CD-ROM nutrient analysis database assists self-monitoring behavior of active duty Air Force personnel receiving nutrition counseling for weight loss

A nutrition intervention with a main focus on vegetables and bread consumption among young men in the Norwegian National Guard

BACKGROUND

Young men are difficult to reach with conventional nutrition information and they have a low intake of vegetables and whole grain cereals. Few intervention studies have focused on improving young men's consumption of vegetables and whole grains.

OBJECTIVE

A 5-month intervention focusing on a combination of increased availability of healthy foods and nutritional information was developed to stimulate the intake of vegetables and semi-whole grain bread among a group of young men in the Norwegian military.

SUBJECTS

A total of 376 recruits in the intervention group and 105 recruits in the control group participated in the entire study.

RESULTS

The average daily increase in consumption of vegetables was 82 g (p<0.001), and semi-whole grain bread 47 g (p<0.001) between baseline and follow-up in the intervention group. No significant changes were observed in the control group. Differences between intervention and control group at follow-up were significant (p<0.001) for vegetables and semi-whole grain bread, when controlling for baseline values, and seasonal variation for vegetables. The recruits in the intervention group received higher scores on the questions concerning nutritional knowledge after the intervention, compared to baseline (p<0.001). There was a significantly higher increase in the intake of vegetables among the recruits who increased the number of correct answers to the knowledge questions (β-value: 0.14, p<0.05) than among the others. There was no significant change in scores of food satisfaction after the intervention.

CONCLUSION

The combination of increased availability of healthy food items and nutrition information was an effective way to increase the intake of vegetables and semi-whole grain bread, without a reduction in food satisfaction, among young men in the military.

Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people

BACKGROUND

The World Health Organization (WHO) estimates that the number of obese or overweight individuals worldwide will increase to 1.5 billion by 2015. Chronic diseases associated with overweight or obesity include diabetes, heart disease, hypertension and stroke.

OBJECTIVES

To assess the effects of interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people.

SEARCH METHODS

We searched several electronic databases, including CENTRAL, MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO, through 25 May 2011. We also searched clinical trials registries to identify studies. We scanned reference lists of included studies and relevant systematic reviews.

SELECTION CRITERIA

Studies were included if they were randomized controlled trials or quasi-randomized controlled trials that evaluated interactive computer-based weight loss or weight maintenance programs in adults with overweight or obesity. We excluded trials if the duration of the intervention was less than four weeks or the loss to follow-up was greater than 20% overall.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted study data and assessed risk of bias. Where interventions, control conditions, outcomes and time frames were similar between studies, we combined study data using meta-analysis.

MAIN RESULTS

We included 14 weight loss studies with a total of 2537 participants, and four weight maintenance studies with a total of 1603 participants. Treatment duration was between four weeks and 30 months. At six months, computer-based interventions led to greater weight loss than minimal interventions (mean difference (MD) -1.5 kg; 95% confidence interval (CI) -2.1 to -0.9; two trials) but less weight loss than in-person treatment (MD 2.1 kg; 95% CI 0.8 to 3.4; one trial). At six months, computer-based interventions were superior to a minimal control intervention in limiting weight regain (MD -0.7 kg; 95% CI -1.2 to -0.2; two trials), but not superior to infrequent in-person treatment (MD 0.5 kg; 95% -0.5 to 1.6; two trials). We did not observe consistent differences in dietary or physical activity behaviors between intervention and control groups in either weight loss or weight maintenance trials. Three weight loss studies estimated the costs of computer-based interventions compared to usual care, however two of the studies were 11 and 28 years old, and recent advances in technology render these estimates unlikely to be applicable to current or future interventions, while the third study was conducted in active duty military personnel, and it is unclear whether the costs are relevant to other settings. One weight loss study reported the cost-effectiveness ratio for a weekly in-person weight loss intervention relative to a computer-based intervention as USD 7177 (EUR 5678) per life year gained (80% CI USD 3055 to USD 60,291 (EUR 2417 to EUR 47,702)). It is unclear whether this could be extrapolated to other studies. No data were identified on adverse events, morbidity, complications or health-related quality of life.

AUTHORS' CONCLUSIONS

Compared to no intervention or minimal interventions (pamphlets, usual care), interactive computer-based interventions are an effective intervention for weight loss and weight maintenance. Compared to in-person interventions, interactive computer-based interventions result in smaller weight losses and lower levels of weight maintenance. The amount of additional weight loss, however, is relatively small and of brief duration, making the clinical significance of these differences unclear.

A review of efficacious technology-based weight-loss interventions: five key components

OBJECTIVE

Obesity is highly prevalent among American adults and has negative health and psychosocial consequences. The purpose of this article was to qualitatively review studies that used technology-based interventions for weight loss and to identify specific components of these interventions that are effective in facilitating weight loss.

MATERIALS AND METHODS

We conducted a narrow, qualitative review, focusing on articles published in the last 10 years that used an experimental or pre/posttest design and used a technology-based intervention for weight loss.

RESULTS

Among the 21 studies reviewed, we identified the following five components that we consider to be crucial in technology-based weight-loss interventions that are successful in facilitating weight loss: self monitoring, counselor feedback and communication, social support, use of a structured program, and use of an individually tailored program.

CONCLUSIONS

Short-term results of technologically driven weight-loss interventions using these components have been promising, but long-term results have been mixed. Although more longitudinal studies are needed for interventions implementing these five components, the interface of technology and behavior change is an effective foundation of a successful, short-term weight-loss program and may prove to be the basis of long-term weight loss.

Treating obesity with a novel hand-held device, computer software program, and Internet technology in primary care: the SMART motivational trial

OBJECTIVE

The purpose of this study was to evaluate the short-term motivational effect of a technology-based weight reduction program for obese adults.

METHODS

One hundred and eleven obese (37.0+/-5.8 kg/m(2)) middle aged (45.5+/-10.8 years) adults (62% female) were randomly assigned to a usual care or experimental (SMART: self-monitoring and resting metabolic rate technology) group. The usual care group received a standard nutritional program in accordance to national guidelines. All participants received a comprehensive weight management program consisting of motivational interviewing (MI) sessions and automated e-mail behavioral newsletters. Bodyweight, arterial blood pressure, and psychobehavioral constructs were assessed over 12 weeks.

RESULTS

Completer analysis (n=80) indicated a significant improvement in bodyweight (-3.9%), systolic arterial pressure (-4 mmHg), and all motivational constructs following the 12-week study (p<or=.05). However, there were no significant differences between groups at any time period.

CONCLUSION

Based on these data, a 12-week comprehensive weight reduction program consisting of MI and automated e-mail behavioral newsletters with or without SMART is efficacious in treating obese adults.

PRACTICE IMPLICATIONS

Although both treatment programs were equally effective, clinicians should consider a treatment program that meets the need of the patient. This study was registered at ClinicalTrials.gov NCT00750022.

Personal digital assistants are comparable to traditional diaries for dietary self-monitoring during a weight loss program

Dietary self-monitoring is considered the core of behavioral weight control programs. As software for personal digital assistants (PDA) has become more available, this study investigated whether the use of a PDA would improve dietary self-monitoring frequency and subsequent weight loss over the use of traditional paper diaries. One-hundred-seventy-six adults (BMI 25-39.9) participated in a 6-month behavioral weight control program. Treatment subjects (n = 61) were provided with a PalmZire 21 with Calorie King's Diet Diary software installed. Their self-monitoring habits and weight loss were compared with the results from a previous program (n = 115) which followed the same protocol using paper diaries for self-monitoring. No significant differences in weight loss or dietary self-monitoring were found. More frequent self-monitoring correlated with weight loss in both groups (p<.001). People seeking to lose weight should be encouraged to self-monitor and be matched with a mode of self-monitoring that is fitting to their lifestyle and skills.

Benefits of and barriers to dietary sodium adherence

Failure to limit dietary sodium leads to thirst, large fluid weight gain, and poor outcomes in patients receiving hemodialysis. Perceived benefits and barriers may influence adherence; however, tools measuring these relationships are not available. This study's purpose, based on the health belief model, was to evaluate the reliability and validity of the Beliefs about Dietary Compliance Scale (BDCS), describe perceived benefits and barriers over time, and identify individual benefits and barriers that may be amenable to tailored interventions. A convenience sample of 229 completed the BDCS at baseline. One week after baseline, 52 participants completed the BDCS to assess test-retest reliability. Four months after baseline, 187 participants (81%) remained. Cronbach's alphas for the scale ranged from .66 to .81. One-week test-retest reliabilities ranged from .68 to .86. Factor structure was supported by factor analysis. Scores remained stable over time. Barriers to dietary sodium limitations were common and more in need of intervention.