Healthy eating and exercise: strategies for weight management in the rural midwest

Recruitment and reach in a pragmatic behavioral weight loss randomized controlled trial: implications for real-world primary care practice

BACKGROUND

Obesity is a major risk factor behind some of the most common problems encountered in primary care. Although effective models for obesity treatment have been developed, the 'reach' of these interventions is poor and only a small fraction of primary care patients receive evidence-based treatment. The purpose of this study is to identify factors that impact the uptake (reach) of an evidence-based obesity treatment program within the context of a pragmatic cluster randomized controlled trial comparing three models of care delivery.

METHODS

Recruitment and reach were evaluated by the following measures: 1) mailing response rates, 2) referral sources among participants contacting the study team, 3) eligibility rates, 4) participation rates, and 5) representativeness based on demographics, co-morbid conditions, and healthcare utilization of 1432 enrolled participants compared to > 17,000 non-participants from the clinic-based patient populations. Referral sources and participation rates were compared across study arms and level of clinic engagement.

RESULTS

The response rate to clinic-based mailings was 13.2% and accounted for 66% of overall program recruitment. An additional 22% of recruitment came from direct clinic referrals and 11% from media, family, or friends. Of those screened, 87% were eligible; among those eligible, 86% enrolled in the trial. Participation rates did not vary across the three care delivery arms, but were higher at clinics with high compared to low provider involvement. In addition, clinics with high provider involvement had a higher rate of in clinic referrals (33% versus 16%) and a more representative sample with regards to BMI, rurality, and months since last clinic visit. However, across clinics, enrolled participants compared to non-participants were older, more likely to be female, more likely to have had a joint replacement but less likely to have CVD or smoke, and had fewer hospitalizations.

CONCLUSIONS

A combination of direct patient mailings and in-clinic referrals may enhance the reach of primary care behavioral weight loss interventions, although more proactive outreach is likely necessary for men, younger patients, and those at greater medial risk. Strategies are needed to enhance provider engagement in referring patients to behavioral weight loss programs.

TRIAL REGISTRATION

clnicialtrials.gov NCT02456636. Registered May 28, 2015, https://www.clinicaltrials.gov/ct2/results?cond=&term=RE-POWER&cntry=&state=&city=&dist=.

Understanding the impact of rural weight loss interventions: A systematic review and meta-analysis

Rural adults have a higher risk of developing obesity than urban adults. Several evidence-based interventions have targeted rural regions, but their impact, defined as reach (number and representativeness of participants) by effectiveness, has not been examined. The purpose of this review was to determine the impact of rural weight loss interventions and the availability of data across dimensions of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. A systematic review was conducted to identify rural weight loss interventions that targeted adults. RE-AIM-related data were abstracted from each article. We performed a meta-analysis to examine effectiveness. Sixty-four articles reported on rural weight loss interventions, describing 50 unique interventions. The median number of participants was 107. Median participation rate differed between values reported by the authors (62%) and values computed using a standard method (32%). Two studies reported on sample representativeness; none reported comparisons made between target and actual delivery settings. Median weight loss per participant was 3.64 kg. Meta-analyses revealed the interventions achieved a significant weight reduction, and longer-duration interventions resulted in greater weight loss. Rural weight loss interventions appear to be effective in supporting clinically meaningful weight loss but reach and cost outcomes are still difficult to determine.

Weight management telehealth intervention for overweight and obese rural cardiac rehabilitation participants: A randomised trial

AIMS AND OBJECTIVES

To determine whether a weight management intervention (WMI) plus cardiac rehabilitation (CR) compared to CR alone improves outcomes for overweight and obese cardiac revascularisation patients.

BACKGROUND

Despite participating in cardiac rehabilitation (CR), few cardiac patients lose enough weight to achieve clinically significant cardiovascular disease risk reduction.

DESIGN

A randomised controlled design was used with measurements at baseline, 4 and 6 months, guided by the CONSORT checklist, see Supporting Information File S1. Adults who had undergone either coronary artery bypass surgery (CABS) or percutaneous coronary intervention (PCI) and participated in a rural CR programmes were recruited. Subjects were randomised to a 12-week telehealth WMI or control group. The primary outcome was weight loss. Secondary outcomes included physical activity, patient activation, perceived self-efficacy and use of weight management behaviours.

RESULTS

A total of 43 subjects participated, with a mean age of 63 (±9.3) years. The WMI group had significantly more weight loss averaged across the 4 and 6 months of 13.8 (±2.8) pounds compared to the control group [mean = 7.8 (±2.2) pounds]. There were no significant differences in physical activity (activity counts or daily minutes in moderate or more intense activity). The WMI group had significantly higher levels of patient activation. They also had significantly higher total scores on the Diet and Exercise Self-Management survey, and subscales that included self-efficacy for specific eating habits and managing diet behaviour.

CONCLUSIONS

Findings demonstrated the usefulness and feasibility of using telehealth delivery of the WMI for cardiac rehabilitation participants in rural communities to improve weight management outcomes.

RELEVANCE TO PRACTICE

Study findings underscore the opportunity to further improve weight loss of overweight and obese cardiac participants using a weight management intervention to augment CR participation.

Prevalence of personal weight control attempts in adults: a systematic review and meta-analysis

The purpose of this systematic review and meta-analysis was to estimate the prevalence of personal weight control attempts (weight loss and/or maintenance) worldwide and to identify correlates, personal strategies used and the underlying motives. We included epidemiological/observational studies of adults (≥18 years) reporting prevalence of weight control attempts in the past-year. Seventy-two studies (n = 1,184,942) met eligibility criteria. Results from high quality studies showed that 42% of adults from general populations and 44% of adults from ethnic-minority populations reported trying to lose weight, and 23% of adults from general populations reported trying to maintain weight annually. In general population studies, higher prevalence of weight loss attempts was observed in the decade of 2000-2009 (48.2%), in Europe/Central Asia (61.3%) and in overweight/obese individuals and in women (p < 0.01). Of the 37 strategies (grouped in 10 domains of the Oxford Food and Activity Behaviours Taxonomy) and 12 motives reported for trying to control weight, exercising and dieting (within the energy compensation and restraint domains, respectively) and wellbeing and long-term health were the most prevalent. To our knowledge, this is the first systematic review to investigate weight control attempts worldwide. Key strategies and motives were identified which have implications for future public health initiatives on weight control.

Quantifying consumer portion control practices. A cross-sectional study

The use of portion control practices has rarely been quantified. The present study aimed to: (1) explore which portion control practices are actually used by the general population and their association with cognitive restraint, demographic background and general health interest (GHI), and (2) examine how the usage of portion control practices predicts the estimated consumption of an energy dense food (i.e. pizza). Twenty-two portion control practices were rated in terms of their frequency of use from 'never' to 'very often' by a representative sample of 1012 consumers from the island of Ireland. Three factors were extracted and named: measurement-strategy scale, eating-strategy scale, and purchasing-strategy scale. The eating-strategy scale score was the highest, while the measurement-strategy scale carried the lowest frequency score. For each strategy scale score, the strongest predictor was GHI, followed by gender. Having higher GHI and being female were independently associated with more frequent portion control. Both the eating-strategy scale score and the purchasing-strategy scale score were negatively associated with pizza portion size consumption estimates. In conclusion, while this study demonstrates that the reported use of portion control practices is low, the findings provide preliminary evidence for their validity. Further studies are needed to explore how portion control practices are used in different kinds of portion size decisions and what their contribution is to the intake of food over an extended period of time.

Uptake of Dietary Sodium Restriction by Overweight and Obese Patients After Cardiac Revascularization

PURPOSE

High sodium intake increases the risk of cardiovascular diseases. Cardiac patients are recommended a daily sodium restriction of ≤1,500 mg. The purpose of this article is to describe daily sodium intake and sodium restriction adherence and its correlates in cardiac rehabilitation (CR) program participants following cardiac revascularizations.

DESIGN

This is a descriptive correlational study.

METHODS

A subanalysis was performed using the data collected from a randomized controlled trial to determine the effect of a 12-week weight management intervention.

FINDINGS

The average daily sodium intake was 3,020 mg ± 1,134 at baseline, 4,047 mg ±1,517 at 4 months, and 4,399 mg ± 1,722 at 6 months. The adherence rates were 4.8% at baseline and zero at 4 and 6 months. The factors influencing daily sodium intake were identified.

CONCLUSION

The CR program participants failed to adhere to the sodium restriction guidelines.

CLINICAL RELEVANCE

Rehabilitation nurses need to identify effective strategies to educate CR participants and their family members regarding dietary sodium adherence in CR participants.

Setting goal and implementation intentions in consultations between practice nurses and patients with overweight or obesity in general practice

Objective

Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight or obesity, in order to identify points for improvement.

Design

An observational checklist was developed to assess goal and implementation intentions and ‘missed opportunities for lifestyle counselling’. Comparisons were made with overall consultation goals set by practice nurses, as measured in a post-visit questionnaire.

Setting

Dutch general practice.

Subjects

One hundred video-taped consultations (2010/2011) between practice nurses and patients with overweight or obesity.

Results

Half of the consultations contained a goal intention, of which the majority aimed to change eating behaviour. Only part of these goal intentions could be considered implementation intentions. It appeared that actions (how elements) were not often included here. Lifestyle change was more often perceived as an overall consultation goal than weight change. Regarding patterns of overall consultation goals, the majority addressed only one lifestyle factor at a time. If practice nurses formulated weight change in their overall consultation goal, they also used goal or implementation intentions, especially for weight change. In a quarter of the consultations, practice nurses did not ask any further questions about weight, nutrition or physical activity to gain insight, which is an important ‘missed opportunity for lifestyle counselling’.

Conclusions

Matching implementation intentions to the broader overall consultation goals of practice nurses would be meaningful, leading to desired goal-directed behaviours and subsequent goal attainment.

Physical activity behavior, barriers to activity, and opinions about a smartphone-based physical activity intervention among rural residents

BACKGROUND

Rural Americans engage in less physical activity (PA) and experience higher rates of consequent health problems (i.e., obesity, cardiovascular disease) than urban Americans. Although geographic barriers have historically made this population hard to reach, rural individuals are increasingly gaining access to smartphones. Thus, the purpose of this study was to evaluate PA behavior and barriers to PA among rural residents and to gauge their receptiveness to a smartphone-based PA intervention that is currently in the development stage.

MATERIALS AND METHODS

Rural Floridian adults (n=113), 18 years of age and older, completed surveys to assess PA behavior, PA barriers, and opinions about an intervention to increase PA. Specifically, they were asked to imagine a program that would require them to do PA with their mobile phones and whether they viewed intended aspects of the program as helpful. The present work is therefore formative research that sought to determine the feasibility and acceptability of a smartphone-based intervention among rural residents. RESULTS of the survey will inform the development of a tailored, smartphone-based PA intervention.

RESULTS

The 37.2% of participants with low PA levels (<600 metabolic equivalent [MET]-min per week) were more likely to report personal and environmental barriers to PA than the 47.8% of participants with moderate PA levels (≥600 MET-min per week). More barriers were reported among participants who self-reported as white and among participants of older age, lower education level, and lower socioeconomic status. Additionally, 75.9% of participants reported features of the intervention as at least somewhat helpful.

CONCLUSIONS

The growing ubiquity of smartphones among rural residents, combined with participants' positive response to the program description, supports the acceptability of a smartphone-based PA intervention for rural communities. Given the participants' receptiveness, future research should evaluate the efficacy of smartphone-delivered health behavior interventions among this population.

The Eating Habits Confidence Survey: Reliability and Validity in Overweight and Obese Postmenopausal Women

Background and Purpose: Psychometric properties of the Eating Habits Confidence Survey (EC) were evaluated in a sample of 86 overweight and obese postmenopausal women. Methods: Inter-item correlations and coefficient alphas of the total and subscale scores were conducted. Correlations of the EC to the Eating Self-Efficacy Scale (ESES), Eating Behavior Inventory (EBI), and Binge Eating Scale (BES) were examined as approaches to concurrent and contrast validity. Results: Cronbach’s alphas were adequate for total (.83) and subscale (.64–.80) scores. Only the EC subscale “sticking to it” correlated with the other eating scales. This correlation demonstrates concurrent validity with the other scales that reflected persistence in healthy eating, and contrast validity with them in that the other scales measured different issues under the rubric of eating self-efficacy and behaviors. Conclusions: Thus, the EC performed well among a different demographic than those used during its development. This inexpensive and easily administered survey manifests credible validity and reliability. Nevertheless, evidence for its validity and reliability needs to be accrued when it is used in diverse populations.

Prevalence of obesity among adults from rural and urban areas of the United States: findings from NHANES (2005-2008)

PURPOSE

Rural residents have higher rates of chronic diseases compared to their urban counterparts, and obesity may be a major contributor to this disparity. This study is the first analysis of obesity prevalence in rural and urban adults using body mass index classification with measured height and weight. In addition, demographic, diet, and physical activity correlates of obesity across rural and urban residence are examined.

METHODS

Analysis of body mass index (BMI), diet, and physical activity from 7,325 urban and 1,490 rural adults in the 2005-2008 National Health and Nutrition Examination Survey (NHANES).

FINDINGS

The obesity prevalence was 39.6% (SE = 1.5) among rural adults compared to 33.4% (SE = 1.1) among urban adults (P = .006). Prevalence of obesity remained significantly higher among rural compared to urban adults controlling for demographic, diet, and physical activity variables (odds ratio = 1.18, P = .03). Race/ethnicity and percent kcal from fat were significant correlates of obesity among both rural and urban adults. Being married was associated with obesity only among rural residents, whereas older age, less education, and being inactive was associated with obesity only among urban residents.

CONCLUSIONS

Obesity is markedly higher among adults from rural versus urban areas of the United States, with estimates that are much higher than the rates suggested by studies with self-reported data. Obesity deserves greater attention in rural America.

Initial development and testing of a questionnaire of parental self-efficacy for enacting healthy lifestyles in their children

PURPOSE

The purpose of this study was to develop and test a questionnaire to assess parental self-efficacy for enacting healthy diet and physical activity behaviors in their 6- to 11-year-old children.

DESIGN AND METHODS

A 35-item questionnaire was developed and tested with 146 U.S. parents.

RESULTS

Participant responses resulted in a 34-item questionnaire with two subscales (dietary behaviors and physical activity behaviors), which were valid and reliable in the study sample.

PRACTICE IMPLICATIONS

This new measure will serve as a tool for the assessment of parental self-efficacy for enacting healthy lifestyles in their children 6-11 years old.

Effect of adherence to self-monitoring of diet and physical activity on weight loss in a technology-supported behavioral intervention

BACKGROUND

Examination of mediating behavioral factors could explain how an intervention works and thus provide guidance to optimize behavioral weight-loss programs. This study examined the mediating role of adherence to self-monitoring of diet and physical activity on weight loss in a behavioral weight-loss trial testing the use of personal digital assistants (PDA) for self-monitoring.

METHODS

Mediation analysis was conducted to examine the possible mediating role of adherence to self-monitoring of diet and physical activity between treatments using varying self-monitoring methods (paper record, PDA, and PDA with daily tailored feedback messages) and weight loss.

FINDINGS

The sample (N = 210) was predominantly white (78%) and female (85%). Compared to a paper record, using a PDA for self-monitoring diet (P = 0.027) and physical activity (P = 0.014) had significant direct effects on weight loss at 12 months, as well as a significant indirect effect on outcomes through improved adherence to self-monitoring (P(S) < 0.001). Receiving an automated daily feedback message via PDA only had a significant indirect effect on weight through self-monitoring adherence to diet (P = 0.004) and physical activity (P = 0.002).

CONCLUSIONS

Adherence to self-monitoring of diet and physical activity is important as the underlying mechanism in this technology-supported behavioral weight-loss intervention.

Using positive deviance for determining successful weight-control practices

Based on positive deviance (examining the practices of successful individuals), we identified five primary themes from 36 strategies that help to maintain long-term weight loss (weight control) in 61 people. We conducted in-depth interviews to determine what successful individuals did and/or thought about regularly to control their weight. The themes included weight-control practices related to (a) nutrition: increase water, fruit, and vegetable intake, and consistent meal timing and content; (b) physical activity: follow and track an exercise routine at least 3x/week; (c) restraint: practice restraint by limiting and/or avoiding unhealthy foods; (d) self-monitor: plan meals, and track calories/weight progress; and (e) motivation: participate in motivational programs and cognitive processes that affect weight-control behavior. Using the extensive data involving both the practices and practice implementation, we used positive deviance to create a comprehensive list of practices to develop interventions for individuals to control their weight.

Self-monitoring in weight loss: a systematic review of the literature

Self-monitoring is the centerpiece of behavioral weight loss intervention programs. This article presents a systematic review of the literature on three components of self-monitoring in behavioral weight loss studies: diet, exercise, and self-weighing. This review included articles that were published between 1993 and 2009 that reported on the relationship between weight loss and these self-monitoring strategies. Of the 22 studies identified, 15 focused on dietary self-monitoring, one on self-monitoring exercise, and six on self-weighing. A wide array of methods was used to perform self-monitoring; the paper diary was used most often. Adherence to self-monitoring was reported most frequently as the number of diaries completed or the frequency of log-ins or reported weights. The use of technology, which included the Internet, personal digital assistants, and electronic digital scales were reported in five studies. Descriptive designs were used in the earlier studies whereas more recent reports involved prospective studies and randomized trials that examined the effect of self-monitoring on weight loss. A significant association between self-monitoring and weight loss was consistently found; however, the level of evidence was weak because of methodologic limitations. The most significant limitations of the reviewed studies were the homogenous samples and reliance on self-report. In all but two studies, the samples were predominantly white and women. This review highlights the need for studies in more diverse populations, for objective measures of adherence to self-monitoring, and for studies that establish the required dose of self-monitoring for successful outcomes.

Effects of the built environment on physical activity of adults living in rural settings

OBJECTIVE

To conduct a systematic review of the literature to examine the influence of the built environment (BE) on the physical activity (PA) of adults in rural settings.

DATA SOURCE

Key word searches of Academic Search Premier, PubMed, CINAHL, Web of Science, and Sport Discus were conducted.

STUDY INCLUSION AND EXCLUSION CRITERIA

Studies published prior to June 2008 were included if they assessed one or more elements of the BE, examined relationships between the BE and PA, and focused on rural locales. Studies only reporting descriptive statistics or assessing the reliability of measures were excluded.

DATA EXTRACTION

Objective(s), sample size, sampling technique, geographic location, and definition of rural were extracted from each study. Methods of assessment and outcomes were extracted from the quantitative literature, and overarching themes were identified from the qualitative literature.

DATA SYNTHESIS

Key characteristics and findings from the data are summarized in Tables 1 through 3.

RESULTS

Twenty studies met inclusion and exclusion criteria. Positive associations were found among pleasant aesthetics, trails, safety/crime, parks, and walkable destinations.

CONCLUSIONS

Research in this area is limited. Associations among elements of the BE and PA among adults appear to differ between rural and urban areas. Considerations for future studies include identifying parameters used to define rural, longitudinal research, and more diverse geographic sampling. Development and refinement of BE assessment tools specific to rural locations are also warranted.

Adaptations to achieve physical activity in rural communities

This multiple, descriptive, explanatory case study design described and explained the perceptions of rural women regarding rural built environments conducive to physical activity. Sources of data included women's focus groups, city council focus groups, city administrator and clerk interviews, women's verification individual interviews, individuals referred to the researcher as individuals with perceived power, and analysis of documents. The study involved two rural communities with populations of 1,000 or less, and data were collected between March 2006 and April 2007. Content analysis of each data source and a combined data source analysis for each community was completed using NVivo7. Rural women adapted to conditions of built environments, seasonal concerns, wild animals, traffic control issues, other people, and personal needs. Adaptation emerged as a central theme in the women's focus groups as a way rural women engaged in physical activity.

Paths to leisure physical activity among adults with intellectual disabilities: self-efficacy and social support

PURPOSE

This study tested a path model that included perceptions of social support and self-efficacy for leisure physical activity and leisure physical activity participation among adults with intellectual disabilities.

DESIGN

A cross-sectional design was used. Data was collected via oral interview.

SETTING

Community-based group, supported-living settings in one Midwestern state.

SAMPLE

A total of 152 adults with mild to moderate intellectual disabilities, which provided a 39% response rate.

MEASURES

Self-efficacy and social support (from family, residential staff and peers with disabilities) for leisure physical activity were assessed using self-reported scales. Leisure physical activity participation was measured with a self-reported checklist of the frequency of leisure physical activity participation.

ANALYSIS

Path analysis was conducted for the entire sample and was repeated for younger and older age groups.

RESULTS

The hypothesized model fit the data from each group. Social support and self-efficacy predicted physical activity participation, and self-efficacy served as a mediator between social support and physical activity. Significant sources of social support differed between groups; among younger participants, social support from family predicted physical activity, whereas, for the older group, social support from staff and peers predicted physical activity.

CONCLUSION

Self-efficacy and social support for leisure physical activity are related to leisure physical activity participation among adults with intellectual disabilities who are receiving supported-living services. The results provide information to guide health promotion programs for this group.

Age group differences in diet and physical activity-related behaviors among rural men and women

OBJECTIVES

Age group variations in dietary intake and physical activity have been noted in large epidemiologic studies. In this study, specific measures of behavioral strategies add depth to our understanding of these variations and can contribute to the design of effective behavioral interventions.

DESIGN

Cross-sectional, behavioral epidemiologic study.

SETTING

Rural Midwestern US.

PARTICIPANTS

407 adults.

MEASUREMENTS

Measures included dietary intake, physical activity, body mass index (BMI), and specific behavioral strategies related to diet and physical activity.

RESULTS

Use of most strategies related to diet increased across age groups, which was consistent with declining caloric intake and a decline in the proportion of total caloric intake from fat. The same patterns were not found with regard to physical activity. Greater use of diet-related strategies was noted in the oldest age groups compared to the others even though BMI was lower.

CONCLUSIONS

In the oldest age group at least, strategy use may be more related to attempts to control health conditions than body weight. The findings provide a unique perspective on age group differences in diet and physical activity behavior. Longitudinal tracking of these specific behaviors and their measurement in other populations is warranted.

Self-efficacy and its association with use of diet-related behavioral strategies and reported dietary intake

The construct of self-efficacy has been widely used in studies of dietary behavior change and is accepted as a helpful process indicator. This study examined associations between self-efficacy and use of specific diet-related behavioral strategies and reported dietary intake over time. Data are from two community surveys of rural adults conducted 1 year apart (n=354). Results indicate that changes in self-efficacy are positively associated with changes in strategy use but not dietary intake. Strategies may be thought of as leading to a particular level of dietary intake but are not the only influence on intake. Findings therefore confirm hypothesized associations between these components of the behavior change process. By attending to and measuring these specific links in the process, researchers and practitioners can better determine where behavioral interventions are succeeding and where they are breaking down.

Eating Behaviors and Health History of Rural Midlife to Older Women in the Midwestern United States

This study was conducted to examine daily energy, food group, and nutrient intakes of late midlife to older women living in the rural Midwestern United States compared with recommended intakes for the US population, and to describe their physical measures and health history. Random-digit dialing was used to recruit 225 community-dwelling women aged 50 to 69 years from a rural Midwestern area of the United States. Participants completed online food intake and health history surveys. Nearly half of the women had energy intakes in excess of their Estimated Energy Requirement. Mean daily servings of fruits, grains, and dairy products were below target levels identified in the 2000 Dietary Guidelines for Americans. Mean calcium and dietary fiber intakes were below recommended levels, while percent calories from fat (39.0%+/-6.8%) were well above recommendations. Eighty percent were overweight or obese and 76% were prehypertensive or hypertensive, yet only 33.5% indicated their health care provider had discussed dietary factors with them in the previous year. Late midlife and older rural Midwestern women, aged 50 to 69 years, need more guidance than they currently receive to learn how to make changes to meet dietary recommendations, particularly with a focus on establishing a more healthful dietary pattern that will be suitable for their older years.

Weight management strategies reported by rural men and women in Iowa

OBJECTIVE

This study compares the specific behavioral strategies that rural men and women use when trying to lose weight.

DESIGN

A cross-sectional, in-person survey.

SETTING

Participants were part of a larger study in rural Iowa (n = 407) intended to identify community health promotion issues.

PARTICIPANTS

184 adults (56 men, 128 women) who reported currently trying to lose weight

VARIABLES MEASURED

Measures capture strategies for dealing with the social environment, food choice and preparation, physical activity planning, social support, self-efficacy, outcome expectations, dietary intake and physical activity level.

ANALYSIS

T-tests, chi-square, Cronbach alpha, descriptive statistics.

RESULTS

Women reported greater use of nearly all strategies measured. Men reported more social support for diet, whereas women reported more social support for physical activity. Results for self-efficacy and outcome expectations were mixed. No gender differences were found for fat intake, fruit and vegetable servings, or physical activity level.

CONCLUSIONS AND IMPLICATIONS

Men and women differ in the specific strategies they use to lose weight, including those related to the social environment. Practitioners planning weight management programs should be aware that men and women may have different levels of experience in using specific behavioral strategies.

Stage of Change for Healthful Eating and Use of Behavioral Strategies

OBJECTIVE

To examine the distribution of behavioral strategy use across stage of change for healthful eating, and to determine if baseline stage predicts change in use of strategies over 1 year in the absence of intervention.

DESIGN

Cross-sectional assessment and 1-year follow-up with no intervention.

SUBJECTS/SETTING

Adult men and women in two rural Midwest communities.

STATISTICAL ANALYSES PERFORMED

Multiple regression, with tests for group difference and trend, controlling for age and sex.

RESULTS

Use of behavioral strategies as measured by six scales (self-monitoring, planning, preparation and buying, portion control, social interactions, and cognitive strategies) followed a clear linear trend across stages of change for healthful eating. Strategy use was more strongly related to stage than energy intake, fat intake, and fruit and vegetable servings as measured via food frequency questionnaire. Baseline stage of change showed some relationship to change in strategy use over time, although most group differences were not statistically significant.

CONCLUSIONS

Use of a range of behavioral strategies is strongly related to stage of change for healthful eating, and more closely associated with stage than dietary intake. In the absence of intervention, baseline stage only weakly predicted changes in strategy use. Programs with the goal of encouraging a range of healthful eating behaviors may find these measures of strategy use to be helpful in defining stage of change, and possibly in tracking behavior change over time.

Measurement of behavioral objectives for weight management

Measurement of specific behaviors involved in weight management is essential to understanding the behavior change process. This study presents measures of common behavioral objectives for weight management interventions. The relationships between these measures and conventional outcomes of weight management are described. Data are from a survey of 407 adults in the rural Midwest ages 23 to 88. Analyses involved bivariate and multivariate statistical tests. Relationships were stronger when limited to diet or physical activity outcomes as opposed to body mass index or waist circumference. Diet-related strategies were more strongly correlated with diet-related outcomes than physical activity-related outcomes and vice versa. Measures of social interactions and self-monitoring for both diet and physical activity were consistently related to outcomes. The measures show promise as reliable and valid indicators of behavior that could be useful in the evaluation of interventions. Intervention studies are needed to further characterize their value and sensitivity to change over time.