1
|
Kranjac AW, Kranjac D. Explaining adult obesity, severe obesity, and BMI: Five decades of change. Heliyon 2023; 9:e16210. [PMID: 37251838 PMCID: PMC10213181 DOI: 10.1016/j.heliyon.2023.e16210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/31/2023] Open
Abstract
Obesity rates have increased across all segments of society since the late 1970s, but the reason behind population-level increases in body weight remains unclear. We used the 1971-2020 NHANES data to examine whether the observed trend in obesity prevalence is attributable to changing public health behaviors (i.e., intracohort change) or changing publics (i.e., cohort replacement). We partitioned total change in mean BMI, and rates of obesity and severe obesity, into its IC and CR components using linear and algebraic decomposition methods. We found that the IC mechanism (i.e., broad sectors of individuals changing) plays a dominant role in the overall increase in mean BMI, and obesity and severe obesity prevalence. Birth cohort membership (i.e., the CR mechanism) is also influencing mean BMI, and rates of obesity and severe obesity, but in differing ways. Specifically, the large positive IC and the small positive CR effects are amplifying one another, thus creating a steep increase in the observed rates of severe obesity. Conversely, the large positive IC effect is offset by a small negative CR effect, which created a more gradual rise in mean BMI and rates of obesity. Furthermore, we computed total change for models that entered separately sociodemographic, lifestyle, nutritional, and physical activity measures to estimate differences in mean BMI, and rates of obesity and severe obesity, among cohorts and time periods. Adjustment for all the compositional differences among the cohorts during the study period indicate that a combination of a more pronounced IC and a less pronounced CR drove the observed increase in mean BMI, and rates of obesity and severe obesity. Thus, "universal prevention" (i.e., entire community) strategies for healthy weight promotion may need to be combined with "selective prevention" (i.e., at-risk groups) and/or "targeted prevention" (i.e., at-risk individuals) approaches in order to reverse the obesity epidemic.
Collapse
Affiliation(s)
- Ashley W. Kranjac
- Department of Sociology, Wilkinson College, Chapman University, Orange, CA, USA
| | - Dinko Kranjac
- Psychology Program, Institute of Mental Health and Psychological Well-Being, College of Health and Community Well-Being, University of La Verne, La Verne, CA, USA
| |
Collapse
|
2
|
Dean S, Marshall J, Whelan E, Watson J, Zorbas C, Cameron AJ. A Systematic Review of Health Promotion Programs to Improve Nutrition for People with Intellectual Disability. Curr Nutr Rep 2021; 10:255-266. [PMID: 34893970 DOI: 10.1007/s13668-021-00382-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW To investigate the type and effectiveness of health promotion programs designed to improve nutrition for people with intellectual disability. This review also sought to highlight gaps in the evidence by mapping interventions to the socio-ecological model. RECENT FINDINGS To date, reviews on health promotion programs for people with intellectual disability have focused on individualised weight management interventions and behaviour change techniques. No reviews have focused solely on nutrition or considered a broader range of interventions and policies targeted beyond the individual. This review found that health promotion interventions to date were predominantly at the individual level of the socio-ecological model and of varying effectiveness. Of the non-individually focused interventions, those targeting the physical environment or considering multiple socio-ecological levels achieved the greatest improvements in nutrition outcomes. Nutrition and obesity prevention research and policy need to include intellectual disability as part of equity considerations, while intellectual disability policy needs to consider the broader food environment.
Collapse
Affiliation(s)
- Sarah Dean
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Josephine Marshall
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Erin Whelan
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Jo Watson
- Faculty of Health, School of Health and Social Development, Deakin University, Geelong, 3220, Australia
| | - Christina Zorbas
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Adrian J Cameron
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia.
| |
Collapse
|
3
|
Cardoso Barbosa H, de Queiroz Oliveira JA, Moreira da Costa J, de Melo Santos RP, Gonçalves Miranda L, de Carvalho Torres H, Pagano AS, Parreiras Martins MA. Empowerment-oriented strategies to identify behavior change in patients with chronic diseases: An integrative review of the literature. PATIENT EDUCATION AND COUNSELING 2021; 104:689-702. [PMID: 33478854 DOI: 10.1016/j.pec.2021.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/24/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Chronic diseases in the Americas account for about 80 % (5.2 million) of all deaths. Instruments are needed to enhance knowledge, skills, behavior change and self-care attitudes drawing on patient autonomy. OBJECTIVE To identify empowerment-oriented strategies focused on behavioral change in patients with chronic diseases. PATIENT INVOLVEMENT None. METHODS This is an integrative review of articles published from any period until June 2020 by journals indexed in the following databases: National Library of Medicine National Institutes of Health (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Biblioteca Virtual em Saúde (BVS). RESULTS Out of 1,287 articles, 25 met our selection criteria. Reported health interventions were based on self-management and behavior change, shared decisions and a personalized collaborative process, peer support and self-confidence, as well as strategies involving educational media and health literacy. DISCUSSION Over 80 % of health interventions were patient-centered and focused on patient knowledge and skill development towards personal goal setting, including effective problem-solving strategy development. Behavior change is not only an outcome of education, but also implicates revisiting values, attitudes, and experiences. Knowledge is important to facilitate decision-making leading to positive outcomes in chronic disease management. PRACTICAL VALUE Empowerment-oriented strategies are important tools for providing trust and motivation to people with chronic diseases. Healthcare professionals should support and encourage patient empowerment as a strategy for behavior change and able to offer qualified care for shared decision making. Thus, patients will be able to participate more actively in their own health condition management and to make decisions to promote self-care.
Collapse
|
4
|
Chang MW, Tan A, Ling J, Wegener DT, Robbins LB. Mediators of intervention effects on dietary fat intake in low-income overweight or obese women with young children. Appetite 2020; 151:104700. [PMID: 32283187 DOI: 10.1016/j.appet.2020.104700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 02/26/2020] [Accepted: 04/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE We investigated whether autonomous motivation and self-efficacy might mediate the association between a lifestyle behavior intervention and dietary fat intake in low-income overweight or obese women with young children. METHODS Participants were randomized to an intervention or comparison group. Intervention participants received a 16-week intervention aimed to prevent weight gain through promotion of stress management, healthy eating and physical activity. During the intervention phase, participants viewed a designated video lesson at home and dialed in a peer support group teleconference every week (weeks 1-4) then every other week (weeks 5-16). Potential mediation effects were analyzed using sequential mixed-effects linear models and path analysis. RESULTS The intervention led to increased autonomous motivation (β = 0.34, standard error [SE] = 0.15, P = 0.005), which subsequently increased self-efficacy (β = 0.18, SE = 0.35, P < 0.001), and higher levels of self-efficacy were associated with decreased dietary fat intake (β = -0.22, SE = 0.28, P < 0.001). In other words, autonomous motivation and self-efficacy mediated the association between the lifestyle behavior intervention and dietary fat intake. CONCLUSION To decrease dietary fat intake for low-income overweight or obese women with young children, strategies, such as those promoting peer encouragement, may be warranted in interventions to enhance autonomous motivation and/or practical skills for increasing self-efficacy.
Collapse
Affiliation(s)
- Mei-Wei Chang
- The Ohio State University College of Nursing, 1585 Neil Avenue, Columbus, OH, 43210, USA.
| | - Alai Tan
- The Ohio State University College of Nursing, 1585 Neil Avenue, Columbus, OH, 43210, USA
| | - Jiying Ling
- Michigan State University College of Nursing, 1355 Bogue St, East Lansing, MI, 48824, USA.
| | - Duane T Wegener
- The Ohio State University Department of Psychology, 1835 Neil Avenue, Columbus, OH, 43210, USA.
| | - Lorraine B Robbins
- Michigan State University College of Nursing, 1355 Bogue St, East Lansing, MI, 48824, USA.
| |
Collapse
|
5
|
Pearce C, Rychetnik L, Wutzke S, Wilson A. Obesity prevention and the role of hospital and community-based health services: a scoping review. BMC Health Serv Res 2019; 19:453. [PMID: 31277640 PMCID: PMC6612151 DOI: 10.1186/s12913-019-4262-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/14/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Control of obesity is an important priority to reduce the burden of chronic disease. Clinical guidelines focus on the role of primary healthcare in obesity prevention. The purpose of this scoping review is to examine what the published literature indicates about the role of hospital and community based health services in adult obesity prevention in order to map the evidence and identify gaps in existing research. METHODS Databases were searched for articles published in English between 2006 and 2016 and screened against inclusion and exclusion criteria. Further papers were highlighted through a manual search of the reference lists. Included papers evaluated interventions aimed at preventing overweight and obesity in adults that were implemented within and/or by hospital and community health services; were an empirical description of obesity prevention within a health setting or reported health staff perceptions of obesity and obesity prevention. RESULTS The evidence supports screening for obesity of all healthcare patients, combined with referral to appropriate intervention services but indicates that health professionals do not typically adopt this practice. As well as practical issues such as time and resourcing, implementation is impacted by health professionals' views about the causes of obesity and doubts about the benefits of the health sector intervening once someone is already obese. As well as lacking confidence or knowledge about how to integrate prevention into clinical care, health professional judgements about who might benefit from prevention and negative views about effectiveness of prevention hinder the implementation of practice guidelines. This is compounded by an often prevailing view that preventing obesity is a matter of personal responsibility and choice. CONCLUSIONS This review highlights that whilst a population health approach is important to address the complexity of obesity, it is important that the remit of health services is extended beyond medical treatment to incorporate obesity prevention through screening and referral. Further research into the role of health services in obesity prevention should take a systems approach to examine how health service structures, policy and practice interrelationships, and service delivery boundaries, processes and perspectives impact on changing models of care.
Collapse
Affiliation(s)
- Claire Pearce
- The Australian Prevention Partnership Centre, Sydney, NSW Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW Australia
- Canberra Health Services, Canberra, ACT Australia
| | - Lucie Rychetnik
- The Australian Prevention Partnership Centre, Sydney, NSW Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Sonia Wutzke
- The Australian Prevention Partnership Centre, Sydney, NSW Australia
| | - Andrew Wilson
- The Australian Prevention Partnership Centre, Sydney, NSW Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW Australia
| |
Collapse
|
6
|
Balhareth A, Meertens R, Kremers S, Sleddens E. Overweight and obesity among adults in the Gulf States: A systematic literature review of correlates of weight, weight-related behaviours, and interventions. Obes Rev 2019; 20:763-793. [PMID: 30653803 PMCID: PMC6850146 DOI: 10.1111/obr.12826] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/16/2018] [Accepted: 11/27/2018] [Indexed: 12/28/2022]
Abstract
Obesity has increased to an epidemic level in the Gulf States. This systematic review is the first to explore the scientific evidence on correlates and interventions for overweight (body mass index [BMI] ≥ 25) or weight-related behaviours in the region. A systematic search of peer-reviewed articles was conducted using PubMed and PsycINFO. Ninety-one studies were eligible for this review including 84 correlate studies and seven intervention studies. Correlate studies of overweight focused on sociodemographic factors, physical activity, and dietary habits. Low physical activity, sedentary behaviour, and unhealthy dietary habits were associated with overweight. The most-reported sociodemographic correlates of overweight were increased age, being married, low education, urban residence, and unemployment. Correlate studies of physical activity and dietary behaviours mostly focused on sociodemographic variables. Being female and increased age (the latter less consistently) were associated with low physical activity. Interventions were very heterogeneous with respect to the target group, intensity, and behavioural strategies used. The effectiveness of interventions was difficult to evaluate because of the chosen study design or outcome measure, the small sample size, or high attrition rate. Few studies have investigated sociocognitive and environmental determinants of weight-related behaviours. Such information is crucial to developing health promotion initiatives that target those weight-related behaviours.
Collapse
Affiliation(s)
- Abdulaziz Balhareth
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical Center+MaastrichtThe Netherlands
- Department of Health Education and Promotion, Faculty of Public Health and Tropical MedicineJazan UniversityJazanSaudi Arabia
| | - Ree Meertens
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical Center+MaastrichtThe Netherlands
- Department of Health Promotion, CAPHRI Care and Public Health Research InstituteMaastricht University Medical Center+MaastrichtThe Netherlands
| | - Stef Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical Center+MaastrichtThe Netherlands
| | - Ester Sleddens
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical Center+MaastrichtThe Netherlands
| |
Collapse
|
7
|
Yang L, Zhao Y, Pan Y, Li D, Zheng G. Dietary supplement of Smilax china L. ethanol extract alleviates the lipid accumulation by activating AMPK pathways in high-fat diet fed mice. Nutr Metab (Lond) 2019; 16:6. [PMID: 30679938 PMCID: PMC6341655 DOI: 10.1186/s12986-019-0333-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 01/07/2019] [Indexed: 01/21/2023] Open
Abstract
Background Obesity has become a public health concern worldwide because it is linked to numerous metabolic disorders, such as hyperlipidemia, hypertension and cardiovascular disease. Therefore, there is an urgent need to develop new therapeutic strategies that are efficacious and have minimal side effects in obesity treatment. This study examined the effect of dietary supplement of Smilax china L. ethanol extract (SCLE) on high-fat diet (HFD) induced obesity. Methods Fifty ICR mice were fed a normal diet, high-fat diet (HFD) or HFD supplemented with 0.25, 0.5% or 1% SCLE for 8 weeks. Body weight, intraperitioneal adipose tissue (IPAT) weight, serum biochemical parameters, and liver lipids were measured. Activity, mRNA and protein expressions of lipid metabolism-related enzymes were analyzed. Results Over 0.5% SCLE had reduced cholesterol biosynthesis by the activation of AMP-activated protein kinase (AMPK), which subsequently suppressed the mRNA expression of both sterol regulatory element binding protein-2 and 3-hydroxy-3-methyl-glutaryl-CoA reductase. Thus, the plasma and liver cholesterol concentrations in the HFD-fed mice were decreased. AMPK activation caused by SCLE also significantly upregulated lipolysis by enhancing adipose triglyceride lipase and hormone-sensitive lipase activities. This accelerated triglyceride hydrolysis and fatty acid release. Finally, SCLE increased carnitine palmitoyltransferase 1 and acyl-CoA oxidase activities, which further promoted fatty acid β-oxidation. Conclusion SCLE could lead to a decrease in body weight gain and fat mass by inhibiting the lipid synthesis and promoting lipolysis and β-oxidation in HFD fed mice. The underlying mechanism is probably associated with regulating AMPK pathway.
Collapse
Affiliation(s)
- Licong Yang
- Jiangxi Key Laboratory of Natural Product and Functional Food, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang, 330045 China
| | - Yan Zhao
- Jiangxi Key Laboratory of Natural Product and Functional Food, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang, 330045 China
| | - Yongfang Pan
- Jiangxi Key Laboratory of Natural Product and Functional Food, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang, 330045 China
| | - Dongming Li
- Jiangxi Key Laboratory of Natural Product and Functional Food, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang, 330045 China
| | - Guodong Zheng
- Jiangxi Key Laboratory of Natural Product and Functional Food, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang, 330045 China
| |
Collapse
|
8
|
Verjans-Janssen SRB, van de Kolk I, Van Kann DHH, Kremers SPJ, Gerards SMPL. Effectiveness of school-based physical activity and nutrition interventions with direct parental involvement on children's BMI and energy balance-related behaviors - A systematic review. PLoS One 2018; 13:e0204560. [PMID: 30261057 PMCID: PMC6160096 DOI: 10.1371/journal.pone.0204560] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/16/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The aims of this systematic review were to study the effectiveness of primary school-based physical activity, sedentary behavior and nutrition interventions with direct parental involvement on children's BMI or BMI z-score, physical activity, sedentary behavior and nutrition behavior and categorize intervention components into targeted socio-cognitive determinants and environmental types using the Environmental Research framework for weight Gain prevention. METHODS In March 2018, a systematic search was conducted in four electronic literature databases. Articles written in English about effectiveness studies on school-based interventions with direct parental involvement targeting 4-12 year olds were included. Interventions with indirect parental involvement, interventions not targeting the school environment, and pilot studies were excluded. Study and intervention characteristics were extracted. Study quality and study effectiveness were assessed and effect sizes (Cohen's d) were calculated for the outcome measures. Types of socio-cognitive factors and environmental types targeted were distinguished. RESULTS In total, 25 studies were included. Most studies on BMI or BMI z-score, physical activity and sedentary behavior found favorable results: 61.1%, 81.1% and 75%, respectively. Results regarding nutrition behavior were inconclusive. Methodological study quality varied. All interventions targeted multiple environmental types in the school and family environment. Five targeted socio-cognitive determinants (knowledge, awareness, attitude, self-efficacy and intrinsic motivation) of the children were identified. No consistent pattern was found between either type of environment targeted, number of type of environment targeted, or the child's targeted socio-cognitive determinants and intervention effectiveness. DISCUSSION School-based interventions with direct parental involvement have the potential to improve children's weight status, physical activity and sedentary behavior. Based on the results, it is recommended that school-based interventions with direct parental involvement target more than one EBRB, last at least one year, and focus particularly on the physical and social environment within both the school and the family environment.
Collapse
Affiliation(s)
- Sacha R. B. Verjans-Janssen
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Ilona van de Kolk
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Dave H. H. Van Kann
- School of Sport Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Stef P. J. Kremers
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Sanne M. P. L. Gerards
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
9
|
Mateo KF, Berner NB, Ricci NL, Seekaew P, Sikerwar S, Tenner C, Dognin J, Sherman SE, Kalet A, Jay M. Development of a 5As-based technology-assisted weight management intervention for veterans in primary care. BMC Health Serv Res 2018; 18:47. [PMID: 29378584 PMCID: PMC5789563 DOI: 10.1186/s12913-018-2834-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/09/2018] [Indexed: 12/04/2022] Open
Abstract
Background Obesity is a worldwide epidemic, and its prevalence is higher among Veterans in the United States. Based on our prior research, primary care teams at a Veterans Affairs (VA) hospital do not feel well-equipped to deliver effective weight management counseling and often lack sufficient time. Further, effective and intensive lifestyle-based weight management programs (e.g. VA MOVE! program) are underutilized despite implementation of systematic screening and referral at all VA sites. The 5As behavior change model (Assess, Advise, Agree, Assist, Arrange) is endorsed by the United States Preventive Service Task Force for use in counseling patients about weight management in primary care and reimbursed by Medicare. In this paper, we describe the iterative development of a technology-assisted intervention designed to provide primary care-based 5As counseling within Patient-Centered Medical Homes without overburdening providers/healthcare teams. Methods Thematic analyses of prior formative work (focus groups with patients [n = 54] and key informant interviews with staff [n = 25]) helped to create a technology-assisted, health coaching intervention called Goals for Eating and Moving (GEM). To further develop the intervention, we then conducted two rounds of testing with previous formative study participants (n = 5 for Round 1, n = 5 for Round 2). Each session included usability testing of prototypes of the online GEM tool, pilot testing of 5As counseling by a Health Coach, and a post-session open-ended interview. Results Three main themes emerged from usability data analyses: participants’ emotional responses, tool language, and health literacy. Findings from both rounds of usability testing, pilot testing, as well as the open-ended interview data, were used to finalize protocols for the full intervention in the clinic setting to be conducted with Version 3 of the GEM tool. Conclusions The use of qualitative research methods and user-centered design approaches enabled timely detection of salient issues to make iterative improvements to the intervention. Future studies will determine whether this intervention can increase enrollment in intensive weight management programs and promote clinically meaningful weight loss in both Veterans and in other patient populations and health systems.
Collapse
Affiliation(s)
- Katrina F Mateo
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Natalie B Berner
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Natalie L Ricci
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Pich Seekaew
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Sandeep Sikerwar
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Craig Tenner
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Joanna Dognin
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Scott E Sherman
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA.,New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Adina Kalet
- New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Melanie Jay
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA. .,New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.
| |
Collapse
|
10
|
Kozica SL, Lombard CB, Harrison CL, Teede HJ. Evaluation of a large healthy lifestyle program: informing program implementation and scale-up in the prevention of obesity. Implement Sci 2016; 11:151. [PMID: 27881146 PMCID: PMC5121947 DOI: 10.1186/s13012-016-0521-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/14/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The Healthy Lifestyle Program for women (HeLP-her) is a low-intensity, self-management program which has demonstrated efficacy in preventing excess weight gain in women. However, little is known about the implementation, reach, and sustainability of low-intensity prevention programs in rural settings, where risk for obesity in women is higher than urban settings. We aimed to evaluate a low-intensity healthy lifestyle program delivered to women in a rural setting to inform development of effective community prevention programs. METHODS A mixed method hybrid implementation and evaluation study, guided by the RE-AIM framework (addressing the Reach, Effectiveness, Adoption, Implementation, and Maintenance), was undertaken. Data collection tools included anthropometric measures, program checklists, questionnaires, and semi-structured interviews with participants and local stakeholders. The RE-AIM self-audit tool was applied to assess evaluation rigor. RESULTS Six hundred and forty-nine women from 41 relatively socio-economic disadvantaged communities in Australia participated: mean age 39.6 years (±SD 6.7) and body mass index of 28.8 kg/m2 (±SD 6.9). A between-group weight difference of -0.92 kg (95% CI -1.67 to -0.16) showed program effectiveness. Reach was broad across 41 towns with 62% of participants reporting influencing some of the health behaviors of their families. Strong implementation fidelity was achieved with good retention rates at 1 year (76%) and high participant satisfaction (82% of participants willing to recommend this program). Over 300 multi-level community partnerships were established supporting high adoption. Stakeholders reported potential capacity to implement and sustain the prevention program in resource poor rural settings, due to the low-intensity design and minimal resources required. CONCLUSIONS Our comprehensive RE-AIM evaluation demonstrates that an evidence-based obesity prevention program can be successfully implemented in real-world settings. The program achieved broad reach, effectiveness, and satisfaction at the community and stakeholder level, revealing potential for program sustainability. The evaluation addressed implementation knowledge gaps to support future obesity prevention program scale-up. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry ACTRN 12612000115831 [ http://www.anzctr.org.au/ ].
Collapse
Affiliation(s)
- S L Kozica
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Monash Medical Centre, Clayton, Victoria, 3168, Australia
| | - C B Lombard
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Monash Medical Centre, Clayton, Victoria, 3168, Australia
| | - C L Harrison
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Monash Medical Centre, Clayton, Victoria, 3168, Australia
| | - H J Teede
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Monash Medical Centre, Clayton, Victoria, 3168, Australia.
- Endocrinology and Diabetes Unit Monash Health, Clayton, Victoria, Australia.
| |
Collapse
|
11
|
Melendez-Torres GJ, O'Mara-Eves A, Thomas J, Brunton G, Caird J, Petticrew M. Interpretive analysis of 85 systematic reviews suggests that narrative syntheses and meta-analyses are incommensurate in argumentation. Res Synth Methods 2016; 8:109-118. [PMID: 27860329 PMCID: PMC5347877 DOI: 10.1002/jrsm.1231] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 09/06/2016] [Accepted: 10/07/2016] [Indexed: 11/17/2022]
Abstract
Using Toulmin's argumentation theory, we analysed the texts of systematic reviews in the area of workplace health promotion to explore differences in the modes of reasoning embedded in reports of narrative synthesis as compared with reports of meta‐analysis. We used framework synthesis, grounded theory and cross‐case analysis methods to analyse 85 systematic reviews addressing intervention effectiveness in workplace health promotion. Two core categories, or ‘modes of reasoning’, emerged to frame the contrast between narrative synthesis and meta‐analysis: practical–configurational reasoning in narrative synthesis (‘what is going on here? What picture emerges?’) and inferential–predictive reasoning in meta‐analysis (‘does it work, and how well? Will it work again?’). Modes of reasoning examined quality and consistency of the included evidence differently. Meta‐analyses clearly distinguished between warrant and claim, whereas narrative syntheses often presented joint warrant–claims. Narrative syntheses and meta‐analyses represent different modes of reasoning. Systematic reviewers are likely to be addressing research questions in different ways with each method. It is important to consider narrative synthesis in its own right as a method and to develop specific quality criteria and understandings of how it is carried out, not merely as a complement to, or second‐best option for, meta‐analysis. © 2016 The Authors. Research Synthesis Methods published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- G J Melendez-Torres
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - A O'Mara-Eves
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, UK
| | - J Thomas
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, UK
| | - G Brunton
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, UK
| | - J Caird
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, UK
| | - M Petticrew
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
12
|
Olson R, Wipfli B, Thompson SV, Elliot DL, Anger WK, Bodner T, Hammer LB, Perrin NA. Weight Control Intervention for Truck Drivers: The SHIFT Randomized Controlled Trial, United States. Am J Public Health 2016; 106:1698-706. [PMID: 27463067 DOI: 10.2105/ajph.2016.303262] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of the Safety and Health Involvement For Truckers (SHIFT) intervention with a randomized controlled design. METHODS The multicomponent intervention was a weight-loss competition supported with body weight and behavioral self-monitoring, computer-based training, and motivational interviewing. We evaluated intervention effectiveness with a cluster-randomized design involving 22 terminals from 5 companies in the United States in 2012 to 2014. Companies were required to provide interstate transportation services and operate at least 2 larger terminals. We randomly assigned terminals to intervention or usual practice control conditions. We assessed participating drivers (n = 452) at baseline and 6 months. RESULTS In an intent-to-treat analysis, the postintervention difference between groups in mean body mass index change was 1.00 kilograms per meters squared (P < .001; intervention = -0.73; control = +0.27). Behavioral changes included statistically significant improvements in fruit and vegetable consumption and physical activity. CONCLUSIONS Results establish the effectiveness of a multicomponent and remotely administered intervention for producing significant weight loss among commercial truck drivers.
Collapse
Affiliation(s)
- Ryan Olson
- Ryan Olson, Brad Wipfli, Sharon V. Thompson, W. Kent Anger and Leslie B. Hammer are with Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland. Todd Bodner is with the Department of Psychology, Portland State University, Portland. Diane L. Elliot is with Division of Health Promotion and Sports Medicine, OHSU. Nancy A. Perrin is with Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Brad Wipfli
- Ryan Olson, Brad Wipfli, Sharon V. Thompson, W. Kent Anger and Leslie B. Hammer are with Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland. Todd Bodner is with the Department of Psychology, Portland State University, Portland. Diane L. Elliot is with Division of Health Promotion and Sports Medicine, OHSU. Nancy A. Perrin is with Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sharon V Thompson
- Ryan Olson, Brad Wipfli, Sharon V. Thompson, W. Kent Anger and Leslie B. Hammer are with Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland. Todd Bodner is with the Department of Psychology, Portland State University, Portland. Diane L. Elliot is with Division of Health Promotion and Sports Medicine, OHSU. Nancy A. Perrin is with Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Diane L Elliot
- Ryan Olson, Brad Wipfli, Sharon V. Thompson, W. Kent Anger and Leslie B. Hammer are with Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland. Todd Bodner is with the Department of Psychology, Portland State University, Portland. Diane L. Elliot is with Division of Health Promotion and Sports Medicine, OHSU. Nancy A. Perrin is with Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - W Kent Anger
- Ryan Olson, Brad Wipfli, Sharon V. Thompson, W. Kent Anger and Leslie B. Hammer are with Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland. Todd Bodner is with the Department of Psychology, Portland State University, Portland. Diane L. Elliot is with Division of Health Promotion and Sports Medicine, OHSU. Nancy A. Perrin is with Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Todd Bodner
- Ryan Olson, Brad Wipfli, Sharon V. Thompson, W. Kent Anger and Leslie B. Hammer are with Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland. Todd Bodner is with the Department of Psychology, Portland State University, Portland. Diane L. Elliot is with Division of Health Promotion and Sports Medicine, OHSU. Nancy A. Perrin is with Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Leslie B Hammer
- Ryan Olson, Brad Wipfli, Sharon V. Thompson, W. Kent Anger and Leslie B. Hammer are with Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland. Todd Bodner is with the Department of Psychology, Portland State University, Portland. Diane L. Elliot is with Division of Health Promotion and Sports Medicine, OHSU. Nancy A. Perrin is with Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Nancy A Perrin
- Ryan Olson, Brad Wipfli, Sharon V. Thompson, W. Kent Anger and Leslie B. Hammer are with Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland. Todd Bodner is with the Department of Psychology, Portland State University, Portland. Diane L. Elliot is with Division of Health Promotion and Sports Medicine, OHSU. Nancy A. Perrin is with Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| |
Collapse
|
13
|
Brennan L, Murphy KD, de la Piedad Garcia X, Ellis ME, Metzendorf MI, McKenzie JE. Psychological interventions for adults who are overweight or obese. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Leah Brennan
- Australian Catholic University; School of Psychology; The Daniel Mannix Building, Young Street, Fitzroy Melbourne Victoria Australia 3065
| | - Kylie D Murphy
- Monash University; Centre for Obesity Research and Education; Level 6, The Alfred Centre, 99 Commercial Road Melbourne Victoria Australia 3004
| | - Xochitl de la Piedad Garcia
- Australian Catholic University; School of Psychology; The Daniel Mannix Building, Young Street, Fitzroy Melbourne Victoria Australia 3065
| | - Miriam E Ellis
- Australian Catholic University; School of Psychology; The Daniel Mannix Building, Young Street, Fitzroy Melbourne Victoria Australia 3065
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf; Cochrane Metabolic and Endocrine Disorders Group; Moorenstr. 5 Düsseldorf Germany 40225
| | - Joanne E McKenzie
- Monash University; School of Public Health & Preventive Medicine; Level 1, 549 St Kilda Road Melbourne Victoria Australia 3004
| |
Collapse
|
14
|
Emodin improves lipid and glucose metabolism in high fat diet-induced obese mice through regulating SREBP pathway. Eur J Pharmacol 2015; 770:99-109. [PMID: 26626587 DOI: 10.1016/j.ejphar.2015.11.045] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 11/17/2015] [Accepted: 11/23/2015] [Indexed: 12/17/2022]
Abstract
Currently, obesity has become a worldwide epidemic associated with Type 2 diabetes, dyslipidemia, cardiovascular disease and chronic metabolic diseases. Emodin is one of the active anthraquinone derivatives from Rheum palmatum and some other Chinese herbs with anti-inflammatory, anticancer and hepatoprotective properties. In the present study, we investigated the anti-obesity effects of emodin in obese mice and explore its potential pharmacological mechanisms. Male C57BL/6 mice were fed with high-fat diet for 12 weeks to induce obesity. Then the obese mice were divided into four groups randomly, HFD or emodin (40mg/kg/day and 80mg/kg/day) or lovastatin (30mg/kg/ day) for another 6 weeks. Body weight and food intake were recorded every week. At the end of the treatment, the fasting blood glucose, glucose and insulin tolerance test, serum and hepatic lipid levels were assayed. The gene expressions of liver and adipose tissues were analyzed with a quantitative PCR assay. Here, we found that emodin inhibited sterol regulatory element-binding proteins (SREBPs) transactivity in huh7 cell line. Furthermore, emodin (80mg/kg/day) treatment blocked body weight gain, decreased blood lipids, hepatic cholesterol and triglyceride content, ameliorated insulin sensitivity, and reduced the size of white and brown adipocytes. Consistently, SREBP-1 and SREBP-2 mRNA levels were significantly reduced in the liver and adipose tissue after emodin treatment. These data demonstrated that emodin could improve high-fat diet-induced obesity and associated metabolic disturbances. The underlying mechanism is probably associated with regulating SREBP pathway.
Collapse
|
15
|
Donaldson EA, Cohen JE, Truant PL, Rutkow L, Kanarek NF, Barry CL. News Media Framing of New York City's Sugar-Sweetened Beverage Portion-Size Cap. Am J Public Health 2015; 105:2202-9. [PMID: 26378853 DOI: 10.2105/ajph.2015.302673] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed news media framing of New York City's proposed regulation to prohibit the sale of sugar-sweetened beverages greater than 16 ounces. METHODS We conducted a quantitative content analysis of print and television news from within and outside New York City media markets. We examined support for and opposition to the portion-size cap in the news coverage from its May 31, 2012, proposal through the appellate court ruling on July 31, 2013. RESULTS News coverage corresponded to key events in the policy's evolution. Although most stories mentioned obesity as a problem, a larger proportion used opposing frames (84%) than pro-policy frames (36%). Mention of pro-policy frames shifted toward the policy's effect on special populations. The debate's most prominent frame was the opposing frame that the policy was beyond the government's role (69%). CONCLUSIONS News coverage within and outside the New York City media market was more likely to mention arguments in opposition to than in support of the portion-size cap. Understanding how the news media framed this issue provides important insights for advocates interested in advancing similar measures in other jurisdictions.
Collapse
Affiliation(s)
- Elisabeth A Donaldson
- Elisabeth A. Donaldson is a PhD candidate with the Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Joanna E. Cohen is with the Department of Health, Behavior and Society, and the Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University. Patricia L. Truant, Lainie Rutkow, and Colleen L. Barry are with the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University. Norma F. Kanarek is with the Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University
| | - Joanna E Cohen
- Elisabeth A. Donaldson is a PhD candidate with the Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Joanna E. Cohen is with the Department of Health, Behavior and Society, and the Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University. Patricia L. Truant, Lainie Rutkow, and Colleen L. Barry are with the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University. Norma F. Kanarek is with the Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University
| | - Patricia L Truant
- Elisabeth A. Donaldson is a PhD candidate with the Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Joanna E. Cohen is with the Department of Health, Behavior and Society, and the Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University. Patricia L. Truant, Lainie Rutkow, and Colleen L. Barry are with the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University. Norma F. Kanarek is with the Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University
| | - Lainie Rutkow
- Elisabeth A. Donaldson is a PhD candidate with the Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Joanna E. Cohen is with the Department of Health, Behavior and Society, and the Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University. Patricia L. Truant, Lainie Rutkow, and Colleen L. Barry are with the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University. Norma F. Kanarek is with the Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University
| | - Norma F Kanarek
- Elisabeth A. Donaldson is a PhD candidate with the Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Joanna E. Cohen is with the Department of Health, Behavior and Society, and the Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University. Patricia L. Truant, Lainie Rutkow, and Colleen L. Barry are with the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University. Norma F. Kanarek is with the Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University
| | - Colleen L Barry
- Elisabeth A. Donaldson is a PhD candidate with the Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Joanna E. Cohen is with the Department of Health, Behavior and Society, and the Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University. Patricia L. Truant, Lainie Rutkow, and Colleen L. Barry are with the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University. Norma F. Kanarek is with the Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University
| |
Collapse
|
16
|
Speed of eating and 3-year BMI change: a nationwide prospective study of mid-age women. Public Health Nutr 2015; 19:463-9. [DOI: 10.1017/s1368980015001548] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo conduct the first nationwide population survey to examine the associations between changes in speed of eating and weight gain over 3 years. The study also explored whether faster eating at baseline was related to healthy-weight women becoming overweight after 3 years.DesignLongitudinal. At baseline, participants were randomly selected from a nationally representative sampling frame to participate in a prospective study. Women completed self-administered baseline questionnaires on demographic and health measures. Self-reported speed of eating, smoking status, physical activity, menopause status, and height and weight were collected at baseline and again 3 years later.SettingNationwide study, New Zealand.SubjectsWomen (n 1601) aged 40–50 years were recruited at baseline from New Zealand electoral rolls.ResultsThere was no evidence of associations between 3-year BMI adjusting for baseline BMI and either baseline speed of eating (slower and faster; P=0·524) or change in speed of eating (consistently faster eating, consistently slower eating, slower eating at baseline but not at 3 years, faster eating at baseline but not at 3 years; P=0·845). Of the 488 women with healthy BMI (18·5 to <25·0 kg/m2) at baseline, seventy-seven (15·8 %) became overweight (BMI≥25·0 kg/m2) after 3 years. Compared with those who were slower eaters at baseline, faster eating at baseline did not increase the risk of becoming overweight 3 years later (P=0·958) nor did change in speed of eating (P=0·236).ConclusionsResults suggest that once women have reached mid-life, faster eating does not predict further weight gain.
Collapse
|
17
|
Donaldson EA, Cohen JE, Villanti AC, Kanarek NF, Barry CL, Rutkow L. Patterns and predictors of state adult obesity prevention legislation enactment in US states: 2010-2013. Prev Med 2015; 74:117-22. [PMID: 25735604 PMCID: PMC4422336 DOI: 10.1016/j.ypmed.2015.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/20/2015] [Accepted: 02/21/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study examined bill- and state-level factors associated with enactment of adult obesity prevention legislation in US states. METHODS A review of bills in the Rudd Center for Food Policy and Obesity's legislative database identified 487 adult obesity prevention bills, or proposed legislation, introduced between 2010 and 2013. Multilevel models were constructed to examine bill- and state-level characteristics associated with enactment. RESULTS From 2010 to 2013, 81 (17%) of obesity prevention bills introduced were enacted across 35 states and the District of Columbia. Bills introduced in 2010 were more likely to be enacted than in 2013 (OR=9.49; 95% CI: 2.61-34.5). Bills focused on access to healthy food, physical activity, general and educational programs, as well as modifying rules and procedures (e.g., preemption) had greater odds of enactment relative to food and beverage taxes (OR=8.18; 95% CI: 2.85-23.4 healthy food; OR=17.3; 95% CI: 4.55-65.7 physical activity; OR=15.2; 95% CI: 4.80-47.9 general; OR=13.7; 95% CI: 3.07-61.5 rules). CONCLUSION The year of bill introduction and overall bill enactment rate were related to adult obesity prevention legislation enactment in states. This study highlights the importance of a bill's topic area for enactment and provides insights for advocates and policymakers trying to address enactment barriers.
Collapse
Affiliation(s)
- Elisabeth A Donaldson
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, United States.
| | - Joanna E Cohen
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, United States; Institute for Global Tobacco Control, Baltimore, MD, United States
| | - Andrea C Villanti
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, United States; Schroeder Institute for Tobacco Research and Policy Studies, Washington, DC, United States
| | - Norma F Kanarek
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Colleen L Barry
- Department of Health, Policy, & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lainie Rutkow
- Department of Health, Policy, & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| |
Collapse
|
18
|
Coffield E, Nihiser AJ, Sherry B, Economos CD. Shape Up Somerville: change in parent body mass indexes during a child-targeted, community-based environmental change intervention. Am J Public Health 2015; 105:e83-9. [PMID: 25521882 DOI: 10.2105/ajph.2014.302361] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated the body mass index (BMI; weight in pounds/[height in inches](2) × 703) of parents whose children participated in Shape Up Somerville (SUS), a community-based participatory research study that altered household, school, and community environments to prevent and reduce childhood obesity. METHODS SUS was a nonrandomized controlled trial with 30 participating elementary schools in 3 Massachusetts communities that occurred from 2002 to 2005. It included first-, second-, and third-grade children. We used an inverse probability weighting estimator adjusted for clustering effects to isolate the influence of SUS on parent (n=478) BMI. The model's dependent variable was the change in pre- and postintervention parent BMI. RESULTS SUS was significantly associated with decreases in parent BMIs. SUS decreased treatment parents' BMIs by 0.411 points (95% confidence interval=-0.725, -0.097) relative to control parents. CONCLUSIONS The benefits of a community-based environmental change childhood obesity intervention can spill over to parents, resulting in decreased parental BMI. Further research is warranted to examine the effects of this type of intervention on parental health behaviors and health outcomes.
Collapse
Affiliation(s)
- Edward Coffield
- Edward Coffield, Allison J. Nihiser, and Bettylou Sherry are with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Christina D. Economos is with the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | | | | |
Collapse
|
19
|
Kozica S, Lombard C, Teede H, Ilic D, Murphy K, Harrison C. Initiating and continuing behaviour change within a weight gain prevention trial: a qualitative investigation. PLoS One 2015; 10:e0119773. [PMID: 25875943 PMCID: PMC4398548 DOI: 10.1371/journal.pone.0119773] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/01/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Preventing obesity is an international health priority. In Australia, young women who live in rural communities are at high risk of unhealthy weight gain. Interventions which engage young women and support sustainable behaviour change are needed and comprehensive evaluation of such interventions generates knowledge for population scale-up. This qualitative sub-study aims to identify enablers and barriers to behaviour change initiation and continuation within a community weight gain prevention program. METHODS In-depth semi-structured interviews were conducted with program participants 6 months after baseline. All interviews were audio-taped and transcribed verbatim. Transcripts were analysed independently by two investigators via thematic analysis. PARTICIPANTS A total of 28 women with a mean age of 39.9±6.2years and a BMI of 28.6±5.2kg/m2 were purposively recruited from the larger cohort (n = 649) that participated in the prevention trial. RESULTS Four behaviour change groups emerged were identified from participant interviews: (i) no change, (ii) relapse, (iii) intermittent and (iv) continued change. Factors influencing behaviour change initiation and continuation included realistic program expectations and the participant's ability to apply the core program elements including: setting small, achievable behaviour change goals, problem solving and using self-management techniques. Personal knowledge, skills, motivation, self-efficacy, accountability and perceived social and environmental barriers also affected behaviour change. Satisfaction with personal program progress and the perceived amount of program supports required to achieve ongoing behaviour change varied amongst participants. Women who relapsed expressed a desire for more intensive and regular support from health professionals, identified more barriers unrelated to the program, anticipated significant weight loss and had lower satisfaction with their progress. CONCLUSION Initiating and continuing behaviour change is a complex process. Our findings elucidate that initiation and continuation of behaviour change in women undertaking a weight gain prevention program may be facilitated by accurate and realistic understanding of program expectation, the ability to apply the core program messages, higher internal motivation, self-efficacy and minimal social and environmental barriers. TRIAL REGISTRATION Australia & New Zealand Clinical Trial Registry ACTRN12612000115831 www.anzctr.org.au.
Collapse
Affiliation(s)
- Samantha Kozica
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Clayton, 3168, Victoria, Australia
| | - Catherine Lombard
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Clayton, 3168, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Clayton, 3168, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, 3168, Victoria, Australia
| | - Dragan Ilic
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
| | - Kerry Murphy
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
| | - Cheryce Harrison
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Clayton, 3168, Victoria, Australia
- * E-mail:
| |
Collapse
|
20
|
Ammer E, Nietzsche S, Rien C, Kühnl A, Mader T, Heller R, Sauerbrei A, Henke A. The anti-obesity drug orlistat reveals anti-viral activity. Med Microbiol Immunol 2015; 204:635-45. [DOI: 10.1007/s00430-015-0391-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/06/2015] [Indexed: 12/28/2022]
|
21
|
ANGULO RAÚL. Aproximaciones cualitativas al estudio de obesidad: Nuevas contribuciones a la comprensión de la nutrición humana. REVISTA DE LA FACULTAD DE MEDICINA 2015. [DOI: 10.15446/revfacmed.v62n3sup.44354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
22
|
Miedema B, Reading SA, Hamilton RA, Morrison KS, Thompson AE. Can certified health professionals treat obesity in a community-based programme? A quasi-experimental study. BMJ Open 2015; 5:e006650. [PMID: 25652801 PMCID: PMC4322212 DOI: 10.1136/bmjopen-2014-006650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To test the effectiveness of a non-pharmaceutical programme for obese participants in a rural Eastern Canadian Province using certified health professionals. DESIGN A prospective quasi-experimental design with repeated premeasure and postmeasure. PARTICIPANTS 146 participants with obesity (body mass index >30 kg/m(2)) from rural and urban communities in an Eastern Canadian Province were divided into four groups. INTERVENTION A 6-month intensive active community-based lifestyle intervention (InI) delivered by Certified Exercise Physiologists, Certified Personal Trainers and Registered Dietitians, followed by 6 months of self-management. A second intervention (InII) was nested in InI and consisted of group-mediated cognitive-behavioral intervention (GMCBI) delivered by an exercise psychologist to two of the four InI groups. OUTCOMES (1) Improving health outcomes among the participants' preactive and postactive 6-month intervention and self-management period, (2) Documenting the impact of InII (GMCBI) and location of the intervention (urban vs rural). RESULTS The 6-month active InI significantly improved cardiovascular health for participants who completed the intervention. InII (GMCBI) significantly lowered the attrition rate among the participants. The self-management period was challenging for the participants and they did not make further gains; however, most were able to maintain the gains achieved during the active intervention. The location of the intervention, urban or rural, had little impact on outcomes. CONCLUSIONS A community-based programme utilising healthcare professionals other than physicians to treat obese patients was effective based on premeasure and postmeasure. During the self-management phase, the participants were able to maintain the gains. Psychological support is essential to participant retention.
Collapse
Affiliation(s)
- Baukje Miedema
- Dalhousie University Family Medicine Teaching Unit, Dr. Everett Chalmers Regional Hospital, Fredericton, Canada
| | - Stacey A Reading
- Department of Sport & Exercise Science, University of Auckland, Auckland, New Zealand
| | - Ryan A Hamilton
- Psychology Department, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Katherine S Morrison
- Dalhousie University Family Medicine Teaching Unit, Dr. Everett Chalmers Regional Hospital, Fredericton, Canada
| | - Ashley E Thompson
- Dalhousie University Family Medicine Teaching Unit, Dr. Everett Chalmers Regional Hospital, Fredericton, Canada
| |
Collapse
|
23
|
Beauchamp A, Backholer K, Magliano D, Peeters A. The effect of obesity prevention interventions according to socioeconomic position: a systematic review. Obes Rev 2014; 15:541-54. [PMID: 24629126 DOI: 10.1111/obr.12161] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/01/2014] [Accepted: 01/02/2014] [Indexed: 01/19/2023]
Abstract
Obesity prevention is a major public health priority. It is important that all groups benefit from measures to prevent obesity, but we know little about the differential effectiveness of such interventions within particular population subgroups. This review aimed to identify interventions for obesity prevention that evaluated a change in adiposity according to socioeconomic position (SEP) and to determine the effectiveness of these interventions across different socioeconomic groups. A systematic search of published and grey literature was conducted. Studies that described an obesity prevention intervention and reported anthropometric outcomes according to a measure of SEP were included. Evidence was synthesized using narrative analysis. A total of 14 studies were analysed, representing a range of study designs and settings. All studies were from developed countries, with eight conducted among children. Three studies were shown to have no effect on anthropometric outcomes and were not further analysed. Interventions shown to be ineffective in lower SEP participants were primarily based on information provision directed at individual behaviour change. Studies that were shown to be effective in lower SEP participants primarily included community-based strategies or policies aimed at structural changes to the environment. Interventions targeting individual-level behaviour change may be less successful in lower SEP populations. It is essential that our efforts to prevent obesity do not leave behind the most disadvantaged members of society.
Collapse
Affiliation(s)
- A Beauchamp
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Population Health Strategic Research Centre, Deakin University, Melbourne, Victoria, Australia
| | | | | | | |
Collapse
|
24
|
Kozica SL, Gibson-Helm ME, Teede HJ, Moran LJ. Assessing self-efficacy and self-help methods in women with and without Polycystic Ovary Syndrome. Behav Med 2014; 39:90-6. [PMID: 23930901 DOI: 10.1080/08964289.2012.720312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in women strongly associated with obesity and psychological dysfunction. It is crucial to assess the contributions of psychological parameters to obesity and weight management. This survey based cross-sectional study assessed self-efficacy, health attitudes and beliefs, response to illness and adult health history in women with (n = 74) and without PCOS (n = 90). There were no significant differences in self-efficacy, health attitudes and beliefs between groups. Women with PCOS reported less engagement in self-help methods compared to women without (p = 0.003). Women with PCOS reported poorer overall (p < 0.001) and recent health history (p = 0.02), greater prevalence (p < 0.001) and impact of a chronic illness (p < 0.001). It is crucial that women recognize that PCOS is a chronic condition requiring on-going lifestyle management; to encourage active engagement in their management, enhance participation in screening for complications and uptake of lifestyle recommendations.
Collapse
Affiliation(s)
- Samantha L Kozica
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | |
Collapse
|
25
|
Schröer S, Haupt J, Pieper C. Evidence-based lifestyle interventions in the workplace--an overview. Occup Med (Lond) 2013; 64:8-12. [PMID: 24280187 DOI: 10.1093/occmed/kqt136] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Lifestyle-related health issues affect the economic position of organizations and contribute to reduced productivity, increased absenteeism and health care costs. AIMS To summarize the effectiveness of different workplace health interventions for promoting healthy lifestyle, preventing diseases and reducing health care costs. METHODS We searched MEDLINE via Pubmed, EMBASE, Cochrane Library, NelH, HighWire Press and Google Scholar in March 2012. Systematic reviews and meta-analyses of workplace interventions aimed at promoting physical activity, healthy weight and good nutrition were included. Three authors assessed the quality of the reviews and extracted data on methods, interventions, outcomes, results and effect sizes. RESULTS We identified 15 publications covering a total of 379 original studies. Three systematic reviews found beneficial effects of workplace nutrition interventions on employees' dietary behaviour. Three reviews found multi-component physical activity interventions to be effective in increasing employees' physical activity and fitness. The other activity promotion interventions were less effective regarding physical activity and weight-related outcomes. In terms of weight management, our findings favour multi-component interventions that focus on both physical activity and nutrition over single dietary programmes. CONCLUSIONS Workplace health promotion interventions may improve physical activity, dietary behaviour and healthy weight. There is no evidence of increased efficacy associated with specific intervention types. Workplace health promotion should focus on either physical activity or weight or nutrition behaviour to maximize effectiveness. Best evidence is available for multi-component interventions.
Collapse
Affiliation(s)
- S Schröer
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen 45145, Germany
| | | | | |
Collapse
|
26
|
Abstract
Obesity has become a growing pandemic of alarming proportions in the developed and developing countries over the last few decades. The most perturbing fact regarding obesity is the increased predisposition for coronary artery disease, congestive heart failure and sudden cardiac death. The modest efficacy of current anti-obesity agents such as orlistat and the increasing withdrawals of several anti-obesity agents such as sibutramine, rimonabant have led to huge gaps in the pharmacotherapy of obesity. Lorcaserin and Phentermine-topiramate combination (phen-top) are two drugs approved by US FDA in 2012. Lorcaserin, a 5HT2C agonist has moderate efficacy with an acceptable safety profile. Clinical trials with Phen-top have shown a reasonable efficacy but at the cost of risks such as teratogenicity and psychiatric disturbances. Cetilistat, a lipase inhibitor is claimed to have superior safety profile to orlistat and is in phase 3 clinical trials. Other promising anti-obesity molecules acting on the gut which are in clinical trials include exenatide and liraglutide. Drugs which act on the monoaminergic and opioid systems include bupropion-naltrexone and bupropion-zonisamide. Other novel first-in-class drugs which have been explored and have limited success in early clinical development include velneperit, tesofensine, and beloranib. Tesofensine is a triple monoamine re-uptake inhibitor, velneperit acts as a neuropeptide Y5 receptor antagonist and beloranib is a methionine amino peptidase 2 inhibitor. Novel targets such as histamine H3 receptor, VEGF, matrix-metalloproteinase, sirtuin receptors are also being investigated. This review is an attempt to describe the new and emerging molecules that are in clinical development for obesity.
Collapse
Affiliation(s)
- Melvin George
- 1Department of Cardiology, SRM Medical College Hospital & Research Centre, Kancheepuram, Tamil Nadu, India
| | | | | |
Collapse
|
27
|
Abstract
PURPOSE OF REVIEW Obesity is well recognized as a major public health crisis throughout the USA. In recent years, governmental bodies at the federal, state and local levels have enacted policies intended to prevent the transition to obesity. Researchers have had the opportunity to study these policies and evaluate their impact on prevention of obesity. RECENT FINDINGS Most public policies have been directed principally, but not exclusively, to the prevention of obesity in school-age children. Interventions have been directed to encouraging breast-feeding, to changing school lunches, limiting access to sugar-sweetened beverages, encouraging physical activity, changing the composition of competitive foods and affecting food advertising directed at children as well as collecting BMI information. Efforts more directed at adults include encouraging workplace wellness programs and improving the nutrition label on packaged foods with front-of-package labels and caloric information on restaurant menus. SUMMARY For the most part, evaluations of the interventions reveal weak or modest benefits. The actual picture might be less positive due to the poor quality of research and publication bias. Push back by industry and others will require higher quality experimental and real world studies. All interventions fail to accommodate the multifactorial aspects of obesity.
Collapse
Affiliation(s)
- Morgan Downey
- Downey Obesity Report, Washington, District of Columbia, USA.
| | | |
Collapse
|
28
|
Waters L, George AS, Chey T, Bauman A. Weight change in control group participants in behavioural weight loss interventions: a systematic review and meta-regression study. BMC Med Res Methodol 2012; 12:120. [PMID: 22873682 PMCID: PMC3499351 DOI: 10.1186/1471-2288-12-120] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 07/23/2012] [Indexed: 11/15/2022] Open
Abstract
Background Unanticipated control group improvements have been observed in intervention trials targeting various health behaviours. This phenomenon has not been studied in the context of behavioural weight loss intervention trials. The purpose of this study is to conduct a systematic review and meta-regression of behavioural weight loss interventions to quantify control group weight change, and relate the size of this effect to specific trial and sample characteristics. Methods Database searches identified reports of intervention trials meeting the inclusion criteria. Data on control group weight change and possible explanatory factors were abstracted and analysed descriptively and quantitatively. Results 85 trials were reviewed and 72 were included in the meta-regression. While there was no change in control group weight, control groups receiving usual care lost 1 kg more than control groups that received no intervention, beyond measurement. Conclusions There are several possible explanations why control group changes occur in intervention trials targeting other behaviours, but not for weight loss. Control group participation may prevent weight gain, although more research is needed to confirm this hypothesis.
Collapse
Affiliation(s)
- Lauren Waters
- Cancer Prevention Research Centre, School of Population Health, The University of Queensland, Herston, Brisbane, QLD, 4006, Australia.
| | | | | | | |
Collapse
|
29
|
Wierenga D, Engbers LH, van Empelen P, Hildebrandt VH, van Mechelen W. The design of a real-time formative evaluation of the implementation process of lifestyle interventions at two worksites using a 7-step strategy (BRAVO@Work). BMC Public Health 2012; 12:619. [PMID: 22871020 PMCID: PMC3490970 DOI: 10.1186/1471-2458-12-619] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 07/17/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Worksite health promotion programs (WHPPs) offer an attractive opportunity to improve the lifestyle of employees. Nevertheless, broad scale and successful implementation of WHPPs in daily practice often fails. In the present study, called BRAVO@Work, a 7-step implementation strategy was used to develop, implement and embed a WHPP in two different worksites with a focus on multiple lifestyle interventions.This article describes the design and framework for the formative evaluation of this 7-step strategy under real-time conditions by an embedded scientist with the purpose to gain insight into whether this this 7-step strategy is a useful and effective implementation strategy. Furthermore, we aim to gain insight into factors that either facilitate or hamper the implementation process, the quality of the implemented lifestyle interventions and the degree of adoption, implementation and continuation of these interventions. METHODS AND DESIGN This study is a formative evaluation within two different worksites with an embedded scientist on site to continuously monitor the implementation process. Each worksite (i.e. a University of Applied Sciences and an Academic Hospital) will assign a participating faculty or a department, to implement a WHPP focusing on lifestyle interventions using the 7-step strategy. The primary focus will be to describe the natural course of development, implementation and maintenance of a WHPP by studying [a] the use and adherence to the 7-step strategy, [b] barriers and facilitators that influence the natural course of adoption, implementation and maintenance, and [c] the implementation process of the lifestyle interventions. All data will be collected using qualitative (i.e. real-time monitoring and semi-structured interviews) and quantitative methods (i.e. process evaluation questionnaires) applying data triangulation. Except for the real-time monitoring, the data collection will take place at baseline and after 6, 12 and 18 months. DISCUSSION This is one of the few studies to extensively and continuously monitor the natural course of the implementation process of a WHPP by a formative evaluation using a mix of quantitative and qualitative methods on different organizational levels (i.e. management, project group, employees) with an embedded scientist on site. TRIAL REGISTRATION NTR2861.
Collapse
Affiliation(s)
- Debbie Wierenga
- Body@Work, Research Centre on Physical Activity, Work and Health, TNO-VUmc, Amsterdam, The Netherlands
- Department of Public and Occupational Health, EMGO + Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
- Netherlands Organisation for Applied Scientific Research, TNO Expertise Centre Life Style, P.O. Box 2215, Leiden, 2301 CE, The Netherlands
| | - Luuk H Engbers
- Body@Work, Research Centre on Physical Activity, Work and Health, TNO-VUmc, Amsterdam, The Netherlands
- Netherlands Organisation for Applied Scientific Research, TNO Expertise Centre Life Style, P.O. Box 2215, Leiden, 2301 CE, The Netherlands
| | - Pepijn van Empelen
- Netherlands Organisation for Applied Scientific Research, TNO Expertise Centre Life Style, P.O. Box 2215, Leiden, 2301 CE, The Netherlands
| | - Vincent H Hildebrandt
- Body@Work, Research Centre on Physical Activity, Work and Health, TNO-VUmc, Amsterdam, The Netherlands
- Netherlands Organisation for Applied Scientific Research, TNO Expertise Centre Life Style, P.O. Box 2215, Leiden, 2301 CE, The Netherlands
| | - Willem van Mechelen
- Body@Work, Research Centre on Physical Activity, Work and Health, TNO-VUmc, Amsterdam, The Netherlands
- Department of Public and Occupational Health, EMGO + Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
30
|
Sikorski C, Luppa M, Schomerus G, Werner P, König HH, Riedel-Heller SG. Public attitudes towards prevention of obesity. PLoS One 2012; 7:e39325. [PMID: 22723996 PMCID: PMC3378564 DOI: 10.1371/journal.pone.0039325] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 05/18/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate obesity prevention support in the German general public and to assess determinants of general prevention support as well as support of specific prevention measures. METHODS This study was a cross-sectional analysis of a telephone based representative German study (3,003 subjects (52.8% women, mean age 51.9, s.d. = 18.0, range 18-97 years). Likert scale-based questions on general prevention support and support of specific measures were used. Furthermore willingness to take part in preventive programs and willingness to pay were assessed. Stigmatizing attitudes were assessed with the Fat Phobia Scale (FPS). Causation of obesity was differentiated in three dimensions (internal, e.g. lack of exercise; external, e.g. social surroundings; and genetic factors). RESULTS Obesity prevention was perceived as possible (98.2%), however, almost exclusively lifestyle changes were named. Participants with higher stigmatizing attitudes were less likely to believe obesity prevention is possible. The majority of participants would take part in preventive programs (59.6%) and pay at least partially themselves (86.9%). Factor analysis revealed three dimensions of preventive measures: promoting healthy eating, restrictive and financial, governmental prevention efforts. In regard to these, promoting healthy eating was the most supported measure. Higher age, female gender and external causation were associated with higher support for all three dimensions of preventive measures. Only for governmental regulation, higher age was associated with lower support. CONCLUSION Obesity prevention support in Germany is high. Structural prevention efforts are supported by the majority of the general public in Germany. The vast majority proclaims willingness to pay themselves for programs of weight gain prevention. This could be an indication of higher perceived self-responsibility in the German system but also for risen "fear of fat" in the population due to media coverage. For Germany, the government and communities ought to be encouraged by these results to start the implementation of structural obesity prevention.
Collapse
Affiliation(s)
- Claudia Sikorski
- Integrated Research and Treatment Center AdiposityDiseases, University of Leipzig, Leipzig, Germany.
| | | | | | | | | | | |
Collapse
|
31
|
Laska MN, Pelletier JE, Larson NI, Story M. Interventions for weight gain prevention during the transition to young adulthood: a review of the literature. J Adolesc Health 2012; 50:324-33. [PMID: 22443834 PMCID: PMC3406485 DOI: 10.1016/j.jadohealth.2012.01.016] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 01/13/2012] [Accepted: 01/19/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To review studies examining weight gain prevention interventions among young adults. METHODS A snowball strategy was used to identify relevant studies, beginning with systematic PubMed, MEDLINE, PsychINFO, Education Resources Information Center (ERIC), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) searches. INCLUDED STUDIES (a) were published from 1985 to 2011; (b) were completed in the United States or Canada; (c) focused on weight gain prevention among young adults aged 18-35 years, assessing weight, body mass index, body composition, diet, or physical activity as an outcome; and (d) comprised pre- and postintervention assessments. RESULTS Thirty-seven interventions were identified. Ten interventions assessed weight, body mass index, or body composition; 27 addressed other relevant outcomes (e.g., diet, physical activity). Of the studies examining weight or body composition, six evaluated university courses or seminar-based interventions. Overall, many studies focused on individual-level intervention delivery and changes in weight-related knowledge and/or skills, although some incorporated relatively unique aspects (e.g., focusing on eating disorders and obesity simultaneously, using online technology, providing personalized feedback on weight change). Most showed promising results as small-scale pilot studies but lacked data from fully powered randomized trials. CONCLUSIONS There is an urgent need to develop effective young adult-focused weight gain prevention strategies. This review identified promising areas for future work, although much additional research is needed.
Collapse
|
32
|
van Genugten L, van Empelen P, Boon B, Borsboom G, Visscher T, Oenema A. Results from an online computer-tailored weight management intervention for overweight adults: randomized controlled trial. J Med Internet Res 2012; 14:e44. [PMID: 22417813 PMCID: PMC3376515 DOI: 10.2196/jmir.1901] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 11/28/2011] [Accepted: 01/16/2012] [Indexed: 11/13/2022] Open
Abstract
Background Prevention of weight gain has been suggested as an important strategy in the prevention of obesity and people who are overweight are a specifically important group to target. Currently there is a lack of weight gain prevention interventions that can reach large numbers of people. Therefore, we developed an Internet-delivered, computer-tailored weight management intervention for overweight adults. The focus of the intervention was on making small (100 kcal per day), but sustained changes in dietary intake (DI) or physical activity (PA) behaviors in order to maintain current weight or achieve modest weight loss. Self-regulation theory was used as the basis of the intervention. Objective This study aims to evaluate the efficacy of the computer-tailored intervention in weight-related anthropometric measures (Body Mass Index, skin folds and waist circumference) and energy balance-related behaviors (physical activity; intake of fat, snacks and sweetened drinks) in a randomized controlled trial. Methods The tailored intervention (TI) was compared to a generic information website (GI). Participants were 539 overweight adults (mean age 47.8 years, mean Body Mass Index (BMI) 28.04, 30.9% male, 10.7% low educated) who where recruited among the general population and among employees from large companies by means of advertisements and flyers. Anthropometric measurements were measured by trained research assistants at baseline and 6-months post-intervention. DI and PA behaviors were assessed at baseline, 1-month and 6-month post-intervention, using self-reported questionnaires. Results Repeated measurement analyses showed that BMI remained stable over time and that there were no statistically significant differences between the study groups (BMI: TI=28.09, GI=27.61, P=.09). Similar results were found for waist circumference and skin fold thickness. Amount of physical activity increased and intake of fat, snacks and sweetened drinks decreased during the course of the study, but there were no differences between the study groups (eg, fat intake: TI=15.4, GI=15.9, P=.74). The first module of the tailored intervention was visited by almost all participants, but only 15% completed all four modules of the tailored intervention, while 46% completed the three modules of the general information intervention. The tailored intervention was considered more personally relevant (TI=3.20, GI=2.83, P=.001), containing more new information (TI=3.11, GI=2.73, P=.003) and having longer texts (TI=3.20, GI=3.07, P=.01), while there were no group differences on other process measures such as attractiveness and comprehensibility of the information (eg, attractive design: TI=3.22, GI=3.16, P=.58). Conclusions The online, computer-tailored weight management intervention resulted in changes in the desired direction, such as stabilization of weight and improvements in dietary intake, but the intervention was not more effective in preventing weight gain or modifying dietary and physical activity behaviors than generic information. A possible reason for the absence of intervention effects is sub-optimal use of the intervention and the self-regulation components. Further research is therefore needed to gain more insight into how the intervention and exposure to its contents can be improved. Trial Registration NTR1862; http://apps.who.int/trialsearch/trial.aspx?trialid=NTR1862
Collapse
Affiliation(s)
- Lenneke van Genugten
- Department of Public Health, Erasmus MC, Univserity Medical Center, Rotterdam, Netherlands.
| | | | | | | | | | | |
Collapse
|
33
|
Familial and societal causes of juvenile obesity—a qualitative model on obesity development and prevention in socially disadvantaged children and adolescents. J Public Health (Oxf) 2012. [DOI: 10.1007/s10389-011-0473-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
34
|
Combining environmental and individual weight management interventions in a work setting: results from the Dow chemical study. J Occup Environ Med 2011; 53:245-52. [PMID: 21346636 DOI: 10.1097/jom.0b013e31820c9023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the comparative effectiveness of environmental weight loss interventions alone versus in combination with an individual intervention. METHODS A quasi-experimental design compared outcomes for two levels of environmental interventions and for participants who did or did not simultaneously self-select into an individually focused weight loss intervention (YW8). Analysis of covariance and logistic regression techniques were used to examine risk outcomes. RESULTS Employees who participated in YW8 were no more successful at losing weight than those exposed to only the environmental interventions. Approximately, 13.5% of each group lost at least 5% of their body weight; overall changes in mean body weight and body mass index were negligible in both groups. CONCLUSIONS Simple worksite environmental modifications may help with weight maintenance, but are not likely to result in substantial weight reductions even when combined with low-intensity individual interventions.
Collapse
|
35
|
Verweij LM, Coffeng J, van Mechelen W, Proper KI. Meta-analyses of workplace physical activity and dietary behaviour interventions on weight outcomes. Obes Rev 2011; 12:406-29. [PMID: 20546142 DOI: 10.1111/j.1467-789x.2010.00765.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This meta-analytic review critically examines the effectiveness of workplace interventions targeting physical activity, dietary behaviour or both on weight outcomes. Data could be extracted from 22 studies published between 1980 and November 2009 for meta-analyses. The GRADE approach was used to determine the level of evidence for each pooled outcome measure. Results show moderate quality of evidence that workplace physical activity and dietary behaviour interventions significantly reduce body weight (nine studies; mean difference [MD]-1.19 kg [95% CI -1.64 to -0.74]), body mass index (BMI) (11 studies; MD -0.34 kg m⁻² [95% CI -0.46 to -0.22]) and body fat percentage calculated from sum of skin-folds (three studies; MD -1.12% [95% CI -1.86 to -0.38]). There is low quality of evidence that workplace physical activity interventions significantly reduce body weight and BMI. Effects on percentage body fat calculated from bioelectrical impedance or hydrostatic weighing, waist circumference, sum of skin-folds and waist-hip ratio could not be investigated properly because of a lack of studies. Subgroup analyses showed a greater reduction in body weight of physical activity and diet interventions containing an environmental component. As the clinical relevance of the pooled effects may be substantial on a population level, we recommend workplace physical activity and dietary behaviour interventions, including an environment component, in order to prevent weight gain.
Collapse
Affiliation(s)
- L M Verweij
- Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Body@Work, Research Center Physical Activity, Work and Health, TNO-VUmc, Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
36
|
Kirk SFL, Penney TL, McHugh TLF, Sharma AM. Effective weight management practice: a review of the lifestyle intervention evidence. Int J Obes (Lond) 2011; 36:178-85. [PMID: 21487396 DOI: 10.1038/ijo.2011.80] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Despite the existence of guidelines for obesity management, uncertainty remains as to what interventions comprise effective practice. This uncertainty could act as a barrier to busy health care professionals, who may lack the time and expertize to fully appraise the huge amount of literature that is published each year on obesity management. Therefore, the objectives of this review were to synthesize the available evidence, determine most effective and most promising practices for obesity management in adults, using an established methodology, and present this information according to its quality. EVIDENCE ACQUISITION This synthesis review was conducted from January 2009. A detailed search of relevant databases was conducted to September 2010. Most effective and promising practices were defined using the Canadian Best Practice Initiative Methodology Background Paper, with systematic reviews (with/without meta analysis) as the most rigorous methodology for developing recommendations that were deemed most effective (level 1), and non-systematic reviews for developing recommendations deemed as most promising (level 2). Literature was reviewed and classified across these two levels of rigor, and supplemented with primary studies to further refine recommendations. RESULTS Evidence from systematic reviews and meta-analyses was classified into three intervention themes or areas of context, in which more specific most effective and/or promising practice recommendations could be nested. These intervention themes were (1) targeted multi-component interventions for weight management, (2) dietary manipulation strategies and (3) delivery of weight management interventions, including health professional roles and method of delivery. Specific recommendations accompanied each theme. CONCLUSIONS This review highlights the value of multi-component interventions that are delivered over the longer term, and reinforces the role of health care professionals. The findings will help to inform evidence-based practice for health care practitioners involved in obesity management and prevention.
Collapse
Affiliation(s)
- S F L Kirk
- Applied Research Collaborations for Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada.
| | | | | | | |
Collapse
|
37
|
Wills T, Fehin P, Callen B. Body mass index knowledge of older adults and motivation to change. Br J Community Nurs 2011; 16:110, 112-5. [PMID: 21378649 DOI: 10.12968/bjcn.2011.16.3.110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Worldwide, 1.6 billion adults are overweight and 400 million are obese. For older adults, being in these categories exacerbates multiple chronic diseases and leads to frailty. The aim of this study was to explore the knowledge of older adults in Ireland and the USA about their body mass index (BMI) category and motivation to change. A quantitative descriptive research design was used in the study. Two convenience samples of community-dwelling older adults, one in Ireland (n=70) and one in the USA (n=70) participated in the study. Data was collected in the form of questionnaires and BMI was calculated. This study found that fewer Irish participants knew their BMI category. In both groups, measured BMI differed greatly from self-perceived BMI. These findings suggest that older adults are unaware of their weight status and therefore do not know that they are in a BMI category with multiple health consequences.
Collapse
Affiliation(s)
- Teresa Wills
- School of Nursing and Midwifery, Cork, Bonnie, Callen.
| | | | | |
Collapse
|
38
|
Walls HL, Peeters A, Proietto J, McNeil JJ. Public health campaigns and obesity - a critique. BMC Public Health 2011; 11:136. [PMID: 21352562 PMCID: PMC3056747 DOI: 10.1186/1471-2458-11-136] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 02/27/2011] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Controlling obesity has become one of the highest priorities for public health practitioners in developed countries. In the absence of safe, effective and widely accessible high-risk approaches (e.g. drugs and surgery) attention has focussed on community-based approaches and social marketing campaigns as the most appropriate form of intervention. However there is limited evidence in support of substantial effectiveness of such interventions. DISCUSSION To date there is little evidence that community-based interventions and social marketing campaigns specifically targeting obesity provide substantial or lasting benefit. Concerns have been raised about potential negative effects created by a focus of these interventions on body shape and size, and of the associated media targeting of obesity. SUMMARY A more appropriate strategy would be to enact high-level policy and legislative changes to alter the obesogenic environments in which we live by providing incentives for healthy eating and increased levels of physical activity. Research is also needed to improve treatments available for individuals already obese.
Collapse
Affiliation(s)
- Helen L Walls
- Department of Epidemiology & Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Victoria 3004, Australia
| | - Anna Peeters
- Department of Epidemiology & Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Victoria 3004, Australia
| | - Joseph Proietto
- Repatriation Hospital, The Department of Medicine at Austine Hospital, Heidelberg, Victoria 3084, Australia
| | - John J McNeil
- Department of Epidemiology & Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Victoria 3004, Australia
| |
Collapse
|
39
|
Brandão MP, Pimentel FL, Cardoso MF. Impact of academic exposure on health status of university students. Rev Saude Publica 2011; 45:49-58. [DOI: 10.1590/s0034-89102011000100006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 06/17/2010] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE: To assess the impact of academic life on health status of university students. METHODS: Longitudinal study including 154 undergraduate students from the Universidade de Aveiro, Portugal, with at least two years of follow-up observations. Sociodemographic and behavioral characteristics were collected using questionnaires. Students' weight, height, blood pressure, serum glucose, serum lipids and serum homocysteine levels were measured. Regression analysis was performed using linear mixed-effect models, allowing for random effects at the participant level. RESULTS: A higher rate of dyslipidemia (44.0% vs. 28.6%), overweight (16.3% vs. 12.5%) and smoking (19.3% vs. 0.0%) was found among students exposed to the academic life when compared to freshmen. Physical inactivity was about 80%. Total cholesterol, high density lipoprotein-cholesterol (HDL-C), triglycerides, systolic blood pressure, and physical activity levels were significantly associated with gender (p<0.001). Academic exposure was associated with increased low density lipoprotein-cholesterol (LDL-C) levels (about 1.12 times), and marginally with total cholesterol levels (p=0.041). CONCLUSIONS: High education level does not seem to have a protective effect favoring a healthier lifestyle and being enrolled in health-related areas does not seem either to positively affect students' behaviors. Increased risk factors for non-transmissible diseases in university students raise concerns about their well-being. These results should support the implementation of health promotion and prevention programs at universities.
Collapse
Affiliation(s)
- Maria Piedade Brandão
- Universidade de Aveiro, Portugal; Universidade de Aveiro; Centro Interdisciplinar de Investigação Marinha e Ambiental, Portugal
| | - Francisco Luís Pimentel
- Universidade de Aveiro, Portugal; Universidade de Aveiro; Hospital Infante D. Pedro, Portugal; Universidade de Coimbra, Portugal
| | - Margarida Fonseca Cardoso
- Centro Interdisciplinar de Investigação Marinha e Ambiental, Portugal; Universidade do Porto, Portugal; Universidade do Porto, Portugal
| |
Collapse
|
40
|
Bai B, Wang Y. The use of lorcaserin in the management of obesity: a critical appraisal. DRUG DESIGN DEVELOPMENT AND THERAPY 2010; 5:1-7. [PMID: 21267355 PMCID: PMC3023275 DOI: 10.2147/dddt.s11945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Obesity is a chronic disease with a high prevalence in both developed and developing countries. Effective management of this worldwide epidemic will have a significant impact on the health care system globally. Lifestyle interventions, such as restricting calorie consumption and increasing physical activity, remain a major component of weight-reduction programs. The development of pharmacotherapy for the management of obesity is still at the infancy stage. Side effects have been the key issue for anti-obesity drugs previously withdrawn from the market. The focus of this review, lorcaserin, is a selective serotonin receptor agonist that is currently undergoing Phase III evaluations. The efficacy of this drug in reducing body weight and improving metabolic parameters of obese patients has been demonstrated in two recent clinical trials. The available evidence indicates that this drug does not show unwanted effects on heart valves or pulmonary artery pressure, and the treatment improves the risk factors for type 2 diabetes and cardiovascular diseases. Despite these promising results, additional experimental and clinical studies are critical for the approval of lorcaserin as a new anti-obesity monodrug therapy by the US Food and Drug Administration.
Collapse
Affiliation(s)
- Bo Bai
- Department of Pharmacology and Pharmacy, University of Hong Kong, People's Republic of China
| | | |
Collapse
|
41
|
Backholer K, Walls HL, Magliano DJ, Peeters A. Setting population targets for measuring successful obesity prevention. Am J Public Health 2010; 100:2033-7. [PMID: 20864694 PMCID: PMC2951924 DOI: 10.2105/ajph.2010.200337] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2010] [Indexed: 11/04/2022]
Abstract
In 2008, The Council of Australian Governments set a target to increase by 5% the proportion of Australian adults at a healthy body weight by 2017, over a 2009 baseline. Target setting is a critical component of public health policy for obesity prevention; however, there is currently no context within which to choose such targets. We analyzed the changes in current weight gain that would be required to meet Australian targets. By using transition-based multistate life tables to project obesity prevalence, we found that meeting national healthy weight targets by 2017 will require a 75% reduction in current 5-year weight gain. A reliable model of future body weight prevalence is critical to set, evaluate, and monitor national obesity targets.
Collapse
Affiliation(s)
- Kathryn Backholer
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Melbourne, Australia.
| | | | | | | |
Collapse
|
42
|
Kremers SPJ. Theory and practice in the study of influences on energy balance-related behaviors. PATIENT EDUCATION AND COUNSELING 2010; 79:291-298. [PMID: 20371159 DOI: 10.1016/j.pec.2010.03.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 03/02/2010] [Accepted: 03/04/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This paper aims to provide an overview of different theoretical approaches in the study of determinants of energy balance-related behaviors (EBRBs). METHODS The Environmental Research framework for weight Gain prevention (EnRG) is used as a general framework to guide the overview. RESULTS Theoretical approaches in the integrated study of EBRBs are discussed, as well as theories addressing environmental factors, mediating factors, moderating factors and automatic environment-behavior links. CONCLUSION Five distinct topics should be deliberated when researchers conceptualize their research model: (1) to apply a theory-based approach in their determinants study within the broader perspective of systematic obesity prevention, (2) to incorporate the notion of potential clustering of (motives to engage in) EBRBs, (3) to accompany research towards environmental determinants of EBRBs with the operationalization of factors that may mediate the environmental influence, (4) to hypothesize both mediated and unmediated paths in environment-behavior relations, and (5) to incorporate potential moderators of the studied influences on EBRBs in the research design. PRACTICE IMPLICATIONS The choice for change objectives and subsequent obesity prevention intervention strategies may be optimized when relevant determinants are interpreted as either primary (direct) causal factors, mediated determinants, mediating determinants or as moderators of causal factors.
Collapse
Affiliation(s)
- Stef P J Kremers
- NUTRIM School for Nutrition, Toxicology and Metabolism, Department of Health Promotion, Maastricht University Medical Center+, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| |
Collapse
|
43
|
Kwak L, Kremers SP, Candel MJ, Visscher TL, Brug J, van Baak MA. Changes in skinfold thickness and waist circumference after 12 and 24 months resulting from the NHF-NRG In Balance-project. Int J Behav Nutr Phys Act 2010; 7:26. [PMID: 20370934 PMCID: PMC2858095 DOI: 10.1186/1479-5868-7-26] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 04/07/2010] [Indexed: 11/17/2022] Open
Abstract
Background More knowledge is needed regarding the effectiveness of weight gain prevention programmes. The present study tested the 12-and 24-month effectiveness of the 'Netherlands Research programme weight Gain prevention' (NHF-NRG)-In Balance-project, a worksite-based intervention aimed at the prevention of weight gain. Methods Twelve worksites (n = 553 participants) were matched and assigned to either intervention or control group. The worksites and employees of the intervention group received individual (i.e. pedometer, computer-tailored advice) and environmental (i.e. changes in worksite canteen) interventions, directed at physical activity and food intake over 1-year. Differences between the intervention and control group in changes in body weight, BMI, skinfold thickness and waist circumference at 12 and 24 months were examined using multilevel linear regression analyses adjusting for various baseline characteristics (age, gender, BMI, marital status, education and smoking status). Results A significant greater reduction in skinfold thickness was found in the intervention group than in the control group, both after 12-and 24 months (Unstandardized regression coefficients (B) = -2.52, 95% C.I. -4.58, -0.45; p = 0.018; B = -4.83, 95% C.I. 6.98, -2.67; p < 0.001 respectively). Significant differences were also observed for changes in waist circumferences both at 12 months (B = -1.50, 95% C.I. -2.35, -0.65; p < 0.001) and at 24 months (B = -1.30, 95% C.I. -2.18, -0.42; p = 0.005). No significant changes were observed for weight and BMI. Conclusions The project was effective with regard to changes in skinfold thickness and waist circumference both at 12 and 24 months. It supports the usefulness of worksite-based prevention, especially regarding maintenance of behavioral changes.
Collapse
Affiliation(s)
- Lydia Kwak
- Unit for Preventive Nutrition, Department of Biosciences, Karolinska Institutet, Huddinge, Sweden.
| | | | | | | | | | | |
Collapse
|