Designing "lifestyle interventions" with the brain in mind

A Digital Health Weight Loss Program in 250,000 Individuals

IMPORTANCE

Obesity is a worsening epidemic worldwide. Effective and accessible weight loss programs to combat obesity on a large scale are warranted, but a need for frequent face-to-face care might impose a limitation.

OBJECTIVE

To evaluate whether individuals following a weight loss program based on a mobile application, wireless scale, and nutritional program but no face-to-face care can achieve clinically significant weight loss in a large cohort.

DESIGN

Retrospective observational analysis. Setting. China from October 2016 to December 2017. Participants. Mobile application users with a minimum of 2 weights (baseline and ≥35 days). Intervention. A commercial (Weijian Technologies) weight loss program consisting of a dietary replacement, self-monitoring using a wireless home scale, and frequent guidance via mobile application. Main Outcome. Mean weight change around 42, 60, 90, and 120 days after program initiation with subgroup analysis by gender, age, and frequency of use.

RESULTS

251,718 individuals, with a mean age of 37.3 years (SD: 9.86) (79% female), were included with a mean weight loss of 4.3 kg (CI: ±0.02) and a mean follow-up of 120 days (SD: 76.8 days). Mean weight loss at 42, 60, 90, and 120 d was 4.1 kg (CI: ±0.02), 4.9 kg (CI: ±0.02), 5.6 kg (CI: ±0.03), and 5.4 kg (CI: ±0.04), respectively. At 120 d, 62.7% of participants had lost at least 5% of their initial weight. Both genders and all usage frequency tertiles showed statistically significant weight loss from baseline at each interval (P < 0.001), and this loss was greater in men than in women (120 d: 6.5 vs. 5.2 kg; P < 0.001). The frequency of recording (categorized as high-, medium-, or low-frequency users) was associated with greater weight loss when comparing high, medium, and low tertile use groups at all time intervals investigated (e.g., 120 d: -8.6, -5.6, and -2.2 kg, respectively; P < 0.001).

CONCLUSIONS

People following a commercially available hybrid weight loss program using a mobile application, wireless scale, and nutritional program without face-to-face interaction on average achieved clinically significant short- and midterm weight loss. These results support the implementation of comparable technologies for weight control in a large population.

An educational program based on the successful aging approach on health-promoting behaviors in the elderly: a clinical trial study

Background:

Many criteria of successful aging are directly connected with Health-Promoting Behaviors.

Objectives:

The current study aimed to evaluate the effect of an educational program based on the successful aging approach on health promoting behaviors in the elderly.

Patients and Methods:

This clinical trial study was conducted on 464 Iranian elderly people over 60 years who were admitted at Health Houses for 12 months. Participants were selected through a two-stage cluster sampling and were placed in the control and intervention groups (232 participants in each group). The data collection tools included: a demographic checklist, Palmore Facts on Aging Quiz and the second version of Health Promoting Lifestyle Profile. The intervention was designed based on adult strategy education in five 45-minute sessions. The data obtained 3 months after the intervention were compared with the data obtained before the intervention. The data were analyzed using the descriptive and analytical tests such as paired T-test with SPSS version 20, at the statistical significant level 0.05.

Results:

The mean age of the participants in this study was 65.9 ± 3.6 (range 60-73). Results showed a statistically significant difference between the intervention and control group after the intervention in the mean scores of awareness of aging facts and score of health promoting behaviors.

Conclusions:

Focusing on successful aging and adopting HPBs can prevent and decrease aging problems which in turn decreases the financial burden and related costs. This is especially important for the policy and decision makers of the health systems.

Relationship of insulin resistance to psychobehavioral characteristics of overweight and obese African American children

OBJECTIVES

The objective of this study was to evaluate the relationships of insulin resistance to positive as well as negative dimensions of the child's emotions, behavior and personality (hereafter referred to as "psychobehavioral characteristics") in a convenience sample of inner-city, overweight and obese, African American children.

METHODS

A secondary analysis was performed on a sample of 127 children ages 9-12 yr old who were participating in a community-based, Type 2 diabetes prevention program. Psychobehavioral characteristics of children were assessed using both child and parent ratings derived from the Behavioral Assessment for Children, 2nd edition (BASC-2). Body fatness was evaluated using anthropometric techniques, and insulin resistance (HOMA-IR) was calculated from fasting glucose and insulin concentrations. Hierarchical multiple linear regression models were employed with BASC scales as dependent variables and HOMA-IR as the independent variable of interest.

RESULTS

After adjusting for child age, pubertal stage, gender, family socioeconomic index, and intervention group assignment, child HOMA-IR was related at p<0.05 to less favorable scores for parent-report of behavioral symptoms and externalizing problems composites, and to content scales for bullying and negative emotionality. Additionally, child HOMA-IR was related at p<0.01 to less favorable scores for child-report inattention/hyperactivity composite. Body fatness suppressed the unfavorable relationship between HOMA-IR and these and other psychobehavioral characteristics as the degree of significance was higher following adjustment for body fatness in this cohort.

CONCLUSION

More than one psychobehavioral characteristic were associated with body fatness and insulin resistance in the overweight children of this study. Whether the associations are due to several, or only one, of these psychobehavioral characteristics could not be determined. A much larger and future study will be needed to determine which, if any, of these psychobehavioral characteristics are independently associated with insulin resistance in overweight children.

Cognitive and behavioral approaches in the treatment of obesity

The research reviewed within this article provides support for both the cognitive and behavioral components of cognitive behavioral weight-loss interventions. Lifestyle based treatments have produced markedly improved results in the past 20 years, in part attributable to changes in treatment structure. Use of pretreatment participant preparation strategies, extended treatment periods with clearly defined weight-loss goals, combining multiple dietary and physical activity strategies, and increasing emphasis on long-term provider contact and relapse prevention have modestly improved long-term weight maintenance. Several investigators have emphasized the need to incorporate additional cognitive components into the cognitive-behavioral treatment of obesity to improve both short- and long-term outcomes. Furthermore, continued insights into metabolic changes producing an energy gap after weight loss should no doubt continue to refine insights into the behavioral requirements of long-term weight loss. Despite increased awareness and behavioral treatment advances, the worldwide prevalence of obesity and weight-related chronic illnesses continues to expound. Behavioral treatment is inherently challenging and time-consuming, and readily available to only a fraction of the population who may benefit from inclusion. Several investigators have cautioned that individual or small group-based interventions are insufficient to serve the population masses requiring treatment, and that continued development of community or Web-based programs, and community-development tactics to increase healthy lifestyles, are needed. The call has been sounded to conceptualize obesity as a chronic health condition requiring lifelong treatment. As such, the conceptualization of cognitive-behavioral therapies as a one-time treatment is passe´ . As the current number of obesity specialists and behaviorally trained professionals is insufficient to combat this problem; an increased emphasis upon training nontraditional weight specialists and nonbehavioral community providers is obviated.

Cognitive and behavioral approaches in the treatment of obesity

Cognitive behavioral interventions have formed the cornerstone of obesity treatment for the past two decades. These techniques, often combined with diet and exercise strategies, have been shown to produce weight losses of sufficient magnitude so as to reduce health risks. Though success in producing short-term weight loss is improving, many factors, including a metabolic energy gap, continue to challenge long-term weight maintenance results. This article reviews the unique influence of cognitive, behavioral, and metabolic factors on weight loss and weight-loss maintenance, and how future treatment packages might be modified to improve long-term weight loss outcomes.

Metabolism, mood and cognition in aging: The importance of lifestyle and dietary intervention

We are witnessing an unprecedented rise in obesity and Type 2 diabetes. Until recently, study of the relation between metabolic dysregulation and higher brain function was limited. This paper summarizes the findings of a Spark workshop that focussed on the impact of obesity and diabetes on mood and cognition. Disturbances in peripheral glucose regulation are associated with cognitive impairment and depressed mood, especially in older adults. Multiple mechanisms and mediators underlie this association including insulin, glucose, neurotropic factors, glucocorticoids, inflammatory agents and reactive oxygen species. Importantly, prevention and even reversal of diabetes and obesity related cognitive impairment and depressive mood can be brought about by lifestyle modification. In particular, increasing physical fitness and moderating/changing food intake will have beneficial effects. Prevention of obesity and hyperglycemia by adopting a healthy lifestyle will contribute to the maintenance of functional integrity and mental health later in life.