Could Vaping be a New Weapon in the Battle of the Bulge?

Eating Disorder Symptomatology Among Young Adult Cigarette and E-Cigarette Users

Objective: Tobacco use is elevated among individuals with eating disorders (EDs). Yet, further research is needed to understand associations between cigarette and e-cigarette use patterns and ED symptomatology. To gain a more comprehensive understanding of tobacco use and EDs, this study characterized ED symptomatology and tobacco use patterns, including exclusive cigarette use, e-cigarette use, dual use, and nonuse. Method: Young adults aged 18-24 years who self-reported exclusive cigarette, e-cigarette, dual, or nonuse (N = 2500) were recruited via Lucid, an online survey management company. Participants completed questionnaires assessing body dissatisfaction, global ED psychopathology, binge eating and self-induced vomiting frequency, and demographics. ED diagnostic groups included: anorexia nervosa (AN), bulimia spectrum eating disorders (BSED), atypical AN, and night eating syndrome (NES). Results: Multinomial logistic models revealed those with AN were more likely to be dual users, those with atypical AN were more likely to be exclusive e-cigarette users, and participants with a BSED or NES were more likely to be exclusive e-cigarette or dual users, compared to those without an ED. General linear models suggested body dissatisfaction and global ED psychopathology were higher among exclusive e-cigarette and dual users, while binge eating and self-induced vomiting frequencies were greater among all tobacco use groups compared to nonusers. Discussion: Our findings suggest young adults with ED symptomatology were more likely to be users of e-cigarettes exclusively or dual users. It will be necessary to examine how these associations manifest using longitudinal and clinical populations in future research.

Systematic review on e-cigarette and its effects on weight gain and adipocytes

Smoking and obesity are leading causes of morbidity and mortality worldwide. E-cigarette which was first introduced in 2000s is perceived as an effective alternative to conventional tobacco smoking. Limited knowledge is available regarding the risks and benefits of e-cigarettes. This study systematically reviews the current literature on the effects of e-cigarettes on body weight changes and adipocytes. The search was performed using OVID Medline and Scopus databases and studies meeting the inclusion criteria were independently assessed. This review included all English language, empirical quantitative and qualitative papers that investigated the effects of e-cigarettes on bodyweight or lipid accumulation or adipocytes. Literature searches identified 4965 references. After removing duplicates and screening for eligibility, thirteen references which involve human, in vivo and in vitro studies were reviewed and appraised. High prevalence of e-cigarette was reported in majority of the cross sectional studies conducted among respondent who are obese or overweight. More conclusive findings were identified in in vivo studies with e-cigarette causing weight decrease. However, these observations were not supported by in vitro data. Hence, the effect of e-cigarette on body weight changes warrants further investigations. Well-designed population and molecular studies are needed to further elucidate the role of e-cigarettes in obesity.

Outcomes of a culturally informed weight-loss competition for New Zealand Indigenous and Pacific peoples: a quasi-experimental trial

Background

Reducing obesity prevalence among marginalised subgroups with disproportionately high obesity rates is challenging. Given the promise of incentives and group-based programmes we trialled a culturally tailored, team-based weight-loss competition with New Zealand Māori (Indigenous) and Pacific Island people.

Methods

A quasi-experimental 12-months trial was designed. The intervention consisted of three six-months competitions, each with seven teams of seven members. Eligible participants were aged 16 years and older, with a BMI ≥30 kg/m² and being at risk of or already diagnosed with type-2 diabetes or cardiovascular disease. Height, weight and waist circumference were measured at baseline, 6 and 12 months.

Results

Recruitment of a control group (n = 29) versus the intervention (n = 132) was poor and retention rates were low (52 and 27% of intervention participants were followed-up at six and 12 months, respectively). Thus, analysis of the primary outcome of individual percentage weight loss was restricted to the 6-months follow-up data. Although not significant, the intervention group appeared to lose more weight than the control group, in both the intention to treat and complete-case analyses.

Conclusions

The intervention promoted some behaviour change in eating behaviours, and a resulting trend toward a reduction in waist circumference.

Trial registration

ACTRN12617000871347 Registered 15/6/2017 Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-021-00457-9.

Weight Status and Effects of Non-Tobacco Flavors on E-Cigarette Product Appeal

BACKGROUND

Flavors in tobacco products may be salient drivers of tobacco product use among people with overweight or obesity. Yet, whether perceived appeal of e-cigarettes with different flavors varies as a function of weight status is unknown. Purpose: To conduct secondary data analyses of a laboratory experiment to examine whether weight moderates differences in perceived appeal of fruit, menthol, and tobacco flavored e-cigarettes in young adults who vape. Methods: Using a within-subjects experimental design, young adults in Los Angeles, CA, USA. (Mage = 25.36 ± 4.42 Range: 18-35) with normal weight (n = 48) or overweight/obesity (n = 51) were administered standardized doses of e-cigarette solutions varying in flavor (fruit, menthol, tobacco). Following each administration, participants rated the appeal of the solution (range: 0-100). Results: The extent to which menthol (vs. tobacco)-flavored e-cigarettes were rated more appealing was amplified among participants with overweight or obesity versus normal weight participants (flavor × weight interaction Estimate = 7.54, p = .01 95% CI = [2.30, 12.80]). There were no differences in the effects of fruit (vs. tobacco) flavored e-cigarettes on appeal as a function of weight status. Conclusions: Menthol flavors in e-cigarettes may be disproportionately appealing to young adults with overweight and obesity.

Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1899229.

Flavor and product messaging are the two most important drivers of electronic cigarette selection in a choice-based task

Electronic cigarette use-vaping-is increasingly popular. Various product factors may influence an individual's choice of e-cigarette. To provide an evidence base for e-cigarette regulation, a better understanding of the role different product attributes play in product preferences is needed. Here, we used conjoint analysis to quantify different factors that influence e-cigarettes choices, including flavors, nicotine level, customizability, or use of e-cigarettes to manage appetite/food craving. Young adults completed a set of choice-based conjoint tasks online. Choice Based Conjoint analysis (CBC) was used to determine utility scores for each attribute. Young adults (n = 587) who vaped at least once per week were included in analyses; gender differences were explored. Flavor was the most important attribute (48.1%), followed by product messaging (21.0%) and nicotine level (15.3%). Within flavor, confectionery and fruit flavors had the highest utility scores, while classic menthol and tobacco flavors had the lowest. Men and women differed in flavors, nicotine levels, and product messaging that appealed most. Among young adults who vape weekly, flavor is the most important factor in e-cigarette preferences. Gender also factors into e-cigarette preferences, especially for preferred nicotine level. Understanding why individuals choose particular e-cigarette products will help inform public health efforts and policy making.

Perceptions, symptoms, and practices of electronic cigarette users: Descriptive analysis and validation of Arabic short form vaping consequences questionnaire

BACKGROUND

E-cigarette (EC) use is increasing worldwide. Understanding the practices and perceptions of e-cigarette users and profiling the symptoms they experience is essential for regulating the use of such products. This study aims to investigate the practices and perceptions of e-cigarette users in Jordan and examine the symptoms (e.g. respiratory) they associate with e-cigarette use.

METHODS

A cross-sectional online survey was conducted to assess EC use and tobacco smoking behaviors and the corresponding health symptoms among EC users in Jordan. EC use expectancies were also assessed using the Short Form Vaping Consequences Questionnaire, which was first translated into Arabic and tested for validity and reliability.

RESULTS

Out of the 400 EC users surveyed, 95.5% were male, 76.2% used nicotine-containing juice, and 56.8% were concurrent tobacco smokers. Further, the participants had a mean age of 28.9 years (±10.2). Among dual EC/cigarette users, 88.6% reported that they tried to quit cigarette smoking, with e-cigarette use being the most commonly tried method of smoking cessation. The smoking-related symptoms reported by regular cigarette smokers mainly included sputum production (77.5%). The participants reported that using e-cigarettes instead of tobacco cigarettes had led to improvements in their sputum production (60.8%), breathing (59%), and general wellbeing (52%). Pleasant taste, enjoyable taste sensation, and flavor were significantly stronger (P-value < 0.05) among e-cigarette users compared to dual users. Dual EC/cigarette users reported stronger perceptions in the negative consequences scale, particularly with regards to the hazardous effects of smoking on health (P-value < 0.05).

CONCLUSION

Dual daily use of e-cigarettes and regular cigarettes is a common practice among EC users. We recommend that further research is conducted on dual EC/cigarette use and the potential health risks this may have (e.g. higher nicotine intake as compared to the single use of either products).

Cardiometabolic Morbidity and Mortality with Smoking Cessation, Review of Recommendations for People with Diabetes and Obesity

PURPOSE OF REVIEW

Obesity is closely linked with the pathogenesis of type 2 diabetes (T2DM) and cardiovascular disease (CVD), and whilst smoking cessation is associated with weight gain, there are concerns that this weight gain may offset the benefit of CVD risk reduction especially in those with considerable post-cessation weight gain. The aim of this narrative review is to evaluate recent evidence on smoking cessation and cardiometabolic outcomes and discuss limitations of current knowledge and studies.

RECENT FINDINGS

Nicotine is a key player in modulating energy balance by influencing lipid storage in adipose tissue by affecting lipolysis, energy input by modulating appetite and energy output by increasing sympathetic drive and thermogenesis. It also increases insulin resistance and promotes abdominal obesity. The CVD risk and mortality associated with cigarette smoking potentiate the CVD risks in patients with diabetes. Evidence supports the benefit of quitting cigarette smoking regardless of any subsequent weight gain. Data suggests that the cardiometabolic risk is limited to the first few years and that cardiovascular health and mortality benefit of smoking cessation outweighs the harm related to weight gain. This weight gain can be limited by nicotine replacement of which e-cigarettes (vaping) are increasingly popular if it is not an alternative to cigarette smoking. However, long-term health data on e-cigarettes is needed prior to formal recommendation for its use in smoking cessation. The recommendation for cessation of cigarette smoking is justified for those at high risk of weight gain and diabetes. However, for most benefit, consideration should be given for personalized weight management to limit weight gain. Awareness of a 'lean paradox' by which lower weight is associated with increased CVD risk may help to improve motivation and insight into the bias of smoking, health and body composition otherwise known to epidemiologists as the 'obesity paradox'.

Vaping for weight control: Findings from a qualitative study

INTRODUCTION

Smokers have expressed concern about weight gain once they stop smoking and weight gain is a risk factor associated with smoking relapse. Nicotine in e-cigarettes, as well as vaping behaviour, may support smoking cessation by reducing weight gain. This study explored the factors that influence attitudes towards, and awareness of, e-cigarettes and weight control post smoking cessation.

METHODS

Qualitative study involving focus groups with adults in the UK (n = 58) who were either exclusive vapers or dual users.

RESULTS

There was limited awareness and/or inclination to vape to prevent weight gain after stopping smoking. Reasons for this centred on: the health gains of stopping smoking outweighing any potential weight gain; a lack of understanding of the appetite supressing effects of nicotine; a belief that vaping could not suppress appetite like a cigarette and could result in craving for certain flavours; concerns about the longer-term effects of e-cigarettes on health and the ethics of promoting vaping as way to support smoking cessation by limiting weight gain, especially for young women.

CONCLUSION

Participants in this study do not appear inclined to use e-cigarettes to prevent weight gain after smoking cessation. There is a lack of understanding about why nicotine might help prevent weight gain and a concern that e-cigarette flavours could provoke cravings and that vaping may be unsafe in the long-term.

Electronic Cigarette Use and Metabolic Syndrome Development: A Critical Review

The metabolic syndrome is a combination of several metabolic disorders, such as cardiovascular disease, atherosclerosis, and type 2 diabetes. Lifestyle modifications, including quitting smoking, are recommended to reduce the risk of metabolic syndrome and its associated complications. Not much research has been conducted in the field of e-cigarettes and the risk of metabolic syndrome. Furthermore, taking into account the influence of e-cigarettes vaping on the individual components of metabolic syndrome, i.e, abdominal obesity, insulin resistance, dyslipidemia and elevated arterial blood pressure, the results are also ambiguous. This article is a review and summary of existing reports on the impact of e-cigarettes on the development of metabolic syndrome as well as its individual components. A critical review for English language articles published until 30 June 2020 was made, using a PubMed (including MEDLINE), Cochrane, CINAHL Plus, and Web of Science data. The current research indicated that e-cigarettes use does not affect the development of insulin resistance, but could influence the level of glucose and pre-diabetic state development. The lipid of profile an increase in the TG level was reported, while the influence on the level of concentration of total cholesterol, LDL fraction, and HDL fraction differed. In most cases, e-cigarettes use increased the risk of developing abdominal obesity or higher arterial blood pressure. Further research is required to provide more evidence on this topic.

Use of Tobacco for Weight Control across Products among Young Adults in the U.S. Military

BACKGROUND

Approximately 17% of young adults currently use tobacco, most commonly cigarettes and/or electronic cigarettes (e-cigarettes), followed by other products (i.e., cigarillos, pipe/hookah, smokeless tobacco). Cigarettes have been historically used to control weight. Little is known about use of non-cigarette products for weight control, particularly among non-college young adults. Tobacco use in the military is higher than civilians, and personnel have increased motivation for weight control due to military fitness standards. This population might be vulnerable to use tobacco for this purpose. Purpose: Exploring prevalence, as well as demographic and behavioral correlates, of using tobacco products for weight control, among a large, diverse sample of military young adults. Methods: U.S. Air Force recruits (N = 24,543) completed a questionnaire about tobacco use. Among users of tobacco products, recruits reported if they had ever used that product to maintain their weight. Results: Smokeless tobacco was most commonly used for weight control (12.2%), followed by cigarettes (7.3%), e-cigarettes (5.5%), cigarillos (3.3%), and hookah/pipe (3.2%). Using tobacco for weight control was associated with fewer harm beliefs and more regular use of that product. Among e-cigarette users, having a higher BMI and a lower educational background was associated with ever using this product for weight control. Conclusions: The belief that a tobacco product helps control one's weight might increase the prevalence, and frequency of use, of that product among military young adults. Tobacco cessation programs should assess for this motivation of use and provide education about tobacco harm and alternative strategies for weight maintenance.

Perceptions of Smoking and Vaping on Weight Control Among Adult American Indians Who Smoke

Interest in electronic cigarette (EC) use, or vaping, to help control weight is increasing. Many American Indian (AI) populations have a high prevalence of smoking, obesity, and EC use, but their perceptions of EC use for weight control are unknown. In Oklahoma in 2016, 375 AI adults who smoke completed a survey including perceptions about smoking and EC effects on weight control. Only 24% believed that smoking helps control weight, and 8% believed that vaping helps control weight. Perceptions differed by EC use, with ever users more often than never users perceiving that smoking (30% vs 12%, respectively; p < .01) and vaping (10% vs 5%; p = .04) help to control weight. Sex, age group (18-44 years vs 45 + years), education (high school graduate/equivalent vs less than high school), smoking cessation attempt in past year, and likelihood to quit in 6 months were not associated with weight control perceptions for either smoking or vaping. Uncertainty regarding EC effects on weight control was less common among EC ever users compared to never users (41% vs 53%, respectively; p = .04). Most people who did not believe or were uncertain that smoking controls weight also did not believe or were uncertain that vaping controls weight. However, only a minority (29%) of people who believed smoking controls weight also believed that vaping controls weight. Among adult AI who smoke, both smoking and vaping were infrequently perceived as helping to control weight, but such perceptions were reported more frequently among those who ever used ECs.

Vaping for weight control: A cross-sectional population study in England

INTRODUCTION

Concern about weight gain is a barrier to smoking cessation. E-cigarettes may help quitters to control their weight through continued exposure to the appetite-suppressant effects of nicotine and behavioural aspects of vaping. This study explored the views and practices of smokers, ex-smokers and current e-cigarette users relating to vaping and weight control.

METHODS

Cross-sectional survey of past-year smokers (n = 1320), current smokers (n = 1240) and current e-cigarette users (n = 394) in England, conducted April-July 2018. Data were weighted to match the English population on key sociodemographic characteristics.

RESULTS

Of e-cigarette users, 4.6% (95%CI 2.6-6.6) reported vaping for weight control, and 1.9% (95%CI 0.6-3.2) reported vaping to replace meals/snacks. It was rare for individuals who had smoked in the past year to have heard (8.8%, 95%CI 7.3-10.3) or believe (6.4%, 95%CI 5.1-7.7) that vaping could help control weight. Women (OR = 0.62, 95%CI 0.42-0.93) and older people (OR = 0.30, 95%CI 0.13-0.72) were less likely to have heard the claim and women were less likely to believe it (OR = 0.44, 95%CI 0.27-0.72). However, 13.4% (95%CI 11.3-15.5) and 13.1% (95%CI 11.0-15.2) of current smokers who did not use e-cigarettes said they would be more likely to try e-cigarettes or quit smoking, respectively, if vaping could help control their weight.

CONCLUSION

One in 16 English people who have smoked in the last year believe that vaping would prevent weight gain after stopping. One in 22 people who vape are using e-cigarettes for this purpose. However, should evidence emerge that e-cigarettes prevent weight gain, one in eight people who smoke would be tempted to quit smoking and use e-cigarettes.

Adherence to daily dietary and activity goals set within a Māori and Pacific weight loss competition

BACKGROUND

New Zealand Pacific and Māori populations measure disproportionately high on the international body mass index (BMI). Information is needed on what behavioural weight loss goals to recommend and how to attract and retain them in interventions. Our team weight loss competition trial for participants with a BMI ≥30 used cash prizes to incentivise completion of nine daily behaviour goals. This paper evaluates the theoretical merit of and adherence to these goals.

METHODS

A qualitative component evaluation methodology was used. Trial data on team activity, demographics and anthropometric outcome data were extracted to determine frequency of daily goal completion by teams throughout the competition and to describe participant characteristics. T-tests were used to compare completion rates of the challenges, challenge completion by day of week and between weekdays and weekends. To examine adherence to the daily challenge activity over 24 weeks the total amount of completed challenges adjusted for number of active teams was plotted by week. A Body Shape Index (ABSI) was used to determine individual anthropometric change from baseline to 8, 16 and 24 weeks. Program documents were analysed to identify barriers to adherence and retention of participants.

RESULTS

Of 19 teams (N = 130) who began only five teams performed daily goals across the whole 24 weeks. Adherence was highest during the first 8 weeks. No difference in performance between goals was found suggesting they were equally viable, though tasks worth less points were performed more frequently. Goal completion was higher on weekdays. The behaviour goals appeared to have theoretical merit in that more members of high performing teams experienced a positive change in their ABSI.

CONCLUSIONS

Incentives offer a promising strategy for encouraging retention in weight loss interventions. This study suggests that participants in a competition will perform incentivised tasks. The findings however, are limited by missing data and high drop out of individuals and whole teams. Further research is needed on how to increase retention.

A Confirmatory Factor Analysis of the Smoking and Weight Eating Episodes Test (SWEET)

INTRODUCTION

The Smoking and Weight Eating Episodes Test (SWEET; Adams et al. 2011) is a self-report measure designed to assess multiple reasons why and when smokers use cigarettes for appetite, weight, and shape management, that was initially developed and validated in young female smokers.

PURPOSE

The aim of the current study was to evaluate the factor structure and psychometric properties of the SWEET measure among both male and female daily cigarette smokers.

METHOD

Participants (n = 577; M_age = 44.42; SD = 13.80; 52.7% female) were daily smokers recruited through Qualtrics Online Sample for an anonymous study on smoking and health. On average, participants reported smoking for 25.7 years (SD = 14.35), smoked 17.0 cigarettes per day (SD = 8.38), and had moderate levels of tobacco dependence.

RESULTS

Confirmatory factor analyses supported the initial factor structure found in the original SWEET measure suggesting a four-factor structure fit the data well, but not a one-factor structure. Factors included using cigarettes for appetite suppression, using cigarettes to prevent overeating, smoking to cope with body dissatisfaction, and using cigarettes to cope with appetite-related withdrawal symptoms. Tests of measurement invariance revealed no significant differences when evaluating SWEET scores by participant sex. The SWEET factor scores evidenced internal consistency, known groups validity, convergent validity with related constructs (compensatory eating behaviors, tobacco dependence) and cessation-relevant variables (smoking abstinence expectancies, prior withdrawal symptoms), and discriminant validity with physical activity and sedentary behavior.

CONCLUSIONS

The present study provides evidence in support of the validity and reliability of scores on the SWEET as a multidimensional measure of smoking for appetite, weight, and body-related concerns in male and female daily cigarette smokers.

E-cigarettes and Weight Loss-Product Design Innovation Insights From Industry Patents

Objective

There is emerging evidence that e-cigarettes are being used by some to mitigate weight gain after quitting smoking, and being used to help control weight. This study sought to identify and describe patents related to innovations for e-cigarette devices associated and weight loss.

Methods

Relevant patents were identified using Google Patents with the core search terms: "electronic cigarette" OR "e-cigarette" OR "vaporizer" OR "vapourizer" AND "nicotine" AND "weight loss" OR "weight control" OR "obesity" OR "hunger". Patents were reviewed to identify and classify the innovation related to weight loss or weight control.

Results

Our search identified 23 unique patents that were filed between 2004 and 2015. Patent applications were sponsored by individual inventors (n = 7), tobacco companies (n = 5), e-cigarette companies (n = 8), pharmaceutical companies (n = 2) and a cannabis company (n = 1). More than half the patents (n = 12) were filed in the United States; other countries included China, Germany, South Korea, and South Africa. Strategies included using e-cigarette devices to deliver constituents to users that support weight loss through altered metabolism, reduced nutrient absorption, suppressed appetite, or supported healthy behavior change. In most cases (n = 18), the innovations detailed in the patents were intended to be used with an e-cigarette device that delivered nicotine to the user.

Conclusions

Companies from around the world, and from a range of industries are developing and patenting technologies related to e-cigarettes and weight loss. E-cigarettes may be presented to cigarette users as a possible solution to support smoking cessation and address the fear of weight gain.

Implications

This article presents evidence that a range of industries are innovating to design e-cigarettes or constituents to be used with e-cigarettes to deliver a variety of drugs beyond nicotine including weight loss drugs, laxatives, and nutritional supplements. This study may inform surveillance studies to systematically include weight loss as a possible motivation to use e-cigarettes. Further, market surveillance of e-cigarette products needs to monitor ingredients in e-liquids including constituents that have been historically used for weight loss or weight control. Regulations around e-cigarette marketing, promotion, product design including e-liquid constituents need to consider weight loss claims.

The diverging trajectories of cannabis and tobacco policies in the United States: reasons and possible implications

AIM

To examine briefly the (i) rationales for two policy proposals in the United States to make it mandatory for cigarettes to contain very low levels of nicotine and to legalize cannabis for recreational use by adults; and (ii) possible lessons that participants in each policy debate may learn from each other.

METHOD

We briefly describe the diverging policies towards cannabis and tobacco in the United States, explain and critically analyse their rationales and discuss possible policy lessons.

RESULTS

Advocates of cannabis legalization have argued that prohibition has been an ineffective and expensive policy that penalizes ethnic minority users unjustly of a drug that is far less harmful than alcohol. The prohibition of traditional tobacco cigarettes has been advocated as a way to eliminate cigarette smoking. These proposals embody very different attitudes towards the harms of recreational adult drug use. Advocates of nicotine prohibition demand that alternative methods of nicotine delivery must be shown to be completely safe before adults are allowed to use them. Advocates of tobacco prohibition ignore evidence that smokers may not use these products and the likelihood of expanding the illicit tobacco market. Advocates of legalizing and regulating recreational cannabis ignore the need to tax and regulate sales in order to minimize the harms of heavy use.

CONCLUSIONS

It is not clear that the prohibition of adult use has a useful role to play in the regulation of either cannabis or tobacco. If both products remain legal, the goals of regulating tobacco and cannabis products should be to restrict youth access, promote the use of the least harmful products, provide users with evidence-based information on both absolute and differential product risks of use and use differential taxes and marketing controls to promote ways of using these products that cause the least harm to their users.

An innovative team-based weightloss competition to reduce cardiovascular and diabetes risk among Māori and Pacific people: rationale and method for the study and its evaluation

Background

Obesity rates for New Zealand (NZ) Pacific and Māori (NZ indigenous people) are among the highest in the world. Long-term results of weight management programmes for adults have been modest but primarily focused on individuals. This paper describes the rationale and methodology for a trial of a culturally tailored team-based weightloss competition conducted online with community level support.

Methods/Design

A quasi-experimental design was used to compare an intervention and control group. Three six-month competitions with seven teams of seven Māori or Pacific people (N = 147) were run. Eligible participants were: Māori or Pacific, 16 years of age and above, obese (BMI ≥30 kg/m²) and either at risk of or already diagnosed with type 2 diabetes (HbA1c >50 mmol/mol) or cardiovascular disease.

The intervention facilitated group use of an internet-based competition offering financial incentives, education and support. The primary outcome was percentage of individual weight lost at 12-months. Secondary outcomes were percentage reduced total cholesterol and glycated haemoglobin (HbA1c). Data collected at baseline, 6-months and 12-months included: height, body weight, blood lipids and HbA1c, eating and dieting habits, family support, food access, alcohol use, nutrition literacy, activity levels, perceptions of weight, stress and sleep, and, perceived contagion effect. Process evaluation tasks will inform acceptability.

Discussion

An attractive, easy to understand weight change programme that effectively reduces disease risk among Māori and Pacific is desperately needed. Web-based delivered support and information to largely self-directed teams could also ease exponential rises in costs to the health system.

Trial registration

Trial Id: ACTRN12617000871347.