSION A telemedicine-delivered, intensive weight loss intervention is feasible, acceptable, and potentially effective in rural adults seeking weight loss.
Collapse
Affiliation(s)
- John A. Batsis
- Section of General Internal MedicineDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy and Clinical PracticeLebanonNew Hampshire
- Dartmouth Centers for Health and AgingDartmouth CollegeHanoverNew Hampshire
- Health Promotion Research Center at DartmouthLebanonNew Hampshire
- Section of Weight & Wellness, Department of MedicineDartmouth‐HitchcockLebanonNew Hampshire
| | - Auden C. McClure
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy and Clinical PracticeLebanonNew Hampshire
- Section of Weight & Wellness, Department of MedicineDartmouth‐HitchcockLebanonNew Hampshire
- Department of PediatricsDartmouth‐HitchcockLebanonNew Hampshire
| | - Aaron B. Weintraub
- Section of Weight & Wellness, Department of MedicineDartmouth‐HitchcockLebanonNew Hampshire
| | - David F. Kotz
- Department of Computer ScienceDartmouth CollegeHanoverNew Hampshire
| | - Sivan Rotenberg
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy and Clinical PracticeLebanonNew Hampshire
- Section of Weight & Wellness, Department of MedicineDartmouth‐HitchcockLebanonNew Hampshire
- Department of PsychiatryDartmouth‐HitchcockLebanonNew Hampshire
| | | | - Diane Gilbert‐Diamond
- Department of EpidemiologyGeisel School of Medicine at DartmouthHanoverNew Hampshire
| | - Kevin Curtis
- Section of Emergency MedicineDartmouth‐HitchcockLebanonNew Hampshire
| | - Courtney J. Stevens
- Dartmouth Centers for Health and AgingDartmouth CollegeHanoverNew Hampshire
- Department of PsychiatryDartmouth‐HitchcockLebanonNew Hampshire
| | - Diane Sette
- Section of Weight & Wellness, Department of MedicineDartmouth‐HitchcockLebanonNew Hampshire
| | - Richard I. Rothstein
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy and Clinical PracticeLebanonNew Hampshire
- Section of Weight & Wellness, Department of MedicineDartmouth‐HitchcockLebanonNew Hampshire
| |
Collapse
|