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Aksoy AN, Abayomi J, Relph N, Butler T. Physiological and psychological determinants of long-term diet-induced type 2 diabetes (T2DM) remission: A narrative review. Obes Rev 2024; 25:e13733. [PMID: 38511597 DOI: 10.1111/obr.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
Type 2 diabetes mellitus (T2DM) is a highly prevalent metabolic disease, causing a heavy burden on healthcare systems worldwide, with related complications and anti-diabetes drug prescriptions. Recently, it was demonstrated that T2DM can be put into remission via significant weight loss using low-carbohydrate diets (LCDs) and very low-energy diets (VLEDs) in individuals with overweight and obesity. Clinical trials demonstrated remission rates of 25-77%, and metabolic improvements such as improved blood lipid profile and blood pressure were observed. In contrast, clinical trials showed that remission rate declines with time, concurrent with weight gain, or diminished weight loss. This review aims to discuss existing literature regarding underlying determinants of long-term remission of T2DM including metabolic adaptations to weight loss (e.g., role of gastrointestinal hormones), type of dietary intervention (i.e., LCDs or VLEDs), maintaining beta (β)-cell function, early glycemic control, and psychosocial factors. This narrative review is significant because determining the factors that are associated with challenges in maintaining long-term remission may help in designing sustainable interventions for type 2 diabetes remission.
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Affiliation(s)
- Ayse Nur Aksoy
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Julie Abayomi
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Nicola Relph
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Thomas Butler
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Cardio-Respiratory Research Centre, Edge Hill University, Ormskirk, UK
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2
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Lee M, Khoo HS, Krishnasamy C, Loo ME, Wong SKW, Cheng SC, Bei E, Tan SY, Xie P, Lee ES, Tang WE. Experiences of living with overweight/obesity and early type 2 diabetes in Singapore-a qualitative interview study. BMJ Open 2024; 14:e079082. [PMID: 38719302 PMCID: PMC11086526 DOI: 10.1136/bmjopen-2023-079082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES To understand the lived experience of adults with overweight/obesity and early type 2 diabetes in a modern urban environment, and the interrelations among the various aspects of these experiences and participants' attitudes to weight management. DESIGN Qualitative inductive approach to analysing data thematically from semistructured interviews and interpreted from a socioecological perspective. SETTING Primary care clinics located in northern and central Singapore. PARTICIPANTS 21 patients between 29 and 59 years old who are living with overweight/obese (Body Mass Index of 25.3-44.0kg/m2) and type 2 diabetes for 6 years or less. RESULTS The main themes - everyday life, people around me and within me - pointed to a combination of barriers to weight and health management for participants. These included environmental factors such as easy physical and digital access to unhealthy food, and high-stress work environments; social factors such as ambiguous family support and dietary practices of peers; and individual factors such as challenges with self-regulation, prioritising work, dealing with co-existing medical conditions and the emotional significance of food. While lack of motivation and cultural dietary practices are hard to change, a problem-solving attitude, and presence of role models, may enable behaviour change. CONCLUSION An exploration of the lifeworld of patients with overweight/obese and early type 2 diabetes revealed that work demands, dietary practices in the workplace and at home, and the easy availability of calorie-dense foods afforded by a technology-infused environment hindered the individual's efforts at maintaining a healthy weight and lifestyle. Policy and initiatives promoting work-life balance as well as individualised interventions can support participants' stress management, and problem-solving capability for behaviour change. These barriers stemmed from the various domains of the environmental, interpersonal and intrapersonal but were interrelated. They underscored the need for an integrated approach to weight and diabetes management.
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Affiliation(s)
- Mary Lee
- Health Services & Outcomes Research, National Healthcare Group, Singapore
| | - Hwee Sing Khoo
- Group Clinical Education, National Healthcare Group, Singapore
| | | | - May Eng Loo
- Health Services & Outcomes Research, National Healthcare Group, Singapore
| | - S K W Wong
- Clinical Services, National Healthcare Group Polyclinics, Singapore
| | - San Chye Cheng
- Health Services & Outcomes Research, National Healthcare Group, Singapore
| | - Eileen Bei
- Group Clinical Education, National Healthcare Group, Singapore
| | - Shu Yun Tan
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Pauline Xie
- National Healthcare Group Polyclinics, Singapore
| | - Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Wern Ee Tang
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
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Råheim M, Moltu C, Natvik E. Living the dream - but not without hardship: stories about self-directed weight transformation from severe obesity. Psychol Health 2024; 39:631-650. [PMID: 35765935 DOI: 10.1080/08870446.2022.2090562] [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: 07/06/2021] [Revised: 05/26/2022] [Accepted: 06/11/2022] [Indexed: 10/17/2022]
Abstract
DESIGN In-depth interviews were conducted with eight women and two men, aged 27 to 59 years, who had carried out self-directed WL from SO for 5 years or more. TWO THEMES RAN ACROSS THE STORIES fear of weight-regain, and food and emotion. We performed a case-based narrative analysis of especially rich interviews that illustrate these. Results pointed to persistently cultivating new competencies, establishing new eating habits, re-establishing old physical-training habits, and forming new relational bonds. Participants reinvented themselves and their lives. However, the stories are not all about transformation, but also about new and old health problems. CONCLUSION The study directs attention to 'different obesities', not only to initial weight from which WL takes place, but also linked to the experiential horizons that the persons embody from childhood on. Furthermore, there was no way back in the present stories, always haunted in the wake of the lost weight. A double burden imposed on the person with obesity related to meta-stories in society deepens the understanding of this imperative: being vulnerable health-wise and exposed to stigmatization.
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Affiliation(s)
- M Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - C Moltu
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- The Center of Health Research, District General Hospital of Førde, Førde, Norway
| | - E Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- The Center of Health Research, District General Hospital of Førde, Førde, Norway
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Dakin C, Finlayson G, Stubbs RJ. Can eating behaviour traits be explained by underlying, latent factors? An exploratory and confirmatory factor analysis. Appetite 2024; 195:107202. [PMID: 38199306 DOI: 10.1016/j.appet.2024.107202] [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: 09/21/2023] [Revised: 11/23/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
Eating Behaviour Traits (EBTs) are psychological constructs developed to explain patterns of eating behaviour, including factors that motivate people to (over or under) eat. There is a need to align and clarify their unique contributions and harmonise the understanding they offer for human eating behaviour. Therefore, the current study examined whether 18 commonly cited EBTs could be explained by underlying, latent factors (domains of eating behaviour). An exploratory factor analysis (EFA) was used to identify latent factors, and these factors were validated using a confirmatory factor analysis (CFA). 1279 participants including the general public and members of a weight management programme were included in the analysis (957 females, 317 males, 3 others, 2 prefer not to say), with a mean age of 54 years (median = 57 years, SD = 12.03) and a mean BMI of 31.93 kg/m2 (median = 30.86, SD = 6.00). The participants completed 8 questionnaires which included 18 commonly cited EBTs and the dataset was split at random with a 70/30 ratio to conduct the EFA (n = 893) and CFA (n = 383). The results supported a four-factor model which indicated that EBTs can be organised into four domains: reactive, restricted, emotional, and homeostatic eating. The four-factor model also significantly predicted self-reported BMI and weight change. Future research should test whether this factor structure is replicated in more diverse populations, and including other EBTs, to advance these domains of eating as a unifying framework for studying individual differences in human eating behaviour.
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Affiliation(s)
- Clarissa Dakin
- Appetite Control and Energy Balance Research Group (ACEB), School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
| | - Graham Finlayson
- Appetite Control and Energy Balance Research Group (ACEB), School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - R James Stubbs
- Appetite Control and Energy Balance Research Group (ACEB), School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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De Leon A, Roemmich JN, Casperson SL. Daily Dietary Protein Distribution Does Not Influence Changes in Body Composition During Weight Loss in Women of Reproductive Years with Overweight or Obesity: A Randomized Controlled Trial. J Nutr 2024; 154:1347-1355. [PMID: 38365118 DOI: 10.1016/j.tjnut.2024.02.009] [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: 09/14/2023] [Revised: 02/01/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Preservation of fat-free mass (FFM) during intentional weight loss is challenging yet important to maintain a resting metabolic rate. A balanced protein distribution of 25-30 g per meal improves 24-h muscle protein synthesis, which may promote FFM maintenance and greater reductions in fat mass (FM) during weight loss in women. OBJECTIVES We aimed to determine whether the daily dietary protein distribution pattern during energy restriction influences changes in body composition in women of reproductive age. We hypothesized that evenly distributing protein across meals compared with the usual intake pattern of consuming most of the protein at the dinner meal would be superior in preserving FFM while reducing FM during weight loss. METHODS Healthy women (n = 43) aged 20-44 y with a BMI of 28-45 kg/m2 completed a randomized parallel feeding study testing 2 patterns of daily protein intake (even distribution across all meals compared with a skewed distribution with most protein consumed at the evening meal). Participants completed an 8-wk controlled 20% energy restriction (all foods provided), followed by an 8-wk self-choice phase in which participants were asked to maintain a similar diet and dietary pattern when purchasing and consuming their own foods. Body composition was measured at baseline, week 8, and week 16. Data were analyzed using mixed models. Statistical significance was set at P < 0.05. Data are presented as differences in least squares means ± SE. RESULTS No significant main effects of group or group-by-time interactions were observed. All measures exhibited the main effect of time (P < 0.001). Overall, body weight, FFM, FM, and body fat percentage decreased 5.6 ± 0.4, 1.0 ± 0.2, 4.6 ± 0.4 kg, and 2.3 ± 0.2%, respectively, during this 16-wk study. CONCLUSION Daily dietary protein distribution at a fixed protein level does not appear to influence changes in body composition during weight loss in women of reproductive age. CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE WHERE IT WAS OBTAINED NCT03202069 https://classic. CLINICALTRIALS gov/ct2/show/NCT03202069.
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Affiliation(s)
- Angela De Leon
- USDA Agricultural Research Services, Grand Forks Human Nutrition Research Center, Grand Forks, ND, United States
| | - James N Roemmich
- USDA Agricultural Research Services, Grand Forks Human Nutrition Research Center, Grand Forks, ND, United States
| | - Shanon L Casperson
- USDA Agricultural Research Services, Grand Forks Human Nutrition Research Center, Grand Forks, ND, United States.
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Miller HN, Gallis JA, Berger MB, Askew S, Egger JR, Kay MC, Finkelstein EA, de Leon M, DeVries A, Brewer A, Holder MG, Bennett GG. Weight Gain Prevention Outcomes From a Pragmatic Digital Health Intervention With Community Health Center Patients: Randomized Controlled Trial. J Med Internet Res 2024; 26:e50330. [PMID: 38416574 PMCID: PMC11009856 DOI: 10.2196/50330] [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: 07/17/2023] [Revised: 02/07/2024] [Accepted: 02/26/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND The prevalence of obesity and its associated comorbidities continue to rise in the United States. Populations who are uninsured and from racial and ethnic minority groups continue to be disproportionately affected. These populations also experience fewer clinically meaningful outcomes in most weight loss trials. Weight gain prevention presents a useful strategy for individuals who experience barriers to weight loss. Given the often-limited weight management resources available to patients in primary care settings serving vulnerable patients, evaluating interventions with pragmatic designs may help inform the design of comprehensive obesity care delivered in primary care. OBJECTIVE This study aims to evaluate the effectiveness of Balance, a 2-arm, 12-month pragmatic randomized controlled trial of a digital weight gain prevention intervention, delivered to patients receiving primary care within federally qualified community health centers. METHODS Balance was a 2-arm, 12-month pragmatic randomized controlled trial of a digital weight gain prevention intervention delivered to individuals who had a BMI of 25-40 kg/m2, spoke English or Spanish, and were receiving primary care within a network of federally qualified community health centers in North Carolina. The Balance intervention was designed to encourage behavioral changes that result in a slight energy deficit. Intervention participants received tailored goal setting and tracking, skills training, self-monitoring, and responsive health coaching from registered dietitians. Weight was measured at regular primary care visits and documented in the electronic health record. We compared the percentage of ≤3% weight gain in each arm at 24 months after randomization-our primary outcome-using individual empirical best linear unbiased predictors from the linear mixed-effects model. We used individual empirical best linear unbiased predictors from participants with at least 1 electronic health record weight documented within a 6-month window centered on the 24-month time point. RESULTS We randomized 443 participants, of which 223 (50.3%) participants were allocated to the intervention arm. At baseline, participants had a mean BMI of 32.6 kg/m2. Most participants were Latino or Hispanic (n=200, 45.1%) or non-Latino or Hispanic White (n=115, 26%). In total, 53% (n=235) of participants had at least 1 visit with weight measured in the primary time window. The intervention group had a higher proportion with ≤3% weight gain at 6 months (risk ratio=1.12, 95% CI 0.94-1.28; risk difference=9.5, 95% CI -4.5 to 16.4 percentage points). This difference attenuated to the null by 24 months (risk ratio=1.00, 95% CI 0.82-1.20; risk difference=0.2, 95% CI -12.1 to 11.0 percentage points). CONCLUSIONS In adults with overweight or obesity receiving primary care at a community health center, we did not find long-term evidence to support the dissemination of a digital health intervention for weight gain prevention. TRIAL REGISTRATION ClinicalTrials.gov NCT03003403; https://clinicaltrials.gov/study/NCT03003403. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-019-6926-7.
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Affiliation(s)
- Hailey N Miller
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - John A Gallis
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Miriam B Berger
- Duke Digital Health Science Center, Duke University, Durham, NC, United States
| | - Sandy Askew
- Duke Digital Health Science Center, Duke University, Durham, NC, United States
| | - Joseph R Egger
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Melissa C Kay
- Department of Pediatrics, Duke University, Durham, NC, United States
| | - Eric Andrew Finkelstein
- Duke-NUS Medical School Singapore, Duke Global Health Institute, Duke University, Durham, NC, United States
| | | | | | - Ashley Brewer
- Piedmont Health Services, Inc, Chapel Hill, NC, United States
| | - Marni Gwyther Holder
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gary G Bennett
- Duke Digital Health Science Center, Duke University, Durham, NC, United States
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
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Gatzemeier J, Wilkinson LL, Price MJ, Lee MD. Self-identified strategies to manage intake of tempting foods: cross-sectional and prospective associations with BMI and snack intake. Public Health Nutr 2024; 27:e107. [PMID: 38504524 PMCID: PMC11036431 DOI: 10.1017/s1368980024000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Individuals often use self-directed strategies to manage intake of tempting foods, but what these strategies are and whether they are effective is not well understood. This study assessed the frequency of use and subjective effectiveness of self-directed strategies in relation to BMI and snack intake. DESIGN A cross-sectional and prospective study with three time points (T1: baseline, T2: 3 months and T3: 3 years). At T1, demographics, frequency of use and subjective effectiveness of forty-one identified strategies were assessed. At T2 and T3, current weight was reported, and at T2 frequency of snack intake was also recorded. SETTING Online study in the UK. PARTICIPANTS Data from 368 participants (Mage = 34·41 years; MBMI = 25·06 kg/m2) were used for analysis at T1, n = 170 (46·20 % of the total sample) at T2 and n = 51 (13·59 %) at T3. RESULTS Two strategy factors were identified via principal axis factoring: (1) diet, exercise, reduction of temptations, and cognitive strategies, and (2) planning, preparation and eating style. For strategy 1, frequency of use, but not subjective effectiveness, was positively related to BMI at T1. Subjective effectiveness predicted an increase in BMI from T1 and T2 to T3. No relationship to snack intake was found. For strategy 2, frequency of use was negatively related to BMI at T1. Neither frequency of use nor subjective effectiveness were related to changes in BMI over time, but subjective effectiveness was negatively correlated with unhealthy snack intake. CONCLUSION Self-directed strategies to reduce the intake of tempting foods are not consistently related to BMI or snack intake.
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Affiliation(s)
| | | | - Menna J Price
- School of Psychology, Swansea University,
SA2 8PPSwansea, UK
| | - Michelle D Lee
- School of Psychology, Swansea University,
SA2 8PPSwansea, UK
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Pietrabissa G, Castelnuovo G, Semonella M, Mannarini S, Rossi AA. Measuring Motivations to Eat Palatable Foods: Adaptation and Psychometric Properties of the Italian Version of the Palatable Eating Motives Scale (PEMS-IT). Healthcare (Basel) 2024; 12:574. [PMID: 38470685 PMCID: PMC10930930 DOI: 10.3390/healthcare12050574] [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: 01/12/2024] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Gaining knowledge of the various reasons behind people's consumption of highly processed foods has the potential to enhance obesity prevention initiatives and open avenues to tailor treatment approaches for obesity and binge eating at a more personalized level. This contribution aimed to test the psychometric properties and factor structure of the Palatable Eating Motives Scale (PEMS-IT) in a community sample of Italian adults. METHODS A confirmatory factor analysis was performed to test the factor structure of the Italian version of the PEMS (PEMS-IT) on a total of 616 respondents. Furthermore, the reliability and convergent validity analysis of the tool were evaluated. RESULTS The analysis confirmed the four-factor structure of PEMS-IT [(YBχ2 (164) = 537.901; p < 0.001, the CFI = 0.918, RMSEA = 0.072; 90%CI [0.065-0.078]; p(RMSEA < 0.05) < 0.001, and SRMR = 0.080] and satisfactory reliability on its subscales (Cronbach's α: 0.745-0.917). Positive correlations were also found with food addiction and binge-eating symptoms, compulsive eating behavior, and uncontrolled and emotional eating. CONCLUSIONS The PEMS-IT appears to be an instrument with promising psychometric properties and potential applications in clinical settings. However, it also has some limitations, and future studies could focus on improving the semantic content of the elements to increase the overall utility and precision of the instrument.
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Affiliation(s)
- Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy;
- Clinical Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy;
- Clinical Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
| | - Michelle Semonella
- Department of Psychology, Bar-Ilan University, Ramat Gan 5290002, Israel;
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (S.M.); (A.A.R.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
| | - Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (S.M.); (A.A.R.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
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Metzendorf MI, Wieland LS, Richter B. Mobile health (m-health) smartphone interventions for adolescents and adults with overweight or obesity. Cochrane Database Syst Rev 2024; 2:CD013591. [PMID: 38375882 PMCID: PMC10877670 DOI: 10.1002/14651858.cd013591.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Obesity is considered to be a risk factor for various diseases, and its incidence has tripled worldwide since 1975. In addition to potentially being at risk for adverse health outcomes, people with overweight or obesity are often stigmatised. Behaviour change interventions are increasingly delivered as mobile health (m-health) interventions, using smartphone apps and wearables. They are believed to support healthy behaviours at the individual level in a low-threshold manner. OBJECTIVES To assess the effects of integrated smartphone applications for adolescents and adults with overweight or obesity. SEARCH METHODS We searched CENTRAL, MEDLINE, PsycINFO, CINAHL, and LILACS, as well as the trials registers ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform on 2 October 2023 (date of last search for all databases). We placed no restrictions on the language of publication. SELECTION CRITERIA Participants were adolescents and adults with overweight or obesity. Eligible interventions were integrated smartphone apps using at least two behaviour change techniques. The intervention could target physical activity, cardiorespiratory fitness, weight loss, healthy diet, or self-efficacy. Comparators included no or minimal intervention (NMI), a different smartphone app, personal coaching, or usual care. Eligible studies were randomised controlled trials of any duration with a follow-up of at least three months. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology and the RoB 2 tool. Important outcomes were physical activity, body mass index (BMI) and weight, health-related quality of life, self-efficacy, well-being, change in dietary behaviour, and adverse events. We focused on presenting studies with medium- (6 to < 12 months) and long-term (≥ 12 months) outcomes in our summary of findings table, following recommendations in the core outcome set for behavioural weight management interventions. MAIN RESULTS We included 18 studies with 2703 participants. Interventions lasted from 2 to 24 months. The mean BMI in adults ranged from 27 to 50, and the median BMI z-score in adolescents ranged from 2.2 to 2.5. Smartphone app versus no or minimal intervention Thirteen studies compared a smartphone app versus NMI in adults; no studies were available for adolescents. The comparator comprised minimal health advice, handouts, food diaries, smartphone apps unrelated to weight loss, and waiting list. Measures of physical activity: at 12 months' follow-up, a smartphone app compared to NMI probably reduces moderate to vigorous physical activity (MVPA) slightly (mean difference (MD) -28.9 min/week (95% confidence interval (CI) -85.9 to 28; 1 study, 650 participants; moderate-certainty evidence)). We are very uncertain about the results of estimated energy expenditure and cardiorespiratory fitness at eight months' follow-up. A smartphone app compared with NMI probably results in little to no difference in changes in total activity time at 12 months' follow-up and leisure time physical activity at 24 months' follow-up. Anthropometric measures: a smartphone app compared with NMI may reduce BMI (MD of BMI change -2.6 kg/m2, 95% CI -6 to 0.8; 2 studies, 146 participants; very low-certainty evidence) at six to eight months' follow-up, but the evidence is very uncertain. At 12 months' follow-up, a smartphone app probably resulted in little to no difference in BMI change (MD -0.1 kg/m2, 95% CI -0.4 to 0.3; 1 study; 650 participants; moderate-certainty evidence). A smartphone app compared with NMI may result in little to no difference in body weight change (MD -2.5 kg, 95% CI -6.8 to 1.7; 3 studies, 1044 participants; low-certainty evidence) at 12 months' follow-up. At 24 months' follow-up, a smartphone app probably resulted in little to no difference in body weight change (MD 0.7 kg, 95% CI -1.2 to 2.6; 1 study, 245 participants; moderate-certainty evidence). A smartphone app compared with NMI may result in little to no difference in self-efficacy for a physical activity score at eight months' follow-up, but the results are very uncertain. A smartphone app probably results in little to no difference in quality of life and well-being at 12 months (moderate-certainty evidence) and in little to no difference in various measures used to inform dietary behaviour at 12 and 24 months' follow-up. We are very uncertain about adverse events, which were only reported narratively in two studies (very low-certainty evidence). Smartphone app versus another smartphone app Two studies compared different versions of the same app in adults, showing no or minimal differences in outcomes. One study in adults compared two different apps (calorie counting versus ketogenic diet) and suggested a slight reduction in body weight at six months in favour of the ketogenic diet app. No studies were available for adolescents. Smartphone app versus personal coaching Only one study compared a smartphone app with personal coaching in adults, presenting data at three months. Two studies compared these interventions in adolescents. A smartphone app resulted in little to no difference in BMI z-score compared to personal coaching at six months' follow-up (MD 0, 95% CI -0.2 to 0.2; 1 study; 107 participants). Smartphone app versus usual care Only one study compared an app with usual care in adults but only reported data at three months on participant satisfaction. No studies were available for adolescents. We identified 34 ongoing studies. AUTHORS' CONCLUSIONS The available evidence is limited and does not demonstrate a clear benefit of smartphone applications as interventions for adolescents or adults with overweight or obesity. While the number of studies is growing, the evidence remains incomplete due to the high variability of the apps' features, content and components, which complicates direct comparisons and assessment of their effectiveness. Comparisons with either no or minimal intervention or personal coaching show minor effects, which are mostly not clinically significant. Minimal data for adolescents also warrants further research. Evidence is also scarce for low- and middle-income countries as well as for people with different socio-economic and cultural backgrounds. The 34 ongoing studies suggest sustained interest in the topic, with new evidence expected to emerge within the next two years. In practice, clinicians and healthcare practitioners should carefully consider the potential benefits, limitations, and evolving research when recommending smartphone apps to adolescents and adults with overweight or obesity.
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Affiliation(s)
- Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - L Susan Wieland
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Brenton-Peters JM, Consedine NS, Cavadino A, Roy R, Ginsberg KH, Serlachius A. Finding kindness: A randomized controlled trial of an online self-compassion intervention for weight management (SC4WM). Br J Health Psychol 2024; 29:37-58. [PMID: 37544883 DOI: 10.1111/bjhp.12686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Weight loss is hard to achieve and even harder to maintain. Engaging in effortful behavioural change to manage body weight can sometimes result in feelings of guilt and shame. Self-compassion, the tendency to find kindness for oneself in times of struggle, may facilitate coping with the unique challenges of weight management. This study assessed whether a remotely delivered self-compassion intervention improved weight management outcomes when delivered as a supplement to an existing digital behavioural weight management programme, Weight Watchers (WW). METHOD Using a mixed-method study design, 249 adults seeking to manage weight were randomized to either the WW programme or WW supplemented with the self-compassion for weight management intervention (SC4WM). Participants completed measures of self-compassion, eating behaviour, physical activity, body weight and emotional well-being along with potential moderators, including weight self-stigma, eating restraint, psychological coping and perceived stress at baseline, post-intervention (4 weeks) and follow-up (12 weeks). RESULTS There was no evidence that the SC4WM intervention had a significantly different effect than WW alone. Other than body weight, all outcomes improved over time in both groups. Self-compassion was slightly higher overall in the SC4WM group (p = .05), with this group reporting higher self-kindness at 4 weeks (p = .014) and lower self-judgement at 12 weeks (p = .023) compared to the control group. CONCLUSIONS Although the SC4WM intervention group did show a small increase in self-kindness and reduction in self-judgement, weight management outcomes were not improved over and above the existing WW programme. Recommendations for adapting the SC4WM intervention to improve efficacy to augment weight management outcomes are provided.
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Affiliation(s)
| | - Nathan S Consedine
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- Section of Epidemiology and Bisostatistics, Facultity of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Rajshri Roy
- Department of Nutrition and Dietetics, The University of Auckland, Auckland, New Zealand
| | | | - Anna Serlachius
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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11
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Tang HB, Jalil NIBA, Tan CS, He L, Zhang SJ. Why more successful? An analysis of participants' self-monitoring data in an online weight loss intervention. BMC Public Health 2024; 24:322. [PMID: 38287333 PMCID: PMC10826064 DOI: 10.1186/s12889-024-17848-9] [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: 07/11/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Self-monitoring is crucial for behavioral weight loss. However, few studies have examined the role of self-monitoring using mixed methods, which may hinder our understanding of its impact. METHODS This study examined self-monitoring data from 61 Chinese adults who participated in a 5-week online group intervention for weight loss. Participants reported their baseline Body Mass Index (BMI), weight loss motivation, and engaged in both daily quantitative self-monitoring (e.g., caloric intake, mood, sedentary behavior, etc.) and qualitative self-monitoring (e.g., daily log that summarizes the progress of weight loss). The timeliness of participants' daily self-monitoring data filling was assessed using a scoring rule. One-way repeated measurement ANOVA was employed to analyze the dynamics of each self-monitoring indicator. Correlation and regression analyses were used to reveal the relationship between baseline data, self-monitoring indicators, and weight change. Content analysis was utilized to analyze participants' qualitative self-monitoring data. Participants were categorized into three groups based on their weight loss outcomes, and a chi-square test was used to compare the frequency distribution between these groups. RESULTS After the intervention, participants achieved an average weight loss of 2.52 kg (SD = 1.36) and 3.99% (SD = 1.96%) of their initial weight. Daily caloric intake, weight loss satisfaction, frequency of daily log, and the speed of weight loss showed a downward trend, but daily sedentary time gradually increased. Moreover, regression analysis showed that baseline BMI, weight loss motivation, and timeliness of daily filling predicted final weight loss. Qualitative self-monitoring data analysis revealed four categories and nineteen subcategories. A significant difference in the frequency of qualitative data was observed, with the excellent group reporting a greater number of daily logs than expected in all categories and most subcategories, and the moderate and poor groups reporting less than expected in all categories and most subcategories. CONCLUSION The self-monitoring data in short-term online group intervention exhibited fluctuations. Participants with higher baseline BMI, higher levels of weight loss motivation, and timely self-monitoring achieved more weight loss. Participants who achieved greater weight loss reported a higher quantity of qualitative self-monitoring data. Practitioners should focus on enhancing dieters' weight loss motivation and promote adherence to self-monitoring practices.
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Affiliation(s)
- Hai-Bo Tang
- Faculty of Education, Yibin University, Yibin, 644000, China.
- Department of Psychology and Counselling, Universiti Tunku Abdul Rahman, Kampar, 31900, Malaysia.
| | | | - Chee-Seng Tan
- School of Psychology, College of Liberal Arts Wenzhou-Kean University, Wenzhou, Zhejiang province, 325060, China
| | - Ling He
- Faculty of Education, Yibin University, Yibin, 644000, China
- Department of Psychology and Counselling, Universiti Tunku Abdul Rahman, Kampar, 31900, Malaysia
| | - Shu-Juan Zhang
- , Sichuan Tianfu New District No. 3 Middle School, Chengdu, 610213, China
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12
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Burke CA, Seidler KJ, Rethorn ZD, Hoenig H, Allen K, Tabriz AA, Norman K, Murphy-McMillan LK, Sharpe J, Joseph LM, Dietch JR, Kosinski AS, Cantrell S, Gierisch JM, Ear B, Gordon A, Goldstein KM. Interventions to Improve Long-Term Adherence to Physical Rehabilitation: A Systematic Review. J Geriatr Phys Ther 2024; 47:00139143-990000000-00044. [PMID: 38215396 PMCID: PMC11239800 DOI: 10.1519/jpt.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To evaluate the impact of physical rehabilitation interventions, supplemented with one or more adherence-enhancing components, on outcomes among adults with hip or knee osteoarthritis or chronic lower back pain. DESIGN Primary literature search from inception of each database to July 27, 2021, guided by relevant search terms and keywords to search titles and abstracts. All articles meeting eligibility criteria were included for data abstraction. DATA SOURCES MEDLINE, CINAHL Complete, and Embase. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomized and nonrandomized trials evaluating adherence-focused intervention components conducted in addition to an index usual care or usual care-like physical rehabilitation program among adults with hip or knee osteoarthritis or chronic low back pain. Eligible studies included a comparator group of the same index physical rehabilitation intervention without the adjunctive adherence components. Included studies measured outcomes at least 3 months after the rehabilitation course. RESULTS Of the 10 studies meeting inclusion criteria, 6 interventions were delivered concurrent to an index rehabilitation program and 4 were delivered sequentially. Of the 3 studies that reported a positive effect on long-term adherence, only 1 was a low risk of bias study. There is very limited evidence of a beneficial treatment effect of adjunct adherence interventions on long-term physical function, self-efficacy, or adverse events. CONCLUSION We found inadequate evidence evaluating adherence-enhancing interventions for the specific promotion of long-term adherence to home rehabilitation programs. Future studies should consider testing interventions specifically built to target behavioral maintenance of home rehabilitation programs.
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Affiliation(s)
- Colleen A. Burke
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Katie J. Seidler
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Zachary D. Rethorn
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Helen Hoenig
- Durham VA Health Care System, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - Kelli Allen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- University of North Carolina at Chapel Hill, Chapel Hill
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
- Department of Oncological Sciences, University of South Florida, Tampa, Florida
| | - Katherine Norman
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | | | - Jason Sharpe
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Letha M. Joseph
- Durham VA Health Care System, Durham, North Carolina
- Duke University School of Nursing, Durham, North Carolina
| | | | - Andrzej S. Kosinski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Sarah Cantrell
- Duke University School of Medicine, Durham, North Carolina
| | - Jennifer M. Gierisch
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
| | - Belinda Ear
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
| | - Adelaide Gordon
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
| | - Karen M. Goldstein
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
- Durham VA Medical Center, Durham, North Carolina
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, North Carolina
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13
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Omondi H, Freysteinson W. Understanding Obesity in African American Women Using Leininger's Theory. Nurs Sci Q 2024; 37:71-75. [PMID: 38054314 DOI: 10.1177/08943184231207383] [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] [Indexed: 12/07/2023]
Abstract
In the United States, African American (AA) women suffer from higher rates of obesity as compared with Caucasians or Asians. Unfortunately, most weight management interventions have been unsuccessful in maintaining weight loss. Prior research has revealed that AA women face unique barriers in managing obesity; therefore, more research is warranted to address this problem. Leininger's theory is used to understand obesity through a cultural lens. The constructs of the sunrise model are defined as a means to intervene when providing nursing care through cultural preservation, accommodation, and repatterning. We conclude that culture care theory offers a theoretical framework to assist nurses in providing culturally sensitive care to Black women with obesity. Nurses caring for this population can utilize this theory to tailor interventions specific to the cultural needs of women to improve outcomes in the management of obesity. In this article, we use AA and Black interchangeably to represent Americans whose ancestors originate from Africa.
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Affiliation(s)
- Harriet Omondi
- College of Nursing, Texas Woman's University, Houston, TX, USA
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14
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Spreckley M, de Lange J, Seidell J, Halberstadt J. Primary care-led weight-management intervention: qualitative insights into patient experiences at two-year follow-up. Int J Qual Stud Health Well-being 2023; 18:2276576. [PMID: 38016037 PMCID: PMC11007633 DOI: 10.1080/17482631.2023.2276576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/25/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE The prevalence of overweight and obesity is continuously increasing globally and long-term weight loss intervention outcomes remain disappointing. To determine which behavioural intervention approaches improve the probability of achieving long-term weight loss, this two-year follow-up study aimed to identify distinct factors and strategies for successful long-term weight loss maintenance. METHODS A cohort of 20 participants with overweight and obesity from a primary-care led weight management programme with diverse backgrounds was interviewed at baseline, after 1 and 2 years, and asked to do quantitative self-description. This study focused on the 2-year follow-up interviews from this study series. RESULTS We found that agile, continuous self-monitoring with personalized, sustainable lifestyle habits correlated with positive outcomes. Participants reported health benefits, maintained weight loss, and found motivation in supportive peer networks. Challenges like anxiety, disappointment, and disruptions derailed progress. Long-term success relied on a strong support system of healthcare professionals, friends, and family. CONCLUSIONS The findings of this study series highlight the intricate nature of long-term weight loss maintenance. This study corroborates the persistence of overarching themes while highlighting the individual variability in their relative importance. Findings emphasize the importance of long-term support to effectively address the diverse needs of patients trying to achieve long-term weight loss maintenance.
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Affiliation(s)
- Marie Spreckley
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, London, UK
| | | | - Jaap Seidell
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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15
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Spreckley M, de Lange J, Seidell J, Halberstadt J. Primary care-led weight-management intervention: qualitative insights into patient experiences at one-year follow up. Int J Qual Stud Health Well-being 2023; 18:2256669. [PMID: 37703440 PMCID: PMC10501160 DOI: 10.1080/17482631.2023.2256669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION The global prevalence of overweight and obesity is continuously increasing. Long-term weight loss results remain disappointing. This study aims to identify factors and strategies for successful long-term weight loss in a primary care-led weight-loss intervention from the perspective of participants. MATERIALS AND METHODS This qualitative interview study is the first follow-up study in a 2-year study series of participants with overweight or obesity. Methods utilized are semi-structured interviews (n = 20) with quantitative self-description. The data were transcribed from audio-taped interviews and analysed thematically. RESULTS This study found that clear, continuously evolving self-monitoring strategies facilitated by strong routines and a long-term focus enhanced successful outcomes. Challenges faced included stress, disappointment and loss of routine along with external criticism and discouragement. Benefits experienced due to weight loss included improved health, self-esteem, communal support and encouragement, which continued to fuel motivation. Receiving continuous support and encouragement from healthcare practitioners was instrumental for long-term success. CONCLUSION This study highlighted the complex, multifaceted experiences patients encounter in the pursuit of trying to achieve long-term weight loss. Personalized treatment protocols taking into account the diverse requirements and circumstances of individuals have the potential to improve treatment outcomes. Continuous, professional support may enhance long-term outcomes.
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Affiliation(s)
- Marie Spreckley
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Judith de Lange
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jaap Seidell
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jutka Halberstadt
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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16
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Greaves CJ, Poltawski L, van Beurden SB, Price L, Taylor RS, Merrifield R, O'Loughlin L. Addressing the psychology of weight loss and maintenance: A feasibility study of the Skills for weight loss and Maintenance weight management programme. Br J Health Psychol 2023; 28:1261-1282. [PMID: 37487646 DOI: 10.1111/bjhp.12683] [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: 05/23/2022] [Accepted: 06/08/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES Building on prior theory, we aimed to evaluate the feasibility and acceptability of integrating novel, weight loss maintenance strategies into existing weight management programmes. We also piloted recruitment and data collection procedures for future research. DESIGN Two phases of action research nested within a single-arm feasibility study. The intervention was refined between phases using feedback from intervention fidelity analysis and qualitative exploration of patient and provider experiences. Changes in outcomes were assessed up to 18 months post-baseline. METHODS One hundred adults with a mean body mass index of 37 kg/m2 were offered the Skills for weight loss and Maintenance (SkiM) intervention. This included existing weight management programme content and additional weight loss maintenance techniques delivered fortnightly for 6 months in local community centres to groups of 11-15 people. RESULTS Of the 100 participants, 65%, 58% and 56% provided data at 7, 12 and 18 months. Across both phases, the mean initial weight loss was 4.2 kg (95% CI: 2.4-5.9) and 3.1 kg at 18 months (95% CI: .8-5.5). In Phase 2, we observed better weight loss maintenance (.5 kg [13.2%] regain from 7 to 18 months, vs. 1.7 kg [36.2%] in Phase 1). Variation in outcomes, high early dropout rates and qualitative feedback indicated that, although delivery of the intervention and trial procedures was feasible and acceptable, there was scope to refine the intervention to engage a wider range of participants. Intervention fidelity was acceptable, particularly in Phase 2. CONCLUSIONS The SkiM intervention seems promising, but more research is needed to improve recruitment and retention prior to further evaluation.
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Affiliation(s)
- Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Leon Poltawski
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Lisa Price
- School of Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Rodney S Taylor
- University of Exeter Medical School, University of Exeter, Exeter, UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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17
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MacAskill W, Gillanders T, Wylie N, Pinidiyapathirage J. Finding what works-Patients' long-term experiences of weight maintenance post bariatric surgery: A systematic review and thematic synthesis of qualitative studies. Obes Rev 2023; 24:e13608. [PMID: 37519095 DOI: 10.1111/obr.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/29/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
Individuals with obesity can attain significant weight loss in a relatively short timeframe following bariatric surgery; however, new healthy behaviors must be sustained in perpetuity to maintain weight loss. This study investigates patients' views on the facilitators and barriers to long-term weight loss maintenance following bariatric surgery. Systematic searches of Medline, PsycINFO, and CINAHL databases identified 403 studies with 15 fitting the study inclusion criteria. Included studies were independently appraised using Critical Appraisal Skills Program (CASP). Data extraction and thematic synthesis generated three themes: changing food relationships, navigating inter- and intrapersonal influences, and caring health professionals. These appeared across six organizing sub-themes: building new food relationships, creating healthy habits, relationships with others, internalized stressors, finding and defining success, and ongoing patient education. Patients experienced a variety of barriers and facilitators to weight loss maintenance, with some facilitators diminishing over time. The findings demonstrate the importance of considering patients' perspectives and individual contexts to assist them to negotiate and overcome challenges to long-term weight loss maintenance post-bariatric surgery.
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Affiliation(s)
- William MacAskill
- Griffith University Rural Clinical School, Toowoomba, Queensland, Australia
- Rural Medical Education Australia, Toowoomba, Queensland, Australia
| | - Tobias Gillanders
- Griffith University Rural Clinical School, Toowoomba, Queensland, Australia
- Rural Medical Education Australia, Toowoomba, Queensland, Australia
| | - Neil Wylie
- Darling Downs General Surgery, St. Andrew's Hospital, Toowoomba, Queensland, Australia
| | - Janani Pinidiyapathirage
- Griffith University Rural Clinical School, Toowoomba, Queensland, Australia
- Rural Medical Education Australia, Toowoomba, Queensland, Australia
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18
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Carvalho M, Dunne P, Kwasnicka D, Byrne M, McSharry J. Barriers and enablers to maintaining self-management behaviours after attending a self-management support intervention for type 2 diabetes: a systematic review and qualitative evidence synthesis. Health Psychol Rev 2023:1-30. [PMID: 37807622 DOI: 10.1080/17437199.2023.2268731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/04/2023] [Indexed: 10/10/2023]
Abstract
Attendance at type 2 diabetes self-management interventions is associated with improved outcomes. However, difficulties maintaining self-management behaviours attenuate long-term impact. This review aimed to identify and synthesise qualitative research on barriers and enablers to maintaining type 2 diabetes self-management behaviours after attending a self-management intervention. Eight electronic databases were searched to identify relevant peer-reviewed and grey literature studies. Data were synthesised using the best-fit framework synthesis approach guided by the themes and constructs identified by Kwasnicka et al. (2016) on their review of theoretical explanations for behaviour change maintenance. Study methodological limitations and confidence in findings were assessed using an adapted version of the Critical Appraisal Skills Programme (CASP) tool and the GRADE-CERQual approach respectively. Eleven articles reporting on 10 studies were included. Twenty-eight barriers and enablers were coded to the a priori themes. Barriers were commonly coded to the themes self-regulation, resources, and environmental and social influences. Enablers were commonly coded to the themes habits and maintenance motives. Methodological limitations of included studies varied, leading to moderate or low confidence in most findings. Interventions may improve behavioural maintenance by providing post-intervention support, promoting positive behaviour change motives, self-regulation, habit formation, and facilitating access to resources and support.
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Affiliation(s)
- Márcia Carvalho
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
| | - Pauline Dunne
- School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
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May CN, Cox‐Martin M, Ho AS, McCallum M, Chan C, Blessing K, Behr H, Blanco P, Mitchell ES, Michaelides A. Weight loss maintenance after a digital commercial behavior change program (Noom Weight): Observational cross-sectional survey study. Obes Sci Pract 2023; 9:443-451. [PMID: 37810531 PMCID: PMC10551118 DOI: 10.1002/osp4.666] [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: 09/14/2022] [Revised: 02/10/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023] Open
Abstract
Background Behavioral weight loss programs often lead to significant short-term weight loss, but long-term weight maintenance remains a challenge. Most weight maintenance data come from clinical trials, in-person programs, or general population surveys, but there is a need for better understanding of long-term weight maintenance in real-world digital programs. Methods This observational survey study examined weight maintenance reported by individuals who had used Noom Weight, a digital commercial behavior change program, and identified factors associated with greater weight maintenance. The cross-sectional survey was completed by 840 individuals who had lost at least 10% of their body weight using Noom Weight 6-24 months prior. Results The study found that 75% of individuals maintained at least 5% weight loss after 1 year, and 49% maintained 10% weight loss. On average, 65% of initial weight loss was maintained after 1 year and 57% after 2 years. Habitual behaviors, such as healthy snacking and exercise, were associated with greater weight maintenance, while demographic factors were not. Conclusion This study provides real-world data on the long-term weight maintenance achieved using a fully digital behavioral program. The results suggest that Noom Weight is associated with successful weight maintenance in a substantial proportion of users. Future research will use a randomized controlled trial to track weight maintenance after random assignment and at a 2 year follow-up.
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Affiliation(s)
| | | | | | | | | | | | - Heather Behr
- Academic ResearchNoom Inc.New YorkNew YorkUSA
- Department of Integrative HealthSaybrook UniversityPasadenaCaliforniaUSA
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John HS, Doucet É, Power KA. Dietary pulses as a means to improve the gut microbiome, inflammation, and appetite control in obesity. Obes Rev 2023; 24:e13598. [PMID: 37395146 DOI: 10.1111/obr.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/16/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023]
Abstract
A dysbiotic intestinal microbiome has been linked to chronic diseases such as obesity, which may suggest that interventions that target the microbiome may be useful in treating obesity and its complications. Appetite dysregulation and chronic systemic low-grade inflammation, such as that observed in obesity, are possibly linked with the intestinal microbiome and are potential therapeutic targets for the treatment of obesity via the microbiome. Dietary pulses (e.g., common beans) are composed of nutrients and compounds that possess the potential to modulate the gut microbiota composition and function which can in turn improve appetite regulation and chronic inflammation in obesity. This narrative review summarizes the current state of knowledge regarding the connection between the gut microbiome and obesity, appetite regulation, and systemic and adipose tissue inflammation. More specifically, it highlights the efficacy of interventions employing dietary common beans as a means to improve gut microbiota composition and/or function, appetite regulation, and inflammation in both rodent obesity and in humans. Collectively, results presented and discussed herein provide insight on the gaps in knowledge necessary for a comprehensive understanding of the potential of beans as a treatment for obesity while highlighting what further research is required to gain this understanding.
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Affiliation(s)
- Hannah St John
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Éric Doucet
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Krista A Power
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- The Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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21
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French DP, Ahern AL, Greaves CJ, Hawkes RE, Higgs S, Pechey R, Sniehotta FF. Preventing type 2 diabetes: A research agenda for behavioural science. Diabet Med 2023; 40:e15147. [PMID: 37171753 PMCID: PMC10947238 DOI: 10.1111/dme.15147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 05/13/2023]
Abstract
AIMS The aim of this narrative review was to identify important knowledge gaps in behavioural science relating to type 2 diabetes prevention, to inform future research in the field. METHODS Seven researchers who have published behaviour science research applied to type 2 diabetes prevention independently identified several important gaps in knowledge. They met to discuss these and to generate recommendations to advance research in behavioural science of type 2 diabetes prevention. RESULTS A total of 21 overlapping recommendations for a research agenda were identified. These covered issues within the following broad categories: (a) evidencing the impact of whole population approaches to type 2 diabetes prevention, (b) understanding the utility of disease-specific approaches to type 2 diabetes prevention such as Diabetes Prevention Programmes (DPPs) compared to generic weight loss programmes, (c) identifying how best to increase reach and engagement of DPPs, whilst avoiding exacerbating inequalities, (d) the need to understand mechanism of DPPs, (e) the need to understand how to increase maintenance of changes as part of or following DPPs, (f) the need to assess the feasibility and effectiveness of alternative approaches to the typical self-regulation approaches that are most commonly used, and (g) the need to address emotional aspects of DPPs, to promote effectiveness and avoid harms. CONCLUSIONS There is a clear role for behavioural science in informing interventions to prevent people from developing type 2 diabetes, based on strong evidence of reach, effectiveness and cost-effectiveness. This review identifies key priorities for research needed to improve existing interventions.
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Affiliation(s)
- David P. French
- Manchester Centre of Health Psychology, Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK
| | - Amy L. Ahern
- MRC Epidemiology Unit, School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Colin J. Greaves
- School of Sport, Exercise and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
| | - Rhiannon E. Hawkes
- Manchester Centre of Health Psychology, Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK
| | - Suzanne Higgs
- School of PsychologyUniversity of BirminghamBirminghamUK
| | - Rachel Pechey
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Falko F. Sniehotta
- Division of Public Health, Social and Preventive Medicine, Center for Preventive Medicine and Digital Health (CPD)Universitätsmedizin Mannheim, Heidelberg UniversityHeidelbergGermany
- NIHR Policy Research Unit Behavioural ScienceNewcastle UniversityUK
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22
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Butryn ML, Kerrigan S, Hagerman CJ, Crane NT, Godfrey K. Do monthly coaching calls influence proximal participant adherence in a behavioral weight loss program? J Behav Med 2023; 46:699-706. [PMID: 36723730 DOI: 10.1007/s10865-023-00394-x] [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: 08/17/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
Participants who receive continued coach contact following behavioral weight loss treatment are more successful in maintaining their weight loss long-term. The current study examines whether these contacts have dynamic effects, such that participants are most adherent to the prescribed weight loss behaviors in the days after the call, when motivation and goal salience may be heightened, than they are as time goes on. The current study examined the trajectory of calorie intake, physical activity, weight, and self-monitoring behavior in the fourteen days after a monthly coaching call among participants completing the maintenance phase of a behavioral weight loss trial. For physical activity outcomes, caloric intake, and weight, there were no changes across time. Participants did have the highest adherence and quality of dietary self-monitoring immediately after the call, which diminished over time. Coach contact may continually renew commitment to this burdensome but critical behavior. Likelihood of self-weighing showed an opposite trend, where participants were more likely to weigh themselves in the days more distal from the coach call. Results can inform the timing and content of future coach contact to promote weight control.
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Affiliation(s)
- Meghan L Butryn
- Department of Psychological and Brain Sciences and Center for Weight, Eating and Lifestyle Sciences (WELL Center), Drexel University, 3141 Chestnut St., Stratton 286, Philadelphia, PA, 19104, USA.
| | | | - Charlotte J Hagerman
- Department of Psychological and Brain Sciences and Center for Weight, Eating and Lifestyle Sciences (WELL Center), Drexel University, 3141 Chestnut St., Stratton 286, Philadelphia, PA, 19104, USA
| | - Nicole T Crane
- Department of Psychological and Brain Sciences and Center for Weight, Eating and Lifestyle Sciences (WELL Center), Drexel University, 3141 Chestnut St., Stratton 286, Philadelphia, PA, 19104, USA
| | - Kathryn Godfrey
- Center for WorkLife Wellbeing, ChristianaCare, Wilmington, DE, USA
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23
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Chang AY, Rahman M, Talukder A, Shah H, Mridha MK, Hasan M, Sarker M, Geldsetzer P. Effectiveness of a community health worker-led low-sodium salt intervention to reduce blood pressure in rural Bangladesh: protocol for a cluster randomized controlled trial. Trials 2023; 24:480. [PMID: 37501102 PMCID: PMC10375753 DOI: 10.1186/s13063-023-07518-3] [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: 03/27/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND High blood pressure is a major public health problem in low- and middle-income countries. Low-sodium salt substitute (LSSS) is a promising population-level blood pressure-lowering intervention requiring minimal behavioral change. The optimal method of delivering LSSS to individuals, however, is currently unknown. Community health workers (CHWs) have successfully been used to implement health interventions in Bangladesh and may provide a venue for the dissemination of LSSS. METHODS We aim to conduct a cluster-randomized controlled trial involving 309 households in rural Bangladesh previously identified and characterized by the BRAC James P Grant School of Public Health, BRAC University (BRAC JPGSPH). These households will be randomly assigned to three arms: (1) control, i.e., no intervention; (2) information only, i.e., community health workers will provide basic information on high blood pressure, the health consequences of excessive salt consumption, and feedback to the participant on the likely quantity of salt s/he consumes (estimated using a questionnaire); (3) free LSSS arm: the same information as in arm 2 will be provided, but participants will receive 6 months of free low-sodium salt along with education on the benefits of LSSS. One male and one female adult (age ≥ 18 years) in each household will be invited to participate, the exclusion criteria being households with members known to have high serum potassium levels, are taking medications known to elevate potassium levels (e.g., ACE inhibitors, ARBs, potassium-sparing diuretics), are already taking potassium supplements, or those who have known kidney disease or abnormal serum creatinine at baseline. The primary endpoint will be blood pressure at 6 months post-intervention. DISCUSSION Recent large clinical trials of LSSS in China and India have shown not only blood pressure improvements, but also stroke, major cardiac event, and all-cause mortality reductions. Nevertheless, how to best translate this intervention to population-level effectiveness remains unclear. Our study would test whether a community health worker-based program could be effectively used to disseminate LSSS and achieve measurable blood pressure benefits. TRIAL REGISTRATION ClinicalTrials.gov NCT05425030. Registered on June 21, 2022.
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Affiliation(s)
- Andrew Y Chang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, USA
- Center for Innovation in Global Health, Stanford University, Stanford, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, USA
| | - Mushfiqur Rahman
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Animesh Talukder
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Humyra Shah
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Malay Kanti Mridha
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Pascal Geldsetzer
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, USA.
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, USA.
- The Chan Zuckerberg Biohub, San Francisco, USA.
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24
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Sillice MA, Dunsiger S, Bock BC. Exploring Factors Associated with Dietary Improvement Among Participants Who Completed a Randomized Controlled Trial for Physical Activity: Evidence of a Transfer Effect. Int J Behav Med 2023:10.1007/s12529-023-10186-x. [PMID: 37308771 DOI: 10.1007/s12529-023-10186-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND This research aimed at understanding how changes in one behavior affect other behaviors, known as "transfer effect," could extend knowledge of shared constructs among compound health risk behaviors, and improve methods for promoting simultaneous behavior changes. The current study explored whether participants who completed a randomized controlled trial for physical activity (PA) improved their diet with no intervention in diet or nutrition. METHODS US adults (N = 283) were randomly assigned to 12 weeks of either exercise videogames, standard exercise, or an attention control. Secondary analyses were conducted to examine a possible transfer effect of the intervention on diet at end of intervention (EOT) and 6-month follow-up. Assessments of potential PA constructs (i.e., exercise enjoyment, self-efficacy) and demographics (e.g., age, gender) were conducted. PA, specifically moderate-to-vigorous levels of physical activity (MVPA), was measured using a self-report measure. Diet was measured using the Rate Your Plate dietary assessment. RESULTS Findings support that a randomization effect was associated with a higher likelihood of increasing MVPA (β = 30.00, 95% CI = 4.46, 64.46) and dietary improvement at EOT (β = 1.48, SE = .83, P = .01) and follow-up (β = 1.74, SE = .52, P = .02). At EOT, changes in diet were associated with higher PA enjoyment (β = 0.41, SE = 0.15, P = .01). This intervention effect on diet was moderated by gender, with women showing more dietary improvement than men (β = - .78, SE = 13, P = .03). At 6 months, dietary improvement was associated with greater self-efficacy (β = .04, SE = .01, P = .01). CONCLUSION This study shows evidence of a transfer effect among two synergistic behaviors and expands understanding of factors that predict the occurrence of this type of behavior change.
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Affiliation(s)
- Marie Aline Sillice
- Center for Systems and Community Design, Department of Health Policy and Management, City University of New York School of Public & Health Policy, 55 W. 125 Street, Room 842, NY, 10027, New York, USA.
| | - Shira Dunsiger
- Department of Psychiatry & Human Behavior , Warren Alpert Medical School of Brown University, RI, 02906, Providence, USA
| | - Beth C Bock
- Department of Psychiatry & Human Behavior , Warren Alpert Medical School of Brown University, RI, 02906, Providence, USA
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25
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Miller NA, Ehmann MM, Hagerman CJ, Forman EM, Arigo D, Spring B, LaFata EM, Zhang F, Milliron BJ, Butryn ML. Sharing digital self-monitoring data with others to enhance long-term weight loss: A randomized controlled trial. Contemp Clin Trials 2023; 129:107201. [PMID: 37080355 PMCID: PMC10231946 DOI: 10.1016/j.cct.2023.107201] [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: 01/19/2023] [Revised: 03/24/2023] [Accepted: 04/16/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Participants in behavioral weight loss (BWL) programs increasingly use digital tools to self-monitor weight, physical activity, and dietary intake. Data collected with these tools can be systematically shared with other parties in ways that might support behavior change. METHODS Adults age 18 to 70 with overweight/obesity (BMI 27-50 kg/m2) will enroll in a remotely delivered, 24-month BWL program designed to produce and maintain a 10% weight loss. Participants will be asked to use a wireless body weight scale, wearable activity sensor, and dietary intake app daily. All participants will receive individual and group counseling, engage in text messaging with members of their group, and appoint a friend or family member to serve in a support role. A 2x2x2 factorial design will test the effects of three types of data sharing partnerships: 1) Coach Share: The behavioral coach will regularly view digital self-monitoring data and address data observations. 2) Group Share: Participants will view each other's self-monitoring data in small-group text messages. 3) Friend/Family Share: A friend or family member will view the participant's data via automated message. The primary outcome is weight loss at 24 months. Mediators and moderators of intervention effects will be tested. CONCLUSION This study will provide a clear indication of whether data sharing can improve long-term weight loss. This study will be the first to discern the mechanisms of action through which each type of data sharing may be beneficial, and elucidate conditions under which the benefits of data sharing may be maximized.
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Affiliation(s)
- Nicole A Miller
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States.
| | - Marny M Ehmann
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Charlotte J Hagerman
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Evan M Forman
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Danielle Arigo
- Department of Psychology, Rowan University, 201 Mullica Hill Rd, Robinson Hall, Glassboro, NJ 08028, United States
| | - Bonnie Spring
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| | - Erica M LaFata
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Fengqing Zhang
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Brandy-Joe Milliron
- Department of Nutrition Sciences, Drexel University, 60 N 36th St, 11(th) floor, Philadelphia, PA 19104, United States
| | - Meghan L Butryn
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States.
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26
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Lawford B, Hinman RS, Jones S, Keating C, Brown C, Bennell KL. 'The fact that I know I can do it is quite a motivator now': a qualitative study exploring experiences maintaining weight loss 6 months after completing a weight loss programme for knee osteoarthritis. BMJ Open 2023; 13:e068157. [PMID: 37142310 PMCID: PMC10163509 DOI: 10.1136/bmjopen-2022-068157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE To explore experiences maintaining weight loss 6 months after completing a multicomponent weight loss programme for knee osteoarthritis. DESIGN Qualitative study based on an interpretivist paradigm and a phenomenological approach that was embedded within a randomised controlled trial. SETTING Semistructured interviews were conducted with participants 6 months after completing a 6-month weight loss programme (ACTRN12618000930280) involving a ketogenic very low calorie diet (VLCD), exercise and physical activity programme, videoconferencing consultations with a dietitian and physiotherapist, and provision of educational and behaviour change resources and meal replacement products. Interviews were audio recorded, transcribed verbatim and data were analysed based on the principles of reflexive thematic analysis. PARTICIPANTS 20 people with knee osteoarthritis. RESULTS Three themes were developed: (1) successfully maintained weight loss; (2) empowering self-management of weight (understand importance of exercise; increased knowledge about food and nutrition; resources from programme still useful; knee pain as a motivator; confidence in ability to self-regulate weight) and (3) challenges keeping on track (loss of accountability to dietitian and study; old habits and social situations; stressful life events or changes in health). CONCLUSION Participants had overall positive experiences maintaining their weight loss since completing the weight loss programme and were confident in their ability to self-regulate their weight in the future. Findings suggest a programme incorporating dietitian and physiotherapist consultations, a VLCD, and educational and behaviour change resources supports confidence maintaining weight loss in the medium term. Further research is required to explore strategies to overcome barriers like loss of accountability and returning to old eating habits.
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Affiliation(s)
- Belinda Lawford
- CHESM, University of Melbourne, Parkville, Victoria, Australia
| | - Rana S Hinman
- CHESM, University of Melbourne, Parkville, Victoria, Australia
| | - Sarah Jones
- CHESM, University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Kim L Bennell
- CHESM, University of Melbourne, Parkville, Victoria, Australia
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27
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Hempler NF, Bjerre N, Varming AR, Termannsen AD, Ringgaard LW, Jensen TH, Færch K, Quist JS. Designing a Co-created Intervention to Promote Motivation and Maintenance of Time-Restricted Eating in Individuals With Overweight and Type 2 Diabetes. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:371-380. [PMID: 37164552 DOI: 10.1016/j.jneb.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/14/2023] [Accepted: 03/02/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To design an appealing time-restricted eating (TRE) intervention by exploring behavioral and social mechanisms to improve TRE adoption and maintenance among people with type 2 diabetes (T2D) and overweight. Time-restricted eating is an intermittent fasting regimen suggested to improve glycemic control and body weight. METHODS Intervention development combined coherence theory and empirical data (workshops and semistructured interviews with the target group, their relatives, and health care professionals [HCPs]). Abductive analysis was applied. RESULTS The analysis suggested designing the TRE intervention in 2 phases: a short period with strict TRE, followed by a longer period focusing on adapting TRE to individual needs with support from HCPs, relatives, and peers. To reinforce TRE motivation and maintenance, HCPs should adopt a whole-person approach that focuses on participants' previous experiences. CONCLUSIONS AND IMPLICATIONS Important intervention elements to promote TRE adoption and maintenance are suggested to include a 2-phase design and support from professionals, family, and peers.
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Affiliation(s)
- Nana Folmann Hempler
- Health Promotion Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark.
| | - Natasja Bjerre
- Health Promotion Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Food and Resource Economics, University of Copenhagen, Frederiksberg, Denmark
| | - Annemarie Reinhardt Varming
- Health Promotion Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Anne-Ditte Termannsen
- Clinical Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Lene Winther Ringgaard
- Health Promotion Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Thit Hjortskov Jensen
- Health Promotion Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kristine Færch
- Clinical Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Salling Quist
- Clinical Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; School of Psychology, University of Leeds, Leeds, United Kingdom.
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28
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Morgan-Bathke M, Raynor HA, Baxter SD, Halliday TM, Lynch A, Malik N, Garay JL, Rozga M. Medical Nutrition Therapy Interventions Provided by Dietitians for Adult Overweight and Obesity Management: An Academy of Nutrition and Dietetics Evidence-Based Practice Guideline. J Acad Nutr Diet 2023; 123:520-545.e10. [PMID: 36462613 DOI: 10.1016/j.jand.2022.11.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
Overweight and obesity affect most adults living in the United States and are causally linked to several adverse health outcomes. Registered dietitian nutritionists or international equivalents (dietitians) collaborate with each client and other health care professionals to meet client-centered goals, informed by the best available evidence, and translated through a lens of clinical expertise and client circumstances and preferences. Since the last iteration of the Academy of Nutrition and Dietetics guideline on adult weight management in 2014, considerable research has been conducted and circumstances confronting dietitians have evolved. Thus, updated guidance is needed. The objective of this evidence-based practice guideline is to provide recommendations for dietitians who deliver medical nutrition therapy behavioral interventions for adults (18 years and older) with overweight and obesity to improve cardiometabolic outcomes, quality of life, and weight outcomes, when appropriate for and desired by the client. Recommendations in this guideline highlight the importance of considering complex contributors to overweight and obesity and individualizing interventions to client-centered goals based on specific needs and preferences and shared decision making. The described recommendations have the potential to increase access to care and decrease costs through utilization of telehealth and group counseling as effective delivery methods, and to address other barriers to overweight and obesity management interventions. It is essential for dietitians to collaborate with clients and interprofessional health care teams to provide high-quality medical nutrition therapy interventions using the nutrition care process to promote attainment of client-centered outcomes for adults with overweight or obesity.
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Affiliation(s)
- Maria Morgan-Bathke
- Department of Nutrition and Dietetics, Viterbo University, La Crosse, Wisconsin
| | - Hollie A Raynor
- College of Education, Health, and Human Sciences, University of Tennessee, Knoxville, Tennessee
| | | | - Tanya M Halliday
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah
| | - Amanda Lynch
- Department of Interdisciplinary Health Sciences, Oakland University, Rochester, MI
| | - Neal Malik
- Department of Health Science and Human Ecology, California State University, San Bernardino, San Bernardino, California
| | - Jessica L Garay
- Department of Nutrition and Food Studies, Syracuse University, Syracuse
| | - Mary Rozga
- Academy of Nutrition and Dietetics, Chicago, Illinois.
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Zhou Y, Stubbs RJ, Finlayson G. A neurocognitive perspective on the relationship between exercise and reward: Implications for weight management and drug addiction. Appetite 2023; 182:106446. [PMID: 36592797 DOI: 10.1016/j.appet.2022.106446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/24/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023]
Abstract
The impact of exercise on food reward is increasingly being discussed as an interplay between executive function (EF), homeostasis and mechanisms promoting or undermining intentional behaviour change. Integrating current knowledge of neurocognitive processes encompassing cognitive and affective networks within an energy balance framework will provide a more comprehensive account. Reward circuitry affected by recreational drugs and food overlap. Therefore the underlying processes explaining changes in drug-taking behaviour may offer new insights into how exercise affects the reward value of recreational drugs and food. EF is important for successful self-regulation, and training EF may boost inhibitory control in relation to food- and drug-related reward. Preclinical and clinical observations suggest that reward-seeking can transfer within and between categories of reward. This may have clinical implications beyond exercise improving metabolic health in people with obesity to understanding therapeutic responses to exercise in people with neurocognitive deficits in non-food reward-based decision making such as drug dependence.
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Affiliation(s)
- Yu Zhou
- Appetite Control & Energy Balance Research Group, School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom; School of Psychology, Shanghai University of Sport, Shanghai, People's Republic of China
| | - R James Stubbs
- Appetite Control & Energy Balance Research Group, School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Graham Finlayson
- Appetite Control & Energy Balance Research Group, School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.
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30
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Enright C, Thomas E, Saxon DR. An Updated Approach to Antiobesity Pharmacotherapy: Moving Beyond the 5% Weight Loss Goal. J Endocr Soc 2023; 7:bvac195. [PMID: 36686585 PMCID: PMC9847544 DOI: 10.1210/jendso/bvac195] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Indexed: 01/11/2023] Open
Abstract
Despite professional society guidelines recommending that obesity be treated as a chronic disease by emphasizing the use of lifestyle modification in conjunction with pharmacotherapy, antiobesity medications are uncommonly prescribed in most clinical practices. The recent Food and Drug Administration approval of semaglutide 2.4 mg weekly to treat obesity-as well as other forthcoming advancements in diabetes and antiobesity medications-highlights the potential of pharmacotherapy to significantly augment weight loss efforts. In this Expert Endocrine Consult, we review the evolving role of antiobesity pharmacotherapy in clinical practice and suggest a framework for the use of these medications.
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Affiliation(s)
- Connor Enright
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Elizabeth Thomas
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO 80045, USA,Endocrinology Section, Rocky Mountain Veterans Affairs Medical Center, Aurora, CO 80045, USA
| | - David R Saxon
- Correspondence: David Saxon, MD, Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, 12801 East 17th Avenue, Mail Stop: 8106, Aurora, CO 80045, USA.
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Al-Hazmi MH, Noorwali EA. Morning individuals in Saudi Arabia have higher self-regulation of eating behavior compared to evening types. Chronobiol Int 2022; 40:223-233. [PMID: 36545690 DOI: 10.1080/07420528.2022.2158846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chronotype is a manifestation of an individual's circadian system, which can be presented as a preference for morningness or eveningness. Evening chronotype has been linked to unhealthy dietary habits. These habits are partially from poor self-regulation of eating behavior (SREB). SREB is a goal-directed process that helps resist food temptation and achieve desired dietary outcomes. It is unclear whether chronotype is associated with SREB. This study aims to investigate the association between chronotypes and SREB. A total of 599 adults (18-50 years) enrolled in this cross-sectional study. Participants received an online questionnaire that collected sociodemographic, anthropometrics, chronotype through the validated reduced Morningness-Eveningness Questionnaire (rMEQ) and SREB using the SREB Questionnaire. ANOVA, Chi-square and multivariate logistic regression were used. In adjusted models, morning types had 85% higher SREB compared to evening types (p = 0.003, OR = 1.85). Evening types found fried foods (p = 0.003), chips (p = 0.005) and French fries (p = 0.018) more tempting than morning types. These findings show a link between chronotype and SREB. Strategies focusing on SREB may help evening types improve dietary habits. Further studies are required to clarify the underlying mechanisms for these associations. This may have important implications for lifestyle and behavioral change policy.
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Affiliation(s)
- Marwa Hamed Al-Hazmi
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Essra Abdulsalam Noorwali
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
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Pavlova NT, Ramasawmy C, Picariello F, Smith C, Moss‐Morris R. ‘I don't know which is the chicken and which is the egg’: A qualitative study of weight loss‐related beliefs and behaviours among adults with psoriasis and comorbid obesity. Br J Health Psychol 2022; 28:532-551. [PMID: 36484107 DOI: 10.1111/bjhp.12639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/12/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Obesity is a common (30%-40%) comorbidity of psoriasis. Weight loss is shown to improve the severity of psoriasis; however, little is known about the factors that may influence successful weight loss in the context of obesity and psoriasis. The current qualitative study aimed to explore the obesity-associated beliefs, perceptions, and behaviours related to weight loss in psoriasis. Preferences for a weight loss intervention were also explored. DESIGN Qualitative in-depth semi-structured interviews were conducted with 24 adults (62.5% male) with moderate-to-severe psoriasis and obesity (mean body mass index = 35.2 kg/m2 , SD = 4.1), recruited through a patient organization website in the UK. Data were analysed using inductive thematic analysis. RESULTS Most participants viewed psoriasis as unrelated to obesity. A well-controlled psoriasis and improvements in psoriasis symptoms were considered as major motivators for engaging in a weight loss program by individuals who viewed psoriasis and obesity as related conditions. Comfort eating was perceived as an escape strategy from the psoriasis-induced negative emotions. Participants shared their dissatisfaction with current weight loss recommendations which were too generic. They suggested that a desirable weight loss program would require both emotional and behavioural support, with an emphasis on psoriasis' burden. CONCLUSION The findings accentuate the importance of (1) clinicians discussing the link between obesity and psoriasis with patients, (2) weight loss advice to include both behavioural and emotional support, and (3) a weight loss advice to consider the psoriasis burden and the perceived barriers which may potentially lead to improved outcomes to obesity management in psoriasis.
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Affiliation(s)
- Neli T. Pavlova
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience King's College London London UK
| | - Celeny Ramasawmy
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience King's College London London UK
| | - Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience King's College London London UK
| | - Catherine Smith
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience King's College London London UK
- St John's Institute of Dermatology Guy's and St Thomas' NHS Foundation Trust London UK
| | - Rona Moss‐Morris
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience King's College London London UK
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Stathi A, Withall J, Greaves CJ, Thompson JL, Taylor G, Medina-Lara A, Green C, Snowsill T, Johansen-Berg H, Bilzon J, Gray S, Cross R, Western MJ, Koning JLD, Ladlow P, Bollen JC, Moorlock SJ, Guralnik JM, Rejeski WJ, Hillsdon M, Fox KR. A group-based exercise and behavioural maintenance intervention for adults over 65 years with mobility limitations: the REACT RCT. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/mqbw6832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background
Mobility limitation in older age reduces quality of life, generates substantial health- and social-care costs, and increases mortality.
Objective
The REtirement in ACTion (REACT) trial aimed to establish whether or not a community-based active ageing intervention could prevent decline in physical functioning in older adults already at increased risk of mobility limitation.
Design
A multicentre, pragmatic, two-arm, parallel-group randomised controlled trial with parallel process and health economic evaluations.
Setting
Urban and semi-rural locations across three sites in England.
Participants
Physically frail or pre-frail older adults (aged ≥ 65 years; Short Physical Performance Battery score of 4–9). Recruitment was primarily via 35 primary care practices.
Interventions
Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal exercise and behavioural maintenance programme delivered in fitness and community centres. Randomisation was stratified by site and used a minimisation algorithm to balance age, sex and Short Physical Performance Battery score. Data collection and analyses were blinded.
Main outcome measures
The primary outcome was change in lower limb physical function (Short Physical Performance Battery score) at 24 months, analysed using an intention-to-treat analysis. The economic evaluation adopted the NHS and Personal Social Services perspective.
Results
Between June 2016 and October 2017, 777 participants (mean age 77.6 years, standard deviation 6.8 years; 66% female; mean Short Physical Performance Battery score 7.37, standard deviation 1.56) were randomised to the intervention arm (n = 410) or the control arm (n = 367). Data collection was completed in October 2019. Primary outcome data at 24 months were provided by 628 (80.8%) participants. At the 24-month follow-up, the Short Physical Performance Battery score was significantly greater in the intervention arm (mean 8.08, standard deviation 2.87) than in the control arm (mean 7.59, standard deviation 2.61), with an adjusted mean difference of 0.49 (95% confidence interval 0.06 to 0.92). The difference in lower limb function between intervention and control participants was clinically meaningful at both 12 and 24 months. Self-reported physical activity significantly increased in the intervention arm compared with the control arm, but this change was not observed in device-based physical activity data collected during the trial. One adverse event was related to the intervention. Attrition rates were low (19% at 24 months) and adherence was high. Engagement with the REACT intervention was associated with positive changes in exercise competence, relatedness and enjoyment and perceived physical, social and mental well-being benefits. The intervention plus usual care was cost-effective compared with care alone over the 2 years of REACT; the price year was 2019. In the base-case scenario, the intervention saved £103 per participant, with a quality-adjusted life-year gain of 0.04 (95% confidence interval 0.006 to 0.074) within the 2-year trial window. Lifetime horizon modelling estimated that further cost savings and quality-adjusted life-year gains were accrued up to 15 years post randomisation.
Conclusion
A relatively low-resource, 1-year multimodal exercise and behavioural maintenance intervention can help older adults to retain physical functioning over a 24-month period. The results indicate that the well-established trajectory of declining physical functioning in older age is modifiable.
Limitations
Participants were not blinded to study arm allocation. However, the primary outcome was independently assessed by blinded data collectors. The secondary outcome analyses were exploratory, with no adjustment for multiple testing, and should be interpreted accordingly.
Future work
Following refinements guided by the process evaluation findings, the REACT intervention is suitable for large-scale implementation. Further research will optimise implementation of REACT at scale.
Trial registration
This trial is registered as ISRCTN45627165.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | | | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Gordon Taylor
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | | | - Colin Green
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Tristan Snowsill
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK
| | - Selena Gray
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Rosina Cross
- Department for Health, University of Bath, Bath, UK
| | | | | | - Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - Jessica C Bollen
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Sarah J Moorlock
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Worrell Professional Centre, Winston-Salem, NC, USA
| | - Melvyn Hillsdon
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Kenneth R Fox
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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Bates RW, Bailey C, Topping AE. 'Out of sync': a qualitative investigation of patients' experiences of atrial fibrillation and perceptions of weight management. BMJ Open 2022; 12:e065995. [PMID: 36343999 PMCID: PMC9644348 DOI: 10.1136/bmjopen-2022-065995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To explore ways to enhance the design of risk factor management and weight-loss services for people with overweight/obesity and atrial fibrillation (AF). BACKGROUND AF is the most common cardiac arrhythmia, with serious consequences for health and quality of life. Some evidence indicates weight reduction in people with AF and overweight/obesity may improve symptoms. This population may require additional support with weight management due to factors associated with ageing and health. DESIGN Qualitative investigation based on semi-structured interviews. METHODS 12 adult participants (4 female, 8 male) with diagnosed AF and a current or previous body mass index >27 kg/m2 were recruited at a large tertiary cardiac referral centre in southern England between September 2020 and January 2021. Participants completed quality of life and AF symptom questionnaires using Think-Aloud technique and semi-structured interviews relating to their weight management experiences, needs and preferences. Interviews were audio recorded and analysed thematically using the Capability, Opportunity and Motivation-Behaviour model as a theoretical framework. RESULTS Three main themes were identified. Being out of rhythm explores the psychological and physical impact of AF on weight management; doing the right thing discusses participants' weight management experiences and broaching the subject explores participants' perspectives on weight management conversations with clinicians. CONCLUSIONS There was dissatisfaction with the weight management advice received from healthcare professionals including cardiologists. Participants wanted open, non-judgemental discussion of cardiac health implications of overweight/obesity supported by referral to weight management services. Improved communication including research findings regarding the benefits of weight loss as a factor in AF management might increase motivation to adhere to weight-loss advice in this population.
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Affiliation(s)
- Rachel Wendy Bates
- School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
- John Radcliffe Hospital, Oxford, UK
| | - Cara Bailey
- School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - A E Topping
- School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Dikyol Mutlu A, Cihan H, KÖKSAL Z. The perceived role of food and eating among turkish women with obesity: A qualitative analysis. CURRENT PSYCHOLOGY 2022; 42:1-12. [PMID: 36313584 PMCID: PMC9589573 DOI: 10.1007/s12144-022-03778-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/29/2022]
Abstract
The studies show the link between Body Mass Index (BMI) and higher food responsiveness despite negative physical, social, and psychological outcomes. The descriptive studies examining what makes individuals with higher BMI values more likely to respond to food are limited, while there is none in the Turkish sample. This study aims to understand the subjective relationship of women with obesity/overweight related to food in Turkish culture. Turkish adult women (aged 22-54) who have BMI higher than 25 (overweight/obesity) participated in semi-structured interviews focusing on how they relate to food and obesity. Participants were reached through Ankara Etlik Zübeyde Hanım Obstetrics and Gynecology Hospital Obesity outpatient service. Audio-recorded interviews were analyzed predominantly inductively by thematic analysis principles. Analysis of these interviews reflected three main themes: (1) the act of eating: "I don't know why I eat when I'm full", (2) being overweight: "I am the kind of person who constantly tries to lose weight", and (3) sources of distress. The results indicated the dynamic relationship between the desire to eat, chronic stress, perceived unavailability of close ones, and low sense of self-worth among adult women with obesity/overweight. The other indication is the effect of culture in shaping the relationship dynamics, the sources of distress, and the eating patterns in developing and maintaining obesity.
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Affiliation(s)
- Ayse Dikyol Mutlu
- Ankara Etlik Zubeyde Hanım Obstetrics Gynecology Hospital, Ankara, Turkey
| | - Hüdayar Cihan
- Faculty of Social Sciences, Department of Psychology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Zuhal KÖKSAL
- Ankara Etlik Zubeyde Hanım Obstetrics Gynecology Hospital, Ankara, Turkey
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Attitudes to Three Weight Maintenance Strategies: A Qualitative Study. Nutrients 2022; 14:nu14214441. [PMID: 36364704 PMCID: PMC9655049 DOI: 10.3390/nu14214441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Weight loss maintenance can be difficult and ultimately unsuccessful, due to psychological, behavioural, social, and physiological influences. The present study investigated three strategies with the potential to improve weight maintenance success: daily weighing, missing an occasional meal, habitually changing high energy foods. The principal aim was to gain an understanding of attitudes to these strategies in participants who had recent experience of weight loss attempts, with or without maintenance. This was a qualitative study involving semi-structured interviews, with 20 participants aged 18–67 (twelve females), analysed using thematic analysis. Most participants disliked daily weighing and missing an occasional meal for long-term maintenance and were concerned about potential negative effects on mental health. All participants had experience of habitual changes to high energy foods and regarded this strategy as obvious and straightforward. Replacement of high energy foods was favoured over elimination. Participants preferred strategies that felt flexible, “normal” and intuitive and disliked those that were thought to have a negative impact on mental health. Further investigation is needed on whether concerns regarding mental health are well founded and, if not, how the strategies can be made more acceptable and useful.
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Personal motivation, self-regulation barriers and strategies for weight loss in people with overweight and obesity: a thematic framework analysis. Public Health Nutr 2022; 25:2426-2435. [PMID: 35190011 PMCID: PMC9991665 DOI: 10.1017/s136898002200043x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore motivations, self-regulation barriers and strategies in a multi-ethnic Southeast Asian population with overweight and obesity. DESIGN Qualitative design using semi-structured face-to-face and videoconferencing interviews. Data were analysed using thematic framework analysis and constant comparison method. SETTING Specialist weight management clinic. PARTICIPANTS Twenty-two participants were purposively sampled from 13 April to 30 April 2021. Median age and BMI of the participants were 37·5 (interquartile range (IQR) = 13·3) and 39·2 kg/m2 (IQR = 6·1), respectively. And 31·8 % were men, majority had a high intention to adopt healthy eating behaviours (median = 6·5; IQR = 4·8-6·3) and 59 % of the participants had a medium level of self-regulation. RESULTS Six themes and fifteen subthemes were derived. Participants were motivated to lose weight by the sense of responsibility as the family's pillar of support and to feel 'normal' again. We coupled self-regulation barriers with corresponding strategies to come up with four broad themes: habitual overconsumption - mindful self-discipline; proximity and convenience of food available - mental tenacity; momentary lack of motivation and sense of control - motivational boosters; and overeating triggers - removing triggers. We highlighted six unique overeating triggers namely: trigger activities (e.g. using social media); eating with family, friends and colleagues; provision of food by someone; emotions (e.g. feeling bored at home, sad and stressed); physiological condition (e.g. premenstrual syndrome); and the time of the day. CONCLUSIONS Future weight management interventions should consider encompassing participant-led weight loss planning, motivation boosters and self-regulation skills to cope with momentary overeating triggers.
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Carvalho M, Dunne P, Kwasnicka D, Byrne M, McSharry J. Barriers and enablers to sustaining self-management behaviours after attending a self-management support intervention for type 2 diabetes: a protocol for a systematic review and qualitative evidence synthesis. HRB Open Res 2022; 4:129. [PMID: 35280847 PMCID: PMC8886171 DOI: 10.12688/hrbopenres.13466.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Attendance at self-management support interventions is associated with improved outcomes for people with type 2 diabetes. However, initial improvements are often not sustained beyond one year, which may be a result of difficulties in sustaining positive changes made to self-management behaviours. The aim of this systematic review is to synthesise qualitative research on the barriers and enablers to sustaining self-management behaviours following attendance at a self-management support intervention for type 2 diabetes. Methods: The review will use the “best fit” framework synthesis method to develop a new conceptual model of sustained behaviour change in type 2 diabetes. MEDLINE (Ovid), EMBASE (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), SCOPUS, ProQuest Dissertations and Theses, WorldCat and Open Grey will be searched to identify primary qualitative studies. A parallel search will be conducted in Google Scholar to identify relevant theories for the development of an
a priori framework to synthesise findings across studies. Methodological limitations of included studies will be assessed using an adapted version of the Critical Appraisal Skills Programme tool for Qualitative Studies. A sensitivity analysis will be conducted to examine the impact of studies with methodological limitations on synthesis findings. Confidence in the synthesis findings will be assessed using the GRADE-CERQual tool. Screening, data extraction, methodological limitation assessment, synthesis and GRADE-CERQual assessment will be conducted by one author with a second author independently verifying a randomly selected 20% sample. Discussion: This review will develop a new model of sustained behaviour change in type 2 diabetes self-management. The findings can be used to inform the development of new interventions or revision of existing interventions to better support sustained engagement in type 2 diabetes self-management behaviours.
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Affiliation(s)
- Márcia Carvalho
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - Pauline Dunne
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Aleksandra Ostrowskiego, Wrocław, Poland
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Melbourne, Australia
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, Ireland
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Jessen-Winge C, Lee K, Surrow S, Christensen JR. Five Vital Components in an Occupational Therapy-Based Municipal Weight Loss Program Obtained Through Research Circles. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:822896. [PMID: 36188971 PMCID: PMC9397691 DOI: 10.3389/fresc.2022.822896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/16/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Currently 1.9 billion adults worldwide are estimated to be overweight or obese. Weight loss sustainability is difficult, and weight loss rehabilitation programs have been criticised for having an individualistic approach. It has been suggested that occupational therapists could be used as part of a transdisciplinary approach because of their holistic perspective. During the development of an occupational therapy- based weight loss program five components arose as essential from earlier interviews with health professionals and citizens with obesity: diet, physical activities, social relations, habits and balancing everyday life. Before developing the program, we needed a clearer picture of which strategies should support the five components. The aim of this study was to obtain a description of strategies related to the five components that could support weight loss to become part of everyday life of people with obesity. METHODS This study took a participatory design by using research circle (RC) methodology. Two RC groups were created, one with occupational therapists and one with citizens with obesity. Researchers participated in both RC groups. Data was obtained through democratic principles. The two RC groups met four times over a period of 4 months. Qualitative content analysis was conducted. RESULTS Five themes arose: (1) Diet-Find the line between either-or, (2) Physical activity-Break the comfort zone, (3) Social relations-Stand strong together, (4) Habits-Focus on possibilities instead of bad habits, and (5) Balancing everyday life-Handling life's bumps. CONCLUSION The strategies for a weight loss program including the five components should include awareness of senses and activity patterns surrounding meals, taking one step at a time when focusing of physical activities and be conscious of values, include family and friends in the program to find common ground and self-confidence and use re-placement activities. We suggest that the component of balancing everyday life should be seen as an overall component as all strategies are related to finding meaning and variation in activities which is part of an ongoing weight loss process.
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Affiliation(s)
- Christina Jessen-Winge
- User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Occupational Therapy, Institute of Physiotherapy and Occupational Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Kim Lee
- User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Occupational Therapy, University College South, Esbjerg, Denmark
| | - Signe Surrow
- User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jeanette R. Christensen
- User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, University of Soutern Denmark, Odense, Denmark
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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Comșa LT, David OA, David DO. Relevant Psychological Factors in Weight Management. How to Think and Behave to Lose Weight and Maintain it for Good. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2022. [DOI: 10.1007/s10942-022-00455-1] [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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Nunes CL, Carraça EV, Jesus F, Finlayson G, Francisco R, Silva MN, Santos I, Bosy-Westphal A, Martins P, Minderico C, Sardinha LB, Silva AM. Changes in food reward and intuitive eating after weight loss and maintenance in former athletes with overweight or obesity. Obesity (Silver Spring) 2022; 30:1004-1014. [PMID: 35347875 DOI: 10.1002/oby.23407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to explore the following: 1) the impact of Champ4Life's intervention on intuitive eating and food reward; and 2) associations between changes in eating behavior and changes in body composition. METHODS A total of 94 former athletes (mean [SD], BMI = 31.1 [4.3] kg/m2 , age = 43.0 [9.4] years, 34% female) assigned to intervention (n = 49) and control groups (n = 45) underwent 4 months of active weight loss (WL) followed by 8 months of WL maintenance. Intuitive eating and food reward were assessed by the Intuitive Eating Scale and the Leeds Food Preference Questionnaire, respectively. RESULTS The WL was -4.8% (4.9%) and 0.3% (2.6%) for the intervention and control groups, respectively. Participants reported a decrease in fat bias for explicit/implicit wanting and explicit liking after 4 months and 1 year. For intuitive eating, the unconditional permission to eat decreased after 4 months, and the body-food choice congruence increased after 1 year. Changes in unconditional permission to eat and in body-food choice congruence were positively and negatively associated with both Δweight and with Δfat mass, respectively. Changes in explicit wanting for fat and taste bias were associated with Δweight. CONCLUSIONS Food reward decreased after a moderate WL intervention. Participants successfully maintained their reduced weight, and most of the changes in eating behavior remained significant at the end of the follow-up period. Lifestyle interventions aiming at WL should also consider intuitive eating and food reward.
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Affiliation(s)
- Catarina L Nunes
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
| | - Eliana V Carraça
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES): Lusophone University, Lisbon, Portugal
| | - Filipe Jesus
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
| | - Graham Finlayson
- Appetite Control Energy Balance Research Group, School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Rúben Francisco
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
| | - Marlene N Silva
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES): Lusophone University, Lisbon, Portugal
- Programa Nacional para a Promoção da Atividade Física, Direcção-Geral da Saúde, Lisbon, Portugal
| | - Inês Santos
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES): Lusophone University, Lisbon, Portugal
- Nutrition Laboratory, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Anja Bosy-Westphal
- Department of Human Nutrition, Institute of Human Nutrition and Food Sciences, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Paulo Martins
- Laboratory of Sport Psychology, Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
| | - Cláudia Minderico
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
| | - Luís B Sardinha
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
| | - Analiza M Silva
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
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Schmidt K, Faerch K, Zoffmann V, Amadid H, Varming AR. The process of health behaviour change following participation in a randomised controlled trial targeting prediabetes: A qualitative study. Diabet Med 2022; 39:e14748. [PMID: 34806793 DOI: 10.1111/dme.14748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/20/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
AIM To explore how participating in a randomised controlled trial affected motivation, barriers and strategies in the process of health behaviour change among individuals with prediabetes. METHODS An extension to the PRE-D trial, a qualitative study investigated the efficacy of glucose-lowering interventions (metformin, dapagliflozin or exercise) compared with a control group among individuals with prediabetes and overweight/obesity. Data were collected through separate focus group interviews with participants using semi-structured interview guides inspired by health behaviour change theories. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis with an inductive-deductive approach. RESULTS Four interrelated themes were generated from interviews: (1) 'self-construction of prediabetes', on how participants understood the term 'prediabetes', (2) 'altered health image', on how participants' health perceptions were affected, (3) 'personal strategies for health behaviour change', on different ways to attempt to implement behaviour changes and (4) 'the process of health behaviour change', on how participants progressed and relapsed while trying to change behaviour. Themes relate to the health belief model, self-determination theory, self-efficacy and the trans-theoretical model of change. Participants shared their experiences and thoughts during interviews and inspired each other, which led some participants to develop a new perspective on prediabetes severity and increased their motivation for behaviour change. CONCLUSIONS How participants perceived and accepted, rejected or neglected prediabetes appeared to affect their health images and whether they realised a need for behaviour change. Their achievements during interventions, health literacy, self-efficacy and perceived support from their social networks, professionals and technological aids influenced the maintenance of health behaviour changes.
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Affiliation(s)
- Kirstine Schmidt
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kristine Faerch
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Zoffmann
- Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanan Amadid
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Annemarie R Varming
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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Bjerre N, Holm L, Veje N, Quist JS, Færch K, Hempler NF. What happens after a weight loss intervention? A qualitative study of drivers and challenges of maintaining time-restricted eating among people with overweight at high risk of type 2 diabetes. Appetite 2022; 174:106034. [PMID: 35378218 DOI: 10.1016/j.appet.2022.106034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
Time-restricted eating (TRE)1 has been conceptualised as a strategy for achieving weight loss and improving metabolic health, but limited knowledge exists about how people can maintain TRE in daily life. This study examined how TRE was maintainable in daily life after a three-month intervention (the RESET study) in which participants were encouraged to consume all food and beverages except water within a 10-hour daily window. Specifically, we examined TRE maintenance patterns across participants, including drivers and challenges for maintenance success. A qualitative longitudinal study was conducted, and twenty participants with overweight at high risk of type 2 diabetes were interviewed using a semi-structured interview guide at the end of the intervention and after a three-month follow-up period. Data were analysed longitudinally in two steps inspired by a pattern-oriented longitudinal analysis approach. Seven participants maintained a strict 10-hour window, ten maintained an adjusted TRE regimen (e.g., taking days off), and three did not attempt maintenance. Maintenance drivers included consistent daily rhythms and regular meal patterns, subjective experiences (e.g., feeling healthier), making flexible adjustments to the TRE regimen, family support and avoiding feelings of guilt. Maintenance challenges included social evening events, inconsistent daily rhythms and eating patterns, preoccupation with losing weight, lack of family support and self-blame. TRE was manageable for most participants; however, personalised support for adjusting TRE to daily life is needed to ensure long-term maintenance. Future studies should explore the effectiveness of a personalised TRE concept to determine the usefulness of TRE in real-life settings.
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Affiliation(s)
- Natasja Bjerre
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark; Department of Food and Resource Economics, University of Copenhagen, Rolighedsvej 25, 1958, Frederiksberg, Denmark.
| | - Lotte Holm
- Department of Food and Resource Economics, University of Copenhagen, Rolighedsvej 25, 1958, Frederiksberg, Denmark.
| | - Nanna Veje
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
| | - Jonas Salling Quist
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
| | - Kristine Færch
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
| | - Nana Folmann Hempler
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
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Stathi A, Greaves CJ, Thompson JL, Withall J, Ladlow P, Taylor G, Medina-Lara A, Snowsill T, Gray S, Green C, Johansen-Berg H, Sexton CE, Bilzon JLJ, deKoning J, Bollen JC, Moorlock SJ, Western MJ, Demnitz N, Seager P, Guralnik JM, Rejeski WJ, Hillsdon M, Fox KR. Effect of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: the REACT (Retirement in Action) randomised controlled trial. Lancet Public Health 2022; 7:e316-e326. [PMID: 35325627 PMCID: PMC8967718 DOI: 10.1016/s2468-2667(22)00004-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 12/09/2021] [Accepted: 12/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mobility limitations in old age can greatly reduce quality of life, generate substantial health and social care costs, and increase mortality. Through the Retirement in Action (REACT) trial, we aimed to establish whether a community-based active ageing intervention could prevent decline in lower limb physical functioning in older adults already at increased risk of mobility limitation. METHODS In this pragmatic, multicentre, two-arm, single-blind, parallel-group, randomised, controlled trial, we recruited older adults (aged 65 years or older and who are not in full-time employment) with reduced lower limb physical functioning (Short Physical Performance Battery [SPPB] score 4-9) from 35 primary care practices across three sites (Bristol and Bath; Birmingham; and Devon) in England. Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal physical activity (64 1-h exercise sessions) and behavioural maintenance (21 45-min sessions) programme delivered by charity and community or leisure centre staff in local communities. Randomisation was stratified by site and adopted a minimisation approach to balance groups by age, sex, and SPPB score, using a centralised, online, randomisation algorithm. Researchers involved in data collection and analysis were masked but participants were not because of the nature of the intervention. The primary outcome was change in SPPB score at 24 months, analysed by intention to treat. This trial is registered with ISRCTN, ISRCTN45627165. FINDINGS Between June 20, 2016, and Oct 30, 2017, 777 participants (mean age 77·6 [SD 6·8] years; 66% female; mean SPPB score 7·37 [1·56]) were randomly assigned to the intervention (n=410) and control (n=367) groups. Primary outcome data at 24 months were provided by 628 (81%) participants (294 in the control group and 334 in the intervention group). At the 24-month follow-up, the SPPB score (adjusted for baseline SPPB score, age, sex, study site, and exercise group) was significantly greater in the intervention group (mean 8·08 [SD 2·87]) than in the control group (mean 7·59 [2·61]), with an adjusted mean difference of 0·49 (95% CI 0·06-0·92; p=0·014), which is just below our predefined clinically meaningful difference of 0·50. One adverse event was related to the intervention; the most common unrelated adverse events were heart conditions, strokes, and falls. INTERPRETATION For older adults at risk of mobility limitations, the REACT intervention showed that a 12-month physical activity and behavioural maintenance programme could help prevent decline in physical function over a 24-month period. FUNDING National Institute for Health Research Public Health Research Programme (13/164/51).
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Affiliation(s)
- Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Janet Withall
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; Department for Health, University of Bath, Bath, UK
| | - Peter Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK
| | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Tristan Snowsill
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Selena Gray
- Faculty of Health and Applied Sciences, University of the West of England (UWE) Bristol, Bristol, UK
| | - Colin Green
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Heidi Johansen-Berg
- Oxford Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Claire E Sexton
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Global Brain Health Institute, Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Jessica C Bollen
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sarah J Moorlock
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Naiara Demnitz
- Danish Research Centre for Magnetic Resonance, Centre for Functional Diagnostic Imaging and Research, Copenhagen University Hospital -Amager and Hvidovre, Hvidovre, Denmark
| | - Poppy Seager
- Oxford Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Melvyn Hillsdon
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Kenneth R Fox
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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45
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Kinsey AW, Phillips J, Desmond R, Gowey M, Jones C, Ard J, Clark JM, Lewis CE, Dutton GR. Factors Associated with Weight Loss Maintenance and Weight Regain Among African American and White Adults Initially Successful at Weight Loss. J Racial Ethn Health Disparities 2022; 9:546-565. [PMID: 33544328 PMCID: PMC8339173 DOI: 10.1007/s40615-021-00985-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Providing ongoing treatment through extended care programs can improve weight loss maintenance (WLM), but the effectiveness of these programs for African Americans (AA) are mixed and may be due to unique cultural factors. PURPOSE To identify, prioritize, and organize factors associated with WLM as experienced by AA and White adults initially successful with weight loss. METHODS Adults identified their greatest amount of lifetime weight loss, and those achieving ≥5% weight loss were classified as maintainers (continued >5% weight reduction for ≥1 year) or regainers (≤5% weight reduction) based on current weight. The nominal group technique was conducted to identify and rank WLM facilitators and barriers. Online card sorting tasks and hierarchical clustering were performed to illustrate conceptual relationships between facilitators (maintainers only) and barriers (regainers only). RESULTS Participants (maintainers, n = 46; regainers, n = 58; 81.7% women, 48.1% AA) identified known factors associated with successful weight management (daily weighing, self-monitoring, regular physical activity, mindful eating). However, the perceived importance of these factors differed between groups (maintainer vs. regainers; AA vs. Whites). Unique factors affecting WLM were also identified (refresher groups recommended by White maintainers and regainers; self-accountability identified by AA maintainers). Salient facilitators and barriers were best represented in 2-3 clusters; each group had ≥1 unique cluster(s) revealing group-specific higher-order domains associated with successful WLM. CONCLUSIONS As lifestyle interventions for WLM (particularly for AA) are developed, attention to the preferences, and lived experiences of these groups is recommended. Strategies targeting physical activity maintenance and autonomy-supportive approaches may improve WLM among AA.
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Affiliation(s)
- Amber W Kinsey
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Janice Phillips
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Renee Desmond
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Marissa Gowey
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catherine Jones
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jamy Ard
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cora E Lewis
- 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, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA.
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46
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Neve KL, Isaacs A. How does the food environment influence people engaged in weight management? A systematic review and thematic synthesis of the qualitative literature. Obes Rev 2022; 23:e13398. [PMID: 34881511 PMCID: PMC9286606 DOI: 10.1111/obr.13398] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/08/2021] [Accepted: 11/03/2021] [Indexed: 01/04/2023]
Abstract
People engaged in weight loss or weight loss maintenance (weight management) often regain weight long term. Unsupportive food environments are one of the myriad challenges people face when working towards a healthier weight. This systematic review explores how the food environment influences people engaged in weight management and the policy implications. Nine electronic databases (CINAHL, Medline, PsycINFO, Academic Search Complete, Embase, Ovid Emcare, PubMed, Open Grey, and BASE) were searched systematically in May 2020 to synthesize the qualitative evidence. Eligible studies were conducted with adults (18+) in high-income countries, available in English and published 2010-2020 with a substantial qualitative element and reference to food environments. Data were analyzed using a thematic synthesis approach. Quality assessment using the Critical Appraisal Skills Programme was undertaken. We identified 26 studies of 679 individuals reporting on weight management experiences with reference to the food environment. Limitations of the included studies included a lack of detail regarding socioeconomic status and ethnicity in many studies. The analysis revealed that food environments undermine efforts at weight management, consistently making purchasing and consumption of healthier food more difficult, particularly for those on a low income. For weight management to be more successful, concurrent actions to reshape food environments are necessary.
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Affiliation(s)
| | - Anna Isaacs
- Centre for Food Policy, City, University of London, London, UK
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47
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Lo BK, Haneuse S, McBride BA, Redline S, Taveras EM, Davison KK. Prospective Associations Between Fathers' Engagement in Infant Caregiving and Their Weight-Related Behaviors and Mental Health. Am J Mens Health 2022; 16:15579883221079152. [PMID: 35225045 PMCID: PMC8882948 DOI: 10.1177/15579883221079152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Fathers’ engagement in infant caregiving is linked with positive social,
emotional, and developmental outcomes in children; however, its relationship
with fathers’ own health is largely unknown. This longitudinal study examined
associations between fathers’ caregiving engagement with their 6-month-old
infants and their physical activity, sugar-sweetened beverage (SSB) consumption,
nighttime sleep duration, and depressive symptoms 6 months later when infants
were 12 months old. Participants were 143 fathers of infants (62.7% non-Hispanic
White, 82.3% with a bachelor’s degree). Fathers reported their frequency of
engagement in seven caregiving activities when infants were 6 months old.
Fathers’ physical activity, SSB consumption, nighttime sleep duration, and
depressive symptoms were assessed when infants were 6 and 12 months old.
Multivariate logistic regression analysis was used to assess if fathers who
reported higher infant caregiving at 6 months had more positive health outcomes
at 12 months, controlling for fathers’ age, race/ethnicity, education,
employment, household income, and the outcome at 6 months. Fathers who reported
higher caregiving engagement when infants were 6 months old had increased odds
of being sufficiently physically active 6 months later (unadjusted odds ratio
[OR] = 1.19, 95% confidence interval [CI] = [1.00, 1.41]; adjusted OR = 1.47,
95% CI = [1.11, 1.96]). No links were identified between fathers’ caregiving
engagement and their SSB consumption, nighttime sleep duration, or depressive
symptoms. In summary, fathers’ engagement in infant caregiving may be beneficial
to their physical activity in the first year after birth. There was insufficient
evidence in this study that the benefits of caregiving engagement were
experienced broadly across multiple health outcomes.
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Affiliation(s)
- Brian K Lo
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brent A McBride
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Elsie M Taveras
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA
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48
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Phelan S, Roake J, Alarcon N, Ng SM, Glanz H, Cardel MI, Foster GD. In their own words: Topic analysis of the motivations and strategies of over 6,000 long-term weight-loss maintainers. Obesity (Silver Spring) 2022; 30:751-761. [PMID: 35137557 PMCID: PMC9305441 DOI: 10.1002/oby.23372] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study aimed to identify major themes of a large cohort experiencing long-term weight-loss maintenance who answered open-ended questions about weight-loss triggers, current motivations, strategies, and experiences. METHODS Machine learning and topic modeling were used to analyze responses to six open-ended questions among 6,139 WW International, Inc., (formerly Weight Watchers) members with weight-loss maintenance; inclusion criteria included ≥9.1-kg loss with weight-loss maintenance for ≥1 year. RESULTS Participants (mean age = 53.6 years; 94.3% White; mean BMI = 27.8 kg/m2 ) had lost 24.5 kg and maintained the loss for 3.4 years. Descriptions of factors triggering weight loss coalesced into five topics: medical status, appearance, mobility, social prompts, and change needed. Factors currently motivating weight-loss maintenance yielded two topics: looking back at experiences at higher weight and health/appearance concerns. Advice for others to succeed in weight-loss maintenance coalesced on two recommendations: perseverance in the face of setbacks and consistency in tracking. Rewards for weight management included improved confidence, pain, mobility, fitness, body image, medical status, and affect. Two thematic negative consequences were clothing costs and sagging skin. CONCLUSIONS Future weight-maintenance research should include more diverse populations and investigate weight-loss maintenance as a journey with highs and lows, perseverance in the face of setbacks, sustained tracking, and making changes in medical status more salient during the weight-maintenance journey.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology and Public HealthCenter for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - James Roake
- Department of Kinesiology and Public HealthCenter for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Noemi Alarcon
- Department of Kinesiology and Public HealthCenter for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Sarah M. Ng
- Department of Kinesiology and Public HealthCenter for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Hunter Glanz
- Department of StatisticsCenter for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Michelle I. Cardel
- WW International, Inc.New YorkNew YorkUSA
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Gary D. Foster
- WW International, Inc.New YorkNew YorkUSA
- Center for Weight and Eating DisordersPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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49
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Asbjørnsen RA, Hjelmesæth J, Smedsrød ML, Wentzel J, Ollivier M, Clark MM, van Gemert-Pijnen JEWC, Solberg Nes L. Combining Persuasive System Design Principles and Behavior Change Techniques in Digital Interventions Supporting Long-term Weight Loss Maintenance: Design and Development of eCHANGE (Preprint). JMIR Hum Factors 2022; 9:e37372. [PMID: 35622394 PMCID: PMC9187967 DOI: 10.2196/37372] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/29/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
Background Long-term weight maintenance after weight loss is challenging, and innovative solutions are required. Digital technologies can support behavior change and, therefore, have the potential to be an effective tool for weight loss maintenance. However, to create meaningful and effective digital behavior change interventions that support end user values and needs, a combination of persuasive system design (PSD) principles and behavior change techniques (BCTs) might be needed. Objective This study aimed to investigate how an evidence-informed digital behavior change intervention can be designed and developed by combining PSD principles and BCTs into design features to support end user values and needs for long-term weight loss maintenance. Methods This study presents a concept for how PSD principles and BCTs can be translated into design features by combining design thinking and Agile methods to develop and deliver an evidence-informed digital behavior change intervention aimed at supporting weight maintenance. Overall, 45 stakeholders participated in the systematic and iterative development process comprising co-design workshops, prototyping, Agile development, and usability testing. This included prospective end users (n=17, 38%; ie, people with obesity who had lost ≥8% of their weight), health care providers (n=9, 20%), healthy volunteers (n=4, 9%), a service designer (n=1, 2%), and stakeholders from the multidisciplinary research and development team (n=14, 31%; ie, software developers; digital designers; and eHealth, behavior change, and obesity experts). Stakeholder input on how to operationalize the design features and optimize the technology was examined through formative evaluation and qualitative analyses using rapid and in-depth analysis approaches. Results A total of 17 design features combining PSD principles and BCTs were identified as important to support end user values and needs based on stakeholder input during the design and development of eCHANGE, a digital intervention to support long-term weight loss maintenance. The design features were combined into 4 main intervention components: Week Plan, My Overview, Knowledge and Skills, and Virtual Coach and Smart Feedback System. To support a healthy lifestyle and continued behavior change to maintain weight, PSD principles such as tailoring, personalization, self-monitoring, reminders, rewards, rehearsal, praise, and suggestions were combined and implemented into the design features together with BCTs from the clusters of goals and planning, feedback and monitoring, social support, repetition and substitution, shaping knowledge, natural consequences, associations, antecedents, identity, and self-belief. Conclusions Combining and implementing PSD principles and BCTs in digital interventions aimed at supporting sustainable behavior change may contribute to the design of engaging and motivating interventions in line with end user values and needs. As such, the design and development of the eCHANGE intervention can provide valuable input for future design and tailoring of evidence-informed digital interventions, even beyond digital interventions in support of health behavior change and long-term weight loss maintenance. Trial Registration ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988
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Affiliation(s)
- Rikke Aune Asbjørnsen
- Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
- Research and Innovation Department, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Jøran Hjelmesæth
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Jobke Wentzel
- Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
- Research Group IT Innovations in Health Care, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Marianne Ollivier
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Matthew M Clark
- Department of Psychiatry & Psychology, College of Medicine & Science, Mayo Clinic, Rochester, MN, United States
| | - Julia E W C van Gemert-Pijnen
- Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
- University of Waterloo, Waterloo, ON, Canada
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Psychiatry & Psychology, College of Medicine & Science, Mayo Clinic, Rochester, MN, United States
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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50
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Valli C, Suñol R, Orrego C, Niño de Guzmán E, Strammiello V, Adrion N, Immonen K, Ninov L, van der Gaag M, Ballester M, Alonso‐Coello P. The development of a core outcomes set for self-management interventions for patients living with obesity. Clin Obes 2022; 12:e12489. [PMID: 34617681 PMCID: PMC9285702 DOI: 10.1111/cob.12489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/05/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
Self-management interventions (SMIs) can improve the life of patients living with obesity. However, there is variability in the outcomes used to assess the effectiveness of SMIs and these are often not relevant for patients. In the context of COMPAR-EU, our aim was to develop a core outcome set (COS) for the evaluation of SMIs for patients with obesity. We followed a four steps multimethod approach: (1) the development of the initial catalogue of outcomes; (2) a scoping review of reviews on patients' values and preferences on outcomes of self-management (SM); (3) a Delphi survey including patients and patient representatives to rate the importance of outcomes; and (4) a 2-day consensus workshop with patients, patient representatives, healthcare professionals and researchers. The initial catalogue included 82 outcomes. Ten patients and patient's representatives participated in the Delphi survey. We identified 16 themes through the thematic synthesis of the scoping review that informed 37.80% of the outcomes on initial catalogue. Five patients, five healthcare professionals, and four researchers participated in the consensus workshop. After the consensus process, 15 outcomes were selected to be part of the final COS, and five supplementary outcomes were also provided. We developed a COS for the evaluation of SMIs in obesity with a significant involvement of patients and other key stakeholders. This COS will help improving data synthesis and increasing the value of SM research data in healthcare decision making.
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Affiliation(s)
- Claudia Valli
- Iberoamerican Cochrane Centre Barcelona—Department of Clinical Epidemiology and Public HealthBiomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaSpain
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive MedicineUniversidad Autónoma de BarcelonaBarcelonaSpain
| | - Rosa Suñol
- Universitat Autònoma de BarcelonaBarcelonaSpain
- Avedis Donabedian Research Institute (FAD)Spain
- Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC)BarcelonaSpain
| | - Carola Orrego
- Universitat Autònoma de BarcelonaBarcelonaSpain
- Avedis Donabedian Research Institute (FAD)Spain
- Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC)BarcelonaSpain
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre Barcelona—Department of Clinical Epidemiology and Public HealthBiomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaSpain
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive MedicineUniversidad Autónoma de BarcelonaBarcelonaSpain
- Cancer Prevention and Control ProgrammeCatalan Institute of Oncology, IDIBELL, Hospitalet de LlobregatBarcelonaSpain
| | | | | | | | | | | | - Marta Ballester
- Universitat Autònoma de BarcelonaBarcelonaSpain
- Avedis Donabedian Research Institute (FAD)Spain
- Cancer Prevention and Control ProgrammeCatalan Institute of Oncology, IDIBELL, Hospitalet de LlobregatBarcelonaSpain
| | - Pablo Alonso‐Coello
- Iberoamerican Cochrane Centre Barcelona—Department of Clinical Epidemiology and Public HealthBiomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaSpain
- CIBER de Epidemiología y Salud Pública (CIBERESP), MadridSpain
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