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Miller CK, King D, Nagaraja HN, Fujita K, Cheavens JS. Does intervention sequence impact self-regulatory and behavioral outcomes in an adaptive trial among adults with prediabetes? Health Psychol Behav Med 2024; 12:2385490. [PMID: 39104715 PMCID: PMC11299451 DOI: 10.1080/21642850.2024.2385490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/19/2024] [Indexed: 08/07/2024] Open
Abstract
Background Lifestyle interventions can promote improvement in dietary intake and physical activity (PA), on average, by strengthening motivation, self-regulatory efforts, and commitment to behavioral change. However, maintenance of behavioral change is challenging, and slow responders during treatment often experience less overall success. Adaptive intervention sequences tailored to treatment response may be more effective in sustaining behavioral change. Methods Adults ≥ 21 years old with prediabetes (n = 187) were stratified at week five to the standard Group Lifestyle Balance (GLB) intervention, if they achieved > 2.5% weight loss, or to the augmented intervention GLB Plus (GLB+) at week five, if they did not. At month five, each person in a matched pair was randomly assigned to GLB or GLB + for the extended intervention phase (months 5-12) followed by no study conduct (months 13-18). The primary comparison of interest was the change in outcomes between the standard (GLB followed by GLB) and augmented (GLB + followed by GLB+) intervention sequences post-intervention at 12 - and 18-months using linear mixed effect models. Results The augmented GLB + intervention sequence reported a decline in the change in self-efficacy for reducing fat intake, self-efficacy for 'sticking to' healthy eating and exercise, and hopeful thought and planning compared to the standard GLB intervention sequence (all P < 0.0167) at 18-months. However, there were no significant differences between these intervention sequences at 18-months in the change in dietary intake or minutes of PA (all P > 0.05). Conclusions No significant change in behavioral measures across intervention sequences occurred at study end. An 18-month decline in self-efficacy regarding diet and PA and hopeful thought and planning among slow responders following no intervention for six months indicates greater extended care is likely needed. The type of extended care that is most effective for slow treatment responders requires additional research.
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Affiliation(s)
- Carla K. Miller
- Dept. of Human Sciences, Ohio State University, Columbus, OH, USA
| | - Danielle King
- Dept. of Human Sciences, Ohio State University, Columbus, OH, USA
| | - Haikady N. Nagaraja
- School of Public Health, Division of Biostatistics, Ohio State University, Columbus, OH, USA
| | - Kentaro Fujita
- Dept. of Psychology, Ohio State University, Columbus, OH, USA
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Coleman CD, Kiel JR, Guarneiri LL, Bell M, Wilcox ML, Maki KC, Unick JL, Jonnalagadda SS. Importance of early weight loss and other predictors of lower weight loss in a commercial program: A secondary data analysis. Obes Sci Pract 2024; 10:e724. [PMID: 38263985 PMCID: PMC10804349 DOI: 10.1002/osp4.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 01/25/2024] Open
Abstract
Objective There is substantial inter-individual variability in response to weight loss interventions and emerging evidence suggests that weight loss during the early weeks of an intervention may be predictive of longer-term weight loss. This secondary analysis of data from a commercial program therefore examined 1) the associations between early weight loss (i.e., week 4) with final visit weight loss and duration on the program, and 2) other predictors of lower weight loss at final visit. Methods Client charts of adults with overweight or obesity (N = 748) were analyzed. Clients were stratified into categories of weight loss at the week 4 (< and ≥2%, 3% and 4%) and final visits (< and ≥5% and 10%). Multivariate logistic regression was used to assess predictors of <5% and <10% final visit weight loss. Results The odds ratios for losing <5% or <10% of weight at the final visit were higher (49.0 (95% CI: 13.84, 173.63) and 20.1 (95% CI: 6.96, 58.06)) for clients who lost <2% or <3% compared to those who lost ≥2% or ≥3% at week 4. Other predictors of not losing a clinically relevant amount of weight included female sex, use of higher calorie meal plans and shorter time in the program, among others. Those who lost ≥2% at week 4 also had a significantly greater percent program completion (109.2 ± 75.2% vs. 82.3 ± 82.4, p < 0.01) compared with those who did not meet the 2% threshold. Conclusions Lower 4-week weight loss was identified as a strong predictor of not losing a clinically relevant amount of weight. These results may be useful for the early identification of individuals who can be targeted for additional counseling and support to aid in attaining weight loss goals.
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Affiliation(s)
| | - Jessica R Kiel
- Department of Scientific and Clinical Affairs Medifast, Inc. Baltimore Maryland USA
| | | | | | | | - Kevin C Maki
- Midwest Biomedical Research Addison Illinois USA
- Indiana University Department of Applied Health Science School of Public Health-Bloomington Bloomington Indiana USA
| | - Jessica L Unick
- The Miriam Hospital's Weight Control and Diabetes Research Center Warren Alpert Medical School at Brown University Providence Rhode Island USA
| | - Satya S Jonnalagadda
- Department of Scientific and Clinical Affairs Medifast, Inc. Baltimore Maryland USA
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Gholami M, Jackson NJ, Loeb T, Chung UYR, Ramm K, Shedd K, Soetenga S, Elashoff D, Hamilton AB, Mangione CM, Duru OK, Moin T. Twelve-Month Reach and Effectiveness of a University-Based Diabetes Prevention Initiative. Am J Prev Med 2024; 66:299-306. [PMID: 37741423 PMCID: PMC10842474 DOI: 10.1016/j.amepre.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION The University of California (UC) implemented the Diabetes Prevention Program (DPP) to address diabetes and obesity risk. This project examined the reach and effectiveness of this university-based DPP delivery approach. METHODS This project compared 12-month weight change among three groups of UC beneficiaries with overweight/obesity: (1) those who received invitation letters and enrolled in UC DPP, (2) those mailed invitation letters but did not enroll, and (3) those who were not mailed letters and did not enroll (controls). Using 2012-2022 EHR, administrative and DPP cohort data, an interrupted time series was conducted in 2022-2023 to compare group differences in rate of weight change. RESULTS Among 6,231 beneficiaries (132 UC DPP aware enrollees, 1,750 DPP aware non-enrollees, 4,349 controls), UC DPP enrollees were older (mean age 49), mostly women (76%), and more diverse (33% Asian, 8% Black, 20% Hispanic, 4% Multi/Other). Over 12 months of follow-up, UC DPP enrollee postenrollment rate of weight loss was -0.68 lbs./month. UC DPP enrollees had significantly greater weight change from pre- to post-enrollment than DPP aware non-enrollees (adjusted Δ-1.02 vs. Δ-0.07 lbs./month, difference= -0.95, p<0.001). Weight change among all participants who received letters with/without DPP enrollment was similar to controls. CONCLUSIONS UC DPP reached a diverse group and was effective for weight loss at 12-month follow-up. However, UC DPP invitation letters to raise prediabetes and DPP awareness were not associated with significant weight change in the absence of DPP enrollment. University-based approaches to DPP delivery are effective and may enhance reach of DPP among at-risk adults.
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Affiliation(s)
- Maryam Gholami
- Altman Clinical and Translational Research Institute, University of California, San Diego, California
| | - Nicholas J Jackson
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Tamra Loeb
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Un Young Rebecca Chung
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Kate Ramm
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Kelly Shedd
- Human Resources, University of California, Irvine, California
| | - Samantha Soetenga
- Campus Recreation, University of California, Los Angeles, California
| | - David Elashoff
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Alison B Hamilton
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California; VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Carol M Mangione
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California; Fielding School of Public Health, University of California, Los Angeles, California
| | - O Kenrik Duru
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Tannaz Moin
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California; VA Greater Los Angeles Healthcare System, Los Angeles, California.
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King D, Miller CK, Cheavens JS, Fujita K. Early and slow weight loss responders' perceptions of an adaptive diabetes prevention trial: A qualitative perspective. HEALTH EDUCATION JOURNAL 2023; 82:807-819. [PMID: 39329049 PMCID: PMC11423868 DOI: 10.1177/00178969231198956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
Objective Behavioural weight loss interventions demonstrate success on average, yet participants who respond more slowly may benefit from an augmented, tailored approach. Thus, an augmented intervention for early, slow weight loss responders was implemented. This qualitative analysis explored participants' perceptions of and experiences of the 12-month weight loss programme to inform future intervention development and implementation. Design Individual interviews were conducted post-treatment. In-person, in-depth interviews were offered prior to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic; videoconferencing interviews were offered following the pandemic onset. Setting A Midwestern US university workplace. Method Adults ⩾21 years old with overweight or obesity and prediabetes (n = 39) were recruited and volunteered to participate in a semi-structured interview. Results Content analysis identified recurring themes among early and early slow weight loss responders. Social support received during weekly group sessions was a critical intervention component. Some early slow responders expressed difficulty with self-regulatory strategies such as setting specific yet attainable goals, and requested additional contact prior to the maintenance study phase - treatment randomisation at month 5 disrupted group dynamics. Early slow responders who received the intervention via videoconferencing believed the format interfered with their ability to establish friendships with other participants and gain insight and support from others' lived experiences. Conclusion Weight loss interventions may be more efficacious when considering participant heterogeneity during implementation of behavioural strategies. Findings suggest early slow weight loss responders may benefit from greater emphasis on goal setting and striving, agentic thinking, and social support. Future research is needed to examine the implications of these insights on intervention outcomes.
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Affiliation(s)
- Danielle King
- Department of Nutrition and Dietetics, SUNY Buffalo State University, Buffalo, NY, USA
| | - Carla K Miller
- School of Public Health, Indiana University, Bloomington, IN, USA
| | | | - Kentaro Fujita
- Department of Psychology, Ohio State University, Columbus, OH, USA
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Miller CK, King D, Nagaraja HN, Fujita K, Cheavens J, Focht BC. Impact of an augmented intervention on self-regulatory, dietary and physical activity outcomes in a diabetes prevention trial among adults with prediabetes. J Behav Med 2023; 46:770-780. [PMID: 36933057 PMCID: PMC10024518 DOI: 10.1007/s10865-023-00406-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023]
Abstract
Self-regulation can facilitate modifications in lifestyle to promote behavioral change. However, little is known about whether adaptive interventions promote improvement in self-regulatory, dietary, and physical activity outcomes among slow treatment responders. A stratified design with an adaptive intervention for slow responders was implemented and evaluated. Adults ≥ 21 years old with prediabetes were stratified to the standard Group Lifestyle Balance intervention (GLB; n = 79) or the adaptive GLB Plus intervention (GLB + ; n = 105) based on first-month treatment response. Intake of total fat was the only study measure that significantly differed between groups at baseline (P = 0.0071). GLB reported greater improvement in self-efficacy for lifestyle behaviors, goal satisfaction with weight loss, and very active minutes of activity than GLB + (all P < 0.01) at 4-months. Both groups reported significant improvement in self-regulatory outcomes and reduction in energy and fat intake (all P < 0.01). An adaptive intervention can improve self-regulation and dietary intake when tailored to early slow treatment responders.
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Affiliation(s)
- Carla K Miller
- School of Public Health-Bloomington, Indiana University, 1025 East 7Th Street, Bloomington, IN, 47405, USA.
| | - Danielle King
- Department of Human Sciences, Human Nutrition, Ohio State University, Columbus, OH, USA
| | - Haikady N Nagaraja
- College of Public Health, Division of Biostatistics, Ohio State University, Columbus, OH, USA
| | - Kentaro Fujita
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | | | - Brian C Focht
- Department of Human Sciences, Kinesiology, Ohio State University, Columbus, OH, USA
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Höchsmann C, Martin CK, Apolzan JW, Dorling JL, Newton RL, Denstel KD, Mire EF, Johnson WD, Zhang D, Arnold CL, Davis TC, Fonseca V, Thethi TK, Lavie CJ, Springgate B, Katzmarzyk PT. Initial weight loss and early intervention adherence predict long-term weight loss during the Promoting Successful Weight Loss in Primary Care in Louisiana lifestyle intervention. Obesity (Silver Spring) 2023; 31:2272-2282. [PMID: 37551762 PMCID: PMC10597572 DOI: 10.1002/oby.23854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE This study tested whether initial weight change (WC), self-weighing, and adherence to the expected WC trajectory predict longer-term WC in an underserved primary-care population with obesity. METHODS Data from the intervention group (n = 452; 88% women; 74% Black; BMI 37.3 kg/m2 [SD: 4.6]) of the Promoting Successful Weight Loss in Primary Care in Louisiana trial were analyzed. Initial (2-, 4-, and 8-week) percentage WC was calculated from baseline clinic weights and daily at-home weights. Weights were considered adherent if they were on the expected WC trajectory (10% at 6 months with lower [7.5%] and upper [12.5%] bounds). Linear mixed-effects models tested whether initial WC and the number of daily and adherent weights predicted WC at 6, 12, and 24 months. RESULTS Percentage WC during the initial 2, 4, and 8 weeks predicted percentage WC at 6 (R2 = 0.15, R2 = 0.28, and R2 = 0.50), 12 (R2 = 0.11, R2 = 0.19, and R2 = 0.32), and 24 (R2 = 0.09, R2 = 0.11, and R2 = 0.16) months (all p < 0.01). Initial daily and adherent weights were significantly associated with WC as individual predictors, but they only marginally improved predictions beyond initial weight loss alone in multivariable models. CONCLUSIONS These results highlight the importance of initial WC for predicting long-term WC and show that self-weighing and adherence to the expected WC trajectory can improve WC prediction.
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Affiliation(s)
- Christoph Höchsmann
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - James L Dorling
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Robert L Newton
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Kara D Denstel
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Emily F Mire
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - Dachuan Zhang
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Connie L Arnold
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Terry C Davis
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Vivian Fonseca
- AdventHealth, Translational Research Institute, Orlando, Florida, USA
| | - Tina K Thethi
- AdventHealth, Translational Research Institute, Orlando, Florida, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, New Orleans, Louisiana, USA
| | - Benjamin Springgate
- Department of Internal Medicine, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
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Griauzde DH, Hershey C, Michaels J, Evans RR, Richardson CR, Heisler M, Kullgren JT, Saslow LR. A very low-carbohydrate diabetes prevention program for veterans with prediabetes: a single-arm mixed methods pilot study. Front Nutr 2023; 10:1069266. [PMID: 37266128 PMCID: PMC10230095 DOI: 10.3389/fnut.2023.1069266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/27/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction All Veterans Affairs (VA) Medical Centers offer the MOVE! Weight Management Program to help patients achieve and maintain a healthy weight through a calorie-restricted, low-fat diet and increased physical activity. Yet, most MOVE! participants do not achieve clinically significant weight loss of ≥5%. A carbohydrate-restricted diet may help more Veterans to achieve ≥5% weight loss. Methods This was a single-arm explanatory sequential mixed methods pilot study conducted in one VA health care system. Veterans with prediabetes and body mass index ≥25 kg/m2 were invited to participate in a group-based, virtual, very low-carbohydrate Diabetes Prevention Program (VLC-DPP) consisting of 23 sessions over 12 months. Participants were taught to follow a very low-carbohydrate eating pattern, defined as 20-35 grams of net carbohydrates per day. The primary outcomes were measures of feasibility and acceptability, including program uptake and session attendance. Secondary outcomes included change in weight, hemoglobin A1c, lipids, and patient-reported measures of food cravings, stress eating, perceived health status, and motivation. Interviews were conducted at 6 months to identify factors that facilitated or hindered participants' achievement of ≥5% weight loss. Results Among 108 screened Veterans, 21 enrolled in the study (19%), and 18 were included in the analytic cohort. On average, participants attended 12.4/16 weekly sessions and 3.6/8 bimonthly or monthly sessions. At 12 months, mean percent weight loss was 9.4% (SD = 10.7) with 9 participants (50%) achieving ≥5% weight loss. Three factors facilitated achievement of ≥5% weight loss among 10/16 interviewees: (1) enjoyment of low-carbohydrate foods; (2) careful monitoring of carbohydrate intake; and (3) reduced hunger and food cravings. Three factors hindered achievement of ≥5% weight loss among 6/16 interviewees: (1) food cravings, particularly for sweets; (2) challenges with maintaining a food log; and (3) difficulty with meal planning. Conclusion A VLC-DPP is feasible and acceptable and shows preliminary efficacy among Veterans with prediabetes. The program's weight loss effectiveness compared to standard MOVE! should be evaluated in a larger-scale trial. Such a program may be offered in addition to the standard MOVE! program to expand the menu of evidence-based lifestyle counseling options for Veterans. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT04881890, identifier NCT04881890.
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Affiliation(s)
- Dina H. Griauzde
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States
| | - Cheryl Hershey
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Jamie Michaels
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | | | - Caroline R. Richardson
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Michele Heisler
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Jeffrey T. Kullgren
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Laura R. Saslow
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States
- University of Michigan School of Nursing, Ann Arbor, MI, United States
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8
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Miller CK, Nagaraja HN, Cheavens JS, Fujita K, Lazarus SA, Brunette DS. Sex Differences in Early Weight Loss Success During a Diabetes Prevention Intervention. Am J Health Behav 2023; 47:337-348. [PMID: 37226352 PMCID: PMC11418087 DOI: 10.5993/ajhb.47.2.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Objectives: Males often lose more weight than females during treatment, and early weight loss predicts weight loss longer-term. Yet, mechanisms for sex differences in early weight loss are unknown and were examined in this study.Methods: Adults≥21 years old with overweight or obesity and prediabetes (N=206) participated in a lifestyle intervention and completed baseline psychosocial questionnaires. Percent weight loss, session attendance, and number of days participants self-monitored dietary intake and weight were determined at week 5. Principal components, regression, and mediation analyses were conducted to determine whether weight loss differed by sex and potential mediators of weight change. Results: Mean (±SD) weight loss was greater for males (2.59±1.62%) than females (2.05±1.54%; p=.02). Attendance, self-monitoring, and beliefs regarding disease risk were independent predictors of weight loss (all p<.05) but did not explain sex differences. The association between attendance and weight loss was stronger for males than females (p<.05). Conclusions: Additional research is needed to identify mechanisms that explain sex differences in early weight loss. However, strengthening risk beliefs, attendance, and self-monitoring may promote greater early weight loss for all participants.
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Affiliation(s)
- Carla K Miller
- Professor, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Haikady N Nagaraja
- Professor Emeritus, The Ohio State University, College of Public Health, Division of Biostatistics, Columbus, OH, United States
| | - Jennifer S Cheavens
- Professor Kentaro Fujita & Daniel S. Brunette, Graduate Student, The Ohio State University, Department of Psychology, Columbus, OH, United States
| | - Kentaro Fujita
- Graduate Student, The Ohio State University, Department of Psychology, Columbus, OH, United States
| | - Sophie A Lazarus
- Clinical Assistant Professor, The Ohio State University, Department of Psychiatry & Behavioral Health, Columbus, OH, United States
| | - Daniel S Brunette
- Graduate Student, The Ohio State University, Department of Psychology, Columbus, OH, United States
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Kim KK, Haam JH, Kim BT, Kim EM, Park JH, Rhee SY, Jeon E, Kang E, Nam GE, Koo HY, Lim JH, Jeong JE, Kim JH, Kim JW, Park JH, Hong JH, Lee SE, Min SH, Kim SJ, Kim S, Kim YH, Lee YJ, Cho YJ, Rhie YJ, Kim YH, Kang JH, Lee CB. Evaluation and Treatment of Obesity and Its Comorbidities: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity. J Obes Metab Syndr 2023; 32:1-24. [PMID: 36945077 PMCID: PMC10088549 DOI: 10.7570/jomes23016] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/28/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
The goal of the 8th edition of the Clinical Practice Guidelines for Obesity is to help primary care physician provide safe, effective care to patients with obesity by offering evidence-based recommendations to improve the quality of treatment. The Committee for Clinical Practice Guidelines comprised individuals with multidisciplinary expertise in obesity management. A steering board of seven experts oversaw the entire project. Recommendations were developed as the answers to key questions formulated in patient/problem, intervention, comparison, outcomes (PICO) format. Guidelines underwent multi-level review and cross-checking and received endorsement from relevant scientific societies. This edition of the guidelines includes criteria for diagnosing obesity, abdominal obesity, and metabolic syndrome; evaluation of obesity and its complications; weight loss goals; and treatment options such as diet, exercise, behavioral therapy, pharmacotherapy, and bariatric and metabolic surgery for Korean people with obesity. Compared to the previous edition of the guidelines, the current edition includes five new topics to keep up with the constantly evolving field of obesity: diagnosis of obesity, obesity in women, obesity in patients with mental illness, weight maintenance after weight loss, and the use of information and communication technology-based interventions for obesity treatment. This edition of the guidelines features has improved organization, more clearly linking key questions in PICO format to recommendations and key references. We are confident that these new Clinical Practice Guidelines for Obesity will be a valuable resource for all healthcare professionals as they describe the most current and evidence-based treatment options for obesity in a well-organized format.
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Affiliation(s)
- Kyoung-Kon Kim
- Department of Family Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Ji-Hee Haam
- Deptartment of Family Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Bom Taeck Kim
- Department of Family Practice & Community Health, Ajou University School of Medicine, Suwon, Korea
| | - Eun Mi Kim
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul, Korea
| | - Jung Hwan Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
| | - Eonju Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Eungu Kang
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea
| | - Ga Eun Nam
- Department of Family Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hye Yeon Koo
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Hyun Lim
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Jo-Eun Jeong
- Department of Psychiatry, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jong-Hee Kim
- Department of Physical Education, Hanyang University, Seoul, Korea
| | - Jong Won Kim
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Ha Park
- Department of Family Medicine, Jeju National University Hospital, Jeju, Korea
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jun Hwa Hong
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Sang Eok Lee
- Department of Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Se Hee Min
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Jun Kim
- Department of Psychiatry, Konyang University College of Medicine, Daejeon, Korea
| | - Sunyoung Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
- Depertment of Family Medicine, Kyung Hee University Medical Center, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yeon Ji Lee
- Department of Family Medicine, Inha University College of Medicine, Incheon, Korea
| | - Yoon Jeong Cho
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Young-Jun Rhie
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Youn-hee Kim
- Mindscan Clinic, Heart Scan Health Care, Seoul, Korea
| | - Jee-Hyun Kang
- Department of Family Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Chang Beom Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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10
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Ramírez-Durán MDV, Basilio-Fernández B, Gómez-Luque A, Alfageme-García P, Clavijo-Chamorro MZ, Jiménez-Cano VM, Fabregat-Fernández J, Robles-Alonso V, Hidalgo-Ruiz S. Efficacy of an Online Educational Intervention in Reducing Body Weight in the Pre-Diabetic Population of 18-45 Years Old, a Randomized Trial Protocol. J Pers Med 2022; 12:1669. [PMID: 36294808 PMCID: PMC9604779 DOI: 10.3390/jpm12101669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/20/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Aim: to analyze the efficacy of an educational online intervention focused on lifestyle changes in reducing body weight from baseline to 6 months in the pre-diabetic population of 18−45 years old in Extremadura (Spain). Methods: a single-blind, multicenter randomized parallel-comparison trial with two intervention groups in a 1:1 ratio will be carried out. Participants will be randomly assigned to intervention A or B with 37 cases in each group according to inclusion criteria of being enrolled or working at Extremadura University, scoring >7 points on the Findrisc test and not having diagnosed diabetes mellitus or physical disabilities. Intervention-A group will have access to online information about healthy diet and exercise. Intervention-B group will have access to a six-session educational program regarding behavioral changes in diet and exercise habits. They will complete follow-up activities and have a personal trainer and motivation. The primary outcome will be identifying changes in body weight from baseline to 1 and 6 months and between groups. The secondary outcomes will be accomplishing regular physical activity (>30 min/day or >4 h/week), decreasing sugary food intake or avoiding it altogether, increasing vegetable/fruit intake and lowering HbA1c levels to non-diabetic status when necessary.
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Affiliation(s)
| | - Belinda Basilio-Fernández
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Adela Gómez-Luque
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Pilar Alfageme-García
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | | | - Víctor Manuel Jiménez-Cano
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Juan Fabregat-Fernández
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Vicente Robles-Alonso
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Sonia Hidalgo-Ruiz
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
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11
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Miller CK, Nagaraja HN, Cheavens J, Fujita K, Lazarus S. Impact of a Novel Diabetes Prevention Intervention for Early Slow Weight Loss Responders Among Adults With Prediabetes: An Adaptive Trial. Diabetes Care 2022; 45:2452-2455. [PMID: 36041053 PMCID: PMC9643139 DOI: 10.2337/dc22-0824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/15/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Some people are slower to respond during lifestyle interventions. An adaptive "rescue" intervention may improve outcomes among slow responders. The impact of a worksite rescue intervention for early slow responders was evaluated. RESEARCH DESIGN AND METHODS Employees ≥21 years old with prediabetes were stratified to intervention using a 2.5% weight loss (%WL) threshold at week 5. Outcomes were assessed at baseline and at 4 months using mixed-effect and linear regression models. RESULTS Significant improvement occurred in mean %WL, glycemia, total cholesterol, and triglycerides in the standard compared with the adaptive (Group Lifestyle Balance Plus [GLB+]) intervention (all P≤ 0.01). However, GLB+ participants also experienced a significant reduction in %WL and glycemia (all P < 0.01). The %WL at week 5 significantly predicted %WL at 4 months (P < 0.0001). The between-group difference of 4-month %WL was not significant for someone achieving 2.5%WL at week 5. CONCLUSIONS Diabetes prevention programs should consider weight loss success following 1 month of treatment and offer a rescue intervention to early slow weight loss responders.
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Affiliation(s)
- Carla K. Miller
- School of Public Health, Indiana University, Bloomington, IN
| | - Haikady N. Nagaraja
- Division of Biostatistics, College of Public Health, Ohio State University, Columbus, OH
| | | | - Kentaro Fujita
- Department of Psychology, Ohio State University, Columbus, OH
| | - Sophie Lazarus
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH
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12
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Griauzde DH, Othman A, Dallas C, Oshman L, Gabison J, Markel DS, Richardson CR, Kullgren JT, Piatt G, Heisler M, Kilbourne AM, Kraftson A. Developing weight navigation program to support personalized and effective obesity management in primary care settings: protocol for a quality improvement program with an embedded single-arm pilot study. Prim Health Care Res Dev 2022; 23:e14. [PMID: 35234116 PMCID: PMC8919179 DOI: 10.1017/s1463423621000906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/03/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary care providers (PCPs) are expected to help patients with obesity to lose weight through behavior change counseling and patient-centered use of available weight management resources. Yet, many PCPs face knowledge gaps and clinical time constraints that hinder their ability to successfully support patients' weight loss. Fortunately, a small and growing number of physicians are now certified in obesity medicine through the American Board of Obesity Medicine (ABOM) and can provide personalized and effective obesity treatment to individual patients. Little is known, however, about how to extend the expertise of ABOM-certified physicians to support PCPs and their many patients with obesity. AIM To develop and pilot test an innovative care model - the Weight Navigation Program (WNP) - to integrate ABOM-certified physicians into primary care settings and to enhance the delivery of personalized, effective obesity care. METHODS Quality improvement program with an embedded, 12-month, single-arm pilot study. Patients with obesity and ≥1 weight-related co-morbidity may be referred to the WNP by PCPs. All patients seen within the WNP during the first 12 months of clinical operations will be compared to a matched cohort of patients from another primary care site. We will recruit a subset of WNP patients (n = 30) to participate in a remote weight monitoring pilot program, which will include surveys at 0, 6, and 12 months, qualitative interviews at 0 and 6 months, and use of an electronic health record (EHR)-based text messaging program for remote weight monitoring. DISCUSSION Obesity is a complex chronic condition that requires evidence-based, personalized, and longitudinal care. To deliver such care in general practice, the WNP leverages the expertise of ABOM-certified physicians, health system and community weight management resources, and EHR-based population health management tools. The WNP is an innovative model with the potential to be implemented, scaled, and sustained in diverse primary care settings.
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Affiliation(s)
- Dina H. Griauzde
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Amal Othman
- Department of Family Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Chris Dallas
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Lauren Oshman
- Department of Family Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Jonathan Gabison
- Department of Family Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Dorene S. Markel
- Department of Learning Health Sciences, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Caroline R. Richardson
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Department of Family Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Jeffrey T. Kullgren
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Gretchen Piatt
- Department of Learning Health Sciences, University of Michigan, Medical School, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Michele Heisler
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Amy M. Kilbourne
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Andrew Kraftson
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
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13
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Gholami M, Jackson NJ, Chung UYR, Duru OK, Shedd K, Soetenga S, Loeb T, Elashoff D, Hamilton AB, Mangione CM, Slusser W, Moin T. Evaluation of the University of California Diabetes Prevention Program (UC DPP) Initiative. BMC Public Health 2021; 21:1775. [PMID: 34592981 PMCID: PMC8482560 DOI: 10.1186/s12889-021-11731-7] [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: 08/09/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background Type 2 diabetes can negatively impact long term health outcomes, healthcare costs and quality of life. However, intensive lifestyle interventions, including the Diabetes Prevention Program (DPP), can significantly lower risk of incident type 2 diabetes among overweight adults with prediabetes. Unfortunately, the majority of adults in the US who are at risk of developing diabetes do not engage in DPP-based lifestyle change programs. Increased adoption of evidence-based obesity and diabetes prevention interventions, such as the DPP, may help large employers reduce health risks and improve health outcomes among employees. In 2018, the University of California Office of thePresident (UCOP) implemented the UC DPP Initiative, a novel, multi-component program to address diabetes and obesity prevention across the UC system. Methods The goal of our study is to conduct a multifaceted evaluation of the UC DPP Initiative using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Our evaluation will integrate unique and diverse UC data sources, including electronic health record (EHR) data, administrative claims, campus-based DPP cohort data, qualitative interviews and site visits. Our primary outcome of interest is the mean percent weight change among three groups of overweight/obese UC beneficiaries at risk for diabetes at 12-month follow-up. Secondary outcomes include mean percent weight change at 24-month follow-up, barriers and facilitators associated with implementatio, as well as the degree of program adoption and maintenance. Discussion Our study will help inform diabetes and obesity prevention efforts across the UC system. Findings from this evaluation will also be highly applicable to universities and large employers, as well as community organizers, healthcare organizations and insurers implementing the DPP and/or other health promotion interventions.
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Affiliation(s)
| | - Nicholas J Jackson
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Un Young Rebecca Chung
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - O Kenrik Duru
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Kelly Shedd
- Campus Recreation, University of California, Los Angeles, Los Angeles, CA, USA
| | - Samantha Soetenga
- Campus Recreation, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tamara Loeb
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - David Elashoff
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Alison B Hamilton
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Carol M Mangione
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Wendelin Slusser
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Tannaz Moin
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA. .,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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14
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Sherwood NE, Crain AL, Seburg EM, Butryn ML, Forman EM, Crane MM, Levy RL, Kunin-Batson AS, Jeffery RW. BestFIT Sequential Multiple Assignment Randomized Trial Results: A SMART Approach to Developing Individualized Weight Loss Treatment Sequences. Ann Behav Med 2021; 56:291-304. [PMID: 34415011 DOI: 10.1093/abm/kaab061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND State-of-the-art behavioral weight loss treatment (SBT) can lead to clinically meaningful weight loss, but only 30-60% achieve this goal. Developing adaptive interventions that change based on individual progress could increase the number of people who benefit. PURPOSE Conduct a Sequential Multiple Assignment Randomized Trial (SMART) to determine the optimal time to identify SBT suboptimal responders and whether it is better to switch to portion-controlled meals (PCM) or acceptance-based treatment (ABT). METHOD The BestFIT trial enrolled 468 adults with obesity who started SBT and were randomized to treatment response assessment at Session 3 (Early TRA) or 7 (Late TRA). Suboptimal responders were re-randomized to PCM or ABT. Responders continued SBT. Primary outcomes were weight change at 6 and 18 months. RESULTS PCM participants lost more weight at 6 months (-18.4 lbs, 95% CI -20.5, -16.2) than ABT participants (-15.7 lbs, 95% CI: -18.0, -13.4), but this difference was not statistically significant (-2.7 lbs, 95% CI: -5.8, 0.5, p = .09). PCM and ABT participant 18 month weight loss did not differ. Early and Late TRA participants had similar weight losses (p = .96), however, Early TRA PCM participants lost more weight than Late TRA PCM participants (p = .03). CONCLUSIONS Results suggest adaptive intervention sequences that warrant further research (e.g., identify suboptimal responders at Session 3, use PCMs as second-stage treatment). Utilizing the SMART methodology to develop an adaptive weight loss intervention that would outperform gold standard SBT in a randomized controlled trial is an important next step, but may require additional optimization work. CLINICAL TRIAL INFORMATION ClinicalTrials.gov identifier; NCT02368002.
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Affiliation(s)
- Nancy E Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Meghan L Butryn
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Evan M Forman
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Melissa M Crane
- Department of Preventive Medicine, Rush University, Chicago, IL, USA
| | - Rona L Levy
- School of Social Work, University of Washington, Seattle, WA, USA
| | | | - Robert W Jeffery
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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15
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Griauzde DH, Standafer Lopez K, Saslow LR, Richardson CR. A Pragmatic Approach to Translating Low- and Very Low-Carbohydrate Diets Into Clinical Practice for Patients With Obesity and Type 2 Diabetes. Front Nutr 2021; 8:682137. [PMID: 34350205 PMCID: PMC8326333 DOI: 10.3389/fnut.2021.682137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/14/2021] [Indexed: 12/26/2022] Open
Abstract
Across all eating patterns, individuals demonstrate marked differences in treatment response; some individuals gain weight and others lose weight with the same approach. Policy makers and research institutions now call for the development and use of personalized nutrition counseling strategies rather than one-size-fits-all dietary recommendations. However, challenges persist in translating some evidence-based eating patterns into the clinical practice due to the persistent notion that certain dietary approaches-regardless of individuals' preferences and health outcomes-are less healthy than others. For example, low- and very low-carbohydrate ketogenic diets (VLCKDs)-commonly defined as 10-26% and <10% total daily energy from carbohydrate, respectively-are recognized as viable lifestyle change options to support weight loss, glycemic control, and reduced medication use. Yet, critics contend that such eating patterns are less healthy and encourage general avoidance rather than patient-centered use. As with all medical treatments, the potential benefits and risks must be considered in the context of patient-centered, outcome-driven care; this is the cornerstone of evidence-based medicine. Thus, the critical challenge is to identify and safely support patients who may prefer and benefit from dietary carbohydrate restriction. In this Perspective, we propose a pragmatic, 4-stepped, outcome-driven approach to help health professionals use carbohydrate-restricted diets as one potential tool for supporting individual patients' weight loss and metabolic health.
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Affiliation(s)
- Dina Hafez Griauzde
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
- University of Michigan Medical School, Ann Arbor, MI, United States
| | | | - Laura R. Saslow
- University of Michigan School of Nursing, Ann Arbor, MI, United States
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16
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Lv N, Xiao L, Rosas LG, Venditti EM, Smyth JM, Lewis MA, Snowden MB, Ronneberg CR, Williams LM, Gerber BS, Ajilore OA, Patel AS, Ma J. Sex Moderates Treatment Effects of Integrated Collaborative Care for Comorbid Obesity and Depression: The RAINBOW RCT. Ann Behav Med 2021; 55:1157-1167. [PMID: 33616188 DOI: 10.1093/abm/kaaa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Sex influences health and related behaviors due to biological and psychosocial/socioeconomic factors. Assessing sex-specific responses to integrated treatment for comorbid obesity and depression could inform intervention targeting. PURPOSE To test (a) whether sex moderates the effects of integrated collaborative care on weight and depression outcomes through 24 months and (b) whether treatment response at 6 months predicts 12 and 24 month outcomes by sex. METHODS Secondary data analyses on weight and depression severity (SCL-20) measured over 24 months among 409 adults with obesity and depression in the Research Aimed at Improving Both Mood and Weight trial. RESULTS Men achieved significantly greater weight reductions in intervention versus usual care than women, whereas women achieved significantly greater percentage reductions in SCL-20 than men at both 12 and 24 months. In logistic models, at 80% specificity for correctly identifying participants not achieving clinically significant long-term outcomes, women who lost <3.0% weight and men who lost <4.1% weight at 6 months had ≥84% probability of not meeting 5% weight loss at 24 months. Similarly, at 80% specificity, women who reduced SCL-20 by <39.5% and men who reduced by <53.0% at 6 months had ≥82% probability of not meeting 50% decrease in SCL-20 at 24 months. CONCLUSIONS Sex modified the integrated treatment effects for obesity and depression. Sex-specific responses at 6 months predicted clinically significant weight loss and depression outcomes through 24 months. Based on early responses, interventions may need to be tailored to address sex-specific barriers and facilitators to achieving healthy weight and depression outcomes at later time points. CLINICAL TRIAL REGISTRATION NCT02246413 (https://clinicaltrials.gov/ct2/show/NCT02246413).
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Affiliation(s)
- Nan Lv
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joshua M Smyth
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Megan A Lewis
- Center for Communication Science, RTI International, Seattle, WA, USA
| | - Mark B Snowden
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Corina R Ronneberg
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Ben S Gerber
- Division of Academic Internal Medicine and Geriatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Aashutos S Patel
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Jun Ma
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
- Department of Medicine, College of Medicine, University of Illinois at Chicago, 1747 W. Roosevelt Rd, Room 586 (MC 275), Chicago, IL 60608, USA
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17
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Arlinghaus KR, O'Connor DP, Ledoux TA, Hughes SO, Johnston CA. The Role of Early and Later Response on Overall Outcomes in School-Based Obesity Intervention. Obesity (Silver Spring) 2021; 29:177-183. [PMID: 33225618 DOI: 10.1002/oby.23040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Early response to obesity intervention consistently predicts long-term BMI reductions. However, little is known about how changes in weight at other times in an intervention may impact long-term outcomes. This study examined the relationship between weight-related changes that occurred early and later during an intervention and the association between these changes with overall outcomes. METHODS A secondary analysis of a school-based obesity intervention with replicated efficacy among Hispanic middle school students was conducted (n = 174). Linear regression models were developed in which first and second semester changes in BMI represented as a percentage of the 95th BMI percentile (%BMIp95) were separately used to predict overall %BMIp95 outcomes. First semester changes in %BMIp95 were used to predict subsequent %BMIp95 change (i.e., second semester). RESULTS Changes in %BMIp95 during both the first and second semesters were independently associated with overall changes from baseline (e.g., at 24 months: first semester, β = 0.59, P < 0.01; second semester, β = 1.02, P < 0.001). First semester %BMIp95 change was not associated with second semester change (β = -0.07, P = 0.32). CONCLUSIONS Change at any point during the intervention was predictive of overall weight outcomes. Additional research is needed to understand patterns of weight changes throughout interventions to better understand long-term outcomes.
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Affiliation(s)
| | - Daniel P O'Connor
- Department of Health and Human Performance, University of Houston, Houston, Texas, USA
| | - Tracey A Ledoux
- Department of Health and Human Performance, University of Houston, Houston, Texas, USA
| | - Sheryl O Hughes
- Department of Pediatrics, USDA ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - Craig A Johnston
- Department of Health and Human Performance, University of Houston, Houston, Texas, USA
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18
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Annesi JJ, Johnson PH. Mitigation of the effects of emotional eating on sweets consumption by treatment-associated self-regulatory skills usage in emerging adult and middle-age women with obesity. Appetite 2020; 155:104818. [PMID: 32750395 DOI: 10.1016/j.appet.2020.104818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/02/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022]
Abstract
An urge to eat in response to negative emotions or mood (emotional eating) is associated with an overconsumption of unhealthy foods such as sweets. Propensities for emotional eating is most prevalent in women, but its effects might differ by age. Within behavioral obesity treatments, it is unclear whether learned self-regulatory skills mitigate the effects of emotional eating susceptibilities on sweets intake, or if expected exercise-induced mood improvements affect the emotional eating-sweets intake relationship. Emerging adult (18-25 years-of-age; n = 43) and middle-age (45-65 years-of-age; n = 79) women with obesity participating in the same cognitive-behavioral treatment that emphasized exercise prior to eating-behavior changes were assessed on levels of propensities for emotional eating, self-regulatory skills usage, mood, and intake of sweets. There were overall significant improvements in self-regulation for eating, overall mood, and daily intake of sweets; with a significantly greater reduction in sweets in the emerging adult women. Self-regulation for eating at Month 3 significantly mediated the prediction of sweets intake at Month 6 by overall emotional eating and emotional eating related to depression. When dimensions of mood (i.e., total negative mood, depression, anxiety, anger) at Month 3 were entered into the models as possible moderators of relationships between a corresponding dimension of emotional eating and sweets intake, anxiety was found to be a significant moderator. Because sweets intake was affected by age, it should be considered in behavioral obesity interventions. Findings suggested advantages of fostering self-regulatory skills and reductions in anxiety, possibly through supported exercise, to mitigate unhealthy eating behaviors associated with propensities for emotional eating.
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19
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Annesi JJ. Contrasting Personal Characteristics and Psychosocial Correlates of Exercise and Eating Behavior Changes in Women Successful vs. Unsuccessful with Weight Loss and Maintenance. Appl Psychol Health Well Being 2020; 12:703-723. [PMID: 32421909 DOI: 10.1111/aphw.12203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/03/2020] [Accepted: 04/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is great variability in individuals' responses to behavioral weight-loss treatments. Beyond attaining meaningful weight loss in the initial several weeks, little is known of the characteristics of participants successful vs. unsuccessful with short- and long-term weight loss. METHODS Separate samples of women with obesity enrolled in cognitive-behavioral weight-loss treatments were assessed over 6 months (Study 1: successful weight-loss group, n = 83; unsuccessful group, n = 158), and over 24 months (Study 2: sustained initially lost weight, n = 25; regained weight, n = 19), on personal characteristics and theory-driven psychosocial variables. RESULTS In Study 1, significantly older age and greater eating self-regulation at baseline were found in the successful group. Significantly greater improvements in exercise- and eating-related self-regulation, mood, exercise- and eating-related self-efficacy, physical self-concept, and body satisfaction were found in the successful group. In Study 2, the sustainer group had significantly more favorable changes over 2 years in exercise- and eating-related self-regulation, and mood. During Months 6-24, the psychosocial correlates of both exercise and eating behaviors regressed, with more pronounced reversions in the regainer group. CONCLUSION Increasing the magnitude of treatment-associated improvement in each of the tested theory-based psychosocial factors is warranted to increase probabilities for success with attaining and maintaining meaningful weight loss.
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Affiliation(s)
- James J Annesi
- YMCA of Metro Atlanta, Atlanta, GA, USA.,University of Alabama at Birmingham, Birmingham, AL, USA
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20
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Tronieri JS, Wadden TA, Walsh O, Berkowitz RI, Alamuddin N, Chao AM. Measures of adherence as predictors of early and total weight loss with intensive behavioral therapy for obesity combined with liraglutide 3.0 mg. Behav Res Ther 2020; 131:103639. [PMID: 32450367 DOI: 10.1016/j.brat.2020.103639] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/12/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
Individual weight loss outcomes with intensive behavioral therapy (IBT) for obesity are variable. The present study assessed whether visit attendance, dietary self-monitoring, medication, and meal-replacement adherence were associated with 52-week weight loss with IBT and tested whether these relationships were independent of associations with early weight loss. This was a secondary analysis of a randomized trial in which 150 participants (76.1% female, 55.8% white, BMI = 38.8 ± 4.8 kg/m2) received either IBT alone, IBT with liraglutide 3.0 mg/d, or IBT-liraglutide combined with a 12-week meal replacement diet (Multi-component). In the full sample, visit attendance accounted for 14.8% of the variance in 52-week weight loss and dietary self-monitoring added 14.9%. Only self-monitoring was independently associated with weight loss. In the 100 liraglutide-treated participants, medication adherence accounted for an additional 9.9% of the variance in 52-week weight loss, and both self-monitoring and medication adherence were independent correlates. For the 50 Multi-component participants, meal replacement adherence did not predict weight loss. Early weight loss was associated with higher early and subsequent session attendance and dietary self-monitoring. However, self-monitoring and medication adherence remained important correlates of total weight loss when controlling for this variable. Strategies that help improve self-monitoring consistency and medication usage could improve weight loss with IBT.
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Affiliation(s)
- Jena S Tronieri
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Center for Weight and Eating Disorders, Philadelphia, PA, USA.
| | - Thomas A Wadden
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Center for Weight and Eating Disorders, Philadelphia, PA, USA
| | - Olivia Walsh
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Center for Weight and Eating Disorders, Philadelphia, PA, USA
| | - Robert I Berkowitz
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Center for Weight and Eating Disorders, Philadelphia, PA, USA; The Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry, Philadelphia, PA, USA
| | - Naji Alamuddin
- Perelman School of Medicine at the University of Pennsylvania, Department of Medicine, Philadelphia, PA, USA
| | - Ariana M Chao
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Center for Weight and Eating Disorders, Philadelphia, PA, USA; University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USA
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21
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Tronieri JS, Wadden TA, Chao AM, Pearl RL, Alamuddin N, Berkowitz RI. Early Weight Loss in Behavioral Treatment Predicts Later Rate of Weight Loss and Response to Pharmacotherapy. Ann Behav Med 2020; 53:290-295. [PMID: 29800080 DOI: 10.1093/abm/kay036] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Early weight loss (EWL) in the first 1-2 months of behavioral treatment is a strong predictor of later total weight loss. It is not clear whether participants with lower early losses lose less in ongoing treatment or simply fail to overcome the smaller initial loss. Furthermore, no study has tested whether EWL in behavioral treatment predicts response to a different treatment modality, such as pharmacotherapy. METHODS Data were from 170 participants with obesity (baseline BMI = 40.8 ± 5.8 kg/m2, 87.6% female; 71.3% Black) enrolled in a two-phase trial. Data from the weight loss phase, which provided weekly lifestyle counseling and a meal replacement diet, were used to examine the relationship between 4-week EWL and subsequent rate of weight loss in behavioral treatment. Data from the maintenance phase, in which 137 participants who had lost ≥5% of initial weight were randomized to 52 weeks of maintenance counseling with lorcaserin or placebo, were used to determine whether EWL with behavioral treatment affects the benefit of pharmacotherapy. RESULTS EWL in the first 4 weeks of behavioral treatment (3.6 ± 1.7%) predicted greater total losses at Week 14 (r2 = 0.61, p < .001) and a faster rate of weight loss in the subsequent 9 weeks of the program (p < .001). During the maintenance phase, lower EWL in behavioral treatment predicted a greater benefit of lorcaserin, in comparison with placebo, for the maintenance of a ≥5% loss at Weeks 24 and 52. CONCLUSIONS These findings support recommendations to modify treatment for individuals with low EWL.
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Affiliation(s)
- Jena Shaw Tronieri
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Suite, Philadelphia, PA, USA
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Suite, Philadelphia, PA, USA
| | - Ariana M Chao
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Suite, Philadelphia, PA, USA.,Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA,USA
| | - Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Suite, Philadelphia, PA, USA.,Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Naji Alamuddin
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Suite, Philadelphia, PA, USA.,Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Robert I Berkowitz
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Suite, Philadelphia, PA, USA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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22
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Inolopú J, Hilario-Huapaya N, Tantaleán-Del-Águila MA, Hurtado-Roca Y, Ugarte-Gil C. Interventions for the prevention of risk factors and incidence of type 2 diabetes in the work environment: a systematic review. Rev Saude Publica 2019; 53:101. [PMID: 31800912 PMCID: PMC6863112 DOI: 10.11606/s1518-8787.2019053001084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 03/17/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of interventions aimed at the prevention of risk factors and incidence of type 2 diabetes in the workers population. METHODS Systematic review of interventions aimed at adult workers at risk of type 2 diabetes published in Medline, Embase, Web of Science, Central Cochrane Registry of Controlled Trials, and Lilacs. Randomized trials, quasi-experimental research and cohort studies were selected; in English, Spanish and Portuguese; published from 2000 to 2017. Intervention effectiveness was evaluated concerning the incidence of type 2 diabetes and a significant reduction in body weight, or another anthropometric or metabolic parameter. RESULTS 3,024 articles were generated, of which 2,825 that did not answer the research question were eliminated, as well as 130 that did not evaluate original interventions, 57 carried out outside the workplace and two reviews; so that 10 selected items remained. Interventions based on structured programs previously evaluated and integrated into the workplace had a favorable impact on the reduction of body weight and other risk factors. CONCLUSIONS The effectiveness of lifestyle interventions for the prevention of type 2 diabetes should be based on structured programs with proven effectiveness and adapted to the workplace, with employer participation in the provision of schedules and work environments.
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Affiliation(s)
- Jorge Inolopú
- Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical Alexander von Humboldt. Lima, Perú.,Universidad Peruana Cayetano Heredia. Facultad de Salud Pública. Lima, Perú
| | - Nélida Hilario-Huapaya
- Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical Alexander von Humboldt. Lima, Perú.,Universidad Peruana Cayetano Heredia. Facultad de Salud Pública. Lima, Perú
| | | | - Yamilee Hurtado-Roca
- EsSalud. Instituto de Evaluación de Tecnologías en Salud e Investigación. Lima, Perú
| | - Cesar Ugarte-Gil
- Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical Alexander von Humboldt. Lima, Perú.,Universidad Peruana Cayetano Heredia. Facultad de Medicina. Lima, Perú
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23
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Korkut Y, Balcıoglu İ, Onbası K. Determination of the Perception Level of Life Style Innovations in Type 2 Diabetes Mellitus. Ethiop J Health Sci 2019; 29:447-452. [PMID: 31447517 PMCID: PMC6689712 DOI: 10.4314/ejhs.v29i4.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background In this tudy, our aim was to measure information and behaviors of our patients about their diseases, and to determine the level of compliance with their treatment and to investigate the causes of nonconformities. Methods A total of 111 patients who applied to outpatient clinics between May–December 2017 were included in this prospective cross-sectional study. Sociodemographic, clinical data, diabetes, medical nutrition therapy and physical activity questionnaires were administered face to face by the researchers. Results About 68.5% of the 111 patients were females. While 64.9% were primary school graduates, 58.6% were housewives and 82.9% were low income level. Body Mass Index (BMI) was found to be significantly higher in women (p=0.041). It has been found that the awareness of the patients about themselves and their illnesses are 37.8% for HbA1c, 64.8% for fasting blood sugar level, 78.3% for their height and body weight. While males had a higher score than females in the diabetes survey, females scored higher than males in the medical nutrition therapy and physical activity questionnaires. On the other hand, 46.8% of patients showed additional health problems as a cause of non-compliance to physical activity. Conclusions Level of knowledge and compliance with treatment were also found to be inadequate.
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Affiliation(s)
- Yasemin Korkut
- Department of Family Medicine, University of Kütahya Health Sciences, Kütahya, 43100, Turkey
| | - İsmail Balcıoglu
- Department of Family Medicine, University of Kütahya Health Sciences, Kütahya, 43100, Turkey
| | - Kevser Onbası
- Department of Internal Medicine, Endocrinology, University of Kütahya Health Sciences, Kütahya, 43100, Turkey
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24
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Beck JE, Zaugg TL, Egge JL, Lima EN, Thielman EJ. Progressive Tinnitus Management at Two Veterans Affairs Medical Centers: Clinical Implementation With Modified Protocols. Am J Audiol 2019; 28:162-173. [PMID: 31022363 DOI: 10.1044/2018_aja-ttr17-18-0040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose This is a description of the clinical implementation and outcomes of progressive tinnitus management (PTM) at 2 Veterans Affairs (VA) medical centers: Both programs modified the protocol originally described by PTM developers. Method Modifications at both sites were classified according to an evidence-based framework set forth by Stirman, Miller, Toder, and Calloway (2013) . The Iowa City VA PTM program clinicians made 2 modifications and the Asheville, North Carolina, VA PTM program clinicians made 6 modifications to the standard PTM protocol. Pre-post outcome measures were analyzed for 20 veterans who completed the Iowa City program and for 200 veterans who completed the Asheville program. Results Veterans who completed the Iowa City program showed a statistically significant decrease in the average Tinnitus Handicap Inventory score ( Newman, Jacobson, & Spitzer, 1996 ). Veterans who completed the Asheville PTM program showed a statistically significant decrease in the average Tinnitus Functional Index (TFI) score. Outcomes in Asheville were compared to outcomes of a clinical trial of PTM conducted by the developers of PTM. The clinical work in Asheville resulted in a greater mean reduction on the TFI and a larger effect size using the TFI as compared to the results of the PTM clinical trial. Conclusions Clinician-directed modifications to PTM that are made to address the unique needs and circumstances of an individual clinic have potential to result in positive outcomes for patients. Clinicians providing care for patients with tinnitus using PTM who modify the protocol to meet the needs of their local setting are encouraged to collect and report the outcomes of their modifications to improve understanding of the impact of various types of modifications to PTM and other evidence-based practices.
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Affiliation(s)
- Jenifer E. Beck
- Audiology and Speech Pathology Service, Charles George Veterans Affairs Medical Center, Asheville, North Carolina
| | - Tara L. Zaugg
- VA Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Oregon
| | - Jessica L. Egge
- Audiology and Speech Pathology Service, Iowa City Veterans Affairs Health Care System, Iowa
| | - Elizabeth N. Lima
- Learning Resources Service, Charles George Veterans Affairs Medical Center, Asheville, North Carolina
| | - Emily J. Thielman
- VA Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Oregon
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25
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Lewis KH, Fischer H, Ard J, Barton L, Bessesen DH, Daley MF, Desai J, Fitzpatrick SL, Horberg M, Koebnick C, Oshiro C, Yamamoto A, Young DR, Arterburn DE. Safety and Effectiveness of Longer-Term Phentermine Use: Clinical Outcomes from an Electronic Health Record Cohort. Obesity (Silver Spring) 2019; 27:591-602. [PMID: 30900410 DOI: 10.1002/oby.22430] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/09/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this work was to study weight loss and risk of cardiovascular disease (CVD) or death associated with longer-term phentermine use. METHODS Using electronic health record data, 13,972 adults were identified with a first phentermine fill in 2010 to 2015, creating exposure categories according to a patient's duration of use (referent: ≤ 3 months). Multivariable linear models were used to compare percent weight loss across categories at 6, 12, and 24 months, and Cox proportional hazards models were used to compare risk of composite CVD or death, up to 3 years after starting phentermine. RESULTS The cohort was 84% female and 45% white, with a mean (SD) baseline age 43.5 (10.7) years and BMI of 37.8 (7.2) kg/m2 . In multivariable models, longer-term users of phentermine experienced more weight loss; patients using continuously for > 12 months lost 7.4% more than the referent group at 24 months (P < 0.001). The composite CVD or death outcome was rare (0.3%, 41 events), with no significant difference in hazard ratios between groups. CONCLUSIONS Greater weight loss without increased risk of incident CVD or death was observed in patients using phentermine monotherapy for longer than 3 months. Despite the limitations of the observational design, this study supports the effectiveness and safety of longer-term phentermine use for low-risk individuals.
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Affiliation(s)
- Kristina H Lewis
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Heidi Fischer
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jamy Ard
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lee Barton
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Daniel H Bessesen
- Diabetes & Endocrinology Division, Denver Health Medical Center, Denver, Colorado, USA
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Jay Desai
- HealthPartners Institute, Bloomington, Minnesota, USA
| | | | - Michael Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - Corinna Koebnick
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Caryn Oshiro
- Center for Health Research, Kaiser Permanente Hawaii, Honolulu, Hawaii, USA
| | - Ayae Yamamoto
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Deborah R Young
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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Abstract
PURPOSE OF REVIEW Adaptive behavioral interventions tailor the type or dose of intervention strategies to individuals over time to improve saliency and intervention efficacy. This review describes the unique characteristics of adaptive intervention designs, summarizes recent diabetes-related prevention studies, which used adaptive designs, and offers recommendations for future research. RECENT FINDINGS Eight adaptive intervention studies were reported since 2013 to reduce sedentary behavior or improve weight management in overweight or obese adults. Primarily, feasibility studies were conducted. Preliminary results suggest that just-in-time adaptive interventions can reduce sedentary behavior or increase minutes of physical activity through repeated prompts. A stepped-down weight management intervention did not increase weight loss compared to a fixed intervention. Other adaptive interventions to promote weight management are underway and require further evaluation. Additional research is needed to target a broader range of health-related behaviors, identify optimal decision points and dose for intervention, develop effective engagement strategies, and evaluate outcomes using randomized trials.
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Affiliation(s)
- Carla K Miller
- Department of Human Sciences/Human Nutrition, Ohio State University, 1787 Neil Ave., 325 Campbell Hall, Columbus, OH, 43210, USA.
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27
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James BL, Roe LS, Loken E, Rolls BJ. Early predictors of weight loss in a 1-year behavioural weight-loss programme. Obes Sci Pract 2018; 4:20-28. [PMID: 29479461 PMCID: PMC5818734 DOI: 10.1002/osp4.149] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/30/2017] [Accepted: 12/09/2017] [Indexed: 02/01/2023] Open
Abstract
Objective Identifying early predictors of weight loss is key for developing personalized treatment. However, few individual factors have been identified that predict weight loss during intervention, other than early weight loss itself. Methods Women with overweight or obesity (n = 186, mean ± SD age 50.0 ± 10.6 years, body mass index 34.0 ± 4.2 kg m-2) participated in the Portion-Control Strategies Trial, a 1-year randomized controlled weight-loss trial with three intervention groups. Early changes in eating behaviours and psychological factors were evaluated by questionnaires at baseline and Month 1. The influence of these early changes on the trajectory of weight loss from baseline to Months 3 and 12 was assessed by random coefficients models. Results Although there were no differences in weight loss between intervention groups at the end of the trial, certain individual factors were shown to predict both early weight loss at Month 3 and longer-term weight loss at Month 12. Across all participants, increases in dietary restraint and healthy lifestyle ratings in the first month predicted more rapid weight loss from baseline to Month 3 (P < 0.05) and also predicted more rapid weight loss and slower regain from baseline to Month 12 (both P < 0.01). Early attendance and changes in disinhibition were not associated with subsequent weight loss. Conclusions Changes in psychological and behavioural measures, such as restraint, in the first month of weight loss intervention predicted longer-term weight loss in women. Early additional support or tailored treatment could promote long-term success by reinforcing these behaviours.
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Affiliation(s)
- B. L. James
- Department of Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - L. S. Roe
- Department of Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - E. Loken
- Department of Human Development and Family StudiesThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - B. J. Rolls
- Department of Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkPAUSA
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28
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Eaglehouse YL, Venditti EM, Kramer MK, Arena VC, Vanderwood KK, Rockette-Wagner B, Kriska AM. Factors related to lifestyle goal achievement in a diabetes prevention program dissemination study. Transl Behav Med 2017; 7:873-880. [PMID: 28397158 PMCID: PMC5634908 DOI: 10.1007/s13142-017-0494-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The U.S. Diabetes Prevention Program (DPP) showed that lifestyle participants who achieved ≥7% weight loss and ≥150 min/week physical activity experienced the greatest reduction in type 2 diabetes incidence. Demographic, clinical, and program factors that are related to achieving both these lifestyle goals have seldom been explored in community-delivered DPP programs. The purpose of this investigation is to examine factors associated with concurrent achievement of weight loss and physical activity goals in a 12-month community DPP lifestyle intervention. Adults [n = 223; age = 58.4 (SD = 11.5); BMI = 33.8 (SD = 6.0)] with glucose or HbA1c values in the pre-diabetes range and/or metabolic syndrome risk factors enrolled from one worksite and three community centers in the Pittsburgh, PA metropolitan area between January 2011 and January 2014. Logistic regression analyses determined the demographic, clinical and program adherence factors related to goal achievement at 6, 12, and 18 months. Participants achieving both intervention goals at 6 months (n = 57) were more likely to attend sessions [Adjusted Odds Ratio (AOR) =1.48], self-weigh (AOR = 1.19), and self-monitor behaviors (AOR = 1.18) than those meeting neither goal (n = 35; all p < 0.05). Baseline BMI (AOR = 0.87, p < 0.01), elevated glycemic status (AOR = 0.49, p < 0.05), and female sex (AOR = 0.52, p < 0.05) were inversely related to goal achievement at 6 months. Meeting either lifestyle goal at 6 months had the strongest association with meeting both goals at 12 and 18 months. Our study supports the importance of early engagement, regular attendance, self-monitoring, and self-weighing for goal achievement. Dissemination efforts should consider alternative approaches for those not meeting goals by 6 months to enhance long-term success.
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Affiliation(s)
- Yvonne L Eaglehouse
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
- Division of Cancer Prevention and Population Sciences, University of Pittsburgh Cancer Institute, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA.
- , 11300 Rockville Pike, Suite 1120, Rockville, MD, 20852, USA.
| | - Elizabeth M Venditti
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
| | - M Kaye Kramer
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Vincent C Arena
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Karl K Vanderwood
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Montana Department of Public Health and Human Services, 111 North Sanders, Helena, MT, 59601, USA
| | - Bonny Rockette-Wagner
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Andrea M Kriska
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
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Unick JL, Pellegrini CA, Demos KE, Dorfman L. Initial Weight Loss Response as an Indicator for Providing Early Rescue Efforts to Improve Long-term Treatment Outcomes. Curr Diab Rep 2017; 17:69. [PMID: 28726155 PMCID: PMC5789799 DOI: 10.1007/s11892-017-0904-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW There is a large variability in response to behavioral weight loss (WL) programs. Reducing rates of obesity and diabetes may require more individuals to achieve clinically significant WL post-treatment. Given that WL within the first 1-2 months of a WL program is associated with long-term WL, it may be possible to improve treatment outcomes by identifying and providing additional intervention to those with poor initial success (i.e., "early non-responders"). We review the current literature regarding early non-response to WL programs and discuss how adaptive interventions can be leveraged as a strategy to "rescue" early non-responders. RECENT FINDINGS Preliminary findings suggest that adaptive interventions, specifically stepped care approaches, offer promise for improving outcomes among early non-responders. Future studies need to determine the optimal time point and threshold for intervening and the type of early intervention to employ. Clinicians and researchers should consider the discussed factors when making treatment decisions.
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Affiliation(s)
- Jessica L Unick
- The Miriam Hospital's Weight Control and Diabetes Research Center, Warren Alpert Medical School at Brown University, 196 Richmond Street, Providence, RI, 02903, USA.
| | - Christine A Pellegrini
- Technology Center to Promote Healthy Lifestyles, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kathryn E Demos
- The Miriam Hospital's Weight Control and Diabetes Research Center, Warren Alpert Medical School at Brown University, 196 Richmond Street, Providence, RI, 02903, USA
| | - Leah Dorfman
- The Miriam Hospital's Weight Control and Diabetes Research Center, Warren Alpert Medical School at Brown University, 196 Richmond Street, Providence, RI, 02903, USA
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30
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Yang S, Wang S, Yang B, Zheng J, Cai Y, Yang Z. Weight loss before a diagnosis of type 2 diabetes mellitus is a risk factor for diabetes complications. Medicine (Baltimore) 2016; 95:e5618. [PMID: 27930591 PMCID: PMC5266063 DOI: 10.1097/md.0000000000005618] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Our goal was to investigate the relationship between weight loss before a diagnosis of type 2 diabetes mellitus (T2DM) and diabetic complications among hospitalized patients with T2DM.We conducted a cross-sectional study and evaluated 347 and 642 hospitalized patients with T2DM who experienced and did not experienced weight loss before T2DM diagnosis, respectively. We used propensity score matching to reduce the confounding bias between the groups. In addition, a logistic regression analysis of the matched data was performed to evaluate the risk of diabetic complications.A total of 339 patients who experienced weight loss were matched to 339 patients who did not experience weight loss. After adjusting for age, gender, origin, occupation, smoking history, alcohol use, and duration of diabetes, the logistic regression analysis showed that compared with patients who did not experience weight loss, patients who lost ≤5 kg had a higher risk of diabetic nephropathy (DN) (odds ratio [OR]: 2.05, 95% confidence interval [CI]: 1.35-3.10) and diabetic retinopathy (OR: 1.79, 95% CI: 1.11-2.87). However, we did not observe a dose-response relationship in terms of weight loss.We found that weight loss before a diagnosis of T2DM might serve as a risk factor for DN and diabetic retinopathy. Our findings demonstrate that we should strengthen the management and prevention of complications in patients who experience weight loss of ≤5 kg prior to a T2DM diagnosis, particularly those who are centrally obese.
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Affiliation(s)
- Shanshan Yang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, Beijing
- Jinan Military Area CDC, Jinan, Shandong
| | - Shuang Wang
- Department of Nephrology and Endocrinology, PLA 148th Hospital, Zibo, China
| | - Bo Yang
- Department of Nephrology and Endocrinology, PLA 148th Hospital, Zibo, China
| | - Jinliang Zheng
- Department of Nephrology and Endocrinology, PLA 148th Hospital, Zibo, China
| | - Yuping Cai
- Department of Nephrology and Endocrinology, PLA 148th Hospital, Zibo, China
| | - Zhengguo Yang
- Department of Nephrology and Endocrinology, PLA 148th Hospital, Zibo, China
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Vimalananda V, Damschroder L, Janney CA, Goodrich D, Kim HM, Holleman R, Gillon L, Lutes L. Weight loss among women and men in the ASPIRE-VA behavioral weight loss intervention trial. Obesity (Silver Spring) 2016; 24:1884-91. [PMID: 27488278 DOI: 10.1002/oby.21574] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 04/09/2016] [Accepted: 05/04/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Weight loss was examined among women and men veterans in a clinical trial comparing Aspiring for Lifelong Health (ASPIRE), a "small changes" weight loss program using either mixed-sex group-visit or telephone-based coaching, to MOVE!(®) , the usual mixed-sex group-based program. METHODS Linear mixed-effects models were used to calculate adjusted percent weight change at 12 months by sex and compare outcomes across arms within sex. RESULTS Analyses included 72 women (ASPIRE-Phone = 26; ASPIRE-Group = 26; MOVE! = 20) and 409 men (ASPIRE-Phone = 136; ASPIRE-Group = 134; MOVE! = 139). At 12 months, women displayed significant weight loss from baseline in ASPIRE-Group (-2.6%) and MOVE! (-2.7%), but not ASPIRE-Phone (+0.2%). Between-arm differences in weight change among women were: ASPIRE-Group versus ASPIRE-Phone, -2.8% (P = 0.15); MOVE! versus ASPIRE-Phone, -2.8% (P = 0.20); and ASPIRE-Group versus MOVE!, 0.0% (P = 1.0). At 12 months, men lost significant weight from baseline across arms (ASPIRE-Phone, -1.5%; ASPIRE-Group, -2.5%; MOVE!, -1.0%). Between-arm differences in weight change among men were: ASPIRE-Group versus ASPIRE-Phone, -0.9% (P = 0.23); MOVE! versus ASPIRE-Phone, +0.5% (P = 0.76); ASPIRE-Group versus MOVE!, -1.5% (P = 0.03). CONCLUSIONS Mixed-sex, group-based programs can result in weight loss for both women and men veterans.
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Affiliation(s)
- Varsha Vimalananda
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA
- Section of Endocrinology, Diabetes and Metabolism, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Laura Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Carol A Janney
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - David Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - H Myra Kim
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert Holleman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Leah Gillon
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Lesley Lutes
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
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