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Lee K, Bauman A, Wolfenden L, Phongsavan P, Crane M. How long does it take to scale-up obesity prevention interventions? Prev Med 2024; 185:108012. [PMID: 38821419 DOI: 10.1016/j.ypmed.2024.108012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/06/2024] [Accepted: 05/25/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE The scale-up of evidence-based interventions is necessary to reverse high rates of obesity. However, scale-up doesn't occur frequently nor in a timely manner. While it has been estimated that takes 14-17 years for research translation to occur, the time taken to scale-up prevention interventions is largely unknown. This study examined the time taken to scale-up obesity prevention interventions across four scale-up pathways. METHODS A sample of obesity prevention interventions that had been scaled-up or implemented at scale were found using a structured search strategy. Included interventions were mapped against four scale-up pathways and timeframes associated with each stage of the scale-up pathway were identified to determine the time taken to scale-up. RESULTS Of the 90 interventions found that were scaled-up to at least a city-wide level, less than half reported a comprehensive research pathway to scale-up and a third did not report any evidence of efficacy or effectiveness prior to scale-up. The time taken to scale-up ranged from 0 to 5 years depending on the pathway taken. Those following a comprehensive pathway took approximately 5 years to scale-up, while interventions that had only one evidence generating step took between 1 and 1.5 years to scale-up. For the remaining interventions, scale-up occurred immediately post-development without evidence generation. CONCLUSIONS Our findings indicate that the scale-up of obesity prevention interventions can occur more quickly than previous estimates of 14-17 years. Our findings support previous research that scale-up of interventions occurs through a variety of pathways and often scale-up occurs in absence of prior evidence of effectiveness.
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Affiliation(s)
- Karen Lee
- Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Charles Perkins Centre, The University of Sydney, NSW 2006, Australia; The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia.
| | - Adrian Bauman
- Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Charles Perkins Centre, The University of Sydney, NSW 2006, Australia; The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia.
| | - Luke Wolfenden
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia; The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Philayrath Phongsavan
- Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Melanie Crane
- Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Charles Perkins Centre, The University of Sydney, NSW 2006, Australia; The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia.
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Wang W, Qiu L, Sa R, Dang S, Liu F, Xiao X. Effect of socioeconomic characteristics and lifestyle on BMI distribution in the Chinese population: a population-based cross-sectional study. BMC Public Health 2021; 21:1369. [PMID: 34246224 PMCID: PMC8272370 DOI: 10.1186/s12889-021-11405-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Body mass index (BMI) is an accepted measurement that is widely used to quantify overweight and obesity at the population level. Previous studies have described the distribution variation of BMI through applying common statistical approaches, such as multiple linear or logistic regression analyses. This study proposed that associations between BMI and socioeconomic characteristics, diet, and lifestyle factors varied across the conditional BMI distribution. Methods This study was based on a sample of 10,023 Chinese adults who participated in the monitoring of chronic diseases and associated risk factors in Shaanxi Province, Northwest China, in 2013. Cross-quantile factors were observed in the relationships between major risk factors and BMI through quantile regression (QR) and ordinary least squares (OLS) regression. Results Participants’ mean BMI was 24.19 ± 3.51 kg/m2 (range 14.33–52.82 kg/m2). The QR results showed that living in urban areas was associated with BMI in the low and central quantiles (10th–60th). Participants with 6–9 years of education were 0.23–0.38 BMI units higher in the first half of the BMI quantiles compared with those with ≤6 years of education. There was a positive association between consumption of red meat and BMI; however, the association diminished from the 10th to the 50th quantile. Intake of oil and alcohol were positively associated with all BMI quantiles. Cigarette smoking per day was negatively associated with BMI, which showed a U-shaped distribution. The above results were also observed in the OLS. Conclusion This study implies that in addition to socioeconomic characteristics, limiting oil and alcohol intake may decrease BMI score. Consuming more red meat could be a strategy to increase BMI.
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Affiliation(s)
- Weihua Wang
- Department of Chronic Disease Control and Prevention, Shaanxi Provincial Center for Disease Control and Prevention, No. 3, Jiandong Road, Xi'an, People's Republic of China
| | - Lin Qiu
- Department of Chronic Disease Control and Prevention, Shaanxi Provincial Center for Disease Control and Prevention, No. 3, Jiandong Road, Xi'an, People's Republic of China
| | - Rina Sa
- Department of Chronic Disease Control and Prevention, Shaanxi Provincial Center for Disease Control and Prevention, No. 3, Jiandong Road, Xi'an, People's Republic of China
| | - Shaonong Dang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, People's Republic of China
| | - Feng Liu
- Department of Chronic Disease Control and Prevention, Shaanxi Provincial Center for Disease Control and Prevention, No. 3, Jiandong Road, Xi'an, People's Republic of China.
| | - Xiang Xiao
- School of Public Health, University of Alberta, Edmonton, Canada
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Taghavi SA, van Wely M, Jahanfar S, Bazarganipour F. Pharmacological and non-pharmacological strategies for obese women with subfertility. Cochrane Database Syst Rev 2021; 3:CD012650. [PMID: 33765343 PMCID: PMC8094444 DOI: 10.1002/14651858.cd012650.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Clinicians primarily recommend weight loss for obese women seeking pregnancy. The effectiveness of interventions aimed at weight loss in obese women with subfertility is unclear. OBJECTIVES To assess the effectiveness and safety of pharmacological and non-pharmacological strategies compared with each other, placebo, or no treatment for achieving weight loss in obese women with subfertility. SEARCH METHODS We searched the CGF Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, and AMED from inception to 18 August 2020. We also checked reference lists and contacted experts in the field for additional relevant papers. SELECTION CRITERIA We included published and unpublished randomised controlled trials in which weight loss was the main goal of the intervention. Our primary effectiveness outcomes were live birth or ongoing pregnancy and primary safety outcomes were miscarriage and adverse events. Secondary outcomes included clinical pregnancy, weight change, quality of life, and mental health outcome. DATA COLLECTION AND ANALYSIS Review authors followed standard Cochrane methodology. MAIN RESULTS This review includes 10 trials. Evidence was of very low to low quality: the main limitations were due to lack of studies and poor reporting of study methods. The main reasons for downgrading evidence were lack of details by which to judge risk of bias (randomisation and allocation concealment), lack of blinding, and imprecision. Non-pharmacological intervention versus no intervention or placebo Evidence is insufficient to determine whether a diet or lifestyle intervention compared to no intervention affects live birth (odds ratio (OR) 0.85, 95% confidence interval (CI) 0.65 to 1.11; 918 women, 3 studies; I² = 78%; low-quality evidence). This suggests that if the chance of live birth following no intervention is assumed to be 43%, the chance following diet or lifestyle changes would be 33% to 46%. We are uncertain if lifestyle change compared with no intervention affects miscarriage rate (OR 1.54, 95% CI 0.99 to 2.39; 917 women, 3 studies; I² = 0%; very low-quality evidence). Evidence is insufficient to determine whether lifestyle change compared with no intervention affects clinical pregnancy (OR 1.06, 95% CI 0.81 to 1.40; 917 women, 3 studies; I² = 73%; low-quality evidence). Lifestyle intervention resulted in a decrease in body mass index (BMI), but data were not pooled due to heterogeneity in effect (mean difference (MD) -3.70, 95% CI -4.10 to -3.30; 305 women, 1 study; low-quality evidence; and MD -1.80, 95% CI -2.67 to -0.93; 43 women, 1 study; very low-quality evidence). Non-pharmacological versus non-pharmacological intervention We are uncertain whether intensive weight loss interventions compared to standard care nutrition counselling affects live birth (OR 11.00, 95% CI 0.43 to 284; 11 women, 1 study; very low-quality evidence), clinical pregnancy (OR 11.00, 95% CI 0.43 to 284; 11 women, 1 study; very low-quality evidence), BMI (MD -3.00, 95% CI -5.37 to -0.63; 11 women, 1 study; very low-quality evidence), weight change (MD -9.00, 95% CI -15.50 to -2.50; 11 women, 1 study; very low-quality evidence), quality of life (MD 0.06, 95% CI -0.03 to 0.15; 11 women, 1 study; very low-quality evidence), or mental health (MD -7.00, 95% CI -13.92 to -0.08; 11 women, 1 study; very low-quality evidence). No study reported on adverse events . Pharmacological versus pharmacological intervention For metformin plus liraglutide compared to metformin we are uncertain of an effect on the adverse events nausea (OR 7.22, 95% CI 0.72 to 72.7; 28 women, 1 study; very low-quality evidence), diarrhoea (OR 0.31, 95% CI 0.01 to 8.3; 28 women, 1 study; very low-quality evidence), and headache (OR 5.80, 95% CI 0.25 to 133; 28 women, 1 study; very low-quality evidence). We are uncertain if a combination of metformin plus liraglutide vs metformin affects BMI (MD 2.1, 95% CI -0.42 to 2.62; 28 women, 1 study; very low-quality evidence) and total body fat (MD -0.50, 95% CI -4.65 to 3.65; 28 women, 1 study; very low-quality evidence). For metformin, clomiphene, and L-carnitine versus metformin, clomiphene, and placebo, we are uncertain of an effect on miscarriage (OR 3.58, 95% CI 0.73 to 17.55; 274 women, 1 study; very low-quality evidence), clinical pregnancy (OR 5.56, 95% CI 2.57 to 12.02; 274 women, 1 study; very low-quality evidence) or BMI (MD -0.3, 95% CI 1.17 to 0.57, 274 women, 1 study, very low-quality evidence). We are uncertain if dexfenfluramine versus placebo affects weight loss in kilograms (MD -0.10, 95% CI -2.77 to 2.57; 21 women, 1 study; very low-quality evidence). No study reported on live birth, quality of life, or mental health outcomes. Pharmacological intervention versus no intervention or placebo We are uncertain if metformin compared with placebo affects live birth (OR 1.57, 95% CI 0.44 to 5.57; 65 women, 1 study; very low-quality evidence). This suggests that if the chance of live birth following placebo is assumed to be 15%, the chance following metformin would be 7% to 50%. We are uncertain if metformin compared with placebo affects gastrointestinal adverse events (OR 0.91, 95% CI 0.32 to 2.57; 65 women, 1 study; very low-quality evidence) or miscarriage (OR 0.50, 95% CI 0.04 to 5.80; 65 women, 1 study; very low-quality evidence) or clinical pregnancy (OR 2.67, 95% CI 0.90 to 7.93; 96 women, 2 studies; I² = 48%; very low-quality evidence). We are also uncertain if diet combined with metformin versus diet and placebo affects BMI (MD -0.30, 95% CI -2.16 to 1.56; 143 women, 1 study; very low-quality evidence) or waist-to-hip ratio (WHR) (MD 2.00, 95% CI -2.21 to 6.21; 143 women, 1 study; very low-quality evidence). Pharmacological versus non-pharmacological intervention No study undertook this comparison. AUTHORS' CONCLUSIONS Evidence is insufficient to support the use of pharmacological and non-pharmacological strategies for obese women with subfertility. No data are available for the comparison of pharmacological versus non-pharmacological strategies. We are uncertain whether pharmacological or non-pharmacological strategies effect live birth, ongoing pregnancy, adverse events, clinical pregnancy, quality of life, or mental heath outcomes. However, for obese women with subfertility, a lifestyle intervention may reduce BMI. Future studies should compare a combination of pharmacological and lifestyle interventions for obese women with subfertility.
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Affiliation(s)
- Seyed Abdolvahab Taghavi
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Madelon van Wely
- Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Shayesteh Jahanfar
- MPH Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Fatemeh Bazarganipour
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Van Zyl N, Andrews L, Williamson H, Meyrick J. The effectiveness of psychosocial interventions to support psychological well-being in post-operative bariatric patients: A systematic review of evidence. Obes Res Clin Pract 2020; 14:404-420. [PMID: 32631804 DOI: 10.1016/j.orcp.2020.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/12/2020] [Accepted: 05/22/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bariatric surgery is considered an effective obesity management intervention for individuals with a BMI greater than 40, or 35 with co-morbidities. However, research documents that psychological difficulties prevalent amongst individuals seeking surgery may persist post-operatively. This systematic review aims to assess the evidence to show which psychosocial interventions support psychological well-being post-operatively. METHODS The review is registered with Prospero (CRD42018100280), complying with PRISMA guidelines. The research protocol included grey literature and database searches of psychosocial interventions for post-operative bariatric patients, between November 2017 and September 2019. The primary outcome was psychological well-being; secondary outcomes included weight loss maintenance and quality of life (QoL). The primary reviewer screened titles and extracted data. Study quality was assessed independently by two reviewers, using the Effective Public Health Practice Project criteria. Due to heterogeneity across studies, narrative synthesis was considered suitable for data analysis. RESULTS Ten studies met inclusion criteria. Psychosocial intervention content was delivered in a variety of ways (e.g., clinic, internet-based). Overall, participants (N = 382, Mage = 46.4) receiving psychosocial interventions post bariatric surgery, demonstrated improvements in psychological well-being and weight loss maintenance, compared to baseline measures and/or controls. The strength of evidence is currently limited by the small number of studies found and study quality, limiting the power to detect clinically meaningful changes; findings should therefore be considered preliminary. CONCLUSION Preliminary findings suggest that interdisciplinary interventions including acceptance-based approaches, psychoeducation, nutrition and lifestyle modification, delivered 1-year post-operative, are promising. Further scientific enquiry is warranted with well-designed studies and long-term follow-ups.
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Affiliation(s)
- Natascha Van Zyl
- Institute for Optimum Nutrition, Paradise Road, Richmond, TW9 1SQ, UK.
| | - Lee Andrews
- Abertillery Group Practice, The Bridge Centre, Foundry Bridge, Abertillery, NP13 1BQ.
| | - Heidi Williamson
- Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK.
| | - Jane Meyrick
- Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK.
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Acceptance- and Mindfulness-Based Interventions for Health Behavior Change: Systematic Reviews and Meta-Analyses. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019; 13:74-93. [PMID: 32832377 DOI: 10.1016/j.jcbs.2019.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Behavioral health issues such as smoking and overweight are risk factors for a variety of adverse health outcomes, including mortality. Over the past decade, a growing number of randomized controlled trials have examined the efficacy of acceptance- and mindfulness-based interventions for smoking cessation and weight loss. The purpose of the current meta-analytic reviews was to quantitatively synthesize the existing literature comparing these interventions to controls for a) smoking cessation and b) weight loss outcomes. Searches identified 17 smoking cessation studies and 31 weight loss studies eligible for inclusion. Meta-analytic results indicated a non-significant effect favoring acceptance- and mindfulness-based interventions over controls for smoking cessation (OR = 1.13) and a small, significant effect favoring these interventions over controls for weight loss outcomes (Hedge's g = 0.30). Statistical heterogeneity and risk of bias were assessed. Subgroup and meta-regression analyses were conducted to examine moderating variables (e.g., sample and intervention characteristics). The findings indicated that acceptance- and mindfulness-based interventions were at least as efficacious as active control conditions. Given the significant health risks associated with smoking and overweight, these findings have important clinical and public health implications. Limitations (e.g., relative infancy of the literature; lack of diversity in sample demographics) and future directions (e.g., further exploration of mediators and moderators of change) are discussed.
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Levels and correlates of nutritional status of women of childbearing age in rural Bangladesh. Public Health Nutr 2018; 21:3037-3047. [PMID: 30107861 DOI: 10.1017/s1368980018001970] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The present study examined the prevalence of and risk factors for malnutrition in a population-based cohort of women of childbearing age in rural Bangladesh. DESIGN A cross-sectional study that collected pre-pregnancy weight, height, and data on selected risk factors for nutritional status of women. SETTING The study was conducted in Sylhet District of Bangladesh. SUBJECTS Study subjects included 13 230 non-pregnant women of childbearing age. Women were classified into underweight (<18·5 kg/m2), normal (18·5-24·9 kg/m2) and overweight/obese (≥25·0 kg/m2) using BMI; and into moderate to severe stunting (<150 cm), mild stunting (150-<155 cm) and normal (≥155 cm) using height. Two multinomial logistic regression models were fitted for BMI: model 1 examined individual and household factors associated with BMI, and model 2 additionally examined the association of community variables. The same analysis was conducted for height. RESULTS Prevalence of underweight, overweight/obesity and moderate to severe stunting was 37·0, 7·2 and 48·6 %, respectively. Women's education and household wealth were inversely related to both underweight status and stunting. Underweight rate was significantly lower in the post-harvest season. Women with any education and who belonged to households with higher wealth were more likely to be overweight/obese. CONCLUSIONS The study documented high underweight and stunting, and moderate overweight/obesity rates among rural Bangladeshi women; and recommends design and implementation of a multidimensional intervention programme based on individual-, household- and community-level risk factors that can address underweight, stunting and overweight/obesity to improve the nutritional status of women of childbearing age in Bangladesh.
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Ing CT, Miyamoto RES, Fang R, Antonio M, Paloma D, Braun KL, Kaholokula JK. Comparing Weight Loss-Maintenance Outcomes of a Worksite-Based Lifestyle Program Delivered via DVD and Face-to-Face: A Randomized Trial. HEALTH EDUCATION & BEHAVIOR 2018; 45:569-580. [PMID: 29504468 DOI: 10.1177/1090198118757824] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Native Hawaiians and other Pacific Islanders have high rates of overweight and obesity compared with other ethnic groups in Hawai'i. Effective weight loss and weight loss-maintenance programs are needed to address obesity and obesity-related health inequities for this group. AIMS Compare the effectiveness of a 9-month, worksite-based, weight loss-maintenance intervention delivered via DVD versus face-to-face in continued weight reduction and weight loss maintenance beyond the initial weight loss phase. METHOD We tested DVD versus face-to-face delivery of the PILI@Work Program's 9-month, weight loss-maintenance phase in Native Hawaiian-serving organizations. After completing the 3-month weight loss phase, participants ( n = 217) were randomized to receive the weight loss-maintenance phase delivered via trained peer facilitators or DVDs. Participant assessments at randomization and postintervention included weight, height, blood pressure, physical functioning, exercise frequency, and fat intake. RESULTS Eighty-three face-to-face participants were retained at 12 months (74.1%) compared with 73 DVD participants (69.5%). There was no significant difference between groups in weight loss or weight loss maintenance. The number of lessons attended in Phase 1 of the intervention (β = 0.358, p = .022) and baseline systolic blood pressure (β = -0.038, p = .048) predicted percent weight loss at 12 months. DISCUSSION AND CONCLUSION Weight loss maintenance was similar across groups. This suggests that low-cost delivery methods for worksite-based interventions targeting at-risk populations can help address obesity and obesity-related disparities. Additionally, attendance during the weight loss phase and lower baseline systolic blood pressure predicted greater percent weight loss during the weight loss-maintenance phase, suggesting that early engagement and initial physical functioning improve long-term weight loss outcomes.
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Affiliation(s)
| | | | - Rui Fang
- 1 University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | | | - Diane Paloma
- 2 Queen's Health Systems, Honolulu, Hawai'i, USA
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Taghavi SA, van Wely M, Jahanfar S, Bazarganipour F. Pharmacological and non-pharmacological strategies for obese women with subfertility. Hippokratia 2017. [DOI: 10.1002/14651858.cd012650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Seyed Abdolvahab Taghavi
- Hormozgan University of Medical Sciences; Fertility and Infertility Research Center; Bandar Abbas Iran
| | - Madelon van Wely
- Academic Medical Center, University of Amsterdam; Center for Reproductive Medicine; Meibergdreef 9 Amsterdam Netherlands 1105 AZ
| | - Shayesteh Jahanfar
- Central Michigan University; School of Health Sciences; Building 2212 Mount Pleasant Michigan USA 48859
| | - Fatemeh Bazarganipour
- Hormozgan University of Medical Sciences; Fertility and Infertility Research Center; Bandar Abbas Iran
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Rogers JM, Ferrari M, Mosely K, Lang CP, Brennan L. Mindfulness-based interventions for adults who are overweight or obese: a meta-analysis of physical and psychological health outcomes. Obes Rev 2017; 18:51-67. [PMID: 27862826 DOI: 10.1111/obr.12461] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of mindfulness-based interventions on psychological and physical health outcomes in adults who are overweight or obese. METHODS We searched 14 electronic databases for randomized controlled trials and prospective cohort studies that met eligibility criteria. Comprehensive Meta-analysis software was used to compute the effect size estimate Hedge's g. RESULTS Fifteen studies measuring post-treatment outcomes of mindfulness-based interventions in 560 individuals were identified. The average weight loss was 4.2 kg. Overall effects were large for improving eating behaviours (g = 1.08), medium for depression (g = 0.64), anxiety (g = 0.62) and eating attitudes (g = 0.57) and small for body mass index (BMI; g = 0.47) and metacognition (g = 0.38) outcomes. Therapeutic effects for BMI (g = 0.43), anxiety (g = 0.53), eating attitudes (g = 0.48) and eating behaviours (g = 0.53) remained significant when examining results from higher quality randomized control trials alone. There was no efficacy advantage for studies exceeding the median dose of 12 h of face-to-face intervention. Studies utilizing an Acceptance and Commitment Therapy approach provided the only significant effect for improving BMI (g = 0.66), while mindfulness approaches produced great variation from small to large (g = 0.30-1.68) effects across a range of psychological health and eating-related constructs. Finally, the limited longitudinal data suggested maintenance of BMI (g = 0.85) and eating attitudes (g = 0.75) gains at follow-up were only detectable in lower quality prospective cohort studies. CONCLUSIONS Mindfulness-based interventions may be both physically and psychologically beneficial for adults who are overweight or obese, but further high-quality research examining the mechanisms of action are encouraged.
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Affiliation(s)
- Jeffrey M Rogers
- Centre for Disability and Development Research, Australian Catholic University, Sydney, NSW, Australia
| | - Madeleine Ferrari
- School of Psychology, Australian Catholic University, Sydney, NSW, Australia
| | - Kylie Mosely
- BodyMatters Australasia, Sydney, NSW, Australia.,Graduate School of Health, University of Technology, Sydney, NSW, Australia
| | - Cathryne P Lang
- School of Psychology, Australian Catholic University, Brisbane, QLD, Australia
| | - Leah Brennan
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
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Abstract
Obesity is one of the leading causes of preventable deaths in this country. Numerous approaches have been used to manage the disease without much success. The lifestyle management of obesity has been shown to be effi cacious for successful weight loss and maintenance. Diet, physical activity, and behavior modification are the key strategies used in lifestyle programs. They are combined to help obese individuals achieve a gradual reduction in weight over an extended time period. The components may be combined in a variety of ways to e fectively promote weight loss, allowing for flexibility and personal preference. Techniques and descriptions of these components are presented in this review. In addition, special populations that may benefit from this approach are reviewed. Optional treatments that may enhance the benefits of lifestyle intervention are also discussed. The authors hope to provide a resource for clinicians that will facilitate adoption of lifestyle approaches for managing the obese patient.
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Wilson KE, Harden SM, Almeida FA, You W, Hill JL, Goessl C, Estabrooks PA. Brief self-efficacy scales for use in weight-loss trials: Preliminary evidence of validity. Psychol Assess 2016; 28:1255-1264. [PMID: 26619093 PMCID: PMC5522615 DOI: 10.1037/pas0000249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Self-efficacy is a commonly included cognitive variable in weight-loss trials, but there is little uniformity in its measurement. Weight-loss trials frequently focus on physical activity (PA) and eating behavior, as well as weight loss, but no survey is available that offers reliable measurement of self-efficacy as it relates to each of these targeted outcomes. The purpose of this study was to test the psychometric properties of brief, pragmatic self-efficacy scales specific to PA, healthful eating and weight-loss (4 items each). An adult sample (n = 1,790) from 28 worksites enrolled in a worksite weight-loss program completed the self-efficacy scales, as well as measures of PA, dietary fat intake, and weight, at baseline, 6-, and 12-months. Confirmatory factor analysis supported the hypothesized factor structure indicating, 3 latent self-efficacy factors, specific to PA, healthful eating, and weight-loss. Measurement equivalence/invariance between relevant demographic groups, and over time was also supported. Parallel growth processes in self-efficacy factors and outcomes (PA, fat intake, and weight) support the predictive validity of score interpretations. Overall, this initial series of psychometric analyses supports the interpretation that scores on these scales reflect self-efficacy for PA, healthful eating, and weight-loss. The use of this instrument in large-scale weight-loss trials is encouraged. (PsycINFO Database Record
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Affiliation(s)
- Kathryn E. Wilson
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University
- Fralin Translational Obesity Research Center, Virginia Polytechnic Institute and State University
| | - Samantha M. Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University
- Fralin Translational Obesity Research Center, Virginia Polytechnic Institute and State University
| | - Fabio A. Almeida
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University
- Fralin Translational Obesity Research Center, Virginia Polytechnic Institute and State University
| | - Wen You
- Fralin Translational Obesity Research Center, Virginia Polytechnic Institute and State University
- Department of Agriculture and Applied Economics, Virginia Polytechnic Institute and State University
| | - Jennie L. Hill
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University
- Fralin Translational Obesity Research Center, Virginia Polytechnic Institute and State University
| | - Cody Goessl
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University
| | - Paul A. Estabrooks
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University
- Fralin Translational Obesity Research Center, Virginia Polytechnic Institute and State University
- Department of Family and Community Medicine, Carilion Clinic
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Beaulac J, Sandre D. Critical review of bariatric surgery, medically supervised diets, and behavioural interventions for weight management in adults. Perspect Public Health 2016; 137:162-172. [PMID: 27354536 DOI: 10.1177/1757913916653425] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS Patient selection of weight management treatment option is often guided by a variety of factors. Currently, there is no comprehensive tool to facilitate informed decision-making for patients and clinicians. This article aims to synthesise evidence on the treatment effectiveness, health benefits, risks, and patient experiences of treatment options presently available at the Weight Management Clinic at The Ottawa Hospital (TOH), as a first step towards developing a decision aid. METHODS Narrative and systematic reviews published in English between 1999 and 2014 were included that focused on one or more of the following weight management treatments in adults aged 18 years and over: roux-en-y gastric bypass (RYGB), sleeve gastrectomy (SG), medically supervised meal replacement, and behavioural or lifestyle intervention. RESULTS Overall, bariatric surgeries have received the greatest research attention and have been associated not only with greater weight loss and health benefit but also with greater risks, complications, and financial cost. Dietary programmes demonstrated weight loss and health benefits to a lesser extent than with surgery but were associated with lower and shorter-term risks and complications. Behavioural and lifestyle interventions have been studied less yet have shown significant, albeit small, weight loss outcomes alone and in combination with dietary or surgical options; they also appear to be the lowest risk interventions. Patient experiences of weight management options are mixed and not well understood. CONCLUSION Further research is needed; however, this review identified some general trends related to weight loss outcomes, benefits, risks, and barriers for weight management options that have implications for shared treatment decision-making.
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Affiliation(s)
- Julie Beaulac
- Psychology Department, The Ottawa Hospital, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Daniella Sandre
- Psychology Department, The Ottawa Hospital, Ottawa, ON, Canada
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14
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Brown A, Gouldstone A, Fox E, Field A, Todd W, Shakher J, Bellary S, Teh MM, Azam M, John R, Jagielski A, Arora T, Thomas GN, Taheri S. Description and preliminary results from a structured specialist behavioural weight management group intervention: Specialist Lifestyle Management (SLiM) programme. BMJ Open 2015; 5:e007217. [PMID: 25854970 PMCID: PMC4390730 DOI: 10.1136/bmjopen-2014-007217] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Specialist Lifestyle Management (SLiM) is a structured patient education and self-management group weight management programme. Each session is run monthly over a 6-month period providing a less intensive long-term approach. The groups are patient-centred incorporating educational, motivational, behavioural and cognitive elements. The theoretical background, programme structure and preliminary results of SLiM are presented. SUBJECTS/METHODS The study was a pragmatic service evaluation of obese patients with a body mass index (BMI) ≥35 kg/m(2) with comorbidity or ≥40 kg/m(2) without comorbidity referred to a specialist weight management service in the West Midlands, UK. 828 patients were enrolled within SLiM over a 48-month period. Trained facilitators delivered the programme. Preliminary anonymised data were analysed using the intention-to-treat principle. The primary outcome measure was weight loss at 3 and 6 months with comparisons between completers and non-completers performed. The last observation carried forward was used for missing data. RESULTS Of the 828 enrolled within SLiM, 464 completed the programme (56%). The mean baseline weight was 135 kg (BMI=49.1 kg/m(2)) with 87.2% of patients having a BMI≥40 kg/m(2) and 12.4% with BMI≥60 kg/m(2). The mean weight change of all patients enrolled was -4.1 kg (95% CI -3.6 to -4.6 kg, p=0.0001) at the end of SLiM, with completers (n=464) achieving -5.5 kg (95% CI -4.2 to -6.2 kg, p=0.0001) and non-completers achieving -2.3 kg (p=0.0001). The majority (78.6%) who attended the 6-month programme achieved weight loss with 32.3% achieving a ≥5% weight loss. CONCLUSIONS The SLiM programme is an effective group intervention for the management of severe and complex obesity.
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Affiliation(s)
- Adrian Brown
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK
- Department of Diabetes, Endocrinology and Metabolism, Faculty of Medicine, Imperial College, London, UK
| | - Amy Gouldstone
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Emily Fox
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Annmarie Field
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Wendy Todd
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jayadave Shakher
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Srikanth Bellary
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Ming Ming Teh
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Muhammad Azam
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Reggie John
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Alison Jagielski
- Theme 8 (Diabetes), Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, UK
| | - Teresa Arora
- Department of Medicine, Weill Cornell Medical College, Doha, Qatar
| | - G Neil Thomas
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
- Mannheim Medical Faculty, Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
| | - Shahrad Taheri
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK
- Theme 8 (Diabetes), Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, UK
- Department of Medicine, Weill Cornell Medical College, Doha, Qatar
- Department of Medicine, Kings College London, London, UK
- Department of Diabetes and Specialist Weight Management Service, Hamad Medical Corporation, Doha, Qatar
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Ko LK, Turner-McGrievy G, Campbell MK. Information processing versus social cognitive mediators of weight loss in a podcast-delivered health intervention. HEALTH EDUCATION & BEHAVIOR 2014; 41:197-206. [PMID: 24082027 PMCID: PMC4868338 DOI: 10.1177/1090198113504413] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Podcasting is an emerging technology, and previous interventions have shown promising results using theory-based podcast for weight loss among overweight and obese individuals. This study investigated whether constructs of social cognitive theory and information processing theories (IPTs) mediate the effect of a podcast intervention on weight loss among overweight individuals. Data are from Pounds off Digitally, a study testing the efficacy of two weight loss podcast interventions (control podcast and theory-based podcast). Path models were constructed (n = 66). The IPTs, elaboration likelihood model, information control theory, and cognitive load theory mediated the effect of a theory-based podcast on weight loss. The intervention was significantly associated with all IPTs. Information control theory and cognitive load theory were related to elaboration, and elaboration was associated with weight loss. Social cognitive theory constructs did not mediate weight loss. Future podcast interventions grounded in theory may be effective in promoting weight loss.
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Affiliation(s)
- Linda K. Ko
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | | | - Marci K. Campbell
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Huye HF, Connell CL, Crook LB, Yadrick K, Zoellner J. Using the RE-AIM Framework in formative evaluation and program planning for a nutrition intervention in the Lower Mississippi Delta. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:34-42. [PMID: 24188802 DOI: 10.1016/j.jneb.2013.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 09/03/2013] [Accepted: 09/14/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Identification of prominent themes to be considered when planning a nutrition intervention using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. DESIGN Qualitative formative research. SETTING Women's social and civic organizations in the Lower Mississippi Delta. PARTICIPANTS Thirty-seven (5 white and 32 black) women with a college degree or higher. PHENOMENON OF INTEREST Impact of dietary and contextual factors related to the Lower Mississippi Delta culture on intervention planning. ANALYSIS Case analysis strategy using question-by-question coding. RESULTS Major themes that emerged were "healthy eating focus" and "promoting a healthy lifestyle" when recruiting organizations (Reach); "positive health changes" as a result of the intervention (Effectiveness); "logistics: time commitment, location, and schedule" to initiate a program (Adoption); "expense of healthy foods" and "cooking and meal planning" as barriers to participation (Implementation); and "resources and training" and "motivation" as necessary for program continuation (Maintenance). The "health of the Delta" theme was found across all dimensions, which reflected participants' compassion for their community. CONCLUSIONS AND IMPLICATIONS Results were used to develop an implementation plan promoting optimal reach, effectiveness, adoption, implementation, and maintenance of a nutrition intervention. This research emphasizes the benefits of formative research using a systematic process at organizational and individual levels.
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Affiliation(s)
- Holly F Huye
- Department of Nutrition and Food Systems, University of Southern Mississippi, Hattiesburg, MS.
| | - Carol L Connell
- Department of Nutrition and Food Systems, University of Southern Mississippi, Hattiesburg, MS
| | - LaShaundrea B Crook
- Department of Nutrition and Food Systems, University of Southern Mississippi, Hattiesburg, MS
| | - Kathy Yadrick
- Department of Nutrition and Food Systems, University of Southern Mississippi, Hattiesburg, MS
| | - Jamie Zoellner
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
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Barry VB, Raiff BR. Weight management preferences in a non-treatment seeking sample. Health Promot Perspect 2013; 3:147-53. [PMID: 24688964 DOI: 10.5681/hpp.2013.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 07/20/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Obesity is a serious public health issue in the United States, with the CDC reporting that most adult Americans are now either overweight or obese. Little is known about the comparative acceptability of available weight management approaches in non-treatment seeking samples. METHOD This report presents preliminary survey data collected from an online sample on weight management preferences for 8 different weight management strategies including a proposed incentive-based program. Participants were 72 individuals (15 men, 55 women and 2 transgendered individuals) who self-re-ported being overweight or obese, or who currently self-reported a normal weight but had attempted to lose weight in the past. RESULTS ANOVA and Pair-wise comparison indicated clear preferences for cer-tain treatments over others in the full sample; most notably, the most popular option in our sample for managing weight was to diet and exercise without pro-fessional assistance. Several differences in preference between the three weight groups were also observed. CONCLUSIONS Dieting and exercising without any professional assistance is the most highly endorsed weight management option among all groups. Overweight and obese individuals may find self-management strategies for weight loss less attractive than normal weight individuals, but still prefer it to other alternatives. This has implications for the development and dissemination of empirically based self-management strategies for weight.
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Affiliation(s)
- Victoria B Barry
- National Development and Research Institute, New York, New York10010, USA
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18
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Donaldson EL, Fallows S, Morris M. A text message based weight management intervention for overweight adults. J Hum Nutr Diet 2013; 27 Suppl 2:90-7. [DOI: 10.1111/jhn.12096] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E. L. Donaldson
- Leicestershire Nutrition & Dietetic Services; Leicestershire UK
| | - S. Fallows
- Department of Clinical Sciences; University of Chester; Chester UK
| | - M. Morris
- Department of Clinical Sciences; University of Chester; Chester UK
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Mechanisms of Weight Regain following Weight Loss. ISRN OBESITY 2013; 2013:210524. [PMID: 24533218 PMCID: PMC3901982 DOI: 10.1155/2013/210524] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/27/2013] [Indexed: 12/15/2022]
Abstract
Obesity is a world-wide pandemic and its incidence is on the rise along with associated comorbidities. Currently, there are few effective therapies to combat obesity. The use of lifestyle modification therapy, namely, improvements in diet and exercise, is preferable over bariatric surgery or pharmacotherapy due to surgical risks and issues with drug efficacy and safety. Although they are initially successful in producing weight loss, such lifestyle intervention strategies are generally unsuccessful in achieving long-term weight maintenance, with the vast majority of obese patients regaining their lost weight during followup. Recently, various compensatory mechanisms have been elucidated by which the body may oppose new weight loss, and this compensation may result in weight regain back to the obese baseline. The present review summarizes the available evidence on these compensatory mechanisms, with a focus on weight loss-induced changes in energy expenditure, neuroendocrine pathways, nutrient metabolism, and gut physiology. These findings have added a major focus to the field of antiobesity research. In addition to investigating pathways that induce weight loss, the present work also focuses on pathways that may instead prevent weight regain. Such strategies will be necessary for improving long-term weight loss maintenance and outcomes for patients who struggle with obesity.
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Nothwehr F, Clark DO, Perkins A. Hope and the use of behavioural strategies related to diet and physical activity. J Hum Nutr Diet 2013; 26 Suppl 1:159-63. [PMID: 23521400 DOI: 10.1111/jhn.12057] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of specific behavioural strategies such as portion control or meal planning is important for weight management, although studies of determinants of strategy use are limited. The present study explored the concept of hope and its association with the use of behavioural strategies. METHODS Data were obtained from a larger cross-sectional survey conducted in 2009 among 178 patients of a city-county sponsored primary care clinic in the Midwest region of the USA. Hope was measured with subscales representing 'agency' (determination in meeting goals) and 'pathways' (perception of ways to meet goals) and a total score. Diet and physical activity-related strategies were captured with five and two scales, respectively. RESULTS Analyses showed a significant (P < 0.05) association between both the total hope score and the agency subscale and all behavioural strategy measures. The pathways subscale was significantly associated with physical activity-related strategies, and a subset of diet-related strategies. CONCLUSIONS The hope measures should be explored further in the context of a weight loss intervention to determine their predictive association with the use of specific behavioural strategies.
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Affiliation(s)
- F Nothwehr
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 105 River Street, Iowa City, IA 52242, USA.
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21
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Turner-McGrievy G, Kalyanaraman S, Campbell MK. Delivering health information via podcast or web: media effects on psychosocial and physiological responses. HEALTH COMMUNICATION 2013; 28:101-9. [PMID: 22420785 PMCID: PMC4860808 DOI: 10.1080/10410236.2011.651709] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This study explored differences in psychosocial and physiological variables in response to being presented with information on weight loss through either reading text on a website or listening to the same information via podcast. Participants were randomized to receive a weight loss website (n = 20) or podcast (n = 20). Participants had skin conductance levels measured and completed questionnaire items assessing demographic characteristics, user control, novelty, and knowledge. Participants in the podcast group exhibited greater levels of physiological arousal and reported the intervention to be more novel than those in the Web group; however, the Web group reported greater user control. There was no difference in knowledge between the groups. This study presents the first step in examining the role that novelty and user control may play in two different weight-loss electronic media, as well as differences in knowledge acquisition. Future research should explore adding additional media features, such as video content, to the podcasts and websites in order to optimize fully the different mediums and to examine whether user control and novelty are potential mediators of weight loss outcomes.
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Affiliation(s)
- Gabrielle Turner-McGrievy
- Department of Health Promotion, Education, and Behavior, University of South Carolina, SC 29208, USA.
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22
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Chur-Hansen A. Cognitive-behavioural and other psychological techniques in the dietetic consultation: Suggestions for practice. Nutr Diet 2012. [DOI: 10.1111/j.1747-0080.2012.01645.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Chur-Hansen
- Discipline of Psychiatry; School of Medicine; University of Adelaide
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23
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Johnston JD, Massey AP, Devaneaux CA. Innovation in weight loss programs: a 3-dimensional virtual-world approach. J Med Internet Res 2012; 14:e120. [PMID: 22995535 PMCID: PMC3510765 DOI: 10.2196/jmir.2254] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 08/10/2012] [Accepted: 08/10/2012] [Indexed: 11/27/2022] Open
Abstract
Background The rising trend in obesity calls for innovative weight loss programs. While behavioral-based face-to-face programs have proven to be the most effective, they are expensive and often inaccessible. Internet or Web-based weight loss programs have expanded reach but may lack qualities critical to weight loss and maintenance such as human interaction, social support, and engagement. In contrast to Web technologies, virtual reality technologies offer unique affordances as a behavioral intervention by directly supporting engagement and active learning. Objective To explore the effectiveness of a virtual-world weight loss program relative to weight loss and behavior change. Methods We collected data from overweight people (N = 54) participating in a face-to-face or a virtual-world weight loss program. Weight, body mass index (BMI), percentage weight change, and health behaviors (ie, weight loss self-efficacy, physical activity self-efficacy, self-reported physical activity, and fruit and vegetable consumption) were assessed before and after the 12-week program. Repeated measures analysis was used to detect differences between groups and across time. Results A total of 54 participants with a BMI of 32 (SD 6.05) kg/m2 enrolled in the study, with a 13% dropout rate for each group (virtual world group: 5/38; face-to-face group: 3/24). Both groups lost a significant amount of weight (virtual world: 3.9 kg, P < .001; face-to-face: 2.8 kg, P = .002); however, no significant differences between groups were detected (P = .29). Compared with baseline, the virtual-world group lost an average of 4.2%, with 33% (11/33) of the participants losing a clinically significant (≥5%) amount of baseline weight. The face-to-face group lost an average of 3.0% of their baseline weight, with 29% (6/21) losing a clinically significant amount. We detected a significant group × time interaction for moderate (P = .006) and vigorous physical activity (P = .008), physical activity self-efficacy (P = .04), fruit and vegetable consumption (P = .007), and weight loss self-efficacy (P < .001). Post hoc paired t tests indicated significant improvements across all of the variables for the virtual-world group. Conclusions Overall, these results offer positive early evidence that a virtual-world-based weight loss program can be as effective as a face-to-face one relative to biometric changes. In addition, our results suggest that a virtual world may be a more effective platform to influence meaningful behavioral changes and improve self-efficacy.
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Affiliation(s)
- Jeanne D Johnston
- Department of Kinesiology, Indiana University, Bloomington, IN 47405, United States.
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24
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Ahn S, Smith ML, Ory MG. Physicians' discussions about body weight, healthy diet, and physical activity with overweight or obese elderly patients. J Aging Health 2012; 24:1179-202. [PMID: 22918131 DOI: 10.1177/0898264312454573] [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
OBJECTIVE To investigate the correlates of physician-patient discussions about body weight, healthy diet, and physical activity. METHOD Subjects were 635 adults (≥65 years; mean 72.8 years) who had an increased body mass index (BMI≥25 kg/m2) and participated in a self-administered community survey. Logistic regression analyses were performed. RESULTS While approximately half of study participants reported having discussed healthy diets (51%) and physical activity (52%) with their physician, only 42% of those who were overweight or obese reported being recognized as such by their physician. Being moderately or severely obese, more chronic conditions, and more frequent physician visits increased the likelihood of being recognized as overweight or obese and reporting lifestyle discussions. DISCUSSION The health care provider is important in recognizing older patient's weight problems and discussing practical lifestyle changes. Tools for more proactive screening and implementation of follow-up behavioral counseling can help the health care providers better address obesity prevention in clinical practice.
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Affiliation(s)
- SangNam Ahn
- School of Public Health, University of Memphis, Memphis, TN 38152-3530, USA.
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Weight management by phone conference call: a comparison with a traditional face-to-face clinic. Rationale and design for a randomized equivalence trial. Contemp Clin Trials 2012; 33:1044-55. [PMID: 22664647 DOI: 10.1016/j.cct.2012.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 05/18/2012] [Accepted: 05/19/2012] [Indexed: 11/21/2022]
Abstract
State-of-the-art treatment for weight management consists of a behavioral intervention to facilitate decreased energy intake and increased physical activity. These interventions are typically delivered face-to-face (FTF) by a health educator to a small group of participants. There are numerous barriers to participation in FTF clinics including availability, scheduling, the expense and time required to travel to the clinic site, and possible need for dependent care. Weight management clinics delivered by conference call have the potential to diminish or eliminate these barriers. The conference call approach may also reduce burden on providers, who could conduct clinic groups from almost any location without the expenses associated with maintaining FTF clinic space. A randomized trial will be conducted in 395 overweight/obese adults (BMI 25-39.9 kg/m(2)) to determine if weight loss (6 months) and weight maintenance (12 months) are equivalent between weight management interventions utilizing behavioral strategies and pre-packaged meals delivered by either a conference call or the traditional FTF approach. The primary outcome, body weight, will be assessed at baseline, 6, 12 and 18 months. Secondary outcomes including waist circumference, energy and macronutrient intake, and physical activity and will be assessed on the same schedule. In addition, a cost analysis and extensive process evaluation will be completed.
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Lehnert T, Sonntag D, Konnopka A, Riedel-Heller S, König HH. The long-term cost-effectiveness of obesity prevention interventions: systematic literature review. Obes Rev 2012; 13:537-53. [PMID: 22251231 DOI: 10.1111/j.1467-789x.2011.00980.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Obesity prevention provides a major opportunity to improve population health. As health improvements usually require additional and scarce resources, novel health technologies (interventions) should be economically evaluated. In the prevention of obesity, health benefits may slowly accumulate over time and it can take many years before an intervention has reached full effectiveness. Decision-analytic simulation models (DAMs), which combine evidence from diverse sources, can be utilized to evaluate the long-term cost-effectiveness of such interventions. This literature review summarizes long-term economic findings (defined as ≥ 40 years) for 41 obesity prevention interventions, which had been evaluated in 18 cost-utility analyses, using nine different DAMs. Interventions were grouped according to their method of delivery, setting and risk factors targeted into behavioural (n=21), community (n=12) and environmental interventions (n=8). The majority of interventions offered good value for money, while seven were cost-saving. Ten interventions were not cost-effective (defined as >50,000 US dollar), however. Interventions that modified a target population's environment, i.e. fiscal and regulatory measures, reported the most favourable cost-effectiveness. Economic findings were accompanied by a large uncertainty though, which complicates judgments about the comparative cost-effectiveness of interventions.
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Affiliation(s)
- T Lehnert
- Department for Medical Sociology and Health Economics, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Folope V, Chapelle C, Grigioni S, Coëffier M, Déchelotte P. Impact of eating disorders and psychological distress on the quality of life of obese people. Nutrition 2012; 28:e7-e13. [PMID: 22484005 DOI: 10.1016/j.nut.2011.12.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 11/29/2011] [Accepted: 12/12/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Quality of life (QoL) is impaired in obesity, but the roles of eating behavior and psychological distress need to be more documented. METHODS One hundred thirty consecutive obese patients seeking medical care filled out questionnaires evaluating QoL, the presence of an eating disorder (ED), levels of anxiety and depression, and perception of body image. RESULTS Global QoL was poor in 16.4% and intermediate in 61.8% of the patients. EDs were present in 58% of patients who were more (P = 0.05) overweight; 24.2% of patients had binging. EDs impaired significantly the global and specific dimensions of QoL; binging impaired physical and sexual QoLs (both P < 0.02). Anxiety and depression were found in 73.6% and 50.4% of patients, respectively; depression was more frequent in women (P = 0.007) and in patients with EDs. Anxiety and/or depression impaired global (P < 0.001) and specific dimensions of QoL. Body shape concern was marked in 86.4% of women and associated with poor global (P < 0.001) and specific QoL, and with anxiety and depression. CONCLUSION The impairment of QoL in obese patients is increased by the presence of an ED, anxiety, and/or depression and marked body shape concern. These psychological factors should be assessed more carefully and taken into account in global strategies aiming to improve the well-being of obese patients.
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Affiliation(s)
- Vanessa Folope
- Rouen University Hospital, Institute for Biomedical Research, Rouen, France.
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Matusitz J, McCormick J. Sedentarism: the effects of Internet use on human obesity in the United States. SOCIAL WORK IN PUBLIC HEALTH 2012; 27:250-269. [PMID: 22486430 DOI: 10.1080/19371918.2011.542998] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This paper analyzes the impact of Internet use on human obesity in the United States. The United States is facing a skyrocketing obesity epidemic among adults and children. The authors hypothesize that the more individuals use the Internet, the more they increase their risks of becoming obese. The explanation is that Internet use may cause sedentarism, which refers to decreased energy expenditure or, simply, physical inactivity. Sedentarism, in turn, may increase obesity.
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Affiliation(s)
- Jonathan Matusitz
- Nicholson School of Communication, University of Central Florida, Sanford, Florida 32773, USA.
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Chambliss HO, Huber RC, Finley CE, McDoniel SO, Kitzman-Ulrich H, Wilkinson WJ. Computerized self-monitoring and technology-assisted feedback for weight loss with and without an enhanced behavioral component. PATIENT EDUCATION AND COUNSELING 2011; 85:375-382. [PMID: 21295433 DOI: 10.1016/j.pec.2010.12.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 11/23/2010] [Accepted: 12/31/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The purpose of this study was to develop and evaluate a 12-week weight management intervention involving computerized self-monitoring and technology-assisted feedback with and without an enhanced behavioral component. METHODS 120 overweight (30.5±2.6kg/m(2)) adults (45.0±10.3 years) were randomized to one of three groups: computerized self-monitoring with Basic feedback (n=45), Enhanced behavioral feedback (n=45), or wait-list control (n=30). Intervention participants used a computer software program to record dietary and physical activity information. Weekly e-mail feedback was based on computer-generated reports, and participants attended monthly measurement visits. RESULTS The Basic and Enhanced groups experienced significant weight reduction (-2.7±3.3kg and -2.5±3.1kg) in comparison to the Control group (0.3±2.2; p<0.05). Waist circumference and systolic blood pressure also decreased in intervention groups compared to Control (p<0.01). CONCLUSIONS A program using computerized self-monitoring, technology-assisted feedback, and monthly measurement visits produced significant weight loss after 12 weeks. However, the addition of an enhanced behavioral component did not improve the effectiveness of the program. PRACTICE IMPLICATIONS This study suggests that healthcare professionals can effectively deliver a weight management intervention using technology-assisted strategies in a format that may complement and reduce face-to-face sessions.
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Affiliation(s)
- Heather O Chambliss
- Department of Health and Sport Sciences, The University of Memphis, Memphis, TN, USA.
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Fielding RA, Rejeski WJ, Blair S, Church T, Espeland MA, Gill TM, Guralnik JM, Hsu FC, Katula J, King AC, Kritchevsky SB, McDermott MM, Miller ME, Nayfield S, Newman AB, Williamson JD, Bonds D, Romashkan S, Hadley E, Pahor M. The Lifestyle Interventions and Independence for Elders Study: design and methods. J Gerontol A Biol Sci Med Sci 2011; 66:1226-37. [PMID: 21825283 PMCID: PMC3193523 DOI: 10.1093/gerona/glr123] [Citation(s) in RCA: 189] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 06/19/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND As the number of older adults in the United States rises, maintaining functional independence among older Americans has emerged as a major clinical and public health priority. Older people who lose mobility are less likely to remain in the community; demonstrate higher rates of morbidity, mortality, and hospitalizations; and experience a poorer quality of life. Several studies have shown that regular physical activity improves functional limitations and intermediate functional outcomes, but definitive evidence showing that major mobility disability can be prevented is lacking. A Phase 3 randomized controlled trial is needed to fill this evidence gap. METHODS The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled trial designed to compare a supervised moderate-intensity physical activity program with a successful aging health education program in 1,600 sedentary older persons followed for an average of 2.7 years. RESULTS LIFE's primary outcome is major mobility disability, defined as the inability to walk 400 m. Secondary outcomes include cognitive function, serious fall injuries, persistent mobility disability, the combined outcome of major mobility disability or death, disability in activities of daily living, and cost-effectiveness. CONCLUSIONS Results of this study are expected to have important public health implications for the large and growing population of older sedentary men and women.
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Affiliation(s)
- Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA.
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LeCheminant JD, Covington NK, Smith J, Lox CL, Kirk EP, Heden TD. Evaluation of a University-Based Community Outreach Weight Management Program. Popul Health Manag 2011; 14:167-73. [DOI: 10.1089/pop.2010.0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
| | - N. Kay Covington
- Southern Illinois University Edwardsville, Edwardsville, Illinois
| | - John Smith
- Texas A&M University-San Antonio, San Antonio, Texas
| | - Curt L. Lox
- Southern Illinois University Edwardsville, Edwardsville, Illinois
| | - Erik P. Kirk
- Southern Illinois University Edwardsville, Edwardsville, Illinois
| | - Tim D. Heden
- Southern Illinois University Edwardsville, Edwardsville, Illinois
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Hopkins KF, DeCristofaro C, Elliott L. How can primary care providers manage pediatric obesity in the real world? ACTA ACUST UNITED AC 2011; 23:278-88. [DOI: 10.1111/j.1745-7599.2011.00614.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dohan M, Tan J. Lose It! INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2011. [DOI: 10.4018/jhisi.2011040105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lose It! is a web-based, food and exercise diary application, assisting its users in weight control. It is part of a growing form of information technology developed to transform self-care through influencing individual care behaviors and impacting on lifestyle changes. Future implications for the development of such electronic tools require research into the connection of key variables dictated by the relevant theoretical body of knowledge and the translation of such knowledge to practice.
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Mowafi M, Khadr Z, Subramanian SV, Bennett G, Hill A, Kawachi I. Are neighborhood education levels associated with BMI among adults in Cairo, Egypt? Soc Sci Med 2011; 72:1274-83. [PMID: 21440350 DOI: 10.1016/j.socscimed.2011.01.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 11/09/2010] [Accepted: 01/22/2011] [Indexed: 11/25/2022]
Abstract
This study examined the association between area-level education and BMI among adults in Cairo, Egypt. A sample of 3993 households including 1990 men and 2003 women were analyzed from the 2007 Cairo Urban Inequity Study, a study which aimed to identify potential intra-urban inequities in health related to the environment and living conditions in Cairo. Using multilevel analysis, we found that residents of high education neighborhoods were significantly less likely to be obese compared to low education neighborhoods. An inverse association between neighborhood education and individual BMI was observed whereby each unit increase in percentage of households with greater than a high school education was associated with a 0.036 kg/m(2) decrease in BMI of individuals. This translated into a difference between high and low education neighborhoods of 6.86 kg (15.1 lb) for women based on an average height of 1.65 m and 6.10 kg (13.4 lb) for men based on an average height of 1.75 m after adjusting for sociodemographic, socioeconomic, health and environmental factors. These findings suggest that programs aiming to reduce BMI among adults in this setting may be well-served by focusing on education since it appears to have an effect at the neighborhood level over and above the impact it has at the individual level. This may be due to several factors such as greater access to knowledge and information regarding health and nutrition, greater food availability, and shifting cultural perceptions of beauty away from an ideal body shape of plumpness in favor of thinness in high education neighborhoods. The cross-sectional nature of our study does not allow for causal interpretations, however, so further studies exploring why the neighborhood education-BMI association is so significant is warranted.
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Affiliation(s)
- Mona Mowafi
- Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02114, United States.
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Towey M, Harrell R, Lee B. Evaluation of "one body, one life": a community-based family intervention for the prevention of obesity in children. J Obes 2011; 2011:619643. [PMID: 22028958 PMCID: PMC3199086 DOI: 10.1155/2011/619643] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 07/15/2011] [Accepted: 07/21/2011] [Indexed: 11/17/2022] Open
Abstract
Service evaluation of a community-based healthy lifestyle programme, designed for families aimed at preventing obesity. Physiological and behaviour measures were recorded at the beginning and end of the programme. Out of a total of 454 participants, 358 (79%) completed. From these completers 293 (64%) were analysed as there was sufficient data. The use of "high visibility recruitment" led to 77% of completers being from Coventry's two most deprived population quintiles. Ethnic minorities were also well represented. There were statistically significant self-reported behaviour changes, with improvements in fruit and vegetables eaten and decrease in consumption of crisps, snacks, and take away foods. There were also significant increases in physical activity. There were small but statistically significant improvements in BMI/BMI percentile for adults and children who started the programme overweight/obese. These results demonstrate the programmes' effectiveness in enabling behaviour change, and attracting participants from deprived communities.
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Affiliation(s)
- Marsha Towey
- Health and Physical Activity Team, Coventry City Council, 1st Floor West Orchard House, Coventry CV1 1GF, UK
- *Marsha Towey:
| | - Ruth Harrell
- Department of Public Health, NHS Coventry, Coventry CV1 2GQ, UK
| | - Berni Lee
- Department of Public Health, NHS Coventry, Coventry CV1 2GQ, UK
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Sanderson PW, Clemes SA, Biddle SJH. The correlates and treatment of obesity in military populations: a systematic review. Obes Facts 2011; 4:229-37. [PMID: 21701240 PMCID: PMC6444481 DOI: 10.1159/000329450] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The emergence of obesity as a distinct disease could have far reaching consequences for an organisation where optimum health and physical fitness are required for personnel to perform their occupational roles effectively. The objectives of this paper are to systematically review the literature concerning correlates and treatment of obesity in military populations. METHODS Through computerised searches of English language studies, 17 papers were identified (treatment (13), correlates (4)). RESULTS Successful treatment interventions incorporated exercise, healthy eating information, behavioural modification, self-monitoring, relapse prevention, and structured follow-up and were supported by trained personnel. Efficacy due to physical activity was underreported. Reduction in body fat rather than body weight was the most significant outcome. The major significant correlates of obesity were being enlisted personnel, male, ≥35 years of age, African-American/Hispanic ethnicity, and married (with spouse present). CONCLUSION This systematic review highlights the deficit in knowledge concerning treatment and the lack of engagement in relation to the specific correlates of obesity in military populations.
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Affiliation(s)
- Paul W Sanderson
- School of Sport, Exercise and Health Sciences, Loughborough University, UK.
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Cahill JM, Freeland-Graves JH, Shah BS, Lu H. Motivations to eat are related to diet quality and food intake in overweight and obese, low-income women in early postpartum. Appetite 2010; 55:263-70. [DOI: 10.1016/j.appet.2010.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 06/01/2010] [Accepted: 06/15/2010] [Indexed: 11/28/2022]
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Kitzman-Ulrich H, Wilson DK, St George SM, Lawman H, Segal M, Fairchild A. The integration of a family systems approach for understanding youth obesity, physical activity, and dietary programs. Clin Child Fam Psychol Rev 2010; 13:231-53. [PMID: 20689989 PMCID: PMC3293190 DOI: 10.1007/s10567-010-0073-0] [Citation(s) in RCA: 190] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Rates of overweight in youth have reached epidemic proportions and are associated with adverse health outcomes. Family-based programs have been widely used to treat overweight in youth. However, few programs incorporate a theoretical framework for studying a family systems approach in relation to youth health behavior change. Therefore, this review provides a family systems theory framework for evaluating family-level variables in weight loss, physical activity, and dietary approaches in youth. Studies were reviewed and effect sizes were calculated for interventions that manipulated the family system, including components that targeted parenting styles, parenting skills, or family functioning, or which had novel approaches for including the family. Twenty-one weight loss interventions were identified, and 25 interventions related to physical activity and/or diet were identified. Overall, family-based treatment programs that incorporated training for authoritative parenting styles, parenting skills, or child management, and family functioning had positive effects on youth weight loss. Programs to improve physical activity and dietary behaviors that targeted the family system also demonstrated improvements in youth health behaviors; however, direct effects of parent-targeted programming is not clear. Both treatment and prevention programs would benefit from evaluating family functioning and parenting styles as possible mediators of intervention outcomes. Recommendations are provided to guide the development of future family-based obesity prevention and treatment programs for youth.
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Affiliation(s)
- Heather Kitzman-Ulrich
- Primary Care Research Institute, Family Medicine Department, University of North Texas Health Science Center, 855 Montgomery, Ft. Worth, TX 76107, USA.
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Papalazarou A, Yannakoulia M, Kavouras SA, Komesidou V, Dimitriadis G, Papakonstantinou A, Sidossis LS. Lifestyle intervention favorably affects weight loss and maintenance following obesity surgery. Obesity (Silver Spring) 2010; 18:1348-53. [PMID: 19834466 DOI: 10.1038/oby.2009.346] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The present study was designed to evaluate the 3 year effects of a lifestyle intervention on weight loss and maintenance, dietary, and physical activity habits and eating behavior of patients following vertical banded gastroplasty (VBG). Thirty severely obese female volunteers were included in the study and they were randomly assigned to one of two intervention groups: usual care (UC) or lifestyle intervention (LS) group. Patients were followed for 3 years postoperatively. Outcome measures included weight loss, dietary habits, physical activity level (PAL), and eating behavior changes. Weight was significantly lower in the LS group after 12 months (84.4 +/- 3.9 kg vs. 98.4 +/- 4.4 kg, P < 0.05), 24 months (83.0 +/- 3.3 vs. 101.9 +/- 5.3 kg, P < 0.05), and 36 months following surgery (84.2 +/- 3.3 vs. 102.5 +/- 3.5 kg, P < 0.05). Repeated measures ANOVA revealed significant differences between the two groups overall and at specific time points for the PAL and TV viewing. With regard to eating behavior, the LS group scored significantly better in total Dutch Eating Behavior Questionnaire (DEBQ), Restraint Eating and External Eating scales at all postoperative time points. Similarly, significant differences were found between the two groups in dietary intake. These findings outline the importance of lifestyle intervention on weight loss and maintenance following bariatric surgery. The favorable effects of lifestyle intervention may be through adoption of healthier eating behaviors and increased physical activity.
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Puri R, Bell C, Evers WD. Dietetics students' ability to choose appropriate communication and counseling methods is improved by teaching behavior-change strategies in computer-assisted instruction. ACTA ACUST UNITED AC 2010; 110:892-7. [PMID: 20497778 DOI: 10.1016/j.jada.2010.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 10/16/2009] [Indexed: 10/19/2022]
Abstract
Several models and theories have been proposed to help registered dietitians (RD) counsel and communicate nutrition information to patients. However, there is little time for students or interns to observe and/or participate in counseling sessions. Computer-assisted instruction (CAI) can be used to give students more opportunity to observe the various methods and theories of counseling. This study used CAI simulations of RD-client communications to examine whether students who worked through the CAI modules would choose more appropriate counseling methods. Modules were created based on information from experienced RD. They contained videos of RD-patient interactions and demonstrated helpful and less helpful methods of communication. Students in didactic programs in dietetics accessed the modules via the Internet. The intervention group of students received a pretest module, two tutorial modules, and a posttest module. The control group only received the pretest and posttest modules. Data were collected during three semesters in 2006 and 2007. Two sample t tests were used to compare pretest and posttest scores. The influence of other factors was measured using factorial analysis of variance. Statistical significance was set at P<0.05. Eleven didactic programs participated. A total of 350 students were in the intervention group and 102 students were in the control group. Pretest scores were not different (6.30+/-0.26 vs 6.21+/-0.15, control and intervention, respectively). The intervention group's posttest score was higher than its pretest score (6.21+/-0.15 vs 6.65+/-0.16, pretest and posttest, respectively). Change in score from pretest to posttest was higher for the intervention group (-0.02+/-0.20 vs 0.44+/-0.11, control and intervention, respectively). For the 21 questions in the tutorials, those who answered 19 to 21 correctly had a greater increase from pretest to posttest than those who answered <13 correctly (-0.44+/-0.37 vs 0.84+/-0.17, <13 and 19 to 21 correct, respectively). There was no effect of instructor, grade point average, school year, or prior counseling on the results. The study provides evidence that the use of CAI can improve communication and counseling methods for dietetics students.
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Affiliation(s)
- Ruchi Puri
- Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Indiana Health Centers, Inc, Frankfort, IN, USA
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Shay LE, Seibert D, Watts D, Sbrocco T, Pagliara C. Adherence and weight loss outcomes associated with food-exercise diary preference in a military weight management program. Eat Behav 2009; 10:220-7. [PMID: 19778751 PMCID: PMC3936599 DOI: 10.1016/j.eatbeh.2009.07.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Revised: 06/28/2009] [Accepted: 07/06/2009] [Indexed: 11/16/2022]
Abstract
The more consistently someone records their food intake the more likely they are to lose weight. We hypothesized that subjects who kept track via their preferred method would demonstrate higher adherence and therefore improved outcomes compared to those who used a non-preferred method. Participants were randomly assigned to use a paper, PDA, or Web-based diary and classified as "Preferred" if they used their preferred method and "Non-Preferred" if they did not. Days adherent to diary use were collected for 12 weeks. Weight, % body fat, waist circumference, and self-efficacy scores were measured at baseline, 6 and 12 weeks. Thirty nine participants completed the 12 week study. Fifty nine percent were male. The mean age was 35 and mean baseline BMI was 33 kg/m(2) (+/-3.5). Forty four % (n=17) used their "Preferred" diary method and 56% (n=22) did not. Participants who used their preferred diary were more adherent to recording both food intake (64.2% vs. 43.4%, p=.015) and exercise (60.6% vs. 31.2%, p=.001). Though no difference was seen between groups on weight management outcomes, these results suggest that diary preference affects adherence to diary use.
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Affiliation(s)
- Laura E. Shay
- Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814, United States,Corresponding author. 3549 Singers Glen Drive, Olney, MD 20832, United States. Tel.: +1 301 796 0994(W), +1 301 774 1886(H); fax: +1 301 796 9899. (L.E. Shay)
| | - Diane Seibert
- Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814, United States
| | - Dorraine Watts
- Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814, United States
| | - Tracy Sbrocco
- Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814, United States
| | - Claire Pagliara
- National Naval Medical Center, 8901 Wisconsin Avenue, Bethesda, Maryland 20889, United States
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Kotani K, Sakane N, Sano Y, Tsuzaki K, Matsuoka Y, Egawa K, Yoshimura M, Horikawa C, Kitagawa Y, Kiso Y, Kimura S, Schulze J, Taing J, Gugliucci A. Changes on the physiological lactonase activity of serum paraoxonase 1 by a diet intervention for weight loss in healthy overweight and obese women. J Clin Biochem Nutr 2009; 45:329-34. [PMID: 19902024 PMCID: PMC2771255 DOI: 10.3164/jcbn.09-26] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 06/15/2009] [Indexed: 11/30/2022] Open
Abstract
Low caloric diet (LCD) is used for weight loss. Paraoxonase 1 (PON-1) is associated with the antioxidant functions of high-density lipoprotein (HDL). Among limited data on the relationships between obesity and PON-1, there has been no study on the effects of a stand-alone LCD on the physiological lactonase activity of PON-1. We investigated the prospective effects of LCD intervention (2 months) for weight loss on serum PON-1 activities (lactonase, arylesterase [mono-esterase] and tri-esterase) and HDL cholesterol (HDL-C), and their association with low-density lipoprotein cholesterol (LDL-C) in overweight and non-morbidly obese but otherwise healthy women (n = 30; mean age, 50.3 years; mean body mass index [BMI], 28.5 kg/m2). In addition to the data such as BMI, blood pressure, blood glucose and lipids, PON-1 activities were examined between pre- and post-intervention. The intervention reduced all metabolic outcomes, and PON-1 lactonase activity (determined with 5-[thiobutyl]butyrolactone) significantly decreased by 6.1%, paralleled by arylesterase (by 7.3%) and tri-esterase (by 7.8%). In multiple regression analysis, the percent change of PON-1 lactonase was significantly, positively and independently correlated to that of LDL-C (β = 0.51), HDL-C (β = 0.40), and BMI (β = 0.37). Our results showed that the solo diet treatment on weight loss might reduce serum PON-1 lactonase activity with reduced HDL-C and LDL-C. The relationship between the lactonase and LDL-C may be adaptive, plausibly hypothesizing less need for PON-1 activity as an antioxidant property to protect lipoproteins. Further research is needed to confirm this prediction.
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Affiliation(s)
- Kazuhiko Kotani
- Division of Preventive Medicine, Clinical Research Institute for Endocrine and Metabolic Disease, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
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Corbalán MD, Morales EM, Canteras M, Espallardo A, Hernández T, Garaulet M. Effectiveness of cognitive-behavioral therapy based on the Mediterranean diet for the treatment of obesity. Nutrition 2009; 25:861-9. [PMID: 19539176 DOI: 10.1016/j.nut.2009.02.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 01/08/2009] [Accepted: 02/05/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The Mediterranean dietary pattern improves cardiovascular disease factors. More research is needed on the usefulness of a Mediterranean dietary pattern in terms of weight loss. The objective of this study was to assess the effectiveness of behavioral therapy based on the Mediterranean diet for the treatment of obesity and to determine the main obstacles to weight loss. METHODS A total of 1406 obese subjects (body mass index, 31+/-5kg/m(2)), aged 20-65 y, from a Mediterranean area in southeast Spain were subjected to a weight-reduction program. To evaluate effectiveness, weight loss, body fat distribution, biochemical variables, blood pressure changes, mean duration of treatment, percentage of attrition, and the ability to fulfill a Mediterranean diet pattern were assessed. To determine the main barriers to losing weight, a "Barriers to Weight Loss" checklist was completed. RESULTS The behavioral therapy program was effective for the treatment of obesity. The average weight loss was 7.7kg. The duration of treatment was 34 wk. Eighty-nine percent of subjects fulfilled the Mediterranean principles during the program, and all the variables studied were significantly improved. Attrition was 4-9%, with the main reason being stress (37%). Main obstacles to weight loss were "losing motivation," being "prone to stress-related eating," and being liable to eat when bored. Recording food intake and assisting group therapy were also important tools for losing weight (P< or =0.05). CONCLUSIONS Dietary/behavioral treatment based on Mediterranean dietary principles is effective in clinical practice. Nutrition professionals should encourage their patients to record food intake and to attend group therapy.
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Turner-McGrievy GM, Campbell MK, Tate DF, Truesdale KP, Bowling JM, Crosby L. Pounds Off Digitally study: a randomized podcasting weight-loss intervention. Am J Prev Med 2009; 37:263-9. [PMID: 19765496 PMCID: PMC2892173 DOI: 10.1016/j.amepre.2009.06.010] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 06/03/2009] [Accepted: 06/19/2009] [Indexed: 01/01/2023]
Abstract
BACKGROUND As obesity rates rise, new weight-loss methods are needed. Little is known about the use of podcasting (audio files for a portable music player or computer) to promote weight loss, despite its growing popularity. DESIGN A 12-week RCT was conducted. SETTING/PARTICIPANTS The study sample comprised overweight men and women (BMI=25-40 kg/m(2); n=78) in the Raleigh-Durham NC area. INTERVENTION In 2008, participants were randomly assigned to receive 24 episodes of a currently available weight-loss podcast (control podcast) or a weight-loss podcast based on social cognitive theory (SCT) designed by the researchers (enhanced podcast) for 12 weeks. MAIN OUTCOME MEASURES Weight was measured on a digital scale at baseline and follow-up. Both groups also completed questionnaires assessing demographic information, food intake, physical activity, and SCT constructs at the introductory and 12-week meetings. Additional questionnaires at the 12-week meeting assessed perceptions of the intervention. RESULTS Data collection and analysis occurred in 2008 and intention-to-treat was used. Enhanced group participants (n=41) had a greater decrease in weight (-2.9+/-3.5 kg enhanced group vs -0.3+/-2.1 control group; p<0.001 between groups) and BMI (-1.0+/-1.2 kg/m(2) enhanced group vs -0.1+/-0.7 kg/m(2) control group; p<0.001 between groups) than the control group (n=37) and had greater weight-loss-related knowledge (p<0.05), elaboration (p<0.001), and user control (p<0.001) and less cognitive load (p<0.001). CONCLUSIONS The results of this study suggest that the use of behavioral, theory-based podcasting may be an effective way to promote weight loss. TRIAL REGISTRATION NCT00771095.
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Affiliation(s)
- Gabrielle M Turner-McGrievy
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7461, USA.
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Turk MW, Tuite PK, Burke LE. Cardiac health: primary prevention of heart disease in women. Nurs Clin North Am 2009; 44:315-25. [PMID: 19683093 DOI: 10.1016/j.cnur.2009.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Heart disease is the number one cause of death among women. Although 450,000 women die annually from heart disease, this fact is unknown to many women. Because heart disease is frequently preventable, increasing awareness of personal risk and preventative measures is a key element of health care for women. Nurse clinicians can evaluate, educate, and counsel women regarding their risk for this pervasive disease and promote behavior changes that will decrease that risk. Research evidence supports that lifestyle behaviors are the cornerstone of heart disease prevention. This article presents current evidence for the prevention of heart disease related to dietary intake, physical activity, weight management, smoking cessation, blood pressure control, and lipid management. Guidelines for implementing findings in clinical practice are discussed.
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Shay LE, Shobert JL, Seibert D, Thomas LE. Adult weight management: translating research and guidelines into practice. ACTA ACUST UNITED AC 2009; 21:197-206. [PMID: 19366378 DOI: 10.1111/j.1745-7599.2008.00383.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To provide a practical approach to managing overweight and obese adult patients based on data from research and recommendations from established guidelines. DATA SOURCES Comprehensive review articles and original research articles identified through Medline and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). CONCLUSIONS There is a great deal of research being conducted on new ways to treat obesity; however, despite all this new information, many primary care providers continue to report that they do not address weight or weight control strategies with their patients. Reasons include too little time, not enough training, lack of financial incentive, and failure to believe that patients can be successful. IMPLICATIONS FOR PRACTICE Weight management essentially comes down to one key concept: negative energy balance (fewer calories in and/or more calories out). Patients can be taught how to achieve a negative energy balance by using a food/exercise diary to track their daily caloric goal to achieve a 1-2 pound weight loss per week. Nurse practitioners (NPs) can implement safe and effective weight management plans for their patients by teaching them how to self-monitor, eat healthy, and exercise. This method is similar to what NPs commonly use for patients with diabetes mellitus.
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Affiliation(s)
- Laura E Shay
- Graduate School of Nursing, Uniformed Services University of Health Sciences, Bethesda, Maryland 20814, USA.
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Al Hourani H, Atoum M, Alboqai O, Ismail LC, Al Dhaheri A, Hijjawi N. Effectiveness of dietary intervention for obese women in Jordan. Int J Food Sci Nutr 2009; 60 Suppl 3:76-82. [PMID: 19548164 DOI: 10.1080/09637480903022727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim was to evaluate the outcome of body weight loss consulting in an outpatient nutrition clinic. METHODS Forty-five adult females attended 10 individualized treatment one-to-one sessions. Weight and height were measured and the body mass index was calculated. Triceps, biceps, subscapular and suprailiac skinfold thickness were measured and the fat percentage was calculated. A hypocaloric diet was given to the women; the percentages of carbohydrate, protein and fat in the diet were kept between 50 and 55% for carbohydrates, between 15 and 20% for protein, and < or =30% of fat. RESULTS Average weight loss was 7.4 kg, which was 8.4% of initial. Class III obese subjects achieved the highest weight loss (-9.4 kg). Weight loss was statistically significant after week 1, week 2, week 3, and week 4 (P < 0.001). The body mass index was significantly decreased (P < 0.001). The mean fat percentage was not significantly different. CONCLUSIONS The results indicate the increasing importance of nutrition counselling in Jordan.
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Tsuzaki K, Kotani K, Nagai N, Saiga K, Sano Y, Hamada T, Moritani T, Yoshimura M, Egawa K, Horikawa C, Kitagawa Y, Kiso Y, Sakane N. Adiponectin gene single-nucleotide polymorphisms and treatment response to obesity. J Endocrinol Invest 2009; 32:395-400. [PMID: 19794286 DOI: 10.1007/bf03346474] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In the adiponectin gene polymorphisms, single-nucleotide polymorphism (SNP)-45 and SNP276 have reportedly been associated with obesity, Type 2 diabetes, and other features of metabolic syndrome. AIM Whether these adiponectin SNP affect obesity-related parameters during caloric restriction in obese subjects. SUBJECTS AND METHODS Thirty- two obese Japanese women were treated by meal replacement with a low calorie diet for 8 weeks and asked to maintain their habitual lifestyle. Obesity-related parameters were measured before and after the treatment period. We determined four SNP (T45G, I164T, G276T, and C-11377G) using a fluorescent allele-specific DNA primer assay systemand FRET probe assay system. RESULTS After the treatment, the extent of decrease in waist circumference was greater in the subjects with the G/G or G/T genotype of SNP276 than in those with the T/T genotype (p=0.026). As for SNP45, the extent of decrease in triglyceride levels was greater in the subjects with the T/T genotype than in those with the T/G genotype (p=0.003). For SNP-11377, the extent of decrease in systolic blood pressure and fasting plasma glucose was greater in the subjects with the C/G or G/G genotype than in those with the C/C genotype (p=0.044). CONCLUSION Our findings indicate that each SNP in the adiponectin gene might modify the change in obesity-related parameters during meal replacement with a low calorie diet.
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Affiliation(s)
- K Tsuzaki
- Division of Preventive Medicine and Diabetes Education, Clinical Research Institute for Endocrine and Metabolic Disease, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Limbers CA, Turner EA, Varni JW. Promoting healthy lifestyles: Behavior modification and motivational interviewing in the treatment of childhood obesity. J Clin Lipidol 2008; 2:169-78. [PMID: 21291736 DOI: 10.1016/j.jacl.2008.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Revised: 03/10/2008] [Accepted: 03/17/2008] [Indexed: 11/19/2022]
Abstract
Childhood obesity has increased dramatically during the past two decades. The growing incidence of childhood obesity is alarming, given the significant short- and long-term health consequences associated with obesity and the strong tracking of obesity from childhood to adulthood. Lifestyle plays an important role in the development and maintenance of obesity. Behavior modification programs targeting eating, exercise, and diet behaviors continue to be the mainstay for treating obese children. Although family-based behavioral weight management programs have resulted in significant improvements in weight status, maintaining improvements in weight status continues to be a challenge, with many interventions resulting in considerable relapse. Motivational interviewing is one innovative approach, used alone or in conjunction with standard behavioral modification programs, which has been proposed to have the potential to enhance motivation for change and therefore improve long-term treatment outcomes for obese children. A broad literature search using two electronic databases, Medline and PsycINFO, to identify studies that used an intervention with a motivational interviewing component to modify diet and/or physical activity in the prevention or treatment of childhood obesity identified two studies that targeted weight as a primary outcome. The studies reviewed indicate that, although initial findings are encouraging, further research is needed to determine the effectiveness of motivational interviewing for prevention and treatment of childhood obesity. Concerted efforts are clearly needed to elucidate the mechanisms for maintenance of initial treatment gains, as well as the ultimate achievement of more ideal weight once formal treatment ceases.
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Affiliation(s)
- Christine A Limbers
- Department of Psychology, College of Liberal Arts, 3137 TAMU, Texas A&M University, College Station, TX, 77843-3137 USA
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