Impact of a male-only weight loss maintenance programme on social-cognitive determinants of physical activity and healthy eating: A randomized controlled trial

Systematic realist synthesis of health-related and lifestyle interventions designed to decrease overweight, obesity and unemployment in adults

Background

Obesity and unemployment are complex social and health issues with underlying causes that are interconnected. While a clear link has been established, there is lack of evidence on the underlying causal pathways and how health-related interventions could reduce obesity and unemployment using a holistic approach.

Objectives

The aim of this realist synthesis was to identify the common strategies used by health-related interventions to reduce obesity, overweight and unemployment and to determine for whom and under what circumstances these interventions were successful or unsuccessful and why.

Methods

A realist synthesis approach was used. Systematic literature searches were conducted in Cochrane library, Medline, SocIndex, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and PsychInfo. The evidence from included studies were synthesised into Context-Mechanism-Outcome configurations (CMOcs) to better understand when and how programmes work, for which participants and to refine the final programme theory.

Results

A total of 83 articles met the inclusion criteria. 8 CMOcs elucidating the contexts of the health-related interventions, underlying mechanisms and outcomes were identified. Interventions that were tailored to the target population using multiple strategies, addressing different aspects of individual and external environments led to positive outcomes for reemployment and reduction of obesity.

Conclusion

This realist synthesis presents a broad array of contexts, mechanisms underlying the success of health-related interventions to reduce obesity and unemployment. It provides novel insights and key factors that influence the success of such interventions and highlights a need for participatory and holistic approaches to maximise the effectiveness of programmes designed to reduce obesity and unemployment.

Trial registration

PROSPERO 2020 CRD42020219897.

The Aussie-FIT process evaluation: feasibility and acceptability of a weight loss intervention for men, delivered in Australian Football League settings

OBJECTIVE

This process evaluation aimed to evaluate the feasibility and acceptability of Aussie-FIT, a group-based weight loss intervention for men with overweight and obesity in Australia.

DESIGN

Process data and data collected from: (1) six-participant focus groups (n= 24), (2) coach interviews (n = 4), (3) audio recordings of Aussie-FIT sessions and (4) post-program participant surveys (n= 93) were analysed.

MAIN OUTCOME MEASURES

We explored the feasibility and acceptability of program setting and context, recruitment strategies, factors impacting implementation and mechanisms of impact.

RESULTS

Recruitment via Australian Football League (AFL) clubs was highly effective; 426 men expressed interest within 3 days of advertising, 130 men took part. Program attendance was not consistently recorded by coaches. Coach interviews indicated a 'core group of men' participated in each session (typically 10-12 of 15 men). Program delivery proved feasible in the AFL context. Program acceptability and satisfaction were high. Internalisation of autonomous motives was identified as driving behaviour change. Behaviour change to support maintained weight loss was facilitated through habit formation, goal setting and effective management of multiple goals.

CONCLUSION

Aussie-FIT sets a blueprint for future weight loss interventions that utilise behaviour change strategies and principles of self-determined motivation to support men to lose weight.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12617000515392.

© 2021 Informa UK Limited, trading as Taylor & Francis Group.

A systematic review of interventions to increase breakfast consumption: a socio-cognitive perspective

OBJECTIVE

Regular breakfast skipping is related to unhealthy dietary behaviours, such as consuming an overall poorer quality diet and lower rates of physical activity, both of which are linked to a higher BMI. Adolescent breakfast skippers struggle with mental focus, sleep issues and lower grades. Solutions that can be implemented to overcome breakfast skipping are needed.

DESIGN

A systematic literature review was undertaken to identify programmes that aimed to increase breakfast eating. Following the PRISMA framework, studies were sourced to examine details of behaviour change, evidence of theory use and other important programme learnings and outcomes.

SETTING

Breakfast consumption empirical studies published from 2000 onwards.

PARTICIPANTS

Nineteen empirical studies that aimed to improve breakfast eating behaviour.

RESULTS

Out of the nineteen studies examined, ten studies reported an increase in breakfast consumption frequency for the entire study group or subgroups. Seven studies found no change, one was inconclusive and one observed a decrease in breakfast frequency. Positive changes to the dietary quality of breakfast were observed in five of the studies that did not observe increased frequency of breakfast consumption. Only six studies reported using theory in the intervention.

CONCLUSIONS

This evidence review points needed to extend theory application to establish a reliable evidence base that can be followed by practitioners seeking to increase breakfast eating rates in their target population.

A gender-sensitised weight-loss and healthy living program for men with overweight and obesity in Australian Football League settings (Aussie-FIT): A pilot randomised controlled trial

BACKGROUND

Recent evidence shows that sport settings can act as a powerful draw to engage men in weight loss. The primary objective of this pilot study was to test the feasibility of delivering and to evaluate preliminary efficacy of Aussie-FIT, a weight-loss program for men with overweight/obesity delivered in Australian Football League (AFL) settings, in preparation for a future definitive trial.

METHODS AND FINDINGS

This 6-month pilot trial took place in Perth, Australia. Participants were overweight/obese (Body Mass Index [BMI] ≥ 28 kg/m2), middle-aged (35-65 years old) men. Participants were recruited in May 2018, and the intervention took place between June and December 2018. The intervention involved 12 weekly 90-min face-to-face sessions, incorporating physical activity, nutrition, and behaviour change information and practical activities delivered by coaches at 2 clubs. Data were collected at baseline and immediately postintervention. For trial feasibility purposes, 6-month follow-ups were completed. Outcomes were differences in weight loss (primary outcome) and recruitment and retention rates, self-reported measures (for example, psychological well-being), device-measured physical activity, waist size, and blood pressure at 3 months. Within 3 days of advertising at each club, 426 men registered interest; 306 (72%) were eligible. Men were selected on a first-come first-served basis (n = 130; M age = 45.8, SD = 8; M BMI = 34.48 kg/m2, SD = 4.87) and randomised by a blinded researcher. Trial retention was 86% and 63% at 3- and 6-month follow-ups (respectively). No adverse events were reported. At 3 months, mean difference in weight between groups, adjusted for baseline weight and group, was 3.3 kg (95% CI 1.9, 4.8) in favour of the intervention group (p < 0.001). The intervention group's moderate-to-vigorous physical activity (MVPA) was higher than the control group by 8.54 min/day (95% CI 1.37, 15.71, p = 0.02). MVPA among men attracted to Aussie-FIT was high at baseline (intervention arm 35.61 min/day, control arm 38.38 min/day), which may have limited the scope for improvement.

CONCLUSIONS

Aussie-FIT was feasible to deliver; participants increased physical activity, decreased weight, and reported improvements in other outcomes. Issues with retention were a limitation of this trial. In a future, fully powered randomised controlled trial (RCT), retention could be improved by conducting assessments outside of holiday seasons.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12617000515392.

Efficacy of a gender-tailored intervention to prevent weight regain in men over 3 years: A weight loss maintenance RCT

OBJECTIVE

To examine whether a gender-tailored weight loss maintenance (WLM) program could reduce men's weight regain following weight loss.

METHODS

Ninety-two men who lost at least 4 kg during a 3-month weight loss phase were randomized to receive: (i) a 6-month WLM program (WL + WLM; n = 47) or (ii) no resources (WL-only; n = 45). The WLM program included written materials and messages (SMS, video email) plus other resources (e.g., pedometer, Gymstick™). The primary outcome was weight change in the first year post-randomization. Participants were assessed at "-3 months" (preweight loss), "0 months" (randomization into the WLM Phase), "6 months," "1 year," and "3 years."

RESULTS

Before randomization, participants lost a mean (SD) of 7.3 kg (2.5). Retention was 83% at 6 months and 1 year and 71% at 3 years. Intention-to-treat analysis detected a significant group × time difference in weight regain favoring the intervention group at 6 months (-1.9 kg, 95% CI -3.7 to -0.1) but not at 1- or 3-year follow-up. Three years after completing the original weight loss program the WL-only and WL + WLM groups had maintained 59% and 51% of their initial weight loss, respectively.

CONCLUSIONS

Men with overweight/obesity demonstrated clinically meaningful WLM 3 years after successfully losing weight. An additional WLM program contributed to enhanced WLM effects in the short term only. (ACTRN12612000749808).

Long-term weight loss maintenance for obesity: a multidisciplinary approach

The long-term weight management of obesity remains a very difficult task, associated with a high risk of failure and weight regain. However, many people report that they have successfully managed weight loss maintenance in the long term. Several factors have been associated with better weight loss maintenance in long-term observational and randomized studies. A few pertain to the behavioral area (eg, high levels of physical activity, eating a low-calorie, low-fat diet; frequent self-monitoring of weight), a few to the cognitive component (eg, reduced disinhibition, satisfaction with results achieved, confidence in being able to lose weight without professional help), and a few to personality traits (eg, low novelty seeking) and patient-therapist interaction. Trials based on the most recent protocols of lifestyle modification, with a prolonged extended treatment after the weight loss phase, have also shown promising long-term weight loss results. These data should stimulate the adoption of a lifestyle modification-based approach for the management of obesity, featuring a nonphysician lifestyle counselor (also called "lifestyle trainer" or "healthy lifestyle practitioner") as a pivotal component of the multidisciplinary team. The obesity physicians maintain a primary role in engaging patients, in team coordination and supervision, in managing the complications associated with obesity and, in selected cases, in the decision for drug treatment or bariatric surgery, as possible more intensive, add-on interventions to lifestyle treatment.