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Fuglestad PT, Rothman AJ, Linde JA. Applying Regulatory Focus Theory to Encourage Weight Loss in a Self-directed Intervention. Int J Behav Med 2024; 31:331-337. [PMID: 37118346 DOI: 10.1007/s12529-023-10180-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Regulatory focus theory proposes two self-regulatory systems: promotion focus-related to fulfilling aspirations and maximizing positive outcomes-and prevention focus-related to fulfilling responsibilities and avoiding negative outcomes. Building on research demonstrating associations between regulatory focus and weight outcomes, a proof-of-concept weight control intervention framed intervention procedures in terms of promotion or prevention focus and descriptively examined whether the impact of the intervention conditions depended on dispositional regulatory focus. METHODS After random assignment to control (received pamphlet on diet and physical activity), promotion, or prevention conditions (1.5-hour baseline sessions; detailed manuals; 1-hour sessions at 3 months), community participants from a metropolitan area in the United States (N = 57; age M = 40; BMI M = 30.9) completed the Regulatory Focus Questionnaire and were weighed at baseline, 3 months, and 6 months. Longitudinal analysis was conducted with SAS Proc Mixed using restricted maximum likelihood estimation. RESULTS Estimated weight change was -2.99 kg, 95% CI [-4.65, -1.32], in the promotion condition, -1.70 kg, 95% CI [-3.29, -0.12], in the prevention condition, and -0.18 kg, 95% CI [-1.42, 1.05], in the control condition. Exploratory analyses revealed that for relatively more promotion-focused participants, estimated weight change was -1.43 kg, 95% CI [-3.38, 0.51], in the promotion condition, +0.48 kg, 95% CI [-1.01, 1.97], in the prevention condition, and -1.09 kg, 95% CI [-2.32, 0.14], in the control condition. For relatively more prevention-focused participants, estimated weight change was -5.19 kg, 95% CI [-7.14, -3.25], in the promotion condition, -3.35 kg, 95% CI [-4.83, -1.86], in the prevention condition, and +0.42 kg, 95% CI [-0.81, 1.65], in the control condition. CONCLUSIONS Results suggest that self-directed, promotion-focused interventions may be effective and that tailoring to self-regulatory dispositions may not be of additional benefit in initiating weight loss.
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Affiliation(s)
- Paul T Fuglestad
- Department of Psychology, University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224, USA.
| | | | - Jennifer A Linde
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, USA
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Seo M, Jun EY, Oh H. Development and effectiveness of a mobile-based autonomy support program for the prevention of metabolic syndrome in middle-aged women. Front Public Health 2024; 12:1334988. [PMID: 38384883 PMCID: PMC10879428 DOI: 10.3389/fpubh.2024.1334988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/03/2024] [Indexed: 02/23/2024] Open
Abstract
Objective Utilizing self-directed strategies for maintaining and managing healthy lifestyle habits is efficient, and it is essential to consider individual motivation, as it is a factor that directly influences the adoption and maintenance of healthy behaviors. The study aimed to assess the effects of a mobile-based autonomy support program on basic psychological needs, autonomous motivation, health behavior, and metabolic syndrome indicators in middle-aged women. Methods This study was a non-randomized controlled trial with a pre-test and post-test design, focused on validating a mobile-based autonomy-supportive program to prevent metabolic syndrome in middle-aged women. The experimental group participated in a 12-week mobile-based autonomy support program, which included components such as education, physical activity guidance, dietary management, and real-time data monitoring. In contrast, the control group was provided with comparable educational resources. Assessments of basic psychological needs, autonomous motivation, health behavior, and metabolic syndrome indicators were conducted at baseline and again at the 12-week mark. Results After a 12-week period, the experimental group demonstrated significant enhancements in autonomy (p = 0.004) and competence (p < 0.001), two key dimensions of basic psychological needs. Autonomous motivation (p < 0.001) and health behavior scores (p < 0.001) were also significantly higher in the experimental group, while waist circumference (p = 0.048) and systolic blood pressure (p = 0.011) were significantly reduced. Other variables such as relatedness, high-density cholesterol, fasting blood sugar, diastolic blood pressure, and neutral fat scores were also improved in the experimental group, but these changes were not statistically significant. Conclusion The autonomy support program offers a cost-effective and community-accessible health care strategy for middle-aged women and may be integrated into various nursing practices.
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Affiliation(s)
- Miseon Seo
- Korea Institute of Oriental Medicine (KIOM), Daejeon, Republic of Korea
| | - Eun-Young Jun
- Department of Nursing, Daejeon University, Daejeon, Republic of Korea
| | - Hyunjin Oh
- College of Nursing, Gachon University, Incheon, Republic of Korea
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Forman EM, Berry MP, Butryn ML, Hagerman CJ, Huang Z, Juarascio AS, LaFata EM, Ontañón S, Tilford JM, Zhang F. Using artificial intelligence to optimize delivery of weight loss treatment: Protocol for an efficacy and cost-effectiveness trial. Contemp Clin Trials 2023; 124:107029. [PMID: 36435427 PMCID: PMC9839592 DOI: 10.1016/j.cct.2022.107029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/09/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
Gold standard behavioral weight loss (BWL) is limited by the availability of expert clinicians and high cost of delivery. The artificial intelligence (AI) technique of reinforcement learning (RL) is an optimization solution that tracks outcomes associated with specific actions and, over time, learns which actions yield a desired outcome. RL is increasingly utilized to optimize medical treatments (e.g., chemotherapy dosages), and has very recently started to be utilized by behavioral treatments. For example, we previously demonstrated that RL successfully optimized BWL by dynamically choosing between treatments of varying cost/intensity each week for each participant based on automatic monitoring of digital data (e.g., weight change). In that preliminary work, participants randomized to the AI condition required one-third the amount of coaching contact as those randomized to the gold standard condition but had nearly identical weight losses. The current protocol extends our pilot work and will be the first full-scale randomized controlled trial of a RL system for weight control. The primary aim is to evaluate the hypothesis that a RL-based 12-month BWL program will produce non-inferior weight losses to standard BWL treatment, but at lower costs. Secondary aims include testing mechanistic targets (calorie intake, physical activity) and predictors (depression, binge eating). As such, adults with overweight/obesity (N = 336) will be randomized to either a gold standard condition (12 months of weekly BWL groups) or AI-optimized weekly interventions that represent a combination of expert-led group, expert-led call, paraprofessional-led call, and automated message). Participants will be assessed at 0, 1, 6 and 12 months.
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Affiliation(s)
- Evan M Forman
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States.
| | - Michael P Berry
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States
| | - Meghan L Butryn
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States
| | - Charlotte J Hagerman
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States
| | - Zhuoran Huang
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States
| | - Adrienne S Juarascio
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States
| | - Erica M LaFata
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States
| | - Santiago Ontañón
- Department of Computer Science, Drexel University, 3675 Market St 10th floor, Philadelphia, PA 19104, United States; Google Research, 1600 Amphitheatre Parkway, Mountain View, CA 94043, United States
| | - J Mick Tilford
- College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, United States
| | - Fengqing Zhang
- Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA 19104, United States
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4
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Hoerster KD, Hunter-Merrill R, Nguyen T, Rise P, Barón AE, McDowell J, Donovan LM, Gleason E, Lane A, Plumley R, Schooler M, Schuttner L, Collins M, Au DH, Ma J. Effect of a Remotely Delivered Self-directed Behavioral Intervention on Body Weight and Physical Health Status Among Adults With Obesity: The D-ELITE Randomized Clinical Trial. JAMA 2022; 328:2230-2241. [PMID: 36511927 PMCID: PMC9856350 DOI: 10.1001/jama.2022.21177] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/27/2022] [Indexed: 12/15/2022]
Abstract
Importance The effectiveness of remotely delivered, self-directed, weight loss programs in routine clinical practice is largely unknown. Objective To test whether a self-directed, remotely administered behavioral lifestyle intervention improves weight and self-reported general health status compared with usual care. Design, Setting, and Participants In this randomized clinical trial, 511 adults with a body mass index (BMI) of 30 or more and less than 45 (based on electronic health record [EHR] weight and height), were enrolled from 30 Veterans Health Administration (VHA) sites between February 15, 2018, and December 18, 2018 (final follow-up February 18, 2021). Interventions Participants were randomly assigned to the intervention group (n = 254) or the control group (n = 257). Both received usual care. Participants randomized to the intervention received Diabetes Prevention Program-based self-directed videos, handouts, and coaching messages via an online platform or US mail for 12 months. Main Outcomes and Measures Coprimary outcomes were weight measured in primary care and recorded in the EHR and self-reported general health status using the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12) physical component score (PCS; higher scores are better [range, 0-100]) at the 12-month follow-up. The between-group minimal clinically important differences are 3 kg for weight and 5 points for the SF-12 PCS. Linear mixed models used weights and SF-12 PCS measured at either time point, with participants analyzed according to randomization assignment. Statistical significance for each coprimary outcome was based on a 2-sided α level of .025. Results Among 511 participants randomized (mean age, 57.4 [SD, 13.9] years; 231 female [45%]), 429 (84.0%) had EHR-based weights and 410 (80.2%) had SF-12 PCS data at 12 months. The unadjusted mean weight at 12 months declined from 102.7 kg to 99.8 kg in the intervention group compared with 101.9 kg to 101.0 kg in the control group (adjusted between-group mean difference, -1.93 [97.5% CI, -3.24 to -0.61]; P = .001). At 12 months, the unadjusted mean SF-12 PCS scores declined from 44.8 to 44.3 among intervention participants compared with 44.5 to 43.2 among control participants (adjusted between-group mean difference, intervention minus control, 0.69 [97.5% CI, -1.11 to 2.49]; P = .39). Cardiovascular events represented the highest percentage of serious adverse events, accounting for 25% of events in the intervention group and 35% in the control group. Conclusions and Relevance Among adults with obesity, a remotely delivered self-directed, behavioral lifestyle intervention, compared with usual care, resulted in statistically significantly greater weight loss at 12 months, although the difference was not clinically important. There was no significant difference in self-reported general physical health status at 12 months. Trial Registration ClinicalTrials.gov Identifier: NCT03260140.
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Affiliation(s)
- Katherine D. Hoerster
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, Seattle, Washington
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Rachel Hunter-Merrill
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, Seattle, Washington
| | - Tanya Nguyen
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, Seattle, Washington
| | - Peter Rise
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, Seattle, Washington
| | - Anna E. Barón
- Colorado School of Public Health, Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora
| | - Jennifer McDowell
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, Seattle, Washington
| | - Lucas M. Donovan
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, Seattle, Washington
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle
| | - Emily Gleason
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, Seattle, Washington
| | - Amber Lane
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, Seattle, Washington
| | - Robert Plumley
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, Seattle, Washington
| | - Mary Schooler
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, Seattle, Washington
| | - Linnaea Schuttner
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | - Margaret Collins
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, Seattle, Washington
| | - David H. Au
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | - Jun Ma
- Department of Medicine, University of Illinois at Chicago
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Mavragani A, Cleare AE, Smith CM, Rosas LG, King AC. Detailed Versus Simplified Dietary Self-monitoring in a Digital Weight Loss Intervention Among Racial and Ethnic Minority Adults: Fully Remote, Randomized Pilot Study. JMIR Form Res 2022; 6:e42191. [PMID: 36512404 PMCID: PMC9795401 DOI: 10.2196/42191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Detailed self-monitoring (or tracking) of dietary intake is a popular and effective weight loss approach that can be delivered via digital tools, although engagement declines over time. Simplifying the experience of self-monitoring diet may counteract this decline in engagement. Testing these strategies among racial and ethnic minority groups is important as these groups are often disproportionately affected by obesity yet underrepresented in behavioral obesity treatment. OBJECTIVE In this 2-arm pilot study, we aimed to evaluate the feasibility and acceptability of a digital weight loss intervention with either detailed or simplified dietary self-monitoring. METHODS We recruited racial and ethnic minority adults aged ≥21 years with a BMI of 25 kg/m2 to 45 kg/m2 and living in the United States. The Pacific time zone was selected for a fully remote study. Participants received a 3-month stand-alone digital weight loss intervention and were randomized 1:1 to either the detailed arm that was instructed to self-monitor all foods and drinks consumed each day using the Fitbit mobile app or to the simplified arm that was instructed to self-monitor only red zone foods (foods that are highly caloric and of limited nutritional value) each day via a web-based checklist. All participants were instructed to self-monitor both steps and body weight daily. Each week, participants were emailed behavioral lessons, action plans, and personalized feedback. In total, 12 a priori benchmarks were set to establish feasibility, including outcomes related to reach, retention, and self-monitoring engagement (assessed objectively via digital tools). Acceptability was assessed using a questionnaire. Weight change was assessed using scales shipped to the participants' homes and reported descriptively. RESULTS The eligibility screen was completed by 248 individuals, of whom 38 (15.3%) were randomized, 18 to detailed and 20 to simplified. At baseline, participants had a mean age of 47.4 (SD 14.0) years and BMI of 31.2 (SD 4.8) kg/m2. More than half (22/38, 58%) were identified as Hispanic of any race. The study retention rate was 92% (35/38) at 3 months. The detailed arm met 9 of 12 feasibility benchmarks, while the simplified arm met all 12. Self-monitoring engagement was moderate to high (self-monitoring diet: median of 49% of days for detailed, 97% for simplified; self-monitoring steps: 99% for detailed, 100% for simplified; self-monitoring weight: 67% for detailed, 80% for simplified). Participants in both arms reported high satisfaction, with 89% indicating that they would recommend the intervention. Weight change was -3.4 (95% CI -4.6 to -2.2) kg for detailed and -3.3 (95% CI -4.4 to -2.2) kg for simplified. CONCLUSIONS A digital weight loss intervention that incorporated either detailed or simplified dietary self-monitoring was feasible, with high retention and engagement, and acceptable to racial and ethnic minority adults. TRIAL REGISTRATION ASPREDICTED #66674; https://aspredicted.org/ka478.pdf.
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Affiliation(s)
| | | | | | - Lisa Goldman Rosas
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Abby C King
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States.,Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, United States
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6
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Levin ME, Petersen JM, Durward C, Bingeman B, Davis E, Nelson C, Cromwell S. A randomized controlled trial of online acceptance and commitment therapy to improve diet and physical activity among adults who are overweight/obese. Transl Behav Med 2021; 11:1216-1225. [PMID: 33289785 DOI: 10.1093/tbm/ibaa123] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acceptance and commitment therapy (ACT) has shown benefit for improving diet, physical activity, and weight among adults who are overweight and obese. However, research to-date in this area has primarily evaluated ACT delivered through in-person interventions, which has more limited access relative to online formats. The present study evaluated an online guided self-help program that integrated ACT with nutrition education to improve healthy eating and physical activity. A sample of 79 adults who were overweight/obese was randomized to receive the 8-week ACT on Health program plus weekly phone coaching or to a waitlist. Participants completed 5.5 ACT sessions on average (out of 8) and reported moderately high program satisfaction. Participants in the ACT condition improved significantly more than the waitlist at posttreatment on the primary outcome of healthy eating index (HEI; based on 24-hr recall assessments) and almost all secondary outcomes assessing self-reported eating behaviors, weight, mental health, weight self-stigma, and psychological inflexibility. However, no intervention effects were found for self-reported physical activity. At 8-week follow-up, improvements were maintained for most outcomes in the ACT condition, but not for the HEI. Improvements in psychological inflexibility mediated treatment effects on some outcomes, but not HEI or weight. Overall, delivering ACT through online guided self-help combined with nutrition education appears promising for improving healthy eating, weight, and self-stigma, but results for physical activity and long-term behavior change are unclear, possibly due to limitations in the ACT on Health program.
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Gold N, Yau A, Rigby B, Dyke C, Remfry EA, Chadborn T. Effectiveness of Digital Interventions for Reducing Behavioral Risks of Cardiovascular Disease in Nonclinical Adult Populations: Systematic Review of Reviews. J Med Internet Res 2021; 23:e19688. [PMID: 33988126 PMCID: PMC8164125 DOI: 10.2196/19688] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/05/2020] [Accepted: 02/03/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Digital health interventions are increasingly being used as a supplement or replacement for face-to-face services as a part of predictive prevention. They may be offered to those who are at high risk of cardiovascular disease and need to improve their diet, increase physical activity, stop smoking, or reduce alcohol consumption. Despite the popularity of these interventions, there is no overall summary and comparison of the effectiveness of different modes of delivery of a digital intervention to inform policy. OBJECTIVE This review aims to summarize the effectiveness of digital interventions in improving behavioral and health outcomes related to physical activity, smoking, alcohol consumption, or diet in nonclinical adult populations and to identify the effectiveness of different modes of delivery of digital interventions. METHODS We reviewed articles published in the English language between January 1, 2009, and February 25, 2019, that presented a systematic review with a narrative synthesis or meta-analysis of any study design examining digital intervention effectiveness; data related to adults (≥18 years) in high-income countries; and data on behavioral or health outcomes related to diet, physical activity, smoking, or alcohol, alone or in any combination. Any time frame or comparator was considered eligible. We searched MEDLINE, Embase, PsycINFO, Cochrane Reviews, and gray literature. The AMSTAR-2 tool was used to assess review confidence ratings. RESULTS We found 92 reviews from the academic literature (47 with meta-analyses) and 2 gray literature items (1 with a meta-analysis). Digital interventions were typically more effective than no intervention, but the effect sizes were small. Evidence on the effectiveness of digital interventions compared with face-to-face interventions was mixed. Most trials reported that intent-to-treat analysis and attrition rates were often high. Studies with long follow-up periods were scarce. However, we found that digital interventions may be effective for up to 6 months after the end of the intervention but that the effects dissipated by 12 months. There were small positive effects of digital interventions on smoking cessation and alcohol reduction; possible effectiveness in combined diet and physical activity interventions; no effectiveness for interventions targeting physical activity alone, except for when interventions were delivered by mobile phone, which had medium-sized effects; and no effectiveness observed for interventions targeting diet alone. Mobile interventions were particularly effective. Internet-based interventions were generally effective. CONCLUSIONS Digital interventions have small positive effects on smoking, alcohol consumption, and in interventions that target a combination of diet and physical activity. Small effects may have been due to the low efficacy of treatment or due to nonadherence. In addition, our ability to make inferences from the literature we reviewed was limited as those interventions were heterogeneous, many reviews had critically low AMSTAR-2 ratings, analysis was typically intent-to-treat, and follow-up times were relatively short. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42019126074; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=126074.
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Affiliation(s)
- Natalie Gold
- Public Health England, London, United Kingdom.,Centre for Philosophy of Natural and Social Science, London School of Economics and Political Science, London, United Kingdom
| | - Amy Yau
- Public Health England, London, United Kingdom.,Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Benjamin Rigby
- Public Health England, London, United Kingdom.,Department of Sociology, University of Durham, Durham, United Kingdom
| | - Chris Dyke
- Public Health England, London, United Kingdom.,Department of Social Science, Institute of Education, University College London, London, United Kingdom
| | - Elizabeth Alice Remfry
- Public Health England, London, United Kingdom.,Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Lillis J, Dunsiger S, Thomas JG, Ross KM, Wing RR. Novel behavioral interventions to improve long-term weight loss: A randomized trial of acceptance and commitment therapy or self-regulation for weight loss maintenance. J Behav Med 2021; 44:527-540. [PMID: 33772702 DOI: 10.1007/s10865-021-00215-z] [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: 11/02/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
Maintenance of weight loss is hard to achieve, and novel interventions are needed to improve long-term outcomes. In this pilot randomized controlled trial, N = 188 participants received an online, 12-week weight loss intervention and N = 102 who lost ≥ 5% were then randomly assigned to a 1-day, 5-h workshop based on Acceptance and Commitment Therapy (ACT), Self-Regulation (SR), or no workshop (Control) with 3 months of limited email follow-up. Assessments were conducted at baseline, 3, 6, 12, 18, and 24 months. The primary outcome was percent weight change; secondary outcomes were weight-related experiential avoidance and health values-consistent behavior. ACT had greater overall weight loss (-7.18%, SE = 1.33) when compared to Control (-1.15%, SE = 1.50; p = .03). Post hoc analyses showed that ACT had significantly greater weight losses than Control (6.11%, β = -2.03, p = .048) among those with lower initial weight loss (5-7%), and significantly greater weight loss than SR (6.19%, β = -1.77, p = .05) among those with the highest initial weight losses (10% +). There is potential for continuing to develop ACT in a limited interventionist-contact format with modifications. This pilot study represents an innovative model for behavioral weight loss by reversing the typical treatment intensity model with the aim of providing interventionist support during a critical period after initial weight loss. REGISTRATION: Clinicaltrials.org #NCT02156752 https://www.clinicaltrials.gov/ct2/show/NCT02156752 .
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Affiliation(s)
- J Lillis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 20903, USA.
| | - S Dunsiger
- Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI, USA
| | - J G Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 20903, USA
| | - K M Ross
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - R R Wing
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 20903, USA
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9
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Lillis J, Schumacher L, Thomas JG, Levin ME, Dunsiger S, Unick JL, Evans E, Hayes JF, Wing RR. Study protocol for a randomized controlled trial comparing two low-intensity weight loss maintenance interventions based on acceptance and commitment therapy or self-regulation. Contemp Clin Trials 2021; 103:106327. [PMID: 33631360 DOI: 10.1016/j.cct.2021.106327] [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: 10/08/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Weight regain is common following behavioral obesity treatment and attenuates many of the benefits of initial weight loss. This paper describes a randomized controlled trial that will evaluate the efficacy of two low-contact weight loss maintenance interventions based on Acceptance and Commitment Therapy (ACT) and self-regulation (SR). Potential mechanisms of action and moderators of treatment effects will also be evaluated. METHODS Adults (anticipated N = 480) with overweight or obesity will complete an initial 3-month online weight loss program (Phase 1). Participants who achieve ≥4 kg weight loss (anticipated N = 288) will then be randomized to an ACT or SR weight loss maintenance intervention. Both interventions will entail four 2.5 h, face-to-face, group-based workshop sessions and 6 months of email contact. Assessments will be conducted at phase 1 baseline, phase 1 completion/pre-randomization, and 6, 12, 18, 24, and 30 months post-randomization. The primary outcome will be weight change for the period from randomization to 30 months. Potential process measures including ACT-based constructs (e.g., psychological acceptance, values-consistent behavior), self-weighing frequency, and motivation will be also be assessed, as will potential moderators (e.g., initial weight loss). CONCLUSIONS This study will compare the efficacy of two intervention approaches (ACT and SR) delivered in a scalable workshop format for long-term weight loss maintenance. Future research could examine efficacy and cost-effectiveness of these approaches in real world settings.
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Affiliation(s)
- Jason Lillis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA.
| | - Leah Schumacher
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Michael E Levin
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Brown University, School of Public Health, Providence, RI, USA
| | - Jessica L Unick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Erin Evans
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Jacqueline F Hayes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
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Bunting JW, Withers TM, Heneghan NR, Greaves CJ. Digital interventions for promoting exercise adherence in chronic musculoskeletal pain: a systematic review and meta-analysis. Physiotherapy 2020; 111:23-30. [PMID: 33316865 DOI: 10.1016/j.physio.2020.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chronic musculoskeletal disorders are the second largest contributor to disability globally. Exercise is typically recommended by physiotherapists to manage symptoms. However, adherence to the prescribed exercise programme is often poor. Adjunctive digital interventions offer potential to enhance exercise adherence. OBJECTIVES To review evidence on the effectiveness of digital interventions for improving exercise adherence in people with chronic musculoskeletal conditions. The study is reported in line with PRISMA guidance and was registered with PROSPERO (CRD42019124502). DATA SOURCES MEDLINE, Embase and PsycInfo were searched using a comprehensive search strategy. The reference lists of all included papers and relevant systematic reviews identified during the search were scanned for relevant articles. STUDY APPRAISAL AND SYNTHESIS METHODS Two researchers independently checked articles for inclusion and extracted data. RESULTS The search returned a total of 4257 results of which five trials were included in the review and two studies were included in a random effects meta-analysis. There was no statistically significant difference in exercise adherence (SMD: 0.23; 95% CI: -0.10, 0.57). Studies that were not suitable for inclusion in the meta-analysis reported similar results. Heterogeneity of effects was high and study quality ranged from low to moderate. All of the meta-analysed data related to osteoarthritis of the hip and/or knee. CONCLUSION We found no evidence that digital interventions enhance adherence to therapeutic exercise in patients with chronic musculoskeletal disorders. However, further, high quality research is required to draw definitive conclusions on their effectiveness and to identify key components that are associated with effectiveness. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019124502.
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Affiliation(s)
- J W Bunting
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - T M Withers
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - N R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - C J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK.
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Grey EB, Thompson D, Gillison FB. Effects of a Web-Based, Evolutionary Mismatch-Framed Intervention Targeting Physical Activity and Diet: a Randomised Controlled Trial. Int J Behav Med 2019; 26:645-657. [PMID: 31654276 PMCID: PMC7524855 DOI: 10.1007/s12529-019-09821-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study sought to test the effectiveness of a 12-week, novel online intervention (Evolife) aiming to increase physical activity level (PAL) and reduce energy intake (EI) among overweight/obese adults. The intervention used an evolutionary mismatch message to frame health information in an engaging way, incorporating evidence-based behaviour change techniques to promote autonomous motivation, self-efficacy and self-regulatory skills. METHOD Men and women aged 35-74 years with a BMI of 25-40 kg/m2 were eligible. Participants were randomised to receive either the intervention (comprising a face-to-face introductory session, 12 weeks' access to the Evolife website and a pedometer) or a control condition (face-to-face introductory session and NHS online health resources). PAL was measured objectively and EI was self-reported using 3-day weighed food records. Secondary measures included BMI, waist circumference and blood pressure. RESULTS Sixty people met inclusion criteria; 59 (30 intervention) completed the trial (mean age = 50; 56% male). Differences between groups' change scores for PAL and EI were of small effect size but did not reach significance (d = 0.32 and d = - 0.49, respectively). Improvements were found in both groups for PAL (int: d = 0.33; control: d = 0.04), EI (int: d = - 0.81; control: d = - 0.16), waist circumference (int: d = - 0.30; control: d = - 0.17) and systolic blood pressure (int: d = - 0.67; control: d = - 0.28). CONCLUSION The intervention did not lead to significantly greater improvement in PAL or reduction in EI than a minimal intervention control, although the changes in the intervention group were of meaningful effect size and comparable with positive outcomes in larger intervention trials. TRIAL REGISTRATION This trail was registered on www.clinicaltrials.gov on 16 January 2017 (appeared online 26 January 2017), reference NCT03032731.
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Affiliation(s)
- Elisabeth B Grey
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - Dylan Thompson
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Fiona B Gillison
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, BA2 7AY, UK
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Natvik E, Råheim M, Andersen JR, Moltu C. An Experientially Derived Model of Flexible and Intentional Actions for Weight Loss Maintenance After Severe Obesity. Front Psychol 2019; 10:2503. [PMID: 31798491 PMCID: PMC6863797 DOI: 10.3389/fpsyg.2019.02503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Knowledge about non-surgical weight loss (WL) is scarce among people with severe obesity (SO). Lifestyle changes are primarily self-driven, occasionally accompanied by professional guidance and weight-management support. Weight regain and intervention discontinuation are common challenges among guidance and support programmes. In the current study, we describe a model of meaningful strategies for maintaining WL after SO based on the experiences of successful cases. METHODS Aiming to investigate the experiences of WL and weight loss maintenance (WLM) (≥5 years) following SO, we designed a qualitative study. Ten adults of Norwegian ethnicity, eight women and two men aged from 27 to 59, participated in individual in-depth interviews. We recruited participants living in rural districts and cities across all four regions of Norway. The interviews concentrated on participants' experiences of losing weight and maintaining a lower weight over the long term. The transcripts were analysed with a rigorous method for thematic cross-case analysis, namely, systematic text condensation (STC). RESULTS Participants identified four experiential themes at the core of long-term WLM: (a) Owning the decision, (b) Creating self-reinforcement, (c) Sustaining a lifestyle-forming identity, and (d) Selecting support appropriate to one's own situation. These core themes represent the intentional level, functioning both as the foundation of and the momentum for sustaining WL. On the behavioural level, participants continued to take action for change, obtain results, record and reflect on their efforts and milestones, observe what worked and felt good, and receive recognition from others, thereby realising changes. CONCLUSION Based on these results, we propose a model of WLM after SO, suggesting that practices toward WLM on the behavioural level achieve meaning and sustainability through their relationship with a core intentional level found across participants' experiences. One implication is that the relationship between the intentional and behavioural levels might be more meaningful when discussing long-term WLM than the behaviours themselves.
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Affiliation(s)
- Eli Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- The Centre for Health Research, District General Hospital of Førde, Førde, Norway
| | - Målfrid Råheim
- Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
| | - John Roger Andersen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- The Centre for Health Research, District General Hospital of Førde, Førde, Norway
| | - Christian Moltu
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Division of Psychiatry, District General Hospital of Førde, Førde, Norway
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Forman EM, Goldstein SP, Crochiere RJ, Butryn ML, Juarascio AS, Zhang F, Foster GD. Randomized controlled trial of OnTrack, a just-in-time adaptive intervention designed to enhance weight loss. Transl Behav Med 2019; 9:989-1001. [DOI: 10.1093/tbm/ibz137] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This randomized trial demonstrated qualified support for the ability of a machine learning-powered, smartphone-based just-in-time, adaptive intervention to enhance weight loss over and above a commercial weight loss program.
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Affiliation(s)
- Evan M Forman
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, USA
| | - Stephanie P Goldstein
- Weight Control & Diabetes Research Center, Warren Alpert Medical School of Brown University, Providence, USA
| | - Rebecca J Crochiere
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, USA
| | - Meghan L Butryn
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, USA
| | - Adrienne S Juarascio
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, USA
| | - Fengqing Zhang
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, USA
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Borek AJ, Abraham C, Greaves CJ, Gillison F, Tarrant M, Morgan-Trimmer S, McCabe R, Smith JR. Identifying change processes in group-based health behaviour-change interventions: development of the mechanisms of action in group-based interventions (MAGI) framework. Health Psychol Rev 2019; 13:227-247. [PMID: 31190619 DOI: 10.1080/17437199.2019.1625282] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Group-based interventions are widely used to promote health-related behaviour change. While processes operating in groups have been extensively described, it remains unclear how behaviour change is generated in group-based health-related behaviour-change interventions. Understanding how such interventions facilitate change is important to guide intervention design and process evaluations. We employed a mixed-methods approach to identify, map and define change processes operating in group-based behaviour-change interventions. We reviewed multidisciplinary literature on group dynamics, taxonomies of change technique categories, and measures of group processes. Using weight-loss groups as an exemplar, we also reviewed qualitative studies of participants' experiences and coded transcripts of 38 group sessions from three weight-loss interventions. Finally, we consulted group participants, facilitators and researchers about our developing synthesis of findings. The resulting 'Mechanisms of Action in Group-based Interventions' (MAGI) framework comprises six overarching categories: (1) group intervention design features, (2) facilitation techniques, (3) group dynamic and development processes, (4) inter-personal change processes, (5) selective intra-personal change processes operating in groups, and (6) contextual influences. The framework provides theoretical explanations of how change occurs in group-based behaviour-change interventions and can be applied to optimise their design and delivery, and to guide evaluation, facilitator training and further research.
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Affiliation(s)
- Aleksandra J Borek
- a University of Exeter Medical School , University of Exeter , Exeter , UK
| | - Charles Abraham
- a University of Exeter Medical School , University of Exeter , Exeter , UK
| | - Colin J Greaves
- a University of Exeter Medical School , University of Exeter , Exeter , UK
| | - Fiona Gillison
- b Department for Health , University of Bath , Bath , UK
| | - Mark Tarrant
- a University of Exeter Medical School , University of Exeter , Exeter , UK
| | | | - Rose McCabe
- a University of Exeter Medical School , University of Exeter , Exeter , UK
| | - Jane R Smith
- a University of Exeter Medical School , University of Exeter , Exeter , UK
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15
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van Beurden SB, Smith JR, Lawrence NS, Abraham C, Greaves CJ. Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App-Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults. JMIR Form Res 2019; 3:e11586. [PMID: 31038464 PMCID: PMC6658245 DOI: 10.2196/11586] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/03/2019] [Accepted: 01/27/2019] [Indexed: 12/19/2022] Open
Abstract
Background ImpulsePal is a theory-driven (dual-process), evidence-informed, and person-centered smartphone app intervention designed to help people manage impulsive processes that prompt unhealthy eating to facilitate dietary change and weight loss. Objective The aims of this study were to (1) assess the feasibility of trial procedures for evaluation of the ImpulsePal intervention, (2) estimate standard deviations of outcomes, and (3) assess usability of, and satisfaction with, ImpulsePal. Methods We conducted an individually randomized parallel two-arm nonblinded feasibility trial. The eligibility criteria included being aged ≥16 years, having a body mass index of ≥25 kg/m2, and having access to an Android-based device. Weight was measured (as the proposed primary outcome for a full-scale trial) at baseline, 1 month, and 3 months of follow-up. Participants were randomized in a 2:1 allocation ratio to the ImpulsePal intervention or a waiting list control group. A nested action-research study allowed for data-driven refinement of the intervention across 2 cycles of feedback. Results We screened 179 participants for eligibility, and 58 were randomized to the intervention group and 30 to the control group. Data were available for 74 (84%, 74/88) participants at 1 month and 67 (76%, 67/88) participants at 3 months. The intervention group (n=43) lost 1.03 kg (95% CI 0.33 to 1.74) more than controls (n=26) at 1 month and 1.01 kg (95% CI −0.45 to 2.47) more than controls (n=43 and n=24, respectively) at 3 months. Feedback suggested changes to intervention design were required to (1) improve receipt and understanding of instructions and (2) facilitate further engagement with the app and its strategies. Conclusions The evaluation methods and delivery of the ImpulsePal app intervention are feasible, and the trial procedures, measures, and intervention are acceptable and satisfactory to the participants. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 14886370; http://www.isrctn.com/ISRCTN14886370 (Archived by WebCite at http://www.webcitation.org/76WcEpZ51)
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Affiliation(s)
| | - Jane R Smith
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | | | - Charles Abraham
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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Bardus M, Ali A, Demachkieh F, Hamadeh G. Assessing the Quality of Mobile Phone Apps for Weight Management: User-Centered Study With Employees From a Lebanese University. JMIR Mhealth Uhealth 2019; 7:e9836. [PMID: 30672742 PMCID: PMC6364203 DOI: 10.2196/mhealth.9836] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 09/15/2018] [Accepted: 09/24/2018] [Indexed: 12/29/2022] Open
Abstract
Background Evaluating the quality of mobile health apps for weight loss and weight management is important to understand whether these can be used for obesity prevention and treatment. Recent reviews call for more research on multidimensional aspects of app quality, especially involving end users, as there are already many expert reviews on this domain. However, no quantitative study has investigated how laypersons see popular apps for weight management and perceive different dimensions of app quality. Objective This study aimed to explore how laypersons evaluate the quality of 6 free weight management apps (My Diet Coach, SparkPeople, Lark, MyFitnessPal, MyPlate, and My Diet Diary), which achieved the highest quality ratings in a related and recent expert review. Methods A user-centered study was conducted with 36 employees of a Lebanese university. Participants enrolled in the study on a rolling basis between October 2016 and March 2017. Participants were randomly assigned an app to use for 2 weeks. App quality was evaluated at the end of the trial period using the Mobile App Rating Scale user version (uMARS). uMARS assesses the dimensions of engagement, functionality, aesthetics, information, and subjective quality on 5-point scales. Internal consistency and interrater agreement were examined. The associations between uMARS scores and users’ demographic characteristics were also explored using nonparametric tests. Analyses were completed in November 2017. Results Overall, the 6 apps were of moderately good quality (median uMARS score 3.6, interquartile range [IQR] 0.3). The highest total uMARS scores were achieved by Lark (mean 4.0 [SD 0.5]) and MyPlate (mean 3.8 [SD 0.4]), which also achieved the highest subjective quality scores (Lark: mean 3.3 [SD 1.4]; MyPlate: mean 3.3 [SD 0.8]). Functionality was the domain with the highest rating (median 3.9, IQR 0.3), followed by aesthetics (median 3.7, IQR 0.5), information (median 3.7, IQR 0.1), and engagement (median 3.3, IQR 0.2). Subjective quality was judged low (median 2.5, IQR 0.9). Overall, subjective quality was strongly and positively related (P<.001) with total uMARS score (ρ=.75), engagement (ρ=.68), information, and aesthetics (ρ=.60) but not functionality (ρ=.40; P=.02). Higher engagement scores were reported among healthy (P=.003) and obese individuals (P=.03), who also showed higher total uMARS (P=.04) and subjective quality (P=.05) scores. Conclusions Although the apps were considered highly functional, they were relatively weak in engagement and subjective quality scores, indicating a low propensity of using the apps in the future. As engagement was the subdomain most strongly associated with subjective quality, app developers and researchers should focus on creating engaging apps, holding constant the functionality, aesthetics, and information quality. The tested apps (in particular Lark and MyPlate) were perceived as more engaging and of higher quality among healthy, obese individuals, making them a promising mode of delivery for self-directed interventions promoting weight control among the sampled population or in similar and comparable settings.
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Affiliation(s)
- Marco Bardus
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ahmed Ali
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Farah Demachkieh
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,SANAD - The Home Hospice Organization of Lebanon, Beirut, Lebanon
| | - Ghassan Hamadeh
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Call CC, Piers AD, Wyckoff EP, Lowe MR, Forman EM, Butryn ML. The relationship of weight suppression to treatment outcomes during behavioral weight loss. J Behav Med 2018; 42:365-375. [DOI: 10.1007/s10865-018-9978-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/05/2018] [Indexed: 12/13/2022]
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18
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Kjær IGH, Anderssen SA, Torstveit MK. A tailored telephone and email based exercise intervention induced reductions in various measures of body composition in physically inactive adults: A randomized controlled trial. Prev Med Rep 2018; 11:160-168. [PMID: 29988751 PMCID: PMC6031217 DOI: 10.1016/j.pmedr.2018.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 06/01/2018] [Accepted: 06/14/2018] [Indexed: 12/27/2022] Open
Abstract
Obesity prevalence has increased the past decades and has become a serious public health problem. The aim of this six-month assessor-blinded, parallel-group randomized controlled trial was to assess the effect of a tailored telephone and email-based exercise intervention on various measures of body composition in a sample of apparently healthy and physically inactive adults. A total of 111 volunteering adults (40-55 yr) in Southern Norway were randomly assigned to an intervention group (IG; n = 39) or a no-information control group (CG; n = 50), by random allocation numbering. The IG received feedback on their health-related physical fitness, information on guidelines and recommendations for physical activity, a leaflet on national dietary recommendations, prompts and reminders in addition to three tailored exercise programs, one every two months, and fortnightly motivational counselling by email or telephone, alternately. The CG received no follow-up during the intervention period. The main outcome measures: weight, body mass index (BMI), waist circumference (WC) and fat percentage by skinfolds (FPskf) were assessed objectively at baseline and posttest. A one-way ANCOVA analysis, adjusted for baseline scores, gender, age, and educational level, revealed a larger reduction on all body compositional measures in the IG compared to the CG (p ≤ 0.043), except for BMI when adjusted for baseline scores. Additionally, a significantly higher percentage of the IG (64.1%) achieved a clinically significant reduction in FPskf compared to the CG (36.2%, p = 0.018). This six-month tailored telephone and email-based exercise intervention induced significant reductions on several measures of body composition in physically inactive adults. TRIAL REGISTRATION ClinicalTrials.gov (NCT03164239).
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Affiliation(s)
- Ingirid Geirsdatter Heald Kjær
- Faculty of Health and Sports Science, The University of Agder, Postboks 422, Kristiansand, Norway
- Department of Sport Medicine, The Norwegian School of Sport Sciences, Postboks 4014, Ullevål stadion, 0806 Oslo, Norway
| | - Sigmund Alfred Anderssen
- Department of Sport Medicine, The Norwegian School of Sport Sciences, Postboks 4014, Ullevål stadion, 0806 Oslo, Norway
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Saxbe D, Corner GW, Khaled M, Horton K, Wu B, Khoddam HL. The weight of fatherhood: identifying mechanisms to explain paternal perinatal weight gain. Health Psychol Rev 2018; 12:294-311. [PMID: 29712505 DOI: 10.1080/17437199.2018.1463166] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Men appear to gain weight during the transition to parenthood, and fathers are heavier than non-fathers. Paternal perinatal weight gain may set weight trajectories in midlife and have long-term health implications. Since men do not undergo the physical demands of pregnancy and breastfeeding, the specific mechanisms underlying weight gain in new fathers warrant investigation. This review aims to stimulate research on paternal perinatal weight gain by suggesting testable potential mechanisms that (1) show change across the transition to parenthood and (2) play a role in weight and body composition. We identify seven mechanisms, within three categories: behavioural mechanisms (sleep, physical activity, and diet), hormonal mechanisms (testosterone and cortisol), and psychological mechanisms (depression and stress). We also discuss direct effects of partner pregnancy influences (e.g., 'couvade syndrome') on men's body weight. In presenting each mechanism, we discuss how it may be affected by the transition to parenthood, and then review its role in body composition and weight. Next, we describe bidirectional and interactive effects, discuss timing, and present three broad research questions to propel theoretical development.
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Affiliation(s)
- Darby Saxbe
- a Department of Psychology , University of Southern California , Los Angeles , CA , USA
| | - Geoffrey W Corner
- a Department of Psychology , University of Southern California , Los Angeles , CA , USA
| | - Mona Khaled
- a Department of Psychology , University of Southern California , Los Angeles , CA , USA
| | - Katelyn Horton
- a Department of Psychology , University of Southern California , Los Angeles , CA , USA
| | - Brian Wu
- b Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
| | - Hannah Lyden Khoddam
- a Department of Psychology , University of Southern California , Los Angeles , CA , USA
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20
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van Beurden SB, Simmons SI, Tang JCH, Mewse AJ, Abraham C, Greaves CJ. Informing the development of online weight management interventions: a qualitative investigation of primary care patient perceptions. BMC OBESITY 2018; 5:7. [PMID: 29449953 PMCID: PMC5810085 DOI: 10.1186/s40608-018-0184-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 01/25/2018] [Indexed: 01/03/2023]
Abstract
Background The internet is a potentially promising medium for delivering weight loss interventions. The current study sought to explore factors that might influence primary care patients’ initial uptake and continued use (up to four-weeks) of such programmes to help inform the development of novel, or refinement of existing, weight management interventions. Methods Semi-structured interviews were conducted with 20 patients purposively sampled based on age, gender and BMI from a single rural general practice. The interviews were conducted 4 weeks after recruitment at the general practice and focused on experiences with using one of three freely available weight loss websites. Thematic Analysis was used to analyse the data. Results Findings suggested that patients were initially motivated to engage with internet-based weight loss programmes by their accessibility and novelty. However, continued use was influenced by substantial facilitators and barriers, such as time and effort involved, reaction to prompts/reminders, and usefulness of information. Facilitation by face-to-face consultations with the GP was reported to be helpful in supporting change. Conclusions Although primary care patients may not be ready yet to solely depend on online interventions for weight loss, their willingness to use them shows potential for use alongside face–to-face weight management advice or intervention. Recommendations to minimise barriers to engagement are provided. Electronic supplementary material The online version of this article (10.1186/s40608-018-0184-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Sally I Simmons
- 1University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | - Charles Abraham
- 1University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Colin J Greaves
- 1University of Exeter Medical School, University of Exeter, Exeter, UK
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Cox M, Basen-Engquist K, Carmack CL, Blalock J, Li Y, Murray J, Pisters L, Rodriguez-Bigas M, Song J, Cox-Martin E, Demark-Wahnefried W. Comparison of Internet and Telephone Interventions for Weight Loss Among Cancer Survivors: Randomized Controlled Trial and Feasibility Study. JMIR Cancer 2017; 3:e16. [PMID: 28954716 PMCID: PMC5637068 DOI: 10.2196/cancer.7166] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 06/14/2017] [Accepted: 07/01/2017] [Indexed: 01/23/2023] Open
Abstract
Background Weight loss interventions have been successfully delivered via several modalities, but recent research has focused on more disseminable and sustainable means such as telephone- or Internet-based platforms. Objective The aim of this study was to compare an Internet-delivered weight loss intervention to a comparable telephone-delivered weight loss intervention. Methods This randomized pilot study examined the effects of 6-month telephone- and Internet-delivered social cognitive theory–based weight loss interventions among 37 cancer survivors. Measures of body composition, physical activity, diet, and physical performance were the outcomes of interest. Results Participants in the telephone intervention (n=13) showed greater decreases in waist circumference (–0.75 cm for telephone vs –0.09 cm for Internet, P=.03) than the Internet condition (n=24), and several other outcomes trended in the same direction. Measures of engagement (eg, number of telephone sessions completed and number of log-ins) suggest differences between groups which may account for the difference in outcomes. Conclusions Cancer survivors in the telephone group evidenced better health outcomes than the Internet group. Group differences may be due to higher engagement in the telephone group. Incorporating a telephone-based component into existing weight loss programs for cancer survivors may help enhance the reach of the intervention while minimizing costs. More research is needed on how to combine Internet and telephone weight loss intervention components so as to maximize engagement and outcomes. Trial Registration ClinicalTrials.gov NCT01311856; https://clinicaltrials.gov/ct2/show/NCT01311856 (Archived by WebCite at http://www.webcitation.org/6tKdklShY)
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Affiliation(s)
- Matthew Cox
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Karen Basen-Engquist
- Center for Energy Balance In Cancer Prevention and Survivorship, Department of Behavioral Science, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Cindy L Carmack
- Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Janice Blalock
- Tobacco Treatment Program, Department of Behavioral, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Yisheng Li
- Department of Biostatistics, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - James Murray
- Department of Breast Medical Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Louis Pisters
- Department of Urology, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Miguel Rodriguez-Bigas
- Department of Surgical Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Jaejoon Song
- Center for Energy Balance In Cancer Prevention and Survivorship, Department of Behavioral Science, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Emily Cox-Martin
- Division of Medical Oncology, University of Colorado, Aurora, CO, United States
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