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Abstract
The research reviewed within this article provides support for both the cognitive and behavioral components of cognitive behavioral weight-loss interventions. Lifestyle based treatments have produced markedly improved results in the past 20 years, in part attributable to changes in treatment structure. Use of pretreatment participant preparation strategies, extended treatment periods with clearly defined weight-loss goals, combining multiple dietary and physical activity strategies, and increasing emphasis on long-term provider contact and relapse prevention have modestly improved long-term weight maintenance. Several investigators have emphasized the need to incorporate additional cognitive components into the cognitive-behavioral treatment of obesity to improve both short- and long-term outcomes. Furthermore, continued insights into metabolic changes producing an energy gap after weight loss should no doubt continue to refine insights into the behavioral requirements of long-term weight loss. Despite increased awareness and behavioral treatment advances, the worldwide prevalence of obesity and weight-related chronic illnesses continues to expound. Behavioral treatment is inherently challenging and time-consuming, and readily available to only a fraction of the population who may benefit from inclusion. Several investigators have cautioned that individual or small group-based interventions are insufficient to serve the population masses requiring treatment, and that continued development of community or Web-based programs, and community-development tactics to increase healthy lifestyles, are needed. The call has been sounded to conceptualize obesity as a chronic health condition requiring lifelong treatment. As such, the conceptualization of cognitive-behavioral therapies as a one-time treatment is passe´ . As the current number of obesity specialists and behaviorally trained professionals is insufficient to combat this problem; an increased emphasis upon training nontraditional weight specialists and nonbehavioral community providers is obviated.
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Affiliation(s)
- Brent Van Dorsten
- Department of Physical Medicine and Rehabilitation, Campus Box 6511, Mail Stop F-493, University of Colorado Denver, 1635 North Ursula Street, Aurora, CO 80045-0511, USA.
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Archer WR, Batan MC, Buchanan LR, Soler RE, Ramsey DC, Kirchhofer A, Reyes M. Promising Practices for the Prevention and Control of Obesity in the Worksite. Am J Health Promot 2011. [DOI: 10.4278/ajhp.080926-lit-220] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To identify worksite practices that show promise for promoting employee weight loss. Data Source. The following electronic databases were searched from January 1, 1966, through December 31, 2005: CARL Uncover (via Ingenta), CDP, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Library, CRISP, Dissertation Abstracts, EMBASE, ERIC, Health Canada, INFORM (part of ABI/INFORM Proquest), LocatorPlus, New York Academy of Medicine, Ovid MEDLINE, SPORTDiscus, PapersFirst, PsycINFO, PubMed, and TRIP. Study Inclusion and Exclusion Criteria. Included studies were published in English, conducted at a worksite, designed for adults (aged ≥18 years), and reported weight-related outcomes. Data Extraction. Data were extracted using an online abstraction form. Data Synthesis. Studies were evaluated on the basis of study design suitability quality of execution, sample size, and effect size. Changes in weight-related outcomes were used to assess effectiveness. Results. The following six promising practices were identified: enhanced access to opportunities for physical activity combined with health education, exercise prescriptions alone, multicomponent educational practices, weight loss competitions and incentives, behavioral practices with incentives, and behavioral practices without incentives. Conclusions. These practices will help employers and employees select programs that show promise for controlling and preventing obesity. (Am J Health Promot 2011;25[3]:e12–e26.)
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Affiliation(s)
- W. Roodly Archer
- W. Roodly Archer, PhD, and David C. Ramsey, MPH, CHES, were with McKing Consulting Corporation, Atlanta, Georgia. Marilyn C. Batan, MPH; Leigh Ramsey Buchanan, PhD; Robin E. Soler, PhD; and Michele Reyes, PhD, are with the Centers for Disease Control and Prevention, Atlanta, Georgia. Ardine Kirchhofer, PhD, is with Youth Leadership for Global Health, Inc, Atlanta, Georgia
| | - Marilyn C. Batan
- W. Roodly Archer, PhD, and David C. Ramsey, MPH, CHES, were with McKing Consulting Corporation, Atlanta, Georgia. Marilyn C. Batan, MPH; Leigh Ramsey Buchanan, PhD; Robin E. Soler, PhD; and Michele Reyes, PhD, are with the Centers for Disease Control and Prevention, Atlanta, Georgia. Ardine Kirchhofer, PhD, is with Youth Leadership for Global Health, Inc, Atlanta, Georgia
| | - Leigh Ramsey Buchanan
- W. Roodly Archer, PhD, and David C. Ramsey, MPH, CHES, were with McKing Consulting Corporation, Atlanta, Georgia. Marilyn C. Batan, MPH; Leigh Ramsey Buchanan, PhD; Robin E. Soler, PhD; and Michele Reyes, PhD, are with the Centers for Disease Control and Prevention, Atlanta, Georgia. Ardine Kirchhofer, PhD, is with Youth Leadership for Global Health, Inc, Atlanta, Georgia
| | - Robin E. Soler
- W. Roodly Archer, PhD, and David C. Ramsey, MPH, CHES, were with McKing Consulting Corporation, Atlanta, Georgia. Marilyn C. Batan, MPH; Leigh Ramsey Buchanan, PhD; Robin E. Soler, PhD; and Michele Reyes, PhD, are with the Centers for Disease Control and Prevention, Atlanta, Georgia. Ardine Kirchhofer, PhD, is with Youth Leadership for Global Health, Inc, Atlanta, Georgia
| | - David C. Ramsey
- W. Roodly Archer, PhD, and David C. Ramsey, MPH, CHES, were with McKing Consulting Corporation, Atlanta, Georgia. Marilyn C. Batan, MPH; Leigh Ramsey Buchanan, PhD; Robin E. Soler, PhD; and Michele Reyes, PhD, are with the Centers for Disease Control and Prevention, Atlanta, Georgia. Ardine Kirchhofer, PhD, is with Youth Leadership for Global Health, Inc, Atlanta, Georgia
| | - Ardine Kirchhofer
- W. Roodly Archer, PhD, and David C. Ramsey, MPH, CHES, were with McKing Consulting Corporation, Atlanta, Georgia. Marilyn C. Batan, MPH; Leigh Ramsey Buchanan, PhD; Robin E. Soler, PhD; and Michele Reyes, PhD, are with the Centers for Disease Control and Prevention, Atlanta, Georgia. Ardine Kirchhofer, PhD, is with Youth Leadership for Global Health, Inc, Atlanta, Georgia
| | - Michele Reyes
- W. Roodly Archer, PhD, and David C. Ramsey, MPH, CHES, were with McKing Consulting Corporation, Atlanta, Georgia. Marilyn C. Batan, MPH; Leigh Ramsey Buchanan, PhD; Robin E. Soler, PhD; and Michele Reyes, PhD, are with the Centers for Disease Control and Prevention, Atlanta, Georgia. Ardine Kirchhofer, PhD, is with Youth Leadership for Global Health, Inc, Atlanta, Georgia
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Bosch-Capblanch X, Abba K, Prictor M, Garner P. Contracts between patients and healthcare practitioners for improving patients' adherence to treatment, prevention and health promotion activities. Cochrane Database Syst Rev 2007; 2007:CD004808. [PMID: 17443556 PMCID: PMC6464838 DOI: 10.1002/14651858.cd004808.pub3] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Contracts are a verbal or written agreement that a patient makes with themselves, with healthcare practitioners, or with carers, where participants commit to a set of behaviours related to the care of a patient. Contracts aim to improve the patients' adherence to treatment or health promotion programmes. OBJECTIVES To assess the effects of contracts between patients and healthcare practitioners on patients' adherence to treatment, prevention and health promotion activities, the stated health or behaviour aims in the contract, patient satisfaction or other relevant outcomes, including health practitioner behaviour and views, health status, reported harms, costs, or denial of treatment as a result of the contract. SEARCH STRATEGY We searched: the Cochrane Consumers and Communication Review Group's Specialised Register (in May 2004); the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library 2004, issue 1); MEDLINE 1966 to May 2004); EMBASE (1980 to May 2004); PsycINFO (1966 to May 2004); CINAHL (1982 to May 2004); Dissertation Abstracts. A: Humanities and Social Sciences (1966 to May 2004); Sociological Abstracts (1963 to May 2004); UK National Research Register (2000 to May 2004); and C2-SPECTR, Campbell Collaboration (1950 to May 2004). SELECTION CRITERIA We included randomised controlled trials comparing the effects of contracts between healthcare practitioners and patients or their carers on patient adherence, applied to diagnostic procedures, therapeutic regimens or any health promotion or illness prevention initiative for patients. Contracts had to specify at least one activity to be observed and a commitment of adherence to it. We included trials comparing contracts with routine care or any other intervention. DATA COLLECTION AND ANALYSIS Selection and quality assessment of trials were conducted independently by two review authors; single data extraction was checked by a statistician. We present the data as a narrative summary, given the wide range of interventions, participants, settings and outcomes, grouped by the health problem being addressed. MAIN RESULTS We included thirty trials, all conducted in high income countries, involving 4691 participants. Median sample size per group was 21. We examined the quality of each trial against eight standard criteria, and all trials were inadequate in relation to three or more of these standards. Trials evaluated contracts in addiction (10 trials), hypertension (4 trials), weight control (3 trials) and a variety of other areas (13 trials). Sixteen trials reported at least one outcome that showed statistically significant differences favouring the contracts group, five trials reported at least one outcome that showed differences favouring the control group and 26 trials reported at least one outcome without differences between groups. Effects on adherence were not detected when measured over longer periods. AUTHORS' CONCLUSIONS There is limited evidence that contracts can potentially contribute to improving adherence, but there is insufficient evidence from large, good quality studies to routinely recommend contracts for improving adherence to treatment or preventive health regimens.
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Affiliation(s)
- X Bosch-Capblanch
- International Health Research Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK L35QA.
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