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Jensen MT, Nielsen SS, Jessen-Winge C, Madsen CMT, Thilsing T, Larrabee Sønderlund A, Christensen JR. The effectiveness of social-support-based weight-loss interventions-a systematic review and meta-analysis. Int J Obes (Lond) 2024; 48:599-611. [PMID: 38332127 DOI: 10.1038/s41366-024-01468-9] [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: 01/02/2023] [Revised: 12/17/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis examined the effectiveness of social-support-based weight-loss interventions in adult populations with excess weight or obesity. METHODS We performed a systematic review of randomized controlled trials that reported on the effectiveness of weight-loss interventions which incorporated a social connectedness component. To this end, we conducted a rigorous database search of MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, and PubMed for relevant articles. The quality of eligible trials was evaluated by the Cochrane Risk-of-Bias2 tool. Five meta-analyses on intervention effectiveness in terms of weight loss were executed at 2-4-month assessment, 6-month assessment, end of intervention, and 3- and 6-month follow-up. RESULTS Twenty-four trials involving couples or peers targeting weight loss in 4 919 adults with BMI ≥ 25 met inclusion criteria. Meta-analyses detected no significant effect of social-support-based weight-loss interventions at either 2-4 month or 6-month assessment. There were, however, significant effects at end of intervention [95% CI 0.39, p = 0.04] and at 3-month [95% CI 0.63, p < 0.01] and 6-month [95% CI 0.34, p = 0.05] follow-up. CONCLUSIONS There seem to be a significant effect at the end of intervention and 3- and 6-month follow-up. However, further high-quality studies are needed before drawing any clear conclusions. TRIAL REGISTRATION PROSPERO 2020 CRD42020173696.
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Affiliation(s)
- Mette Tækker Jensen
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Svetlana Solgaard Nielsen
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved, Slagelse & Ringsted Hospitals, Slagelse, Denmark
| | - Christina Jessen-Winge
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Midwifery, Physiotherapy, Occupational therapy, University College Copenhagen, Copenhagen, Denmark
| | - Christina Merete Tvede Madsen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Trine Thilsing
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anders Larrabee Sønderlund
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jeanette Reffstrup Christensen
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Aarhus, Denmark.
- DRIVEN, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
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Jessen-Winge C, Kolind M, Lee K, Leth MB, Surrow S, Knürr DS, Christensen CS, Christensen JR. Occupational balance as a component in weight loss interventions. Scand J Occup Ther 2023; 30:1028-1036. [PMID: 37247198 DOI: 10.1080/11038128.2023.2217544] [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: 02/04/2022] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Obesity can limit occupational participation because of physical and mental barriers. Weight loss programmes emphasizing dietary and physical activity may lower body weight; however, mental barriers and sustainable weight loss seemed to be challenged. Weight loss influences daily patterns and structure of occupations and finding a balance in daily life during the weight loss process might improve sustainable weight loss. AIM To explore if and how health professionals conducting weight loss programmes in Danish municipalities address elements related to occupational balance in the daily life of citizens with obesity. MATERIAL AND METHODS Twenty individual interviews with health professionals from Danish municipalities were conducted and analysed. RESULTS (1) Helping participants find the time and energy to lose weight, (2) Emphasizing small steps for sustainable changes and (3) Utilizing the citizen's life experience for direction. CONCLUSION Elements of occupational balance might be addressed by the participants, however values and meaningfulness regarding occupations seem to be missing. Integrating occupational balance in weight loss programmes could enable health professionals to understand and address sustainable weight loss. SIGNIFICANCE Occupational therapists may be ideally suited to support citizens with obesity to sustain weight loss by supporting a balanced life focussing on meaningfulness and values in occupations.
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Affiliation(s)
- C Jessen-Winge
- Department of Occupational Therapy, Institute of Physiotherapy and Occupational Therapy, University College Copenhagen, Copenhagen, Denmark
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - M Kolind
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - K Lee
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Occupational Therapy, University College South, Esbjerg, Denmark
| | - M B Leth
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - S Surrow
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - D S Knürr
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - C S Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - J R Christensen
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Aarhus University, Aarhus, Denmark
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Muntefering C, Fields B, Christensen JR. Going Beyond Management and Maintenance: Occupational Therapy's Role in Primary Prevention for Adults at Risk of Obesity. Am J Occup Ther 2023; 77:7705347020. [PMID: 37824722 DOI: 10.5014/ajot.2023.050154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
There is a critical need to address the escalating obesity epidemic by examining new methods of care. Adult obesity has historically been addressed through management and maintenance once an individual is clinically diagnosed as obese. Research and practice demonstrate that significant weight loss can be difficult to achieve and even harder to maintain. Despite this, preventive interventions targeted toward adult obesity have been limited in many health care professions, including occupational therapy. As professionals who are skilled in supporting clients' holistic development of healthy habits and routines, occupational therapists are equipped to play a key role in moving health care practices away from a reactive model of care to a proactive one that emphasizes primary prevention. This column identifies how this issue is aligned with occupational therapy's domain and presents potential examples of interventions to support adult obesity prevention.
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Affiliation(s)
- Chloe Muntefering
- Chloe Muntefering, MS, OTR/L, is Doctoral Candidate, Department of Kinesiology, University of Wisconsin-Madison;
| | - Beth Fields
- Beth Fields, PhD, OTR/L, BCG, is Assistant Professor, Department of Kinesiology, University of Wisconsin-Madison
| | - Jeanette Reffstrup Christensen
- Jeanette Reffstrup Christensen, PhD, OTR/L, is Associate Professor, Department of Public Health, University of Southern Denmark, Odense, Denmark, and Senior Researcher, Research Unit of General Practice, Aarhus, Denmark
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Jessen-Winge C, Lee K, Surrow S, Christensen JR. Five Vital Components in an Occupational Therapy-Based Municipal Weight Loss Program Obtained Through Research Circles. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:822896. [PMID: 36188971 PMCID: PMC9397691 DOI: 10.3389/fresc.2022.822896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/16/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Currently 1.9 billion adults worldwide are estimated to be overweight or obese. Weight loss sustainability is difficult, and weight loss rehabilitation programs have been criticised for having an individualistic approach. It has been suggested that occupational therapists could be used as part of a transdisciplinary approach because of their holistic perspective. During the development of an occupational therapy- based weight loss program five components arose as essential from earlier interviews with health professionals and citizens with obesity: diet, physical activities, social relations, habits and balancing everyday life. Before developing the program, we needed a clearer picture of which strategies should support the five components. The aim of this study was to obtain a description of strategies related to the five components that could support weight loss to become part of everyday life of people with obesity. METHODS This study took a participatory design by using research circle (RC) methodology. Two RC groups were created, one with occupational therapists and one with citizens with obesity. Researchers participated in both RC groups. Data was obtained through democratic principles. The two RC groups met four times over a period of 4 months. Qualitative content analysis was conducted. RESULTS Five themes arose: (1) Diet-Find the line between either-or, (2) Physical activity-Break the comfort zone, (3) Social relations-Stand strong together, (4) Habits-Focus on possibilities instead of bad habits, and (5) Balancing everyday life-Handling life's bumps. CONCLUSION The strategies for a weight loss program including the five components should include awareness of senses and activity patterns surrounding meals, taking one step at a time when focusing of physical activities and be conscious of values, include family and friends in the program to find common ground and self-confidence and use re-placement activities. We suggest that the component of balancing everyday life should be seen as an overall component as all strategies are related to finding meaning and variation in activities which is part of an ongoing weight loss process.
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Affiliation(s)
- Christina Jessen-Winge
- User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Occupational Therapy, Institute of Physiotherapy and Occupational Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Kim Lee
- User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Occupational Therapy, University College South, Esbjerg, Denmark
| | - Signe Surrow
- User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jeanette R. Christensen
- User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, University of Soutern Denmark, Odense, Denmark
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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Christensen JR, Konge MB, Devantier M, Brandt CJ, Gommesen JB, Kolind MI. Preferred Content in Occupational Therapy-Based Weight Loss Interventions: A Survey. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2022; 42:199-208. [PMID: 35481436 DOI: 10.1177/15394492221088511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite decades of attempts from doctors and dietitians to break the obesity curve, obesity rates are increasing in Denmark. To counteract this, municipal occupational therapy-based interventions are in development as part of the Danish Obesity Intervention Trial (DO: IT). The objective was to survey Danish adults on preferred content in an occupational therapy municipal weight loss intervention and determine if preferences differed by gender and age. A 21-item questionnaire was developed to explore preferences related to diet, physical activity, occupational balance, habits, and social relations. In all, 429 respondents were included. Chi-square statistics were performed to determine if preferences differed by gender and age. A total of 15 of the 21 items indicated gender-based differences in preferences. Two items indicated age-based differences. Notably, compared to men, women indicated significantly more interest in content relating to habit formation and occupational balance. Gender-based differences should be considered when developing a weight loss intervention.
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Affiliation(s)
- Jeanette Reffstrup Christensen
- Department of Public Health, University of Southern Denmark, Odense, Denmark.,Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Maria B Konge
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Martin Devantier
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Carl J Brandt
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Joakim B Gommesen
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mikkel I Kolind
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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Friedman C, Feldner H, VanPuymbrouck L. Anti-Fat Biases of Occupational and Physical Therapy Assistants. Occup Ther Health Care 2021; 36:63-83. [PMID: 34459721 DOI: 10.1080/07380577.2021.1972380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Fat people are highly stigmatized, and anti-fat bias is pervasive resulting in stigma, prejudice, and discrimination, including in health care. The aim of this study was to explore occupational and physical therapy assistants' anti-fat biases. We analyzed secondary weight implicit association tests from 5,671 occupational/physical therapy assistants. The overwhelming majority (82%) of occupational/physical therapy assistants were implicitly prejudiced against fat people. Interventions for occupational/physical therapy assistants' anti-fat biases are critical, especially with increasing prevalence and responsibilities of occupational/physical therapy assistants in the provision of rehabilitation services.
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Affiliation(s)
- Carli Friedman
- CQL
- The Council on Quality and Leadership, Towson, MD, USA
| | - Heather Feldner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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