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Khokhar S, Holden J, Toomer C, Del Parigi A. Weight Loss with an AI-Powered Digital Platform for Lifestyle Intervention. Obes Surg 2024; 34:1810-1818. [PMID: 38573389 DOI: 10.1007/s11695-024-07209-1] [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: 12/31/2023] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Lifestyle intervention remains the cornerstone of weight loss programs in addition to pharmacological or surgical therapies. Artificial intelligence (AI) and other digital technologies can offer individualized approaches to lifestyle intervention to enable people with obesity to reach successful weight loss. METHODS SureMediks, a digital lifestyle intervention platform using AI, was tested by 391 participants (58% women) with a broad range of BMI (20-78 kg/m2), with the aim of losing weight over 24 weeks in a multinational field trial. SureMediks consists of a mobile app, an Internet-connected scale, and a discipline of artificial intelligence called Expert system to provide individualized guidance and weight-loss management. RESULTS All participants lost body weight (average 14%, range 4-22%). Almost all (98.7%) participants lost at least 5% of body weight, 75% lost at least 10%, 43% at least 15%, and 9% at least 20%, suggesting that this AI-powered lifestyle intervention was also effective in reducing the burden of obesity co-morbidities. Weight loss was partially positively correlated with female sex, accountability circle size, and participation in challenges, while it was negatively correlated with sub-goal reassignment. The latter three variables are specific features of the SureMediks weight loss program. CONCLUSION An AI-assisted lifestyle intervention allowed people with different body sizes to lose 14% body weight on average, with 99% of them losing more than 5%, over 24 weeks. These results show that digital technologies and AI might provide a successful means to lose weight, before, during, and after pharmacological or surgical therapies.
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Affiliation(s)
| | - John Holden
- Rockford-College of Medicine, University of Illinois, Rockford, IL, 6110, USA
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Suire KB, Kavookjian J, Strunk K, Wadsworth DD. Motivational interviewing for weight management among college students during COVID-19: An exploratory randomized controlled trial. OBESITY PILLARS (ONLINE) 2024; 9:100097. [PMID: 38268522 PMCID: PMC10805662 DOI: 10.1016/j.obpill.2023.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024]
Abstract
Background College students encounter challenges in managing their weight. The Coronavirus Disease 2019 (COVID-19) pandemic exacerbated the problem. The purpose of this study was to determine the effect of a motivational interviewing (MI) intervention compared to online education (control) on body composition and self-determination theory constructs among college students with overweight. Methods This was a randomized clinical trial of 40 college students comparing an MI versus a control group. The MI group received monthly interviews: three face-to-face interviews before the pandemic, and three video chat interviews after the outbreak of COVID-19 spanning a total of six months. The control group received six, monthly education modules. Body composition was measured by the iDexa and self-determination theory (SDT) variables were assessed with surveys. Results Mixed ANOVAs from pre-post revealed significant changes in fat mass (p = .03, η2 = 0.22), lean mass (p < .05, η2 = 0.18), body fat percentage (p < .01, η2 = 0.37), autonomy (p < .01, η2 = 0.38), relatedness (p < .01, η2 = 0.41), amotivation (p = .01, η2 = 0.29), external regulation (p = .02, η2 = 0.23), identified regulation (p = .02, η2 = 0.25), integrated regulation (p < .00, η2 = 0.49), and intrinsic regulation (p = .01, η2 = 0.27). Conclusions In this exploratory analysis, MI demonstrated a positive trend in body composition maintenance when compared to online education among overweight college students during a national pandemic. Future studies utilizing MI would enhance the literature by further investigating the relationship between MI and SDT and measuring body composition.Clinicaltrials.gov. identifier: NCT04130386.
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Affiliation(s)
- Kameron B. Suire
- Motivating Movement Lab, Kinesiology Department, Berry College, Mt. Berry, Georgia, USA
| | - Jan Kavookjian
- Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
| | - Kamden Strunk
- Foundations of Education, School of Education, Virginia Commonwealth University, Richmond, VA, USA
| | - Danielle D. Wadsworth
- Exercise Adherence and Obesity Prevention Laboratory, School of Kinesiology, Auburn University, Auburn, AL, USA
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Wren GM, Koutoukidis DA, Scragg J, Whitman M, Jebb S. The Association Between Goal Setting and Weight Loss: Prospective Analysis of a Community Weight Loss Program. J Med Internet Res 2023; 25:e43869. [PMID: 37405833 DOI: 10.2196/43869] [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: 10/28/2022] [Revised: 05/05/2023] [Accepted: 06/06/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Goal setting aids health-related behavior changes; however, the influence of different types of goals on weight loss remains unclear. OBJECTIVE We aimed to investigate the association of 3 aspects of goal setting with weight and program dropout over a 24-week period. METHODS This study was a prospective longitudinal analysis of participants in a 12-week digital behavioral weight loss program. Weight and engagement data for eligible participants (N=36,794) were extracted from the database. Eligible participants were adults in the United Kingdom who had enrolled in the program, had a BMI ≥25 kg/m2, and a weight reading recorded at baseline. Three aspects of goal setting were self-reported at enrollment: weight loss motivation (appearance, health, fitness, or self-efficacy), overall goal preference (low, medium, or high), and percentage weight loss goal (<5%, 5%-10%, or >10%). Weight was measured at 4, 12, and 24 weeks. Mixed models for repeated measures were used to explore the association between goals and weight across the 24-week period. To measure sustained weight change, the primary outcome was weight at 24 weeks. We explored dropout rates over the 24-week period by goal and whether engagement mediated the association between goals and weight loss. RESULTS Of the 36,794 participants (mean 46.7, SD 11.1 years; 33,902/36,794, 92.14% female) included in the cohort, 13.09% (n=4818) reported weight at 24 weeks. Most participants set goals of 5%-10% weight loss (23,629/36,794, 64.22%), but setting goals for >10% was associated with greater weight loss (mean difference 5.21 kg, 95% CI 5.01-5.41; P<.001). There was no difference between goals of 5%-10% and <5% (mean difference 0.59 kg, 95% CI 0.00-1.18; P=.05). Appearance was the most prevalent motivational factor (14,736/36,794, 40.05%), but health and fitness were associated with greater weight losses (mean difference health vs appearance 1.40 kg, 95% CI 1.15-1.65; P<.001 and mean difference fitness vs appearance 0.38 kg, 95% CI 0.05-0.70; P=.03). Goal preference had no association with weight. Engagement was an independent predictor of weight loss but not a mediator of the effect of goal setting. At 24 weeks, those who set goals of >10% were less likely to drop out compared with 5%-10% goals (odds ratio [OR] 0.40, 95% CI 0.38-0.42; P<.001); those who liked to set overall high goals were more likely to drop out compared with medium goals (OR 1.20, 95% CI 1.11-1.29; P<.001); and those motivated by fitness or health were less likely to drop out compared with appearance (OR 0.92, 95% CI 0.85-0.995; P=.04 and OR 0.84, 95% CI 0.78-0.89; P<.001, respectively). CONCLUSIONS Setting higher weight loss goals and being motivated by health or fitness were associated with greater weight loss and lower likelihood of dropout. Randomized trials for setting these types of goals are required to confirm causality.
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Affiliation(s)
- Gina M Wren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Dimitrios A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jadine Scragg
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Susan Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Hagerman CJ, Miller NA, Butryn ML. Latent Profile Analysis of Physical Activity Motivation during Behavioral Weight Loss Treatment. PSYCHOLOGY OF SPORT AND EXERCISE 2023; 66:102376. [PMID: 37383031 PMCID: PMC10299802 DOI: 10.1016/j.psychsport.2022.102376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 06/30/2023]
Abstract
Participants in behavioral weight loss (BWL) treatment often struggle to meet and maintain physical activity (PA) prescriptions; improving participants' motivation for the behavior is a potential intervention strategy. Self-Determination Theory (SDT) outlines a continuum of qualitatively different dimensions of motivation, suggesting that more self-determined forms of motivation should predict more PA, whereas less self-determined forms of motivation should be unrelated or negatively related to PA. Although SDT has ample empirical support, most existing research in this area has used statistical analyses that oversimplify the complex, interdependent relationships between dimensions of motivation and behavior. This study's purpose was to explore commonly occurring motivational "profiles" for PA based on the SDT dimensions of motivation (amotivation, external, introjected, integrated/identified, and intrinsic motivation) and how these profiles relate to PA behavior among participants with overweight/obesity (N=281, 79.4% female) at baseline and six months into BWL treatment. Latent profile analysis determined that three motivational profiles fit the data best at both timepoints and the profile characterized by high self-determined (i.e., integrated/identified and intrinsic) motivation and moderate introjected motivation was by far the most common. There were no differences in physical activity behavior across motivational profiles, which contrasts previous literature. Findings suggest that participants who take the initiative to sign up for intensive BWL programs may have sufficiently high PA motivation, which may be a poor predictor of their actual behavior. Future research should examine these relationships later in treatment, when motivation may have more variability, as well as among participants who initiate lower-commitment weight loss programs (e.g., self-help).
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Affiliation(s)
- Charlotte J Hagerman
- Center for Weight, Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA
| | - Nicole A Miller
- Center for Weight, Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA
| | - Meghan L Butryn
- Center for Weight, Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA
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Pluta K, More KR, Phillips LA. Predicting implicit and explicit exercise identity from descriptive social norms regarding exercise. Psychol Health 2023:1-19. [PMID: 36606581 DOI: 10.1080/08870446.2022.2156580] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Exercise identity may promote exercise maintenance. However, less is known about factors that affect exercise identity. Whether descriptive social norms are potential intervention targets for identity development was evaluated. DESIGN A cross-sectional design using data from the Attitudes, Identities, and Individual Differences (AIID) study was employed - with additional cases collected to increase sample size and power - to evaluate whether descriptive social norms regarding exercise are related to implicit and explicit exercise identities. MAIN OUTCOME MEASURES Participants completed measures of proximal and distal descriptive social norms regarding exercise, explicit and implicit exercise identity, physical activity behavior, and demographics. Multiple regression was used to assess whether social norms regarding exercise predict exercise identities. RESULTS Only proximal descriptive social norms were significantly associated with explicit exercise identity, whereas neither proximal nor distal descriptive social norms were associated with implicit exercise identity. The slopes for explicit and implicit identity differed when predicted by distal (but not proximal) descriptive social norms. CONCLUSIONS Proximal descriptive social norms may be associated with explicit exercise identity and may be a worthy intervention targeting alongside identity to influence change in exercise behavior. More research is needed to further understand these relationships.
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Affiliation(s)
- Kathryn Pluta
- College of Medicine, University of Florida, Gainesville, FL, USA
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Wade J, Alexander R, Giscombé CW, Keegan D, Parker S, Jackson K, Gibbs J, McElroy A, Ferguson JV. Using Black Feminist Theory and Methods to Uncover Best Practices in Health Promotion Programming. QUALITATIVE HEALTH RESEARCH 2022; 32:581-594. [PMID: 34931558 PMCID: PMC8879412 DOI: 10.1177/10497323211061108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This study was created to uncover the social determinants of Black American women's success in health promotion programs. We used the Superwoman Schema to understand the complexities of Black womanhood and uncover best practices in the promotion of their health. The sample consisted of women ages 18-25 who attend a large southern HBCU. We collected data using qualitative focus groups. Participants reported the greatest health-related concerns Black American women facing are mental health, obesity, and relationships with Black men. When it comes to health promotion programs, respondents reported a desire for classes that are fun, interactive, informative, educational, and include group interaction, accessible, and incentivize participation. Uncovering the social determinants of Black American women's health and program success is central in decreasing extant health disparities. Future health scholars are urged to incorporate Black feminist theory and methods into their work to create health promotion interventions tailored for Black women.
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Affiliation(s)
- Jeannette Wade
- Department of Social Work and Sociology, North Carolina A&T State University, Greensboro, NC, USA
| | - Ramine Alexander
- Department of Food and Nutritional Sciences, North Carolina A&T State University, Greensboro, NC, USA
| | - Cheryl Woods Giscombé
- Division & Program Levine Family Distinguished Scholar in Quality of Life, Health Promotion, and Wellness, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel Keegan
- Department of Social Work and Sociology, North Carolina A&T State University, Greensboro, NC, USA
| | - Sharon Parker
- Department of Social Work and Sociology, North Carolina A&T State University, Greensboro, NC, USA
| | - Katia Jackson
- Department of Psychology, North Carolina A&T State University, Greensboro, NC, USA
| | - Jasmine Gibbs
- Department of Social Work and Sociology, North Carolina A&T State University, Greensboro, NC, USA
| | - Asha McElroy
- Department of Food and Nutritional Sciences, North Carolina A&T State University, Greensboro, NC, USA
| | - Ja Vae Ferguson
- Department of Food and Nutritional Sciences, North Carolina A&T State University, Greensboro, NC, USA
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Suire KB, Peart A, Kavookjian J, Wadsworth DD. Impact of motivational interviewing as a follow-up to an exercise intervention among women with or at risk for metabolic syndrome: A randomized controlled trial. SAGE Open Med 2022; 10:20503121211073434. [PMID: 35070315 PMCID: PMC8771748 DOI: 10.1177/20503121211073434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/23/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Women have a higher prevalence of metabolic syndrome than their male counterparts, and interventions should target women with or at risk for metabolic syndrome. The objective of this study was to compare two intervention strategies on long-term outcomes following the completion of an exercise intervention. METHODS Twenty-six women (M age = 43.35 ± 9.03) with at least one risk factor for metabolic syndrome were randomized into either a motivational interviewing group (n = 10) or self-regulation-based mobile messaging control group (n = 16) as a 12-week follow-up to a 10-week, 30-session exercise intervention. Outcomes of interest were body fat percentage, bone mineral density, waist circumference, systolic blood pressure, diastolic blood pressure, triglycerides, high-density cholesterol, and fasting blood glucose. RESULTS Mixed ANOVAs revealed a significant effect for group × time for body fat percentage F(1, 24) = 8.30, p = 0.01,η p 2 = 0.26, bone mineral density F(1, 24) = 6.68, p = 0.02,η p 2 = 0.22, waist circumference F(1, 24) = 10.35, p = 0.01,η p 2 = 0.30, triglycerides F(1, 24) = 5.06, p = 0.03,η p 2 = 0.17, and systolic blood pressure F(1, 24) = 5.39, p = 0.03,η p 2 = 0.18 all in favor of the motivational interviewing group after 12 weeks when compared to the self-regulation-based mobile messaging group. No significant effect for group × time was noted for diastolic blood pressure p = 0.36,η p 2 = 0.04, high-density cholesterol p = 0.08,η p 2 = 0.12, or fasting blood glucose p = 0.85,η p 2 = 0.01 when comparing the motivational interviewing and self-regulation-based mobile messaging groups. CONCLUSIONS Motivational interviewing may be a more impactful solution to extend the effects of exercise intervention studies compared to a self-regulation-based mobile messaging control group. Future interventions should focus on increasing sample size, utilizing more objective measures of body composition, utilizing booster sessions, and increasing the length of follow-up periods.
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Affiliation(s)
- Kameron B Suire
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Desoto, KS, USA
| | - Ashley Peart
- Exercise Adherence and Obesity Prevention Laboratory, School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Jan Kavookjian
- Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
| | - Danielle D Wadsworth
- Exercise Adherence and Obesity Prevention Laboratory, School of Kinesiology, Auburn University, Auburn, AL, USA
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8
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Zhang J, Bloom I, Dennison EM, Ward KA, Robinson SM, Barker M, Cooper C, Lawrence W. Understanding influences on physical activity participation by older adults: A qualitative study of community-dwelling older adults from the Hertfordshire Cohort Study, UK. PLoS One 2022; 17:e0263050. [PMID: 35077522 PMCID: PMC8789143 DOI: 10.1371/journal.pone.0263050] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 01/12/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The health benefits of physical activity (PA) participation in later life are widely recognised. Understanding factors that can influence the participation of community-dwelling older adults in PA is crucial in an ageing society. This will be paramount in aiding the design of future interventions to effectively promote PA in this population. The main aim of this qualitative study was to explore influences on PA among community-dwelling older people, and the secondary aim was to explore gender differences. METHODS Qualitative data were collected in 2014 by conducting focus group discussions using a semi-structured discussion guide with older people resident in Hertfordshire, UK. Discussions were audio-recorded, transcribed verbatim and transcripts analysed thematically. RESULTS Ninety-two participants were recruited to the study (47% women; 74-83 years) and a total of 11 focus groups were conducted. Findings indicated six themes that appeared to affect older adults' participation in PA: past life experiences; significant life events; getting older; PA environment; psychological/personal factors; and social capital. Overall, the findings emphasised the role of modifiable factors, namely psychological factors (such as self-efficacy, motivation, outcome expectancy) and social factors (such as social support and social engagement). These factors exerted their own influence on physical activity participation, but also appeared to mediate the effect of other largely non-modifiable background and ageing-related factors on participants' engagement with PA in later life. CONCLUSION In view of these findings, intervention designers could usefully work with behavioural scientists for insight as to how to enhance psychological and social factors in older adults. Our data suggest that interventions that aim to build self-efficacy, motivation and social networks have the potential to indirectly promote PA participation in older adults. This would be best achieved by developing physical activity interventions through working with participants in an empowering and engaging way.
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Affiliation(s)
- Jean Zhang
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Ilse Bloom
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- * E-mail:
| | - Elaine M. Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- Victoria University of Wellington, Wellington, New Zealand
| | - Kate A. Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Sian M. Robinson
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Mary Barker
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, United Kingdom
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Makin H, Chisholm A, Fallon V, Goodwin L. Use of motivational interviewing in behavioural interventions among adults with obesity: A systematic review and meta-analysis. Clin Obes 2021; 11:e12457. [PMID: 33955152 DOI: 10.1111/cob.12457] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 01/29/2023]
Abstract
This review aimed to identify whether motivational interviewing (MI) (a counselling approach for supporting behaviour change [BC]) helps to reduce bodyweight and BMI in an adult obesity context. This included evaluating effectiveness of MI interventions within this population and reporting the methodology used, including theoretical underpinnings and identification of BC and MI techniques. Eight databases were searched using controlled vocabulary. Eligible studies included adults with obesity (BMI ≥30 kg/m2 ), author-reported interventions using MI aiming to reduce body weight or BMI, and comparator groups not receiving an MI intervention. Data extraction and quality appraisal tools were used to identify study characteristics, intervention content was coded for techniques, and random-effects meta-analysis were conducted to investigate effects. Meta-analysis of 12 studies indicated no overall pooled effect on bodyweight and BMI outcomes between intervention and control groups (SMD = -0.01 [95%CI -0.13 to 0.12, P = .93]). Findings were limited by multiple sources accounting for risk of bias, and poor reporting of intervention fidelity and content. Intervention and control content descriptions indicated similar techniques, with social support, goal setting (behaviour) and self-monitoring of behaviour occurring most frequently across both. Findings do not contribute additional evidence for MI use in this context, however methodological limitations were identified which must be resolved to better identify the intervention effects on obesity-related outcomes.
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Affiliation(s)
- Harriet Makin
- Department of Psychology, Institute of Population Health, University of Liverpool, Merseyside, UK
| | - Anna Chisholm
- Department of Psychology, Institute of Population Health, University of Liverpool, Merseyside, UK
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Merseyside, UK
| | - Laura Goodwin
- Department of Psychology, Institute of Population Health, University of Liverpool, Merseyside, UK
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Iłowiecka K, Glibowski P, Skrzypek M, Styk W. The Long-Term Dietitian and Psychological Support of Obese Patients Who Have Reduced Their Weight Allows Them to Maintain the Effects. Nutrients 2021; 13:nu13062020. [PMID: 34208363 PMCID: PMC8231289 DOI: 10.3390/nu13062020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 12/25/2022] Open
Abstract
The role of post-therapeutic support after weight loss in obesity treatment is not fully understood. Therefore, weight maintenance after a successful weight loss intervention is not very common, especially in obese individuals. This randomized controlled study was conducted to explore the efficacy of following dietary and psychological support in a group of 36 obese individuals. Participants (22 women, 14 men aged 35.58 ± 9.85 years, BMI 35.04 ± 3.80 kg/m2) who completed a 12-month weight loss phase (balanced energy-restricted diet) were randomly allocated to receive 18-month support (SG) or no additional care (CG). The support phase included some elements of Ten Top Tips (TTT), cognitive behavioral therapy (CBT), motivational interviewing (MI) in combination with nutritional education and assessment of the level of physical activity. The primary outcome was the maintenance of anthropometric parameters at an 18-month follow-up. The secondary outcomes included evaluation of biochemical parameters and single nucleotide polymorphisms (SNPs) in genes connected with obesity. A comparison of SG vs. CG after a 30-month period of the study revealed significant differences in weight changes (−3.83 ± 6.09 vs. 2.48 ± 6.24 kg), Body Mass Index (−1.27 ± 2.02 vs. 0.72 ± 2.12 kg/m2), visceral adipose tissue (−0.58 ± 0.63 vs. 0.45 ± 0.74 L), and waist circumference (−4.83 ± 4.05 vs. 1.83 ± 5.97 cm). Analysis of SNPs (rs9939609 FTO, rs987237 TFAP2B, and rs894160 PLIN1) provided further insight into the potential modulating effect of certain genotypes on weight loss and maintenance and extended the knowledge of the potential benefits of personalized medicine. Post-therapeutical support in current clinical practice may increase the chances of long-term weight loss maintenance in obesity treatment even in patients with a genetic predisposition to excessive weight.
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Affiliation(s)
- Katarzyna Iłowiecka
- Department of Biotechnology, Microbiology and Human Nutrition, University of Life Sciences in Lublin, 20-704 Lublin, Poland;
| | - Paweł Glibowski
- Department of Biotechnology, Microbiology and Human Nutrition, University of Life Sciences in Lublin, 20-704 Lublin, Poland;
- Correspondence: ; Tel.: +48-(81)-462-33-49
| | - Michał Skrzypek
- Department of Clinical Dietetics, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Wojciech Styk
- Institute of Psychology, The John Paul II Catholic University of Lublin, 20-950 Lublin, Poland;
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11
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Chew HSJ, Ang WHD, Lau Y. The potential of artificial intelligence in enhancing adult weight loss: a scoping review. Public Health Nutr 2021; 24:1993-2020. [PMID: 33592164 PMCID: PMC8145469 DOI: 10.1017/s1368980021000598] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/12/2021] [Accepted: 02/03/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To present an overview of how artificial intelligence (AI) could be used to regulate eating and dietary behaviours, exercise behaviours and weight loss. DESIGN A scoping review of global literature published from inception to 15 December 2020 was conducted according to Arksey and O'Malley's five-step framework. Eight databases (CINAHL, Cochrane-Central, Embase, IEEE Xplore, PsycINFO, PubMed, Scopus and Web of Science) were searched. Included studies were independently screened for eligibility by two reviewers with good interrater reliability (k = 0·96). RESULTS Sixty-six out of 5573 potential studies were included, representing more than 2031 participants. Three tenets of self-regulation were identified - self-monitoring (n 66, 100 %), optimisation of goal setting (n 10, 15·2 %) and self-control (n 10, 15·2 %). Articles were also categorised into three AI applications, namely machine perception (n 50), predictive analytics only (n 6) and real-time analytics with personalised micro-interventions (n 10). Machine perception focused on recognising food items, eating behaviours, physical activities and estimating energy balance. Predictive analytics focused on predicting weight loss, intervention adherence, dietary lapses and emotional eating. Studies on the last theme focused on evaluating AI-assisted weight management interventions that instantaneously collected behavioural data, optimised prediction models for behavioural lapse events and enhance behavioural self-control through adaptive and personalised nudges/prompts. Only six studies reported average weight losses (2·4-4·7 %) of which two were statistically significant. CONCLUSION The use of AI for weight loss is still undeveloped. Based on the current study findings, we proposed a framework on the applicability of AI for weight loss but cautioned its contingency upon engagement and contextualisation.
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Affiliation(s)
- Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
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12
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Gavin KL, Voils CI, Yancy WS, Olsen MK. Two-year weight trajectories following completion of a behavioral weight loss maintenance intervention. Obes Sci Pract 2021; 7:321-325. [PMID: 34123398 PMCID: PMC8170567 DOI: 10.1002/osp4.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/08/2021] [Accepted: 01/31/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Long‐term effects of behavioral weight loss maintenance interventions need to be assessed in order to understand their durability of effects. This can be evaluated with the use of weights recorded in the electronic medical record. The goal of this study was to use electronic health record (EHR)‐recorded weight to examine outcomes 2 years beyond the completion of a trial in which participants were randomized to receive a weight maintenance intervention or usual care after required initial weight loss. Methods Weights collected in the Veteran's Affairs national EHR were obtained for 2 years following trial completion. Outliers and implausible weights were identified and removed prior to analysis. Mixed‐effects models with quadratic time were fit to estimate between‐arm differences in weight change. Results Model‐estimated weight at trial completion was 109.7 kg for usual care and 106.8 kg for intervention, estimated difference of −2.9 kg (95% confidence interval [CI]: −8.8, 3.0; p = 0.34). Two years later, estimated mean weight collected from (n = 211) participants with available EMR weights was 111.5 kg for usual care and 108.0 kg for intervention, estimated difference −3.4 kg (95% CI: −9.3, 2.4 kg; p = 0.35). Conclusions While not statistically significant, weights from the EHR suggest the possibility of a clinically meaningful difference that should be confirmed by future adequately powered studies.
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Affiliation(s)
- Kara L Gavin
- Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA.,Research Service William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
| | - Corrine I Voils
- Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA.,Research Service William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
| | - William S Yancy
- Department of Medicine Duke University School of Medicine Durham North Carolina USA.,Center for Health Services Research in Primary Care Durham VA Health Care System Durham North Carolina USA
| | - Maren K Olsen
- Center for Health Services Research in Primary Care Durham VA Health Care System Durham North Carolina USA.,Department of Biostatistics and Bioinformatics Duke University School of Medicine Durham North Carolina USA
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13
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Does Setting Goals Enhance Parenting Intervention Effects? A Field Experiment. Behav Ther 2021; 52:418-429. [PMID: 33622510 DOI: 10.1016/j.beth.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 02/06/2020] [Accepted: 05/24/2020] [Indexed: 11/24/2022]
Abstract
People who pursue approach goals (i.e., desired outcomes to be reached) tend to be more likely to achieve their goals than people who pursue avoidance goals (i.e., undesired outcomes to be prevented). We tested this premise in a brief preventive parenting intervention targeting parental praise to reduce disruptive child behavior. We also tested whether goal setting effects depend on behavior change phase (initiation versus maintenance) and parents' regulatory focus (high versus low promotion and prevention focus). Parents (N = 224; child age 4-8) were randomized to one of four conditions: an approach goal-enhanced or an avoidance goal-enhanced intervention condition, a no-goal intervention condition, or a waitlist control condition. Outcomes were parent-reported and audio-recorded positive parenting and disruptive child behavior. Results show that goal setting had very limited effects. Setting avoidance goals, not approach goals, improved self-reported positive parenting. However, goal setting did not enhance effects of parenting intervention on observed (i.e., audio-recorded) positive parenting and disruptive child behavior. Furthermore, goal setting effects depended neither on the phase of change, nor on parents' regulatory focus. This field experiment suggests that setting approach goals does not enhance the brief parenting intervention to improve parent-child interactions.
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14
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Kinsey AW, Gowey MA, Tan F, Zhou D, Ard J, Affuso O, Dutton GR. Similar weight loss and maintenance in African American and White women in the Improving Weight Loss (ImWeL) trial. ETHNICITY & HEALTH 2021; 26:251-263. [PMID: 29966428 PMCID: PMC6314901 DOI: 10.1080/13557858.2018.1493435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 06/06/2018] [Indexed: 06/08/2023]
Abstract
Objective: African Americans (AA) are often underrepresented and tend to lose less weight than White participants during the intensive phase of behavioral obesity treatment. Some evidence suggests that AA women experience better maintenance of lost weight than White women, however, additional research on the efficacy of extended care programs (i.e. continued contacts to support the maintenance of lost weight) is necessary to better understand these differences.Methods: The influence of race on initial weight loss, the likelihood of achieving ≥5% weight reduction (i.e. extended care eligibility), the maintenance of lost weight and extended care program efficacy was examined in 269 AA and White women (62.1% AA) participating in a 16-month group-based weight management program. Participants achieving ≥5% weight reduction during the intensive phase (16 weekly sessions) were randomized to a clustered campaign extended care program (12 sessions delivered in three, 4-week clusters) or self-directed control.Results: In adjusted models, race was not associated with initial weight loss (p = 0.22) or the likelihood of achieving extended care eligibility (odds ratio 0.64, 95% CI [0.29, 1.38]). AA and White women lost -7.13 ± 0.39 kg and -7.62 ± 0.43 kg, respectively, during initial treatment. There were no significant differences in weight regain between AA and White women (p = 0.64) after adjusting for covariates. Clustered campaign program participants (AA: -6.74 ± 0.99 kg, White: -6.89 ± 1.10 kg) regained less weight than control (AA: -5.15 ± 0.99 kg, White: -4.37 ± 1.04 kg), equating to a 2.12 kg (p = 0.03) between-group difference after covariate adjustments.Conclusions: Weight changes and extended care eligibility were comparable among all participants. The clustered campaign program was efficacious for AA and White women. The high representation and retention of AA participants may have contributed to these findings.
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Affiliation(s)
- Amber W. Kinsey
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marissa A. Gowey
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fei Tan
- Department of Mathematical Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Dali Zhou
- Department of Mathematical Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Jamy Ard
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Olivia Affuso
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gareth R. Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Poulimeneas D, Anastasiou CA, Kokkinos A, Panagiotakos DB, Yannakoulia M. Motives for weight loss and weight loss maintenance: results from the MedWeight study. J Hum Nutr Diet 2021; 34:504-510. [PMID: 33493356 DOI: 10.1111/jhn.12856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The relationship of weight loss motives with long-term outcomes is equivocal. We aimed to examine differences in weight loss motives of maintainers and regainers, as well as explore associations between motives and successful maintenance. METHODS The study sample includes 607 adults, with a history of overweight/obesity and self-reported ≥10% voluntary weight loss, 12 months before study entry. Participants were classified as maintainers (weighing ≤90% maximum weight) or regainers. Volunteers identified possible motives for weight loss and maintenance (maintainers only), from a specific list. RESULTS Both maintainers and regainers were predominantly motivated by physical appearance (38.6% versus 39.9%, P > 0.05) and self-esteem (26.8% versus 32.0%, P > 0.05) for weight loss. Compared to regainers, more maintainers reported weight reduction driven by social purposes (16.6% versus 9.4%, P = 0.022) and less were prompted by friends/family to lose weight (21.1% versus 31.7%, P = 0.005). In maintainers, shifts in motives from weight loss to maintenance phase were found, including an increased prevalence of health motives (6.4% versus 9.6%, P < 0.001) and decreased physical appearance motives (38.6% versus 30.3%, P < 0.001). Reporting physical appearance as main maintenance motive was inversely associated with maintained weight loss, after adjusting for age, sex and years of education (B = -3.49 [1.07], P = 0.001); maintainers reporting physical appearance as the main motive maintained 3.5% less weight loss compared to those who did not (P = 0.001). CONCLUSIONS The present study has highlighted motivational influences associated with weight loss outcomes. Future studies should explore the ability of people with overweight/obesity to act upon motives for long-term weight management, as well as the impact of shifting through motives on the magnitude of maintenance.
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Affiliation(s)
- Dimitrios Poulimeneas
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Costas A Anastasiou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
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16
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Suire KB, Kavookjian J, Feiss R, Wadsworth DD. Motivational Interviewing for Weight Management Among Women: a Meta-Analysis and Systematic Review of RCTs. Int J Behav Med 2020; 28:403-416. [PMID: 33083891 DOI: 10.1007/s12529-020-09934-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Motivational interviewing (MI) is a communication skill set used by clinicians to help facilitate adherence to numerous health behaviors. Currently, MI's evidence supports its use among adults in various realms; however, clarity is needed regarding weight management among females. The purpose of this systematic review and meta-analysis is to synthesize the literature examining the use of MI and its impact on anthropometric measures among adult females. METHOD The authors conducted a modified Cochrane method of systematic search and review in several relevant databases to explore and report evidence and gaps in the literature for MI in weight management among females in addition to meta-analyses for weight and BMI. Criteria for retention included randomized controlled trials with open inclusion of studies with varied settings, methods, interventionists, target behaviors, and outcomes. RESULTS Of the 3289 references initially identified, 10 intervention arms met the criteria across review tiers. Seven of 10 intervention groups reported significant anthropometric changes compared with a control group, as well as significant changes in non-anthropometric outcomes related to weight management. Using a random-effects model, the effect size of MI on reduction in body weight (kg) was 0.19 (95% CI - 0.13, 0.26; p < 0.01), and the effect size of MI on reduction in BMI was 0.35 (95% CI 0.12, 0.58; p < 0.01). CONCLUSIONS Results suggest that MI interventions are useful for weight management among females. Future studies would enhance the current base of literature by utilizing advanced anthropometric outcomes, including sex-specific results, and including more diverse and larger sample sizes.
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Affiliation(s)
- Kameron B Suire
- School of Kinesiology, Auburn University, 301 Wire Rd, Auburn, AL, 36849, US.
| | - Jan Kavookjian
- Harrison School of Pharmacy, Auburn University, Auburn, AL, US
| | - Robyn Feiss
- School of Kinesiology, Auburn University, 301 Wire Rd, Auburn, AL, 36849, US
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17
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BİLGİN S, EVCİMEN H. Fazla Kilolu ve Obez Adölesanlarda Motivasyonel Görüşme Tekniğinin Kullanımı. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2020. [DOI: 10.33631/duzcesbed.553805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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18
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Nutrition knowledge, attitudes, and self-regulation as predictors of overweight and obesity. J Am Assoc Nurse Pract 2020; 31:502-510. [PMID: 30829975 DOI: 10.1097/jxx.0000000000000169] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Nutrition knowledge, attitudes, and eating self-regulation are important determinants of overweight and obesity. Eating self-regulation is the link between eating intention and behavior. However, the extent to which these factors influence overweight and obesity has not been thoroughly studied. The study examined nutrition knowledge, attitudes, and eating self-regulation as predictors of overweight and obesity among adults in a community setting. METHODS A total of 313 adults participated in an online survey, which included the General Nutrition Knowledge Questionnaire-Revised, the Nutrition Attitudes Questionnaire, and the Self-Regulation of Eating Behavior Questionnaire. Descriptive statistics, Kendall's tau tests, and multivariate logistic regression procedures were performed. CONCLUSIONS More than half of the participants were either overweight or obese (56.5%). The mean nutrition knowledge score was 74.1%, and only 28.1% correctly identified the body mass index for obesity. Positive predictors of overweight and obesity included poor eating self-regulation of giving up too easily on eating intentions (odds ratio [OR] = 3.81), male gender (OR = 2.0), and age (OR = 1.03), whereas nutrition attitudes were a negative predictor (OR = 0.74). IMPLICATIONS FOR PRACTICE The odds of overweight or obesity were nearly four times greater for those who gave up too easily on their eating intentions. Nurse practitioners can play a critical role in establishing healthy dietary habits to maintain weight control by promoting good eating self-regulation, despite the current obesogenic environment. After assessing patient readiness and motivation, it is important to help patients make eating self-regulation as manageable as possible to promote long-term weight management.
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Summers C, Curtis K. Novel Digital Architecture of a "Low Carb Program" for Initiating and Maintaining Long-Term Sustainable Health-Promoting Behavior Change in Patients with Type 2 Diabetes. JMIR Diabetes 2020; 5:e15030. [PMID: 32130113 PMCID: PMC7081139 DOI: 10.2196/15030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/29/2019] [Accepted: 09/29/2019] [Indexed: 12/11/2022] Open
Abstract
Globally, the burden of noncommunicable diseases such as type 2 diabetes is crippling health care systems. Type 2 diabetes, a disease linked with obesity, affects 1 in every 30 people today and is expected to affect 1 in 10 people by 2030. Current provisions are struggling to manage the trajectory of type 2 diabetes prevalence. Offline, face-to-face education for patients with type 2 diabetes has shown to lack long-term impact or the capacity for widespread democratized adoption. Digitally delivered interventions have been developed for patients with type 2 diabetes, and the evidence shows that some interventions provide the capacity to support hyperpersonalization and real-time continuous support to patients, which can result in significant engagement and health outcomes. However, digital health app engagement is notoriously difficult to achieve. This paper reviews the digital behavior change architecture of the Low Carb Program and the application of health behavioral theory underpinning its development and use in scaling novel methods of engaging the population with type 2 diabetes and supporting long-term behavior change.
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Affiliation(s)
| | - Kristina Curtis
- Faculty Research Centre for Advances in Behavioural Science, University of Coventry, Coventry, United Kingdom
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20
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Rounds T, Crane M, Harvey J. The Impact of Incentives on Weight Control in Men: A Randomized Controlled Trial. Am J Mens Health 2020; 14:1557988319895147. [PMID: 32106757 PMCID: PMC7052474 DOI: 10.1177/1557988319895147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Overweight and obese men were recruited to a 6-month, randomized controlled
weight loss trial, which compared the Gutbusters weight loss program alone to
the Gutbusters program with incentives for successful weight loss. The
intervention was delivered primarily online, with weekly in-person weight
collections. Gutbusters was designed using a template from the REFIT
intervention and encouraged participants (N = 102, 47.0 ± 12.3
years, 32.5 kg/m2) to make six 100-calorie changes to their typical
daily diet for a total of 42 changes per week. Weight loss was significantly
greater in the Gutbusters+Incentive group compared to the Gutbusters alone group
at both 12 and 24 weeks (p’s = < .01). The
Gutbusters+Incentive group’s a mean weight loss was 9.9 pounds at 12 weeks (95%
CI: 6.9, 12.9) and 8.4 pounds at 24 weeks (95% CI: 3.9, 13.0). The Gutbusters
alone group mean weight loss was 3.7 pounds at 12 weeks (95% CI: –.06, 7.5) and
3.4 pounds at 24 weeks (95% CI: –2.2, 9.0). This study adds to the literature of
behavioral weight programs that are designed for men. Unlike the majority of
previous male weight loss interventions, which were designed with an
intervention comparison to a no treatment or waitlist control, Gutbusters was
implemented as a comparative effectiveness trial, which will help bolster the
evidence base for real-world application.
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Affiliation(s)
| | | | - Jean Harvey
- The University of Vermont, Burlington, VT, USA
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21
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Schumacher LM, Kerrigan SG, Remmert JE, Call CC, Zhang F, Butryn ML. I think therefore I Am? Examining the relationship between exercise identity and exercise behavior during behavioral weight loss treatment. PSYCHOLOGY OF SPORT AND EXERCISE 2019; 43:123-127. [PMID: 34121930 PMCID: PMC8191234 DOI: 10.1016/j.psychsport.2019.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Identification as an exerciser may promote physical activity. This study examined exercise identity (EI) and its relationship with demographic characteristics and exercise among adults participating in behavioral weight loss treatment, which is a key target population for increasing exercise. DESIGN Longitudinal. METHOD Participants (N = 320) completed a measure of EI and exercise was assessed with accelerometers at baseline and 6 months. RESULTS Baseline EI and exercise were positively related and EI and exercise increased over time. However, change in EI was not meaningfully related to change in exercise, baseline EI did not predict change in exercise, and 6-month EI was not related to 6-month exercise. Participants identifying as non-White reported greater EI but lower exercise. CONCLUSIONS Although EI and exercise may increase among weight loss participants, the two may not be meaningfully related during active weight loss treatment. The relationship between EI and exercise may also differ based on race.
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Affiliation(s)
- Leah M. Schumacher
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Stratton Hall, 2nd Floor, 3201 Chestnut St., Philadelphia, PA, 19104, USA
- Department of Psychology, Drexel University, 3141 Chestnut St., Suite 119, Philadelphia, PA, 19104, USA
| | | | - Jocelyn E. Remmert
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Stratton Hall, 2nd Floor, 3201 Chestnut St., Philadelphia, PA, 19104, USA
- Department of Psychology, Drexel University, 3141 Chestnut St., Suite 119, Philadelphia, PA, 19104, USA
| | - Christine C. Call
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Stratton Hall, 2nd Floor, 3201 Chestnut St., Philadelphia, PA, 19104, USA
- Department of Psychology, Drexel University, 3141 Chestnut St., Suite 119, Philadelphia, PA, 19104, USA
| | - Fengqing Zhang
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Stratton Hall, 2nd Floor, 3201 Chestnut St., Philadelphia, PA, 19104, USA
- Department of Psychology, Drexel University, 3141 Chestnut St., Suite 119, Philadelphia, PA, 19104, USA
| | - Meghan L. Butryn
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Stratton Hall, 2nd Floor, 3201 Chestnut St., Philadelphia, PA, 19104, USA
- Department of Psychology, Drexel University, 3141 Chestnut St., Suite 119, Philadelphia, PA, 19104, USA
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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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Martínez-González MA, Buil-Cosiales P, Corella D, Bulló M, Fitó M, Vioque J, Romaguera D, Martínez JA, Wärnberg J, López-Miranda J, Estruch R, Bueno-Cavanillas A, Arós F, Tur JA, Tinahones F, Serra-Majem L, Martín V, Lapetra J, Vázquez C, Pintó X, Vidal J, Daimiel L, Delgado-Rodríguez M, Matía P, Ros E, Fernández-Aranda F, Botella C, Portillo MP, Lamuela-Raventós RM, Marcos A, Sáez G, Gómez-Gracia E, Ruiz-Canela M, Toledo E, Alvarez-Alvarez I, Díez-Espino J, Sorlí JV, Basora J, Castañer O, Schröder H, Navarrete-Muñoz EM, Zulet MA, García-Rios A, Salas-Salvadó J, Corella D, Estruch R, Fitó M, Martínez-González MA, Ros E, Salas-Salvadó J, Babio N, Ros E, Sánchez-Tainta A, Martínez-González MA, Fitó M, Schröder H, Marcos A, Corella D, Wärnberg J, Martínez-González MA, Estruch R, Fernández-Aranda F, Botella C, Salas-Salvadó J, Razquin C, Bes-Rastrollo M, Sanchez Tainta A, Vázquez Z, SanJulian Aranguren B, Goñi E, Goñi L, Barrientos I, Canales M, Sayón-Orea MC, Rico A, Basterra Gortari J, Garcia Arellano A, Lecea-Juarez O, Carlos Cenoz-Osinaga J, Bartolome-Resano J, Sola-Larraza† A, Lozano-Oloriz E, Cano-Valles B, Eguaras S, Güeto V, Pascual Roquet-Jalmar E, Galilea-Zabalza I, Lancova H, Ramallal R, Garcia-Perez ML, Estremera-Urabayen V, Ariz-Arnedo MJ, Hijos-Larraz C, Fernandez Alfaro C, Iñigo-Martinez B, Villanueva Moreno R, Martin-Almendros S, Barandiaran-Bengoetxea L, Fuertes-Goñi C, Lezaun-Indurain A, Guruchaga-Arcelus MJ, Olmedo-Cruz O, Iñigo-Martínez B, Escriche-Erviti L, Ansorena-Ros R, Sanmatin-Zabaleta R, Apalategi-Lasa J, Villanueva-Telleria J, Hernández-Espinosa MM, Arroyo-Bergera I, Herrera-Valdez L, Dorronsoro-Dorronsoro L, González JI, Sorlí JV, Portolés O, Fernández-Carrión R, Ortega-Azorín C, Barragán R, Asensio EM, Coltell O, Sáiz C, Osma R, Férriz E, González-Monje I, Giménez-Fernández F, Quiles L, Carrasco P, San Onofre N, Carratalá-Calvo A, Valero-Barceló C, Antón F, Mir C, Sánchez-Navarro S, Navas J, González-Gallego I, Bort-Llorca L, Pérez-Ollero L, Giner-Valero M, Monfort-Sáez R, Nadal-Sayol J, Pascual-Fuster V, Martínez-Pérez M, Riera C, Belda MV, Medina A, Miralles E, Ramírez-Esplugues MJ, Rojo-Furió M, Mattingley G, Delgado MA, Pages MA, Riofrío Y, Abuomar L, Blasco-Lafarga N, Tosca R, Lizán L, Guillem-Saiz P, Valcarce AM, Medina MD, Monfort R, de Valcárcel S, Tormo N, Felipe-Román O, Lafuente S, Navío EI, Aldana G, Crespo JV, Llosa JL, González-García L, Raga-Marí R, Pedret Llaberia R, Gonzalez R, Sagarra Álamo R, París Palleja F, Balsells J, Roca JM, Basora Gallisa T, Vizcaino J, Llobet Alpizarte P, Anguera Perpiñá C, Llauradó Vernet M, Caballero C, Garcia Barco M, Morán Martínez MD, García Rosselló J, Del Pozo A, Poblet Calaf C, Arcelin Zabal P, Floresví X, Ciutat Benet M, Palau Galindo A, Cabré Vila JJ, Dolz Andrés F, Boj Casajuana J, Ricard M, Saiz F, Isach A, Sanchez Marin Martinez M, Bulló M, Babio N, Becerra-Tomás N, Mestres G, Basora J, Mena-Sánchez G, Barrubés Piñol L, Gil Segura M, Papandreou C, Rosique Esteban N, Chig S, Abellán Cano I, Ruiz García V, Salas-Huetos A, Hernandez P, Canudas S, Camacho-Barcia L, García-Gavilán J, Diaz A, Castañer O, Muñoz MA, Zomeño MD, Hernaéz A, Torres L, Quifer M, Llimona R, Gal LA, Pérez A, Farràs M, Elosua R, Marrugat J, Vila J, Subirana I, Pérez S, Muñoz MA, Goday A, Chillaron Jordan JJ, Flores Lerroux JA, Benaiges Boix D, Farré M, Menoyo E, Muñoz-Aguayo D, Gaixas S, Blanchart G, Sanllorente A, Soria M, Valussi J, Cuenca A, Forcano L, Pastor A, Boronat A, Tello S, Cabañero M, Franco L, Schröder H, De la Torre R, Medrano C, Bayó J, García MT, Robledo V, Babi P, Canals E, Soldevila N, Carrés L, Roca C, Comas MS, Gasulla G, Herraiz X, Martínez A, Vinyoles E, Verdú JM, Masague Aguade M, Baltasar Massip E, Lopez Grau M, Mengual M, Moldon V, Vila Vergaz M, Cabanes Gómez Ciurana R, Gili Riu M, Palomeras Vidal A, Garcia de la Hera M, González Palacios S, Torres Collado L, Valera Gran D, Compañ Gabucio L, Oncina Canovas A, Notario Barandiaran L, Orozco Beltran D, Pertusa Martínez S, Cloquell Rodrigo B, Hernándis Marsán MV, Asensio A, Altozano Rodado MC, Ballester Baixauli JJ, Fernándis Brufal N, Martínez Vergara MC, Román Maciá J, Candela García I, Pedro Cases Pérez E, Tercero Maciá C, Mira Castejón LA, de los Ángeles García García I, Zazo JM, Gisbert Sellés C, Sánchez Botella C, Fiol M, Moñino M, Colom A, Konieczna J, Morey M, Zamanillo R, Galmés AM, Pereira V, Martín MA, Yáñez A, Llobera J, Ripoll J, Prieto R, Grases F, Costa A, Fernández-Palomeque C, Fortuny E, Noris M, Munuera S, Tomás F, Fiol F, Jover A, Janer JM, Vallespir C, Mattei I, Feuerbach N, del Mar Sureda M, Vega S, Quintana L, Fiol A, Amador M, González S, Coll J, Moyá A, Abete I, Cantero I, Cristobo C, Ibero-Baraibar I, Lezáun Burgui MD, Goñi Ruiz N, Bartolomé Resano R, Cano Cáceres E, Elcarte López T, Echarte Osacain E, Pérez Sanz B, Blanco Platero I, Andueza Azcárate SA, Gimeno Aznar A, Ursúa Sesma E, Ojeda Bilbao B, Martinez Jarauta J, Ugalde Sarasa L, Rípodas Echarte B, Güeto Rubio MV, Fernández-Crehuet Navajas J, Gutiérrez Bedmar M, García Rodriguez A, Mariscal Larrubia A, Carnero Varo M, Muñoz Bravo C, Barón-López FJ, Fernández García JC, Pérez-Farinós N, Moreno-Morales N, del C Rodríguez-Martínez M, Pérez-López J, Benavente-Marín JC, Crespo Oliva E, Contreras Fernández E, Carmona González FJ, Carabaño Moral R, Torres Moreno S, Martín Ruíz MV, Alcalá Cornide M, Fuentes Gómez V, Criado García J, Jiménez Morales AI, Delgado Casado N, Ortiz Morales A, Torres Peña JD, Gómez Delgado FJ, Rodríguez Cantalejo F, Caballero Villaraso J, Alcalá JF, Peña Orihuela PJ, Quintana Navarro G, Casas R, Domenech M, Viñas C, Castro-Barquero S, Ruiz-León AM, Sadurní M, Frontana G, Villanueva P, Gual M, Soriano R, Camafort M, Sierra C, Sacanella E, Sala-Vila A, Cots JM, Sarroca I, García M, Bermúdez N, Pérez A, Duaso I, de la Arada A, Hernández R, Simón C, de la Poza MA, Gil I, Vila M, Iglesias C, Assens N, Amatller M, Rams LL, Benet T, Fernández G, Teruel J, Azorin A, Cubells M, López D, Llovet JM, Gómez ML, Climente P, de Paula L, Soto J, Carbonell C, Llor C, Abat X, Cama A, Fortuny M, Domingo C, Liberal AI, Martínez T, Yañez E, Nieto MJ, Pérez A, Lloret E, Carrazoni C, Belles AM, Olmos C, Ramentol M, Capell MJ, Casas R, Giner I, Muñoz A, Martín R, Moron E, Bonillo A, Sánchez G, Calbó C, Pous J, Massip M, García Y, Massagué MC, Ibañez R, Llaona J, Vidal T, Vizcay N, Segura E, Galindo C, Moreno M, Caubet M, Altirriba J, Fluxà G, Toribio P, Torrent E, Anton JJ, Viaplana A, Vieytes G, Duch N, Pereira A, Moreno MA, Pérez A, Sant E, Gené J, Calvillo H, Pont F, Puig M, Casasayas M, Garrich A, Senar E, Martínez A, Boix I, Sequeira E, Aragunde V, Riera S, Salgado M, Fuentes M, Martín E, Ubieto A, Pallarés F, Sala C, Abilla A, Moreno S, Mayor E, Colom T, Gaspar A, Gómez A, Palacios L, Garrigosa R, García Molina L, Riquelme Gallego B, Cano Ibañez N, Maldonado Calvo A, López Maldonado A, Garrido EM, Baena Dominguez A, García Jiménez F, Thomas Carazo E, Jesús Turnes González A, González Jiménez F, Padilla Ruiz F, Machado Santiago J, Martínez Bellón MD, Pueyos Sánchez A, Arribas Mir L, Rodríguez Tapioles R, Dorador Atienza F, Baena Camus L, Osorio Martos C, Rueda Lozano D, López Alcázar M, Ramos Díaz F, Cruz Rosales Sierra M, Alguacil Cubero P, López Rodriguez A, Guerrero García F, Tormo Molina J, Ruiz Rodríguez F, Rekondo J, Salaverria I, Alonso-Gómez A, Belló MC, Loma-Osorio A, Tojal L, Bruyel P, Goicolea L, Sorto C, Casi Casanellas A, Arnal Otero ML, Ortueta Martínez De Arbulo J, Vinagre Morgado J, Romeo Ollora J, Urraca J, Sarriegui Carrera MI, Toribio FJ, Magán E, Rodríguez A, Castro Madrid S, Gómez Merino MT, Rodríguez Jiménez M, Gutiérrez Jodra M, López Alonso B, Iturralde Iriso J, Pascual Romero C, Izquierdo De La Guerra A, Abbate M, Aguilar I, Angullo E, Arenas A, Argelich E, Bibiloni MM, Bisbal Y, Bouzas C, Busquets C, Capó X, Carreres S, De la Peña A, Gallardo L, Gámez JM, García B, García C, Julibert A, Llompart I, Mascaró CM, Mateos D, Montemayor S, Pons A, Ripoll T, Rodríguez T, Salaberry E, Sureda A, Tejada S, Ugarriza L, Valiño L, Bernal López MR, Macías González M, Ruiz Nava J, Fernández García JC, Muñoz Garach A, Vilches Pérez A, González Banderas A, Alcaide Torres J, Vargas Candela A, León Fernández M, Hernández Robles R, Santamaría Fernández S, Marín JM, Valdés Hernández S, Villalobos JC, Ortiz A, Álvarez-Pérez J, Díaz Benítez EM, Díaz-Collado F, Sánchez-Villegas A, Pérez-Cabrera J, Casañas-Quintana LT, García-Guerra RB, Bautista-Castaño I, Ruano-Rodríguez C, Sarmiento de la Fe F, García-Pastor JA, Macías-Gutiérrez B, Falcón-Sanabria I, Simón-García C, Santana-Santana AJ, Álvarez-Álvarez JB, Díaz-González BV, Castillo Anzalas JM, Sosa-Also RE, Medina-Ponce J, Abajo Olea S, Adlbi Sibai A, Aguado Arconada A, Álvarez L, Carriedo Ule E, Escobar Fernández M, Ferradal García JI, Fernández Vázquez JP, García González M, González Donquiles C, González Quintana C, González Rivero F, Lavinia Popescu M, López Gil JI, López de la Iglesia J, Marcos Delgado A, Merino Acevedo C, Reguero Celada S, Rodríguez Bul M, Vilorio-Marqués L, Santos-Lozano JM, Miró-Moriano L, Domínguez-Espinaco C, Vaquero-Díaz S, García-Corte FJ, Santos-Calonge A, Toro-Cortés C, Pelegrina-López N, Urbano-Fernández V, Ortega-Calvo M, Lozano-Rodríguez J, Rivera-Benítez I, Caballero-Valderrama M, Iglesias-Bonilla P, Román-Torres P, Corchado-Albalat Y, Mayoral-Sánchez E, de Cos AI, Gutierrez S, Artola S, Galdon A, Gonzalo I, Más S, Sierra R, Luca B, Prieto L, Galera A, Gimenez-Gracia M, Figueras R, Poch M, Freixedas R, Trias F, Sarasa I, Fanlo M, Lafuente H, Liceran M, Rodriguez-Sanchez A, Pallarols C, Monedero J, Corbella X, Corbella E, Altés A, Vinagre I, Mestres C, Viaplana J, Serra M, Vera J, Freitas T, Ortega E, Pla I, Ordovás JM, Micó V, Berninches L, Concejo MJ, Muñoz J, Adrián M, de la Fuente Y, Albertos C, Villahoz E, Cornejo ML, Gaforio JJ, Moraleda S, Liétor N, Peis JI, Ureña T, Rueda M, Ballesta MI, Moreno Lopera C, Aragoneses Isabel C, Sirur Flores MA, Ceballos de Diego M, Bescos Cáceres T, Peña Cereceda Y, Martínez Abad M, Cabrera Vela R, González Cerrajero M, Rubio Herrera MA, Torrego Ellacuría M, Barabash Bustelo A, Ortiz Ramos M, Garin Barrutia U, Baños R, García-Palacios A, Cerdá Micó C, Estañ Capell N, Iradi A, Fandos Sánchez M. Cohort Profile: Design and methods of the PREDIMED-Plus randomized trial. Int J Epidemiol 2018; 48:387-388o. [PMID: 30476123 DOI: 10.1093/ije/dyy225] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 01/04/2023] Open
Affiliation(s)
- Miguel A Martínez-González
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, Pamplona, Spain
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Pilar Buil-Cosiales
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, Pamplona, Spain
- Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Dolores Corella
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Monica Bulló
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Rovira i Virgili University, Department of Biochemistry and Biotechnology, Human Nutrition Unit, IISPV, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Montserrat Fitó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain
| | - Jesús Vioque
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Miguel Hernandez University, ISABIAL-FISABIO, Alicante, Spain
| | - Dora Romaguera
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Clinical Epidemiology and Public Health Department, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - J Alfredo Martínez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- University of Navarra, Department of Nutrition, Food Science and Physiology, IDISNA, Pamplona, Spain
| | - Julia Wärnberg
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Nursing, School of Health Sciences, University of Málaga-IBIMA, Málaga, Spain
| | - Jose López-Miranda
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Ramón Estruch
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Aurora Bueno-Cavanillas
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine, University of Granada, Granada, Spain
| | - Fernando Arós
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Cardiology, University Hospital Araba, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Josep A Tur
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, Palma de Mallorca, Spain
| | - Francisco Tinahones
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Virgen de la Victoria Hospital, Department of Endocrinology, University of Málaga, Málaga, Spain
| | - Lluis Serra-Majem
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- University of Las Palmas de Gran Canaria, Research Institute of Biomedical and Health Sciences (IUIBS), Preventive Medicine Service, Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, Las Palmas, Spain
| | - Vicente Martín
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Institute of Biomedicine (IBIOMED), University of León, León, Spain
| | - Jose Lapetra
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain
| | - Clotilde Vázquez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Endocrinology, Fundación Jiménez-Díaz, Madrid, Spain
| | - Xavier Pintó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Vidal
- CIBER Diabetes y enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Endocrinology, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Lidia Daimiel
- Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, Madrid, Spain
| | - Miguel Delgado-Rodríguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Division of Preventive Medicine, Faculty of Medicine, University of Jaén, Jaén, Spain
| | - Pilar Matía
- Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Emilio Ros
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Fernando Fernández-Aranda
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Eating Disorders Unit, Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Hospitalet del Llobregat, Barcelona, Spain
| | - Cristina Botella
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - María Puy Portillo
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Nutrition and Food Science, Faculty of Pharmacy and Lucio Lascaray Research Center, Universidad del País Vasco (UPV/EHU), Vitoria, Spain
| | - Rosa M Lamuela-Raventós
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Nutrition, Food Science and Gastronomy, XaRTA, INSA, -UB, School of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain
| | - Ascensión Marcos
- Institute of Food Science, Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain
| | - Guillermo Sáez
- Department of Biochemistry and Molecular Biology, Faculty of Medicine and Odontology, University Hospital Dr. Peset, University of Valencia, Valencia, Spain
| | | | - Miguel Ruiz-Canela
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, Pamplona, Spain
| | - Estefania Toledo
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, Pamplona, Spain
| | - Ismael Alvarez-Alvarez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, Pamplona, Spain
| | - Javier Díez-Espino
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, Pamplona, Spain
- Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - José V Sorlí
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Josep Basora
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Rovira i Virgili University, Department of Biochemistry and Biotechnology, Human Nutrition Unit, IISPV, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Olga Castañer
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain
| | - Helmut Schröder
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Eva María Navarrete-Muñoz
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Miguel Hernandez University, ISABIAL-FISABIO, Alicante, Spain
| | - Maria Angeles Zulet
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- University of Navarra, Department of Nutrition, Food Science and Physiology, IDISNA, Pamplona, Spain
| | - Antonio García-Rios
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Rovira i Virgili University, Department of Biochemistry and Biotechnology, Human Nutrition Unit, IISPV, Hospital Universitari Sant Joan de Reus, Reus, Spain
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Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, Aceves-Martins M, Retat L, Fraser C, Aveyard P, Stewart F, MacLennan G, Webber L, Corbould E, Xu B, Jaccard A, Boyle B, Duncan E, Shimonovich M, Bruin MD. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 2018; 22:1-246. [PMID: 30511918 PMCID: PMC6296173 DOI: 10.3310/hta22680] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2] have an increased risk of comorbidities and psychological, social and economic consequences. OBJECTIVES Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment. DATA SOURCES Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017). REVIEW METHODS Four systematic reviews evaluated clinical effectiveness, cost-effectiveness and qualitative evidence for adults with a BMI of ≥ 35 kg/m2. Data from meta-analyses populated a microsimulation model predicting costs, outcomes and cost-effectiveness of Roux-en-Y gastric bypass (RYGB) surgery and the most effective lifestyle WMPs over a 30-year time horizon from a NHS perspective, compared with current UK population obesity trends. Interventions were cost-effective if the additional cost of achieving a quality-adjusted life-year is < £20,000-30,000. RESULTS A total of 131 randomised controlled trials (RCTs), 26 UK studies, 33 qualitative studies and 46 cost-effectiveness studies were included. From RCTs, RYGB produced the greatest long-term weight change [-20.23 kg, 95% confidence interval (CI) -23.75 to -16.71 kg, at 60 months]. WMPs with very low-calorie diets (VLCDs) produced the greatest weight loss at 12 months compared with no WMPs. Adding a VLCD to a WMP gave an additional mean weight change of -4.41 kg (95% CI -5.93 to -2.88 kg) at 12 months. The intensive Look AHEAD WMP produced mean long-term weight loss of 6% in people with type 2 diabetes mellitus (at a median of 9.6 years). The microsimulation model found that WMPs were generally cost-effective compared with population obesity trends. Long-term WMP weight regain was very uncertain, apart from Look AHEAD. The addition of a VLCD to a WMP was not cost-effective compared with a WMP alone. RYGB was cost-effective compared with no surgery and WMPs, but the model did not replicate long-term cost savings found in previous studies. Qualitative data suggested that participants could be attracted to take part in WMPs through endorsement by their health-care provider or through perceiving innovative activities, with WMPs being delivered to groups. Features improving long-term weight loss included having group support, additional behavioural support, a physical activity programme to attend, a prescribed calorie diet or a calorie deficit. LIMITATIONS Reviewed studies often lacked generalisability to UK settings in terms of participants and resources for implementation, and usually lacked long-term follow-up (particularly for complications for surgery), leading to unrealistic weight regain assumptions. The views of potential and actual users of services were rarely reported to contribute to service design. This study may have failed to identify unpublished UK evaluations. Dual, blinded numerical data extraction was not undertaken. CONCLUSIONS Roux-en-Y gastric bypass was costly to deliver, but it was the most cost-effective intervention. Adding a VLCD to a WMP was not cost-effective compared with a WMP alone. Most WMPs were cost-effective compared with current population obesity trends. FUTURE WORK Improved reporting of WMPs is needed to allow replication, translation and further research. Qualitative research is needed with adults who are potential users of, or who fail to engage with or drop out from, WMPs. RCTs and economic evaluations in UK settings (e.g. Tier 3, commercial programmes or primary care) should evaluate VLCDs with long-term follow-up (≥ 5 years). Decision models should incorporate relevant costs, disease states and evidence-based weight regain assumptions. STUDY REGISTRATION This study is registered as PROSPERO CRD42016040190. FUNDING The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoë Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - Bonnie Boyle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Täuber S, Gausel N, Flint SW. Weight Bias Internalization: The Maladaptive Effects of Moral Condemnation on Intrinsic Motivation. Front Psychol 2018; 9:1836. [PMID: 30319517 PMCID: PMC6170635 DOI: 10.3389/fpsyg.2018.01836] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/10/2018] [Indexed: 11/24/2022] Open
Abstract
Weight stigma typically focuses on suggestions that people with overweight and obesity are incompetent and immoral. Integrating so far unconnected lines of research, the current research presents two studies that examine the motivational relevance of these aspects of weight stigma. Specifically, we tested the proposition that people with overweight and obesity respond differently to the public viewing them as incompetent compared to immoral, as these aspects of weight stigma differ in reparability. We expect that threats to competence are more acceptable and thus related to a constructive response that is more effective in losing weight in the long-run. By contrast, we propose that threats to morality elicit an acute urge to defend one's moral image, thereby prompting responses that are more visible to the social environment, but potentially less effective for losing weight. Study 1 experimentally compared exposure to weight stigma focused on morality vs. weight stigma focused on competence in a sample of adults with overweight and obesity (N = 122; M BMI = 31.89, SD BMI = 4.39). We found that when exposed to weight stigma focused on morality, people with overweight and obesity respond by defending their moral social-image but that this is less effective for encouraging weight loss, while exposure to weight stigma focused on competence led to an increased likelihood of engagement in weight loss behaviors. Complementing and extending the findings, Study 2 (N = 348, M BMI = 26.78, SD BMI = 6.78) tested the notion that internalized weight bias predominantly revolves around moral concerns, and thus will lead to less self-determined behavioral regulation. We found strong support for the moral core of weight bias internalization. In line with our predictions, greater weight bias internalization was associated less self-determined and more other-determined regulation of dieting and exercising. This suggests that weight bias internalization operates as a facilitator of maladaptive behavioral regulation following weight stigma, contributing to lower psychological functioning and well-being of people with overweight and obesity. The current research presents novel findings about the underlying mechanisms of weight stigma and weight bias internalization and identifies strategies to avoid maladaptive and facilitate adaptive health behaviors.
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Affiliation(s)
- Susanne Täuber
- Department of Human Resource Management and Organizational Behavior, University of Groningen, Groningen, Netherlands
| | - Nicolay Gausel
- Department of Psychosocial Health, University of Agder, Kristiansand, Norway
| | - Stuart W. Flint
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
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Mikhail DS, Jensen TB, Wade TW, Myers JF, Frank JM, Wieland M, Hensrud D, McMahon MM, Collazo-Clavell ML, Abu-Lebdeh H, Kennel KA, Hurley DL, Grothe K, Jensen MD. Methodology of a multispecialty outpatient Obesity Treatment Research Program. Contemp Clin Trials Commun 2018; 10:36-41. [PMID: 29696156 PMCID: PMC5898534 DOI: 10.1016/j.conctc.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/21/2018] [Accepted: 03/08/2018] [Indexed: 01/19/2023] Open
Abstract
Despite the large number of U.S. adults who overweight or obese, few providers have ready access to comprehensive lifestyle interventions, the cornerstone of medical obesity management. Our goal was to establish a research infrastructure embedded in a comprehensive lifestyle intervention treatment for obesity. The Obesity Treatment Research Program (OTRP) is a multi-specialty project at Mayo Clinic in Rochester, Minnesota designed to provide a high intensity, year-long, comprehensive lifestyle obesity treatment. The program includes a nutritional intervention designed to reduce energy intake, a physical activity program and a cognitive behavioral approach to increase the likelihood of long-term adherence. The behavioral intervention template incorporated the Diabetes Prevention Program and the Look AHEAD trial materials. The OTRP is consistent with national recommendations for the management of overweight and obesity in adults, but with embedded features designed to identify patient characteristics that might help predict outcomes, assure long-term follow up and support various research initiatives. Our goal was to develop approaches to understand whether there are patient characteristics that predict treatment outcomes.
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Affiliation(s)
- Dalia S Mikhail
- Division of Endocrinology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Teresa B Jensen
- Department of Family Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Todd W Wade
- Department of Family Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Jane F Myers
- Department of Family Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Jennifer M Frank
- Department of Family Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Mark Wieland
- Division of Community Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Don Hensrud
- Division of Endocrinology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - M Molly McMahon
- Division of Endocrinology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | | | - Haitham Abu-Lebdeh
- Division of Endocrinology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Kurt A Kennel
- Division of Endocrinology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Daniel L Hurley
- Division of Endocrinology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Karen Grothe
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Michael D Jensen
- Division of Endocrinology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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27
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Forman EM, Schumacher LM, Crosby R, Manasse SM, Goldstein SP, Butryn ML, Wyckoff EP, Graham Thomas J. Ecological Momentary Assessment of Dietary Lapses Across Behavioral Weight Loss Treatment: Characteristics, Predictors, and Relationships with Weight Change. Ann Behav Med 2018; 51:741-753. [PMID: 28281136 DOI: 10.1007/s12160-017-9897-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Adherence to dietary prescriptions is critical for successful weight loss and weight loss maintenance. However, research on specific instances of inadherence (lapses) is limited, and findings regarding the frequency, nature, and causes of lapses are mixed. Additionally, no studies have examined lapses over the course of a weight loss program. PURPOSE In the context of a reduced calorie diet prescribed as part of a behavioral treatment, we aimed to characterize lapse occurrence, examine lapse frequency across treatment, examine predictors of lapses, and assess the relationship between lapses and weight loss. METHODS Adults (n = 189) enrolled in a 12-month behavioral weight loss program completed ecological momentary assessment (EMA) at baseline, mid-treatment, and end of treatment. At each EMA survey, participants indicated whether a lapse had occurred, and responded to questions assessing situational, environmental, and affective states. RESULTS Lapse frequency showed a curvilinear relationship over time, such that frequency first decreased and then increased. Lapse frequency at baseline was negatively associated with early and overall weight loss. Lapses most often occurred at home, in the evenings, on the weekends, and entailed eating a forbidden food. Greater overall levels of assessed affective and environmental triggers predicted lapses, and greater momentary hunger and deprivation, and the presence of palatable food, also prospectively predicted lapses. CONCLUSIONS In addition to characterizing lapse frequency, the current study identified prospective predictors of lapses across treatment. These findings support the importance of lapses to weight control and provide insight for potential targets of intervention to prevent lapse occurrence.
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Affiliation(s)
- Evan M Forman
- Department of Psychology, Drexel University, 3141 Chestnut St, Suite 119, Philadelphia, PA, 19104, USA.
| | - Leah M Schumacher
- Department of Psychology, Drexel University, 3141 Chestnut St, Suite 119, Philadelphia, PA, 19104, USA
| | - Ross Crosby
- Neuropsychiatric Research Institute, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Stephanie M Manasse
- Department of Psychology, Drexel University, 3141 Chestnut St, Suite 119, Philadelphia, PA, 19104, USA
| | - Stephanie P Goldstein
- Department of Psychology, Drexel University, 3141 Chestnut St, Suite 119, Philadelphia, PA, 19104, USA
| | - Meghan L Butryn
- Department of Psychology, Drexel University, 3141 Chestnut St, Suite 119, Philadelphia, PA, 19104, USA
| | - Emily P Wyckoff
- Department of Psychological Sciences, University of Connecticut, Mansfield, CT, USA
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Lachman ME, Lipsitz L, Lubben J, Castaneda-Sceppa C, Jette AM. When Adults Don't Exercise: Behavioral Strategies to Increase Physical Activity in Sedentary Middle-Aged and Older Adults. Innov Aging 2018; 2:igy007. [PMID: 30003146 PMCID: PMC6037047 DOI: 10.1093/geroni/igy007] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Indexed: 12/12/2022] Open
Abstract
Physical activity is one of the most promising nonpharmacological, noninvasive, and cost-effective methods of health-promotion, yet statistics show that only a small percentage of middle-aged and older adults engage in the recommended amount of regular exercise. This state of affairs is less likely due to a lack of knowledge about the benefits of exercise than to failures of motivation and self-regulatory mechanisms. Many types of intervention programs target exercise in later life, but they typically do not achieve sustained behavior change, and there has been very little increase in the exercise rate in the population over the last decade. The goal of this paper is to consider the use of effective low-cost motivational and behavioral strategies for increasing physical activity, which could have far-reaching benefits at the individual and population levels. We present a multicomponent framework to guide development of behavior change interventions to increase and maintain physical activity among sedentary adults and others at risk for health problems. This involves a personalized approach to motivation and behavior change, which includes social support, goal setting, and positive affect coupled with cognitive restructuring of negative and self-defeating attitudes and misconceptions. These strategies can lead to increases in exercise self-efficacy and control beliefs as well as self- management skills such as self-regulation and action planning, which in turn are expected to lead to long-term increases in activity. These changes in activity frequency and intensity can ultimately lead to improvements in physical and psychological well-being among middle-aged and older adults, including those from underserved, vulnerable populations. Even a modest increase in physical activity can have a significant impact on health and quality of life. Recommendations for future interventions include a focus on ways to achieve personalized approaches, broad outreach, and maintenance of behavior changes.
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Affiliation(s)
- Margie E Lachman
- Department of Psychology, Brandeis University, Waltham, Massachusetts
| | - Lewis Lipsitz
- Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
| | - James Lubben
- School of Social Work, Boston College, Chestnut Hill, Massachusetts
| | - Carmen Castaneda-Sceppa
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Alan M Jette
- Department of Health Sciences, Massachusetts General Hospital Institute of Health Professions, Boston
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Ma C, Avenell A, Bolland M, Hudson J, Stewart F, Robertson C, Sharma P, Fraser C, MacLennan G. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. BMJ 2017; 359:j4849. [PMID: 29138133 PMCID: PMC5682593 DOI: 10.1136/bmj.j4849] [Citation(s) in RCA: 285] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective To assess whether weight loss interventions for adults with obesity affect all cause, cardiovascular, and cancer mortality, cardiovascular disease, cancer, and body weight.Design Systematic review and meta-analysis of randomised controlled trials (RCTs) using random effects, estimating risk ratios, and mean differences. Heterogeneity investigated using Cochran's Q and I2 statistics. Quality of evidence assessed by GRADE criteria.Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials, and full texts in our trials' registry for data not evident in databases. Authors were contacted for unpublished data.Eligibility criteria for selecting studies RCTs of dietary interventions targeting weight loss, with or without exercise advice or programmes, for adults with obesity and follow-up ≥1 year.Results 54 RCTs with 30 206 participants were identified. All but one trial evaluated low fat, weight reducing diets. For the primary outcome, high quality evidence showed that weight loss interventions decrease all cause mortality (34 trials, 685 events; risk ratio 0.82, 95% confidence interval 0.71 to 0.95), with six fewer deaths per 1000 participants (95% confidence interval two to 10). For other primary outcomes moderate quality evidence showed an effect on cardiovascular mortality (eight trials, 134 events; risk ratio 0.93, 95% confidence interval 0.67 to 1.31), and very low quality evidence showed an effect on cancer mortality (eight trials, 34 events; risk ratio 0.58, 95% confidence interval 0.30 to 1.11). Twenty four trials (15 176 participants) reported high quality evidence on participants developing new cardiovascular events (1043 events; risk ratio 0.93, 95% confidence interval 0.83 to 1.04). Nineteen trials (6330 participants) provided very low quality evidence on participants developing new cancers (103 events; risk ratio 0.92, 95% confidence interval 0.63 to 1.36).Conclusions Weight reducing diets, usually low in fat and saturated fat, with or without exercise advice or programmes, may reduce premature all cause mortality in adults with obesity.Systematic review registration PROSPERO CRD42016033217.
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Affiliation(s)
- Chenhan Ma
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Mark Bolland
- Bone and Joint Research Group, Department of Medicine, University of Auckland, Private Bag 92 019, Auckland 1142, New Zealand
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Pawana Sharma
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
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Warren JC, Smalley KB, Barefoot KN. Discrepancy in Motivation for Weight Loss and Exercise in Rural Patients. Am J Health Behav 2017; 41:803-809. [PMID: 29025508 PMCID: PMC5823257 DOI: 10.5993/ajhb.41.6.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We explored the extent to which discrepancy between motivation for weight loss and exercise is related to obesity among rural patients with chronic disease, and identified the psychosocial correlates of this discrepancy. METHODS 497 patients with diabetes and/or hypertension were recruited from a network of Federally Qualified Health Centers in the rural South and completed a battery of assessments. RESULTS Most persons in the sample (83.1%) were overweight and 65.0% were obese. For motivation for change, 70.8% reported being in the Action stage or higher for weight loss, whereas only 24.9% reported being in the Action stage or higher for motivation for exercise. When controlling for age, education level, income, sex, and race/ethnicity, individuals who were motivated for weight loss but not exercise were twice as likely to be obese (p = .005). Race and sex were significantly associated with this discrepancy, with African-American patients 1.7 times as likely (p = .05) and women 2.3 times as likely to be discrepant (p = .001). CONCLUSIONS Findings underscore the importance of focusing not simply on weight loss among rural patients with chronic disease, but rather to incorporate specific activities designed to build simultaneous motivation for engaging in exercise.
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Affiliation(s)
- Jacob C Warren
- Director, Center for Rural Health and Health Disparities, Mercer University School of Medicine, Macon, GA;,
| | - K Bryant Smalley
- Executive Director, Rural Health Research Institute, Georgia Southern University, Statesboro, GA
| | - K Nikki Barefoot
- Assistant Director, Rural Health Research Institute, Georgia Southern University, Statesboro, GA
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Voils CI, Adler R, Liu N, Funk LM. Understanding Weight Regain and the Need for Life-Long Follow-up After Bariatric Surgery. CURRENT SURGERY REPORTS 2017. [DOI: 10.1007/s40137-017-0196-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dutton GR, Gowey MA, Tan F, Zhou D, Ard J, Perri MG, Lewis CE. Comparison of an alternative schedule of extended care contacts to a self-directed control: a randomized trial of weight loss maintenance. Int J Behav Nutr Phys Act 2017; 14:107. [PMID: 28806992 PMCID: PMC5557426 DOI: 10.1186/s12966-017-0564-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 08/07/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Behavioral interventions for obesity produce clinically meaningful weight loss, but weight regain following treatment is common. Extended care programs attenuate weight regain and improve weight loss maintenance. However, less is known about the most effective ways to deliver extended care, including contact schedules. METHODS We compared the 12-month weight regain of an extended care program utilizing a non-conventional, clustered campaign treatment schedule and a self-directed program among individuals who previously achieved ≥5% weight reductions. Participants (N = 108; mean age = 51.6 years; mean weight = 92.6 kg; 52% African American; 95% female) who achieved ≥5% weight loss during an initial 16-week behavioral obesity treatment were randomized into a 2-arm, 12-month extended care trial. A clustered campaign condition included 12 group-based visits delivered in three, 4-week clusters. A self-directed condition included provision of the same printed intervention materials but no additional treatment visits. The study was conducted in a U.S. academic medical center from 2011 to 2015. RESULTS Prior to randomization, participants lost an average of -7.55 ± 3.04 kg. Participants randomized to the 12-month clustered campaign program regained significantly less weight (0.35 ± 4.62 kg) than self-directed participants (2.40 ± 3.99 kg), which represented a significant between-group difference of 2.28 kg (p = 0.0154) after covariate adjustments. This corresponded to maintaining 87% and 64% of lost weight in the clustered campaign and self-directed conditions, respectively, which was a significant between-group difference of 29% maintenance of lost weight after covariate adjustments, p = 0.0396. CONCLUSIONS In this initial test of a clustered campaign treatment schedule, this novel approach effectively promoted 12-month maintenance of lost weight. Future trials should directly compare the clustered campaigns with conventional (e.g., monthly) extended care schedules. TRIAL REGISTRATION Clinicaltrials.gov NCT02487121 . Registered 06/26/2015 (retrospectively registered).
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Affiliation(s)
- Gareth R. Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Marissa A. Gowey
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Fei Tan
- Department of Mathematical Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, IN USA
| | - Dali Zhou
- Department of Mathematical Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, IN USA
| | - Jamy Ard
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC USA
| | - Michael G. Perri
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL USA
| | - Cora E. Lewis
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
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Voils CI, Olsen MK, Gierisch JM, McVay MA, Grubber JM, Gaillard L, Bolton J, Maciejewski ML, Strawbridge E, Yancy WS. Maintenance of Weight Loss After Initiation of Nutrition Training: A Randomized Trial. Ann Intern Med 2017; 166:463-471. [PMID: 28241185 PMCID: PMC5483942 DOI: 10.7326/m16-2160] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Weight regain after successful weight loss interventions is common. OBJECTIVE To establish the efficacy of a weight loss maintenance program compared with usual care in obese adults. DESIGN 2-group, parallel, randomized trial stratified by initial weight loss (<10 kg vs. ≥10 kg), conducted from 20 August 2012 to 18 December 2015. Outcome assessors were blinded to treatment assignment. (ClinicalTrials.gov: NCT01357551). SETTING 3 primary care clinics at the Veterans Affairs Medical Center in Durham and Raleigh, North Carolina. PATIENTS Obese outpatients (body mass index ≥30 kg/m2) who lost 4 kg or more of body weight during a 16-week, group-based weight loss program. INTERVENTION The maintenance intervention, delivered primarily by telephone, addressed satisfaction with outcomes, relapse-prevention planning, self-monitoring, and social support. Usual care involved no contact except for study measurements. MEASUREMENTS Primary outcome was mean weight regain at week 56. Secondary outcomes included self-reported caloric intake, walking, and moderate physical activity. RESULTS Of 504 patients in the initial program, 222 lost at least 4 kg of body weight and were randomly assigned to maintenance (n = 110) or usual care (n = 112). Retention was 85%. Most patients were middle-aged white men. Mean weight loss during initiation was 7.2 kg (SD, 3.1); mean weight at randomization was 103.6 kg (SD, 20.4). Estimated mean weight regain was statistically significantly lower in the intervention (0.75 kg) than the usual care (2.36 kg) group (estimated mean difference, 1.60 kg [95% CI, 0.07 to 3.13 kg]; P = 0.040). No statistically significant differences in secondary outcomes were seen at 56 weeks. No adverse events directly attributable to the intervention were observed. LIMITATIONS Results may not generalize to other settings or populations. Dietary intake and physical activity were self-reported. Duration was limited to 56 weeks. CONCLUSION An intervention focused on maintenance-specific strategies and delivered in a resource-conserving way modestly slowed the rate of weight regain in obese adults. PRIMARY FUNDING SOURCE Veterans Affairs Health Services Research and Development Service.
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Affiliation(s)
- Corrine I Voils
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Maren K Olsen
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Jennifer M Gierisch
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Megan A McVay
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Janet M Grubber
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Leslie Gaillard
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Jamiyla Bolton
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Matthew L Maciejewski
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Elizabeth Strawbridge
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - William S Yancy
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
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Trief PM, Cibula D, Delahanty LM, Weinstock RS. Self-determination theory and weight loss in a Diabetes Prevention Program translation trial. J Behav Med 2016; 40:483-493. [DOI: 10.1007/s10865-016-9816-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
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Gordon B, Shorter B, Isoldi KK, Moldwin RM. Obesity with Comorbid Stress Urinary Incontinence in Women: A Narrative Review to Inform Dietetics Practice. J Acad Nutr Diet 2016; 117:889-907. [PMID: 27881287 DOI: 10.1016/j.jand.2016.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/23/2016] [Indexed: 12/20/2022]
Abstract
Stress urinary incontinence (SUI) is a common problem among women; clinical treatment guidelines include weight reduction as a strategy for controlling urinary leakage. The purpose of this review was to gather evidence on the association between obesity and SUI and to ascertain whether there are any special considerations for implementing medical nutrition therapy with community-dwelling, obese, adult females with comorbid SUI. Five key findings emerged: epidemiologic studies consistently report statistically significant associations between obesity and SUI, randomized control trials found that weight loss appears to ameliorate SUI symptoms, the SUI-activity link may affect weight management, there is a potential interplay between SUI and the obesity-sleep connection, and dietary components are associated with the exacerbation of urinary symptoms. The pathogenesis of SUI and obesity-related contributions to urinary leakage is included in the introductory discussion. Lastly, insights on special considerations for implementing nutrition interventions with this population are offered.
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Smalley KB, Warren JC, McClendon S, Peacock W, Caro M. Ethnic Identity Attachment and Motivation for Weight Loss and Exercise Among Rural, Overweight, African-American Women. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2016; 9:95-101. [PMID: 27891059 PMCID: PMC5115611 DOI: 10.4137/cmwh.s34691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 11/17/2022]
Abstract
Rural and minority women are disproportionately impacted by the obesity epidemic; however, little research has studied the intersection of these disparity groups. The purpose of this study was to examine the influence of racial identity on motivation for weight loss and exercise among rural, African-American women with an obesity-linked chronic disease. A total of 154 African-American women were recruited from the patient population of a Federally Qualified Health Center in the rural South to complete a questionnaire battery including the Multigroup Ethnic Identity Measure and separate assessments of motivation for weight loss and exercise. Multivariate analyses, controlling for age, education status, insurance status, and body mass index revealed that attachment to ethnic identity was predictive of motivation for exercise but not for weight loss. Our findings suggest that attachment to ethnic identity may be an important factor in motivation for change among African-American women, particularly with respect to exercise, with direct implications for the development of culturally and geographically tailored weight loss interventions.
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Affiliation(s)
- K Bryant Smalley
- Executive Director, Rural Health Research Institute, Georgia Southern University, Statesboro, GA, USA.; Associate Professor of Psychology, Georgia Southern University, Statesboro, GA, USA
| | - Jacob C Warren
- Endowed Chair and Director, Center for Rural Health and Health Disparities, Mercer University School of Medicine, Macon, GA, USA.; Associate Professor of Community Medicine, Mercer University School of Medicine, Macon, GA, USA
| | | | - Wilburn Peacock
- Graduate Student, Florida State University, Tallahassee, FL, USA
| | - Marisol Caro
- Undergraduate Student, New Mexico State University, Las Cruces, NM, USA
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Snowdon-Carr V. Using psychological approaches for working with obesity and type 2 diabetes. PRACTICAL DIABETES 2016. [DOI: 10.1002/pdi.2045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sharman MJ, Venn AJ, Hensher M, Wilkinson S, Palmer AJ, Williams D, Ezzy D. Motivations for Seeking Bariatric Surgery: The Importance of Health Professionals and Social Networks. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2016.0004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Melanie J. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Alison J. Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Martin Hensher
- Department of Health and Human Services, Hobart, Australia
| | | | - Andrew J. Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Danielle Williams
- School of Nursing and Midwifery, University of Tasmania, Hobart, Australia
| | - Douglas Ezzy
- School of Social Sciences, University of Tasmania, Hobart, Australia
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Voils CI, Grubber JM, McVay MA, Olsen MK, Bolton J, Gierisch JM, Taylor SS, Maciejewski ML, Yancy WS. Recruitment and Retention for a Weight Loss Maintenance Trial Involving Weight Loss Prior to Randomization. Obes Sci Pract 2016; 2:355-365. [PMID: 28090340 PMCID: PMC5192533 DOI: 10.1002/osp4.58] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/27/2016] [Accepted: 07/10/2016] [Indexed: 01/06/2023] Open
Abstract
Objective A weight loss maintenance trial involving weight loss prior to randomization is challenging to implement due to the potential for dropout and insufficient weight loss. We examined rates and correlates of non‐initiation, dropout, and insufficient weight loss during a weight loss maintenance trial. Methods The MAINTAIN trial involved a 16‐week weight loss program followed by randomization among participants losing at least 4 kg. Psychosocial measures were administered during a screening visit. Weight was obtained at the first group session and 16 weeks later to determine eligibility for randomization. Results Of 573 patients who screened as eligible, 69 failed to initiate the weight loss program. In adjusted analyses, failure to initiate was associated with lower age, lack of a support person, and less encouragement for making dietary changes. Among participants who initiated, 200 dropped out, 82 lost insufficient weight, and 222 lost sufficient weight for randomization. Compared to losing sufficient weight, dropping out was associated with younger age and tobacco use, whereas losing insufficient weight was associated with non‐White race and controlled motivation for physical activity. Conclusions Studies should be conducted to evaluate strategies to maximize recruitment and retention of subgroups that are less likely to initiate and be retained in weight loss maintenance trials.
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Affiliation(s)
- C I Voils
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA; Department of Medicine Duke University Medical Center Durham NC USA
| | - J M Grubber
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA
| | - M A McVay
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA; Department of Psychiatry Duke University Medical Center Durham NC USA
| | - M K Olsen
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA; Department of Biostatistics and Bioinformatics Duke University Medical Center Durham NC USA
| | - J Bolton
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA
| | - J M Gierisch
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA; Department of Medicine Duke University Medical Center Durham NC USA
| | - S S Taylor
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA
| | - M L Maciejewski
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA; Department of Medicine Duke University Medical Center Durham NC USA
| | - W S Yancy
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA; Department of Medicine Duke University Medical Center Durham NC USA
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Joelsson LS, Berglund A, Wånggren K, Lood M, Rosenblad A, Tydén T. Do subfertile women adjust their habits when trying to conceive? Ups J Med Sci 2016; 121:184-91. [PMID: 27216564 PMCID: PMC4967265 DOI: 10.1080/03009734.2016.1176094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 01/07/2023] Open
Abstract
AIM The aim of this study was to investigate lifestyle habits and lifestyle adjustments among subfertile women trying to conceive. MATERIALS AND METHODS Women (n = 747) were recruited consecutively at their first visit to fertility clinics in mid-Sweden. Participants completed a questionnaire. Data were analyzed using logistic regression, t tests, and chi-square tests. RESULTS The response rate was 62% (n = 466). Mean duration of infertility was 1.9 years. During this time 13.2% used tobacco daily, 13.6% drank more than three cups of coffee per day, and 11.6% consumed more than two glasses of alcohol weekly. In this sample, 23.9% of the women were overweight (body mass index, BMI 25-29.9 kg/m(2)), and 12.5% were obese (BMI ≥30 kg/m(2)). Obese women exercised more and changed to healthy diets more frequently than normal-weight women (odds ratio 7.43; 95% confidence interval 3.7-14.9). Six out of ten women (n = 266) took folic acid when they started trying to conceive, but 11% stopped taking folic acid after some time. Taking folic acid was associated with a higher level of education (p < 0.001). CONCLUSIONS Among subfertile women, one-third were overweight or obese, and some had other lifestyle factors with known adverse effects on fertility such as use of tobacco. Overweight and obese women adjusted their habits but did not reduce their body mass index. Women of fertile age would benefit from preconception counseling, and the treatment of infertility should routinely offer interventions for lifestyle changes.
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Affiliation(s)
- Lana Salih Joelsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research, Uppsala University, County Council of Västmanland, Västmanland County Hospital, Västerås, Sweden
| | - Anna Berglund
- The National Centre for Knowledge of Men’s Violence against Women, Uppsala University, Uppsala, Sweden
| | - Kjell Wånggren
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Lood
- Department of Women’s Health, Fertility Unit, Örebro University Hospital, Örebro, Sweden
| | - Andreas Rosenblad
- Centre for Clinical Research, Uppsala University, County Council of Västmanland, Västmanland County Hospital, Västerås, Sweden
| | - Tanja Tydén
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Shiyko M, Hallinan S, Seif El-Nasr M, Subramanian S, Castaneda-Sceppa C. Effects of Playing a Serious Computer Game on Body Mass Index and Nutrition Knowledge in Women. JMIR Serious Games 2016; 4:e8. [PMID: 27255497 PMCID: PMC4911511 DOI: 10.2196/games.4977] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 12/20/2015] [Indexed: 12/01/2022] Open
Abstract
Background Obesity and weight gain is a critical public health concern. Serious digital games are gaining popularity in the context of health interventions. They use persuasive and fun design features to engage users in health-related behaviors in a non-game context. As a young field, research about effectiveness and acceptability of such games for weight loss is sparse. Objective The goal of this study was to evaluate real-world play patterns of SpaPlay and its impact on body mass index (BMI) and nutritional knowledge. SpaPlay is a computer game designed to help women adopt healthier dietary and exercise behaviors, developed based on Self-Determination theory and the Player Experience of Need Satisfaction (PENS) model. Progress in the game is tied to real-life activities (e.g., eating a healthy snack, taking a flight of stairs). Methods We recruited 47 women to partake in a within-subject 90-day longitudinal study, with assessments taken at baseline, 1-, 2-, and 3- months. Women were on average, 29.8 years old (±7.3), highly educated (80.9% had BA or higher), 39% non-White, baseline BMI 26.98 (±5.6), who reported at least contemplating making changes in their diet and exercise routine based on the Stages of Change Model. We computed 9 indices from game utilization data to evaluate game play. We used general linear models to examine inter-individual differences between levels of play, and multilevel models to assess temporal changes in BMI and nutritional knowledge. Results Patterns of game play were mixed. Participants who reported being in the preparation or action stages of behavior change exhibited more days of play and more play regularity compared to those who were in the contemplation stage. Additionally, women who reported playing video games 1-2 hours per session demonstrated more sparse game play. Brief activities, such as one-time actions related to physical activity or healthy food, were preferred over activities that require a longer commitment (e.g., taking stairs every day for a week). BMI decreased significantly (P<.001) from baseline to 3-month follow-up, yielding a large effect size of 1.28. Nutritional knowledge increased significantly (P<.001) from first to third month follow-ups, with an effect size of .86. The degree of change in both outcomes was related to game play, baseline readiness to change, and the extent of video game play in general. Conclusions This work demonstrates initial evidence of success for using a serious game as an intervention for health behavior change in real world settings. Our findings also highlight the need to understand not only game effectiveness but also inter-individual differences. Individualizing content and the intervention medium appears to be necessary for a more personalized and long-lasting impact.
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Affiliation(s)
- Mariya Shiyko
- Northeastern University, Applied Psychology, Boston, MA, United States.
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Krukowski RA, DiLillo V, Ingle K, Harvey JR, West DS. Design and Methods of a Synchronous Online Motivational Interviewing Intervention for Weight Management. JMIR Res Protoc 2016; 5:e69. [PMID: 27095604 PMCID: PMC4858594 DOI: 10.2196/resprot.5382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/11/2016] [Accepted: 01/28/2016] [Indexed: 01/20/2023] Open
Abstract
Background While Internet-based weight management programs can facilitate access to and engagement in evidence-based lifestyle weight loss programs, the results have generally not been as effective as in-person programs. Furthermore, motivational interviewing (MI) has shown promise as a technique for enhancing weight loss outcomes within face-to-face programs. Objective This paper describes the design, intervention development, and analysis of a therapist-delivered online MI intervention for weight loss in the context of an online weight loss program. Methods The MI intervention is delivered within the context of a randomized controlled trial examining the efficacy of an 18-month, group-based, online behavioral weight control program plus individually administered, synchronous online MI sessions relative to the group-based program alone. Six individual 30-minute MI sessions are conducted in private chat rooms over 18 months by doctoral-level psychologists. Sessions use a semistructured interview format for content and session flow and incorporate core MI components (eg, collaborative agenda setting, open-ended questions, reflective listening and summary statements, objective data, and a focus on evoking and amplifying change talk). Results The project was funded in 2010 and enrollment was completed in 2012. Data analysis is currently under way and the first results are expected in 2016. Conclusions This is the first trial to test the efficacy of a synchronous online, one-on-one MI intervention designed to augment an online group behavioral weight loss program. If the addition of MI sessions proves to be successful, this intervention could be disseminated to enhance other distance-based weight loss interventions. Trial Registration Clinicaltrials.gov NCT01232699; https://clinicaltrials.gov/ct2/show/NCT01232699
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Affiliation(s)
- Rebecca Anne Krukowski
- Center for Population Sciences, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States.
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Lyons EJ, Baranowski T, Basen-Engquist KM, Lewis ZH, Swartz MC, Jennings K, Volpi E. Testing the effects of narrative and play on physical activity among breast cancer survivors using mobile apps: study protocol for a randomized controlled trial. BMC Cancer 2016; 16:202. [PMID: 26960972 PMCID: PMC4784467 DOI: 10.1186/s12885-016-2244-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 03/02/2016] [Indexed: 01/02/2023] Open
Abstract
Background Physical activity reduces risk for numerous negative health outcomes, but postmenopausal breast cancer survivors do not reach recommended levels. Many interventions encourage self-monitoring of steps, which can increase physical activity in the short term. However, these interventions appear insufficient to increase motivation for sustained change. There is a need for innovative strategies to increase physical activity motivation in this population. Narratives are uniquely persuasive, and video games show promise for increasing motivation. This study will determine the effectiveness of an intervention that combines narrative and gaming to encourage sustained physical activity. Methods/Design SMARTGOAL (Self-Monitoring Activity: a Randomized Trial of Game-Oriented AppLications) is a randomized controlled intervention trial. The intervention period is six months, followed by a six month maintenance period. Participants (overweight, sedentary postmenopausal breast cancer survivors aged 45–75) will be randomized to a self-monitoring group or an enhanced narrative game group. The self-monitoring group will be encouraged to use a mobile application for self-monitoring and feedback and will receive 15 counseling phone calls emphasizing self-regulation. The narrative game group will be encouraged to use a mobile application that includes self-monitoring and feedback as well as a narrative-based active video game. The 15 calls for this group will emphasize concepts related to the game storyline. Counseling calls in both groups will occur weekly in months 1 – 3 and monthly in months 4 – 6. No counseling calls will occur after month 6, but both groups will be encouraged to continue using their apps. The primary outcome of the study is minutes of moderate to vigorous physical activity at six months. Other objectively measured outcomes include fitness and physical function. Self-reported outcomes include quality of life, depression, and motivation. Discussion This protocol will result in implementation and evaluation of two technology-based physical activity interventions among breast cancer survivors. Both interventions hold promise for broad dissemination. Understanding the potential benefit of adding narrative and game elements to interventions will provide critical information to interventionists, researchers, clinicians, and policymakers. This study is uniquely suited to investigate not just whether but how and why game elements may improve breast cancer survivors’ health. Trial registration clinicaltrials.gov NCT02341235 (January 9, 2015) Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2244-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth J Lyons
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1124, USA.
| | - Tom Baranowski
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates St, Houston, TX, 77030, USA
| | - Karen M Basen-Engquist
- Department of Behavioral Science and Center for Energy Balance in Cancer Prevention and Survivorship, M.D. Anderson Cancer Center, 1155 Pressler St, Houston, TX, 77030, USA
| | - Zakkoyya H Lewis
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Maria C Swartz
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Kristofer Jennings
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Elena Volpi
- Department of Geriatrics and Claude D. Pepper Older Americans Independence Center, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
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Warren J, Smalley B, Barefoot N. Higher Motivation for Weight Loss in African American than Caucasian Rural Patients with Hypertension and/or Diabetes. Ethn Dis 2016; 26:77-84. [PMID: 26843799 DOI: 10.18865/ed.26.1.77] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine the relationship between race/ethnicity and motivation for weight loss and motivation for exercise among patients with chronic disease. DESIGN Cross-sectional. SETTING Our study took place within a network of federally qualified health centers (FQHCs) in the rural southern United States. PATIENTS OR PARTICIPANTS 463 active FQHC patients with diabetes and/or hypertension identifying as African American, White Hispanic, or non-Hispanic White participated in our study. MAIN OUTCOME MEASURES Primary outcomes were assessed using standardized measures of motivation for a) weight loss; and b) hypertension per the Transtheoretical Model. RESULTS Multivariate logistic regression revealed that, when controlling for age, sex, education status, employment status, poverty, comorbidity, and weight status, there were no significant differences in motivation for exercise among the different racial/ethnic groups (P=.361). However, when controlling for the same factors, there was a significant difference in motivation for weight loss, with African American participants more than twice as likely as non-Hispanic White participants to be motivated to lose weight (ORADJ = 2.430, P=.002). CONCLUSIONS Our study suggests that, among rural patients with obesity-related chronic disease, there is a significant variation in motivation to lose weight between racial/ethnic groups. This underscores the importance of culturally tailoring interventions and in considering motivation for change when promoting weight loss behaviors. Additional implications for intervention development and delivery are discussed.
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Affiliation(s)
- Jacob Warren
- Mercer University School of Medicine, Center for Rural Health and Health Disparities
| | - Bryant Smalley
- Georgia Southern University, Rural Health Research Institute
| | - Nikki Barefoot
- Georgia Southern University, Rural Health Research Institute
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Imamura M, Williams K, Wells M, McGrother C. Lifestyle interventions for the treatment of urinary incontinence in adults. Cochrane Database Syst Rev 2015; 2015:CD003505. [PMID: 26630349 PMCID: PMC8612696 DOI: 10.1002/14651858.cd003505.pub5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Low cost, non-invasive alterations in lifestyle are frequently recommended by healthcare professionals or those presenting with incontinence. However, such recommendations are rarely based on good evidence. OBJECTIVES The objective of the review was to determine the effectiveness of specific lifestyle interventions (i.e. weight loss; dietary changes; fluid intake; reduction in caffeinated, carbonated and alcoholic drinks; avoidance of constipation; stopping smoking; and physical activity) in the management of adult urinary incontinence. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in process, and handsearching of journals and conference proceedings (searched 3 July 2013), and the reference lists of relevant articles. We incorporated the results of these searches fully in the review. We undertook an updated search of the Specialised Register, which now includes searches of ClinicalTrials.gov and WHO ICTRP, on 27 October 2014; potentially eligible studies from this search are currently awaiting classification. SELECTION CRITERIA Randomised and quasi-randomised studies of community-based lifestyle interventions compared with no treatment, other conservative therapies, or pharmacological interventions for the treatment of urinary incontinence in adults. DATA COLLECTION AND ANALYSIS Two authors independently assessed study quality and extracted data. We collected information on adverse effects from the trials. Data were combined in a meta-analysis when appropriate. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included 11 trials in the review, involving a total of 5974 participants.Four trials involving 4701 women compared weight loss programmes with a control intervention. Low quality evidence from one trial suggested that more women following weight loss programmes reported improvement in symptoms of incontinence at six months (163/214 (76%) versus 49/90 (54%), risk ratio (RR) 1.40, 95% confidence interval (CI) 1.14 to 1.71), and this effect was sustained at 18 months (N = 291, 75% versus 62%, RR not estimable, reported P value 0.02). No data were available for self-reported cure and quality of life. One of the weight loss trials involving 1296 women reported very low quality evidence for a reduction in weekly urinary incontinence a mean of 2.8 years after following a lifestyle weight loss intervention that had been compared with a pharmacological weight loss intervention.Three trials involving 181 women and 11 men compared change in fluid intake with no change. Limited, very low quality evidence suggested that symptom-specific quality of life scores improved when fluid intake was reduced, although some people reported headaches, constipation or thirst. A further three trials involving 160 women and nine men compared reduction in caffeinated drinks with no change, and one trial involving 42 women compared a soy-rich diet with soy-free diet. However, it was not possible to reach any conclusions about the effects of these changes, due to methodological limitations, that resulted in very low quality evidence.Adverse effects appeared relatively uncommon for all interventions studied.All included studies had a high or unclear risk of bias across all bias parameters, but most notably for allocation concealment. The main factors for our downgrading of the evidence were risk of bias, indirect evidence (less than 12 months of follow-up; and not all participants having confirmed urinary incontinence at baseline in some studies), and imprecise results with wide confidence intervals.Other interventions such as reduction in consumption of sweetened fizzy or diet drinks; reduction in alcohol consumption; avoiding constipation; smoking cessation; restricting strenuous physical forces; or reducing high levels of, or increasing low levels of, physical activity, could not be assessed in this review, as no evidence from randomized controlled trials or quasi-randomised trials was available. AUTHORS' CONCLUSIONS Evidence for the effect of weight loss on urinary incontinence is building and should be a research priority. Generally, there was insufficient evidence to inform practice reliably about whether lifestyle interventions are helpful in the treatment of urinary incontinence.
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Affiliation(s)
- Mari Imamura
- University of AberdeenAcademic Urology UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Kate Williams
- University of LeicesterDepartment of Health Sciences22‐28 Princess Road WestLeicesterUKLE2 6GS
| | - Mandy Wells
- NHS DevonIntegrated Bladder and Bowel Care ServicesFranklyn House, Franklyn DriveSt ThomasExeterDevonUKEX2 9HS
| | - Catherine McGrother
- University of LeicesterDept of Health SciencesUniversity RoadLeicesterLeicestershireUKLE1 7RH
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Gilmartin J, Murphy M. The effects of contemporary behavioural weight loss maintenance interventions for long term weight loss: a systematic review. J Res Nurs 2015. [DOI: 10.1177/1744987115599671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background A major challenge in the treatment of obesity is the long term maintenance of weight loss and prevention of weight regain. The Department of Health in England has recommended that health professionals should consider behavioural weight loss interventions. Objective To evaluate the effectiveness of behavioural weight loss interventions in maintaining long term weight loss. Methods Using the PRISMA statement we performed a systematic review of randomised controlled trials. Data sources involved in the study are the Cochrane Library, MEDLINE, EMBASE, psycINFO, CINAHL and the Web of Science. Studies were assessed independently by two authors to provide inter-rater reliability. Results This review presents the findings from 13 randomised controlled trials of weight loss maintenance utilising interventions that include diet strategies, behavioural strategies, lifestyle counselling and drug therapy, group therapy and the Internet. The sample population included adult participants of 18 years+ with a BMI > 30 kg/m2. The results revealed that lifestyle interventions targeting diet and physical activity are effective in sustaining weight loss up to two years with extended care. Moreover, pharmacology combined with lifestyle interventions was effective. Conclusion There is important evidence that the use of behavioural weight loss interventions are effective in sustaining long term weight loss, albeit limited. There was high heterogeneity among the studies; hence caution is required when interpreting the findings. Also, intentions to treat principles and methods to handle missing data are not clearly reported across some studies. Blinding of participants and outcome assessors is very limited.
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Affiliation(s)
- Jo Gilmartin
- Lecturer in Nursing, School of Healthcare, University of Leeds, UK
| | - Monica Murphy
- Lecturer in Nursing, School of Healthcare, University of Leeds, UK
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Santos I, Mata J, Silva MN, Sardinha LB, Teixeira PJ. Predicting long-term weight loss maintenance in previously overweight women: a signal detection approach. Obesity (Silver Spring) 2015; 23:957-64. [PMID: 25865433 DOI: 10.1002/oby.21082] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/19/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Examine psychological and behavioral predictors of 3-year weight loss maintenance in women. METHODS Participants were 154 women in a 1-year randomized controlled trial on weight management with a 2-year follow-up. Signal detection analyses identified behavioral and psychological variables that best predicted 5% and 10% weight loss at 3 years. RESULTS Women with better body image were more likely to have lost ≥5% weight at 3 years (P < 0.001). Exercise intrinsic motivation had a partial compensatory effect, in that women with poor body image but higher motivation were more likely to maintain weight loss than women with poor body image and lower motivation (P < 0.001). Women with high exercise autonomous motivation were three times more likely to have lost ≥10% weight than were those with lower autonomous motivation (P < 0.001). Among women with lower autonomous motivation, perceiving fewer exercise barriers was somewhat compensatory: these women were more likely to maintain weight loss than women with lower autonomy but more perceived barriers (P < 0.01). CONCLUSIONS In overweight women, improving body image and increasing autonomous and intrinsic motivation for exercise likely promotes clinically significant long-term weight loss maintenance. Decreasing perceived exercise barriers is another promising intervention target.
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Affiliation(s)
- Inês Santos
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
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Cherrington AL, Willig AL, Agne AA, Fowler MC, Dutton GR, Scarinci IC. Development of a theory-based, peer support intervention to promote weight loss among Latina immigrants. BMC OBESITY 2015. [PMID: 26217532 PMCID: PMC4511020 DOI: 10.1186/s40608-015-0047-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Obesity rates are disproportionately high among Latinas living in the United States. Few community-based weight management studies have focused on Latina immigrants living in emerging Latino communities. The purpose of this study was to develop and pilot test a theory-based, promotora-delivered, peer support weight loss intervention for Latina immigrants to be administered in a community setting. We employed participatory methods to develop an 8-week program grounded in self-determination theory. Overweight Latina immigrants were recruited to participate in a quasi-experimental pilot study. Data collected pre and post-intervention included height, weight, fasting lipids, glucose, dietary practices, physical activity and depressive symptoms. Results Twenty-two women completed the intervention. Mean age was 36, mean time in the U.S. was 12 years; the majority was from Mexico. Mean BMI was 33; 68% had a family history of diabetes. The intervention resulted in statistically significant weight loss (mean 2.1 kg, SD 2.6, p < 0.001); mean change in weight remained significant when compared with that of a historical control group (-2.1 kg vs 1.10 kg, p < 0.01) but was attenuated at 6 months. Levels of moderate physical activity increased significantly (p < 0.05) and dietary practices improved (p < 0.01) and remained significant at 6 months. Notably, depressive symptoms also improved (p = <0.001). Conclusions This theory-based, promotora-delivered intervention resulted in significant weight loss among a sample of Latina immigrants at 8 weeks. Future studies are needed to test the impact of an extended peer support intervention on long-term weight management. Trial registration National Clinical Trials: NCT02344212. Registered 21 January 2015.
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Affiliation(s)
- Andrea L Cherrington
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, MT 612, 1720 2nd Avenue South, Birmingham, Alabama 35294 USA
| | - Amanda L Willig
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, BBRD 207, 1720 2nd Avenue South, Birmingham, Alabama 35294 USA
| | - April A Agne
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, MT 612, 1720 2nd Avenue South, Birmingham, Alabama 35294 USA
| | - M Cecilia Fowler
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, MT 612, 1720 2nd Avenue South, Birmingham, Alabama 35294 USA
| | - Gareth R Dutton
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, MT 612, 1720 2nd Avenue South, Birmingham, Alabama 35294 USA
| | - Isabel C Scarinci
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, MT 612, 1720 2nd Avenue South, Birmingham, Alabama 35294 USA
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Asadollahi T, Khakpour S, Ahmadi F, Seyedeh L, Tahami, Matoo S, Bermas H. Effectiveness of mindfulness training and dietary regime on weight loss in obese people. J Med Life 2015; 8:114-124. [PMID: 28316717 PMCID: PMC5319254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The present research was aimed to investigate the effectiveness of mindfulness training and dietary regime on weight loss in obese people. The research was quasi-experimental with posttest-pretest that used control group. The population consisted of all the individuals who attended two clinics of nutrition advice and diet therapy in Karaj. 60 individuals, whose BMI was more than 30, were selected by using the random sampling method. Moreover, they were evaluated by using the SCL-90 test in order to neglect them in case there existed any other significant disorder. Next, they were selected based on age, sex, and education. After explaining the individuals the ongoing research and collecting the informed consent written by them, the samples were placed in four groups (15 in each group). The groups that received mindfulness training attended the nutrition center for eight to 120-minute sessions. In addition, since all the participants referred to the center were motivated to lose weight, individuals who were placed in the control group and those who received mindfulness training were asked not to follow any specific diet for two months. Moreover, the in depth relaxation CD was prepared for those who asked, in order to train themselves at home. Descriptive statistical methods were employed in order to analyze the data and ANACOVA and variance analysis with frequent measurement were used. The research findings indicated that mindfulness training was accompanied by diet, which resulted in weight loss in obese patients. In addition, the findings of the two-month follow-up indicated lasting results.
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Affiliation(s)
- T Asadollahi
- Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - S Khakpour
- Department of Psychology, Sari Branch, Islamic Azad University, Sari, Iran
| | - F Ahmadi
- Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - L Seyedeh
- Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Tahami
- Department of Management, Tehran Branch, Payame Noor University, Tehran, Iran
| | - S Matoo
- Department of Psychology, Asalouyeh Branch, Payam Noor International University of Asalouyeh, Asalouyeh, Iran
| | - H Bermas
- Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
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MacLean PS, Wing RR, Davidson T, Epstein L, Goodpaster B, Hall KD, Levin BE, Perri MG, Rolls BJ, Rosenbaum M, Rothman AJ, Ryan D. NIH working group report: Innovative research to improve maintenance of weight loss. Obesity (Silver Spring) 2015; 23:7-15. [PMID: 25469998 PMCID: PMC5841916 DOI: 10.1002/oby.20967] [Citation(s) in RCA: 365] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/21/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The National Institutes of Health, led by the National Heart, Lung, and Blood Institute, organized a working group of experts to discuss the problem of weight regain after weight loss. A number of experts in integrative physiology and behavioral psychology were convened with the goal of merging their perspectives regarding the barriers to scientific progress and the development of novel ways to improve long-term outcomes in obesity therapeutics. The specific objectives of this working group were to: (1) identify the challenges that make maintaining a reduced weight so difficult; (2) review strategies that have been used to improve success in previous studies; and (3) recommend novel solutions that could be examined in future studies of long-term weight control. RESULTS Specific barriers to successful weight loss maintenance include poor adherence to behavioral regimens and physiological adaptations that promote weight regain. A better understanding of how these behavioral and physiological barriers are related, how they vary between individuals, and how they can be overcome will lead to the development of novel strategies with improved outcomes. CONCLUSIONS Greater collaboration and cross-talk between physiological and behavioral researchers is needed to advance the science and develop better strategies for weight loss maintenance.
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Affiliation(s)
- Paul S. MacLean
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rena R. Wing
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Terry Davidson
- Department of Psychology, American University, Washington, DC, USA
| | - Leonard Epstein
- Department of Pediatrics, University of Buffalo, Buffalo, New York, USA
| | - Bret Goodpaster
- Florida Hospital Translational Institute for Metabolism and Diabetes and Sanford Burnham Medical Research Institute, Orlando, Florida, USA
| | - Kevin D. Hall
- Laboratory of Biological Modeling, Integrative Physiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Barry E. Levin
- Department of Neurology and Neurosciences, Rutgers-New Jersey Medical School, Neurology Service, East Orange VA Medical Center, East Orange, New Jersey, USA
| | - Michael G. Perri
- College of Public Health and Health Professions, Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Barbara J. Rolls
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Michael Rosenbaum
- Department of Pediatrics, Columbia University, New York, New York, USA
| | | | - Donna Ryan
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
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