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Li S, Du Y, Meireles C, Song D, Sharma K, Yin Z, Brimhall B, Wang J. Decoding Heterogeneity in Data-Driven Self-Monitoring Adherence Trajectories in Digital Lifestyle Interventions for Weight Loss: A Qualitative Study. RESEARCH SQUARE 2024:rs.3.rs-3854650. [PMID: 38313251 PMCID: PMC10836100 DOI: 10.21203/rs.3.rs-3854650/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Background Data-driven trajectory modeling is a promising approach for identifying meaningful participant subgroups with various self-monitoring (SM) responses in digital lifestyle interventions. However, there is limited research investigating factors that underlie different subgroups. This qualitative study aimed to investigate factors contributing to participant subgroups with distinct SM trajectory in a digital lifestyle intervention over 6 months. Methods Data were collected from a subset of participants (n = 20) in a 6-month digital lifestyle intervention. Participants were classified into Lower SM Group (n = 10) or a Higher SM (n = 10) subgroup based on their SM adherence trajectories over 6 months. Qualitative data were obtained from semi-structured interviews conducted at 3 months. Data were thematically analyzed using a constant comparative approach. Results Participants were middle-aged (52.9 ± 10.2 years), mostly female (65%), and of Hispanic ethnicity (55%). Four major themes with emerged from the thematic analysis: Acceptance towards SM Technologies, Perceived SM Benefits, Perceived SM Barriers, and Responses When Facing SM Barriers. Participants across both subgroups perceived SM as positive feedback, aiding in diet and physical activity behavior changes. Both groups cited individual and technical barriers to SM, including forgetfulness, the burdensome SM process, and inaccuracy. The Higher SM Group displayed positive problem-solving skills that helped them overcome the SM barriers. In contrast, some in the Lower SM Group felt discouraged from SM. Both subgroups found diet SM particularly challenging, especially due to technical issues such as the inaccurate food database, the time-consuming food entry process in the Fitbit app. Conclusions This study complements findings from our previous quantitative research, which used data-drive trajectory modeling approach to identify distinct participant subgroups in a digital lifestyle based on individuals' 6-month SM adherence trajectories. Our results highlight the potential of enhancing action planning problem solving skills to improve SM adherence in the Lower SM Group. Our findings also emphasize the necessity of addressing the technical issues associated with current diet SM approaches. Overall, findings from our study may inform the development of practical SM improvement strategies in future digital lifestyle interventions. Trial registration The study was pre-registered at ClinicalTrials.gov (NCT05071287) on April 30, 2022.
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Affiliation(s)
- Shiyu Li
- Department of Kinesiology, Pennsylvania State University
| | - Yan Du
- School of Nursing, UT Health San Antonio
| | | | - Dan Song
- College of Nursing, Florida State University
| | | | - Zenong Yin
- Department of Public Health, The University of Texas at San Antonio
| | | | - Jing Wang
- College of Nursing, Florida State University
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Myers JS, Manson A, Billinger SA, Hamilton-Reeves J, Parker W, Maliski SL. Staying Strong and Healthy During Androgen Deprivation Therapy. Cancer Nurs 2024; 47:43-55. [PMID: 35984916 PMCID: PMC10232673 DOI: 10.1097/ncc.0000000000001151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) for prostate cancer is associated with cardiovascular comorbidities and numerous adverse effects decreasing health-related quality of life. Both exercise and dietary interventions have shown promise in reducing ADT-related negative sequelae. However, feasibility for personalized combined exercise/nutrition/education interventions is not well established. OBJECTIVE The purpose of this randomized, controlled, mixed-methods pilot study was to evaluate the feasibility of a nurse-led, telephone-delivered education, exercise, and nutrition intervention, Staying Strong & Healthy, to minimize ADT-related cardiovascular/metabolic risks and symptoms. METHODS Staying Strong & Healthy involves individually tailored education, exercise (aerobic and resistance), and nutrition intervention delivered over 6 months and was compared with attention control. The primary quantitative outcome measure was change from baseline in low-density lipoprotein. Secondary outcomes included change in lipid levels (total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides), fasting blood glucose, hemoglobin A 1c , health-related quality of life, and diet quality. Assessments were performed at baseline, 6 months, and 12 months. RESULTS Feasibility was demonstrated by low attrition rates and high participant satisfaction. No between-group differences were demonstrated in the cardiovascular/metabolic outcomes. Significant within-group improvements were noted for high-density lipoprotein and hemoglobin A 1c in the intervention group. CONCLUSION The study results indicate that participation in a personalized, nurse-delivered exercise, nutrition, and educational intervention is feasible and acceptable to men with prostate cancer receiving ADT. IMPLICATIONS FOR PRACTICE Future randomized controlled research powered to detect significant differences is needed to confirm the impact of the Staying Strong & Healthy intervention on reduction of the cardiovascular/metabolic impact of ADT for men with prostate cancer.
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Affiliation(s)
- Jamie S Myers
- Author Affiliations: University of Kansas School of Nursing (Drs Myers, Manson, and Maliski); University of Kansas School of Health Professions (Dr Billinger); and University of Kansas Medical Center (Drs Hamilton-Reeves and Parker), Kansas City
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3
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Pavlovic N, Naylor J, Boland R, Harris IA, Flood VM, Genel F, Gao M, Hackett D, Vleeskens C, Brady B. Why do some people with osteoarthritis and obesity awaiting hip or knee arthroplasty achieve successful weight management? A qualitative study. J Clin Nurs 2023; 32:7543-7559. [PMID: 37583254 DOI: 10.1111/jocn.16841] [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: 04/16/2023] [Revised: 06/25/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023]
Abstract
AIM To explore perceived barriers and enablers to weight management among people with obesity awaiting total knee or hip arthroplasty. DESIGN A nested qualitative study within a multi-centre, quasi-experimental pilot study comparing usual care weight management to a dietitian-led weight-loss diet. METHODS Semi-structured individual interviews were conducted with adults with end-stage osteoarthritis and a body mass index ≥30 kg/m2 waitlisted for primary total knee or hip arthroplasty. Participants with diverse sociodemographic characteristics and varied success with weight management in the pilot study were purposively sampled. Interviews were analysed using inductive thematic analysis, underpinned by constructivist-interpretivist epistemology. The Patient Activation Measure and Health Literacy Questionnaire were used for context when interpreting the findings. RESULTS Twenty-five participant interviews were conducted with a sociodemographically varied sample (aged 44-80 years, 9 born in Australia, 6 in paid employment and 11 lost ≥5% of their baseline weight). Four identified themes underpinned successful weight management: beliefs, adaptability, navigating healthcare and sociocultural context. Beliefs about whether weight was perceived as a problem, the expectation of weight loss and treatment-related beliefs influenced participants' perspectives towards weight loss. Adaptability, the ability to overcome barriers to weight loss, comprised three subthemes; readiness to act, degree of independence and problem-solving skills. Approaches towards navigating healthcare influenced uptake and adherence to weight management recommendations. Importantly, these themes were dependent on social and environmental circumstances, which influenced the type of barriers experienced and resources available to the individual. CONCLUSION Differences in a person's beliefs, their ability to adapt and navigate healthcare and sociocultural context appear to explain successful weight management among people with end-stage arthritis. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Clinicians should allow for individualisation cognisant of the identified themes when providing advice and treatment to promote adherence to weight management interventions. IMPACT This study explored perceived barriers and enablers to weight management among people with obesity awaiting total knee or hip arthroplasty. Four identified themes underpinned successful weight management: beliefs, adaptability, navigating healthcare and sociocultural context. Beliefs about whether weight was perceived as a problem, the expectation of weight loss and treatment-related beliefs influenced participants' perspectives towards weight loss. Understanding and assessing the contribution of each factor may guide weight management from clinicians treating patients with obesity and osteoarthritis. REPORTING METHOD The data are reported using the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION Patients contributed to the data collected.
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Affiliation(s)
- Natalie Pavlovic
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Fairfield Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Justine Naylor
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Robert Boland
- Fairfield Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Victoria M Flood
- University Centre for Rural Health, Northern Rivers, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Furkan Genel
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- St George and Sutherland Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Manxin Gao
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Danella Hackett
- Fairfield Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Carol Vleeskens
- SPHERE Musculoskeletal Clinical Academic Group, Consumer Community Council, Sydney, New South Wales, Australia
| | - Bernadette Brady
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
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Mitchell CJ, Althouse A, Feldman R, Arnold RM, Rosenzweig M, Smith K, Chu E, White D, Smith T, Schenker Y. Symptom Burden and Shared Care Planning in an Oncology Nurse-Led Primary Palliative Care Intervention (CONNECT) for Patients with Advanced Cancer. J Palliat Med 2023; 26:667-673. [PMID: 36472545 PMCID: PMC10150730 DOI: 10.1089/jpm.2022.0277] [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] [Accepted: 10/26/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose: Primary palliative care (PPC) interventions are needed to address unmet symptom needs within standard oncology care. We designed an oncology nurse-led PPC intervention using shared care planning to facilitate patient engagement. This analysis examines the prevalence and severity of symptoms reported by patients and how symptoms were addressed on shared care plans (SCPs). Methods: Secondary analysis of a cluster randomized PPC intervention trial. Adult patients with metastatic solid tumors whose oncologist "would not be surprised if the patient died within a year" were included. Twenty-three oncology nurses received PPC training and conducted up to three monthly visits with patients. Symptom prevalence and severity were assessed before each visit using the Edmonton Symptom Assessment Scale (ESAS). Nurses collaboratively developed treatment strategies with patients, targeting the most bothersome symptoms for improvement. Results: Among 571 nurse-led PPC visits with 235 patients, the most prevalent and severe symptoms were tiredness (reported at 86% of visits; ESAS ≥4 in 55% of visits), low sense of wellbeing (78%; ESAS ≥4 in 38%), and poor appetite (69%; ESAS ≥4 in 42%). Moderately severe symptoms were addressed on SCPs ranging from 4% (drowsiness) to 35% (tiredness) of the time. Symptom management plans developed by PPC-trained oncology nurses primarily focused on nonpharmaceutical interventions (70%) compared with pharmaceutical interventions (30%). Conclusion: The symptoms that patients report most frequently and as most severe on SCPs were addressed less frequently than expected. Further research is needed to understand how PPC interventions can be designed to more effectively target and improve bothersome symptoms for patients with advanced cancer. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT02712229.
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Affiliation(s)
- Chandler J. Mitchell
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Andrew Althouse
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert Feldman
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert M. Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Margaret Rosenzweig
- Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Kenneth Smith
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edward Chu
- Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Doug White
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tom Smith
- Division of General Internal Medicine, Section of Palliative Medicine, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Yael Schenker
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Williams DR, Chaves E, Karp SM, Browne NT. Clinical review: Implementation of trauma informed care to optimally impact the treatment of childhood obesity. OBESITY PILLARS (ONLINE) 2023; 5:100052. [PMID: 37990746 PMCID: PMC10662032 DOI: 10.1016/j.obpill.2022.100052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 11/23/2023]
Abstract
Background Traumatic events that occur in infancy, childhood, and adolescence can be impactful over the course of a lifespan. Adverse childhood experiences (ACEs) are associated with chronic health problems and mental illness, and can negatively impact educational and job opportunities. There is a growing body of evidence about the relationship between ACEs and the risk of childhood obesity. Trauma informed care (TIC) is an approach to patient care both at the clinical and organizational level that is responsive to the impact past trauma can have on an individual. Methods This clinical review will focus on the impact of toxic stress from trauma on the child through threats to normal physiology, including the manifestation of obesity through energy regulation pathophysiology, followed by a discussion of TIC principles. Available resources and how trauma informed principles can be used in practice are discussed using case study methodology. Results TIC programs recognize the impact of trauma on both patients and clinicians. TIC implementation includes application of TIC four assumptions and six key principles out-lined by Substance Abuse and Mental Health Services Administration's guidance. Clinicians supported by well-designed systems recognize that disclosure is not the goal of TIC; instead, broad trauma inquiry, proceeding to risk and safety assessment if indicated, and connection to interventions is the focus. Best practice communication allows clinicians to access information without retraumatizing the patient with ongoing repetition of their trauma experience. Conclusion Combining the pillars of obesity treatment (i.e., nutrition, physical activity, behavior therapy, medical management) with the tenets of TIC (realize, recognize, respond, resist re-traumatization) affords patients holistic, intentional care and family support. The desired outcomes of TIC align with goals of obesity treatment in children, namely improvement of health and quality of life, sense of self (e.g., body image and self-esteem), and prevention of negative health outcomes.
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Affiliation(s)
- Dominique R. Williams
- The Ohio State University College of Medicine, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LAC, Suite 5F, Columbus, OH, 43215, USA
| | - Eileen Chaves
- Neuropsychology & Pediatric Psychology, The Ohio State University, College of Medicine, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LAC, Suite 5F, Columbus, OH, 43215, USA
| | - Sharon M. Karp
- Vanderbilt University School of Nursing, 461 21st Ave South, Nashville, TN, 37240, USA
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Understanding how educational interventions improve treatment adherence in patients with familial hypercholesterolaemia: a systematic review. J Community Genet 2023; 14:5-15. [PMID: 36512192 PMCID: PMC9947204 DOI: 10.1007/s12687-022-00620-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 11/05/2022] [Indexed: 12/15/2022] Open
Abstract
Effective treatments for familial hypercholesterolaemia (FH) offer patients the opportunity of normal life expectancy, but lifelong adherence to both lipid-lowering therapies and lifestyle measures is challenging, and thus, this is rarely achieved. The aim of this systematic review is to identify attributes of educational interventions that promote adherence to treatment in FH. A systematic literature search was undertaken using Medline, CINAHL, HMIC and Embase. Papers were included based upon pre-defined inclusion and exclusion criteria; the quality of each included paper was assessed using the MERSQI scoring system. Relevant data were extracted, and a narrative synthesis was created. Six relevant studies of varying methodological quality were found amongst 2963 papers identified during the search. In total, there were 619 patients with FH in the intervention arm of the relevant studies. All six studies showed a positive effect of education on adherence to FH treatment; however, only two papers observed a statistically significant effect. Assessment was limited to the short-term. Four themes were identified as important when using education to improve treatment adherence: involving family, patient empowerment, practical problem solving and use of information leaflets. Educational interventions improve short term treatment adherence in patients with FH. Successful interventions are those that involve the whole family, set practical problem solving tasks, and that use techniques to increase the patients self-efficacy. This should all be supported by contemporaneous provision of written, age-appropriate information. There were no studies looking at education and long-term adherence in FH patients, and more research is needed in this area.
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7
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Forman EM, Berry MP, Butryn ML, Hagerman CJ, Huang Z, Juarascio AS, LaFata EM, Ontañón S, Tilford JM, Zhang F. Using artificial intelligence to optimize delivery of weight loss treatment: Protocol for an efficacy and cost-effectiveness trial. Contemp Clin Trials 2023; 124:107029. [PMID: 36435427 PMCID: PMC9839592 DOI: 10.1016/j.cct.2022.107029] [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: 08/30/2022] [Revised: 11/09/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
Gold standard behavioral weight loss (BWL) is limited by the availability of expert clinicians and high cost of delivery. The artificial intelligence (AI) technique of reinforcement learning (RL) is an optimization solution that tracks outcomes associated with specific actions and, over time, learns which actions yield a desired outcome. RL is increasingly utilized to optimize medical treatments (e.g., chemotherapy dosages), and has very recently started to be utilized by behavioral treatments. For example, we previously demonstrated that RL successfully optimized BWL by dynamically choosing between treatments of varying cost/intensity each week for each participant based on automatic monitoring of digital data (e.g., weight change). In that preliminary work, participants randomized to the AI condition required one-third the amount of coaching contact as those randomized to the gold standard condition but had nearly identical weight losses. The current protocol extends our pilot work and will be the first full-scale randomized controlled trial of a RL system for weight control. The primary aim is to evaluate the hypothesis that a RL-based 12-month BWL program will produce non-inferior weight losses to standard BWL treatment, but at lower costs. Secondary aims include testing mechanistic targets (calorie intake, physical activity) and predictors (depression, binge eating). As such, adults with overweight/obesity (N = 336) will be randomized to either a gold standard condition (12 months of weekly BWL groups) or AI-optimized weekly interventions that represent a combination of expert-led group, expert-led call, paraprofessional-led call, and automated message). Participants will be assessed at 0, 1, 6 and 12 months.
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Affiliation(s)
- Evan M Forman
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States.
| | - Michael P Berry
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States
| | - Meghan L Butryn
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States
| | - Charlotte J Hagerman
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States
| | - Zhuoran Huang
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States
| | - Adrienne S Juarascio
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States
| | - Erica M LaFata
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States
| | - Santiago Ontañón
- Department of Computer Science, Drexel University, 3675 Market St 10th floor, Philadelphia, PA 19104, United States; Google Research, 1600 Amphitheatre Parkway, Mountain View, CA 94043, United States
| | - J Mick Tilford
- College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, United States
| | - Fengqing Zhang
- Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States
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Carlisle S, Ayling K, Jia R, Buchanan H, Vedhara K. The effect of choice interventions on retention-related, behavioural and mood outcomes: a systematic review with meta-analysis. Health Psychol Rev 2021; 16:220-256. [PMID: 34423744 DOI: 10.1080/17437199.2021.1962386] [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] [Indexed: 10/20/2022]
Abstract
The provision of choice within interventions has been associated with increased motivation, engagement and interest, as well as improved clinical outcomes. Existing reviews are limited by their wide inclusion criteria or by not assessing behaviour change and mood outcomes. This review examines whether participant-driven choice-based interventions specifically are more likely to be enjoyed and accepted by participants compared to no-choice interventions, and whether this impacts on intervention outcomes in terms of behaviour change or mood. Forty-four randomised controlled trials were identified for inclusion. Random effects meta-analyses were performed for retention-related outcomes (drop-out, adherence and satisfaction), and aggregate behaviour change and mood outcomes. Choice-based interventions resulted in significantly less participant drop-out and increased adherence compared to interventions not offering choice. Results for the behaviour change and mood analyses were mixed. This meta-analytic review demonstrates that choice-based interventions may enhance participant retention and adherence, thus researchers and clinicians alike should consider the provision of choice when designing research and interventions. The evidence for the role of choice in behaviour change and mood is less convincing, and there is a need for more, higher quality research in this area.
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Affiliation(s)
- Sophie Carlisle
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kieran Ayling
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ru Jia
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Kavita Vedhara
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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Molina K, Baskin ML, Long D, Carson TL. Psychological and behavioral pathways between perceived stress and weight change in a behavioral weight loss intervention. J Behav Med 2021; 44:822-832. [PMID: 34003418 DOI: 10.1007/s10865-021-00231-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/07/2021] [Indexed: 11/30/2022]
Abstract
Black women have a higher prevalence of obesity and tend to have suboptimal outcomes in behavioral weight loss programs for reasons that are not fully understood. Studies have shown a potential relationship between perceived psychological stress and weight loss in behavioral interventions. This study sought to assess whether baseline stress was directly or indirectly associated with 6-month weight change among Black women participating in a behavioral weight loss study. Indirect pathways of interest included depressive symptoms and dietary intake. A secondary analysis of data (n = 409) collected from a cluster, randomized behavioral weight loss trial was conducted. Demographics, anthropometry, surveys, and dietary data were collected at baseline and 6 months. Path analysis was used to test for direct and indirect effects of baseline stress on 6-month weight change while controlling for sociodemographic factors and intervention group. Baseline stress was not directly associated with 6-month weight change nor was it indirectly associated via depressive symptoms in the adjusted model. However, each of the direct paths linking baseline stress to weight loss were statistically significant. Stress was not associated with 6-month weight change via dietary intake. Baseline stress was positively associated with 6-month depressive symptoms which in turn was associated with less weight change. Depressive symptoms may offer an additional psychosocial target to consider when designing behavioral weight loss interventions for Black women.
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Affiliation(s)
- Kristine Molina
- Department of Psychological Sciences, University of California Irvine, Irvine, CA, USA
| | - Monica L Baskin
- School of Medicine, Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dustin Long
- School of Public Health, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, Division of Population Sciences, H. Lee Moffitt Cancer Center & Research Institute, MFC-EDU, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
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Food reward sensitivity, impulsivity, and weight change during and after a 3-month weight loss program. PLoS One 2020; 15:e0243530. [PMID: 33306690 PMCID: PMC7732120 DOI: 10.1371/journal.pone.0243530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/22/2020] [Indexed: 01/19/2023] Open
Abstract
Background Greater sensitivity to food rewards and higher levels of impulsivity (and an interaction between these variables, termed “reinforcement pathology”) have been associated with obesity in cross-sectional studies. Less is known regarding how these constructs may impact attempts at weight loss or longer-term weight loss maintenance. Methods We provided 75 adults (69%Female, 84%White, age = 50.8y, BMI = 31.2kg/m2) with a 3-month Internet-based weight loss program and assessed weight, food reward sensitivity (via the Power of Food Scale [PFS]), and impulsivity (via Go No-Go [GNG] and Delay Discounting [DD] computer tasks) at baseline and at Months 3, 6, 9, and 12. No additional intervention was provided Months 3–12. Multi-level mixed-effect models were used to examine changes in PFS, GNG, and DD over time and associations between these measures and weight loss/regain. Results Participants lost 6.0±1.1kg Months 0–3 and regained 2.4±1.1kg Months 3–12. Across time points, higher PFS scores were associated with higher weight, p = .007; however, there were no significant associations between GNG or DD and weight nor between the interactions of PFS and GNG or DD and weight, ps>.05. There were significant decreases from Months 0–3 in PFS, GNG, and DD, ps < .05; however, neither baseline values nor changes were significantly associated with weight change and there were no significant associations between the interactions of PFS and GNG or DD and weight change, ps>.05. Conclusion Results demonstrated an association between food reward sensitivity and weight. Further, decreases in both food reward sensitivity and impulsivity were observed during an initial weight loss program, but neither baseline levels nor improvements were associated with weight change. Taken together, results suggest that the constructs of food reward sensitivity, impulsivity, and reinforcement pathology may have limited clinical utility within behavioral weight management interventions. Future intervention studies should examine whether food-related impulsivity tasks lead to a similar pattern of results.
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Hamilton-Reeves JM, Johnson CN, Hand LK, Bechtel MD, Robertson HL, Michel C, Metcalf M, Chalise P, Mahan NJ, Mirza M, Lee EK, Sullivan DK, Klemp JR, Befort CA, Parker WP, Gibbs HD, Demark-Wahnefried W, Thrasher JB. Feasibility of a Weight Management Program Tailored for Overweight Men with Localized Prostate Cancer - A Pilot Study. Nutr Cancer 2020; 73:2671-2686. [PMID: 33295204 PMCID: PMC8371995 DOI: 10.1080/01635581.2020.1856890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/21/2020] [Accepted: 11/13/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Overweight men with prostate cancer are more likely to suffer from recurrence and death following prostatectomy compared with healthy weight men. This study tested the feasibility of delivering a comprehensive program to foster weight loss before and weight maintenance after surgery in overweight men with localized prostate cancer. METHODS Twenty overweight men scheduled for prostatectomy elected either the intervention (n = 15) or the nonintervention (n = 5). Anthropometrics, biomarkers, diet quality, nutrition literacy, quality of life, and long-term follow-up were assessed in both groups. RESULTS The intervention led to 5.55 kg of weight loss including 3.88 kg of fat loss from baseline to surgery (mean = 8.3 weeks). The intervention significantly increased fiber, protein, fruit, nut, and vegetable intake; and decreased trans fats intake during weight loss. The intervention significantly reduced insulin, C-peptide, systolic blood pressure, leptin:adiponectin ratio, and visceral adiposity compared to the nonintervention. Post-surgically, weight loss was maintained. Changes in lipid profiles, nutrition literacy, and follow-up were not statistically significant in either group. CONCLUSION Significant weight loss (≥5%) is feasible with a coaching intervention in overweight men preparing for prostatectomy and is associated with favorable cardiometabolic effects. This study is registered under NCT02252484 (www.clinicaltrials.gov).
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Affiliation(s)
- Jill M Hamilton-Reeves
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Chelsea N Johnson
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lauren K Hand
- Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Misty D Bechtel
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hilary L Robertson
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Carrie Michel
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Meredith Metcalf
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Prabhakar Chalise
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Nicholas J Mahan
- Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Moben Mirza
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Eugene K Lee
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Debra K Sullivan
- Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jennifer R Klemp
- Breast Cancer Prevention Center, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Christie A Befort
- Department of Preventative Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - William P Parker
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Heather D Gibbs
- Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J Brantley Thrasher
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Stinson EJ, Piaggi P, Votruba SB, Venti C, Lovato‐Morales B, Engel S, Krakoff J, Gluck ME. Is Dietary Nonadherence Unique to Obesity and Weight Loss? Results From a Randomized Clinical Trial. Obesity (Silver Spring) 2020; 28:2020-2027. [PMID: 32808484 PMCID: PMC7644624 DOI: 10.1002/oby.23008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Weight stigma is associated with poor dietary adherence, yet adherence is essential for weight loss and maintenance. This study aimed to determine differences in dietary adherence and perceived hunger between lean individuals and two groups of individuals with obesity. METHODS In a 6-week outpatient dietary intervention (23 males; aged 48 [SD 14] years), lean participants (n = 23; BMI 23 [SD 2] kg/m2 ) received a weight-maintaining energy needs (WMEN) diet, and participants with obesity (BMI 36 [SD 7]) were randomized to either WMEN (n = 18) or a 35% calorie-reduced (CR) diet (n = 19). All food was provided, and multiple adherence and hunger ratings were assessed daily and weekly on an outpatient basis and in person at twice-weekly visits (e.g., 24-hour recall, diaries). RESULTS Weight decreased more in the group of CR individuals with obesity (β = -0.301 kg/wk, P = 0.02) compared with the group of lean individuals and the group of WMEN individuals with obesity. However, total percent adherence did not differ between groups (P = 0.60), and hunger scores did not change across groups over time (P = 0.08). CONCLUSIONS Results indicate that there are no differences in dietary adherence between lean individuals and individuals with obesity and adherence is not associated with adiposity or hunger. Thus, the belief that nonadherence (e.g., lack of willpower) is unique to obesity is untrue and may perpetuate weight bias and stigma.
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Affiliation(s)
- Emma J. Stinson
- Obesity and Diabetes Clinical Research SectionNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthPhoenixArizonaUSA
| | - Paolo Piaggi
- Obesity and Diabetes Clinical Research SectionNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthPhoenixArizonaUSA
| | - Susanne B. Votruba
- Obesity and Diabetes Clinical Research SectionNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthPhoenixArizonaUSA
| | - Colleen Venti
- Obesity and Diabetes Clinical Research SectionNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthPhoenixArizonaUSA
| | - Barbara Lovato‐Morales
- Obesity and Diabetes Clinical Research SectionNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthPhoenixArizonaUSA
| | | | - Jonathan Krakoff
- Obesity and Diabetes Clinical Research SectionNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthPhoenixArizonaUSA
| | - Marci E. Gluck
- Obesity and Diabetes Clinical Research SectionNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthPhoenixArizonaUSA
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13
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Problem-solving, Adherence to Lifestyle Goals, and Weight Loss Among Individuals Participating in a Weight Loss Study. Int J Behav Med 2020; 28:328-336. [PMID: 32681361 DOI: 10.1007/s12529-020-09922-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The role of problem-solving is not well understood in behavioral weight loss interventions. In a 12-month behavioral weight loss study, we examined whether problem-solving changed over time and the relationships between problem-solving and changes in adherence to calorie, fat, and physical activity (PA) goals and percent weight change. METHODS One of the 24 intervention sessions (15th) was devoted to problem-solving. Participants received individualized calorie and fat goals and were given a 150 min/week moderate-to-vigorous PA goal. Adherence to calorie/fat goals and PA goals was calculated at 1, 6, and 12 months using self-reported food intake in a mobile-based weight loss app and accelerometer data, respectively. Weight was measured via a digital scale at baseline, and 6 and 12 months. A general linear model was used to compare problem-solving across time points; post hoc linear mixed modeling was used to examine the relationships between problem-solving and changes in adherence to lifestyle goals and percent weight change. RESULTS The sample (N = 150) was mostly female (90.7%), white (80.70%), with a mean age of 51.1 ± 10.2 years, and a mean body mass index of 34.1 + 4.6 kg/m2. The mean total score of problem-solving at baseline was 81.2 ± 12.3. Problem-solving total and subscale scores did not significantly change over time. Baseline problem-solving was not significantly associated with changes in adherence to lifestyle goals and percent weight change (P > 0.05). CONCLUSION A behavioral weight loss study did not impact problem-solving, and problem-solving may not influence lifestyle adherence and weight changes. Future work needs to examine problem-solving in larger and more diverse samples.
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14
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Yorgason JB, Sandberg JG, Weinstock RS, Trief PM, Fisher L, Hessler D. The importance of relationship processes for lowering BMI over time in women with type 2 diabetes in a randomized controlled trial. Obes Res Clin Pract 2019; 13:599-601. [PMID: 31653476 DOI: 10.1016/j.orcp.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Weight change may be affected by dyadic processes within couple relationships. The aim of this secondary data analysis was to explore trends in BMI across time, and assess whether relationship processes (i.e., relationship satisfaction, positive problem-solving), predict BMI trajectories in men and women. METHODS Data are from 268 participants in the Diabetes Support Project, a randomized trial of behavioral intervention for individuals with type 2 diabetes (T2D) in poor glycemic control. For secondary analyses, BMI was measured at pre-treatment (baseline), 4 months (post-treatment), 8 months, and 12 months. Multiple relationship variables were measured at all time points and were modeled as predictors and correlates of change in BMI across time. RESULTS In general, BMI trajectories had higher starting values (intercepts) for females than for males in the sample (b = -2.51, p < .05), and slopes trended downward from pre-treatment to 12 months (b = -.09, p < .05). Downward trajectories of BMI were more pronounced for women with higher relationship satisfaction (b = .05, p < .05) and higher positive problem solving skills (b = .06, p < .05) at baseline. Change in relationship processes were not correlated with change in BMI across time. CONCLUSION For women with T2D in this behavioral intervention study, relationship process scores at the beginning of treatment predicted changes in BMI over time, with better problem solving and higher relationship satisfaction at baseline related to steeper decreases in BMI across treatment. Additional research is needed to understand how improving relationship interaction prior to diabetes treatment may positively influence weight loss during treatment.
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Affiliation(s)
- Jeremy B Yorgason
- School of Family Life, Brigham Young University, Provo, UT United States.
| | | | - Ruth S Weinstock
- The State University of New York Upstate Medical University, Syracuse, NY United States
| | - Paula M Trief
- The State University of New York Upstate Medical University, Syracuse, NY United States
| | - Lawrence Fisher
- The University of California, San Francisco, CA United States
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15
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Kohlenberg-Müller K, Ramminger S, Kolm A, Barkmeijer A, Gast C, Adam M, Le Bruyn B, Heine-Bröring R, Rachman-Elbaum S, Werkman A, Vanherle K, Höld E, Wewerka-Kreimel D, Valentini L. Nutrition assessment in process-driven, personalized dietetic intervention - The potential importance of assessing behavioural components to improve behavioural change: Results of the EU-funded IMPECD project. Clin Nutr ESPEN 2019; 32:125-134. [PMID: 31221277 DOI: 10.1016/j.clnesp.2019.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS Although up-to-date definitions for nutrition assessment integrate behavioural components, it is not clear what behavioural components are to be assessed. Since behavioural modification is linked to effective therapeutic dietetic interventions, assessing behaviour and factors influencing behaviour might be beneficial to improve personalized dietetic outcome. The aim of the following report is to emphasize the role of behavioural components and factors affecting behaviour at baseline nutrition assessment in personalized dietetic intervention. METHODS The present work is part of the EU-funded project IMPECD ("Improvement of Education and Competences in Dietetics", www.impecd.eu). The project aims to improve the clarity and consistency of national dietetic process models to unify education and training of future dietitians. Experts from five European Universities of Applied Sciences (UAS) in Antwerp (BE), Fulda (DE), Groningen (NL), Neubrandenburg (DE) and St. Pölten (AT) developed a Massive Open Online Course (MOOC) consisting of several clinical cases. It warranted a detailed evaluation of all dietetic care process steps, starting with nutrition assessment. RESULTS Results for motivation assessed during nutrition assessment are not consistently positively associated with outcome and the added value of assessing them at baseline is still unclear. However, depressive symptoms, emotional distress, and anxiety negatively affect eating and physical activity and therefore limit the efficacy of the dietetic intervention. Assessing behavioural components including nutrition literacy is an important precondition for influence on behavioural modification. CONCLUSION Indisputably, baseline assessment of behavioural components and factors influencing behaviour are important to increase the therapeutic efficacy of personalized dietetic interventions.
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Affiliation(s)
- Kathrin Kohlenberg-Müller
- Fulda University of Applied Sciences, Department of Nutritional, Food and Consumer Sciences, Leipziger Str. 123, D-36037, Fulda, Germany.
| | - Sara Ramminger
- Hochschule Neubrandenburg - University of Applied Sciences, Department of Agriculture and Food Sciences, Section of Dietetics, Brodaerstraße 2, D-17033, Neubrandenburg, Germany
| | - Alexandra Kolm
- Fachhochschule St. Pölten GmbH - University of Applied Sciences, Department of Health Sciences, Matthias Corvinus-Straße 15, A-3100, St. Pölten, Austria
| | - Alyanne Barkmeijer
- Hanzehogeschool Groningen, School of Health Care Studies, Nutrition and Dietetics Programme, Petrus Driessenstraat 3, NL 9714 CA, Groningen, the Netherlands
| | - Christina Gast
- Fulda University of Applied Sciences, Department of Nutritional, Food and Consumer Sciences, Leipziger Str. 123, D-36037, Fulda, Germany
| | - Marleen Adam
- Artesis Plantijn University College Antwerp, Department of Science and Technology, Nutrition and Dietetics Programme, Kronenburgstraat 47, 2000, Antwerp, Belgium
| | - Bente Le Bruyn
- Artesis Plantijn University College Antwerp, Department of Science and Technology, Nutrition and Dietetics Programme, Kronenburgstraat 47, 2000, Antwerp, Belgium
| | - Renate Heine-Bröring
- Hanzehogeschool Groningen, School of Health Care Studies, Nutrition and Dietetics Programme, Petrus Driessenstraat 3, NL 9714 CA, Groningen, the Netherlands
| | - Shelly Rachman-Elbaum
- Hochschule Neubrandenburg - University of Applied Sciences, Department of Agriculture and Food Sciences, Section of Dietetics, Brodaerstraße 2, D-17033, Neubrandenburg, Germany
| | - Andrea Werkman
- Hanzehogeschool Groningen, School of Health Care Studies, Nutrition and Dietetics Programme, Petrus Driessenstraat 3, NL 9714 CA, Groningen, the Netherlands
| | - Koen Vanherle
- Artesis Plantijn University College Antwerp, Department of Science and Technology, Nutrition and Dietetics Programme, Kronenburgstraat 47, 2000, Antwerp, Belgium
| | - Elisabeth Höld
- Fachhochschule St. Pölten GmbH - University of Applied Sciences, Department of Health Sciences, Matthias Corvinus-Straße 15, A-3100, St. Pölten, Austria
| | - Daniela Wewerka-Kreimel
- Fachhochschule St. Pölten GmbH - University of Applied Sciences, Department of Health Sciences, Matthias Corvinus-Straße 15, A-3100, St. Pölten, Austria
| | - Luzia Valentini
- Hochschule Neubrandenburg - University of Applied Sciences, Department of Agriculture and Food Sciences, Section of Dietetics, Brodaerstraße 2, D-17033, Neubrandenburg, Germany
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16
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Tasian GE, Ross M, Song L, Audrain-McGovern J, Wiebe D, Warner SG, Henderson B, Patel A, Furth SL. Ecological Momentary Assessment of Factors Associated with Water Intake among Adolescents with Kidney Stone Disease. J Urol 2019; 201:606-614. [PMID: 30076905 DOI: 10.1016/j.juro.2018.07.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Maintaining high water intake decreases kidney stone recurrence but is difficult to do. Strategies to reduce stone recurrence among adolescents are lacking. We conducted an ecological momentary assessment study to identify factors associated with water intake in adolescents with nephrolithiasis. MATERIALS AND METHODS The study population consisted of 15 female and 10 male patients 12 to 18 years old with at least 1 prior kidney stone. For 7 days participants used "smart" bottles to self-monitor water intake and received questionnaires randomly 4 times daily, which were completed in real time on mobile devices. The questionnaires ascertained awareness of water intake volume, awareness of water intake goals, perceived need to drink, access to water, alternative beverage consumption and attitudes toward bathrooms. Linear mixed effects models were fit to estimate the association between momentary responses and daily water intake. RESULTS During 175 person-days 595 assessments (85%) were completed. Median daily water intake was 1,304 ml (IQR 848-1,832) and 20% of participants met their intake goal for 4 days or more. Unawareness of water intake volume was associated with drinking 690 ml less water per day (p = 0.04). A strong self-perceived need to drink more was associated with drinking 1,954 ml less water each day compared to no self-perceived need to drink more (p <0.01). Unawareness of intake goals was weakly associated with drinking 1,129 ml less water each day (p = 0.1). Access to water, alternative beverage consumption and bathroom aversion were not associated with water intake. CONCLUSIONS Unawareness of water volume consumed and low responsiveness to perceived need to drink more were associated with low water intake. Interventions that help adolescents recognize when and identify how to increase water intake may be effective in decreasing stone recurrence.
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Affiliation(s)
- Gregory E Tasian
- Department of Surgery, Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle Ross
- Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lihai Song
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Janet Audrain-McGovern
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas Wiebe
- Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven G Warner
- Department of Surgery, Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brittney Henderson
- Department of Surgery, Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anisha Patel
- Department of Pediatrics, Stanford University, Stanford, California
| | - Susan L Furth
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Chen MJ, Bhowmick S, Beseler L, Schneider KL, Kahan SI, Morton JM, Goodman SB, Amanatullah DF. Strategies for Weight Reduction Prior to Total Joint Arthroplasty. J Bone Joint Surg Am 2018; 100:1888-1896. [PMID: 30399084 DOI: 10.2106/jbjs.18.00020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael J Chen
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
| | - Subhrojyoti Bhowmick
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
| | - Lucille Beseler
- Family Nutrition Center of South Florida, Coconut Creek, Florida
| | - Kristin L Schneider
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Scott I Kahan
- National Center for Weight and Wellness, Washington, DC
| | - John M Morton
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
| | - Stuart B Goodman
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
| | - Derek F Amanatullah
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
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18
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Pagoto S, Tulu B, Agu E, Waring ME, Oleski JL, Jake-Schoffman DE. Using the Habit App for Weight Loss Problem Solving: Development and Feasibility Study. JMIR Mhealth Uhealth 2018; 6:e145. [PMID: 29925496 PMCID: PMC6031896 DOI: 10.2196/mhealth.9801] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 12/19/2022] Open
Abstract
Background Reviews of weight loss mobile apps have revealed they include very few evidence-based features, relying mostly on self-monitoring. Unfortunately, adherence to self-monitoring is often low, especially among patients with motivational challenges. One behavioral strategy that is leveraged in virtually every visit of behavioral weight loss interventions and is specifically used to deal with adherence and motivational issues is problem solving. Problem solving has been successfully implemented in depression mobile apps, but not yet in weight loss apps. Objective This study describes the development and feasibility testing of the Habit app, which was designed to automate problem-solving therapy for weight loss. Methods Two iterative single-arm pilot studies were conducted to evaluate the feasibility and acceptability of the Habit app. In each pilot study, adults who were overweight or obese were enrolled in an 8-week intervention that included the Habit app plus support via a private Facebook group. Feasibility outcomes included retention, app usage, usability, and acceptability. Changes in problem-solving skills and weight over 8 weeks are described, as well as app usage and weight change at 16 weeks. Results Results from both pilots show acceptable use of the Habit app over 8 weeks with on average two to three uses per week, the recommended rate of use. Acceptability ratings were mixed such that 54% (13/24) and 73% (11/15) of participants found the diet solutions helpful and 71% (17/24) and 80% (12/15) found setting reminders for habits helpful in pilots 1 and 2, respectively. In both pilots, participants lost significant weight (P=.005 and P=.03, respectively). In neither pilot was an effect on problem-solving skills observed (P=.62 and P=.27, respectively). Conclusions Problem-solving therapy for weight loss is feasible to implement in a mobile app environment; however, automated delivery may not impact problem-solving skills as has been observed previously via human delivery. Trial Registration ClinicalTrials.gov NCT02192905; https://clinicaltrials.gov/ct2/show/NCT02192905 (Archived by WebCite at http://www.webcitation.org/6zPQmvOF2)
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Affiliation(s)
- Sherry Pagoto
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Bengisu Tulu
- Foisie Business School, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Emmanuel Agu
- Computer Science Department, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Molly E Waring
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Jessica L Oleski
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Danielle E Jake-Schoffman
- Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
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Rafiei N, Gill T. Identification of factors contributing to successful self-directed weight loss: a qualitative study. J Hum Nutr Diet 2017; 31:329-336. [PMID: 29160007 DOI: 10.1111/jhn.12522] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite the number of weight management programmes and their wide promotion, most overweight and obese individuals tend to lose weight on their own. The present study aimed to understand the characteristics and strategies of those who successfully engage in self-directed weight loss, which could empower other overweight and obese individuals with information and strategies to manage their weight on their own. METHODS Men and women who had lost at least 5% of their body weight without direct interaction with professionals or weight management programmes were recruited. Demographic data were collected by questionnaire and participants' weight-loss experiences were explored using semi- structured interviews to elicit in-depth individual experiences and perspectives. Iterative thematic method data analysis was used to generate themes describing contributing factors to the success of self-directed weight loss identified by participants. RESULTS Most characteristics of those who successfully self-managed their weight loss were in line with those reported by successful weight losers participating in professional-led projects. However, strategies such as early embedding of new lifestyle behaviours into daily routine, the ability to learn from previous weight-loss experiences, and not requiring social support were identified as distinctive factors that contributed to the success of self-directed weight loss by participants of the present study. CONCLUSIONS Overweight or obese individuals with strong internal motivation, problem-solving skills and self-reliance are more likely to be successful at achieving self-directed weight loss. The patients identified with these characteristics could be encouraged to self-manage their weight-loss process, leaving the places available in more resource-intensive professional-led programmes to those individuals unlikely to succeed on their own.
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Affiliation(s)
- N Rafiei
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, NSW, Australia
| | - T Gill
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, NSW, Australia
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20
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Garner J, Brown C, Levy S. Diet and Exercise Failures: A Theoretical Extension of Relapse. PSYCHOLOGICAL RECORD 2017. [DOI: 10.1007/s40732-017-0234-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Gettens KM, Gorin AA. Executive function in weight loss and weight loss maintenance: a conceptual review and novel neuropsychological model of weight control. J Behav Med 2017; 40:687-701. [PMID: 28160229 DOI: 10.1007/s10865-017-9831-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/18/2017] [Indexed: 02/07/2023]
Abstract
Weight loss maintenance is a complex, multifaceted process that presents a significant challenge for most individuals who lose weight. A growing body of literature indicates a strong relationship between cognitive dysfunction and excessive body weight, and suggests that a subset of high-order cognitive processes known as executive functions (EF) likely play an important role in weight management. Recent reviews cover neuropsychological correlates of weight status yet fail to address the role of executive function in the central dilemma of successful weight loss maintenance. In this paper, we provide an overview of the existing literature examining executive functions as they relate to weight status and initial weight loss. Further, we propose a novel conceptual model of the relationships between EF, initial weight loss, and weight loss maintenance, mapping specific executive functions onto strategies known to be associated with both phases of the weight control process. Implications for the development of more efficacious weight loss maintenance interventions are discussed.
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Bauer AM, Parker MM, Moffet HH, Schillinger D, Adler NE, Adams AS, Schmittdiel JA, Katon WJ, Karter AJ. Depressive symptoms and adherence to cardiometabolic therapies across phases of treatment among adults with diabetes: the Diabetes Study of Northern California (DISTANCE). Patient Prefer Adherence 2017; 11:643-652. [PMID: 28392679 PMCID: PMC5373834 DOI: 10.2147/ppa.s124181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Among adults with diabetes, depression is associated with poorer adherence to cardiometabolic medications in ongoing users; however, it is unknown whether this extends to early adherence among patients newly prescribed these medications. This study examined whether depressive symptoms among adults with diabetes newly prescribed cardiometabolic medications are associated with early and long-term nonadherence. PATIENTS AND METHODS An observational follow-up of 4,018 adults with type 2 diabetes who completed a survey in 2006 and were newly prescribed oral antihyperglycemic, antihypertensive, or lipid-lowering agents within the following year at Kaiser Permanente Northern California was conducted. Depressive symptoms were examined based on Patient Health Questionnaire-8 scores. Pharmacy utilization data were used to identify nonadherence by using validated methods: early nonadherence (medication never dispensed or dispensed once and never refilled) and long-term nonadherence (new prescription medication gap [NPMG]: percentage of time without medication supply). These analyses were conducted in 2016. RESULTS Patients with moderate-to-severe depressive symptoms had poorer adherence than nondepressed patients (8.3% more patients with early nonadherence, P=0.01; 4.9% patients with longer NPMG, P=0.002; 7.8% more patients with overall nonadherence [medication gap >20%], P=0.03). After adjustment for confounders, the models remained statistically significant for new NPMG (3.7% difference, P=0.02). There was a graded association between greater depression severity and nonadherence for all the models (test of trend, P<0.05). CONCLUSION Depressive symptoms were associated with modest differences in early and long-term adherence to newly prescribed cardiometabolic medications in diabetes patients. Interventions targeting adherence among adults with diabetes and depression need to address both initiation and maintenance of medication use.
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Affiliation(s)
- Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Correspondence: Amy M Bauer, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, USA, Tel +1 206 221 8385, Fax +1 206 543 9520, Email
| | | | | | - Dean Schillinger
- Division of General Internal Medicine, University of California, San Francisco
- Center for Vulnerable Populations, San Francisco General Hospital and Trauma Center
| | - Nancy E Adler
- Department of Psychiatry and Pediatrics, Center for Health and Community, University of California, San Francisco, CA, USA
| | | | | | - Wayne J Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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Dibb-Smith AE, Brindal E, Chapman J, Noakes M. A mixed-methods investigation of psychological factors relevant to weight maintenance. J Health Psychol 2016; 24:440-452. [DOI: 10.1177/1359105316678053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated perceptions of and engagement with the concepts of planning and problem-solving, within a weight management sample. A total of 53 participants (62% female, 20–74 years old) completed a semi-structured interview and quantitative measures after a 16-week weight maintenance period. Preliminary weight maintainers (who had maintained losses of, at least 10% of their original weight) were compared with heavier-than-baseline participants (who had re-gained more weight than was originally lost). The maintainers exhibited stronger problem-solving skills ( p < .05). The heavier-than-baseline participants tended towards non-rational problem-solving styles. Qualitatively, the maintainers described more planning events and were more accepting of mistakes than the heavier-than-baseline participants. Implications are discussed.
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Fitzpatrick SL, Wischenka D, Appelhans BM, Pbert L, Wang M, Wilson DK, Pagoto SL. An Evidence-based Guide for Obesity Treatment in Primary Care. Am J Med 2016; 129:115.e1-7. [PMID: 26239092 PMCID: PMC5988348 DOI: 10.1016/j.amjmed.2015.07.015] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/09/2015] [Accepted: 07/10/2015] [Indexed: 12/31/2022]
Abstract
On behalf of the Society of Behavioral Medicine, we present a model of obesity management in primary care based on the 5As counseling framework (Assess, Advise, Agree, Assist, and Arrange). Primary care physicians can use the 5As framework to build and coordinate a multidisciplinary team that: 1) addresses patients' psychosocial issues and medical and psychiatric comorbidities associated with obesity treatment failure; 2) delivers intensive counseling that consists of goal setting, self-monitoring, and problem solving; and 3) connects patients with community resources to assist them in making healthy lifestyle changes. This paper outlines reimbursement guidelines and weight-management counseling strategies, and provides a framework for building a multidisciplinary team to maximize the patient's success at weight management.
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Affiliation(s)
| | | | - Bradley M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Ill
| | - Lori Pbert
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester
| | - Monica Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Mass
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia
| | - Sherry L Pagoto
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester.
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Sullivan DK, Goetz JR, Gibson CA, Mayo MS, Washburn RA, Lee Y, Ptomey LT, Donnelly JE. A virtual reality intervention (Second Life) to improve weight maintenance: Rationale and design for an 18-month randomized trial. Contemp Clin Trials 2015; 46:77-84. [PMID: 26616535 DOI: 10.1016/j.cct.2015.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/20/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
Abstract
Despite the plethora of weight loss programs available in the US, the prevalence of overweight and obesity (BMI≥25kg/m(2)) among US adults continues to rise at least, in part, due to the high probability of weight regain following weight loss. Thus, the development and evaluation of novel interventions designed to improve weight maintenance are clearly needed. Virtual reality environments offer a promising platform for delivering weight maintenance interventions as they provide rapid feedback, learner experimentation, real-time personalized task selection and exploration. Utilizing virtual reality during weight maintenance allows individuals to engage in repeated experiential learning, practice skills, and participate in real-life scenarios without real-life repercussions, which may diminish weight regain. We will conduct an 18-month effectiveness trial (6 months weight loss, 12 months weight maintenance) in 202 overweight/obese adults (BMI 25-44.9kg/m(2)). Participants who achieve ≥5% weight loss following a 6month weight loss intervention delivered by phone conference call will be randomized to weight maintenance interventions delivered by conference call or conducted in a virtual environment (Second Life®). The primary aim of the study is to compare weight change during maintenance between the phone conference call and virtual groups. Secondarily, potential mediators of weight change including energy and macronutrient intake, physical activity, consumption of fruits and vegetables, self-efficacy for both physical activity and diet, and attendance and completion of experiential learning assignments will also be assessed.
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Affiliation(s)
- D K Sullivan
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - J R Goetz
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - C A Gibson
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - M S Mayo
- Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - R A Washburn
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Y Lee
- Department of Educational Leadership and Policy Studies, The University of Kansas, 1122 West Campus Rd., Lawrence, KS 66045-3101, USA.
| | - L T Ptomey
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - J E Donnelly
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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Appelhans BM, French SA, Pagoto SL, Sherwood NE. Managing temptation in obesity treatment: A neurobehavioral model of intervention strategies. Appetite 2015; 96:268-279. [PMID: 26431681 DOI: 10.1016/j.appet.2015.09.035] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/26/2015] [Accepted: 09/28/2015] [Indexed: 12/31/2022]
Abstract
Weight loss outcomes in lifestyle interventions for obesity are primarily a function of sustained adherence to a reduced-energy diet, and most lapses in diet adherence are precipitated by temptation from palatable food. The high nonresponse and relapse rates of lifestyle interventions suggest that current temptation management approaches may be insufficient for most participants. In this conceptual review, we discuss three neurobehavioral processes (attentional bias, temporal discounting, and the cold-hot empathy gap) that emerge during temptation and contribute to lapses in diet adherence. Characterizing the neurobehavioral profile of temptation highlights an important distinction between temptation resistance strategies aimed at overcoming temptation while it is experienced, and temptation prevention strategies that seek to avoid or minimize exposure to tempting stimuli. Many temptation resistance and temptation prevention strategies heavily rely on executive functions mediated by prefrontal systems that are prone to disruption by common occurrences such as stress, insufficient sleep, and even exposure to tempting stimuli. In contrast, commitment strategies are a set of devices that enable individuals to manage temptation by constraining their future choices, without placing heavy demands on executive functions. These concepts are synthesized in a conceptual model that categorizes temptation management approaches based on their intended effects on reward processing and degree of reliance on executive functions. We conclude by discussing the implications of our model for strengthening temptation management approaches in future lifestyle interventions, tailoring these approaches based on key individual difference variables, and suggesting high-priority topics for future research.
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Affiliation(s)
- Bradley M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren St, Suite 470, Chicago, IL 60612, USA; Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd Suite 400, Chicago, IL 60612, USA.
| | - Simone A French
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Suite 300, Minneapolis, MN 55454, USA.
| | - Sherry L Pagoto
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, 8170 33rd Ave S, Mail Stop 23301A, Bloomington, MN 55425, USA.
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Fitzpatrick SL, Hill-Briggs F. Measuring health-related problem solving among African Americans with multiple chronic conditions: application of Rasch analysis. J Behav Med 2014; 38:787-97. [PMID: 25319236 DOI: 10.1007/s10865-014-9603-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
Identification of patients with poor chronic disease self-management skills can facilitate treatment planning, determine effectiveness of interventions, and reduce disease complications. This paper describes the use of a Rasch model, the Rating Scale Model, to examine psychometric properties of the 50-item Health Problem-Solving Scale (HPSS) among 320 African American patients with high risk for cardiovascular disease. Items on the positive/effective HPSS subscales targeted patients at low, moderate, and high levels of positive/effective problem solving, whereas items on the negative/ineffective problem solving subscales mostly targeted those at moderate or high levels of ineffective problem solving. Validity was examined by correlating factor scores on the measure with clinical and behavioral measures. Items on the HPSS show promise in the ability to assess health-related problem solving among high risk patients. However, further revisions of the scale are needed to increase its usability and validity with large, diverse patient populations in the future.
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Affiliation(s)
- Stephanie L Fitzpatrick
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Room 478A, Chicago, IL, 60607, USA.
| | - Felicia Hill-Briggs
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Gee L, Agras WS. A randomized pilot study of a brief outpatient problem-solving intervention to promote healthy eating and activity habits in adolescents. Clin Pediatr (Phila) 2014; 53:293-6. [PMID: 23897759 DOI: 10.1177/0009922813497093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Leslie Gee
- 1Stanford University School of Medicine, Stanford, CA, USA
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Befort CA, Klemp JR, Fabian C, Perri MG, Sullivan DK, Schmitz KH, Diaz FJ, Shireman T. Protocol and recruitment results from a randomized controlled trial comparing group phone-based versus newsletter interventions for weight loss maintenance among rural breast cancer survivors. Contemp Clin Trials 2014; 37:261-71. [PMID: 24486636 PMCID: PMC3992482 DOI: 10.1016/j.cct.2014.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/21/2014] [Accepted: 01/24/2014] [Indexed: 01/12/2023]
Abstract
Obesity is a risk factor for breast cancer recurrence and death. Women who reside in rural areas have higher obesity prevalence and suffer from breast cancer treatment-related disparities compared to urban women. The objective of this 5-year randomized controlled trial is to compare methods for delivering extended care for weight loss maintenance among rural breast cancer survivors. Group phone-based counseling via conference calls addresses access barriers, is more cost-effective than individual phone counseling, and provides group support which may be ideal for rural breast cancer survivors who are more likely to have unmet support needs. Women (n=210) diagnosed with Stage 0 to III breast cancer in the past 10 years who are ≥ 3 months out from initial cancer treatments, have a BMI 27-45 kg/m(2), and have physician clearance were enrolled from multiple cancer centers. During Phase I (months 0 to 6), all women receive a behavioral weight loss intervention delivered through group phone sessions. Women who successfully lose 5% of weight enter Phase II (months 6 to 18) and are randomized to one of two extended care arms: continued group phone-based treatment or a mail-based newsletter. During Phase III, no contact is made (months 18 to 24). The primary outcome is weight loss maintenance from 6 to 18 months. Secondary outcomes include quality of life, serum biomarkers, and cost-effectiveness. This study will provide essential information on how to reach rural survivors in future efforts to establish weight loss support for breast cancer survivors as a standard of care.
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Affiliation(s)
- Christie A. Befort
- University of Kansas Medical Center 3901 Rainbow Blvd, Kansas City, KS, USA ; ; ;
| | - Jennifer R. Klemp
- University of Kansas Medical Center 3901 Rainbow Blvd, Kansas City, KS, USA ; ; ;
| | - Carol Fabian
- University of Kansas Medical Center 3901 Rainbow Blvd, Kansas City, KS, USA ; ; ;
| | | | - Debra K. Sullivan
- University of Kansas Medical Center 3901 Rainbow Blvd, Kansas City, KS, USA ; ; ;
| | - Kathryn H. Schmitz
- University of Pennsylvania, Perelman School of Medicine 423 Guardian Drive, Philadelphia, PA 19104
| | - Francisco J. Diaz
- University of Kansas Medical Center 3901 Rainbow Blvd, Kansas City, KS, USA ; ; ;
| | - Theresa Shireman
- University of Kansas Medical Center 3901 Rainbow Blvd, Kansas City, KS, USA ; ; ;
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Venditti EM, Wylie-Rosett J, Delahanty LM, Mele L, Hoskin MA, Edelstein SL. Short and long-term lifestyle coaching approaches used to address diverse participant barriers to weight loss and physical activity adherence. Int J Behav Nutr Phys Act 2014; 11:16. [PMID: 24521153 PMCID: PMC4015875 DOI: 10.1186/1479-5868-11-16] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Individual barriers to weight loss and physical activity goals in the Diabetes Prevention Program, a randomized trial with 3.2 years average treatment duration, have not been previously reported. Evaluating barriers and the lifestyle coaching approaches used to improve adherence in a large, diverse participant cohort can inform dissemination efforts. Methods Lifestyle coaches documented barriers and approaches after each session (mean session attendance = 50.3 ± 21.8). Subjects were 1076 intensive lifestyle participants (mean age = 50.6 years; mean BMI = 33.9 kg/m2; 68% female, 48% non-Caucasian). Barriers and approaches used to improve adherence were ranked by the percentage of the cohort for whom they applied. Barrier groupings were also analyzed in relation to baseline demographic characteristics. Results Top weight loss barriers reported were problems with self-monitoring (58%); social cues (58%); holidays (54%); low activity (48%); and internal cues (thought/mood) (44%). Top activity barriers were holidays (51%); time management (50%); internal cues (30%); illness (29%), and motivation (26%). The percentage of the cohort having any type of barrier increased over the long-term intervention period. A majority of the weight loss barriers were significantly associated with younger age, greater obesity, and non-Caucasian race/ethnicity (p-values vary). Physical activity barriers, particularly thought and mood cues, social cues and time management, physical injury or illness and access/weather, were most significantly associated with being female and obese (p < 0.001 for all). Lifestyle coaches used problem-solving with most participants (≥75% short-term; > 90% long term) and regularly reviewed self-monitoring skills. More costly approaches were used infrequently during the first 16 sessions (≤10%) but increased over 3.2 years. Conclusion Behavioral problem solving approaches have short and long term dissemination potential for many kinds of participant barriers. Given minimal resources, increased attention to training lifestyle coaches in the consistent use of these approaches appears warranted.
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Affiliation(s)
- Elizabeth M Venditti
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical School, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Fjeldsoe B, Phongsavan P, Bauman A, Goode A, Maher G, Eakin E. 'Get Healthy, Stay Healthy': protocol for evaluation of a lifestyle intervention delivered by text-message following the Get Healthy Information and Coaching Service®. BMC Public Health 2014; 14:112. [PMID: 24495781 PMCID: PMC3928918 DOI: 10.1186/1471-2458-14-112] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/03/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Behavioural lifestyle interventions can be effective at promoting initial weight loss and supporting physical activity and dietary behaviour change, however maintaining improvements in these outcomes is often more difficult to achieve. Extending intervention contact to reinforce learnt behavioural skills has been shown to improve maintenance of behaviour change and weight loss. This trial aims to evaluate the feasibility, acceptability and efficacy of a text message-delivered extended contact intervention to enhance or maintain change in physical activity, dietary behaviour and weight loss among participants who have completed a six month Government-funded, population-based telephone coaching lifestyle program: the Get Healthy Information and Coaching Service (GHS). METHODS/DESIGN GHS completers will be randomised to the 6-month extended contact intervention (Get Healthy, Stay Healthy, GHSH) or a no contact control group (standard practice following GHS completion). GHSH participants determine the timing and frequency of the text messages (3-13 per fortnight) and content is tailored to their behavioural and weight goals and support preferences. Two telephone tailoring calls are made (baseline, 12-weeks) to facilitate message tailoring. Primary outcomes, anthropometric (body weight and waist circumference via self-report) and behavioural (moderate-vigorous physical activity via self-report and accelerometer, fruit and vegetable intake via self-report), will be assessed at baseline (at GHS completion), 6-months (end of extended contact intervention) and 12-months (6-months post intervention contact). Secondary aims include evaluation of: the feasibility of program delivery; the acceptability for participants; theoretically-guided, potential mediators and moderators of behaviour change; dose-responsiveness; and, costs of program delivery. DISCUSSION Findings from this trial will inform the delivery of the GHS in relation to the maintenance of behaviour change and weight loss, and will contribute to the broader science of text message lifestyle interventions delivered in population health settings. TRIAL REGISTRATION ACTRN12613000949785.
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Affiliation(s)
- Brianna Fjeldsoe
- School of Population Health, Cancer Prevention Research Centre, The University of Queensland, Brisbane, Australia
| | - Philayrath Phongsavan
- Sydney School of Public Health, Prevention Research Collaboration, The University of Sydney, Sydney, Australia
| | - Adrian Bauman
- Sydney School of Public Health, Prevention Research Collaboration, The University of Sydney, Sydney, Australia
| | - Ana Goode
- School of Population Health, Cancer Prevention Research Centre, The University of Queensland, Brisbane, Australia
| | - Genevieve Maher
- School of Population Health, Cancer Prevention Research Centre, The University of Queensland, Brisbane, Australia
| | - Elizabeth Eakin
- School of Population Health, Cancer Prevention Research Centre, The University of Queensland, Brisbane, Australia
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Wang J, Matthews JT, Sereika SM, Chasens EA, Ewing LJ, Burke LE. Psychometric Evaluation of the Social Problem-Solving Inventory- Revised among Overweight or Obese Adults. JOURNAL OF PSYCHOEDUCATIONAL ASSESSMENT 2013; 3:585-590. [PMID: 25132720 PMCID: PMC4130479 DOI: 10.1177/0734282913480470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Problem solving is a key component of weight loss programs. The Social Problem Solving Inventory-Revised (SPSI-R) has not been evaluated in weight loss studies. The purpose of this study was to evaluate the psychometrics of the SPSI-R. Cronbach's alpha (.95 for total score; .67 - .92 for subscales) confirmed internal consistency reliability. The SPSI-R score was significantly associated (ps<.05) with decreased eating barriers and binge eating, increased self-efficacy in following a cholesterol-lowering diet, consumption of fewer calories and fat grams, more frequent exercise, lower psychological distress, and higher mental quality of life; all suggesting concurrent validity with other instruments used in weight loss studies. However, confirmatory factor analysis of the hypothesized 5-factor structure did not fit the data well (χ2=350, p<.001).
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Affiliation(s)
- Jing Wang
- Department of Nursing Systems, University of Texas Health Science Center at Houston School of Nursing, 6901 Bertner Ave, SON Room 614, Houston, TX 77030,
| | - Judith T Matthews
- University of Pittsburgh School of Nursing; Associate Director, Gerontology Program, University of Pittsburgh University Center for Social and Urban Research, 3343 Forbes Ave, Room 200, Pittsburgh, PA 15260,
| | - Susan M Sereika
- University of Pittsburgh School of Nursing and Graduate School of Public Health; Director, Center for Research and Evaluation at the University of Pittsburgh School of Nursing. 360 Victoria Building, 3500 Victoria St, Pittsburgh, PA 15261,
| | - Eileen A Chasens
- University of Pittsburgh School of Nursing, 415 Victoria Building, 3500 Victoria St, Pittsburgh, PA 15261,
| | - Linda J Ewing
- University of Pittsburgh School of Medicine, 3811 O'Hara St, Pittsburgh, PA, 15213,
| | - Lora E Burke
- University of Pittsburgh School of Nursing and Graduate School of Public Health., 415 Victoria Building, 3500 Victoria St, Pittsburgh, PA 15261,
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Sousa P, Fonseca H, Gaspar P, Gaspar F. Internet-based intervention programme for obese adolescents and their families (Next.Step): research protocol of a controlled trial. J Adv Nurs 2013; 70:904-14. [PMID: 24020828 DOI: 10.1111/jan.12245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2013] [Indexed: 11/28/2022]
Abstract
AIM This paper describes the design and rationale of a controlled trial that aims to determine the effectiveness of an intervention programme in which the internet is used. BACKGROUND Adolescent obesity is a major health problem, there being urgency to find effective interventions that induce behavioural change. The inclusion of the internet in the intervention may improve adolescents' adherence to the weight management programme and lead to adoption of healthier lifestyles. DESIGN A clinical trial with a control group (non-randomized). METHODS Participants are adolescents with appointments at a paediatric obesity clinic (Portugal). Sample size was calculated according to the power analysis. The experimental group will follow the standard treatment protocol and receive free access to the e-therapeutic platform. The control group will follow the standard treatment protocol and join a waiting list. Intervention length will be 36 weeks (24 weeks of direct intervention with a follow-up for 12 weeks). This study was approved by the Ethical Committee for Health (Lisbon, Portugal) in January 2012 and funded by the Foundation for Science and Technology (Portugal) in December 2012. DISCUSSION The results of this research will promote reflection on new approaches directed to treat adolescent obesity and on the promotion of healthy behaviours. We expect to gather empirical evidence of the intervention programme effectiveness. The expectations lie on the population health gains, empowerment in decision-making and adoption of healthier lifestyles.
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Affiliation(s)
- Pedro Sousa
- School of Health Sciences, Polytechnic Institute of Leiria, Portugal; Health Research Unit (UIS) of the Polytechnic Institute of Leiria, Portugal
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Kreier F, Genco ŞM, Boreel M, Langkemper MP, Nugteren IC, Rijnveld V, Thissen V, Deden S, Keessen M. An individual, community-based treatment for obese children and their families: the solution-focused approach. Obes Facts 2013; 6:424-32. [PMID: 24107796 PMCID: PMC5644677 DOI: 10.1159/000355909] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 06/19/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study evaluates an individual, community-based treatment for obese children and their families. In this program, a treatment team applied solution-focused techniques to develop a custom-made treatment plan in collaboration with the participants. The treatment plan consisted of community-based lifestyle activities. METHODS 559 obese children with an average BMI z-score of 2.76 ± 0.54 took part in the 12-month study, and 372 children with an average BMI z-score of 2.75 ± 0.52 took part in the 24-month study. At the start of the study, ethnicity and special school needs were recorded. Before, after 12 months, and after 24 months of the treatment, body weight and height were measured. The effect of the treatment on body weight was evaluated using BMI z-scores. RESULTS 291 children (52%) completed 12 months of treatment, whereas 22 children (4%) were dismissed earlier due to a good response. After 12 months, the children showed a significant decrease in BMI z-score by 0.16 (95% confidence interval (CI) 0.11-0.20; p < 0.005). After 24 months, 103 children (28%) were participating in the program, with a significant decrease in BMI z-score of 0.15 (95% CI 0.07-0.22; p < 0.005). 50 children (13%) were dismissed before the end of the second year due to significant weight loss (standard deviation z-score reduction -0.38; 95% CI 0.30-0.46; p < 0.005; with an average treatment duration of 12.9 ± 6.4 months). There was a negative correlation of age and reduction in BMI z-score: children younger than 6 years showed a decrease in BMI z-score of 0.45 (95% CI 0.26-0.65) and 0.31 (95% CI 0.11-0.53) after 12 and after 24 months, respectively. CONCLUSIONS Children showed a significant decrease in BMI z-score after the treatment. We found a negative correlation of age and weight loss. Special attention to patients with a high risk of drop-out might further improve these results. We advise a referral to obesity treatment as early as possible since a 'wait and see' policy might have adverse results in obese children.
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Affiliation(s)
- Felix Kreier
- *Dr. Felix Kreier, Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, Postbus 95500, 1090 HM Amsterdam (The Netherlands),
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The Prevention Of WEight Regain in diabetes type 2 (POWER) study: the effectiveness of adding a combined psychological intervention to a very low calorie diet, design and pilot data of a randomized controlled trial. BMC Public Health 2012; 12:1026. [PMID: 23176668 PMCID: PMC3599599 DOI: 10.1186/1471-2458-12-1026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/18/2012] [Indexed: 11/12/2022] Open
Abstract
Background Obesity is of major pathogenetic importance to type 2 diabetes, it contributes to poor glycemic control and increases the risk of cardiovascular disease. Over 80% of patients with diabetes type 2 are overweight. To achieve a more favourable risk profile, changes in diet and lifestyle are needed. However, current treatment programs for obese DM type 2 patients are not effective in the long term. In this RCT, we compare the effectiveness of a Combined Psychological Intervention (CPI) and usual care in maintaining the favourable effects on weight and risk profile during 2 years of follow-up after a Very Low Calorie Diet (VLCD). Methods and design In a randomised parallel group intervention study, 140 patients with type 2 diabetes and overweight (BMI>27 kg/m2) will be recruited from the outpatient department of the Erasmus Medical Centre. After obtaining ≥5% of weight loss with a VLCD, participants will be randomly assigned to CPI or usual care for 10 weeks. CPI consists of cognitive behaviour therapy, problem solving therapy and proactive coping. Primary outcome measure is weight change (kg). Other outcome measures are Body Mass Index (BMI = weight (kg)/length (m)2), waist circumference (cm), systolic blood pressure (mmHg), HbA1c (mmol/mol), lipid levels (LDL, HDL, TG (mmol/l) and chol/HDL-ratio), antidiabetic agents and doses, cardiovascular risk profile (UKPDS), lifestyle and quality of life (EuroQol EQ-5D). Psychosocial parameters are also studied, as secondary outcomes as well as determinants for weight loss. When successful, we want to conduct an analysis of the cost effectiveness of the intervention as compared to usual care. Discussion We expect that a CPI after a VLCD will be effective in maintaining weight loss and improving cardiovascular risk and glycaemic control, while being cost-effective and improving quality of life in patients with type 2 diabetes. Clinical trials registration trialregister.nl NTR2264
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Broekhuizen K, Althuizen E, van Poppel MNM, Donker M, van Mechelen W. From theory to practice: intervention fidelity in a randomized controlled trial aiming to optimize weight development during pregnancy. Health Promot Pract 2012; 13:816-25. [PMID: 22773616 DOI: 10.1177/1524839912447190] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intervention fidelity is an increasingly important methodological concept in process evaluations. In this article, the authors investigated the intervention fidelity in a randomized controlled trial on excessive weight gain prevention in pregnancy. METHOD A sample of 109 audiotaped counseling sessions, linked to 65 women in the intervention group of the New Life(style) trial, was drawn. The following criteria were quantitatively evaluated using a fidelity checklist: (a) reach, (b) dose, (c) adherence to study objectives, (d) adherence to underlying problem-solving treatment (PST) theory, and (e) counselor competence. RESULTS A total of 60.4% received all counseling sessions. The dose of intervention components was generally moderate (50.9% to 60.4%), and the dose of PST components was low (17.3%). Adherence to study objectives was moderate (64.2%) and adherence to PST theory was low (43.2%). The counselors sufficiently stimulated the participant to optimize lifestyle (54.2% of the sessions), provided positive feedback (50.5%), and left the initiative regarding problem solving to the participant (71%). One of the two counselors performed significantly better on all measured criteria (p < .001). CONCLUSIONS Intervention fidelity in the New Life(style) trial was generally low to moderate. In future interventions, it is recommended to put more emphasis on counselor recruitment, training, and intervention protocol contents. Fellow researchers are encouraged to embed a process evaluation into all study stages, taking into account all essential process elements, and to link process outcomes to more distal, health outcomes.
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Affiliation(s)
- Karen Broekhuizen
- Department of Public and Occupational Health, EMGO+Institute of Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
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Ricanati EH, Golubić M, Yang D, Saager L, Mascha EJ, Roizen MF. Mitigating preventable chronic disease: Progress report of the Cleveland Clinic's Lifestyle 180 program. Nutr Metab (Lond) 2011; 8:83. [PMID: 22112436 PMCID: PMC3264524 DOI: 10.1186/1743-7075-8-83] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 11/23/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Poor lifestyle choices are key in development and progression of preventable chronic diseases. The purpose of the study was to design and test a program to mitigate the physical and fiscal consequences of chronic diseases. METHODS Here we report the outcomes for 429 participants with one or more chronic conditions, including obesity, hypertension, hyperlipidemia and diabetes mellitus, many of whom had failed traditional disease management programs, who enrolled into a comprehensive lifestyle intervention. The Lifestyle 180 program integrates nutrition, physical activity and stress management interventions and was conducted at the Wellness Institute of the Cleveland Clinic, United States. An intensive 6 week immersion course, with 8 hours of group instruction per week, was followed by 3 follow-up, 4 hour-long sessions over the course of 6 months. RESULTS Changes in biometric (weight, height, waist circumference, resting heart rate and blood pressure) and laboratory variables (fasting lipid panel, blood glucose, insulin, hemoglobin A1c, ultra sensitive C-reactive protein) at 6 months were compared with baseline (pre-post analysis). At week 30, biometric and laboratory data were available for 244 (57%) and 299 (70%) participants, respectively. These had a mean ± SD reduction in weight (6.8 ± 6.9 kg, P < 0.001), waist circumference (6.1 ± 7.3 cm, P < 0.001), glucose (4.5 ± 29.6 mg/dL or 0.25 ± 1.64 mmol/L, P = 0.009), triglycerides (26.4 ± 58.5 mg/dL or 0.30 ± 0.66 mmol/L, P < 0.001), low-density lipoprotein cholesterol (LDL) (7.9 ± 25.1 mg/dL or 0.2 ± 0.65 mmol/L, P < 0.001), hemoglobin A1c (HgbA1c) (0.20 ± 0.64%, P = 0.001), insulin (3.8 ± 11 microU/ml or 26.6 ± 76.4 ρmol, P < 0.001) and ultra sensitive C-reactive protein (US - CRP) (0.9 ± 4.8 mg/dL or 7.3 ± 40.2 nmol/L, P = 0.012), an increase in mean high-density lipoprotein cholesterol (HDL) (3.7 ± 8.4 mg/dL or 0.1 ± 0.22, P < 0.001), and decreased use of medications. CONCLUSION Implementation of a comprehensive lifestyle modification program among adults with common chronic conditions results in significant and clinically meaningful improvements in biometric and laboratory outcomes after 6 months.
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Affiliation(s)
- Elizabeth Hw Ricanati
- Wellness Institute, Cleveland Clinic, 1950 Richmond Road, TR2-341, Lyndhurst, OH 44124, USA.
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Sciamanna CN, Kiernan M, Rolls BJ, Boan J, Stuckey H, Kephart D, Miller CK, Jensen G, Hartmann TJ, Loken E, Hwang KO, Williams RJ, Clark MA, Schubart JR, Nezu AM, Lehman E, Dellasega C. Practices associated with weight loss versus weight-loss maintenance results of a national survey. Am J Prev Med 2011; 41:159-66. [PMID: 21767723 DOI: 10.1016/j.amepre.2011.04.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 03/24/2011] [Accepted: 04/13/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few studies have examined the weight-control practices that promote weight loss and weight-loss maintenance in the same sample. PURPOSE To examine whether the weight control practices associated with weight loss differ from those associated with weight-loss maintenance. METHODS Cross-sectional survey of a random sample of 1165 U.S. adults. The adjusted associations of the use of 36 weight-control practices in the past week with success in weight loss (≥10% lost in the past year) and success in weight-loss maintenance (≥10% lost and maintained for ≥1 year) were examined. RESULTS Of the 36 practices, only 8 (22%) were associated with both weight loss and weight-loss maintenance. Overall, there was poor agreement (kappa=0.22) between the practices associated with weight loss and/or weight-loss maintenance. For example, those who reported more often following a consistent exercise routine or eating plenty of low-fat sources of protein were 1.97 (95% CI=1.33, 2.94) and 1.76 (95% CI=1.25, 2.50) times more likely, respectively, to report weight-loss maintenance but not weight loss. Alternatively, those who reported more often doing different kinds of exercises or planning meals ahead of time were 2.56 (95% CI=1.44, 4.55) and 1.68 (95% CI=1.03, 2.74) times more likely, respectively, to report weight loss but not weight-loss maintenance. CONCLUSIONS Successful weight loss and weight-loss maintenance may require two different sets of practices. Designing interventions with this premise may inform the design of more effective weight-loss maintenance interventions.
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Affiliation(s)
- Christopher N Sciamanna
- Department of Medicine, Penn State Hershey Medical Center, Penn State University, Hershey, Pennsylvania 17033, USA.
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Brenninkmeijer V, Blonk RWB. The effectiveness of the JOBS program among the long-term unemployed: a randomized experiment in the Netherlands. Health Promot Int 2011; 27:220-9. [PMID: 21653628 DOI: 10.1093/heapro/dar033] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Given the adverse effects of long-term unemployment, it is of major concern that evidence-based interventions are available for the long-term unemployed. Therefore, we examined the effectiveness of the JOBS program, a group training for the unemployed [Caplan, R. D., Vinokur, A. D., Price, R. H. and Van Ryn, M. (1989). Journal of Applied Psychology, 74, 759-769], among long-term unemployed individuals. In a randomly controlled trial, JOBS was compared with a control condition and a voucher intervention, in which individuals were given the opportunity to spend a certain budget on services that could help them reintegrate. After 6 months JOBS participants had more often found a job and were more satisfied with the intervention. After 12 months effects were still visible, but less pronounced.
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Affiliation(s)
- Veerle Brenninkmeijer
- Department of Social and Organizational Psychology, Utrecht University, PO Box 80.140, 3508 TC Utrecht, The Netherlands.
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