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Neri LDCL, Mariotti F, Guglielmetti M, Fiorini S, Tagliabue A, Ferraris C. Dropout in cognitive behavioral treatment in adults living with overweight and obesity: a systematic review. Front Nutr 2024; 11:1250683. [PMID: 38784136 PMCID: PMC11111870 DOI: 10.3389/fnut.2024.1250683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
Obesity is a chronic, complex, and multifactorial disease resulting from the interaction of genetic, environmental, and behavioral factors. It is characterized by excessive fat accumulation in adipose tissue, which damages health and deteriorates the quality of life. Although dietary treatment can significantly improve health, high attrition is a common problem in weight loss interventions with serious consequences for weight loss management and frustration. The strategy used to improve compliance has been combining dietary prescriptions and recommendations for physical activity with cognitive behavioral treatment (CBT) for weight management. This systematic review determined the dropout rate and predictive factors associated with dropout from CBT for adults with overweight and obesity. The data from the 37 articles selected shows an overall dropout rate between 5 and 62%. The predictive factors associated with attrition can be distinguished by demographics (younger age, educational status, unemployed status, and ethnicity) and psychological variables (greater expected 1-year Body Mass Index loss, previous weight loss attempts, perceiving more stress with dieting, weight and shape concerns, body image dissatisfaction, higher stress, anxiety, and depression). Common reasons for dropping out were objective (i.e., long-term sickness, acute illness, and pregnancy), logistical, poor job conditions or job difficulties, low level of organization, dissatisfaction with the initial results, lack of motivation, and lack of adherence. According to the Mixed Methods Appraisal quality analysis, 13.5% of articles were classified as five stars, and none received the lowest quality grade (1 star). The majority of articles were classified as 4 stars (46%). At least 50% of the selected articles exhibited a high risk of bias. The domain characterized by a higher level of bias was that of randomization, with more than 60% of the articles having a high risk of bias. The high risk of bias in these articles can probably depend on the type of study design, which, in most cases, was observational and non-randomized. These findings demonstrate that CBT could be a promising approach for obesity treatment, achieving, in most cases, lower dropout rates than other non-behavioral interventions. However, more studies should be conducted to compare obesity treatment strategies, as there is heterogeneity in the dropout assessment and the population studied. Ultimately, gaining a deeper understanding of the comparative effectiveness of these treatment strategies is of great value to patients, clinicians, and healthcare policymakers. Systematic review registration: PROSPERO 2022 CRD42022369995 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022369995.
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Affiliation(s)
- Lenycia de Cassya Lopes Neri
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Francesca Mariotti
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Monica Guglielmetti
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Simona Fiorini
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Anna Tagliabue
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Cinzia Ferraris
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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Brenton-Peters JM, Consedine NS, Cavadino A, Roy R, Ginsberg KH, Serlachius A. Finding kindness: A randomized controlled trial of an online self-compassion intervention for weight management (SC4WM). Br J Health Psychol 2024; 29:37-58. [PMID: 37544883 DOI: 10.1111/bjhp.12686] [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: 02/20/2023] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Weight loss is hard to achieve and even harder to maintain. Engaging in effortful behavioural change to manage body weight can sometimes result in feelings of guilt and shame. Self-compassion, the tendency to find kindness for oneself in times of struggle, may facilitate coping with the unique challenges of weight management. This study assessed whether a remotely delivered self-compassion intervention improved weight management outcomes when delivered as a supplement to an existing digital behavioural weight management programme, Weight Watchers (WW). METHOD Using a mixed-method study design, 249 adults seeking to manage weight were randomized to either the WW programme or WW supplemented with the self-compassion for weight management intervention (SC4WM). Participants completed measures of self-compassion, eating behaviour, physical activity, body weight and emotional well-being along with potential moderators, including weight self-stigma, eating restraint, psychological coping and perceived stress at baseline, post-intervention (4 weeks) and follow-up (12 weeks). RESULTS There was no evidence that the SC4WM intervention had a significantly different effect than WW alone. Other than body weight, all outcomes improved over time in both groups. Self-compassion was slightly higher overall in the SC4WM group (p = .05), with this group reporting higher self-kindness at 4 weeks (p = .014) and lower self-judgement at 12 weeks (p = .023) compared to the control group. CONCLUSIONS Although the SC4WM intervention group did show a small increase in self-kindness and reduction in self-judgement, weight management outcomes were not improved over and above the existing WW programme. Recommendations for adapting the SC4WM intervention to improve efficacy to augment weight management outcomes are provided.
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Affiliation(s)
| | - Nathan S Consedine
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- Section of Epidemiology and Bisostatistics, Facultity of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Rajshri Roy
- Department of Nutrition and Dietetics, The University of Auckland, Auckland, New Zealand
| | | | - Anna Serlachius
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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Weydmann G, Miguel PM, Hakim N, Dubé L, Silveira PP, Bizarro L. How are overweight and obesity associated with reinforcement learning deficits? A systematic review. Appetite 2024; 193:107123. [PMID: 37992896 DOI: 10.1016/j.appet.2023.107123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
Reinforcement learning (RL) refers to the ability to learn stimulus-response or response-outcome associations relevant to the acquisition of behavioral repertoire and adaptation to the environment. Research data from correlational and case-control studies have shown that obesity is associated with impairments in RL. The aim of the present study was to systematically review how obesity and overweight are associated with RL performance. More specifically, the relationship between high body mass index (BMI) and task performance was explored through the analysis of specific RL processes associated with different physiological, computational, and behavioral manifestations. Our systematic analyses indicate that obesity might be associated with impairments in the use of aversive outcomes to change ongoing behavior, as revealed by results involving instrumental negative reinforcement and extinction/reversal learning, but further research needs to be conducted to confirm this association. Hypotheses regarding how obesity might be associated with altered RL were discussed.
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Affiliation(s)
- Gibson Weydmann
- Department of Psychology, Universidade Federal Do Rio Grande Do Sul (UFRGS), 2600 Ramiro Barcelos, Postal Code 90035-003, Porto Alegre, Brazil; Ludmer Centre for Neuroinformatics and Mental Health, Montreal Neurological Institute, 3801 University, Postal Code H3A 2B4, Montreal, Quebec, Canada.
| | - Patricia Maidana Miguel
- Ludmer Centre for Neuroinformatics and Mental Health, Montreal Neurological Institute, 3801 University, Postal Code H3A 2B4, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, 1033 Pine Ave W, Postal Code H3A 1A1, Montreal, Quebec, Canada
| | - Nour Hakim
- Department of Psychology, University of Toronto, 100 George Street, Postal Code M1C 1A4, Toronto, Ontario, Canada; Desautels Faculty of Management, McGill Center for the Convergence of Health and Economics, McGill University, 1001 Sherbrooke, Postal Code H3A 1G5, Montreal, Quebec, Canada
| | - Laurette Dubé
- Desautels Faculty of Management, McGill Center for the Convergence of Health and Economics, McGill University, 1001 Sherbrooke, Postal Code H3A 1G5, Montreal, Quebec, Canada
| | - Patricia Pelufo Silveira
- Ludmer Centre for Neuroinformatics and Mental Health, Montreal Neurological Institute, 3801 University, Postal Code H3A 2B4, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, 1033 Pine Ave W, Postal Code H3A 1A1, Montreal, Quebec, Canada
| | - Lisiane Bizarro
- Department of Psychology, Universidade Federal Do Rio Grande Do Sul (UFRGS), 2600 Ramiro Barcelos, Postal Code 90035-003, Porto Alegre, Brazil
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Cavaggioni L, Gilardini L, Croci M, Formenti D, Merati G, Bertoli S. The usefulness of Integrative Neuromuscular Training to counteract obesity: a narrative review. Int J Obes (Lond) 2024; 48:22-32. [PMID: 37775520 PMCID: PMC10746545 DOI: 10.1038/s41366-023-01392-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND AND OBJECTIVE The association between physical activity and diet has a valuable impact in weight status management to counteract obesity. In this context, within different training strategies (i.e., endurance, resistance training, concurrent training, agility training) the Integrative Neuromuscular Training (INT) represents a structured training mode focused on global human movement pattern development with the aim to enhance motor control, mobility and stability. In this narrative review we aimed to discuss the feasibility of INT interventions on physical fitness and body composition outcomes in individuals with obesity. SUBJECTS Medline/PubMed, EMBASE, Web of Science, Google Scholar including were searched before 1st February 2023 without restrictions on publication year. METHODS Two researchers extracted data from published trials. Randomized controlled trials or clinical trials, Body Mass Index of children and adolescents at the 95% percentile or greater, and for adults to be above 30 kg/m2, detailed intervention description, randomization process and allocation into an experimental or a control group, trials must have been written in English, were included. RESULTS We included a total of 19 studies complying with the inclusion criteria for the review process. There is evidence that INT promotes positive adaptations in fitness levels in both younger and older participants with concomitant ameliorations during a shorter, medium and longer time period. Moreover, cardiorespiratory fitness, muscular strength, balance, postural control and body composition reached significant remarkable improvements following a specific intervention based on INT principles compared to other training mode. However, Body Mass Index, fat mass percentage and waist circumference showed similar changes overtime. CONCLUSIONS Taken together, these findings support the effectiveness of INT in ameliorating physical fitness (i.e., health-related and skill related components) without negative changes in body composition. Nevertheless, fitness coaches and therapists may consider this training modality a feasible option when prescribing physical exercise in outpatients with obesity.
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Affiliation(s)
- Luca Cavaggioni
- Obesity Unit - Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20145, Milan, Italy.
| | - Luisa Gilardini
- Obesity Unit - Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20145, Milan, Italy
| | - Marina Croci
- Obesity Unit - Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20145, Milan, Italy
| | - Damiano Formenti
- Department of Biotechnology and Life Sciences, University of Insubria, 21100, Varese, Italy
| | - Giampiero Merati
- Department of Biotechnology and Life Sciences, University of Insubria, 21100, Varese, Italy
- IRCCS Fondazione don Carlo Gnocchi, 20148, Milan, Italy
| | - Simona Bertoli
- Obesity Unit - Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20145, Milan, Italy
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133, Milan, Italy
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Everitt JD, Battista-Dowds EM, Heggs D, Hewlett P, Squire ALM. Determinants of completion and early dropout in an adult weight management service: a prospective observational study. J Hum Nutr Diet 2023; 36:1931-1941. [PMID: 37357716 DOI: 10.1111/jhn.13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/05/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND High attrition rates in weight management interventions (WMIs) undermine their effectiveness but are poorly understood. This study aimed to identify determinants of completion and early dropout in National Health Service (NHS) WMIs. METHODS In this prospective observational study, 329 patients recruited at initial consultation appointments satisfied the eligibility criteria: age ≥18 years and body mass index (BMI) ≥30 kg/m2 . Multivariate logistic regression analyses were performed to identify the odds ratios (OR, given with 95% confidence interval) of completion and early dropout. RESULTS Intervention completion rate was 39.8% (131 of 329). Variables that increased the likelihood of completion included engagement in support sessions, OR10.6 (4.7-23.6, p < 0.001); male sex, OR2.5 (1.4-4.5, p = 0.002); osteoarthritis, OR1.9 (1.1-3.3, p = 0.014); and one or more missed intervention appointments marked as 'could not attend' (notified nonattendance), OR1.8 (1.1-2.9, p = 0.032). Odds of early dropout were higher for participants with anxiety and depression OR2.0 (1.0-4.0, p = 0.039). Dietetic 1:1 participants were less likely to drop out early compared with group programme participants, OR0.3 (0.2-0.7, p = 0.002), but were less likely to complete the full intervention, OR0.5 (0.3-0.9, p = 0.02). Age, BMI, social deprivation and travel distance were among the variables not associated with completion or early dropout. CONCLUSIONS This study provides further evidence of the importance of support for participants of WMIs and the need for services to consider how support networks can be incorporated. Patients with poorer mental health may be more likely to drop out early and consequently benefit less from WMIs. Future research should qualitatively explore why these factors contribute to attrition to improve WMI effectiveness.
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Affiliation(s)
| | - Enzo M Battista-Dowds
- Weight Management Service, Nutrition and Dietetics Department, Cwm Taff Morgannwg University Health Board, Merthyr Tydfil, Wales, UK
| | - Daniel Heggs
- Department of Applied Psychology, School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Paul Hewlett
- Department of Applied Psychology, School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Amanda L M Squire
- Department of Healthcare and Food, School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
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Cava E, Spadaccini D, Aimaretti G, Marzullo P, Cavigiolo B, Farinelli D, Gennari A, Saggia C, Carbonelli MG, Riso S, Prodam F. Weight Management Effectiveness and Predictors of Dropout in Breast Cancer Survivors: A Retrospective Study. Cancers (Basel) 2023; 15:4401. [PMID: 37686676 PMCID: PMC10486561 DOI: 10.3390/cancers15174401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Reducing obesity and weight gain, which often occurs during breast cancer treatment, may represent an efficient secondary or tertiary prevention against cancer. PURPOSE This retrospective observational cohort study aimed to assess the impact of a Mediterranean diet on weight and anthropometric changes in women completing active breast cancer treatment. Additionally, we sought to identify factors associated with study dropout within one year. METHODS A total of 182 female patients (20 normal weight, 59 overweight, 103 obese) received personalized Mediterranean diet interventions and underwent monthly outpatient visits. RESULTS Dropout rates were 42.3% at 6 months and 64.1% at 12 months. Among the obese subgroup, BMI (p < 0.001) and fat mass (p < 0.05) decreased after 6 months. At 12 months, the obese subgroup showed a borderline significant further reduction in BMI (p = 0.062). BMI or weight loss did not predict dropout at any time point. However, age (OR = 0.91) and diastolic blood pressure (OR = 1.07) were significant predictors of dropout at 12 months. CONCLUSION Implementing a Mediterranean diet can lead to weight and anthropometric improvements in breast cancer survivors. Further research is necessary to explore the long-term effects of weight loss on these individuals, identify effective dietary approaches, and consider specific predictors of dropout.
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Affiliation(s)
- Edda Cava
- Unit of Dietetic and Clinical Nutrition, San Camillo-Forlanini Hospital, 00149 Rome, Italy; (E.C.); (M.G.C.)
| | - Daniele Spadaccini
- Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy; (D.S.); (G.A.); (P.M.)
| | - Gianluca Aimaretti
- Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy; (D.S.); (G.A.); (P.M.)
- SCDU Endocrinology, University Hospital “Maggiore della Carità”, Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy;
| | - Paolo Marzullo
- Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy; (D.S.); (G.A.); (P.M.)
- SCDU Endocrinology, University Hospital “Maggiore della Carità”, Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy;
| | - Beatrice Cavigiolo
- SCDU Endocrinology, University Hospital “Maggiore della Carità”, Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy;
| | - Deborah Farinelli
- Unit of Dietetic and Clinical Nutrition, University Hospital “Maggiore della Carità”, 28100 Novara, Italy; (D.F.); (S.R.)
| | - Alessandra Gennari
- Division of Oncology, University Hospital “Maggiore della Carità”, Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy; (A.G.)
| | - Chiara Saggia
- Division of Oncology, University Hospital “Maggiore della Carità”, Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy; (A.G.)
| | - Maria Grazia Carbonelli
- Unit of Dietetic and Clinical Nutrition, San Camillo-Forlanini Hospital, 00149 Rome, Italy; (E.C.); (M.G.C.)
| | - Sergio Riso
- Unit of Dietetic and Clinical Nutrition, University Hospital “Maggiore della Carità”, 28100 Novara, Italy; (D.F.); (S.R.)
| | - Flavia Prodam
- Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy; (D.S.); (G.A.); (P.M.)
- SCDU Endocrinology, University Hospital “Maggiore della Carità”, Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy;
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Skjåkødegård HF, Hystad S, Bruserud I, Conlon RPK, Wilfley D, Frisk B, Roelants M, Juliusson PB, Danielsen YS. Perceived barriers in family-based behavioural treatment of paediatric obesity - Results from the FABO study. Pediatr Obes 2023; 18:e12992. [PMID: 36468217 PMCID: PMC10078207 DOI: 10.1111/ijpo.12992] [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: 06/01/2022] [Revised: 10/24/2022] [Accepted: 11/18/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND To date, few studies have investigated perceived barriers among those who participate in and drop out of family-based behavioural treatment (FBT) for paediatric obesity. Examining experienced barriers during treatment, and their role in participation and completion of treatment has important implications for clinical practice. OBJECTIVES To compare perceived barriers to participating in a family-based behavioural social facilitation treatment (FBSFT) for obesity among families who completed and did not complete treatment. METHODS Data were analysed from 90 families of children and adolescents (mean (M) age = 12.8 years, standard deviation (SD) = 3.05) with severe obesity enrolled in a 17-session FBSFT program. After completing 12 sessions or at the time of dropout, parents and therapists completed the Barriers to Treatment Participation Scale (BTPS), a 5-point Likert scale (1 = never a problem, 5 = very often a problem) which includes four subscales: 1. Stressors and obstacles that compete with treatment, 2. Treatment demands and issues, 3. Perceived relevance of treatment, 4. Relationship with the therapist. RESULTS Families who did not complete treatment scored significantly higher on the BTPS subscales stressors and obstacles that compete with treatment (M = 2.03, SD = 0.53 vs. M = 1.70, SD = 0.42), p = 0.010 and perceived relevance of treatment (M = 2.27, SD = 0.48 vs. M = 1.80, SD = 0.50), p < 0.001 than families who completed treatment. No other significant differences between groups were observed. CONCLUSION Families are more likely to drop out of FBSFT when experiencing a high burden from life stressors or when treatment is not meeting the expectations and perceived needs of the family.
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Affiliation(s)
| | - Sigurd Hystad
- Department of Psychosocial ScienceUniversity of BergenBergenNorway
| | - Ingvild Bruserud
- Faculty of HealthVID Specialized UniversityBergenNorway
- Department of PediatricsHaukeland University HospitalBergenNorway
| | - Rachel P. K. Conlon
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Denise Wilfley
- Department of PsychiatryWashington University School of MedicineSt. LouisMissouriUSA
| | - Bente Frisk
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
- Department of PhysiotherapyHaukeland University HospitalBergenNorway
| | - Mathieu Roelants
- Department of Public Health and Primary CareKU Leuven, University of LeuvenLeuvenBelgium
| | - Petur B. Juliusson
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Children and Youth ClinicHaukeland University HospitalBergenNorway
- Department of Health Registry Research and DevelopmentNorwegian Institute of Public HealthBergenNorway
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Ball GDC, O’Neill MG, Noor R, Alberga A, Azar R, Buchholz A, Enright M, Geller J, Ho J, Holt NL, Lebel T, Rosychuk RJ, Tarride JE, Zenlea I. A multi-center, randomized, 12-month, parallel-group, feasibility study to assess the acceptability and preliminary impact of family navigation plus usual care versus usual care on attrition in managing pediatric obesity: a study protocol. Pilot Feasibility Stud 2023; 9:14. [PMID: 36691103 PMCID: PMC9868519 DOI: 10.1186/s40814-023-01246-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Pediatric obesity management can be successful, but some families discontinue care prematurely (i.e., attrition), limiting treatment impact. Attrition is often a consequence of barriers and constraints that limit families' access to obesity management. Family Navigation (FN) can improve access, satisfaction with care, and treatment outcomes in diverse areas of healthcare. To help our team prepare for a future effectiveness trial, the objectives of our randomized feasibility study are to (i) explore children's and caregivers' acceptability of FN and (ii) examine attrition, measures of study rigor and conduct, and responses to FN + Usual Care vs Usual Care by collecting clinical, health services, and health economic data. METHODS In our 2.5-year study, 108 6-17-year-olds with obesity and their caregivers will be randomized (1:1) to FN + Usual Care or Usual Care after they enroll in obesity management clinics in Calgary and Mississauga, Canada. Our Stakeholder Steering Committee and research team will use Experience-Based Co-Design to design and refine our FN intervention to reduce families' barriers to care, maximizing the intervention dose families receive. FN will be delivered by a navigator at each site who will use logistical and relational strategies to enhance access to care, supplementing obesity management. Usual Care will be offered similarly at both clinics, adhering to expert guidelines. At enrollment, families will complete a multidisciplinary assessment, then meet regularly with a multidisciplinary team of clinicians for obesity management. Over 12 months, both FN and Usual Care will be delivered virtually and/or in-person, pandemic permitting. Data will be collected at 0, 3, 6, and 12 months post-baseline. We will explore child and caregiver perceptions of FN acceptability as well as evaluate attrition, recruitment, enrolment, randomization, and protocol integrity against pre-set success thresholds. Data on clinical, health services, and health economic outcomes will be collected using established protocols. Qualitative data analysis will apply thematic analysis; quantitative data analysis will be descriptive. DISCUSSION Our trial will assess the feasibility of FN to address attrition in managing pediatric obesity. Study data will inform a future effectiveness trial, which will be designed to test whether FN reduces attrition. TRIAL REGISTRATION This trial was registered prospectively at ClinicalTrials.gov (# NCT05403658 ; first posted: June 3, 2022).
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Affiliation(s)
- Geoff D. C. Ball
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Marcus G. O’Neill
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Rafat Noor
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Angela Alberga
- grid.410319.e0000 0004 1936 8630Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC Canada
| | - Rima Azar
- grid.260288.60000 0001 2169 3908Psychobiology of Stress & Health Lab, Department of Psychology, Mount Allison University, Sackville, NB Canada
| | - Annick Buchholz
- grid.34428.390000 0004 1936 893XDepartment of Psychology, Carleton University, Ottawa, ON Canada
| | | | - Josie Geller
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Josephine Ho
- grid.22072.350000 0004 1936 7697Department of Paediatrics, University of Calgary, Calgary, AB Canada
| | - Nicholas L. Holt
- grid.17089.370000 0001 2190 316XFaculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB Canada
| | - Tracy Lebel
- Patient and Family Partner, Edmonton, AB Canada
| | - Rhonda J. Rosychuk
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Jean-Eric Tarride
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
| | - Ian Zenlea
- grid.17063.330000 0001 2157 2938Department of Pediatrics, University of Toronto, Toronto, ON Canada
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Sexton JB, Adair KC, Cui X, Tawfik DS, Profit J. Effectiveness of a bite-sized web-based intervention to improve healthcare worker wellbeing: A randomized clinical trial of WISER. Front Public Health 2022; 10:1016407. [PMID: 36568789 PMCID: PMC9773843 DOI: 10.3389/fpubh.2022.1016407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
Importance Problems with the wellbeing of healthcare workers (HCWs) are widespread and associated with detrimental consequences for the workforce, organizations, and patients. Objective This study tested the effectiveness of the Web-based Implementation for the Science of Enhancing Resilience (WISER) intervention, a positive psychology program, to improve six dimensions of the wellbeing of HCWs. Design We conducted a randomized controlled trial of HCWs between 1 April 2018 and 22 July 2019. Cohort 1 received WISER daily for 10 days. Cohort 2 acted as a waitlist control before receiving WISER. Setting Web-based intervention for actively employed HCWs across the United States. Participants Eligibility criteria included being ≥18 years old and working as a HCW. Each participant was randomized to start the intervention or serve as a waitlist control for 14 days before starting the intervention. Interventions Cohorts received links via 10 texts exposing them to introductory videos and positive psychology exercises (3 good things, cultivating awe, random acts of kindness, cultivating relationships, and gratitude letters). Main outcomes and measures The primary outcome was emotional exhaustion; secondary outcomes included depressive symptoms, work-life integration, happiness, emotional thriving, and emotional recovery. All outcomes were assessed at baseline, 1-week post-intervention (primary endpoint), and 1, 6, and 12-month post-intervention. Outcomes were measured using six validated wellbeing instruments, rescaled to 100-point scales for comparison. Six items assessed participants' WISER experience. The analysis employed mixed-effects models. Results In cohorts 1 and 2, 241 and 241 initiated WISER, and 178 (74%) and 186 (77%) completed the 6-month follow-up, respectively. Cohort populations were similar at baseline, mostly female (81; 76%) and nurses (34; 32%) or physicians (22; 23%), with 1-10 years of experience in their current position (54; 52%). Relative to control, WISER significantly improved depressive symptoms [-7.5 (95%CI: -11.0, -4.0), p < 0.001], work-life integration [6.5 (95%CI: 4.1, 8.9), p < 0.001], happiness [5.7 (95%CI: 3.0, 8.4), p < 0.001], emotional thriving [6.4 (95%CI: 2.5, 10.3), p = 0.001], and emotional recovery [5.3 (95%CI: 1.7, 8.9), p = 0.004], but not emotional exhaustion [-3.7 (95%CI: -8.2, 0.8), p = 0.11] at 1 week. Combined cohort results at 1, 6, and 12 months showed that all six wellbeing outcomes were significantly improved relative to baseline (p < 0.05 for all). Favorable impressions of WISER were reported by 87% of participants at the 6-month post-assessment. Conclusion and relevance WISER improved HCW depressive symptoms, work-life integration, happiness, emotional thriving, and emotional recovery. Improvements in all HCW wellbeing outcomes endured at the 1-, 6-, and 12-month follow-ups. HCW's impressions of WISER were positive. Clinical trials number https://clinicaltrials.gov/ct2/show/, identifier: NCT02603133. Web-based Implementation for the Science of Enhancing Resilience Study (WISER).
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Affiliation(s)
- J. Bryan Sexton
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, United States,Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States,*Correspondence: J. Bryan Sexton
| | - Kathryn C. Adair
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, United States,Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States
| | - Xin Cui
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, United States,California Perinatal Quality Care Collaborative, Palo Alto, CA, United States
| | - Daniel S. Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, United States
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, United States,California Perinatal Quality Care Collaborative, Palo Alto, CA, United States
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Lennon C, Voss K, Vitek WS. Preconception health optimization in women with polycystic ovary syndrome - how to find the time? Curr Opin Endocrinol Diabetes Obes 2022; 29:541-546. [PMID: 36218230 DOI: 10.1097/med.0000000000000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive-age women, the most common cause of infertility among women and a major contributor to pregnancy complications. RECENT FINDINGS Diagnostic and associated features of PCOS, including hyperandrogenism, insulin resistance, and obesity, contribute to the 2-4-fold increased risk of pregnancy-induced hypertension and preeclampsia, gestational diabetes and preterm birth observed among pregnant women with PCOS. PCOS should be diagnosed according to the 2018 International Guideline. Screening for and optimizing management of hypertension, impaired glucose tolerance and obesity in the preconception window in women with PCOS provides an opportunity to increase the odds of a spontaneous pregnancy, live birth with fertility treatment and possibly reduce the risk of pregnancy complications. SUMMARY Providers should prioritize individualizing recommendations for preconception health optimization in women with PCOS in order to maximize the chance of conception, a healthy pregnancy and the health of future generations.
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Affiliation(s)
- Clare Lennon
- University of Rochester School of Medicine & Dentistry
| | - Kathryn Voss
- University of Rochester Medical Center, Department of Obstetrics and Gynecology, Rochester, New York, USA
| | - Wendy S Vitek
- University of Rochester Medical Center, Department of Obstetrics and Gynecology, Rochester, New York, USA
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Walker MS, Tarasiuk FS, Gustavo AS, Oliveira MS, Donadio MVF, Feoli AMP. Lifestyle improvement reduces the consumption of ultra-processed foods in adults with metabolic syndrome. Nutr Metab Cardiovasc Dis 2022; 32:1990-1997. [PMID: 35606223 DOI: 10.1016/j.numecd.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS The high consumption of ultra-processed products is a concern because it is positively associated with the incidence of chronic non-communicable diseases, as metabolic syndrome (MetS). The aim is to evaluate the effects of three different interventions to modify lifestyle on the consumption of ultra-processed foods in adults with MetS. METHODS AND RESULTS This was a randomized clinical trial, in which the participants were divided into three groups: Standard Intervention (SI), Group Intervention (GI) and Individual Intervention (II). The interventions were carried out over a three-month period and the data was collected in a 24-h food record, taken at the beginning and end of the intervention. The food they ate was classified into four groups according to the degree of processing (unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods) in accordance with the NOVA food classification. Seventy adults took part in the study with a mean age of 51.2 ± 6.6 years old; most of whom were female (55.7%). The amount of ultra-processed food consumed by the three groups (SI, GI and II) was significantly reduced (46%, 34%, and 33%, respectively). The amount of processed food consumed only reduced in the II group. The Total Energy Value (TEV) consumed by the SI and II groups decreased. CONCLUSIONS The interventions that were intended to alter lifestyles were able to reduce the amount of ultra-processed food consumed, which can have an impact on the prevention and treatment of MetS. REGISTRATION registered in the Brazilian Registry of Clinical Trials, ReBEC, under number: RBR-9wz5fc.
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Affiliation(s)
- M S Walker
- Pontifical Catholic University of Rio Grande do Sul, PUCRS, Brazil
| | - F S Tarasiuk
- Pontifical Catholic University of Rio Grande do Sul, PUCRS, Brazil
| | - A S Gustavo
- Pontifical Catholic University of Rio Grande do Sul, PUCRS, Brazil
| | - M S Oliveira
- Pontifical Catholic University of Rio Grande do Sul, PUCRS, Brazil
| | - M V F Donadio
- Pontifical Catholic University of Rio Grande do Sul, PUCRS, Brazil
| | - A M P Feoli
- Pontifical Catholic University of Rio Grande do Sul, PUCRS, Brazil.
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12
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Ho AS, Behr H, Mitchell ES, Yang Q, Lee J, May CN, Michaelides A. Goal language is associated with attrition and weight loss on a digital program: Observational study. PLOS DIGITAL HEALTH 2022; 1:e0000050. [PMID: 36812521 PMCID: PMC9931249 DOI: 10.1371/journal.pdig.0000050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/24/2022] [Indexed: 06/18/2023]
Abstract
Behavioral weight loss reduces risk of weight-related health complications. Outcomes of behavioral weight loss programs include attrition and weight loss. There is reason to believe that individuals' written language on a weight management program may be associated with outcomes. Exploring associations between written language and these outcomes could potentially inform future efforts towards real-time automated identification of moments or individuals at high risk of suboptimal outcomes. Thus, in the first study of its kind, we explored whether individuals' written language in actual use of a program (i.e., outside of a controlled trial) is associated with attrition and weight loss. We examined two types of language: goal setting (i.e., language used in setting a goal at the start of the program) and goal striving (i.e., language used in conversations with a coach about the process of striving for goals) and whether they are associated with attrition and weight loss on a mobile weight management program. We used the most established automated text analysis program, Linguistic Inquiry Word Count (LIWC), to retrospectively analyze transcripts extracted from the program database. The strongest effects emerged for goal striving language. In striving for goals, psychologically distanced language was associated with more weight loss and less attrition, while psychologically immediate language was associated with less weight loss and higher attrition. Our results highlight the potential importance of distanced and immediate language in understanding outcomes like attrition and weight loss. These results, generated from real-world language, attrition, and weight loss (i.e., from individuals' natural usage of the program), have important implications for how future work can better understand outcomes, especially in real-world settings.
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Affiliation(s)
- Annabell Suh Ho
- Academic Research, Noom, Inc., New York, New York, United States of America
| | - Heather Behr
- Academic Research, Noom, Inc., New York, New York, United States of America
- Department of Integrative Health, Saybrook University, Pasadena, California, United States of America
| | | | - Qiuchen Yang
- Academic Research, Noom, Inc., New York, New York, United States of America
| | - Jihye Lee
- Department of Communication, Stanford University, Stanford, California, United States of America
| | - Christine N. May
- Academic Research, Noom, Inc., New York, New York, United States of America
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Crockett KB, Borgatti A, Tan F, Tang Z, Dutton G. Weight Discrimination Experienced Prior to Enrolling in a Behavioral Obesity Intervention is Associated with Treatment Response Among Black and White Adults in the Southeastern U.S. Int J Behav Med 2022; 29:152-159. [PMID: 34341957 PMCID: PMC9125874 DOI: 10.1007/s12529-021-10009-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The current study evaluated the associations between history of weight discrimination and race on pre-treatment depressive symptoms, treatment session attendance, and weight loss among Black and White adults enrolled in a 16-week obesity intervention. METHODS Participants (N = 271; mean BMI = 35.7 kg/m2; 59% Black; 92% women) reported prior experiences of weight discrimination and completed the Center for Epidemiological Studies Depression (CES-D) Scale at baseline. Weekly attendance at group sessions was recorded, and weight was measured at baseline and post-treatment. All models adjusted for baseline BMI, age, and sex. RESULTS Participants with a history of weight discrimination scored 2.4 points higher on the CES-D (B = 2.432, p = .012) and lost 2% less weight relative to those without weight discrimination (B = 0.023, p = .002). Race modified the association between weight discrimination and treatment session attendance, such that Black individuals attended fewer sessions if they had prior experience of weight discrimination, but prior weight discrimination was not significantly associated with treatment attendance among White individuals. CONCLUSION Weight discrimination is associated with pre-treatment depressive symptoms and may hinder weight loss regardless of race. Black individuals may attend fewer weight loss treatment sessions if they have prior experience of weight discrimination.
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Affiliation(s)
- Kaylee B Crockett
- Department of Family and Community Medicine, School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA.
| | - Alena Borgatti
- Division of Preventive Medicine, School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Fei Tan
- Department of Mathematical Sciences, School of Science, Indiana University - Purdue University Indianapolis, IN, Indianapolis, USA
| | - Ziting Tang
- Department of Mathematical Sciences, School of Science, Indiana University - Purdue University Indianapolis, IN, Indianapolis, USA
| | - Gareth Dutton
- Division of Preventive Medicine, School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
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Brenton-Peters JM, Consedine NS, Cavadino A, Roy R, Serlachius AS. Investigating the effect of an online self-compassion for weight management (SC4WM) intervention on self-compassion, eating behaviour, physical activity and body weight in adults seeking to manage weight: protocol for a randomised controlled trial. BMJ Open 2022; 12:e056174. [PMID: 35105594 PMCID: PMC8808316 DOI: 10.1136/bmjopen-2021-056174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Individual weight management, defined as engaging in behaviours to maintain or lose weight, can improve health and well-being. However, numerous factors influence weight management outcomes, such as genetics, biology, stress, the social and physical environment. Consequently, weight management can be hard. Self-compassion, described as treating oneself kindly in times of failure or distress, has shown promise in improving weight management outcomes. The objectives of this study are twofold: (1) to examine the efficacy of an online self-compassion for weight management (SC4WM) intervention coupled with an online commercial weight management programme (WW Weight Watchers reimagined) with increasing self-compassion and improving weight management outcomes (eating behaviour, physical activity and body weight) in comparison with the WW programme only and (2) to explore whether improvements in weight management outcomes are moderated by eating restraint, weight self-stigma, perceived stress and psychological coping. METHODS AND ANALYSIS To achieve these objectives, 240 participants seeking to manage their weight were randomised to either an online behavioural commercial weight management programme (WW) or the online WW +SC4 WM intervention. Validated measures of self-compassion, stress, weight self-stigma, eating restraint, psychological coping and weight management outcomes were administered online at baseline, 4 weeks and at a 12-week follow-up. ETHICS AND DISSEMINATION Ethics has been granted by the University of Auckland Health Research Ethics committee. Results will be communicated in peer-review journals, conferences and a doctoral thesis. If effective in increasing self-compassion and improving weight management outcomes, the intervention could be made more widely available to supplement behavioural weight management programmes. TRIAL REGISTRATION NUMBER ACTRN12621000580875; Pre-results.
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Affiliation(s)
| | - Nathan S Consedine
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rajshri Roy
- Department of Nutrition and Dietetics, The University of Auckland, Auckland, New Zealand
| | - Anna Sofia Serlachius
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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Vermeiren E, Van Eyck A, Van De Maele K, Ysebaert M, Makhout S, De Guchtenaere A, Van Helvoirt M, Tanghe A, Naets T, Vervoort L, Braet C, Bruyndonckx L, De Winter B, Verhulst S, Van Hoorenbeeck K. The Predictive Value of Adipokines and Metabolic Risk Factors for Dropouts and Treatment Outcomes in Children With Obesity Treated in a Pediatric Rehabilitation Center. Front Endocrinol (Lausanne) 2022; 13:822962. [PMID: 35769076 PMCID: PMC9234213 DOI: 10.3389/fendo.2022.822962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/29/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Inpatient pediatric obesity treatments are highly effective, although dropouts and weight regain threaten long-term results. Preliminary data indicate that leptin, adiponectin, and cardiometabolic comorbidities might predict treatment outcomes. Previous studies have mainly focused on the individual role of adipokines and comorbidities, which is counterintuitive, as these risk factors tend to cluster. This study aimed to predict the dropouts and treatment outcomes by pre-treatment patient characteristics extended with cardiometabolic comorbidities (individually and in total), leptin, and adiponectin. METHODS Children aged 8-18 years were assessed before, immediately after and 6 months after a 12-month inpatient obesity treatment. Anthropometric data were collected at each visit. Pre-treatment lipid profiles; glucose, insulin, leptin, and adiponectin levels; and blood pressure were measured. The treatment outcome was evaluated by the change in body mass index (BMI) standard deviation score (SDS) corrected for age and sex. RESULTS We recruited 144 children with a mean age of 14.3 ± 2.2 years and a mean BMI of 36.7 ± 6.2 kg/m2 corresponding to 2.7 ± 0.4 BMI SDS. The 57 patients who dropped out during treatment and the 44 patients who dropped out during aftercare had a higher pre-treatment BMI compared to the patients who completed the treatment (mean BMI, 38.3 ± 6.8 kg/m2 vs 35.7 ± 5.5 kg/m2) and those who completed aftercare (mean BMI, 34.6 ± 5.3 kg/m2 vs 37.7 ± 6.3 kg/m2) (all p<0.05). Additionally, aftercare attenders were younger than non-attenders (mean age, 13.4 ± 2.3 years vs 14.9 ± 2.0, p<0.05).Patients lost on average 1.0 ± 0.4 SDS during treatment and regained 0.4 ± 0.3 SDS post-treatment corresponding to regain of 43 ± 27% (calculated as the increase in BMI SDS post-treatment over the BMI SDS lost during treatment). A higher BMI and more comorbidities inversely predicted BMI SDS reduction in linear regression (all p<0.05).The absolute BMI SDS increase after returning home was predicted by pre-treatment leptin and systolic blood pressure, whereas the post-treatment BMI SDS regain was predicted by pre-treatment age, leptin, and adiponectin levels (all p<0.05) in multivariate linear regressions. CONCLUSION Patients who need treatment the most are at increased risk for dropouts and weight regain, emphasizing the urgent need for interventions to reduce dropout and support inpatients after discharge. Furthermore, this study is the first to report that pre-treatment leptin and adiponectin levels predict post-treatment BMI SDS regain, requiring further research.
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Affiliation(s)
- Eline Vermeiren
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | | | - Marijke Ysebaert
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Sanae Makhout
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | | | | | - Tiffany Naets
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Leentje Vervoort
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
- Department of Developmental Psychology, Radboud University, Nijmegen, Netherlands
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Luc Bruyndonckx
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
- Department of Pediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Benedicte De Winter
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stijn Verhulst
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
- *Correspondence: Kim Van Hoorenbeeck,
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James A, Lawrence B, O’Connor M. Healthy Eating as a New Way of Life: A Qualitative Study of Successful Long-Term Diet Change. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221090397. [PMID: 35418258 PMCID: PMC9016560 DOI: 10.1177/00469580221090397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Improving diet quality has been shown to be an effective way to improve
health and well-being. Yet information on how to assist those wanting to
transition to and maintain a healthier diet is still limited. The aim of
this study was to explore what motivated people to initiate and maintain a
healthy diet. Methods Semi-structured interviews were conducted with 20 participants (all
Australian residents) who had made significant improvements to their diets
and had maintained these changes for a minimum of two years
(nfemale = 15, nmale = 5, Mage = 37.7, SD = 12.4). The transcripts were analysed
using thematic analysis which identified five overarching themes: A desire
to feel better, investigation and learning, helpful habits, benefits, and
values. Results Participants reported a strong wish to feel better and investigated the role
of diet as a possible way to improve well-being. Through daily habits and
continuous engagement with the topic, healthy eating became a way of life
for many participants. Experiencing the benefits of a healthier diet and
having developed strong values regarding diet and health supported long-term
maintenance. Conclusions Findings from the present study contribute to the literature in highlighting
the importance of internal motivation and autonomy for health behaviours.
Findings may inform the development of healthy eating interventions.
Encouraging autonomy, fostering values aligned with a healthier diet, and
helping individuals establish daily habits is likely to support change.
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Affiliation(s)
- Anna James
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Blake Lawrence
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Moira O’Connor
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
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Robinson K, Muir S, Newbury A, Santos-Merx L, Appleton KM. Perceptions of body weight that vary by body mass index: Clear associations with perceptions based on personal control and responsibility. J Health Psychol 2022; 27:147-165. [PMID: 32431165 PMCID: PMC8739579 DOI: 10.1177/1359105320916540] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This project aimed to identify the perceptions of body weight that vary by body mass index. First, a qualitative study explored body weight perceptions in 17 individuals with overweight. Second, a questionnaire was developed and completed by a UK sample with body mass index from 16.6 to 59.7 kg/m2 (N = 328). A higher body mass index was associated with perceptions of less personal control and responsibility. Body mass index in females was also associated with three other questionnaire factors and body mass index in males with illness/medication. Thus, body mass index was associated with different perceptions of body weight. Focussing on personal control and responsibility may be useful for treatment and prevention.
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Gourash WF, King WC, Shirley E, Hinerman A, Ebel F, Pomp A, Pories WJ, Courcoulas AP. Five-year attrition, active enrollment, and predictors of level of participation in the Longitudinal Assessment of Bariatric Surgery (LABS-2) study. Surg Obes Relat Dis 2021; 18:394-403. [PMID: 35027321 DOI: 10.1016/j.soard.2021.11.023] [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: 10/14/2021] [Revised: 11/16/2021] [Accepted: 11/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reporting high-quality bariatric surgery outcomes depends on participant attrition and level of study participation among enrolled participants. OBJECTIVES Our aims are to report participant attrition, active enrollment, and level of participation, and to evaluate pre-surgery sociodemographic, physical health, and psychosocial factors as predictors of attrition and level of participation through 5 years. SETTING The Longitudinal Assessment of Bariatric Surgery-2 study which enrolled 2458 adults undergoing a first bariatric surgical procedure at 1 of 6 US cites from 2006 through 2009. METHODS In-person research assessments were conducted pre-surgery and annually for five years. Extensive retention strategies including offering remote assessments (telephone, email, mail, or a combination) were fully implemented in 2009. Among living participants, including those inactivated, annual follow-up assessments were categorized as in-person, remote or missed through 5 years. RESULTS By year 5, 1.7% of participants had died and 3.2% had withdrawn or were inactivated by the study staff; thus, attrition was 4.9% (n = 121). Controlling for site and calendar year, missed assessments increased from 14.7%-21.8% between years 1 and 2 and then stayed relatively stable (20.8%-19.6%) for years 3-5. Younger age, male sex, White race, lower body mass index, smoking, illicit drug use, and higher weight loss expectations preoperatively were independently associated with a higher likelihood of a missed versus in-person assessment across follow-up. CONCLUSION The LABS-2 participant attrition was low. The percentage of missed assessments did not increase after year 2, perhaps due to implementation of a comprehensive retention plan. Predictors of missed assessments highlight subgroups to target for focused retention efforts.
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Affiliation(s)
- William F Gourash
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Wendy C King
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eleanor Shirley
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amanda Hinerman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Faith Ebel
- Department of Surgery, Division of GI Metabolic and Bariatric Surgery, Weill Cornell Medicine, New York, New York
| | - Alfons Pomp
- Department of Surgery, University of Montreal, Montreal, Canada
| | - Walter J Pories
- Department of Surgery, East Carolina University, Greenville, North Carolina
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Ee C, Pirotta S, Mousa A, Moran L, Lim S. Providing lifestyle advice to women with PCOS: an overview of practical issues affecting success. BMC Endocr Disord 2021; 21:234. [PMID: 34814919 PMCID: PMC8609880 DOI: 10.1186/s12902-021-00890-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/28/2021] [Indexed: 12/22/2022] Open
Abstract
Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting up to 13 % of women. Lifestyle interventions are first-line treatments, however attrition in women with PCOS is high. This review summarises current evidence on barriers to lifestyle management in PCOS and suggested strategies for overcoming these challenges, mapped to the Capability, Opportunity, Motivation and Behaviour model.Physical capability for lifestyle changes may be impacted by altered gut hormone regulation and energy expenditure in PCOS. This may contribute to difficulties with weight management. The higher prevalence of eating disorders, disordered eating, fatigue and sleep disturbances are further barriers. Psychological capability may be reduced due psychological symptoms and lack of critical health literacy. Women with PCOS face similar challenges in terms of Opportunity to make lifestyle changes as other women of reproductive age. However, these are complicated by features more common in PCOS including body dissatisfaction. Motivation to adopt healthy lifestyles may be impacted by suboptimal risk perception and intrinsic motivation.To address these barriers, screening for and management of eating disorders, disordered eating, depression, and Obstructive Sleep Apnoea should be undertaken as per international evidence-based guidelines. A weight-neutral approach may be appropriate with disordered eating. Building capability among health professionals to better partner with women with PCOS on their management is essential in addressing health literacy gaps. Behavioural strategies that target risk perception and build intrinsic motivation should be utilised. More research is required to understand optimal self-management strategies, risk perception, energy homeostasis and overcoming attrition in women with PCOS.
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Affiliation(s)
- Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, NSW 2751 Penrith, Australia
| | - Stephanie Pirotta
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St. Kilda Road, VIC 3004 Melbourne, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation - MCHRI, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, VIC 3168 Clayton, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation - MCHRI, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, VIC 3168 Clayton, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation - MCHRI, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, VIC 3168 Clayton, Australia
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20
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Jones RA, Mueller J, Sharp SJ, Vincent A, Duschinsky R, Griffin SJ, Ahern AL. The impact of participant mental health on attendance and engagement in a trial of behavioural weight management programmes: secondary analysis of the WRAP randomised controlled trial. Int J Behav Nutr Phys Act 2021; 18:146. [PMID: 34743721 PMCID: PMC8574009 DOI: 10.1186/s12966-021-01216-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/20/2021] [Indexed: 01/07/2023] Open
Abstract
Background Low attendance and engagement in behavioural weight management trials are common. Mental health may play an important role, however previous research exploring this association is limited with inconsistent findings. We aimed to investigate whether mental health was associated with attendance and engagement in a trial of behavioural weight management programmes. Methods This is a secondary data analysis of the Weight loss referrals for adults in primary care (WRAP) trial, which randomised 1267 adults with overweight or obesity to brief intervention, WW (formerly Weight Watchers) for 12-weeks, or WW for 52-weeks. We used regression analyses to assess the association of baseline mental health (depression and anxiety (by Hospital Anxiety and Depression Scale), quality of life (by EQ5D), satisfaction with life (by Satisfaction with Life Questionnaire)) with programme attendance and engagement in WW groups, and trial attendance in all randomised groups. Results Every one unit of baseline depression score was associated with a 1% relative reduction in rate of WW session attendance in the first 12 weeks (Incidence rate ratio [IRR] 0.99; 95% CI 0.98, 0.999). Higher baseline anxiety was associated with 4% lower odds to report high engagement with WW digital tools (Odds ratio [OR] 0.96; 95% CI 0.94, 0.99). Every one unit of global quality of life was associated with 69% lower odds of reporting high engagement with the WW mobile app (OR 0.31; 95% CI 0.15, 0.64). Greater symptoms of depression and anxiety and lower satisfaction with life at baseline were consistently associated with lower odds of attending study visits at 3-, 12-, 24-, and 60-months. Conclusions Participants were less likely to attend programme sessions, engage with resources, and attend study assessments when reporting poorer baseline mental health. Differences in attendance and engagement were small, however changes may still have a meaningful effect on programme effectiveness and trial completion. Future research should investigate strategies to maximise attendance and engagement in those reporting poorer mental health. Trial registration The original trial (ISRCTN82857232) and five year follow up (ISRCTN64986150) were prospectively registered with Current Controlled Trials on 15/10/2012 and 01/02/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01216-6.
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Affiliation(s)
- Rebecca A Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| | - Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ann Vincent
- Department of Medicine, University College London, London, UK
| | - Robbie Duschinsky
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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21
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Brenton-Peters J, Consedine NS, Boggiss A, Wallace-Boyd K, Roy R, Serlachius A. Self-compassion in weight management: A systematic review. J Psychosom Res 2021; 150:110617. [PMID: 34560404 DOI: 10.1016/j.jpsychores.2021.110617] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Self-compassion - the tendency or ability to treat oneself kindly in times of failure or distress - may be a natural fit to support individuals who struggle with weight management. However, while self-compassion shows promise with improving health behaviours, the associations self-compassion has on weight management outcomes are unclear. The objective of this systematic review was three-fold: (1) to evaluate whether self-compassion interventions can increase individual self-compassion in the context of weight management, (2) to investigate if self-compassion interventions can improve weight management outcomes, defined as healthier eating, increased physical activity, or reduced weight and finally, (3) to explore whether these benefits can be sustained over the longer term. METHODS Following PRISMA guidelines, Scopus, PsycINFO, Medline, PubMed and Embase databases were searched. Studies including a measure of self-compassion and a self-compassion intervention reporting weight management outcomes were included. Studies in populations living with an eating disorder were excluded. The Quality Criteria Checklist from the American Dietetic Association was used to assess study quality. Prospero Registration #CRD42019146707. RESULTS Of the 9082 records screened, a total of 20 studies met inclusion criteria. Seventeen studies reported significant increases in self-compassion post-intervention. Improvements were also found for eating behaviours (15 of 18), physical activity behaviours (6 of 9), and weight loss (6 of 11). The majority of improvements were maintained at follow-up, except for physical activity behaviours (1 of 7). CONCLUSION Self-compassion interventions tailored to weight management outcomes demonstrate efficacy with increasing self-compassion post-intervention. Methodological weaknesses and questions about the maintenance of any improvements in weight management outcomes limit our ability to make strong conclusions. However, there is promise and clear relevance for including self-compassion interventions to enhance weight management outcomes; directions for improved intervention and study design are given.
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Affiliation(s)
| | - Nathan S Consedine
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
| | - Anna Boggiss
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
| | - Kate Wallace-Boyd
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Rajshri Roy
- Discipline of Nutrition and Dietetics, University of Auckland, Auckland, New Zealand.
| | - Anna Serlachius
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
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22
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Profit J, Adair KC, Cui X, Mitchell B, Brandon D, Tawfik DS, Rigdon J, Gould JB, Lee HC, Timpson WL, McCaffrey MJ, Davis AS, Pammi M, Matthews M, Stark AR, Papile LA, Thomas E, Cotten M, Khan A, Sexton JB. Randomized controlled trial of the "WISER" intervention to reduce healthcare worker burnout. J Perinatol 2021; 41:2225-2234. [PMID: 34366432 PMCID: PMC8440181 DOI: 10.1038/s41372-021-01100-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/26/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Test web-based implementation for the science of enhancing resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) burnout. DESIGN RCT using two cohorts of HCWs of four NICUs each, to improve HCW well-being (primary outcome: burnout). Cohort 1 received WISER while Cohort 2 acted as a waitlist control. RESULTS Cohorts were similar, mostly female (83%) and nurses (62%). In Cohorts 1 and 2 respectively, 182 and 299 initiated WISER, 100 and 176 completed 1-month follow-up, and 78 and 146 completed 6-month follow-up. Relative to control, WISER decreased burnout (-5.27 (95% CI: -10.44, -0.10), p = 0.046). Combined adjusted cohort results at 1-month showed that the percentage of HCWs reporting concerning outcomes was significantly decreased for burnout (-6.3% (95%CI: -11.6%, -1.0%); p = 0.008), and secondary outcomes depression (-5.2% (95%CI: -10.8, -0.4); p = 0.022) and work-life integration (-11.8% (95%CI: -17.9, -6.1); p < 0.001). Improvements endured at 6 months. CONCLUSION WISER appears to durably improve HCW well-being. CLINICAL TRIALS NUMBER NCT02603133; https://clinicaltrials.gov/ct2/show/NCT02603133.
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Affiliation(s)
- Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Kathryn C Adair
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, USA
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, USA
| | - Xin Cui
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Briana Mitchell
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Debra Brandon
- Duke University School of Nursing, Durham, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, USA
| | - Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Joseph Rigdon
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeffrey B Gould
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Henry C Lee
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Wendy L Timpson
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Martin J McCaffrey
- Division of Neonatal-Perinatal Medicine, University of North Carolina Chapel Hill School of Medicine and University of North Carolina Children's Hospital, Chapel Hill, NC, USA
| | - Alexis S Davis
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Mohan Pammi
- Section of Neonatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Melissa Matthews
- Department of Pediatrics-Neonatology, The University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Ann R Stark
- Department of Pediatrics, Division of Newborn Medicine, Harvard Medical School, Boston, MA, USA
| | - Lu-Ann Papile
- Division of Neonatology, Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Eric Thomas
- Department of Internal Medicine, The University of Texas Health Science Center and Memorial Hermann Medical Center, Houston, TX, USA
| | - Michael Cotten
- Division of Pediatrics-Neonatology, Duke University School of Medicine and Duke University Hospital, Durham, NC, USA
| | - Amir Khan
- Division of Neonatology, Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - J Bryan Sexton
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, USA.
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, USA.
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Wolver S, Fadel K, Fieger E, Aburish Z, O'Rourke B, Chandler TM, Shimotani D, Clingempeel N, Jain S, Jain A, Puri P. Clinical Use of a Real-World Low Carbohydrate Diet Resulting in Reduction of Insulin Dose, Hemoglobin A1c, and Weight. Front Nutr 2021; 8:690855. [PMID: 34458301 PMCID: PMC8385129 DOI: 10.3389/fnut.2021.690855] [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: 04/04/2021] [Accepted: 07/06/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction: Type 2 Diabetes Mellitus (T2DM) is increasing in epidemic proportions. In addition to the morbidity and mortality, for those treated with insulin, the physical, psychological, and financial tolls are often greater. Our real-world study evaluated a Low Carbohydrate Diet (LCD) in patients with T2DM on insulin with respect to glycemic control, insulin reduction, and weight loss. Materials and Methods: A prospective cohort study was conducted via an Electronic Medical Record search for patients attending the Virginia Commonwealth University Medical Weight Loss Program from 2014 to 2020 with Type 2 Diabetes Mellitus who initially presented on insulin. Data was extracted for 1 year after enrollment. The weight loss program focuses on a LCD. Results: Of 185 participants, the mean (± SD) age was 56.1 (9.9) years. Seventy percent were female and 63% were black. Eighty-five completed 12 months (45.9%), reduced their median (25-75% interquartile range, IQR) insulin dose from 69 to 0 units (0-18, p < 0.0001), HbA1c from 8 to 6.9% (6.2-7.8, p < 0.0001), and weight from 116 to 99 kg (85-120, p < 001). Eighty six percent who completed 12 months were able to reduce or discontinue insulin, with 70.6% completely discontinuing. Among all participants who completed 3, 6, or 12 months, 97.6% were able to reduce or eliminate insulin use. Conclusion: In patients with T2DM on a LCD, it is possible to reduce and even discontinue insulin use while facilitating weight loss and achieving glycemic control. A Low Carbohydrate Diet should be offered to all patients with diabetes, especially those using insulin.
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Affiliation(s)
- Susan Wolver
- Virginia Commonwealth University, Medical Center, Richmond, VA, United States
| | - Kristen Fadel
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Ethan Fieger
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Zein Aburish
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Brennen O'Rourke
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Toni-Marie Chandler
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Dorian Shimotani
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Natasha Clingempeel
- Virginia Commonwealth University, Medical Center, Richmond, VA, United States
| | - Shuchi Jain
- Virginia Commonwealth University, Richmond, VA, United States
| | - Aashish Jain
- Independent Researcher, Richmond, VA, United States
| | - Puneet Puri
- Virginia Commonwealth University, Medical Center, Richmond, VA, United States
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24
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Predictors of attrition from a weight loss program. A study of adult patients with obesity in a community setting. Eat Weight Disord 2021; 26:1729-1736. [PMID: 32816208 PMCID: PMC8292291 DOI: 10.1007/s40519-020-00990-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/11/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Obesity unit attrition is frequent and contributes to treatment failure. Many studies evaluating attrition predictors were part of randomized trials, and different terminology and criteria were used in the engagement field. We aimed to investigate the factors potentially implicated in early (< 12 weeks) and late (> 12 weeks) attrition from an obesity unit in a community setting METHODS: This was a retrospective cohort study of 250 patients with obesity who were followed-up at our obesity unit. Our program included at least 6 meetings in 12 months. Sociodemographic and anthropometric data, and psychometric questionnaires were collected from all participants. RESULTS One-hundred thirty-four (53.6%) participants dropped out. Those individuals showed lower BMI, lower overall health status, and increased depression scores. In a multiple regression model, BMI (inversely; OR = 0.90; 95%CI 0.84-0.96) and depression score (directly, OR = 1.05; 1.00-1.10) were associated with attrition risk. Early dropouts (n = 47) had lower weights, smaller waist circumferences and worse mental health scores than late dropouts (n = 87) and more frequently lived alone. When compared to completers, early dropouts had lower weights, BMIs, waist circumferences, overall health and mental status scores, increased depression scores and percentage of individuals living alone. In a multiple regression, lower BMI (OR = 0.83; 0.75-0.92), lower mental status score (OR = 3.17; 1.17-8.59) and living alone (OR = 2.25; 1.02-4.97) were associated with early attrition risk. CONCLUSION Lower BMI and increased depression score were associated with attrition. Early attrition was associated with lower weight, decreased mental well-being, and living alone. Individuals with these characteristics might need tailored approaches to enhance their engagement. LEVEL OF EVIDENCE Level V, retrospective descriptive study.
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25
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Jones HM, Oyebode O, Melendez-Torres GJ, Al-Khudairy L. Professional stakeholder's views of adolescent weight management programmes: a qualitative study. BMC Res Notes 2021; 14:125. [PMID: 33812371 PMCID: PMC8019507 DOI: 10.1186/s13104-021-05512-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Family-based multi-component weight management programmes are recommended for adolescents with obesity in England and Wales, however, these programmes suffer from poor uptake and high attrition rates. This study aimed to gather the views of professional stakeholders in a UK weight management programme to identify potential areas to target to improve engagement and success for such programmes. RESULTS Semi-structured interviews were conducted with those involved in the commissioning, referral, coordination or delivery of a weight management programme (n = 11). Interviews were analysed using qualitative content analysis. Three main categories developed: professional support, tailoring and intervention content. Participants recognised the importance of support from experienced professionals, as well as family and peers. There was agreement that longer-term support was needed for adolescents with obesity; suggestions included integrating follow-up support with schools and leisure services. Emotional and psychological support must be prioritised. Having a variety of delivery modes, such as group and one to one, particularly in the home environment, were recommended. Stakeholders agreed that weight management programmes for adolescents need to be more proactive at incorporating technology. By acting on the views of those that work closely with adolescents, engagement with weight management programmes may be improved.
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Affiliation(s)
- Helen M. Jones
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Oyinlola Oyebode
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - G. J. Melendez-Torres
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Lena Al-Khudairy
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
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26
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Determinants of attrition in a pediatric healthy lifestyle intervention: The CIRCUIT program experience. Obes Res Clin Pract 2021; 15:157-162. [PMID: 33608233 DOI: 10.1016/j.orcp.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 01/18/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Attrition in pediatric weight management programs is notoriously high. Greater understanding of its determinants is needed to inform retention strategies. We identified determinants of attrition in CIRCUIT, a healthy lifestyle intervention program for youth at risk of cardiovascular disease. METHODS A one-arm intervention study of children aged 4-18 years who initiated the CIRCUIT program in the first five years of its existence (N = 403). We defined attrition as attending the baseline visit but ceasing attendance prior to the 1-year follow-up. Potential determinants of dropout included the child's age, sex, ethnicity, body mass index (BMI) z-score, family socio-demographic characteristics, and estimated driving time to the program, all measured at baseline. Associations were estimated bivariately, using chi-squared- and t-tests, and simultaneously in a multivariable logistic regression model. RESULTS Of the 403 participants who started the program, 198 (49%) dropped out within 12 months of enrollment. Youth who dropped out were older (mean age 12.8y vs. 11.3y; p < 0.01), were less likely to live with both parents (62% vs. 71%; p = 0.05), and to have mothers who had completed high school (79% vs. 88%; p = 0.01). No group differences were observed for sex, ethnicity, baseline BMI z-score, fathers' education, or driving time to the program. In multivariate models, only older age at initiation of the intervention (OR: 1.2; CI: 1.1,1.3) and lower maternal education (OR: 2.0; CI: 1.0,3.8) were associated with dropout. CONCLUSION Improved tailoring of interventions to older pediatric participants and to families of lower maternal education may help reduce attrition in CIRCUIT and similar lifestyle intervention programs.
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27
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Amianto F, Martini M, Olandese F, Davico C, Abbate-Daga G, Fassino S, Vitiello B. Affectionless control: A parenting style associated with obesity and binge eating disorder in adulthood. EUROPEAN EATING DISORDERS REVIEW 2020; 29:178-192. [PMID: 33247868 DOI: 10.1002/erv.2809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Obesity is rising globally with a heavy health and economic burden. Early attachment experiences are relevant to the development of obesity. The purpose of this study was to investigate if parental care and attachment style experienced in childhood is associated with obesity, with or without binge eating disorder (BED), in adulthood. METHOD Parental style, personality traits, and psychopathology were assessed in 810 clinically referred adults with obesity, of whom 357 with BED and 453 without BED (non-BED), and 463 healthy subjects (HS). Assessments included the Parental Bonding Instrument, Temperament and Character Inventory, Eating Disorder Inventory-2, Symptom Checklist-90 and Beck Depression Inventory-II. RESULTS Both BED and non-BED reported lower maternal and paternal care and higher overprotection than HS. BED reported worse levels of parental care than non-BED and HS. 'Affectionless control' parenting style was more frequently reported by both BED and non-BED than HS. No significant differences in parenting style emerged between BED and non-BED. CONCLUSIONS Perception of parental 'affectionless control' was associated with obesity in adults, and lower quality of parental care was more frequently reported by participants with BED. Parental style may constitute an important target for early interventions to prevent obesity.
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Affiliation(s)
- Federico Amianto
- Department of Neurosciences, Psychiatry Section, Regional Pilot Centre for Eating Disorders, University of Torino, Torino, Italy
| | - Matteo Martini
- Department of Neurosciences, Psychiatry Section, Regional Pilot Centre for Eating Disorders, University of Torino, Torino, Italy
| | - Francesco Olandese
- Department of Neurosciences, Psychiatry Section, Regional Pilot Centre for Eating Disorders, University of Torino, Torino, Italy
| | - Chiara Davico
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Giovanni Abbate-Daga
- Department of Neurosciences, Psychiatry Section, Regional Pilot Centre for Eating Disorders, University of Torino, Torino, Italy
| | - Secondo Fassino
- Department of Neurosciences, Psychiatry Section, Regional Pilot Centre for Eating Disorders, University of Torino, Torino, Italy
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
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Grootens-Wiegers P, van den Eynde E, Halberstadt J, Seidell JC, Dedding C. The "Stages Towards Completion Model": what helps and hinders children with overweight or obesity and their parents to be guided towards, adhere to and complete a group lifestyle intervention. Int J Qual Stud Health Well-being 2020; 15:1735093. [PMID: 32148191 PMCID: PMC7144242 DOI: 10.1080/17482631.2020.1735093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: Lifestyle interventions can be effective in the management of overweight and obesity in children. However, ineffective guidance towards interventions and high attrition rates affect health impacts and cost effectiveness. The aim of this study was to gain insight into the factors influencing participation, in particular guidance towards, adherence to and completion of an intervention. Methods: A narrative literature review was performed to identify factors related to participation, leading to the development of the “Stages towards Completion Model”. Semi-structured interviews (n = 33) and three focus group discussions (n = 25) were performed with children and parents who completed two different group lifestyle interventions, as well as with their coaches. Results: The main barrier to participating in a lifestyle intervention was the complex daily reality of the participants. The main facilitator to overcome these barriers was a personal approach by all professionals involved. Conclusions: Participation in a lifestyle intervention is not influenced by one specific factor, but by the interplay of facilitators and barriers. A promising way to stimulate participation and thereby increase the effectiveness of interventions would be an understanding of and respect for the complex circumstances of participants and to personalize guidance towards and execution of interventions.
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Affiliation(s)
- Petronella Grootens-Wiegers
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Emma van den Eynde
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands.,Department of Pediatric Endocrinology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jutka Halberstadt
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Christine Dedding
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Medical Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Batrakoulis A, Tsimeas P, Deli CK, Vlachopoulos D, Ubago-Guisado E, Poulios A, Chatzinikolaou A, Draganidis D, Papanikolaou K, Georgakouli K, Batsilas D, Gracia-Marco L, Jamurtas AZ, Fatouros I. Hybrid neuromuscular training promotes musculoskeletal adaptations in inactive overweight and obese women: A training-detraining randomized controlled trial. J Sports Sci 2020; 39:503-512. [PMID: 33054601 DOI: 10.1080/02640414.2020.1830543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study investigated the effects of a 10-month high-intensity interval-type neuromuscular training programme on musculoskeletal fitness in overweight and obese women. Forty-nine inactive females (36.4 ± 4.4 yrs) were randomly assigned to either a control (N = 21), a training (N = 14, 10 months) or a training-detraining group (N = 14, 5 months training followed by 5 months detraining). Training used progressive loaded fundamental movement patterns with prescribed work-to-rest intervals (1:2, 1:1, 2:1) in a circuit fashion (2-3 rounds). Muscular strength and endurance, flexibility, passive range of motion (PRoM), static balance, functional movement screen (FMS) and bone mass density (BMD) and content (BMC) were measured at pre-, mid-, and post-intervention. Ten months of training induced greater changes than the controls in (i) BMD (+1.9%, p < 0.001) and BMC (+1.5%, p = 0.023) ii) muscular strength (25%-53%, p = 0.001-0.005); iii) muscular endurance (103%-195%, p < 0.001); and iv) mobility (flexibility: 40%, p < 0.001; PRoM [24%-53%, p = 0.001-0.05;]; balance: 175%, p = 0.058; FMS: +58%, p < 0.001). The response rate to training was exceptionally high (86-100%). Five months of detraining reduced but not abolished training-induced adaptations. These results suggest that a hybrid-type exercise approach integrating endurance-based bodyweight drills with resistance-based alternative modes into a real-world gym setting may promote musculoskeletal fitness in overweight and obese women.
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Affiliation(s)
- Alexios Batrakoulis
- School of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Panagiotis Tsimeas
- School of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Chariklia K Deli
- School of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Dimitrios Vlachopoulos
- College of Life and Environmental Sciences, Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Esther Ubago-Guisado
- Health and Social Research Center, Universidad De Castilla-La Mancha, Cuenca, Spain
| | - Athanasios Poulios
- School of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | | | - Dimitrios Draganidis
- School of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | | | - Kalliopi Georgakouli
- School of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Dimitrios Batsilas
- School of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Luis Gracia-Marco
- Faculty of Sport Sciences, Department of Physical Education and Sports, University of Granada, Granada, Spain
| | - Athanasios Z Jamurtas
- School of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Ioannis Fatouros
- School of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
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Königstein K, Infanger D, Klenk C, Carrard J, Hinrichs T, Schmidt-Trucksäss A. Physical activity is favorably associated with arterial stiffness in patients with obesity and elevated metabolic risk. Int J Clin Pract 2020; 74:e13563. [PMID: 32478973 DOI: 10.1111/ijcp.13563] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Physical activity and cardiorespiratory fitness (CRF) are relevant modifiers of cardiovascular risk. Their independent effects on arterial stiffness have not been assessed in people with obesity. This study aimed to assess the independent effects of light (LPA) and moderate-to-vigorous (MVPA) physical activity and CRF on Pulse wave velocity (PWV). METHODS Brachial-ankle PWV (baPWV) was measured cross-sectionally in 55 subjects (43.0 ± 13.8 years; 66% women) with moderate cardiovascular risk. Body composition was assessed with bioelectrical impedance-analysis. Daily minutes of LPA and MVPA were measured by accelerometry and CRF (peak oxygen uptake [VO2 peak]) with spiroergometry. Independent effects of LPA, MVPA, and VO2 peak on baPWV were analyzed in an age-, sex-, body fat mass-, and blood pressure-adjusted ANOVA. RESULTS Every 10 minutes increase of daily MVPA was associated with a 2.8% (0.32m/s [-0.64 to 0.001 m/s], P = .05) reduction of baPWV, whereas LPA and VO2 peak had only a little or no relevant effects on baPWV. CONCLUSIONS Higher MVPA is associated with lower composite arterial stiffness independent of CRF and the number of metabolic risk factors in patients with obesity and further metabolic risk factors. Thus, lifestyle interventions should aim for an increase in MVPA. BaPWV may improve the monitoring of favorable effects of MVPA, even if an improvement of VO2 peak cannot be obtained.
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Affiliation(s)
- Karsten Königstein
- Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Switzerland
| | - Christopher Klenk
- Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Switzerland
- Department of Radiology, Ludwig-Maximilians University, Munich, Germany
| | - Justin Carrard
- Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Switzerland
| | - Timo Hinrichs
- Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Switzerland
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Rispler C, Luria G. Employee perseverance in a "no phone use while driving" organizational road-safety intervention. ACCIDENT; ANALYSIS AND PREVENTION 2020; 144:105689. [PMID: 32682049 DOI: 10.1016/j.aap.2020.105689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION This interdisciplinary study explores factors that contribute to the perseverance of participants in an organizational "no phone use while driving" road-safety intervention. METHOD The study sample comprised 200 employees (mean age 43 years; 104 females [52 %], 96 males [48 %]) from 8 organizations in Israel. Subjects completed a 4-month organizational intervention using a smartphone application that monitored smartphone use, operationalized as taps per minute, where each tap represents a single instance of contact with the screen (e.g., touching, tapping or swiping). The app also silenced notifications during the intervention stage. Changes over time in tapping-while-driving behavior were examined through self-report questionnaires and objectively through the application's monitoring function. Validated measures were used to examine factors associated with perseverance in the program. RESULTS Organizational safety climate and gender (male) were positively related to perseverance in the intervention. Contrary to our hypothesis, safety motivation was not found to influence perseverance. CONCLUSIONS The present intervention is most effective for employees with high safety climate perceptions and for male employees. PRACTICAL APPLICATIONS The organizational intervention presented in the current study was shown to be effective in reducing smartphone use (touching, tapping or swiping) while driving. Our findings show that people will download and use an app that actively reduces their incentive to use their phones at the wheel by silencing incoming notifications. The findings support calls to harness the positive potential of information and communications technologies for organizational interventions.
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Affiliation(s)
- Clara Rispler
- Faculty of Welfare and Health Sciences, Department of Human Services, University of Haifa, Mount Carmel, Haifa, 31905, Israel.
| | - Gil Luria
- Faculty of Welfare and Health Sciences, Department of Human Services, University of Haifa, Mount Carmel, Haifa, 31905, Israel.
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Lie Fong S, Douma A, Verhaeghe J. Implementing the international evidence-based guideline of assessment and management of polycystic ovary syndrome (PCOS): how to achieve weight loss in overweight and obese women with PCOS? J Gynecol Obstet Hum Reprod 2020; 50:101894. [PMID: 32814159 DOI: 10.1016/j.jogoh.2020.101894] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 06/29/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. Many of these women are overweight or obese. A minor weight loss of 5%-10% can significantly reduce reproductive, metabolic and psychological symptoms of PCOS and is recommended as a first step in the treatment of overweight or obese women with PCOS. Many weight loss programs have been proposed, but optimal methods on how to achieve the recommend weight loss are lacking. The aim of this systematic review was to generate practical tools for health professionals to guide women with PCOS towards a sustainable healthier lifestyle. PRISMA guidelines were used to conduct the systematic review. Eleven randomized controlled trials were found eligible for inclusion. Lifestyle modification strategies consisted of a diet, physical exercise, behavioural coaching or combined interventions. Mean weight loss ranged from +0.5 to -10.6 % of the initial body weight. However, the majority of the studies reported considerable drop-out rates varying between 12% and 47%. The heterogeneity of the described interventions and the high drop-out rates impede extrapolation of these results to daily clinical care. Hence, none of the described interventions seems superior to another in achieving substantial weight loss. In conclusion, the need for obtaining a healthier weight in overweight and obese women with PCOS is now well accepted. However, achieving this goal remains a challenge for both patients and healthcare providers. More research focusing on the multidisciplinary approach of lifestyle modification advice in daily practice is needed.
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Affiliation(s)
- Sharon Lie Fong
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Herestraat 49 3000 Leuven, Belgium; Leuven University Fertility Centre, University Hospitals Leuven, Herestraat 49 3000 Leuven, Belgium.
| | - Annewiets Douma
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Herestraat 49 3000 Leuven, Belgium
| | - Johan Verhaeghe
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Herestraat 49 3000 Leuven, Belgium
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Holt RIG. The Management of Obesity in People with Severe Mental Illness: An Unresolved Conundrum. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:327-332. [PMID: 31587002 DOI: 10.1159/000503835] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/01/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom,
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Rombeek M, De Jesus S, Prapavessis H, Dempsey AA, Fraser D, Welisch E, Altamirano-Diaz L, Norozi K. Improving remote lifestyle intervention studies in children: Participant and caregiver feedback of the smart heart study. PATIENT EDUCATION AND COUNSELING 2020; 103:1326-1334. [PMID: 32089389 DOI: 10.1016/j.pec.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We sought to describe and analyze the quantitative and qualitative feedback obtained from participants and their caregivers of the Smart Heart study, a successful 12-month lifestyle intervention for children with overweight or obesity and congenital heart disease that provided remote lifestyle counseling, to improve future lifestyle interventions in children. METHODS Thirty-six participants and caregivers were polled using a standard program evaluation questionnaire at the end of the intervention. Feedback was compiled into themes, and facilitators and barriers to program success were identified. RESULTS There was a high level of satisfaction with the intervention and staff interactions as well as a low perceived burden of participation. There were also specific concerns, including mixed impressions regarding technology usage and a less impressive indication of actual impactful behavior change. CONCLUSIONS The study identified five themes, and corresponding facilitators and barriers to participant compliance, from the Smart Heart intervention feedback and offered suggestions for improving future lifestyle behavioral intervention study designs in children. PRACTICE IMPLICATIONS Remote smartphone counseling is effective and efficient. It is recommended that the counseling messages are specific, the counseling schedule is patient-centric, patient burden is limited, methods with immediate patient feedback are used and family is included when feasible.
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Affiliation(s)
- Meghan Rombeek
- Department of Paediatrics, Western University, London, Canada
| | - Stefanie De Jesus
- Department of Paediatrics, Western University, London, Canada; School of Kinesiology, Western University, London, Canada
| | | | - Adam A Dempsey
- Department of Paediatrics, Western University, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, Canada
| | - Douglas Fraser
- Department of Paediatrics, Western University, London, Canada; Children's Health Research Institute, London, Canada; Translational Research Centre, London, Canada; Lawson Health Research Institute, London, Canada
| | - Eva Welisch
- Department of Paediatrics, Western University, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, Canada; Children's Health Research Institute, London, Canada
| | - Luis Altamirano-Diaz
- Department of Paediatrics, Western University, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, Canada; Children's Health Research Institute, London, Canada
| | - Kambiz Norozi
- Department of Paediatrics, Western University, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, Canada; Children's Health Research Institute, London, Canada; Lawson Health Research Institute, London, Canada; Department of Paediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Germany.
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Torres S, Sales CMD, Guerra MP, Simões MP, Pinto M, Vieira FM. Emotion-Focused Cognitive Behavioral Therapy in Comorbid Obesity With Binge Eating Disorder: A Pilot Study of Feasibility and Long-Term Outcomes. Front Psychol 2020; 11:343. [PMID: 32194485 PMCID: PMC7066206 DOI: 10.3389/fpsyg.2020.00343] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/13/2020] [Indexed: 11/13/2022] Open
Abstract
Obesity coupled with binge eating disorder (BED) is an increasing problem. Incorporation of treatment strategies that address both problems in people with comorbid symptoms is of major interest. This study aimed to investigate the feasibility and preliminary long-term outcomes of a brief emotion-focused cognitive behavioral therapy (EF-CBT) program. Seven out of 10 women with obesity and BED completed the intervention. Standardized outcome measures to assess the intensity of distress caused by complaints, psychological distress, emotional processing, eating behavior, and weight loss were completed at baseline, end-of-treatment, 6- and 18-month follow-ups. Individualized outcome measures were also applied to describe the personal experiences during the intervention. Findings suggest the program's long-term efficacy for improving psychological distress, emotional processing, and alexithymia. Positive reliable changes in emotional processing and alexithymia were observed in almost all participants. The mean intensity of distress caused by complaints also decreased at the end of the intervention, with a large effect size (d = 0.89). Reliable changes in these outcome measures were observed at all time-points, despite the mean scores for the 18-month follow-up suggest a retraction in improvement. Weight loss was below expectations at all time-points, as were changes in emotional and external eating. Restrained eating mean scores remained stable throughout the study. Participants perceived the program to be useful in improving emotional awareness and eating control. Program feasibility was supported by the retention rate (70%) and the average number of attended sessions (M = 9.71; SD = 2.06). Further studies are needed to examine the effectiveness of EF-CBT interventions.
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Affiliation(s)
- Sandra Torres
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Center for Psychology, University of Porto (CPUP), Porto, Portugal
| | - Célia M. D. Sales
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Center for Psychology, University of Porto (CPUP), Porto, Portugal
| | - Marina Prista Guerra
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Center for Psychology, University of Porto (CPUP), Porto, Portugal
| | - Maria P. Simões
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Mariana Pinto
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Filipa M. Vieira
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Center for Psychology, University of Porto (CPUP), Porto, Portugal
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Spence ND, Skelton JA, Ball GDC. A proposed standardized approach to studying attrition in pediatric weight management. Obes Res Clin Pract 2019; 14:60-65. [PMID: 31818674 DOI: 10.1016/j.orcp.2019.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/29/2019] [Accepted: 11/20/2019] [Indexed: 11/19/2022]
Abstract
Pediatric obesity is a major public health issue. Lifestyle and behavioral interventions are the foundation of pediatric weight management; however, intervention effectiveness is compromised when families (children, youth, and/or parent[s]) discontinue care prematurely. Intervention attrition minimizes the potential health benefits derived from interventions, results in inefficient use of health services resources, and can magnify health disparities. Most attrition research in pediatric weight management has been descriptive, highlighting the need to advance the field, both academically and clinically. Herein, we propose a standard approach to studying attrition in pediatric weight management interventions to enhance our understanding, elevate the quality of research, enable study-to-study comparisons, and inform strategies designed to mitigate its impact. We focus on three issues. First, "Conceptualization and operationalization," whereby the processes underlying attrition from interventions should be decomposed into clinically important phases that are defined based on intervention characteristics. Relatedly, theoretically relevant variables should be identified with different mechanisms driving attrition in each phase. We propose a matrix of attrition, a tool designed to delineate the relevant stages of attrition and associated variables of analytical value. Second, "Pre-study" underscores the value of developing a plan to study attrition a priori rather than post hoc, including variable and sample size considerations, which broadens the range and quality of analysis. Finally, "Post-study" emphasizes comprehensive reporting of attrition, outlines typical comparisons of analytical interest, and statistical techniques used to handle missing data. Implications for clinical practice in pediatric weight management are discussed. Clinical Trial Registration: Not applicable.
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Affiliation(s)
- Nicholas D Spence
- Department of Sociology, University of Toronto, Toronto, ON, Canada; Interdisciplinary Center for Health and Society, University of Toronto, Toronto, ON, Canada
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, United States; Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Medical Center Boulevard, Winston-Salem, NC, United States; Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada; Pediatric Centre for Weight & Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, AB, Canada.
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Fielding-Singh P, Patel ML, King AC, Gardner CD. Baseline Psychosocial and Demographic Factors Associated with Study Attrition and 12-Month Weight Gain in the DIETFITS Trial. Obesity (Silver Spring) 2019; 27:1997-2004. [PMID: 31633313 PMCID: PMC6868338 DOI: 10.1002/oby.22650] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/26/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The purpose of this study was to examine correlates of failure-trial attrition and weight gain-in a randomized clinical weight-loss trial. METHODS The Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial included 609 adults (18-50 years; BMI 28-40). Participants were randomized to a 12-month healthy low-fat or healthy low-carbohydrate diet for weight loss. At baseline, participants completed psychosocial, demographic, and anthropometric measures. Stepwise logistic regressions identified baseline factors associated with (1) study attrition and (2) among trial completers, weight gain at 12 months. RESULTS Having higher baseline food addiction and self-efficacy was linked to treatment failure. Being younger, not having a college education, having higher outcome expectations and quality of life, and having lower social functioning and self-control increased the odds of trial attrition. Identifying as other than non-Hispanic white; not being married or cohabitating; having higher cognitive restraint and self-control; and having lower amotivation, family encouragement, and physical limitations increased the odds of gaining weight by treatment's end. CONCLUSIONS Participants' baseline psychosocial and demographic factors may support or impede successful weight loss. Trialists should attend to these factors when designing treatments in order to promote participants' likelihood of completing the trial and achieving their weight-loss goals.
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Affiliation(s)
- Priya Fielding-Singh
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States
| | - Michele L. Patel
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States
| | - Abby C. King
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States
- Department of Health Research & Policy, Stanford University School of Medicine, Stanford, California, United States
| | - Christopher D. Gardner
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States
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Valero-Elizondo J, Aneni EC, Osondu CU, Grandhi GR, Virani SS, Nasir K. Gaps in provider lifestyle counseling and its adherence among obese adults with prediabetes and diabetes in the United States. Prev Med 2019; 129:105815. [PMID: 31454663 DOI: 10.1016/j.ypmed.2019.105815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/18/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022]
Abstract
Obesity is an epidemic affecting about 40% of the US adult population. Tracking with the obesity epidemic is an increase in the prevalence of diabetes and pre-diabetes. Both pre-diabetes and diabetes are often coexistent with obesity and contribute to an increased total and cardiovascular disease related morbidity and mortality. Lifestyle modification is usually the first step in management among individuals with obesity and/or pre-diabetes or diabetes, but remains an unfulfilled potential by healthcare providers to promote healthier lifestyles in obese patients. We aimed to describe the current patterns of lifestyle counseling (diet, physical activity, and weight loss) and their adherence by patients with obesity in the US using the National Health Interview Survey, 2016-2017. We analyzed these patterns among individuals with pre-diabetes and diabetes. We found that, regardless of pre-diabetes or diabetes status, almost 1 in 3 individuals with mild obesity (BMI ≥ 30 & < 35) and 1 in 4 with severe obesity (BMI ≥ 35) reported lack of lifestyle counseling from healthcare providers regarding diet or physical activity, and 2 in 3 individuals with any level of obesity reported lack of referral/counsel concerning weight loss programs. Lifestyle counseling and its compliance among obese adults from a contemporary dataset in the US is still suboptimal. This study highlights the gaps in the implementation of the AHA/ACC 2013 guidelines on management of obesity among adults particularly among those with metabolic disease, who would derive the greatest benefit.
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Affiliation(s)
- Javier Valero-Elizondo
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, United States of America. https://twitter.com/jvaleromd
| | - Ehimen C Aneni
- Yale University School of Medicine, Division of Cardiovascular Medicine, New Haven, CT, United States of America.
| | - Chukwuemeka U Osondu
- Baptist Health South Florida, Miami, FL, United States of America. https://twitter.com/droz09
| | - Gowtham R Grandhi
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, United States of America. https://twitter.com/gowthyharsha
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Baylor College of Medicine, Houston, TX, United States of America. https://twitter.com/virani_md
| | - Khurram Nasir
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, United States of America; Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States of America. https://twitter.com/khurramn1
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Occupationally Tailored, Web-Based, Nutrition and Physical Activity Program for Firefighters: Cluster Randomized Trial and Weight Outcome. J Occup Environ Med 2019; 61:841-848. [PMID: 31348415 DOI: 10.1097/jom.0000000000001685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the efficacy of an occupationally tailored, web-based health and wellness program, The First Twenty® (TF20), for weight change among volunteer firefighters. METHODS The impact of TF20 on firefighters' 6-month weight change was tested in a cluster, randomized controlled trial, using a crossover design of firefighters in 10 departments. TF20 has web-based nutrition, physical activity, and behavioral health components. RESULTS An adjusted treatment-induced weight loss from 1.7 to 2.8 lb was observed for all participants and 2.3 to 3.1 lb among overweight and obese participants. An average weight gain was observed among firefighters in the control condition and weight loss for those in the treatment condition. CONCLUSIONS TF20 supports firefighters' weight loss. Firefighters need wellness interventions to improve nutrition and physical activity given their high prevalence of obesity.
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Pirotta S, Joham A, Hochberg L, Moran L, Lim S, Hindle A, Brennan L. Strategies to reduce attrition in weight loss interventions: A systematic review and meta-analysis. Obes Rev 2019; 20:1400-1412. [PMID: 31347759 DOI: 10.1111/obr.12914] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 01/02/2023]
Abstract
The primary objective of the study was to identify the effect of intervention strategies on attrition within a weight loss programme among adults aged 18 to 65 years. The secondary objective of the study was to assess the impact of such intervention strategies among female-only weight loss programmes. The literature search was performed in Ovid (CINAHL Plus, MEDLINE, EMBASE, Cochrane [Cochrane Database of Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Methodology Register], and PsycINFO). Studies must have identified weight loss as the main aim and compared the primary weight loss programme alone (control) with the primary weight loss programme coupled with an additional intervention strategy (intervention). Papers must have had a mean participant age between 18 and 65 years and available in English. Fifty-seven trials met the inclusion criteria and were included in the meta-analysis. Strategies that successfully reduced attrition included the incorporation of financial incentives (n = 8), a multicomponent approach (n = 13), and use of self-monitoring technology (n = 4). The majority of studies were of low to moderate methodological quality because of insufficient reporting. A limited number of female-only trials were found (n = 13). Implementation of financial incentives, multicomponent interventions, and self-monitoring technology help reduce attrition among adult weight loss programmes. Further studies are required to identify the impact of intervention strategies on attrition in women.
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Affiliation(s)
- Stephanie Pirotta
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Anju Joham
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
| | - Lisa Hochberg
- Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Annemarie Hindle
- Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Leah Brennan
- Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
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Jones HM, Al-Khudairy L, Melendez-Torres GJ, Oyebode O. Viewpoints of adolescents with overweight and obesity attending lifestyle obesity treatment interventions: a qualitative systematic review. Obes Rev 2019; 20:156-169. [PMID: 30375160 DOI: 10.1111/obr.12771] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/18/2018] [Accepted: 08/15/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Current UK guidance recommends that adolescents with obesity attend a family-based multi-component obesity intervention. However, these programmes suffer from low recruitment and high rates of attrition. Understanding the views of adolescents is necessary for developing future interventions. The aim of this systematic review was to synthesize and explore the views of adolescents who have attended an obesity intervention. METHODS Published literature was identified by searching six databases. Studies of adolescents (12-17 years) who attended an obesity intervention were examined. Only studies that collected and analysed data qualitatively were included. Full texts were analysed using thematic synthesis. RESULTS Twenty-eight studies were included. Thirty-five analytical themes were developed that were broadly divided into seven domains. Key themes included ensuring adolescents receive a 'tailored intervention' that involves 'active engagement'. Support from professionals, family and peers were valued highly. Adolescents expressed 'prior fears of attending interventions' and wanted 'longer term support'. 'Enjoyment of sport and physical activity' was evident, and adolescents were strongly motivated by improving body image and social desirability. DISCUSSION Considering the views of adolescents attending obesity interventions may help to inform policy makers in the development of future interventions. This may lead to an improvement in recruitment and attrition rates.
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Affiliation(s)
- H M Jones
- Warwick Medical School, University of Warwick, Coventry, UK
| | - L Al-Khudairy
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - O Oyebode
- Warwick Medical School, University of Warwick, Coventry, UK
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Alexander E, Tseng E, Durkin N, Jerome GJ, Dalcin A, Appel LJ, Clark JM, Gudzune KA. Factors associated with early dropout in an employer-based commercial weight-loss program. Obes Sci Pract 2018; 4:545-553. [PMID: 30574348 PMCID: PMC6298204 DOI: 10.1002/osp4.304] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/20/2018] [Accepted: 09/22/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Minimizing program dropout is essential for weight-loss success, but factors that influence dropout among commercial programs are unclear. This study's objective was to determine factors associated with early dropout in a commercial weight-loss program. METHODS A retrospective analysis of a remotely delivered, employer-based commercial program from 2013 to 2016 was conducted. The dependent variable was 'early dropout', defined as enrollees who disengaged from telephone coaching by month 2's end. Independent variables included demographics, program website engagement and early weight change. Multivariate logistic regression analyses were used to assess for differences in early dropout by several factors, adjusted for employer clustering. RESULTS Of the 5,274 participants, 26.8% dropped out early. Having ≥1 chronic condition (odds ratio [OR] 1.41, p < 0.001) and 'weight-loss failure' defined as ≥0% weight change at month 1's end (OR 1.86, p < 0.001) had significantly increased odds of early dropout. Increasing age by 10-year intervals (OR 0.90, p = 0.002) and 'meeting the website login goal' defined as ≥90 logins in 3 months (OR 0.13, p < 0.001) significantly decreased the odds of early dropout. CONCLUSIONS Presence of comorbidities, less online engagement and weight-loss failure were associated with early dropout in a commercial program. Strategies to prevent dropout among high-risk participants, such as increased support or program tailoring, should be developed and tested.
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Affiliation(s)
- E. Alexander
- Department of Health Policy and ManagementThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - E. Tseng
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins School of MedicineBaltimoreMDUSA
- The Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreMDUSA
| | - N. Durkin
- The Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreMDUSA
| | - G. J. Jerome
- The Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreMDUSA
- Department of KinesiologyTowson UniversityTowsonMDUSA
| | - A. Dalcin
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins School of MedicineBaltimoreMDUSA
- The Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreMDUSA
| | - L. J. Appel
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins School of MedicineBaltimoreMDUSA
- The Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreMDUSA
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - J. M. Clark
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins School of MedicineBaltimoreMDUSA
- The Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreMDUSA
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - K. A. Gudzune
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins School of MedicineBaltimoreMDUSA
- The Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreMDUSA
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Perna S, Spadaccini D, Riva A, Allegrini P, Edera C, Faliva MA, Peroni G, Naso M, Nichetti M, Gozzer C, Vigo B, Rondanelli M. A path model analysis on predictors of dropout (at 6 and 12 months) during the weight loss interventions in endocrinology outpatient division. Endocrine 2018; 61:447-461. [PMID: 29470776 DOI: 10.1007/s12020-018-1563-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/04/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This study aimed to identify the dropout rate at 6 and 12 months from the first outpatient visit, and to analyze dropout risk factors among the following areas: biochemical examinations, anthropometric measures, psychological tests, personal data, and life attitude such as smoking, physical activity, and pathologies. METHODS This is a retrospective longitudinal observational study. Patients undergo an outpatient endocrinology visit, which includes collecting biographical data, anthropometric measurements, physical and pathological history, psychological tests, and biochemical examinations. RESULTS The sample consists of 913 subjects (682 women and 231 men), with an average age of 50.88 years (±15.80) for the total sample, with a BMI of 33.11 ± 5.65 kg/m2. 51.9% of the patients abandoned therapy at 6 months after their first visit, and analyzing the dropout rate at 12 months, it appears that 69.5% of subjects abandon therapy. The main predictor of dropout risk factors at 6 and 12 months is the weight loss during the first 3 months (p < 0.05). As regards the hematological predictors, white blood cell and iron level stated dropout at 12 months. Patients who introduced physical activity had a reduction of - 17% (at 6 months) and -13% (at 12 months) of dropout risk (p < 0.05). As regards the "worker" status, patients classified as"retired" had a decrease risk of dropout vs. other categories of worker (i = 0.58; p < 0.05). Dropout risk at 12 months decrease in patients with a previous history of cancer, Endocrine and psychic and behavioral disorders (p < 0.001). CONCLUSIONS The main factor that predisposes patients to continue therapy or to abandon it is the success (or failure) of the diet in the initial period, based on weight lost (or not lost) in the early months of the initiation of therapy. Furthermore, considerable differences were found in different categories of "workers", and with previous "pathologies". The level of physical activity and previous diseases also seem to be predictors of dropout.
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Affiliation(s)
- Simone Perna
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy.
| | - Daniele Spadaccini
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | | | | | - Chiara Edera
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Milena Anna Faliva
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Gabriella Peroni
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Maurizio Naso
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Mara Nichetti
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Carlotta Gozzer
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Beatrice Vigo
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Mariangela Rondanelli
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
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Batrakoulis A, Jamurtas AZ, Georgakouli K, Draganidis D, Deli CK, Papanikolaou K, Avloniti A, Chatzinikolaou A, Leontsini D, Tsimeas P, Comoutos N, Bouglas V, Michalopoulou M, Fatouros IG. High intensity, circuit-type integrated neuromuscular training alters energy balance and reduces body mass and fat in obese women: A 10-month training-detraining randomized controlled trial. PLoS One 2018; 13:e0202390. [PMID: 30138475 PMCID: PMC6107179 DOI: 10.1371/journal.pone.0202390] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/02/2018] [Indexed: 01/06/2023] Open
Abstract
This randomized controlled trial examined body mass, body composition, energy balance and performance responses of previously sedentary overweight/obese women to a circuit-type integrated neuromuscular training program with alternative modalities. Forty-nine healthy overweight or class I obese females (36.4±4.4 yrs) were randomly assigned to either a control (N = 21), training (N = 14) or training-detraining (N = 14) group. In weeks 1-20, the training groups trained three times/week using 10-12 whole-body exercises of progressively increased intensity/volume, organized in timed interval circuit form. In weeks 21-40, the training group continued training whereas the training-detraining group not. Heart rate, perceived exertion, blood lactate, exertion, oxygen consumption and excess post-exercise oxygen consumption were measured for one session/phase/person and exercise energy expenditure was calculated. Energy intake, habitual physical activity, resting metabolic rate, body composition, body mass, strength and maximal oxygen consumption were measured at baseline, mid-intervention and post-intervention. A two-way repeated measures ANOVA was used to determine differences between three time points and three groups. In C, VO2max declined (p<0.013) and body fat (p<0.008), waist (p<0.059) and hip (p<0.012) circumferences increased after 40 weeks compared to baseline. Training reduced body mass (6%, p<0.001), body fat (~5.5%, p<0.001) and increased fat-free mass (1.2-3.4%, p<0.05), strength (27.2%, p<0.001) and endurance (26.8%, p<0.001) after a 10-month implementation period using a metabolic overload of only 5-12 metabolic equivalents of task-hours per week. Training induced a long-term negative energy balance during an exercise and a non-exercise day due to an elevation of resting metabolic rate (6%-10%, p<0.05) and exercise-related energy expenditure. Training had an 8% and 94% attrition and attendance rates, respectively. Training-induced gains were attenuated but not lost following a 5-month detraining. A 10-month implementation of a high-intensity interval type training program elicited both endurance and musculoskeletal gains and resulted in a long-term negative energy balance that induced a progressive and sustained reduction of body and fat mass. TRIAL REGISTRATION ClinicalTrials.gov NCT03134781.
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Affiliation(s)
- Alexios Batrakoulis
- School of Physical Education and Sport Sciences, University of Thessaly, Karies, Trikala, Greece
| | - Athanasios Z. Jamurtas
- School of Physical Education and Sport Sciences, University of Thessaly, Karies, Trikala, Greece
| | - Kalliopi Georgakouli
- School of Physical Education and Sport Sciences, University of Thessaly, Karies, Trikala, Greece
| | - Dimitrios Draganidis
- School of Physical Education and Sport Sciences, University of Thessaly, Karies, Trikala, Greece
| | - Chariklia K. Deli
- School of Physical Education and Sport Sciences, University of Thessaly, Karies, Trikala, Greece
| | | | - Alexandra Avloniti
- School of Physical Education and Sport Sciences, Democritus University of Thrace, Komotini, Greece
| | | | - Diamanda Leontsini
- School of Physical Education and Sport Sciences, Democritus University of Thrace, Komotini, Greece
| | - Panagiotis Tsimeas
- School of Physical Education and Sport Sciences, University of Thessaly, Karies, Trikala, Greece
| | - Nikolaos Comoutos
- School of Physical Education and Sport Sciences, University of Thessaly, Karies, Trikala, Greece
| | - Vassilios Bouglas
- School of Physical Education and Sport Sciences, University of Thessaly, Karies, Trikala, Greece
| | - Maria Michalopoulou
- School of Physical Education and Sport Sciences, Democritus University of Thrace, Komotini, Greece
| | - Ioannis G. Fatouros
- School of Physical Education and Sport Sciences, University of Thessaly, Karies, Trikala, Greece
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Linardon J, Fitzsimmons-Craft EE, Brennan L, Barillaro M, Wilfley DE. Dropout from interpersonal psychotherapy for mental health disorders: A systematic review and meta-analysis. Psychother Res 2018; 29:870-881. [PMID: 30005586 DOI: 10.1080/10503307.2018.1497215] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective: Dropout is one factor that might limit the effectiveness of interpersonal psychotherapy (IPT). Improved understanding of IPT dropout is an important research priority. This meta-analysis examined dropout rates from IPT in randomized controlled trials. Method: Seventy-two trials met inclusion criteria. Results: The weighted mean dropout rate from IPT was 20.6% (95% CI = 17.4-24.2). Dropout rates were similar for depressive (20.9%; 95% CI = 17.2-25.2), anxiety (16.1%; 95% CI = 11.1-22.9), and eating disorders (18.7%; 95% CI = 11.6-28.8). Dropout was highest when more stringent definitions of dropout were applied (e.g., failure to complete the entire IPT protocol versus failure to complete at least 50% of sessions) and was lowest when adolescent patients were sampled. There was some evidence that IPT was associated with significantly lower rates of dropout than both CBT and non-specific supportive therapies. These effects were generally replicated when analysing trials that provided a clear definition of treatment (rather than study) dropout. Conclusions: Overall, findings provide preliminary evidence to suggest that IPT may be an accepted and tolerated treatment option for patients with common mental health disorders. This review also highlights the need for future trials to rigorously report detail pertaining to patient dropout.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | | | - Leah Brennan
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Mary Barillaro
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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46
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Linardon J, Hindle A, Brennan L. Dropout from cognitive-behavioral therapy for eating disorders: A meta-analysis of randomized, controlled trials. Int J Eat Disord 2018; 51:381-391. [PMID: 29493805 DOI: 10.1002/eat.22850] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/14/2018] [Accepted: 01/14/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Cognitive-behavioral therapy (CBT) is efficacious for a range of eating disorder presentations, yet premature dropout is one factor that might limit CBTs effectiveness. Improved understanding of dropout from CBT for eating disorders is important. This meta-analysis aimed to study dropout from CBT for eating disorders in randomized controlled trials (RCTs), by (a) identifying the types of dropout definitions applied, (b) providing estimates of dropout, (c) comparing dropout rates from CBT to non-CBT interventions for eating disorders, and (d) testing moderators of dropout. METHOD RCTs of CBT for eating disorders that reported rates of dropout were searched. Ninety-nine RCTs (131 CBT conditions) were included. RESULTS Dropout definitions varied widely across studies. The overall dropout estimate was 24% (95% CI = 22-27%). Diagnostic type, type of dropout definition, baseline symptom severity, study quality, and sample age did not moderate this estimate. Dropout was highest among studies that delivered internet-based CBT and was lowest in studies that delivered transdiagnostic enhanced CBT. There was some evidence that longer treatment protocols were associated with lower dropout. No significant differences in dropout rates were observed between CBT and non-CBT interventions for all eating disorder subtypes. CONCLUSION Present study dropout estimates are hampered by the use of disparate dropout definitions applied. This meta-analysis highlights the urgency for RCTs to utilize a standardized dropout definition and to report as much information on patient dropout as possible, so that strategies designed to minimize dropout can be developed, and factors predictive of CBT dropout can be more easily identified.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Annemarie Hindle
- School of Psychology, Australian Catholic University, 115 Victoria Parade/Locked Bag 4115, Melbourne, Victoria, 3065, Australia
| | - Leah Brennan
- School of Psychology, Australian Catholic University, 115 Victoria Parade/Locked Bag 4115, Melbourne, Victoria, 3065, Australia.,Centre for Eating and Weight Disorders, 382 Victoria Parade East Melbourne, Victoria, 3002, Australia
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47
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Wald ER, Ewing LJ, Moyer SCL, Eickhoff JC. An Interactive Web-Based Intervention to Achieve Healthy Weight in Young Children. Clin Pediatr (Phila) 2018; 57:547-557. [PMID: 29067819 PMCID: PMC10360456 DOI: 10.1177/0009922817733703] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This prospective, randomized, controlled trial for parents of overweight and obese 3- to 7-year-olds was performed to assess the feasibility of a program promoting healthy eating and lifestyle by targeting parents as agents of change. The intervention was composed of 6-in-person group sessions and a customized website over 12 months. The control group received customary care. The primary outcome was feasibility of the intervention to promote healthy behavior change measured by attendance. The secondary outcome was effectiveness assessed by attaining reduced body mass index (BMI) z scores, healthy behavior changes and increased parent self-efficacy. Seventy-three child-parent dyads were enrolled; 14 parents never attended any sessions. Participation in follow-up assessments did not meet the hypothesized level. Ultimate BMI z scores did not differ between control and intervention groups. Parenting skills did not improve in the intervention group. This intervention to achieve healthy lifestyle changes in children via their parents as "change agents" was unsuccessful.
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Affiliation(s)
- Ellen R Wald
- 1 University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Linda J Ewing
- 2 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Jens C Eickhoff
- 1 University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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48
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Cleo G, Glasziou P, Beller E, Isenring E, Thomas R. Habit-based interventions for weight loss maintenance in adults with overweight and obesity: a randomized controlled trial. Int J Obes (Lond) 2018; 43:374-383. [PMID: 29686382 DOI: 10.1038/s41366-018-0067-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The objective of this study was to determine whether habit-based interventions are clinically beneficial in achieving long-term (12-month) weight loss maintenance and explore whether making new habits or breaking old habits is more effective. METHODS Volunteer community members aged 18-75 years who had overweight or obesity (BMI ≥ 25 kg/m2) were randomized in a single-blind, three-arm, randomized controlled trial. Ten Top Tips (TTT), Do Something Different (DSD), and the attention-only waitlist (WL) control groups were conducted for 12 weeks from July to October 2015. Participants were followed up post-intervention (all groups) and at 6 and 12-month post-intervention (Ten Top Tips and Do Something Different only). The primary outcome was weight-loss maintenance at 12-month follow-up. Secondary outcomes included weight loss at all time points, fruit and vegetable consumption, exercise, wellbeing, depression, anxiety, habit strength, and openness to change. RESULTS Of the 130 participants assessed for eligibility, 75 adults (mean BMI 34.5 kg/m2 [SD 6.2]), with a mean age of 51 years were recruited. Assessments were completed post-intervention by 66/75 (88%) of participants and by 43/50 (86%) at 12 months. At post-intervention, participants in the Ten Top Tips (-3.3 kg; 95% CI -5.2, -1.4) and Do Something Different (-2.9 kg; 95% CI -4.3, -1.4) interventions lost significantly more weight (P = < .001) than those on the waitlist control (-0.4 kg; 95% CI -1.2, 0.3). Both intervention groups continued to lose further weight to the 12-month follow-up; TTT lost an additional -2.4 kg (95% CI -5.1, 0.4) and DSD lost -1.7 kg (95% CI -3.4, -0.1). At 12-month post-intervention, 28/43 (65%) of participants in both intervention groups had reduced their total body weight by ≥5%, a clinically important change. CONCLUSIONS Habit-based weight-loss interventions-forming new habits (TTT) and breaking old habits (DSD), resulted in clinically important weight-loss maintenance at 12-month follow-up.
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Affiliation(s)
- Gina Cleo
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia. .,Centre for Research in Evidence-Based Practice (CREBP), Bond University, Gold Coast, QLD, Australia.
| | - Paul Glasziou
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.,Centre for Research in Evidence-Based Practice (CREBP), Bond University, Gold Coast, QLD, Australia
| | - Elaine Beller
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.,Centre for Research in Evidence-Based Practice (CREBP), Bond University, Gold Coast, QLD, Australia
| | - Elisabeth Isenring
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Rae Thomas
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.,Centre for Research in Evidence-Based Practice (CREBP), Bond University, Gold Coast, QLD, Australia
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49
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Sasdelli AS, Petroni ML, Delli Paoli A, Collini G, Calugi S, Dalle Grave R, Marchesini G. Expected benefits and motivation to weight loss in relation to treatment outcomes in group-based cognitive-behavior therapy of obesity. Eat Weight Disord 2018; 23:205-214. [PMID: 29368291 DOI: 10.1007/s40519-017-0475-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE We aimed to determine cognitive drivers, expected to play a role in target reach and/or attrition in obesity programs. METHODS We recorded the expected benefits of weight loss, weight targets, primary motivation for weight loss, perceived treatment needs, readiness and self-confidence to be successful and a battery of psychopathology questionnaires in 793 subjects with obesity (68% women; mean age 48.7; 46% obesity class III) enrolled into a group-based cognitive-behavioral treatment program. Their relevance on attrition and successful weight loss outcome were tested by logistic regression analysis. RESULTS The expected benefits of weight loss scored very high in all physical, psychological and social areas, with differences between genders. Attrition rate was 24, 41 and 65% at 6-, 12-, and 24-month follow-up. Average weight loss was 5.8 ± 7.1 kg (- 4.8%) at 6 months, with 17% of cases (32% of continuers) maintaining weight loss > 10% at 24 months. After adjustment for confounders, attrition was reduced by concern for present health, motivation/consciousness of the importance of physical activity and need for support; treatment discontinuation was favored by concern for body image, by expectations for drug treatment or bariatric surgery, and by high-challenging weight loss targets. Male gender, higher BMI and concern for present health predicted weight loss > 10%, whereas concern for body appearance was associated with lower probability of attaining the desired weight loss targets. CONCLUSION A more precise definition of needs and expectations might help tailor treatment to individual patients, but attrition rates and target reach remain difficult to predict. LEVEL OF EVIDENCE Level V, descriptive studies.
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Affiliation(s)
- Anna Simona Sasdelli
- Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy
| | - Maria Letizia Petroni
- Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy.,Obesity Unit, "Solatrix" Private Hospital, Via Bellini 11, 38068, Rovereto, Italy
| | - Anna Delli Paoli
- Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy
| | - Giulia Collini
- Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, 37016, Garda, Verona, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, 37016, Garda, Verona, Italy
| | - Giulio Marchesini
- Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy.
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50
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Nobles JD, Perez A, Skelton JA, Spence ND, Ball GD. The engagement pathway: A conceptual framework of engagement-related terms in weight management. Obes Res Clin Pract 2018; 12:133-138. [PMID: 29396232 DOI: 10.1016/j.orcp.2017.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/17/2017] [Accepted: 12/23/2017] [Indexed: 01/31/2023]
Abstract
Engagement denotes the extent to which, and how, individuals participate in weight management (WM) services. Effective WM services should generate meaningful outcomes and promote high participant engagement; however, research is predominantly focused on the former. Given that engagement is a poorly understood phenomenon, and that engagement-related concepts are often used synonymously (e.g., dropout and attrition), the engagement pathway is hereby introduced. This pathway defines key concepts (e.g., recruitment, adherence, attrition) and their relationships in the enrolment, intervention, and maintenance stages of treatment. The pathway will help researchers and practitioners better understand engagement-related concepts whilst encouraging greater conceptual consistency between studies.
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Affiliation(s)
- James D Nobles
- Centre for Active Lifestyles, Leeds Beckett University, Leeds, UK.
| | - Arnaldo Perez
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Geoff D Ball
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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