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Khattab R. Weight Loss Programs: Why Do They Fail? A Multidimensional Approach for Obesity Management. Curr Nutr Rep 2024; 13:478-499. [PMID: 38861120 DOI: 10.1007/s13668-024-00551-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE OF REVIEW Despite the prevalence of weight loss programs, their success rates remain discouraging, with around half of individuals regaining lost weight within two years. The primary objective of this review is to explore the factors contributing to the failure of weight loss programs and to provide insights into effective weight management strategies. RECENT FINDINGS Factors contributing to the failure of weight loss programs include the impracticality of restrictive diets, potential metabolic impacts, limited focus on lifestyle changes, genetic predispositions, psychological influences, socioeconomic status, and medical conditions. A holistic approach considering these factors is crucial for safe and sustainable weight loss. Key findings indicate the importance of holistic approaches to weight management, including lifestyle modifications, medical interventions, and behavioral and psychological strategies. Effective weight loss strategies emphasize low-calorie, nutrient-rich diets, regular physical activity, and interventions tailored to individual needs. Combining multiple approaches offers the best chance of successful weight management and improved health outcomes. This review provides insights into the complexities of obesity management and the factors contributing to the failure of weight loss programs. It highlights the necessity of adopting a holistic approach that addresses dietary habits, physical activity, genetic factors, psychological well-being, and socioeconomic influences. Recommendations include implementing lifestyle modifications, medical interventions when necessary, and integrating behavioral and psychological support to achieve sustainable weight loss and mitigate the global health challenge posed by obesity.
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Affiliation(s)
- Rabie Khattab
- Clinical Nutrition Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
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2
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Baillot A, Asselin M, Bernard P, Lapointe J, Bond DS, Romain AJ, Garneau PY, Biertho L, Tchernof A, Blackburn P, Langlois MF, Brunet J. Acceptability and Feasibility of the Telehealth Bariatric Behavioral Intervention to Increase Physical Activity Before Bariatric Surgery: A Single-Case Experimental Study (Part I). Obes Surg 2024; 34:1639-1652. [PMID: 38483742 DOI: 10.1007/s11695-024-07161-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Physical activity (PA) can play an important role in optimizing metabolic/bariatric surgery (MBS) outcomes. However, many MBS patients have difficulty increasing PA, necessitating the development of theory-driven counseling interventions. This study aimed to (1) assess the feasibility and acceptability of the TELEhealth BARIatric behavioral intervention (TELE-BariACTIV) trial protocol/methods and intervention, which was designed to increase moderate-to-vigorous intensity physical activity (MVPA) in adults awaiting MBS and (2) estimate the effect of the intervention on MVPA. METHODS This trial used a repeated single-case experimental design. Twelve insufficiently active adults awaiting MBS received 6 weekly 45-min PA videoconferencing counseling sessions. Feasibility and acceptability data (i.e., refusal, recruitment, retention, attendance, and attrition rates) were tracked and collected via online surveys, and interviews. MVPA was assessed via accelerometry pre-, during, and post-intervention. RESULTS Among the 24 patients referred to the research team; five declined to participate (refusal rate = 20.8%) and seven were ineligible or unreachable. The recruitment rate was 1.2 participants per month between 2021-09 and 2022-07. One participant withdrew during the baseline phase, and one after the intervention (retention rate = 83.3%). No participant dropouts occurred during the intervention and 98.6% of sessions were completed. Participants' anticipated and retrospective acceptability of the intervention was 3.2/4 (IQR, 0.5) and 3.0/4 (IQR, 0.2), respectively. There was a statistically significant increase in MVPA [Tau-U = 0.32(0.11; 0.51)] from pre- to post-intervention. CONCLUSION Despite a low recruitment rate, which could be explained by circumstances (COVID-19 pandemic), results support feasibility, acceptability, and preliminary efficacy of the TELE-Bari-ACTIV intervention for increasing MVPA in patients awaiting MBS.
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Affiliation(s)
- Aurélie Baillot
- École Interdisciplinaire de Santé, Université du Québec en Outaouais, 283 Boul. Alexandre-Taché, Gatineau, Québec, J8X 3X7, Canada.
- Institut du Savoir Montfort, Ottawa, ON, Canada.
- Centre de Recherche en Médecine Psychosociale, Centre Intégré de Santé et Services, Sociaux de L'Outaouais, Gatineau, Québec, Canada.
| | | | - Paquito Bernard
- Department of Physical Activity Sciences, Université du Québec À Montréal, Montréal, Québec, Canada
- Centre de Recherche, Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada
| | - Josyanne Lapointe
- Department of Physical Activity Sciences, Université du Québec À Montréal, Montréal, Québec, Canada
- Centre de Recherche, Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada
| | - Dale S Bond
- Department of Surgery, Hartford Hospital/HealthCare, Hartford, CT, USA
| | - Ahmed Jérôme Romain
- Centre de Recherche, Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Pierre Y Garneau
- Department of Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Laurent Biertho
- Institut Universitaire de Cardiologie et de Pneumologie de Québec et Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - André Tchernof
- Institut Universitaire de Cardiologie et de Pneumologie de Québec et École de Nutrition, Université Laval, Québec, Québec, Canada
| | - Patricia Blackburn
- Division of Kinesiology, Department of Health Sciences, Université du Québec À Chicoutimi, Chicoutimi, Québec, Canada
| | - Marie-France Langlois
- CHUS Research Center and Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jennifer Brunet
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- Cancer Therapeutic Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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3
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Hoevenaars D, Holla JFM, de Groot S, Weijs PJM, Kraaij W, Janssen TWJ. Lifestyle and health changes in wheelchair users with a chronic disability after 12 weeks of using the WHEELS mHealth application. Disabil Rehabil Assist Technol 2024; 19:648-657. [PMID: 36165036 DOI: 10.1080/17483107.2022.2115563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The aim of this study was to determine changes in physical activity, nutrition, sleep behaviour and body composition in wheelchair users with a chronic disability after 12 weeks of using the WHEELS mHealth application (app). METHODS A 12-week pre-post intervention study was performed, starting with a 1-week control period. Physical activity and sleep behaviour were continuously measured with a Fitbit charge 3. Self-reported nutritional intake, body mass and waist circumference were collected. Pre-post outcomes were compared with a paired-sample t-test or Wilcoxon signed-rank test. Fitbit data were analysed with a mixed model or a panel linear model. Effect sizes were determined and significance was accepted at p < .05. RESULTS Thirty participants completed the study. No significant changes in physical activity (+1.5 √steps) and sleep quality (-9.7 sleep minutes; -1.2% sleep efficiency) were found. Significant reduction in energy (-1022 kJ, d = 0.71), protein (-8.3 g, d = 0.61) and fat (-13.1 g, d = 0.87) intake, body mass (-2.2 kg, d = 0.61) and waist circumference (-3.3 cm, d = 0.80) were found. CONCLUSION Positive changes were found in nutritional behaviour and body composition, but not in physical activity and sleep quality. The WHEELS app seems to partly support healthy lifestyle behaviour.Implications for RehabilitationHealthy lifestyle promotion is crucial, especially for wheelchair users as they tend to show poorer lifestyle behaviour despite an increased risk of obesity and comorbidity.The WHEELS lifestyle app seems to be a valuable tool to support healthy nutrition choices and weight loss and to improve body satisfaction, mental health and vitality.
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Affiliation(s)
- Dirk Hoevenaars
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
| | - Jasmijn F M Holla
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
- Center for Adapted Sports Amsterdam, Amsterdam Institute of Sport Science, Amsterdam, The Netherlands
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
| | - Sonja de Groot
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
- Center for Adapted Sports Amsterdam, Amsterdam Institute of Sport Science, Amsterdam, The Netherlands
| | - Peter J M Weijs
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Wessel Kraaij
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, The Netherlands
| | - Thomas W J Janssen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
- Center for Adapted Sports Amsterdam, Amsterdam Institute of Sport Science, Amsterdam, The Netherlands
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Lee Y, Sang H, Kim S, Choi DA, Rhee SY. Weight Management Health Note, a Mobile Health Platform for Obesity Management Developed by the Korean Society for the Study of Obesity. J Obes Metab Syndr 2024; 33:1-10. [PMID: 38281733 PMCID: PMC11000511 DOI: 10.7570/jomes23074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/18/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024] Open
Abstract
The Weight Management Health Note application, developed by the Korean Society for the Study of Obesity (KSSO), was designed to assist individuals in weight management and enhance overall well-being. The Committee of IT-Convergence Treatment of Metabolic Syndrome of the KSSO designed this application. Committee members reviewed and supervised the application's underlying driving algorithms and scientific rationale. A healthcare-specific application developer subsequently finalized the application. This application encompasses a myriad of features, including a comprehensive food diary, an exercise tracker, and tailor-made lifestyle recommendations aligned with individual needs and aspirations. Moreover, it facilitates connections within a community of like-minded individuals endeavoring to manage their weight, fostering mutual support and motivation. Importantly, the application is rich in evidence-based health content curated by the KSSO, ensuring users access accurate information for effective obesity management. Looking ahead, the KSSO is committed to orchestrating diverse academic research endeavors linked to this application and refining its functionalities through continuous feedback from users. The KSSO aspires for this application to serve as a valuable resource for individuals striving to manage their health and enhance their quality of life.
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Affiliation(s)
- Yujung Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
| | - Hyunji Sang
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sunyoung Kim
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | | | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
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Kocol D, Bäuerle A, Schadendorf T, Geiger S, Krakowczyk JB, Skoda EM, Teufel M. Efficacy of eHealth interventions to reduce depression symptoms in individuals with obesity: a systematic review of randomized controlled trials. Front Psychiatry 2024; 15:1296433. [PMID: 38516265 PMCID: PMC10954845 DOI: 10.3389/fpsyt.2024.1296433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/07/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Obesity and depression are inter-related health concerns, demanding a high level of treatment and costs in the health care system. The development of eHealth interventions that simultaneously address obesity and mental health can be supportive in this regard. However, evidence of the efficacy of eHealth interventions in the treatment of depression symptoms in individuals with obesity is lacking. The aim of this systematic literature review is to evaluate the efficacy of existing eHealth interventions for individuals with obesity that target depression symptoms. Methods We systematically searched electronic databases (Cochrane Library, PubMed, Scopus) to identify studies published in English between January 2016 and January 2023, that focused on eHealth interventions, targeting depression symptoms in individuals with obesity people. Exclusion criteria were study objectives that (1) focused specifically on one or more metabolic comorbidities of individuals with obesity, e.g., hypertension, hyperlipidemia, diabetes; (2) focused specifically on eating disorders comorbidities e.g., binge eating disorder, and (3) focused specifically on patients before or after bariatric surgery. Results The database search identified 214 records. Six articles were included in this review. Sample sizes ranged from 70 to 1267 participants of ages 18-60 years. All included studies were randomized controlled trials. Two of the six included studies were web-based interventions guided either by medical doctors or psychologists. All interventions included video, printed materials, and interactive parts of which two studies integrated elements of Cognitive Behavioural Therapy and Social Cognitive Therapy. The findings showed that eHealth treatment services, supported and guided throughout the intervention had high acceptance and efficacy in the reduction of depression symptoms among individuals with obesity. Conclusion EHealth interventions that address and target both mental and physical health with interactive strategies calls for better efficacy in the reduction of depression symptoms. Future eHealth interventions that target depression symptoms in individuals with obesity should integrate digital strategies that address both mental and physical health through interactive modules.
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Affiliation(s)
- Dilara Kocol
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Theresa Schadendorf
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Sheila Geiger
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Julia Barbara Krakowczyk
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Turnbull SL, Dack C, Lei J, Aksu I, Grant S, Lasseter G, Silarova B, Ainsworth B. Barriers and facilitators to use of digital health tools by healthcare practitioners and their patients, before and during the COVID-19 pandemic: a multimethods study. BMJ Open 2024; 14:e080055. [PMID: 38448080 PMCID: PMC10916085 DOI: 10.1136/bmjopen-2023-080055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/21/2023] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES To explore how healthcare practitioners (HCPs) made decisions about the implementation of digital health technologies (DHTs) in their clinical practice before and during the COVID-19 pandemic. DESIGN A multimethods study, comprising semistructured interviews conducted prior to the COVID-19 pandemic, supplemented with an online survey that was conducted during the pandemic with a different sample, to ensure the qualitative findings remained relevant within the rapidly changing healthcare context. Participants were recruited through HCP networks, snowballing and social media. Data were analysed thematically. SETTING Phone interviews and online survey. PARTICIPANTS HCPs represented a range of professions from primary and secondary care across England, with varied socioeconomic deprivation. RESULTS 24 HCPs were interviewed, and 16 HCPs responded to the survey. In the interviews, HCPs described three levels where decisions were made, which determined who would have access to what DHTs: health organisation, HCP and patient levels. These decisions resulted in the unequal implementation of DHTs across health services, created barriers for HCPs using DHTs in their practice and influenced HCPs' decisions on which patients to supply DHTs with. In the survey, HCPs described being provided support to overcome some of the barriers at the organisation and HCP level during the pandemic. However, they cited similar concerns to pre-pandemic about barriers patients faced using DHTs (eg, digital literacy). In the absence of centralised guidance on how to manage these barriers, health services made their own decisions about how to adapt their services for those who struggled with DHTs. CONCLUSIONS Decision-making at the health organisation, HCP and patient levels influences inequalities in access to DHTs for HCPs and patients. The mobilisation of centralised information and resources during the pandemic can be viewed as good practice for reducing barriers to use of DHTs for HCPs. However, attention must also be paid to reducing barriers to accessing DHTs for patients.
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Affiliation(s)
| | | | | | - Irem Aksu
- Department of Psychology, City University of London, London, UK
| | | | | | - Barbora Silarova
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
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Markkanen JO, Oikarinen N, Savolainen MJ, Merikallio H, Nyman V, Salminen V, Virkkula T, Karppinen P, Oinas-Kukkonen H, Hukkanen J. Mobile health behaviour change support system as independent treatment tool for obesity: a randomized controlled trial. Int J Obes (Lond) 2024; 48:376-383. [PMID: 38062218 PMCID: PMC10896717 DOI: 10.1038/s41366-023-01426-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/01/2023] [Accepted: 11/23/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND/OBJECTIVES Digital health interventions are increasingly utilized as an adjunct to face-to-face counselling in the treatment of obesity. However, previous studies have shown inconsistent efficacy when digital interventions are used as stand-alone treatment. The purpose of this study was to investigate whether a mobile health behaviour change support system (mHBCSS) is effective in weight reduction and weight loss maintenance without additional counselling. Furthermore, changes in cardiometabolic risk factors were investigated. METHODS In this randomized controlled trial, a mHBCSS intervention was conducted for 200 volunteers with obesity (BMI 30-40 kg/m² and age 18-65 years). The study participants were randomly assigned into two groups: immediate access to mHBCSS intervention or wait-list control with access to mHBCSS after 6 months. Anthropometric and metabolic traits were also measured. The primary outcome was weight loss from the baseline to the 6-month visit. RESULTS Among 200 participants (88.5% women), mean BMI (SD) was 34.3 kg/m² (2.8) and age 46.5 years (9.5). The retention rate was 98.5% and 89.0% at the 6- and 12-month visits, respectively. At the 6-month visit, those with immediate access to mHBCSS had significantly greater weight loss (-2.5%, 95% CI -3.4 to -1.6, p < 0.001) compared with the wait-list control group (0.2%, 95% CI -0.4 to 0.9, p = 0.466; between groups p < 0.001). Weight loss was maintained until the 12-month time point in the mHBCSS group (-2.1%, 95% CI -3.3 to -0.9, p = 0.001). The usage of mHBCSS had no significant effect on metabolic traits. CONCLUSION The mHBCSS as a stand-alone treatment of obesity results in weight reduction and weight loss maintenance with remarkable adherence rate. Further studies are needed to establish how to best implement the scalable and resource-efficient mHBCSS into the standard care of obesity to achieve optimal weight loss results.
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Affiliation(s)
- Jaakko O Markkanen
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland
| | - Noora Oikarinen
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland
| | - Markku J Savolainen
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Medicine, Oulu University Hospital, Oulu, Finland
| | - Heta Merikallio
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ville Nyman
- Oulu Advanced Research on Service and Information Systems, University of Oulu, Oulu, Finland
| | - Ville Salminen
- Oulu Advanced Research on Service and Information Systems, University of Oulu, Oulu, Finland
| | - Teppo Virkkula
- Oulu Advanced Research on Service and Information Systems, University of Oulu, Oulu, Finland
| | - Pasi Karppinen
- Oulu Advanced Research on Service and Information Systems, University of Oulu, Oulu, Finland
| | - Harri Oinas-Kukkonen
- Oulu Advanced Research on Service and Information Systems, University of Oulu, Oulu, Finland
| | - Janne Hukkanen
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland.
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
- Biocenter Oulu, Oulu, Finland.
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Kocol D, Geiger S, Schweda A, Beckord J, Schadendorf T, Jansen C, Robitzsch A, Skoda EM, Teufel M, Bäuerle A. An e-mental health intervention to reduce depression symptoms in individuals with obesity: study protocol for the randomized, controlled, two-armed, confirmatory LightMood trial. Trials 2024; 25:149. [PMID: 38419096 PMCID: PMC10900592 DOI: 10.1186/s13063-024-07970-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Patients with obesity often experience psychological distress, specifically depression symptoms. Due to various barriers, such as limitations of healthcare offers, digital interventions, for example medical apps, can provide a suitable approach to support affected people. In the envisaged prospective randomized controlled trial, we aim to examine the efficacy of the LightMood intervention. The LightMood intervention is a manualized and user-centered, digital intervention for patients with obesity, with a duration of 4 months, which contains elements of cognitive behavioral therapy and mindfulness-based and skills-based exercises. We expect the LightMood intervention to be superior to treatment as usual (TAU) in terms of reducing depression symptoms. METHODS The trial incorporates four distinct measurement time points: the baseline assessment, the post-treatment assessment, and 1- and 3-month follow-up assessments. Furthermore, we implemented in-treatment assessments for both groups. Participants will be randomized into two groups (LightMood intervention vs TAU). The aim is to include 128 participants (64 per group) in the study. Inclusion criteria are patients who are obese, at least 18 years old, with a private Internet access, and with adequate digital literacy and show depression symptoms (PHQ ≥ 10). Exclusion criteria are weekly outpatient individual psychotherapy, obesity surgery within the last year or planned within the next 7 months, no private Internet access, and the prescription of a new psychotropic drug within the last 2 weeks. The primary outcome is the post-assessment reduction in depression symptoms. Secondary outcomes will include the improvement in self-efficacy, quality of life, mindfulness, reduction in eating disorder symptoms, and body mass index (BMI). Furthermore, we expect a positive development of depression symptoms throughout the different time points (T1, T2, and T3) in patients with obesity. DISCUSSION LightMood is an evidence-based, efficient, low-threshold online intervention that aims to reduce depression symptoms in people with obesity. Online interventions could offer a promising alternative to conventional face-to-face therapy. The primary objective of the current study is to add essential insight into the feasibility, efficacy, effectiveness, and acceptance of e-mental health interventions for people with obesity and depression symptoms. TRIAL REGISTRATION German Clinical Trial Register (DRKS), DRKS00029219. Registered on May 19, 2023.
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Affiliation(s)
- Dilara Kocol
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany.
| | - Sheila Geiger
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Adam Schweda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Jil Beckord
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Theresa Schadendorf
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Christoph Jansen
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Anita Robitzsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Metzendorf MI, Wieland LS, Richter B. Mobile health (m-health) smartphone interventions for adolescents and adults with overweight or obesity. Cochrane Database Syst Rev 2024; 2:CD013591. [PMID: 38375882 PMCID: PMC10877670 DOI: 10.1002/14651858.cd013591.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Obesity is considered to be a risk factor for various diseases, and its incidence has tripled worldwide since 1975. In addition to potentially being at risk for adverse health outcomes, people with overweight or obesity are often stigmatised. Behaviour change interventions are increasingly delivered as mobile health (m-health) interventions, using smartphone apps and wearables. They are believed to support healthy behaviours at the individual level in a low-threshold manner. OBJECTIVES To assess the effects of integrated smartphone applications for adolescents and adults with overweight or obesity. SEARCH METHODS We searched CENTRAL, MEDLINE, PsycINFO, CINAHL, and LILACS, as well as the trials registers ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform on 2 October 2023 (date of last search for all databases). We placed no restrictions on the language of publication. SELECTION CRITERIA Participants were adolescents and adults with overweight or obesity. Eligible interventions were integrated smartphone apps using at least two behaviour change techniques. The intervention could target physical activity, cardiorespiratory fitness, weight loss, healthy diet, or self-efficacy. Comparators included no or minimal intervention (NMI), a different smartphone app, personal coaching, or usual care. Eligible studies were randomised controlled trials of any duration with a follow-up of at least three months. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology and the RoB 2 tool. Important outcomes were physical activity, body mass index (BMI) and weight, health-related quality of life, self-efficacy, well-being, change in dietary behaviour, and adverse events. We focused on presenting studies with medium- (6 to < 12 months) and long-term (≥ 12 months) outcomes in our summary of findings table, following recommendations in the core outcome set for behavioural weight management interventions. MAIN RESULTS We included 18 studies with 2703 participants. Interventions lasted from 2 to 24 months. The mean BMI in adults ranged from 27 to 50, and the median BMI z-score in adolescents ranged from 2.2 to 2.5. Smartphone app versus no or minimal intervention Thirteen studies compared a smartphone app versus NMI in adults; no studies were available for adolescents. The comparator comprised minimal health advice, handouts, food diaries, smartphone apps unrelated to weight loss, and waiting list. Measures of physical activity: at 12 months' follow-up, a smartphone app compared to NMI probably reduces moderate to vigorous physical activity (MVPA) slightly (mean difference (MD) -28.9 min/week (95% confidence interval (CI) -85.9 to 28; 1 study, 650 participants; moderate-certainty evidence)). We are very uncertain about the results of estimated energy expenditure and cardiorespiratory fitness at eight months' follow-up. A smartphone app compared with NMI probably results in little to no difference in changes in total activity time at 12 months' follow-up and leisure time physical activity at 24 months' follow-up. Anthropometric measures: a smartphone app compared with NMI may reduce BMI (MD of BMI change -2.6 kg/m2, 95% CI -6 to 0.8; 2 studies, 146 participants; very low-certainty evidence) at six to eight months' follow-up, but the evidence is very uncertain. At 12 months' follow-up, a smartphone app probably resulted in little to no difference in BMI change (MD -0.1 kg/m2, 95% CI -0.4 to 0.3; 1 study; 650 participants; moderate-certainty evidence). A smartphone app compared with NMI may result in little to no difference in body weight change (MD -2.5 kg, 95% CI -6.8 to 1.7; 3 studies, 1044 participants; low-certainty evidence) at 12 months' follow-up. At 24 months' follow-up, a smartphone app probably resulted in little to no difference in body weight change (MD 0.7 kg, 95% CI -1.2 to 2.6; 1 study, 245 participants; moderate-certainty evidence). A smartphone app compared with NMI may result in little to no difference in self-efficacy for a physical activity score at eight months' follow-up, but the results are very uncertain. A smartphone app probably results in little to no difference in quality of life and well-being at 12 months (moderate-certainty evidence) and in little to no difference in various measures used to inform dietary behaviour at 12 and 24 months' follow-up. We are very uncertain about adverse events, which were only reported narratively in two studies (very low-certainty evidence). Smartphone app versus another smartphone app Two studies compared different versions of the same app in adults, showing no or minimal differences in outcomes. One study in adults compared two different apps (calorie counting versus ketogenic diet) and suggested a slight reduction in body weight at six months in favour of the ketogenic diet app. No studies were available for adolescents. Smartphone app versus personal coaching Only one study compared a smartphone app with personal coaching in adults, presenting data at three months. Two studies compared these interventions in adolescents. A smartphone app resulted in little to no difference in BMI z-score compared to personal coaching at six months' follow-up (MD 0, 95% CI -0.2 to 0.2; 1 study; 107 participants). Smartphone app versus usual care Only one study compared an app with usual care in adults but only reported data at three months on participant satisfaction. No studies were available for adolescents. We identified 34 ongoing studies. AUTHORS' CONCLUSIONS The available evidence is limited and does not demonstrate a clear benefit of smartphone applications as interventions for adolescents or adults with overweight or obesity. While the number of studies is growing, the evidence remains incomplete due to the high variability of the apps' features, content and components, which complicates direct comparisons and assessment of their effectiveness. Comparisons with either no or minimal intervention or personal coaching show minor effects, which are mostly not clinically significant. Minimal data for adolescents also warrants further research. Evidence is also scarce for low- and middle-income countries as well as for people with different socio-economic and cultural backgrounds. The 34 ongoing studies suggest sustained interest in the topic, with new evidence expected to emerge within the next two years. In practice, clinicians and healthcare practitioners should carefully consider the potential benefits, limitations, and evolving research when recommending smartphone apps to adolescents and adults with overweight or obesity.
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Affiliation(s)
- Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - L Susan Wieland
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Buss VH, Barr M, Parker SM, Kabir A, Lau AYS, Liaw ST, Stocks N, Harris MF. Mobile App Intervention of a Randomized Controlled Trial for Patients With Obesity and Those Who Are Overweight in General Practice: User Engagement Analysis Quantitative Study. JMIR Mhealth Uhealth 2024; 12:e45942. [PMID: 38335014 PMCID: PMC10891495 DOI: 10.2196/45942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/21/2023] [Accepted: 12/19/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The Health eLiteracy for Prevention in General Practice trial is a primary health care-based behavior change intervention for weight loss in Australians who are overweight and those with obesity from lower socioeconomic areas. Individuals from these areas are known to have low levels of health literacy and are particularly at risk for chronic conditions, including diabetes and cardiovascular disease. The intervention comprised health check visits with a practice nurse, a purpose-built patient-facing mobile app (mysnapp), and a referral to telephone coaching. OBJECTIVE This study aimed to assess mysnapp app use, its user profiles, the duration and frequency of use within the Health eLiteracy for Prevention in General Practice trial, its association with other intervention components, and its association with study outcomes (health literacy and diet) to determine whether they have significantly improved at 6 months. METHODS In 2018, a total of 22 general practices from 2 Australian states were recruited and randomized by cluster to the intervention or usual care. Patients who met the main eligibility criteria (ie, BMI>28 in the previous 12 months and aged 40-74 years) were identified through the clinical software. The practice staff then provided the patients with details about this study. The intervention consisted of a health check with a practice nurse and a lifestyle app, a telephone coaching program, or both depending on the participants' choice. Data were collected directly through the app and combined with data from the 6-week health check with the practice nurses, the telephone coaching, and the participants' questionnaires at baseline and 6-month follow-up. The analyses comprised descriptive and inferential statistics. RESULTS Of the 120 participants who received the intervention, 62 (52%) chose to use the app. The app and nonapp user groups did not differ significantly in demographics or prior recent hospital admissions. The median time between first and last app use was 52 (IQR 4-95) days, with a median of 5 (IQR 2-10) active days. App users were significantly more likely to attend the 6-week health check (2-sided Fisher exact test; P<.001) and participate in the telephone coaching (2-sided Fisher exact test; P=.007) than nonapp users. There was no association between app use and study outcomes shown to have significantly improved (health literacy and diet) at 6 months. CONCLUSIONS Recruitment and engagement were difficult for this study in disadvantaged populations with low health literacy. However, app users were more likely to attend the 6-week health check and participate in telephone coaching, suggesting that participants who opted for several intervention components felt more committed to this study. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12617001508369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373505. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-023239.
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Affiliation(s)
- Vera Helen Buss
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Alamgir Kabir
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Annie Y S Lau
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Siaw-Teng Liaw
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Nigel Stocks
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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11
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Arcan C, Hou W, Hoffman K, Reichardt A, Yang X, Clouston SAP, Bromet EJ, Luft B. Mediterranean diet intervention among World Trade Center responders with post-traumatic stress disorder: Feasibility and outcomes of a pilot randomized controlled trial. Obes Sci Pract 2024; 10:e725. [PMID: 38263989 PMCID: PMC10804354 DOI: 10.1002/osp4.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/25/2024] Open
Abstract
Objective Responders of the World Trade Center (WTC) disaster suffer from co-morbidities. A Mediterranean Diet (MedDiet) nutrition intervention with physical activity was implemented among WTC responders with overweight/obesity and post-traumatic stress disorder (PTSD). Methods WTC Health Program members (N = 62), 45-65 years, males 87%, body mass index (BMI) 27-45 kg/m2 randomized to MedDiet (n = 31) or usual nutrition counseling (n = 31). The 10-week intervention included online nutrition education, text messages, and group experiential cooking; both groups had three in-person individual nutrition counseling. Anthropometrics, serum biomarkers, psychosocial factors, MedDiet score, and PTSD symptoms were assessed at baseline, post-intervention, and 3-months (follow-up). The primary outcome was intervention feasibility and secondary outcomes were within- and between-group changes of all measures at post-intervention and follow-up. Nonparametric Wilcoxon rank sum tests for between-group comparisons and Wilcoxon signed rank tests for pre-post within-group comparisons. Results A total of 58(94%) and 46(74%) participants completed the post-intervention and follow-up measurements, respectively. Both groups experienced significant improvements in anthropometrics, MedDiet score, oxidized low-density lipoprotein, and PTSD symptoms. Baseline median (range) were weight 100.42 (73.66-135.17) kg, BMI 33.20 (27.50-41.75) kg/m2, and Waist circumference (WC) 109.22 (90.17-150.62) cm. Median % weight loss at post-intervention was MedDiet: -3% (-11%-7%), p = 0.0002; Control: -1% (-13%-4%), p = 0.008 and at follow-up MedDiet: -2% (-14%-12%), p = 0.07; Control: -2% (-20%-3%), p = 0.006. The overall BMI was reduced by -0.68 kg/m2 (-4.61-2.09) kg/m2 p < 0.0001 at post-intervention and by -0.60 kg/m2 (-6.91-3.39) kg/m2, p < 0.0009 at follow-up. Overall, median WC was reduced (p < 0.0001); post-intervention -3.81 cm (-33.00-3.30)cm and follow-up -4.45(-38.10-4.57)cm. There were group differences in HbA1c (p = 0.019) and serum ω6/ω3 (p = 0.029) at post-intervention. Conclusion Online intervention with personal counseling was feasible in this population. Improvements in anthropometrics, MedDiet score, selected serum biomarkers and PTSD symptoms were found in both groups; group differences in HbA1c and serum ω6/ω3. A larger study with a delayed control is needed to better assess intervention effects.
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Affiliation(s)
- Chrisa Arcan
- Department of EpidemiologySchool of Population HealthVirginia Commonwealth UniversityRichmondVirginiaUSA
- Department of FamilyPopulation and Preventive MedicineRenaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Wei Hou
- Department of FamilyPopulation and Preventive MedicineRenaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
- Vertex Pharmaceuticals IncorporatedBostonMassachusettsUSA
| | - Kathryn Hoffman
- Stony Brook World Trade Center Health Plan and Wellness ProgramRenaissance School of MedicineStony Brook UniversityCommackNew YorkUSA
| | - Amanda Reichardt
- Stony Brook World Trade Center Health Plan and Wellness ProgramRenaissance School of MedicineStony Brook UniversityCommackNew YorkUSA
| | - Xiaohua Yang
- Stony Brook World Trade Center Health Plan and Wellness ProgramRenaissance School of MedicineStony Brook UniversityCommackNew YorkUSA
| | - Sean A. P. Clouston
- Department of FamilyPopulation and Preventive MedicineRenaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Evelyn J. Bromet
- Neurosciences InstituteRenaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Benjamin Luft
- Stony Brook World Trade Center Health Plan and Wellness ProgramRenaissance School of MedicineStony Brook UniversityCommackNew YorkUSA
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12
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He Y, Huang C, He Q, Liao S, Luo B. Effects of mHealth-Based Lifestyle Interventions on Gestational Diabetes Mellitus in Pregnant Women With Overweight and Obesity: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2024; 12:e49373. [PMID: 38231555 PMCID: PMC10831670 DOI: 10.2196/49373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem that is more likely to occur in pregnant women with overweight or obesity. Adhering to a healthy lifestyle is associated with a reduced risk of GDM. With the development of IT, mobile health (mHealth) interventions have become widely available in health care. However, there are no definitive conclusions on the effectiveness of mHealth-based lifestyle interventions in preventing GDM. OBJECTIVE This study aims to evaluate the impact of mHealth-based lifestyle interventions on GDM and other pregnancy outcomes in pregnant women with overweight or obesity. METHODS A systematic literature search was conducted in 5 English databases (MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL) and 4 Chinese databases (CBM, CNKI, Vip, and Wanfang) to identify randomized controlled trials (RCTs) on the effectiveness of mHealth-based interventions for GDM from inception to January 10, 2023. In total, 2 authors independently screened the studies and extracted the data. The quality of the included studies was examined using the Cochrane risk-of-bias tool. Data synthesis was conducted using Review Manager (version 5.4; The Cochrane Collaboration). RESULTS A total of 16 RCTs with 7351 participants were included in this study. The included studies were published between 2014 and 2021 and were conducted in China, the United States, Australia, New Zealand, the United Kingdom, Ireland, and Norway. The sample sizes of the studies ranged from 75 to 2202, and the duration of the mHealth-based lifestyle interventions ranged from 4 to 28 weeks. Compared with usual care, mHealth-based lifestyle interventions significantly reduced the incidence of GDM (odds ratio [OR] 0.74, 95% CI 0.56-0.96; P=.03; I2=65%), preterm birth (OR 0.65, 95% CI 0.48-0.87; P=.004; I2=25%), macrosomia (OR 0.59, 95% CI 0.40-0.87; P=.008; I2=59%), and gestational weight gain (mean difference=-1.12 kg, 95% CI -1.44 to -0.80; P<.001; I2=43%). The subgroup analysis showed that interventions delivered via apps (OR 0.55, 95% CI 0.37-0.83; P=.004; I2=44%), provided by obstetricians (OR 0.69, 95% CI 0.51-0.93; P=.02; I2=60%), and targeted at Asian populations (OR 0.44, 95% CI 0.34-0.58; P<.001; I2=0%) and that used the International Association of Diabetes and Pregnancy Study Groups diagnostic criteria (OR 0.58, 95% CI 0.39-0.86; P=.007; I2=69%) showed a statistically significant reduction in the risk of GDM. CONCLUSIONS mHealth-based lifestyle interventions had a favorable impact on the prevention of GDM in pregnant women with overweight and obesity. Future studies need to further explore the potential of mHealth-based interventions for GDM through better design and more rigorous large-scale RCTs. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021286995; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286995.
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Affiliation(s)
- Yirong He
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Chuanya Huang
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Qiuyang He
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- Department of Obstetric Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shujuan Liao
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Biru Luo
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
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Železnik U, Kokol P, Starc J, Železnik D, Završnik J, Vošner HB. Research Trends in Motivation and Weight Loss: A Bibliometric-Based Review. Healthcare (Basel) 2023; 11:3086. [PMID: 38063654 PMCID: PMC10706120 DOI: 10.3390/healthcare11233086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 02/28/2024] Open
Abstract
Obesity is a complex disease that, like COVID-19, has reached pandemic proportions. Consequently, it has become a rapidly growing scientific field, represented by an extensive body of research publications. Therefore, the aim of this study was to present the research trends in the scientific literature on motivation and weight loss. Because traditional knowledge synthesis approaches are not appropriate for analyzing large corpora of research evidence, we utilized a novel knowledge synthesis approach called synthetic knowledge synthesis (SKS) to generate new holistic insights into obesity research focusing on motivation. SKS is a triangulation of bibliometric analysis, bibliometric mapping, and content analysis. Using it, we analyzed the corpus of publications retrieved from the Scopus database, using the search string TITLE-ABS-KEY((obesity or overweight) and "weight loss" and motiv*) in titles, keywords, and abstracts, without any additional inclusion or exclusion criteria. The search resulted in a corpus of 2301 publications. The United States of America, the United Kingdom, and Australia were the most productive countries. Four themes emerged, namely, weight loss and weight-loss maintenance through motivational interventions, lifestyle changes supported by smart ICT, maintaining sustainable weight with a healthier lifestyle, and weight management on the level of primary healthcare and bariatric surgery. Further, we established that the volume of research literature is growing, as is the scope of the research. However, we observed a regional concentration of research and its funding in developed countries and almost nonexistent research cooperation between developed and less-developed countries.
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Affiliation(s)
- Uroš Železnik
- Faculty of Health and Social Sciences Slovenj Gradec, 2380 Slovenj Gradec, Slovenia; (D.Ž.); (H.B.V.)
- Health Education Center, Community Healthcare Center Ptuj, 2250 Ptuj, Slovenia
| | - Peter Kokol
- Laboratory for System Design, Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia;
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Jasmina Starc
- Faculty of Business and Management Sciences, University of Novo Mesto, 8000 Novo Mesto, Slovenia;
| | - Danica Železnik
- Faculty of Health and Social Sciences Slovenj Gradec, 2380 Slovenj Gradec, Slovenia; (D.Ž.); (H.B.V.)
| | - Jernej Završnik
- Community Healthcare Center Dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia;
| | - Helena Blažun Vošner
- Faculty of Health and Social Sciences Slovenj Gradec, 2380 Slovenj Gradec, Slovenia; (D.Ž.); (H.B.V.)
- Community Healthcare Center Dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia;
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Kheirmandparizi M, Gouin JP, Bouchaud CC, Kebbe M, Bergeron C, Madani Civi R, Rhodes RE, Farnesi BC, Bouguila N, Conklin AI, Lear SA, Cohen TR. Perceptions of self-monitoring dietary intake according to a plate-based approach: A qualitative study. PLoS One 2023; 18:e0294652. [PMID: 38015899 PMCID: PMC10683993 DOI: 10.1371/journal.pone.0294652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/05/2023] [Indexed: 11/30/2023] Open
Abstract
Dietary self-monitoring is a behaviour change technique used to help elicit and sustain dietary changes over time. Current dietary self-monitoring tools focus primarily on itemizing foods and counting calories, which can be complex, time-intensive, and dependent on health literacy. Further, there are no dietary self-monitoring tools that conform to the plate-based approach of the 2019 Canada Food Guide (CFG), wherein the recommended proportions of three food groups are visually represented on a plate without specifying daily servings or portion sizes. This paper explored the perceptions of end-users (i.e., general public) and Registered Dietitians of iCANPlateTM-a dietary self-monitoring mobile application resembling the CFG. Qualitative data were collected through virtual focus groups. Focus group questions were based on the Capability, Opportunity, Motivation-Behaviour (COM-B) theoretical framework to explore perceptions of using the CFG and currently available dietary self-monitoring tools. The prototype iCANPlateTM (version 0.1) was presented to gain feedback on perceived barriers and facilitators of its use. Focus group discussions were audio recorded and verbatim transcribed. Trained researchers used thematic analysis to code and analyze the transcripts independently. Seven focus groups were conducted with Registered Dietitians (n = 44) and nine focus groups with members from the general public (n = 52). During the focus groups, participants mainly discussed the capabilities and opportunities required to use the current iteration of iCANPlateTM. Participants liked the simplicity of the application and its capacity to foster self-awareness of dietary behaviours rather than weight control or calorie counting. However, concerns were raised regarding iCANPlateTM's potential to improve adherence to dietary self-monitoring due to specific characteristics (i.e., insufficient classifications, difficulty in conceptualizing proportions, and lack of inclusivity). Overall, participants liked the simplicity of iCANPlateTM and its ability to promote self-awareness of dietary intakes, primarily through visual representation of foods on a plate as opposed to reliance on numerical values or serving sizes, were benefits of using the app. Findings from this study will be used to further develop the app with the goal of increasing adherence to plate-based dietary approaches.
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Affiliation(s)
- Maryam Kheirmandparizi
- Faculty of Land and Food Systems, Food, Nutrition and Health, the University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean-Philippe Gouin
- PERFORM Centre, Concordia University, Montreal, Quebec, Canada
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | | | - Maryam Kebbe
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Coralie Bergeron
- Faculty of Land and Food Systems, Food, Nutrition and Health, the University of British Columbia, Vancouver, British Columbia, Canada
- PERFORM Centre, Concordia University, Montreal, Quebec, Canada
| | - Rana Madani Civi
- Faculty of Land and Food Systems, Food, Nutrition and Health, the University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan E. Rhodes
- School of Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Biagina-Carla Farnesi
- Division of Adolescent Medicine, Montreal Children’s Hospital, Westmount, Quebec, Canada
| | - Nizar Bouguila
- Concordia Institute for Information Systems Engineering, Engineering, Computer Science and Visual Arts Integrated Complex, Concordia University, Montreal, Quebec, Canada
| | - Annalijn I. Conklin
- Faculty of Pharmaceutical Sciences, the University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott A. Lear
- Faculty of Health Sciences, Burnaby and Division of Cardiology, Providence Health Care, Simon Fraser University, Vancouver, BC, Canada
| | - Tamara R. Cohen
- Faculty of Land and Food Systems, Food, Nutrition and Health, the University of British Columbia, Vancouver, British Columbia, Canada
- PERFORM Centre, Concordia University, Montreal, Quebec, Canada
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Stanic T, Saygin Avsar T, Gomes M. Economic Evaluations of Digital Health Interventions for Children and Adolescents: Systematic Review. J Med Internet Res 2023; 25:e45958. [PMID: 37921844 PMCID: PMC10656663 DOI: 10.2196/45958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/13/2023] [Accepted: 08/03/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Digital health interventions (DHIs) are defined as digital technologies such as digital health applications and information and communications technology systems (including SMS text messages) implemented to meet health objectives. DHIs implemented using various technologies, ranging from electronic medical records to videoconferencing systems and mobile apps, have experienced substantial growth and uptake in recent years. Although the clinical effectiveness of DHIs for children and adolescents has been relatively well studied, much less is known about the cost-effectiveness of these interventions. OBJECTIVE This study aimed to systematically review economic evaluations of DHIs for pediatric and adolescent populations. This study also reviewed methodological issues specific to economic evaluations of DHIs to inform future research priorities. METHODS We conducted a database search in PubMed from 2011 to 2021 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. In total, 2 authors independently screened the titles and abstracts of the search results to identify studies eligible for full-text review. We generated a data abstraction procedure based on recommendations from the Panel on Cost-Effectiveness in Health and Medicine. The types of economic evaluations included in this review were cost-effectiveness analyses (costs per clinical effect), cost-benefit analyses (costs and effects expressed in monetary terms as net benefit), and cost-utility analyses (cost per quality-adjusted life year or disability-adjusted life year). Narrative analysis was used to synthesize the quantitative data because of heterogeneity across the studies. We extracted methodological issues related to study design, analysis framework, cost and outcome measurement, and methodological assumptions regarding the health economic evaluation. RESULTS We included 22 articles assessing the cost-effectiveness of DHI interventions for children and adolescents. Most articles (14/22, 64%) evaluated interventions delivered through web-based portals or SMS text messaging, most frequently within the health care specialties of mental health and maternal, newborn, and child health. In 82% (18/22) of the studies, DHIs were found to be cost-effective or cost saving compared with the nondigital standard of care. The key drivers of cost-effectiveness included population coverage, cost components, intervention effect size and scale-up, and study perspective. The most frequently identified methodological challenges were related to study design (17/22, 77%), costing (11/22, 50%), and economic modeling (9/22, 41%). CONCLUSIONS This is the first systematic review of economic evaluations of DHIs targeting pediatric and adolescent populations. We found that most DHIs (18/22, 82%) for children and adolescents were cost-effective or cost saving compared with the nondigital standard of care. In addition, this review identified key methodological challenges directly related to the conduct of economic evaluations of DHIs and highlighted areas where further methodological research is required to address these challenges. These included the need for measurement of user involvement and indirect effects of DHIs and the development of children-specific, generic quality-of-life outcomes.
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Affiliation(s)
- Tijana Stanic
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Tuba Saygin Avsar
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Manuel Gomes
- Department of Applied Health Research, University College London, London, United Kingdom
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Brame J, Kohl J, Centner C, Wurst R, Fuchs R, Tinsel I, Maiwald P, Fichtner UA, Sehlbrede M, Farin-Glattacker E, Gollhofer A, König D. Effects of a Web-Based Lifestyle Intervention on Physical Fitness and Health in Physically Inactive Adults: A Randomized Controlled Trial. Healthcare (Basel) 2023; 11:2847. [PMID: 37957992 PMCID: PMC10649962 DOI: 10.3390/healthcare11212847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Web-based lifestyle interventions are a new area of health research. This randomized controlled trial evaluated the effectiveness of an interactive web-based health program on physical fitness and health. N = 189 healthy adults participated in a 12-week interactive (intervention) or non-interactive (control) web-based health program. The intervention provided a web-based lifestyle intervention to promote physical activity and fitness through individualized activities as part of a fully automated, multimodal health program. The control intervention included health information. Cardiorespiratory fitness measured as maximum oxygen uptake (VO2max) was the primary outcome, while musculoskeletal fitness, physical activity and dietary behavior, and physiological health outcomes were assessed as secondary outcomes (t0: 0 months, t1: 3 months, t2: 9 months, t3: 15 months). Statistical analysis was performed with robust linear mixed models. There were significant time effects in the primary outcome (VO2max) (t0-t1: p = 0.018) and individual secondary outcomes for the interactive web-based health program, but no significant interaction effects in any of the outcomes between the interactive and non-interactive web-based health program. This study did not demonstrate the effectiveness of an interactive compared with a non-interactive web-based health program in physically inactive adults. Future research should further develop the evidence on web-based lifestyle interventions.
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Affiliation(s)
- Judith Brame
- Department of Sport and Sport Science, University of Freiburg, 79102 Freiburg, Germany; (J.B.)
| | - Jan Kohl
- Department of Sport and Sport Science, University of Freiburg, 79102 Freiburg, Germany; (J.B.)
| | - Christoph Centner
- Department of Sport and Sport Science, University of Freiburg, 79102 Freiburg, Germany; (J.B.)
- Praxisklinik Rennbahn, 4132 Muttenz, Switzerland
| | - Ramona Wurst
- Department of Sport and Sport Science, University of Freiburg, 79102 Freiburg, Germany; (J.B.)
| | - Reinhard Fuchs
- Department of Sport and Sport Science, University of Freiburg, 79102 Freiburg, Germany; (J.B.)
| | - Iris Tinsel
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center–University of Freiburg, 79106 Freiburg, Germany
| | - Phillip Maiwald
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center–University of Freiburg, 79106 Freiburg, Germany
| | - Urs A. Fichtner
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center–University of Freiburg, 79106 Freiburg, Germany
| | - Matthias Sehlbrede
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center–University of Freiburg, 79106 Freiburg, Germany
| | - Erik Farin-Glattacker
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center–University of Freiburg, 79106 Freiburg, Germany
| | - Albert Gollhofer
- Department of Sport and Sport Science, University of Freiburg, 79102 Freiburg, Germany; (J.B.)
| | - Daniel König
- Centre for Sport Science and University Sports, Department of Sport Science, Division for Nutrition, Exercise and Health, University of Vienna, 1150 Vienna, Austria
- Faculty of Life Sciences, Department of Nutritional Sciences, Division for Nutrition, Exercise and Health, University of Vienna, 1090 Vienna, Austria
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17
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Palmeira AL, Marques MM, Sánchez-Oliva D, Encantado J, Santos I, Duarte C, Matos M, Carneiro-Barrera A, Larsen SC, Horgan G, Sniehotta FF, Teixeira PJ, Stubbs RJ, Heitmann BL. Are motivational and self-regulation factors associated with 12 months' weight regain prevention in the NoHoW study? An analysis of European adults. Int J Behav Nutr Phys Act 2023; 20:128. [PMID: 37891654 PMCID: PMC10605649 DOI: 10.1186/s12966-023-01529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE Preventing weight regain can only be achieved by sustained changes in energy balance-related behaviors that are associated with weight, such as diet and physical activity. Changes in motivation and self-regulatory skills can support long-term behavioral changes in the context of weight loss maintenance. We propose that experiencing a supportive climate care is associated with enhanced satisfaction of basic psychological needs, intrinsic goals, and autonomous motivation. These factors are expected to be associate with the utilization of self-regulation skills, leading to more sustained behavior changes and ultimately preventing weight regain. This hypothesis was tested in this ancillary analysis of the NoHoW trial, where the study arms were pooled and followed for 12 months. METHODS The NoHoW was a three-center, large-scale weight regain prevention full factorial trial. In this longitudinal study, data were collected in adults who lost > 5% weight in the past year (N = 870, complete data only, 68.7% female, 44.10 ± 11.86 years, 84.47 ± 17.03 kg) during their participation in a 12-month digital behavior change intervention. Weight and validated measures of motivational- and self-regulatory skills-related variables were collected at baseline, six- and 12 months. Change variables were used in Mplus' path analytical models informed by NoHoW's logic model. RESULTS The bivariate correlations confirmed key mediators' potential effect on weight outcomes in the expected causal direction. The primary analysis showed that a quarter of the variance (r2 = 23.5%) of weight regain prevention was achieved via the mechanisms of action predicted in the logic model. Specifically, our results show that supportive climate care is associated with needs satisfaction and intrinsic goal content leading to better weight regain prevention via improvements in self-regulatory skills and exercise-controlled motivation. The secondary analysis showed that more mechanisms of action are significant in participants who regained or maintained their weight. CONCLUSIONS These results contribute to a better understanding of the mechanisms of action leading to behavior change in weight regain prevention. The most successful participants used only a few intrinsic motivation-related mechanisms of action, suggesting that habits may have been learned. While developing a digital behavior change intervention, researchers and practitioners should consider creating supportive climate care to improve needs satisfaction and intrinsic goal contents. TRIAL REGISTRATION ISRCTN, ISRCTN88405328 , registered 12/22/2016.
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Affiliation(s)
- António L Palmeira
- CIDEFES, Universidade Lusófona, Campo Grande, 376, 1749-024, Lisbon, Portugal.
| | - Marta M Marques
- Comprehensive Health Research Centre (CHRC), NOVA Medical School | Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - David Sánchez-Oliva
- Department of Didactics of Musical, Plastic and Body Expression, Faculty of Sports Sciences, University of Extremadura, Cáceres, Spain
| | | | - Inês Santos
- CIDEFES, Universidade Lusófona, Campo Grande, 376, 1749-024, Lisbon, Portugal
- Laboratório de Nutrição, Faculdade de Medicina, Centro Académico de Medicina de Lisboa, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cristiana Duarte
- Appetite Control and Energy Balance Group, School of Psychology, University of Leeds, Leeds, U.K
| | - Marcela Matos
- Center for Research in Neuropsychology and Cognitive-Behavioural Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
| | | | - Sofus C Larsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | | | - Falko F Sniehotta
- Department of Public Health, Social and Preventive Medicine, Center for Preventive Medicine and Digital Health (CPD), Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | | | - R James Stubbs
- Appetite Control and Energy Balance Group, School of Psychology, University of Leeds, Leeds, U.K
| | - Berit L Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
- Department of Public Health, Section for General Medicine, University of Copenhagen, Copenhagen, Denmark
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18
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Lorenzo E, O’Neal AL, Garcia LC, Mendoza K, Lee RE. Electronic Health Interventions for Type 2 Diabetes and Obesity in Hispanic or Latino Adults: A Systematic Review of English and Spanish Studies. Diabetes Spectr 2023; 37:65-85. [PMID: 38385094 PMCID: PMC10877215 DOI: 10.2337/ds22-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Objective The objective of this study was to synthesize English and Spanish literature to determine whether electronic health interventions (EHIs) such as telehealth, telemedicine, digital health, and mobile health (mHealth) improve A1C, blood glucose, BMI, and/or weight among Hispanic/Latino adults with type 2 diabetes or overweight/obesity in the Americas. Design and methods Searches were conducted in June 2021 using the Scientific Electronic Library Online, Cumulative Index of Nursing and Allied Health Literature, PubMed, and PsycInfo literature databases. Studies were identified that investigated the effect of an EHI on A1C, blood glucose, BMI, or weight in populations that were ≥12% Hispanic/Latino adults with type 2 diabetes or overweight/obesity, were conducted in the Americas, and were published in English or Spanish. Study quality was determined using the Quality Index Score. Data were extracted and synthesized, and themes were identified. Results Twenty-five studies met inclusion criteria, including 23 in English (from the United States) and two in Spanish (from Chile). A total of 22 investigated type 2 diabetes, and three investigated overweight/obesity. The studies encompassed 6,230 participants, including 3,413 Hispanic/Latino adults. Sixty-three percent of studies demonstrated significant improvements in A1C or blood glucose and 67% in weight. Thirteen studies offered an EHI in both English and Spanish, and six offered the intervention in either English or Spanish alone. All EHIs involving mHealth exclusively and most (90%) involving more than one electronic modality demonstrated a higher number of significant findings compared with those having only one EHI modality, especially telehealth (44.4%). EHIs lasting ≤12 months had more significant findings (72.7%) than those lasting >12 months (50%). Six studies had industry-related funding, with 83.3% of those demonstrating significant improvements in outcomes. Conclusion EHIs improved A1C and weight in adults (n = 4,355), including 45.5% Hispanic/Latino adults. mHealth and EHIs using more than one electronic modality and those lasting ≤12 months were especially effective. However, overall study quality was modest. Future research should be conducted in Spanish-speaking countries in Latin America and should compare the effectiveness of different EHI modalities.
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Affiliation(s)
- Elizabeth Lorenzo
- School of Nursing at the University of Texas Medical Branch, Galveston, TX
| | - Alicia Lynn O’Neal
- University of Kansas Medical Center, Kansas City, KS
- Digital Medicine Society, Boston, MA
| | - Lisbeth Cantu Garcia
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Kenny Mendoza
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, México
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA
| | - Rebecca E. Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
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19
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Enriquez JP, Ader D. Associations between health issues and food consumption with overweight and obesity in three university students minorities. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-9. [PMID: 37819376 DOI: 10.1080/07448481.2023.2266045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
Objective: To determine the presence of overweight and obesity among minorities, and the factors contributing to this weight disparity. Participants: The study comprises 3405 students including nonwhite, international, and first-generation college students. Methods: An online cross-sectional survey collected data on demographics, height, weight, self-health perception, overall sleep quality, progress in school, and food consumption. Three logistic regressions tested abnormal weight associations with health issues and food consumption. Results: Being 31 years-old or older, perception of health and consumption of ultra-processed food was significant with abnormal weight (BMI > 25). Only nonwhite and international students were correlated with ultra-processed and fast-food consumption respectively. Conclusion: Each minority presented vulnerabilities to high percentages of weights exceeding the appropriate rates of BMI. The high consumption of fast and ultra-processed foods makes it important to consider factors related to health perception in each minority group.
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Affiliation(s)
- Jean Pierre Enriquez
- Smith Center for International Sustainable Agriculture, Institute of Agriculture, The University of Tennessee, Knoxville, Tennessee, USA
| | - David Ader
- Smith Center for International Sustainable Agriculture, Institute of Agriculture, The University of Tennessee, Knoxville, Tennessee, USA
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20
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Dol A, van Gemert-Pijnen L, Schwartz LM, Velthuijsen H, Bode C. Exploring tailored virtual emotion regulation approaches for individuals with emotional eating. J Eat Disord 2023; 11:134. [PMID: 37573369 PMCID: PMC10422816 DOI: 10.1186/s40337-023-00856-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Emotional eating is a complex problem fostering obesity and resulting from maladaptive emotion regulation. Traditional behavioural weight loss interventions have shown insignificant effect. They can be improved by targeting the specific needs of individuals with emotional eating. OBJECTIVE The current study explored a tailored online approach with the aim to positively influence affect (positive and negative) and emotion regulation by applying one of three exercises: body scan, opposite action, and positive reappraisal. DESIGN An embedded mixed-method design (questionnaire data (t0, t1, t2) and perceived usefulness of exercises in t2) was used to evaluate the effects of a two-week online quasi-experimental pilot study. SUBJECTS/SETTING In total, 80 participants with self-reported emotional eating difficulties (DEBQ-E; Memo = 3.48, SD = .64, range 1.62-4.92) finished baseline measurements; 15 completed the intervention. The study sample was predominantly female (95%), from 18 till 66 (Mage = 38,0 ± SD = 14.25). RESULTS Participants reported that the exercises helped them to pay attention to their physical sensations, and to see positive aspects in negative matters. The exercises were considered difficult by the participants, with too little explanation, and dull, due to minor variation. The observed changes revealed small, and moreover, not significant improvements of the three exercises on positive and negative affect and overall emotion dysregulation. Although the quantitative results did not reach significance, the qualitative data highlighted which aspects of the tailored exercises may have contributed to mood and emotion regulation outcomes. A notable observation in the present study is the substantial dropout rate, with the number of participants decreasing from 80 at baseline (T0) to 15 at the post-intervention stage (T2). CONCLUSIONS Future studies should identify tailored online exercises in emotion regulation skills in more detail and explore the contexts in which they are most effective in a personalized virtual coach virtual coach to be developed for individuals with emotional eating. Given the high dropout rate, more emphasis should be given to a proper presentation of the exercises, as well as more explanation of their usefulness and how to perform them.
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Affiliation(s)
- Aranka Dol
- Department of Psychology, Health and Technology, University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
- Research Group New Business & ICT, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Lisette van Gemert-Pijnen
- Department of Psychology, Health and Technology, University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
| | - Lysanne M. Schwartz
- Department of Psychology, Health and Technology, University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
| | - Hugo Velthuijsen
- Research Group New Business & ICT, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
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21
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Lee S, Patel P, Myers ND, Pfeiffer KA, Smith AL, Kelly KS. A Systematic Review of eHealth Interventions to Promote Physical Activity in Adults with Obesity or Overweight. Behav Med 2023; 49:213-230. [PMID: 35465851 DOI: 10.1080/08964289.2022.2065239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 11/02/2022]
Abstract
Use of information and communication technology to improve health, known as eHealth, is an emerging concept in healthcare that may present opportunities to promote physical activity in adults with obesity. The purpose of this research was to systematically review eHealth intervention studies to promote physical activity in adults with obesity. Five electronic databases were used. Two authors screened articles, assessed risk of bias, and extracted data independently. A qualitative data synthesis for summarizing the findings was performed using harvest plots. In the search, 2276 articles were identified, and 18 studies met all inclusion criteria. Study quality ranged from poor to good. The included studies varied in intervention technology (e.g., web-based), physical activity assessment (e.g., device-based), and control group (e.g., wait-list). Behavioral change techniques used in the included studies were consistent with some techniques (e.g., self-monitoring) known as effective in face-to-face interventions, but more efficiently employed in eHealth using information and communication technology. Overall, this systematic review showed that a web-based or physical activity monitor-based eHealth intervention had the potential to effectively promote physical activity in adults with obesity. Some recommendations for future eHealth interventions to promote physical activity in adults with obesity were provided (e.g., use of theory, accelerometers).
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Affiliation(s)
- Seungmin Lee
- Department of Health and Wellness Studies, Binghamton University
| | - Priya Patel
- Department of Kinesiology, Michigan State University
| | | | | | - Alan L Smith
- The Emma Eccles Jones College of Education and Human Services, Utah State University
| | - Kimberly S Kelly
- Department of Counseling, Educational Psychology and Special Education, Michigan State University
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22
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Raiman L, Amarnani R, Abdur-Rahman M, Marshall A, Mani-Babu S. The role of physical activity in obesity: let's actively manage obesity. Clin Med (Lond) 2023; 23:311-317. [PMID: 38614643 PMCID: PMC10541051 DOI: 10.7861/clinmed.2023-0152] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Obesity, physical inactivity and sedentary behaviour are major public health concerns. A complex interaction of many factors leads to obesity, which requires an individualised multicomponent management strategy. As new interventions become available to help individuals manage obesity, it is essential that physical activity remains a core part of the approach. Here, we summarise current evidence regarding the benefits of physical activity as part of a management strategy of obesity. Additionally, we discuss current methods for increasing physical activity levels in individuals with obesity and outline the role of sport and exercise medicine physicians as part of the multidisciplinary team.
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Affiliation(s)
- Lewis Raiman
- Imperial College Healthcare NHS Trust, London, UK
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23
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Sithole BR, Pappas Y, Randhawa G. eHealth in obesity care. Clin Med (Lond) 2023; 23:347-352. [PMID: 38614648 PMCID: PMC10541052 DOI: 10.7861/clinmed.2023-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Obesity in adults is a growing health concern. Although effective, current treatment options have not been able to overcome the various factors that contribute toward rising obesity rates. eHealth might hold the capacity to improve the effectiveness, delivery and flexibility of some of these treatments. Here, we show that eHealth lifestyle change interventions delivered through smartphones (mHealth) can facilitate significant weight loss, making mHealth an attractive adjunct to clinical obesity care. However, evidence is currently limited to short-term effects, and is also lacking with regards to effectiveness based on socioeconomic status and ethnic group. This raises concerns around the potential and inadvertent widening of obesity prevalence disparities between groups as mHealth lifestyle change interventions are increasingly used in obesity care. Thus, we also describe opportunities to address these concerns and gaps in evidence.
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Affiliation(s)
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, UK
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24
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Kohl J, Brame J, Centner C, Wurst R, Fuchs R, Sehlbrede M, Tinsel I, Maiwald P, Fichtner UA, Armbruster C, Farin-Glattacker E, Gollhofer A, König D. Effects of a Web-Based Lifestyle Intervention on Weight Loss and Cardiometabolic Risk Factors in Adults With Overweight and Obesity: Randomized Controlled Clinical Trial. J Med Internet Res 2023; 25:e43426. [PMID: 37368484 DOI: 10.2196/43426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/17/2023] [Accepted: 04/20/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND The high proportion of people with overweight and obesity has become a worldwide problem in recent decades, mainly due to health consequences, such as cardiovascular diseases, neoplasia, and type 2 diabetes mellitus. Regarding effective countermeasures, the digitization of health services offers numerous potentials, which, however, have not yet been sufficiently evaluated. Web-based health programs are becoming increasingly interactive and can provide individuals with effective long-term weight management support. OBJECTIVE The purpose of this randomized controlled clinical trial was to evaluate the effectiveness of an interactive web-based weight loss program on anthropometric, cardiometabolic, and behavioral variables and to compare it with a noninteractive web-based weight loss program. METHODS The randomized controlled trial included people who were aged between 18 and 65 years (mean 48.92, SD 11.17 years) and had a BMI of 27.5 to 34.9 kg/m2 (mean 30.71, SD 2.13 kg/m2). Participants (n=153) were assigned to either (1) an interactive and fully automated web-based health program (intervention) or (2) a noninteractive web-based health program (control). The intervention program focused on dietary energy density and allowed for dietary documentation with appropriate feedback on energy density and nutrients. The control group only received information on weight loss and energy density, but the website did not contain interactive content. Examinations were performed at baseline (t0), at the end of the 12-week intervention (t1), and at 6 months (t2) and 12 months (t3) thereafter. The primary outcome was body weight. The secondary outcomes were cardiometabolic variables as well as dietary and physical activity behaviors. Robust linear mixed models were used to evaluate the primary and secondary outcomes. RESULTS The intervention group showed significant improvements in anthropometric variables, such as body weight (P=.004), waist circumference (P=.002), and fat mass (P=.02), compared with the control group over the course of the study. The mean weight loss after the 12-month follow-up was 4.18 kg (4.7%) in the intervention group versus 1.29 kg (1.5%) in the control group compared with the initial weight. The results of the nutritional analysis showed that the energy density concept was significantly better implemented in the intervention group. Significant differences in cardiometabolic variables were not detected between the 2 groups. CONCLUSIONS The interactive web-based health program was effective in reducing body weight and improving body composition in adults with overweight and obesity. However, these improvements were not associated with relevant changes in cardiometabolic variables, although it should be noted that the study population was predominantly metabolically healthy. TRIAL REGISTRATION German Clinical Trials Register DRKS00020249; https://drks.de/search/en/trial/DRKS00020249. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.3390/ijerph19031393.
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Affiliation(s)
- Jan Kohl
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Judith Brame
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Christoph Centner
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Ramona Wurst
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Reinhard Fuchs
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Matthias Sehlbrede
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Iris Tinsel
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Phillip Maiwald
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Urs Alexander Fichtner
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Armbruster
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Albert Gollhofer
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Daniel König
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
- Department of Sport Science, Institute for Nutrition, Exercise and Health, University of Vienna, Vienna, Austria
- Department of Nutritional Sciences, Institute for Nutrition, Exercise and Health, University of Vienna, Vienna, Austria
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25
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Schladitz K, Luppa M, Riedel-Heller SG, Loebner M. Effectiveness of internet-based and mobile-based interventions for adults with overweight or obesity experiencing symptoms of depression: a systematic review protocol. BMJ Open 2023; 13:e067930. [PMID: 37339836 DOI: 10.1136/bmjopen-2022-067930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION Internet-based and mobile-based interventions (IMIs) provide innovative low-threshold and cost-effective prevention and self-management options for mental health problems complementary to standard treatment. The objective of this systematic review is to summarise the effectiveness and to critically evaluate studies on IMIs addressing comorbid depressive symptoms in adults with overweight or obesity. METHODS AND ANALYSIS The study authors will systematically search the databases MEDLINE, Cochrane Library, PsycINFO, Web of Science, Embase and Google Scholar (for grey literature) for randomised controlled trials (RCTs) of IMIs for individuals with overweight or obesity and comorbid depressive symptoms without restrictions on publication date (planned inception 1 June 2023 to 1 December 2023). Two reviewers will independently extract and evaluate data from studies eligible for inclusion by assessing quality of evidence and qualitatively synthesising results. Preferred Reporting Items for Systematic reviews Meta-Analyses (PRISMA) standards and the revised Cochrane Risk of Bias tool in RCTs (RoB 2) will be applied. ETHICS AND DISSEMINATION Ethical approval is not required as no primary data will be collected. Study results will be disseminated through publication in a peer-reviewed journal and presentations on conferences. PROSPERO REGISTRATION NUMBER CRD42023361771.
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Affiliation(s)
- Katja Schladitz
- Institute of Social Medicine, Occupational Health and Public Health, Leipzig University, Leipzig, Sachsen, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, Leipzig University, Leipzig, Sachsen, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Leipzig University, Leipzig, Sachsen, Germany
| | - Margrit Loebner
- Institute of Social Medicine, Occupational Health and Public Health, Leipzig University, Leipzig, Sachsen, Germany
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26
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Miller NA, Ehmann MM, Hagerman CJ, Forman EM, Arigo D, Spring B, LaFata EM, Zhang F, Milliron BJ, Butryn ML. Sharing digital self-monitoring data with others to enhance long-term weight loss: A randomized controlled trial. Contemp Clin Trials 2023; 129:107201. [PMID: 37080355 PMCID: PMC10231946 DOI: 10.1016/j.cct.2023.107201] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/24/2023] [Accepted: 04/16/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Participants in behavioral weight loss (BWL) programs increasingly use digital tools to self-monitor weight, physical activity, and dietary intake. Data collected with these tools can be systematically shared with other parties in ways that might support behavior change. METHODS Adults age 18 to 70 with overweight/obesity (BMI 27-50 kg/m2) will enroll in a remotely delivered, 24-month BWL program designed to produce and maintain a 10% weight loss. Participants will be asked to use a wireless body weight scale, wearable activity sensor, and dietary intake app daily. All participants will receive individual and group counseling, engage in text messaging with members of their group, and appoint a friend or family member to serve in a support role. A 2x2x2 factorial design will test the effects of three types of data sharing partnerships: 1) Coach Share: The behavioral coach will regularly view digital self-monitoring data and address data observations. 2) Group Share: Participants will view each other's self-monitoring data in small-group text messages. 3) Friend/Family Share: A friend or family member will view the participant's data via automated message. The primary outcome is weight loss at 24 months. Mediators and moderators of intervention effects will be tested. CONCLUSION This study will provide a clear indication of whether data sharing can improve long-term weight loss. This study will be the first to discern the mechanisms of action through which each type of data sharing may be beneficial, and elucidate conditions under which the benefits of data sharing may be maximized.
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Affiliation(s)
- Nicole A Miller
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States.
| | - Marny M Ehmann
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Charlotte J Hagerman
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Evan M Forman
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Danielle Arigo
- Department of Psychology, Rowan University, 201 Mullica Hill Rd, Robinson Hall, Glassboro, NJ 08028, United States
| | - Bonnie Spring
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| | - Erica M LaFata
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Fengqing Zhang
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Brandy-Joe Milliron
- Department of Nutrition Sciences, Drexel University, 60 N 36th St, 11(th) floor, Philadelphia, PA 19104, United States
| | - Meghan L Butryn
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States.
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Carrello J, Hayes A, Baur LA, Lung T. Potential cost-effectiveness of e-health interventions for treating overweight and obesity in Australian adolescents. Pediatr Obes 2023; 18:e13003. [PMID: 36649693 PMCID: PMC10909552 DOI: 10.1111/ijpo.13003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/04/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND E-health, defined as the use of information and communication technologies to improve healthcare delivery and health outcomes, has been promoted as a cost-effective strategy to treat adolescent overweight and obesity. However, evidence supporting this claim is lacking. OBJECTIVES Assess the potential cost-effectiveness of a hypothetical e-health intervention for adolescents with overweight and obesity. METHODS The costs and effect size (BMI reduction) of the hypothetical intervention were sourced from recent systematic reviews. Using a micro-simulation model with a lifetime time horizon, we conducted a modelled cost-utility analysis of the intervention compared to a 'do-nothing' approach. To explore uncertainty, we conducted bootstrapping on individual-level costs and quality-adjusted life years (QALYs) and performed multiple one-way sensitivity analyses. RESULTS The incremental cost-effectiveness ratio (ICER) for the e-health intervention was dominant (cheaper and more effective), with a 96% probability of being cost-effective at a willingness-to-pay (WTP) of $50 000/QALY. The ICER remained dominant in all sensitivity analyses except when using the lower bounds of the hypothetical intervention effect size, which reduced the probability of cost-effectiveness at a WTP of $50 000/QALY to 51%. CONCLUSION E-health interventions for treatment of adolescent overweight and obesity demonstrate very good cost-effectiveness potential and should be considered by healthcare decision makers. However, further research on the efficacy of such interventions is warranted to strengthen the case for investment.
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Affiliation(s)
- Joseph Carrello
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Alison Hayes
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Louise A. Baur
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
- Weight Management Services, The Children's Hospital at WestmeadWestmeadAustralia
| | - Thomas Lung
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
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Myers-Ingram R, Sampford J, Milton-Cole R, Jones GD. Effectiveness of eHealth weight management interventions in overweight and obese adults from low socioeconomic groups: a systematic review. Syst Rev 2023; 12:59. [PMID: 36998094 PMCID: PMC10061957 DOI: 10.1186/s13643-023-02207-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 03/01/2023] [Indexed: 03/31/2023] Open
Abstract
Background Low socioeconomic status (SES) is associated with increased rates of overweight and obesity. Proponents of electronic health (eHealth) hypothesise that its inclusion in weight management interventions can improve efficacy by mitigating typical barriers associated with low SES. Objectives To establish the scope of eHealth weight management interventions for people with overweight and obesity from a low SES. Secondary objectives were to determine the efficacy of eHealth interventions in facilitating weight loss, physical activity and fitness improvements. Methods Four databases and grey literature were systematically searched to identify eligible studies published in English from inception to May 2021. Studies examining an eHealth intervention with low SES participants were included. Outcomes included temporal change in weight and BMI, anthropometry, physiological measures and physical activity levels. The number and heterogeneity of studies precluded any meta-analyses; thus, a narrative review was undertaken. Results Four experimental studies with low risk of bias were reviewed. There was variance in how SES was defined. Study aims and eHealth media also varied and included reducing/maintaining weight or increasing physical activity using interactive websites or voice responses, periodic communication and discourse via telephone, social media, text messaging or eNewsletters. Irrespectively, all studies reported short-term weight loss. eHealth interventions also increased short-term physical activity levels where it was assessed, but did not change anthropometry or physiological measures. None reported any effect on physical fitness. Conclusions This review revealed short-term effects of eHealth interventions on weight loss and increased physical activity levels for low SES participants. Evidence was limited to a small number of studies, with small to moderate sample sizes. Inter-study comparison is challenging because of considerable variability. Future work should prioritise how to utilise eHealth in the longer term either as a supportive public health measure or by determining its long-term efficacy in engendering volitional health behaviour changes. Systematic review registration PROSPERO CRD42021243973 Supplementary Information The online version contains supplementary material available at 10.1186/s13643-023-02207-3.
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Affiliation(s)
- Richard Myers-Ingram
- grid.420545.20000 0004 0489 3985Department of Physiotherapy, Guy’s & St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Jade Sampford
- grid.420545.20000 0004 0489 3985Department of Physiotherapy, Guy’s & St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Rhian Milton-Cole
- grid.420545.20000 0004 0489 3985Department of Physiotherapy, Guy’s & St Thomas’ Hospital NHS Foundation Trust, London, UK
- grid.13097.3c0000 0001 2322 6764Department of Population and Health Sciences, King’s College London, London, UK
| | - Gareth David Jones
- grid.420545.20000 0004 0489 3985Department of Physiotherapy, Guy’s & St Thomas’ Hospital NHS Foundation Trust, London, UK
- grid.13097.3c0000 0001 2322 6764Faculty of Life Sciences & Medicine, Centre for Human & Applied Physiological Sciences (CHAPS), King’s College London, London, UK
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Voss C, Liu J, Chang A, Kosmas JA, Biehl A, Flynn RL, Kruzan KP, Wildes JE, Graham AK. Weight Loss Expectations of Adults With Binge Eating: Cross-sectional Study With a Human-Centered Design Approach. JMIR Form Res 2023; 7:e40506. [PMID: 36853750 PMCID: PMC10015344 DOI: 10.2196/40506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/17/2022] [Accepted: 01/03/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND People tend to overestimate their expectations for weight loss relative to what is achievable in a typical evidence-based behavioral weight management program, which can impact treatment satisfaction and outcomes. We are engaged in formative research to design a digital intervention that addresses binge eating and weight management; thus, understanding expectations among this group can inform more engaging intervention designs to produce a digital intervention that can achieve greater clinical success. Studies examining weight loss expectations have primarily focused on people who have overweight or obesity. Only one study has investigated weight loss expectations among people with binge eating disorder, a population that frequently experiences elevated weight and shape concerns and often presents to treatment with the goal of losing weight. OBJECTIVE The aim of the study is to investigate differences in weight loss expectations among people with varying levels of binge eating to inform the design of a digital intervention for binge eating and weight management. Such an evaluation may be crucial for people presenting for a digital intervention, given that engagement and dropout are notable problems for digital behavior change interventions. We tested the hypotheses that (1) people who endorsed some or recurrent binge eating would expect to lose more weight than those who did not endorse binge eating and (2) people who endorsed a more severe versus a low or moderate overvaluation of weight and shape would have higher weight loss expectations. METHODS A total of 760 adults (n=504, 66% female; n=441, 58% non-Hispanic White) completed a web-based screening questionnaire. One-way ANOVAs were conducted to explore weight loss expectations for binge eating status as well as overvaluation of shape and weight. RESULTS Weight loss expectations significantly differed by binge eating status. Those who endorsed some and recurrent binge eating expected to lose more weight than those who endorsed no binge eating. Participants with severe overvaluation of weight or shape expected to lose the most weight compared to those with low or moderate levels of overvaluation of weight and shape. CONCLUSIONS In the sample, people interested in a study to inform a digital intervention for binge eating and weight management overestimated their expectations for weight loss. Given that weight loss expectations can impact treatment completion and success, it may be important to assess and modify weight loss expectations among people with binge eating prior to enrolling in a digital intervention. Future work should design and test features that can modify these expectations relative to individuals' intended treatment goals to facilitate engagement and successful outcomes in a digital intervention.
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Affiliation(s)
- Claire Voss
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jianyi Liu
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Angela Chang
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jacqueline A Kosmas
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Abigail Biehl
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rebecca L Flynn
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kaylee P Kruzan
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Jaén-Extremera J, Afanador-Restrepo DF, Rivas-Campo Y, Gómez-Rodas A, Aibar-Almazán A, Hita-Contreras F, Carcelén-Fraile MDC, Castellote-Caballero Y, Ortiz-Quesada R. Effectiveness of Telemedicine for Reducing Cardiovascular Risk: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12030841. [PMID: 36769487 PMCID: PMC9917681 DOI: 10.3390/jcm12030841] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of death globally. There are six cardiovascular risk factors: diabetes, hypertension, hypercholesterolemia, overweight, sedentary lifestyle and smoking. Due to the low attendance of healthy people in the health system, the use of telemedicine can influence the acquisition of a heart-healthy lifestyle. OBJECTIVE this systematic review and meta-analysis aimed to determine the effectiveness of telemedicine and e-health in reducing cardiovascular risk. METHODS A systematic review and meta-analysis were carried out using the PubMed, Scopus, Cinhal and WOS databases. Randomized controlled studies between 2017 and 2022 in which telemedicine was used to reduce any of the risk factors were included. The methodological quality was assessed using the "PEDro" scale. RESULTS In total, 763 studies were obtained; after the review, 28 target articles were selected and finally grouped as follows: 13 studies on diabetes, six on hypertension, seven on obesity and two on physical activity. For all of the risk factors, a small effect of the intervention was seen. CONCLUSIONS although the current evidence is heterogeneous regarding the statistically significant effects of telemedicine on various cardiovascular risk factors, its clinical relevance is undeniable; therefore, its use is recommended as long as the necessary infrastructure exists.
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Affiliation(s)
- Jesús Jaén-Extremera
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | | | - Yulieth Rivas-Campo
- Faculty of Human and Social Sciences, University of San Buenaventura, Santiago de Cali 760016, Colombia
| | - Alejandro Gómez-Rodas
- Faculty of Health Sciences and Sport, University Foundation of the Área Andina, Pereira 660004, Colombia
| | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
- Correspondence:
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | | | | | - Raúl Ortiz-Quesada
- Department of Anatomy and Embryology, Faculty of Medicine, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18014 Granada, Spain
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Almeida FA, You W, Brito FA, Alves TF, Goessl C, Wall SS, Seidel RW, Davy BM, Greenawald MH, Hill JL, Estabrooks PA. A randomized controlled trial to test the effectiveness of two technology-enhanced diabetes prevention programs in primary care: The DiaBEAT-it study. Front Public Health 2023; 11:1000162. [PMID: 36908422 PMCID: PMC9998510 DOI: 10.3389/fpubh.2023.1000162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023] Open
Abstract
Objective To evaluate the effectiveness of two technology-enhanced interventions for diabetes prevention among adults at risk for developing diabetes in a primary care setting. Methods The DiaBEAT-it study employed a hybrid 2-group preference (Choice) and 3-group randomized controlled (RCT) design. This paper presents weight related primary outcomes of the RCT arm. Patients from Southwest Virginia were identified through the Carilion Clinic electronic health records. Eligible participants (18 and older, BMI ≥ 25, no Type 2 Diabetes) were randomized to either Choice (n = 264) or RCT (n = 334). RCT individuals were further randomized to one of three groups: (1) a 2-h small group class to help patients develop a personal action plan to prevent diabetes (SC, n = 117); (2) a 2-h small group class plus automated telephone calls using an interactive voice response system (IVR) to help participants initiate weight loss through a healthful diet and regular physical activity (Class/IVR, n = 110); or (3) a DVD with same content as the class plus the same IVR calls over a period of 12 months (DVD/IVR, n = 107). Results Of the 334 participants that were randomized, 232 (69%) had study measured weights at 6 months, 221 (66%) at 12 months, and 208 (62%) at 18 months. Class/IVR participants were less likely to complete weight measures than SC or DVD/IVR. Intention to treat analyses, controlling for gender, race, age and baseline BMI, showed that DVD/IVR and Class/IVR led to reductions in BMI at 6 (DVD/IVR -0.94, p < 0.001; Class/IVR -0.70, p < 0.01), 12 (DVD/IVR -0.88, p < 0.001; Class/IVR-0.82, p < 0.001) and 18 (DVD/IVR -0.78, p < 0.001; Class/IVR -0.58, p < 0.01) months. All three groups showed a significant number of participants losing at least 5% of their body weight at 12 months (DVD/IVR 26.87%; Class/IVR 21.62%; SC 16.85%). When comparing groups, DVD/IVR were significantly more likely to decrease BMI at 6 months (p < 0.05) and maintain the reduction at 18 months (p < 0.05) when compared to SC. There were no differences between the other groups. Conclusions The DiaBEAT-it interventions show promise in responding to the need for scalable, effective methods to manage obesity and prevent diabetes in primary care settings that do not over burden primary care clinics and providers. Registration https://clinicaltrials.gov/ct2/show/NCT02162901, identifier: NCT02162901.
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Affiliation(s)
- Fabio A Almeida
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, United States
| | - Wen You
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Fabiana A Brito
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, United States
| | - Thais F Alves
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, United States
| | - Cody Goessl
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Sarah S Wall
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Richard W Seidel
- Department of Psychiatry, Carilion Clinic, Roanoke, VA, United States
| | - Brenda M Davy
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Mark H Greenawald
- Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA, United States
| | - Jennie L Hill
- Department of Populational Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Paul A Estabrooks
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
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Cheng KC, Lau KMK, Cheng ASK, Lau TSK, Lau FOT, Lau MCH, Law SW. Use of mobile app to enhance functional outcomes and adherence of home-based rehabilitation program for elderly with hip fracture: A randomized controlled trial. Hong Kong Physiother J 2022; 42:99-110. [PMID: 37560168 PMCID: PMC10406639 DOI: 10.1142/s101370252250010x] [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: 12/09/2021] [Accepted: 04/11/2022] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Mobile app has been used to improve exercise adherence and outcomes in populations with different health conditions. However, the effectiveness of mobile app in delivering home-based rehabilitation program to elderly patients with hip fracture is unclear. OBJECTIVE The aim of this study was to test the effectiveness of mobile app in delivering home-based rehabilitation program for improving functional outcomes and reducing caregiver stress with enhancing adherence among the elderly patients with hip fracture. METHODS A randomized controlled trial with an intervention period of two months was performed. Eligible participants were randomized into either experimental group with home-based rehabilitation program using a mobile app or control group with home-based rehabilitation program using an exercise pamphlet. Primary outcomes were Modified Functional Ambulatory Category (MFAC), Elderly Mobility Scale (EMS) and Lower Extremity Functional Scale (LEFS). Secondary outcomes were exercise adherence and Modified Caregiver Strain Index (M-CSI). The outcomes were collected at pre-discharge training session, one month and two months after hospital discharge. RESULTS A total of 50 participants were enrolled, with 19 participants in the experimental group and 20 participants in the control group. Eleven participants had withdrawn from the study. The experimental group showed higher exercise adherence than the control group in first month (p = 0 . 03 ). There were no between-group differences in MFAC, EMS, LEFS and M-CSI at the first month and second month. CONCLUSION Use of the mobile app improved exercise adherence, yet it did not improve physical performance, self-efficacy and reduce caregiver stress when compared to a standard home rehabilitation program for elderly patients with hip fracture. Further studies to investigate the benefits of mobile apps are required. (ClinicalTrials.gov ID: NCT04053348.).
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Affiliation(s)
- Kui Ching Cheng
- Physiotherapy Department, Tai Po Hospital, 9 Chuen on Road, Tai Po New Territories, Hong Kong SAR, China
| | - Kin Ming Ken Lau
- Physiotherapy Department, Tung Wah Eastern Hospital 19 Eastern Hospital Road, Causeway Bay, Hong Kong SAR, China
| | - Andy S K Cheng
- Department of Rehabilitation Sciences The Hong Kong Polytechnic University, 11 Yuk Choi Road Hung Hom, Kowloon, Hong Kong SAR, China
| | - Tin Sing Keith Lau
- Physiotherapy Department, Tai Po Hospital, 9 Chuen on Road, Tai Po New Territories, Hong Kong SAR, China
| | - Fuk On Titanic Lau
- Physiotherapy Department, Tai Po Hospital, 9 Chuen on Road, Tai Po New Territories, Hong Kong SAR, China
| | - Mun Cheung Herman Lau
- CUHK Medical Centre, 9 Chak Cheung Street Shatin, New Territories, Hong Kong SAR, China
| | - Sheung Wai Law
- Department of Orthopaedics and Traumatology CUHK Medical Centre, 9 Chak Cheung Street Shatin, New Territories, Hong Kong SAR, China
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Christensen JR, Hesseldal L, Olesen TB, Olsen MH, Jakobsen PR, Laursen DH, Lauridsen JT, Nielsen JB, Søndergaard J, Brandt CJ. Long-term weight loss in a 24-month primary care-anchored telehealth lifestyle coaching program: Randomized controlled trial. J Telemed Telecare 2022; 28:764-770. [DOI: 10.1177/1357633x221123411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Long-term weight loss can reduce the risk of type 2 diabetes for people living with obesity and reduce complications for patients diagnosed with type 2 diabetes. We investigated whether a telehealth lifestyle-coaching program (Liva) leads to long-term (24 months) weight loss compared to usual care. In a randomized controlled trial, n = 340 participants living with obesity with or without type 2 diabetes were enrolled and randomized via an automated computer algorithm to an intervention group ( n = 200) or to a control group ( n = 140). The telehealth lifestyle-coaching program comprised of an initial one-hour face-to-face motivational interview followed by asynchronous telehealth coaching. The behavioural change techniques used were enabled by individual live monitoring. The primary outcome was a change in body weight from baseline to 24 months. Data were assessed for n = 136 participants (40%), n = 81 from the intervention group and n = 55 from the control group, who completed the 24-month follow-up. After 24 months mean body weight and body mass index were reduced significantly for completers in both groups, but almost twice as much was registered for those in the intervention group which was not significant between groups −4.4 (CI −6.1; −2.8) kg versus −2.5 (CI −3.9; −1.1) kg, P = 0.101. Haemoglobin A1c was significantly reduced in the intervention group −3.1 (CI −5.0; −1.2) mmol/mol, but not in the control group −0.2 (CI −2.4; −2.0) mmol/mol without a significant between group difference ( P = 0.223). Low completion was partly due to coronavirus disease 2019. Telehealth lifestyle coaching improve long-term weight loss (> 24 months) for obese people with and without type 2 diabetes compared to usual care.
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Affiliation(s)
- Jeanette R Christensen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Aarhus University, Aarhus, Denmark
| | - Laura Hesseldal
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Holbaek Hospital and Steno Diabetes Center Zealand, Holbaek, Denmark
| | - Thomas B Olesen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Michael H Olsen
- Department of Internal Medicine, Holbaek Hospital and Steno Diabetes Center Zealand, Holbaek, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Pernille R Jakobsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ditte H Laursen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen T Lauridsen
- Department of Economics and Data Science, University of Southern Denmark, Odense, Denmark
| | - Jesper B Nielsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Carl J Brandt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Yen HY, Jin G, Chiu HL. Smartphone app-based interventions targeting physical activity for weight management: a meta-analysis of randomized controlled trials. Int J Nurs Stud 2022; 137:104384. [DOI: 10.1016/j.ijnurstu.2022.104384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
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López A, Escobar MF, Urbano A, Alarcón J, Libreros-Peña L, Martinez-Ruiz DM, Casas LÁ. Experience with Obese Patients Followed via Telemedicine in a Latin American Tertiary Care Medical Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912406. [PMID: 36231703 PMCID: PMC9564633 DOI: 10.3390/ijerph191912406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 05/07/2023]
Abstract
BACKGROUND Obesity is a major public health concern worldwide. Latin America has experienced rapid growth in obesity incidence during the last few decades. Driven by confinement measures, a telemedicine program was implemented in March 2020 to give continuity to obese patients' care through a weight loss program led by the endocrinology department in a tertiary care medical center in Latin America. OBJECTIVE This study aimed to describe the clinical experience of using digital health for monitoring and attention of obese patients and description of weight change outcomes of these patients followed via telemedicine during March 2020-December 2020. METHODS A retrospective cohort study was conducted including 202 patients. A Skillings-Mack test was performed to conduct a subgroup analysis of the medians of the weight over the follow-up period, and a mixed multiple linear regression model was performed to estimate the expected average change in weight over time Results: We observed good adherence to the program, represented by a weight loss of -4.1 kg at three months of follow-up, which was maintained even during the sixth month of follow-up. CONCLUSIONS Digital Health strategies such as telemedicine can be a helpful tool for both patients and health care providers to support the continuity of care and showing satisfactory results in the management of obese patients.
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Affiliation(s)
- Alejandro López
- Department of Endocrinology, Fundación Valle del Lili, Cali 760032, Colombia
| | - Maria Fernanda Escobar
- Department of Telemedicine, Fundación Valle del Lili, Cali 760032, Colombia
- Department of Gynecology and Obstetrics, Universidad Icesi, Cali 760031, Colombia
- Correspondence:
| | - Alejandra Urbano
- Department of Endocrinology, Fundación Valle del Lili, Cali 760032, Colombia
| | - Juliana Alarcón
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia
| | - Laura Libreros-Peña
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia
| | | | - Luz Ángela Casas
- Department of Endocrinology, Fundación Valle del Lili, Cali 760032, Colombia
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Hoek A, Wang Z, van Oers AM, Groen H, Cantineau AEP. Effects of preconception weight loss after lifestyle intervention on fertility outcomes and pregnancy complications. Fertil Steril 2022; 118:456-462. [PMID: 36116799 DOI: 10.1016/j.fertnstert.2022.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 01/13/2023]
Abstract
It is well documented that obesity decreases natural fertility among men and women as well as pregnancy chances after conventional infertility and assisted reproductive technology (ART)-based treatments. Moreover, pregnancy complications are increased in women with overweight and obesity. General guidelines on the treatment of obesity recommend lifestyle intervention, including diet and exercise as the first-line treatment, coupled with or without medical treatments, such as weight loss medication or bariatric surgery, to reduce complications of obesity in adults. In the context of infertility in various countries and infertility clinics, there is a body mass index limit for public refund of infertility treatment of women with obesity. In this respect, it is important to investigate the evidence of effects of lifestyle intervention preceding infertility treatment on reproductive outcomes. The combined results of 15 randomized controlled trials (RCTs) of the effectiveness of preconception lifestyle intervention on reproductive outcomes documented in the latest systemic review and meta-analysis, together with the most recent RCT performed in 2022 are discussed. The current evidence suggests that greater weight loss and increase in clinical pregnancy, live birth, and natural conception rates after lifestyle intervention compared with no intervention were observed, but it seems no beneficial effect of lifestyle intervention preceding ART was observed on these parameters. With respect to potential harm of lifestyle intervention, there is no significant increased risk of early pregnancy loss, although the most recent RCT (not included in the systematic review and meta-analysis) showed a trend toward an increased risk. Complications during pregnancy, such as early pregnancy loss and maternal as well as fetal and neonatal complications, are underreported in most studies and need further analysis in an individual participant data meta-analysis. Limitations of the studies as well as future perspectives and challenges in this field of research will be highlighted.
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Affiliation(s)
- Annemieke Hoek
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Zheng Wang
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anne M van Oers
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Astrid E P Cantineau
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Dobbie LJ, Tahrani A, Alam U, James J, Wilding J, Cuthbertson DJ. Exercise in Obesity-the Role of Technology in Health Services: Can This Approach Work? Curr Obes Rep 2022; 11:93-106. [PMID: 34791611 PMCID: PMC8597870 DOI: 10.1007/s13679-021-00461-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Physical activity (PA) is an important strategy to prevent and treat obesity. Electronic health (eHealth) interventions, such as wearable activity monitors and smartphone apps, may promote adherence to regular PA and successful weight loss. This review highlights the evidence for eHealth interventions in promoting PA and reducing weight. RECENT FINDINGS Wearables can increase PA and are associated with moderate weight loss in middle/older-aged individuals, with less convincing effects long-term (> 1 year) and in younger people. Data for interventions such as mobile phone applications, SMS, and exergaming are less robust. Investigations of all eHealth interventions are often limited by complex, multi-modality study designs, involving concomitant dietary modification, making the independent contribution of each eHealth intervention on body weight challenging to assess. eHealth interventions may promote PA, thereby contributing to weight loss/weight maintenance; however, further evaluation is required for this approach to be adopted into routine clinical practice.
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Affiliation(s)
- Laurence J. Dobbie
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- University Hospital Aintree, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Abd Tahrani
- Institute of Metabolism and Systems, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- University Hospital Aintree, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jennifer James
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- University Hospital Aintree, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - John Wilding
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- University Hospital Aintree, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Daniel J. Cuthbertson
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- University Hospital Aintree, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Mamalaki E, Poulimeneas D, Tsiampalis T, Kouvari M, Karipidou M, Bathrellou E, Collins CE, Panagiotakos DB, Yannakoulia M. The effectiveness of technology-based interventions for weight loss maintenance: A systematic review of randomized controlled trials with meta-analysis. Obes Rev 2022; 23:e13483. [PMID: 35686875 DOI: 10.1111/obr.13483] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To systematically review and meta-analyze randomized controlled trials on the effects of technology-based interventions for maintenance of lost weight. METHODS A systematic literature search was performed to identify randomized controlled trials with at least one intervention arm delivered through the internet or mobile application, published in English until September 2021. Weight change at the end of the weight loss maintenance phase was considered the primary outcome. RESULTS Twelve manuscripts with 2941 adults were included in the review; 10 studies were meta-analyzed. Included interventions had a duration of 3-30 months and were tested compared with minimum interventions (no contact with the study staff or intervention with only a limited number of features) or in-person groups. Technology-based interventions resulted in similar weight regain when compared with minimum interventions (ES = -0.07 kg; 95% CI = [-0.57, 0.42]; p = 0.770). However, when compared with in-person interventions, technology-based interventions were found to lead in significantly higher weight regain (ES = 1.36 kg; 95% CI = [0.29, 2.43]; p = 0.010). CONCLUSION Web- and app-based interventions for weight loss maintenance produced similar results with minimum interventions and resulted in greater weight regain compared with in-person interventions. Appropriate interventions for weight loss maintenance provide benefits against weight regain, only when provided in-person.
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Affiliation(s)
- Eirini Mamalaki
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
| | - Dimitrios Poulimeneas
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
| | - Melina Karipidou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
| | - Eirini Bathrellou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
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Lytle LA, Wasser HM, Godino J, Lin P, Tate DF. Identifying the behavior change techniques used in obesity interventions: AN EXAMPLE FROM THE EARLY TRIALS. Obes Sci Pract 2022; 9:179-189. [PMID: 37034560 PMCID: PMC10073819 DOI: 10.1002/osp4.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 11/06/2022] Open
Abstract
Objective The dissemination of effective obesity interventions requires the documentation of key elements of the intervention. But outcome papers and other published manuscripts often lack detail that allow the replication of the intervention. The Behavior Change Technique (BCT) Taxonomy (BCTTv1) is a widely used approach to identify key elements of an intervention study. This study compares the extent to which BCTs and domains identified in studies' intervention protocol are concordant with detail from corresponding intervention design and study outcome papers. Methods Data come from four obesity interventions with complete intervention protocols as well as published intervention design and outcome papers. The number of domains and BCTs was calculated for each treatment arm and stratified by coding source. Emphasis of domains and BCTs was determined using an Analytical Hierarchy Process (AHP). Results A review of each study's intervention protocol showed the mean number of domains and BCTs used in treatment arms as 11.8 and 26.7, respectively. Primary outcome papers had a mean loss of 34% of the reported domains and 43% of BCTS as compared with intervention protocl. Design papers showed a loss of 11% and 21% of domains and BCTs, respectively. Conclusions The results confirm the limitations of using the BCTTv1 coding of outcome papers to describe obesity-related interventions. The results also highlight the need for mechanisms that allow for a full description of intervention content such as inclusion in a supplemental section of an online journal or the use of intervention-focused consort guidelines.
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Affiliation(s)
- Leslie A Lytle
- Department of Health Behavior Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC United States
- Department of Nutrition Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC United States
| | - Heather M Wasser
- Department of Nutrition Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC United States
| | - Job Godino
- Laura Rodriguez Research Institute Family Health Centers of San Diego San Diego CA United States
- Herbert Wertheim School of Public Health and Human Longevity Science University of California San Diego La Jolla CA United States
- Center for Wireless and Population Health Systems University of California San Diego La Jolla CA United States
| | - Pao‐Hwa Lin
- Department of Nephrology School of Medicine Duke University Durham NC United States
| | - Deborah F Tate
- Department of Health Behavior Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC United States
- Department of Nutrition Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC United States
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Chapel B, Alexandre F, Heraud N, Ologeanu-Taddei R, Cases AS, Bughin F, Hayot M. Standardization of the assessment process within telerehabilitation in chronic diseases: a scoping meta-review. BMC Health Serv Res 2022; 22:984. [PMID: 35918690 PMCID: PMC9344755 DOI: 10.1186/s12913-022-08370-y] [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: 05/28/2021] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Telerehabilitation (TR) interventions are receiving increasing attention. They have been evaluated in various scientific areas through systematic reviews. However, there is a lack of data on how to standardize assessment and report on their domains to guide researchers across studies and bring together the best evidence to assess TR for chronic diseases. Aims and objectives The aim of this study was to identify domains of assessment in TR and to qualitatively and quantitatively analyze how and when they are examined to gain an overview of assessment in chronic disease. Methods A scoping meta-review was carried out on 9 databases and gray literature from 2009 to 2019. The keyword search strategy was based on "telerehabilitation", “evaluation", “chronic disease" and their synonyms. All articles were subjected to qualitative analysis using the Health Technology Assessment (HTA) Core Model prior to further analysis and narrative synthesis. Results Among the 7412 identified articles, 80 studies met the inclusion criteria and addressed at least one of the noncommunicable diseases (NCD) categories of cardiovascular disease (cardiovascular accidents), cancer, chronic respiratory disease, diabetes, and obesity. Regarding the domains of assessment, the most frequently occurring were “social aspect” (n = 63, 79%) (e.g., effects on behavioral changes) and “clinical efficacy” (n = 53, 66%), and the least frequently occurring was “safety aspects” (n = 2, 3%). We also identified the phases of TR in which the assessment was conducted and found that it most commonly occurred in the pilot study and randomized trial phases and least commonly occurred in the design, pretest, and post-implementation phases. Conclusions Through the HTA model, this scoping meta-review highlighted 10 assessment domains which have not been studied with the same degree of interest in the recent literature. We showed that each of these assessment domains could appear at different phases of TR development and proposed a new cross-disciplinary and comprehensive method for assessing TR interventions. Future studies will benefit from approaches that leverage the best evidence regarding the assessment of TR, and it will be interesting to extend this assessment framework to other chronic diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08370-y.
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Affiliation(s)
- Blandine Chapel
- University of Montpellier, Montpellier Research of Management, Montpellier, France.
| | - François Alexandre
- Direction de La Recherche Clinique Et de L'Innovation en Santé, Korian ; GCS CIPS, 800 Avenue Joseph Vallot, Lodève, France
| | - Nelly Heraud
- Direction de La Recherche Clinique Et de L'Innovation en Santé, Korian ; GCS CIPS, 800 Avenue Joseph Vallot, Lodève, France
| | | | - Anne-Sophie Cases
- University of Montpellier, Montpellier Research of Management, Montpellier, France
| | - François Bughin
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU Montpellier, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU Montpellier, Montpellier, France
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Wright HH, O’Shea MC, Sekula J, Mitchell LJ. Assessment of communication skills using telehealth: considerations for educators. Front Med (Lausanne) 2022; 9:841309. [PMID: 35979204 PMCID: PMC9377413 DOI: 10.3389/fmed.2022.841309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The main aim of this study was to explore the views and perceptions of dietetic educators on their ability to assess communication skills of undergraduate student dietitians in a telehealth setting. A secondary aim was to provide recommendations to educators when assessing these skills using telehealth. Methods A descriptive qualitative study design was used. Australian and New-Zealand dietetic educators used a validated global communication rating scale to evaluate three pre-recorded telehealth encounters. Educators then answered a series of open-ended questions on their ability to assessed communication skills in the telehealth environment. Analysis Inductive analysis allowed the emergence of themes and sub-themes independent of a specific framework or theory. Peer debriefing and triangulation increased research rigor. Results Twenty-four educators were included in this study with the majority (87.5%) having > 10 years experience as a dietetic educator, and 41.6% (n = 10) with experience in assessing dietetics student using telehealth. Most (76%) educators reported the assessment of non-verbal communication skills were challenging in the telehealth environment. Five themes and 15 subthemes emerged relating to advice for students and educators when assessing communication skills and a checklist was developed from recommendations that students and educators can use when preparing, planning, implementing, and assessing telehealth consultations. Conclusion Assessing student communication skills via telehealth provides a useful opportunity with the growing use of the online environment, however, it also presents challenges that must be taken into consideration. While verbal communication skills are easier to assess than non-verbal, both need to be adapted for the telehealth setting.
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Affiliation(s)
- Hattie H. Wright
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD, Australia
- Sunshine Coast Health Institute, Britinya, QLD, Australia
- *Correspondence: Hattie H. Wright,
| | - Marie-Claire O’Shea
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia
| | - Julia Sekula
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lana J. Mitchell
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia
- Menzies Health Institute Queensland, Southport, QLD, Australia
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Les facteurs influençant l’adhésion à la santé connectée pour la gestion du poids auprès d’adultes en situation d’obésité ou de surpoids : une revue narrative de la littérature. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Thomas JG, Panza E, Espel-Huynh HM, Goldstein CM, O’Leary K, Benedict N, Puerini AJ, Wing RR. Pragmatic implementation of a fully automated online obesity treatment in primary care. Obesity (Silver Spring) 2022; 30:1621-1628. [PMID: 35894075 PMCID: PMC9335894 DOI: 10.1002/oby.23502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/28/2022] [Accepted: 05/06/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Behavioral obesity treatment implemented in primary care is efficacious but typically involves face-to-face or phone contact. This study evaluated enrollment, engagement, and 12-week weight loss in a fully automated online behavioral weight-loss intervention implemented pragmatically in a primary care network. METHODS As part of routine primary care, providers and nurse care managers offered a no-cost online obesity treatment program to 1,721 patients. Of these, 721 consented and were eligible (aged 18-75 years with BMI ≥ 25 kg/m2 and internet access), and 464 started the program. The program included 12 weekly online lessons, a self-monitoring platform, and automated feedback. RESULTS More than one-quarter of patients who were offered the program (26%) initiated treatment. In intent-to-treat analyses using all data available, mean 12-week weight change was -5.10% (SE = 0.21). Patients who submitted their weights on all 12 weeks (37% of 464) lost an estimated 7.2% body weight versus 3.4% in those submitting less frequently. CONCLUSIONS This fully automated online program, implemented into the routine workflow of a primary care setting without any human counseling or researcher involvement, produced clinically meaningful short-term weight loss. Greater program engagement was associated with greater weight loss; efforts are needed to understand barriers to engagement.
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Affiliation(s)
- J. Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
| | - Emily Panza
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
| | - Hallie M. Espel-Huynh
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
| | - Carly M. Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
| | - Kevin O’Leary
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
| | - Noah Benedict
- Rhode Island Primary Care Physicians Corporation, Cranston, RI
| | - Albert J. Puerini
- Rhode Island Primary Care Physicians Corporation, Cranston, RI
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Rena R. Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
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Toon J, Geneva M, Sharpe P, Lavin J, Bennett S, Avery A. Weight loss outcomes achieved by adults accessing an online programme offered as part of Public Health England's 'Better Health' campaign. BMC Public Health 2022; 22:1456. [PMID: 35907834 PMCID: PMC9339188 DOI: 10.1186/s12889-022-13847-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
Effective use of health technology may offer a scalable solution to the obesity pandemic. Online digital programmes provide a convenient and flexible way for more people to access regular support. This service evaluation aims to determine whether adults accessing an online weight management programme via a national campaign are successful in losing weight. Data was analysed for adults registering with Slimming World’s online programme using a discounted membership offered as part of PHE’s ‘Better Health’ campaign between July and December 2020. Last-weight carried forward was used to calculate weight outcomes for participants who had the opportunity to complete 12-weeks and recorded ≥ one weight besides baseline. Engagement was determined using number of online weekly weights recorded with high engagers having weight data for ≥ 9 occasions. Socioeconomic status was assessed using postcode data. Resubscription and uploaded weight data were used to determine numbers who continued beyond the offer period. Twenty-seven thousand two hundred forty-eight adults (5.3% males) with mean age 41.0 ± 11.4 years met inclusion criteria. Mean baseline BMI was 33.4 ± 6.8 kg/m2 (29.2% 30–34.9, 18.3% 35–39.9 and 15.1% > 40 kg/m2). Mean weight loss at 12 weeks was 2.7 (± 3) kg representing a mean loss of 3% (± 3.1) body weight with 42.3% achieving ≥ 3% and 22.1% weight loss ≥ 5%. Median number of weigh-ins was six. Men had greater weight losses compared to women (p < 0.001). High engagers, both men and women, achieved greater weight losses (p < 0.001). Absolute weight loss was associated with joining BMI (rs = -0.15, p < 0.001) but for % weight change only small differences were seen (max effect size = 0.03) with no differences in weight change for high engagers between different baseline BMI categories (p > 0.05). 30.9% were in the lowest two IMD quintiles and absolute and percentage weight change did not differ across deprivation quintiles (p > 0.05). 34.9% continued to access the online support after the offer period. This service evaluation shows that an online programme, offered as part of a national campaign, can offer effective support to a large number of people with different starting BMIs and from different socioeconomic backgrounds. An increased level of engagement leads to better weight losses.
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Affiliation(s)
- Josef Toon
- Nutrition, Health & Research Team, Slimming World, Alfreton, UK
| | - Martina Geneva
- Nutrition, Health & Research Team, Slimming World, Alfreton, UK
| | - Paul Sharpe
- Nutrition, Health & Research Team, Slimming World, Alfreton, UK
| | - Jacquie Lavin
- Nutrition, Health & Research Team, Slimming World, Alfreton, UK
| | - Sarah Bennett
- Nutrition, Health & Research Team, Slimming World, Alfreton, UK
| | - Amanda Avery
- Nutrition, Health & Research Team, Slimming World, Alfreton, UK. .,Division of Food, Nutrition & Dietetics, University of Nottingham, Nottingham, UK.
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Flynn AC, Suleiman F, Windsor‐Aubrey H, Wolfe I, O'Keeffe M, Poston L, Dalrymple KV. Preventing and treating childhood overweight and obesity in children up to 5 years old: A systematic review by intervention setting. MATERNAL & CHILD NUTRITION 2022; 18:e13354. [PMID: 35333450 PMCID: PMC9218326 DOI: 10.1111/mcn.13354] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 01/01/2023]
Abstract
The prevalence of childhood obesity is increasing worldwide with long-term health consequences. Effective strategies to stem the rising childhood obesity rates are needed but systematic reviews of interventions have reported inconsistent effects. Evaluation of interventions could provide more practically relevant information when considered in the context of the setting in which the intervention was delivered. This systematic review has evaluated diet and physical activity interventions aimed at reducing obesity in children, from birth to 5 years old, by intervention setting. A systematic review of the literature, consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Three electronic databases were searched from 2010 up to December 2020 for randomised controlled trials aiming to prevent or treat childhood obesity in children up to 5 years old. The studies were stratified according to the setting in which the intervention was conducted. Twenty-eight studies were identified and included interventions in childcare/school (n = 11), home (n = 5), community (n = 5), hospital (n = 4), e-health (n = 2) and mixed (n = 1) settings. Thirteen (46%) interventions led to improvements in childhood obesity measures, including body mass index z-score and body fat percentage, 12 of which included both parental/family-based interventions in conjunction with modifying the child's diet and physical activity behaviours. Home-based interventions were identified as the most effective setting as four out of five studies reported significant changes in the child's weight outcomes. Interventions conducted in the home setting and those which included parents/families were effective in preventing childhood obesity. These findings should be considered when developing optimal strategies for the prevention of childhood obesity.
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Affiliation(s)
- Angela C. Flynn
- Department of Women and Children's HealthKing's College LondonLondonUK
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Fatma Suleiman
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Hazel Windsor‐Aubrey
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Ingrid Wolfe
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
| | - Majella O'Keeffe
- School of Food and Nutritional SciencesUniversity College CorkCorkIreland
| | - Lucilla Poston
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
| | - Kathryn V. Dalrymple
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
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46
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Emsley C, Snell G, Paul E, Fuller L, Paraskeva M, Nyulasi I, King S. Can we HALT obesity following lung transplant? A Dietitian- and Physiotherapy-directed pilot intervention. Clin Transplant 2022; 36:e14763. [PMID: 35761751 DOI: 10.1111/ctr.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Unintentional weight gain, overweight and obesity following solid organ transplantation (SOT) are well-established and linked to morbidity and mortality risk factors. No interventional studies aimed at prevention have been undertaken among lung transplant (LTx) recipients. The combination of group education and telephone coaching is effective in the general population but is untested among SOT cohorts. METHODS A non-randomised, interventional pilot study was conducted among new LTx recipients. The control group received standard care. In addition to standard care, the intervention involved four group education and four individual, telephone coaching sessions over 12-months. Data collection occurred at 2 weeks, 3- and 12 months post-LTx. Measurements included weight, BMI, fat mass (FM), fat mass index (FMI), fat-free mass (FFM), fat-free mass index (FFMI), waist circumference (WC), visceral adipose tissue (VAT), nutrition knowledge, diet, physical activity, lipid profile, HbA1C , FEV1 , six-minute walk distance and patient satisfaction. RESULTS Fifteen LTx recipients were recruited into each group. One control participant died 120 days post-LTx, unrelated to the study. There were trends towards lower increases in weight (6.7±7.2kg vs 9.8±11.3kg), BMI (9.6% of baseline vs 13%), FM (19.7% vs 40%), FMI, VAT (7.1% vs 30.8%) and WC (5.5% vs 9.5%), and greater increases in FFM and FFMI (all p>0.05), among the intervention group by 12 months. The intervention was well-accepted by participants. CONCLUSION This feasible intervention demonstrated non-significant, but clinically meaningful, favourable weight and body composition trends among LTx recipients over 12 months compared to standard care. Australian New Zealand Clinical Trials Registry (ACTRN12619001606178) This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Christie Emsley
- Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Greg Snell
- Lung Transplant Service, The Alfred Hospital, Victoria, Australia
| | - Eldho Paul
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Louise Fuller
- Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Ibolya Nyulasi
- Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia.,Discipline of Food, Nutrition and Dietetics, LaTrobe University, Bundoora, Victoria, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Susannah King
- Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia.,Discipline of Food, Nutrition and Dietetics, LaTrobe University, Bundoora, Victoria, Australia
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47
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Lei XG, Huang Z, Rashi T, Yang X. Effectiveness of mHealth/eHealth interventions on obesity treatment: a protocol for umbrella review of meta-analyses. BMJ Open 2022; 12:e052443. [PMID: 35667735 PMCID: PMC9171196 DOI: 10.1136/bmjopen-2021-052443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Mobile health (mHealth)/electronic health (eHealth) have the effect of facilitating weight loss in overweight and obese populations. However, studies have shown varied results and relatively high heterogeneity in the efficacy of mHealth/eHealth interventions. The aim of the paper was to systematically summarise published studies about the weight loss efficacy of mHealth/eHealth. METHODS AND ANALYSIS A comprehensive review of PubMed, Embase and Cochrane Library databases published from inception to 21 March 2021 will be conducted. The selected articles are meta-analyses that integrated the studies, which evaluated efficacy of mHealth/eHealth. Two people will select eligible articles and extract data independently. Any disputes will be resolved by discussion or the arbitration of a third person. The methodological quality of the included meta-analyses will be assessed with AMSTAR V.2 and the quality of evidence will be obtained with Grade of Recommendations Assessment, Development and Evaluation (GRADE). The study selection process will be presented using a flowchart. We will reanalyse each outcome with random effect methods. If possible, we will use funnel plot and Egger's test to evaluate if publication bias existed. ETHICS AND DISSEMINATION Ethical approval is not required for the study, as we collected data only from available published materials. This umbrella review will also be submitted to a peer-reviewed journal for publication after completion. PROSPERO REGISTRATION NUMBER CRD42021247006.
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Affiliation(s)
- Xiang-Guo Lei
- Geriatrics Department of Endocrinology and Metabolism, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
- Guangxi Clinical Research Center for Cardiocerebrovascular Diseases, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Zhongheng Huang
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Guangxi Medical University, Nanning, Guangxi, China
| | - Tamrakar Rashi
- Geriatrics Department of Endocrinology and Metabolism, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
- Guangxi Clinical Research Center for Cardiocerebrovascular Diseases, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Xi Yang
- Geriatrics Department of Endocrinology and Metabolism, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
- Guangxi Clinical Research Center for Cardiocerebrovascular Diseases, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
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Shepherd LM, Schmidtke KA, Hazlehurst JM, Melson E, Dretzke J, Hawks N, Arlt W, Tahrani AA, Swift A, Carrick-Sen DM. Interventions for the prevention of adrenal crisis in adults with primary adrenal insufficiency: a systematic review. Eur J Endocrinol 2022; 187:S1-S20. [PMID: 35536876 PMCID: PMC9175553 DOI: 10.1530/eje-21-1248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/10/2022] [Indexed: 11/08/2022]
Abstract
Objective The incidence of adrenal crisis (AC) remains high, particularly for people with primary adrenal insufficiency, despite the introduction of behavioural interventions. The present study aimed to identify and evaluate available evidence of interventions aiming to prevent AC in primary adrenal insufficiency. Design This study is a systematic review of the literature and theoretical mapping. Methods MEDLINE, MEDLINE in Process, EMBASE, ERIC, Cochrane CENTRAL, CINAHL, PsycINFO, the Health Management Information Consortium and trial registries were searched from inception to November 2021. Three reviewers independently selected studies and extracted data. Two reviewers appraised the studies for the risk of bias. Results Seven observational or mixed methods studies were identified where interventions were designed to prevent AC in adrenal insufficiency. Patient education was the focus of all interventions and utilised the same two behaviour change techniques, 'instruction on how to perform a behaviour' and 'pharmacological support'. Barrier and facilitator themes aiding or hindering the intervention included knowledge, behaviour, emotions, skills, social influences and environmental context and resources. Most studies did not measure effectiveness, and assessment of knowledge varied across studies. The study quality was moderate. Conclusion This is an emerging field with limited studies available. Further research is required in relation to the development and assessment of different behaviour change interventions to prevent AC.
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Affiliation(s)
- Lisa M Shepherd
- Diabetes & Endocrine Centre, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Nursing, Institute of Clinical Sciences
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
| | | | - Jonathan M Hazlehurst
- Diabetes & Endocrine Centre, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Eka Melson
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Janine Dretzke
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Noel Hawks
- Addison Disease Self-Help Group, Starling House, Bristol, UK
| | - Wiebeke Arlt
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Abd A Tahrani
- Diabetes & Endocrine Centre, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amelia Swift
- School of Nursing, Institute of Clinical Sciences
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Hesseldal L, Christensen JR, Olesen TB, Olsen MH, Jakobsen PR, Laursen DH, Lauridsen JT, Nielsen JB, Søndergaard J, Brandt CJ. Long term Weight Loss in a Primary Care-Anchored eHealth Lifestyle Coaching Program in Denmark: Randomized Controlled Trial (Preprint). JMIR Diabetes 2022; 24:e39741. [PMID: 36149735 PMCID: PMC9547330 DOI: 10.2196/39741] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/06/2022] [Accepted: 07/31/2022] [Indexed: 12/15/2022] Open
Abstract
Background Long-term weight loss in people living with obesity can reduce the risk and progression of noncommunicable diseases. Observational studies suggest that digital coaching can lead to long-term weight loss. Objective We investigated whether an eHealth lifestyle coaching program for people living with obesity with or without type 2 diabetes led to significant, long-term (12-month) weight loss compared to usual care. Methods In a randomized controlled trial that took place in 50 municipalities in Denmark, 340 people living with obesity with or without type 2 diabetes were enrolled from April 16, 2018, to April 1, 2019, and randomized via an automated computer algorithm to an intervention (n=200) or a control (n=140) group. Patients were recruited via their general practitioners, the Danish diabetes organization, and social media. The digital coaching intervention consisted of an initial 1-hour face-to-face motivational interview followed by digital coaching using behavioral change techniques enabled by individual live monitoring. The primary outcome was change in body weight from baseline to 12 months. Results Data were assessed for 200 participants, including 127 from the intervention group and 73 from the control group, who completed 12 months of follow-up. After 12 months, mean body weight and BMI were significantly reduced in both groups but significantly more so in the intervention group than the control group (–4.5 kg, 95% CI –5.6 to –3.4 vs –1.5 kg, 95% CI –2.7 to –0.2, respectively; P<.001; and –1.5 kg/m2, 95% CI –1.9 to –1.2 vs –0.5 kg/m2, 95% CI –0.9 to –0.1, respectively; P<.001). Hemoglobin A1c was significantly reduced in both the intervention (–6.0 mmol/mol, 95% CI –7.7 to –4.3) and control (–4.9 mmol/mol, 95% CI –7.4 to –2.4) groups, without a significant group difference (all P>.46). Conclusions Compared to usual care, digital lifestyle coaching can induce significant weight loss for people living with obesity, both with and without type 2 diabetes, after 12 months. Trial Registration ClinicalTrials.gov NCT03788915; https://clinicaltrials.gov/ct2/show/NCT03788915
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Affiliation(s)
- Laura Hesseldal
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Zealand, Holdbaek, Denmark
| | - Jeanette Reffstrup Christensen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Aarhus University, Aarhus, Denmark
| | | | - Michael Hecht Olsen
- Steno Diabetes Center Zealand, Holdbaek, Denmark
- Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Pernille Ravn Jakobsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | | | - Jesper Bo Nielsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Carl Joakim Brandt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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50
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Baillot A, St-Pierre M, Lapointe J, Bernard P, Bond D, Romain AJ, Garneau PY, Biertho L, Tchernof A, Blackburn P, Langlois MF, Brunet J. Acceptability and feasibility of the TELEhealth BARIatric behavioural intervention to increase physical ACTIVity (TELE-BariACTIV): A single-case experimental study protocol (Preprint). JMIR Res Protoc 2022; 11:e39633. [PMID: 36173668 PMCID: PMC9562082 DOI: 10.2196/39633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background Regular physical activity (PA) is recommended to optimize weight and health outcomes in patients who have undergone metabolic and bariatric surgery (MBS). However, >70% of patients have low PA levels before MBS that persist after MBS. Although behavioral interventions delivered face-to-face have shown promise for increasing PA among patients who have undergone MBS, many may experience barriers, preventing enrollment into and adherence to such interventions. Delivering PA behavior change interventions via telehealth to patients who have undergone MBS may be an effective strategy to increase accessibility and reach, as well as adherence. Objective This paper reports the protocol for a study that aims to assess the feasibility and acceptability of the protocol or methods and the Telehealth Bariatric Behavioral Intervention (TELE-BariACTIV). The intervention is designed to increase moderate-to-vigorous intensity PA (MVPA) in patients awaiting bariatric surgery and is guided by a multitheory approach and a patient perspective. Another objective is to estimate the effect of the TELE-BariACTIV intervention on presurgical MVPA to determine the appropriate sample size for a multicenter trial. Methods This study is a multicenter trial using a repeated (ABAB’A) single-case experimental design. The A phases are observational phases without intervention (A1=pre-MBS phase; A2=length personalized according to the MBS date; A3=7 months post-MBS phase). The B phases are interventional phases with PA counseling (B1=6 weekly pre-MBS sessions; B2=3 monthly sessions starting 3 months after MBS). The target sample size is set to 12. Participants are inactive adults awaiting sleeve gastrectomy who have access to a computer with internet and an interface with a camera. The participants are randomly allocated to a 1- or 2-week baseline period (A1). Protocol and intervention feasibility and acceptability (primary outcomes) will be assessed by recording missing data, refusal, recruitment, retention, attendance, and attrition rates, as well as via web-based acceptability questionnaires and semistructured interviews. Data collected via accelerometry (7-14 days) on 8 occasions and via questionnaires on 10 occasions will be analyzed to estimate the effect of the intervention on MVPA. Generalization measures assessing the quality of life, anxiety and depressive symptoms, and theory-based constructs (ie, motivational regulations for PA, self-efficacy to overcome barriers to PA, basic psychological needs satisfaction and frustration, PA enjoyment, and social support for PA; secondary outcomes for a future large-scale trial) will be completed via web-based questionnaires on 6-10 occasions. The institutional review board provided ethics approval for the study in June 2021. Results Recruitment began in September 2021, and all the participants were enrolled (n=12). Data collection is expected to end in fall 2023, depending on the MBS date of the recruited participants. Conclusions The TELE-BariACTIV intervention has the potential for implementation across multiple settings owing to its collaborative construction that can be offered remotely. International Registered Report Identifier (IRRID) DERR1-10.2196/39633
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Affiliation(s)
- Aurélie Baillot
- Nursing Department, Université du Québec en Outaouais, Gatineau, QC, Canada
- Institut du savoir de l'hôpital Montfort-recherche, Ottawa, ON, Canada
- Centre de Recherche en Médecine Psychosociale, Centre Intégré de Santé et Services Sociaux de l'Outaouais, Gatineau, QC, Canada
| | - Maxime St-Pierre
- Basic Science Department, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Josyanne Lapointe
- Department of Physical Activity Sciences, Université du Québec à Montréal, Montréal, QC, Canada
- Montreal Mental Health University Institute Research Centre, Montreal, QC, Canada
| | - Paquito Bernard
- Department of Physical Activity Sciences, Université du Québec à Montréal, Montréal, QC, Canada
- Montreal Mental Health University Institute Research Centre, Montreal, QC, Canada
| | - Dale Bond
- Department of Surgery, Hartford Hospital/HealthCare, Hartford, CT, United States
| | - Ahmed Jérôme Romain
- Montreal Mental Health University Institute Research Centre, Montreal, QC, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Pierre Y Garneau
- Department of Surgery, Université de Montréal, Montréal, QC, Canada
| | - Laurent Biertho
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
| | - André Tchernof
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
| | - Patricia Blackburn
- Division of Kinesiology, Department of Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Marie-France Langlois
- CHUS Research Center and Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jennifer Brunet
- Institut du savoir de l'hôpital Montfort-recherche, Ottawa, ON, Canada
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- Cancer Therapeutic Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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