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Butryn ML, Crane NT, Lufburrow E, Hagerman CJ, Forman EM, Zhang F. The Role of Physical Activity in Long-term Weight Loss: 36-month Results From a Randomized Controlled Trial. Ann Behav Med 2022; 57:146-154. [PMID: 35640225 PMCID: PMC9899066 DOI: 10.1093/abm/kaac028] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Physical activity (PA) may promote long-term weight loss, but facilitating high levels of PA in behavioral weight loss programs is challenging. PURPOSE This study reports the 36-month follow-up of a behavioral weight loss trial that tested the efficacy of increasing the emphasis on PA during treatment and using traditional or acceptance-based therapy (ABT) for this purpose. We also examined the extent to which long-term weight loss differed by PA pattern and tested if individual differences in eating behavior moderated this relationship. METHODS Participants (N = 320) were randomized to (1) standard behavioral weight loss treatment (BT), (2) BT with a focus on PA, or (3) ABT with a focus on PA. Weight loss and PA were measured at 24- and 36-month follow-up. RESULTS There were no differences between conditions in weight loss or PA at 24 or 36 months. Participants consistently engaging in high PA experienced the greatest weight losses. The positive impact of PA on weight loss was more pronounced among those with low emotional eating and those who believed that exercise did not affect their appetite. CONCLUSIONS Findings emphasize the difficulty of improving long-term PA among adults with overweight/obesity beyond what standard behavioral weight loss treatment achieves. This study highlights the need to develop new PA treatment strategies, and suggests that ABT for weight loss may be more effective when applied to eating behavior versus PA. Results also demonstrate the importance of addressing problematic eating behavior and cognitions to fully realize the benefits of PA for weight loss. CLINICAL TRIAL INFORMATION ClinicalTrials.gov identifier: NCT02363010.
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Affiliation(s)
| | - Nicole T Crane
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA,Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Emily Lufburrow
- Department of Medicine, Drexel University, Philadelphia, PA, USA
| | - Charlotte J Hagerman
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Evan M Forman
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA,Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Fengqing Zhang
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
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2
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Helland MH, Nordbotten GL. Dietary Changes, Motivators, and Barriers Affecting Diet and Physical Activity among Overweight and Obese: A Mixed Methods Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10582. [PMID: 34682331 PMCID: PMC8535513 DOI: 10.3390/ijerph182010582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/24/2021] [Accepted: 10/05/2021] [Indexed: 11/21/2022]
Abstract
The aims of this study were to examine (1) effects of nutritional guidance and physical activity on dietary habits among overweight and obese after an intervention and one year after follow-up (quantitative study) and (2) barriers and motivators for changes in diet and physical activity (qualitative study). A total of 98 participants with a mean age of 46.8 ± 10.2 years were included and divided into a Training Group (TG) (n = 51) or a Nutritional Guidance and Training Group (NTG) (n = 47). At baseline, after 33 weeks, and one year after the intervention, participants answered a questionnaire. Interviews gave data to elicit motivations and challenges related to diet and exercise. A GLM repeated measures analysis was used to investigate differences and interactions between factors. Participants ate healthier after starting to exercise. After 33 weeks, the NTG ate significantly more vegetables (p = 0.026) and legumes (p < 0.01) than the TG. No significant differences were found one year after follow-up. General health was the most important motivator for changing diet and exercise. Barriers to changing diet were related to work, family, meal size, and participants' internal decisions to change habits. Barriers to exercise were holidays and time constraints. Planning purchases and regular exercise were important factors to achieve and maintain weight loss.
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Affiliation(s)
- Merete Hagen Helland
- Department of Education and Sports Science, University of Stavanger, 4021 Stavanger, Norway;
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3
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Halali F, Lapveteläinen A, Karhunen L, Kantanen T. Eating behavior tendencies among Finnish adults in relation to previous weight loss attempts. Appetite 2020; 150:104650. [PMID: 32145371 DOI: 10.1016/j.appet.2020.104650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND The number of weight loss attempts may be associated with higher weight status and unfavorable health behaviors as well as dysfunctional eating behaviors. We aimed to study eating behavior tendencies, i.e., cognitive restraint, uncontrolled eating and emotional eating among a sample of Finnish adults who had engaged in a different number of attempts to lose weight during their lifetime. METHODS Data were collected through a web-based survey. Participants completed a background questionnaire (including questions on weight, height, number of attempts to lose weight) and the Three-Factor Eating Questionnaire (TFEQ-R18). Out of 1985 individuals, 1679 with complete data were included in the study. The TFEQ-R18 was tested for its reliability and fit to our study population using Cronbach's alpha and Confirmatory Factor Analysis (CFA). RESULTS Subscales of the TFEQ-R18 had acceptable reliability except for that of 'cognitive restraint', which reached acceptable reliability when three items were deleted (items 15, 16, 18). The revised version of the questionnaire was designated as the TFEQ-R15, which showed good fit based on CFA fit indices. Participants who had attempted to lose weight during their lifetime (n = 1229), especially those with ≥3 weight loss attempts (n = 499), had greater cognitive restraint, uncontrolled eating, emotional eating, and higher body mass index (BMI) than those with no previous weight loss attempts (n = 132). CONCLUSIONS Our findings suggest that eating behavior tendencies, i.e., decreasing tendencies of uncontrolled and emotional eating should receive more emphasis to support successful weight management.
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Affiliation(s)
- Faranak Halali
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland (UEF), Kuopio, Finland.
| | - Anja Lapveteläinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland (UEF), Kuopio, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland (UEF), Kuopio, Finland
| | - Teuvo Kantanen
- Department of Business, Faculty of Social Sciences and Business Studies, University of Eastern Finland (UEF), Kuopio, Finland
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Xu S, Zhang J, Dong Y, Chen R, Xu W, Tan Z, Gao L, Shang L. The PROMOTE study (High-protein and resistance-training combination in overweight and obesity) for short-term weight loss and long-term weight maintenance for Chinese people: a protocol for a pilot randomized controlled trial. Trials 2020; 21:47. [PMID: 31915038 PMCID: PMC6950796 DOI: 10.1186/s13063-019-3954-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 12/03/2019] [Indexed: 11/23/2022] Open
Abstract
Background It is very important for clinicians and dieticians to explore reasonable weight management strategies for obese people that address both short-term weight loss and subsequent weight maintenance. We hypothesized that resistance training combined with a high-protein diet would result in similar short-term weight loss but better long-term weight maintenance than either a conventional low-fat diet control or a high-protein diet alone. Methods/design This is an 8-week randomized parallel controlled trial followed by a 24-week observational follow-up study. A 48-week supplementary follow-up study will be carried out if necessary. The study will be conducted between June 2019 and October 2020. The 90 overweight or obese participants will be randomly assigned to the conventional low-fat diet group, the high-protein diet group and the high-protein diet and resistance training combination group. Primary outcomes are body weight change at week 8 and week 24 compared with the baseline level. Discussion High-quality research on the effect of a high-protein diet combined resistance training on weight loss and weight maintenance is limited in the Chinese population. Our study will provide a basis for obesity management in China and will promote the development of exercise- and diet-related studies. Trial registration Chinese Clinical Trial Registry, ChiCTR1900023841. Registered on 14 June 2019.
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Affiliation(s)
- Shaoyong Xu
- Department of Health Statistics, Shaanxi Key Laboratory of Free Radical Biology and Medicine and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University of PLA, Changle West Road No. 169, Xi'an, 710032, Shaanxi, China.,Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, No. 136, Jingzhou Street, Xiangyang, 441021, Hubei, China
| | - Juan Zhang
- Department of Endocrinology, 3201 Hospital of Xi'an Jiao tong University Health Science Center, 783 Tianhan Road, Hanzhong, 723000, Shaanxi, China
| | - Yuxiang Dong
- Department of Clinical Nutrition, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, No. 136, Jingzhou Street, Xiangyang City, 441021, Hubei, China
| | - Ruikun Chen
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, No. 136, Jingzhou Street, Xiangyang, 441021, Hubei, China
| | - Wenlei Xu
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, No. 136, Jingzhou Street, Xiangyang, 441021, Hubei, China
| | - Zhijun Tan
- Department of Health Statistics, Shaanxi Key Laboratory of Free Radical Biology and Medicine and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University of PLA, Changle West Road No. 169, Xi'an, 710032, Shaanxi, China
| | - Ling Gao
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, No. 136, Jingzhou Street, Xiangyang, 441021, Hubei, China.
| | - Lei Shang
- Department of Health Statistics, Shaanxi Key Laboratory of Free Radical Biology and Medicine and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University of PLA, Changle West Road No. 169, Xi'an, 710032, Shaanxi, China.
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5
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Varkevisser RDM, van Stralen MM, Kroeze W, Ket JCF, Steenhuis IHM. Determinants of weight loss maintenance: a systematic review. Obes Rev 2019; 20:171-211. [PMID: 30324651 PMCID: PMC7416131 DOI: 10.1111/obr.12772] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/21/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Discerning the determinants of weight loss maintenance is important in the planning of future interventions and policies regarding overweight and obesity. We have therefore systematically synthesized recent literature on determinants of weight loss maintenance for individuals with overweight and obesity. METHODS With the use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, prospective studies were identified from searches in PubMed and PsycINFO from 2006 to 2016. We included articles investigating adults with overweight and obesity undergoing weight loss without surgery or medication. Included articles were scored on their methodological quality, and a best-evidence synthesis was applied to summarize the results. RESULTS Our search resulted in 8,222 articles of which 67 articles were selected. In total, 124 determinants were identified of which 5 were demographic, 59 were behavioural, 51 were psychological/cognitive and 9 were social and physical environmental determinants. We found consistent evidence that demographic determinants were not predictive of weight loss maintenance. Behavioural and cognitive determinants that promote a reduction in energy intake, an increase in energy expenditure and monitoring of this balance are predictive determinants. CONCLUSION This review identifies key determinants in weight loss maintenance. However, more research regarding cognitive and environmental determinants of weight loss maintenance is needed to advance our knowledge on determinants of weight loss maintenance.
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Affiliation(s)
- R D M Varkevisser
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M M van Stralen
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - W Kroeze
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - I H M Steenhuis
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Prehn K, Jumpertz von Schwartzenberg R, Mai K, Zeitz U, Witte AV, Hampel D, Szela AM, Fabian S, Grittner U, Spranger J, Flöel A. Caloric Restriction in Older Adults-Differential Effects of Weight Loss and Reduced Weight on Brain Structure and Function. Cereb Cortex 2017; 27:1765-1778. [PMID: 26838769 DOI: 10.1093/cercor/bhw008] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Dietary modifications such as caloric restriction (CR) have been suggested as a means to improve memory and prevent age-related decline. However, it is unclear whether those effects remain stable over time or are related specifically to negative energy balance during the weight loss phase of CR. Using a randomized interventional design, we investigated changes in recognition memory and neural correlates in postmenopausal obese women (n = 19): 1) after intense weight loss in the course of a 12-week low-caloric diet (reduced body weight and negative energy balance) and 2) after having sustained the reduced weight over 4 more weeks (reduced body weight, but energy balance equilibrium). Participants were contrasted to a control group (n = 18) instructed not to change dietary habits. In the CR group, we found improved recognition memory, paralleled by increased gray matter volume in inferior frontal gyrus and hippocampus, and augmented hippocampal resting-state functional connectivity to parietal areas. Moreover, effects were specific for transient negative energy balance and could not be detected after subsequent weight maintenance. Our data demonstrate for the first time in humans that beneficial effects of CR on brain structure and function are due to weight loss rather than an overall reduced weight.
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Affiliation(s)
- Kristin Prehn
- Department of Neurology and NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Reiner Jumpertz von Schwartzenberg
- Department of Endocrinology, Diabetes and Nutrition, Experimental and Clinical Research Center and Center for Cardiovascular Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Knut Mai
- Department of Endocrinology, Diabetes and Nutrition, Experimental and Clinical Research Center and Center for Cardiovascular Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Zeitz
- Department of Endocrinology, Diabetes and Nutrition, Experimental and Clinical Research Center and Center for Cardiovascular Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A Veronica Witte
- Department of Neurology and NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Aging and Obesity Group, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Dierk Hampel
- Department of Endocrinology, Diabetes and Nutrition, Experimental and Clinical Research Center and Center for Cardiovascular Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anna-Maria Szela
- Department of Neurology and NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sonja Fabian
- Department of Neurology and NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Grittner
- Department of Biostatistics and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Spranger
- Department of Endocrinology, Diabetes and Nutrition, Experimental and Clinical Research Center and Center for Cardiovascular Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Agnes Flöel
- Department of Neurology and NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
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7
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Stubbs RJ, Morris L, Pallister C, Horgan G, Lavin JH. Weight outcomes audit in 1.3 million adults during their first 3 months' attendance in a commercial weight management programme. BMC Public Health 2015; 15:882. [PMID: 26359180 PMCID: PMC4566482 DOI: 10.1186/s12889-015-2225-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 09/04/2015] [Indexed: 01/07/2023] Open
Abstract
Background Over sixty percent of adults in the UK are now overweight/obese. Weight management on a national scale requires behavioural and lifestyle solutions that are accessible to large numbers of people. Evidence suggests commercial weight management programmes help people manage their weight but there is little research examining those that pay to attend such programmes rather than being referred by primary care. The objective of this analysis was to evaluate the effectiveness of a UK commercial weight management programme in self-referred, fee-paying participants. Methods Electronic weekly weight records were collated for self-referred, fee-paying participants of Slimming World groups joining between January 2010 and April 2012. This analysis reports weight outcomes in 1,356,105 adult, non-pregnant participants during their first 3 months’ attendance. Data were analysed by regression, ANOVA and for binomial outcomes, chi-squared tests using the R statistical program. Results Mean (SD) age was 42.3 (13.6) years, height 1.65 m (0.08) and start weight was 88.4 kg (18.8). Mean start BMI was 32.6 kg/m2 (6.3 kg/m2) and 5 % of participants were men. Mean weight change of all participants was −3.9 kg (3.6), percent weight change −4.4 (3.8), and BMI change was −1.4 kg/m2 (1.3). Mean attendance was 7.8 (4.3) sessions in their first 3 months. For participants attending at least 75 % of possible weekly sessions (n = 478,772), mean BMI change was −2.5 kg/m2 (1.3), weight change −6.8 kg (3.7) and percent weight change −7.5 % (3.5). Weight loss was greater in men than women absolutely (−6.5 (5.3) kg vs −3.8 (3.4) kg) and as a percentage (5.7 % (4.4) vs 4.3 % (3.7)), respectively. All comparisons were significant (p < 0.001). Level of attendance and percent weight loss in the first week of attendance together accounted for 55 % of the variability in weight lost during the study period. Conclusions A large-scale commercial lifestyle-based weight management programme had a significant impact on weight loss outcomes over 3 months. Higher levels of attendance led to levels of weight loss known to be associated with significant clinical benefits, which on this scale may have an impact on public health.
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Affiliation(s)
- R James Stubbs
- Nutrition and Research Department, Slimming World, Clover Nook Road, Somercotes, Alfreton, Derbyshire, DE55 4RF, UK. .,College of Life and Natural Sciences, University of Derby, Kedleston Road, Derby, DE22 1GB, UK.
| | - Liam Morris
- Nutrition and Research Department, Slimming World, Clover Nook Road, Somercotes, Alfreton, Derbyshire, DE55 4RF, UK.
| | - Carolyn Pallister
- Nutrition and Research Department, Slimming World, Clover Nook Road, Somercotes, Alfreton, Derbyshire, DE55 4RF, UK.
| | - Graham Horgan
- Biomathematics and Statistics Scotland, The Rowett Institute of Nutrition and Health, Greenburn road, Aberdeen, AB21 9SB, UK.
| | - Jacquie H Lavin
- Nutrition and Research Department, Slimming World, Clover Nook Road, Somercotes, Alfreton, Derbyshire, DE55 4RF, UK.
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8
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Nurkkala M, Kaikkonen K, Vanhala ML, Karhunen L, Keränen AM, Korpelainen R. Lifestyle intervention has a beneficial effect on eating behavior and long-term weight loss in obese adults. Eat Behav 2015; 18:179-85. [PMID: 26112229 DOI: 10.1016/j.eatbeh.2015.05.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/05/2015] [Accepted: 05/13/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the change in eating behavior and the factors related with the change among successful dieters (maintained a weight loss of ≥5% of original weight). METHODS Obese adult subjects (21 male, 55 female) were randomized into three-year lifestyle intervention (n=59) and control groups (n=17). Eating behavior (cognitive restraint of eating, uncontrolled eating and emotional eating) was evaluated by the TFEQ-18 and motivation to lose weight and tolerance to problems by a separate questionnaire. Weight, height and body mass index were measured. RESULTS Weight decreased more in the intervention group than in the control group (5.0% vs 0.6%, p=0.027). Cognitive restraint increased twice as much in the intervention group compared to the control group (16.0 vs. 7.0, p=0.044). The increment in cognitive restraint was positively associated with weight loss and high baseline motivation and tolerance to problems. Cognitive restraint increased in both successful (n=27) and unsuccessful dieters (n=32), but only the successful dieters were able to decrease uncontrolled eating in the long term. CONCLUSIONS Our results showed that intensive lifestyle counseling improved cognitive restraint which was associated with enhanced weight loss among obese adults. Successful dieters also showed a long-term improvement of uncontrolled eating. Eating behavior should be evaluated and followed before and during lifestyle interventions in order to support the change, e.g. by finding methods to control eating at risk situations and strengthening motivation and tolerance to problems.
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Affiliation(s)
- Marjukka Nurkkala
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute, P.O. BOX 365, FI-90101 Oulu, Finland; Institute of Health Sciences, University of Oulu, P.O. BOX 5000, FI-90014 University of Oulu, Finland; MRC Oulu, University Hospital of Oulu and University of Oulu, P.O. BOX 5000, FI-90014 OYS, Finland.
| | - Kaisu Kaikkonen
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute, P.O. BOX 365, FI-90101 Oulu, Finland; Institute of Health Sciences, University of Oulu, P.O. BOX 5000, FI-90014 University of Oulu, Finland; MRC Oulu, University Hospital of Oulu and University of Oulu, P.O. BOX 5000, FI-90014 OYS, Finland.
| | - Marja L Vanhala
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute, P.O. BOX 365, FI-90101 Oulu, Finland.
| | - Leila Karhunen
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. BOX 1627, FI-70211 Kuopio, Finland; Clinical Nutrition and Obesity Centre, Department of Medicine, Kuopio University Hospital, P.O. BOX 100, FI-70029 KYS, Finland.
| | - Anna-Maria Keränen
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute, P.O. BOX 365, FI-90101 Oulu, Finland; MRC Oulu, University Hospital of Oulu and University of Oulu, P.O. BOX 5000, FI-90014 OYS, Finland; Clinical Research Center and Medical Research Center, University Hospital of Oulu, P.O. BOX 5000, FI-90014 OYS, Finland.
| | - Raija Korpelainen
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute, P.O. BOX 365, FI-90101 Oulu, Finland; Institute of Health Sciences, University of Oulu, P.O. BOX 5000, FI-90014 University of Oulu, Finland; MRC Oulu, University Hospital of Oulu and University of Oulu, P.O. BOX 5000, FI-90014 OYS, Finland.
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9
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Stead M, Craigie AM, Macleod M, McKell J, Caswell S, Steele RJC, Anderson AS. Why are some people more successful at lifestyle change than others? Factors associated with successful weight loss in the BeWEL randomised controlled trial of adults at risk of colorectal cancer. Int J Behav Nutr Phys Act 2015; 12:87. [PMID: 26112014 PMCID: PMC4487855 DOI: 10.1186/s12966-015-0240-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 06/12/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The BeWEL (BodyWEight and physicaL activity) randomised controlled trial demonstrated that a weight management programme offered in the colorectal cancer screening setting was effective. However, the differential responses of participants to the programme were notable. This study aimed to explore the factors associated with success and to identify implications for future programme design. METHODS Analyses were conducted of quantitative data (n = 148) from the BeWEL intervention group to compare demographic and psychosocial characteristics and lifestyle changes in those who met and exceeded the target 7% weight loss ('super-achievers') with those who achieved only 'moderate' or 'low' amounts of weight loss (2-7% loss, or <2% loss, respectively). In-depth qualitative interviews (n = 24) explored in detail the motivations, actions, pathways to weight loss and circumstances of study participants. RESULTS Over the 12 month intervention period, mean percentage weight loss of super-achievers (n = 33) was 11.5%, compared with moderate-achievers (n = 58) who lost 4.2%, and low-achievers (n = 57) who gained 0.8%. Compared to other groups, super- achievers increased their fruit and vegetable intake (p < 0.01) and physical activity (step count, p < 0.01). 'Super-achievers' did not differ in baseline demographic characteristics from other participants. However, significantly fewer reported that their activities were limited by physical and emotional health and they were more likely to perceive their current diet as harmful. Qualitative analyses found no consistent patterns among super-achievers in relation to some factors identified as important in previous studies, such as social support. However, super-achievers shared several characteristics such as determination and consistency in their engagement with the intervention, receptivity to new information and prompts, previous positive experience of changing health behaviours, being motivated by early success, making changes routine, and an ability to devise and apply strategies for dealing with setback and 'relapse' triggers. CONCLUSIONS Successful lifestyle change depends on active engagement as well as effective intervention ingredients. Weight loss interventions are likely to be more effective where they can adapt to participants' differing characteristics and needs, while also providing core elements likely to build success.
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Affiliation(s)
- Martine Stead
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
| | - Angela M Craigie
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Level 7, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - Maureen Macleod
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Level 7, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - Jennifer McKell
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
| | - Stephen Caswell
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Level 7, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - Robert J C Steele
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Level 7, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Level 7, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
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Svensson M, Hult M, van der Mark M, Grotta A, Jonasson J, von Hausswolff-Juhlin Y, Rössner S, Trolle Lagerros Y. The change in eating behaviors in a Web-based weight loss program: a longitudinal analysis of study completers. J Med Internet Res 2014; 16:e234. [PMID: 25367316 PMCID: PMC4259913 DOI: 10.2196/jmir.3131] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/07/2014] [Accepted: 07/22/2014] [Indexed: 01/01/2023] Open
Abstract
Background Eating behaviors are essential components in weight loss programs, but limited research has explored eating behaviors in Web-based weight loss programs. Objectives The aim was to evaluate an interactive Web-based weight loss program on eating behaviors using the 18-item Three-Factor Eating Questionnaire Revised (TFEQ-R18) which measures uncontrolled eating, emotional eating, and cognitive restrained eating. Our Web-based weight loss program is comprised of information about healthy lifestyle choices, weekly chats with experts, social networking features, databases for recipe searches, and features allowing members to self-report and track their weight, physical activity, and dietary intake on the website. Methods On registering for the weight loss program, 23,333 members agreed to take part in the research study. The participants were then asked to complete the TFEQ-R18 questionnaire at baseline and after 3 and 6 months of participation. All data collection was conducted online, with no face-to-face contact. To study changes in TFEQ-R18 eating behaviors we restricted our study to those members who completed all 3 TFEQ-R18 questionnaires. These participants were defined as “completers” and the remaining as “noncompleters.” The relationships between sex, change in eating behaviors, and total weight loss were studied using repeated measures ANOVA and Pearson correlation coefficient. Results In total, 22,800 individuals participated (females: 19,065/22,800, 83.62%; mean age 39.6, SD 11.4 years; BMI 29.0 kg/m2; males: 3735/22,800, 16.38%; mean age 43.2, SD 11.7 years; BMI 30.8 kg/m2). Noncompleters (n=22,180) were younger and reported a lower score of uncontrolled eating and a higher score of cognitive restrained eating. Over time, completers (n=620) decreased their uncontrolled eating score (from 56.3 to 32.0; P<.001) and increased their cognitive restrained eating (from 50.6 to 62.9; P<.001). Males decreased their emotional eating (from 57.2 to 35.9; P<.001), but no significant change was found among females. The baseline cognitive restrained eating score was significantly and positively associated with weight loss for completers in both men (P=.02) and women (P=.002). Conclusions To our knowledge, this is the largest TFEQ sample that has been documented. This Web-based weight loss intervention suggests that eating behaviors (cognitive restrained eating, uncontrolled eating, and emotional eating) measured by TFEQ-R18 were significantly changed during 6 months of participation. Our findings indicate differences in eating behaviors with respect to sex, but should be interpreted with caution because attrition was high.
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Affiliation(s)
- Madeleine Svensson
- Halmstad University, Deparment of Health and Social Sciences, Halmstad, Sweden.
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Stelmach-Mardas M, Mardas M, Warchoł W, Jamka M, Walkowiak J. Successful maintenance of body weight reduction after individualized dietary counseling in obese subjects. Sci Rep 2014; 4:6620. [PMID: 25311271 PMCID: PMC4340361 DOI: 10.1038/srep06620] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/21/2014] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to describe the effectiveness of individualized dietary counseling in obese subjects based on narrative interview technique on the maintenance of body weight reduction, changes in dietary behaviors, including type of cooking and physical activity. One-hundred subjects out of four-hundred patients met the inclusion criteria. Individually, 45-minute educational program with motivation counseling was performed in 0, 6 and 12 weeks of the study. Patients were advised to follow individually well-balanced diet for 12 weeks. The individuals were asked about the changes in their dietary habits (Food Frequency Questionnaire). The mean percentage of body weight changes from the baseline were as follows: in 6th week- 5.9%, in 12th week - 10.9% and in 52th week - 9.7% (P < 0.0001), however there were no statistically significant changes while comparing body weight in 12th and 52th week. The maintenance of body weight reduction was connected with the dietary habits changes, mainly the type of cooking and increased consumption of vegetable oils. In conclusion, individualized dietary counseling, based on narrative interview technique is an effective intervention for obesity treatment that may help maintain body weight reduction and adapt the pro-healthy changes in type of cooking and sources of dietary fat.
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Affiliation(s)
- Marta Stelmach-Mardas
- Department of Bromatology and Human Nutrition, Poznan University of Medical Sciences, 42 Marcelinska Str., 60-354 Poznan Poland
| | - Marcin Mardas
- 1] Department of Human Nutrition and Hygiene, Poznan University of Life Sciences, 31 Wojska Polskiego Str., 60-624 Poznan, Poland [2] Department of Oncology, Poznan University of Medical Sciences, 82/84 Szamarzewskiego Str., 60-569 Poznan, Poland
| | - Wojciech Warchoł
- Department of Biophysics, Poznan University of Medical Sciences, 10 Fredry Str. 61-701 Poznan, Poland
| | - Małgorzata Jamka
- Department of Bromatology and Human Nutrition, Poznan University of Medical Sciences, 42 Marcelinska Str., 60-354 Poznan Poland
| | - Jarosław Walkowiak
- Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, 27/33 Szpitalna Str., 60-572 Poznan, Poland
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12
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Long-term weight status in regainers after weight loss by lifestyle intervention: status and challenges. Proc Nutr Soc 2014; 73:509-18. [PMID: 25192545 DOI: 10.1017/s0029665114000718] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
After having participated in a weight loss trial, most participants do not stabilise the obtained weight loss but return to their initial weight. The aim of this review is to describe the main determinants of continued low weight status after weight loss, and the effectiveness of physical activity (PA), energy restriction and macronutrient composition of the diet for low long-term weight regain. Studies with intervention periods of at least 3 months duration of weight reduction measures and a follow-up at least 2 years after the intervention period were considered as eligible for the review. Owing to limited data, the studies describing the role of PA in weight management were eligible with a follow-up of 1 year only. It appears that a diet with self-regulation of dietary intake seems to be given a prominent role in the strategy of successful long-term weight loss among the obese. This measure could be combined with behaviour therapy and PA and tailored to the individual situation. However, considering available evidence it is difficult to conclude regarding unambiguous measures and to recommend a specific dietary intervention. Nevertheless, interventions should be effective in promoting intrinsic motivation and self-efficacy. The harmonisation and standardisation of data collection in the follow-up period of long-term weight loss studies is a major challenge.
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Collins CE, Morgan PJ, Hutchesson MJ, Callister R. Efficacy of standard versus enhanced features in a Web-based commercial weight-loss program for obese adults, part 2: randomized controlled trial. J Med Internet Res 2013; 15:e140. [PMID: 23876832 PMCID: PMC3786000 DOI: 10.2196/jmir.2626] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/12/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Commercial Web-based weight-loss programs are becoming more popular and increasingly refined through the addition of enhanced features, yet few randomized controlled trials (RCTs) have independently and rigorously evaluated the efficacy of these commercial programs or additional features. OBJECTIVE To determine whether overweight and obese adults randomized to an online weight-loss program with additional support features (enhanced) experienced a greater reduction in body mass index (BMI) and increased usage of program features after 12 and 24 weeks compared to those randomized to a standard online version (basic). METHODS An assessor-blinded RCT comparing 301 adults (male: n=125, 41.5%; mean age: 41.9 years, SD 10.2; mean BMI: 32.2 kg/m(2), SD 3.9) who were recruited and enrolled offline, and randomly allocated to basic or enhanced versions of a commercially available Web-based weight-loss program for 24 weeks. RESULTS Retention at 24 weeks was greater in the enhanced group versus the basic group (basic 68.5%, enhanced 81.0%; P=.01). In the intention-to-treat analysis of covariance with imputation using last observation carried forward, after 24 weeks both intervention groups had reductions in key outcomes with no difference between groups: BMI (basic mean -1.1 kg/m(2), SD 1.5; enhanced mean -1.3 kg/m(2), SD 2.0; P=.29), weight (basic mean -3.3 kg, SD 4.7; enhanced mean -4.0 kg, SD 6.2; P=.27), waist circumference (basic mean -3.1 cm, SD 4.6; enhanced mean -4.0 cm, SD 6.2; P=.15), and waist-to-height ratio (basic mean -0.02, SD 0.03; enhanced mean -0.02, SD 0.04, P=.21). The enhanced group logged in more often at both 12 and 24 weeks, respectively (enhanced 12-week mean 34.1, SD 28.1 and 24-week mean 43.1, SD 34.0 vs basic 12-week mean 24.6, SD 25.5 and 24-week mean 31.8, SD 33.9; P=.002). CONCLUSIONS The addition of personalized e-feedback in the enhanced program provided limited additional benefits compared to a standard commercial Web-based weight-loss program. However, it does support greater retention in the program and greater usage, which was related to weight loss. Further research is required to develop and examine Web-based features that may enhance engagement and outcomes and identify optimal usage patterns to enhance weight loss using Web-based programs. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) trial number: ACTRN12610000197033; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=335159 (Archived by WebCite at http://www.webcitation.org/6HoOMGb8j).
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Affiliation(s)
- Clare E Collins
- Priority Research Centre in Nutrition and Physical Activity, Nutrition and Dietetics, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, Australia.
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