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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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Seid A, Fufa DD, Bitew ZW. The use of internet-based smartphone apps consistently improved consumers' healthy eating behaviors: a systematic review of randomized controlled trials. Front Digit Health 2024; 6:1282570. [PMID: 38283582 PMCID: PMC10811159 DOI: 10.3389/fdgth.2024.1282570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Introduction Digital tools, such as mobile apps and the Internet, are being increasingly used to promote healthy eating habits. However, there has been inconsistent reporting on the effectiveness of smartphones and web-based apps in influencing dietary behaviors. Moreover, previous reviews have been limited in scope, either by focusing on a specific population group or by being outdated. Therefore, the purpose of this review is to investigate the impacts of smartphone- and web-based dietary interventions on promoting healthy eating behaviors worldwide. Methods A systematic literature search of randomized controlled trials was conducted using databases such as Google Scholar, PubMed, Global Health, Informit, Web of Science, and CINAHL (EBSCO). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to prepare the entire document. EndNote (version 20) was used for reference management. The risk of bias in the articles was assessed using the "Revised Cochrane Risk of Bias tool for randomized trials (RoB 2.0)" by the Cochrane Collaboration. Narrative synthesis, using text and tables, was used to present the results. The study was registered in PROSPERO under protocol number CRD42023464315. Results This review analyzed a total of 39 articles, which consisted of 25 smartphone-based apps and 14 web-based apps. The studies involved a total of 14,966 participants. Out of the 25 studies, 13 (52%) showed that offline-capable smartphone apps are successful in promoting healthier eating habits. The impact of smartphone apps on healthy adults has been inconsistently reported. However, studies have shown their effectiveness in chronically ill patients. Likewise, internet-based mobile apps, such as social media or nutrition-specific apps, have been found to effectively promote healthy eating behaviors. These findings were consistent across 14 studies, which included healthy adults, overweight or obese adults, chronically ill patients, and pregnant mothers. Conclusion Overall, the findings suggest that smartphone apps contribute to improving healthy eating behaviors. Both nutrition-specific and social media-based mobile apps consistently prove effective in promoting long-term healthy eating habits. Therefore, policymakers in the food system should consider harnessing the potential of internet-based mobile apps and social media platforms to foster sustainable healthy eating behaviors.
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Affiliation(s)
- Awole Seid
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Desta Dugassa Fufa
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
- Haramaya Institute of Technology, Haramaya University, Dire Dawa, Ethiopia
| | - Zebenay Workneh Bitew
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
- Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Zheng S, Edney SM, Goh CH, Tai BC, Mair JL, Castro O, Salamanca-Sanabria A, Kowatsch T, van Dam RM, Müller-Riemenschneider F. Effectiveness of holistic mobile health interventions on diet, and physical, and mental health outcomes: a systematic review and meta-analysis. EClinicalMedicine 2023; 66:102309. [PMID: 38053536 PMCID: PMC10694579 DOI: 10.1016/j.eclinm.2023.102309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 12/07/2023] Open
Abstract
Background Good physical and mental health are essential for healthy ageing. Holistic mobile health (mHealth) interventions-including at least three components: physical activity, diet, and mental health-could support both physical and mental health and be scaled to the population level. This review aims to describe the characteristics of holistic mHealth interventions and their effects on related behavioural and health outcomes among adults from the general population. Methods In this systematic review and meta-analysis, we searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, Scopus, China National Knowledge Infrastructure, and Google Scholar (first 200 records). The initial search covered January 1, 2011, to April 13, 2022, and an updated search extended from April 13, 2022 to August 30, 2023. Randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) were included if they (i) were delivered via mHealth technologies, (ii) included content on physical activity, diet, and mental health, and (iii) targeted adults (≥18 years old) from the general population or those at risk of non-communicable diseases (NCDs) or mental disorders. Studies were excluded if they targeted pregnant women (due to distinct physiological responses), individuals with pre-existing NCDs or mental disorders (to emphasise prevention), or primarily utilised web, email, or structured phone support (to focus on mobile technologies without exclusive human support). Data (summary data from published reports) extraction and risk-of-bias assessment were completed by two reviewers using a standard template and Cochrane risk-of-bias tools, respectively. Narrative syntheses were conducted for all studies, and random-effects models were used in the meta-analyses to estimate the pooled effect of interventions for outcomes with comparable data in the RCTs. The study was registered in PROSPERO, CRD42022315166. Findings After screening 5488 identified records, 34 studies (25 RCTs and 9 pre-post NRSIs) reported in 43 articles with 5691 participants (mean age 39 years, SD 12.5) were included. Most (91.2%, n = 31/34) were conducted in high-income countries. The median intervention duration was 3 months, and only 23.5% (n = 8/34) of studies reported follow-up data. Mobile applications, short-message services, and mobile device-compatible websites were the most common mHealth delivery modes; 47.1% (n = 16/34) studies used multiple mHealth delivery modes. Of 15 studies reporting on weight change, 9 showed significant reductions (6 targeted on individuals with overweight or obesity), and in 10 studies reporting perceived stress levels, 4 found significant reductions (all targeted on general adults). In the meta-analysis, holistic mHealth interventions were associated with significant weight loss (9 RCTs; mean difference -1.70 kg, 95% CI -2.45 to -0.95; I2 = 89.00%) and a significant reduction in perceived stress levels (6 RCTs; standardised mean difference [SMD] -0.32; 95% CI -0.52 to -0.12; I2 = 14.52%). There were no significant intervention effects on self-reported moderate-to-vigorous physical activity (5 RCTs; SMD 0.21; 95%CI -0.25 to 0.67; I2 = 74.28%) or diet quality scores (5 RCTs; SMD 0.21; 95%CI -0.47 to 0.65; I2 = 62.27%). All NRSIs were labelled as having a serious risk of bias overall; 56% (n = 14/25) of RCTs were classified as having some concerns, and the others as having a high risk of bias. Interpretation Findings from identified studies suggest that holistic mHealth interventions may aid reductions in weight and in perceived stress levels, with small to medium effect sizes. The observed effects on diet quality scores and self-reported moderate-to-vigorous physical activity were less clear and require more research. High-quality RCTs with longer follow-up durations are needed to provide more robust evidence. To promote population health, future research should focus on vulnerable populations and those in middle- and low-income countries. Optimal combinations of delivery modes and components to improve efficacy and sustain long-term effects should also be explored. Funding National Research Foundation, Prime Minister's Office, Singapore, under its Campus for Research Excellence and Technological Enterprise (CREATE) Programme and Physical Activity and Nutrition Determinants in Asia (PANDA) Research Programme.
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Affiliation(s)
- Shenglin Zheng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Sarah Martine Edney
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Chin Hao Goh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Jacqueline Louise Mair
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Oscar Castro
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Alicia Salamanca-Sanabria
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Tobias Kowatsch
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology and Economics ETH Zürich, Zürich, Switzerland
| | - Rob M. van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Digital Health Centre, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Thomas EBK, Sagorac Gruichich T, Maronge JM, Hoel S, Victory A, Stowe ZN, Cochran A. Mobile Acceptance and Commitment Therapy With Distressed First-Generation College Students: Microrandomized Trial. JMIR Ment Health 2023; 10:e43065. [PMID: 37184896 DOI: 10.2196/43065] [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: 10/01/2022] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Extant gaps in mental health services are intensified among first-generation college students. Improving access to empirically based interventions is critical, and mobile health (mHealth) interventions are growing in support. Acceptance and commitment therapy (ACT) is an empirically supported intervention that has been applied to college students, via mobile app, and in brief intervals. OBJECTIVE This study evaluated the safety, feasibility, and effectiveness of an ACT-based mHealth intervention using a microrandomized trial (MRT) design. METHODS Participants (N=34) were 18- to 19-year-old first-generation college students reporting distress, who participated in a 6-week intervention period of twice-daily assessments and randomization to intervention. Participants logged symptoms, moods, and behaviors on the mobile app Lorevimo. After the assessment, participants were randomized to an ACT-based intervention or no intervention. Analyses examined proximal change after randomization using a weighted and centered least squares approach. Outcomes included values-based and avoidance behavior, as well as depressive symptoms and perceived stress. RESULTS The findings indicated the intervention was safe and feasible. The intervention increased values-based behavior but did not decrease avoidance behavior. The intervention reduced depressive symptoms but not perceived stress. CONCLUSIONS An MRT of an mHealth ACT-based intervention among distressed first-generation college students suggests that a larger MRT is warranted. Future investigations may tailor interventions to contexts where intervention is most impactful. TRIAL REGISTRATION ClinicalTrials.gov NCT04081662; https://clinicaltrials.gov/show/NCT04081662. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/17086.
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Affiliation(s)
| | | | - Jacob M Maronge
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sydney Hoel
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Amanda Victory
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Amy Cochran
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States
- Department of Mathematics, University of Wisconsin-Madison, Madison, WI, United States
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Fang YY, Lee JI, Wu NY, Chang CI, Huang MC, Lee CY, Huang JY, Lee GGC, Chen CS. Effect of a novel telehealth device for dietary cognitive behavioral intervention in overweight or obesity care. Sci Rep 2023; 13:6441. [PMID: 37081127 PMCID: PMC10116097 DOI: 10.1038/s41598-023-33238-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/10/2023] [Indexed: 04/22/2023] Open
Abstract
Obesity has become a major public health issue which relate to numerous physical problems and highly comorbid with depression and anxiety. Recently, some studies of technology-based interventions for weight reduction emerged to overcome the barriers from time, cost and distance. Mood component and eating behavior related to obesity are less discussed so far with technology-based intervention though. This pilot study was aimed to investigate the effect of telehealth assisted intervention on weight reduction, mood status, and eating behavior change under a smartphone application (app) with novel 3D food picture recognition and incorporated with cognitive behavioral training programs. Adult aged 30-60 years old with overweight were recruited and randomly assigned to control-first group and intervention-first group. In period 1, control-first group had regular life and intervention-first group underwent app intervention; in period 2, two groups went crossover. Body composition and psychological/behavioral questionnaires were collected at baseline, end of period 1, and end of period 2. Nonparametric statistics was performed for data analyzing. A total of 20 participants were enrolled. In control-first group, there were statistically significant reduction in body weight (- 0.55 kg, p = 0.02) and change of body weight percentage (- 0.6%, p = 0.02) after App use. In intervention-first group, the fat percentage decreased by 0.4% after App use in period 1, and increased by 0.05% in period 2. The integrated crossover data revealed that subjects of App group had significant improvements in mindful eating behavior. This pilot study showed the effectiveness in using CogniNU app for weight control and eating behavior. The difference of short-term and long-term effectiveness of technology-based weight control intervention deserves more investigation in the future.Clinical Trial Registration: ISRCTN16082909.
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Affiliation(s)
- Yi-Ya Fang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-In Lee
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Nai-Yuan Wu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Chiao-I Chang
- Department of Public Health and Environmental Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Chuan Huang
- Division of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Ying Lee
- Division of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jui-Yen Huang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gwo Giun Chris Lee
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Sheng Chen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Pi L, Shi X, Wang Z, Zhou Z. Effect of smartphone apps on glycemic control in young patients with type 1 diabetes: A meta-analysis. Front Public Health 2023; 11:1074946. [PMID: 37064701 PMCID: PMC10097897 DOI: 10.3389/fpubh.2023.1074946] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/02/2023] [Indexed: 04/03/2023] Open
Abstract
ObjectivesAchieving glycemic control is a great challenge for young patients with type 1 diabetes (T1D), especially during the transition from childhood to adulthood. As various smartphone apps have been developed to improve glycemic control in T1D, we performed a meta-analysis of randomized controlled trials to assess the effect of smartphone apps on glycemic control in young patients with T1D.MethodsWe systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials comparing combined usual care and smartphone app treatment to usual care alone. This meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The primary outcomes were the weighted difference in means (WMD) of HbA1c change from baseline and the person-years incidence of mild hypoglycemia or severe hypoglycemia between intervention and control groups. We assessed pooled data by use of a random-effects model.ResultsOf 1,190 identified studies, nine were eligible and included in our analysis (N = 748 participants). Relative to the control, using smartphone apps yielded a non-significant reduction in glycated hemoglobin (HbA1c) (WMD = −0.26, 95% CI: −0.56 to 0.05; p = 0.10) and no increased frequency of mild hypoglycemia (WMD = 1.87, 95% CI: −1.52 to 5.27; p = 0.49) or severe hypoglycemia (WMD = −0.04, 95% CI: −0.35 to 0.27; p = 0.80). In further subgroup analysis, compared with the recording-style app group, the auxiliary-style app group exhibited a significant reduction in HbA1c (WMD = −0.83, 95% CI: −1.10 to −0.56, p < 0.001).ConclusionThe current pooled data analysis did not reveal a significant reduction in HbA1c in young patients with T1D undergoing treatment with smartphone apps and usual care in combination. However, auxiliary-style apps with insulin or carbo calculators were beneficial in reducing HbA1c.
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McAuley EA, MacLaughlin HL, Hannan-Jones MT, King N, Ross LJ. Effectiveness of diet quality indices in measuring a change in diet quality over time: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev 2023; 81:361-383. [PMID: 36102824 DOI: 10.1093/nutrit/nuac063] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
CONTEXT Diet quality indices (DQIs) were developed to score and rank adherence to dietary patterns in observational studies, but their use to measure changes in diet quality in intervention trials is becoming common in the literature. OBJECTIVE This systematic review and meta-analysis aimed to assess the effectiveness of DQIs to measure change in diet quality in intervention trials. DATA SOURCES MEDLINE, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials databases were searched from January 1994 to June 2020. Two reviewers independently completed full-text screening. Eligible studies were randomized controlled trials that used validated a priori DQIs to measure change in diet quality in adults. DATA EXTRACTION Data were extracted by an independent reviewer and reviewed by the research team. Risk of bias was assessed by the Cochrane Collaboration's Risk of Bias 2.0 tool. DATA ANALYSIS The 34 included studies (52% of reviewed studies, 0.6% of initially identified studies) used 10 different DQIs, 7 of which were able to measure significant change in diet quality. Meta-analyses of pooled results demonstrated change in the Healthy Eating Index (MD 5.35; 95%CI, 2.74-7.97; P < 0.001) and the Mediterranean Dietary Adherence Screener (MD 1.61; 95%CI, 1.00-2.23; P < 0.001) scores. DQIs were more likely to measure change in diet quality if they reflected the diet pattern being implemented, if the intervention was significantly different from the baseline and control diets, and if the study was adequately powered to detect change. CONCLUSION DQIs are responsive to change in diet quality in intervention trials when the index used reflects the dietary changes made and the study is adequately powered. The appropriate selection of a DQI to suitably match dietary changes and study populations is important for future dietary intervention trials. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020181357.
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Affiliation(s)
- Erynn A McAuley
- are with the School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,are with the Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Helen L MacLaughlin
- are with the School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,are with the Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Mary T Hannan-Jones
- are with the School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,are with the Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Neil King
- are with the School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Lynda J Ross
- are with the School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,are with the Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Smith J, Ang XQ, Giles EL, Traviss-Turner G. Emotional Eating Interventions for Adults Living with Overweight or Obesity: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2722. [PMID: 36768088 PMCID: PMC9915727 DOI: 10.3390/ijerph20032722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Emotional eating (EE) may be defined as a tendency to eat in response to negative emotions and energy-dense and palatable foods, and is common amongst adults with overweight or obesity. There is limited evidence regarding the effectiveness of interventions that address EE. OBJECTIVES To synthesize evidence on the effectiveness of EE interventions for weight loss and EE in adults living with overweight or obesity. METHODS This is a systematic review and meta-analysis. Adhering to the PRISMA guidance, a comprehensive electronic search was completed up to February 2022. Random effects meta-analysis was carried out to determine the percentage change in weight and EE scores. RESULTS Thirty-four studies were included. The combined effect size for percentage weight change was -1.08% (95% CI: -1.66 to -0.49, I2 = 64.65%, n = 37), once adjusted for publication bias. Similarly, the combined effect size for percentage change in EE was -2.37%, (95% CI: -3.76 to -0.99, I2 = 87.77%, n = 46). Cognitive Behavioural Therapy showed the most promise for reducing weight and improving EE. CONCLUSIONS Interventions to address EE showed promise in reducing EE and promoted a small amount of weight loss in adults living with overweight or obesity.
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Affiliation(s)
- Jo Smith
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington DL2 2TS, UK
| | - Xiao Qi Ang
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK
| | - Emma L. Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK
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Hoare JK, Lister NB, Garnett SP, Baur LA, Jebeile H. Weight-neutral interventions in young people with high body mass index: A systematic review. Nutr Diet 2023; 80:8-20. [PMID: 35411702 PMCID: PMC10084274 DOI: 10.1111/1747-0080.12729] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/09/2022] [Accepted: 01/24/2022] [Indexed: 01/10/2023]
Abstract
AIM This systematic review explored the feasibility, acceptability and effect on health outcomes of weight-neutral interventions in health improvement-seeking young people with overweight/obesity. METHODS Six databases were searched to March 2021 for health, but not weight, focused interventions (PROSPERO, CRD42020152671). Eligible studies recruited young people (10-24 years) with overweight/obesity. The studies were described using narrative synthesis, with numerical results summarised. The quality of included studies was assessed using the Joanna Briggs Institute critical appraisal tools. RESULTS Six articles were included, representing three pilot studies. Study 1 (n = 37, 14-17 years) compared a 6-week mindful eating program with single-session lifestyle education; Study 2 (n = 35, 14-17 years) compared 12-week weight-neutral lifestyle education focused on intuitive eating and carbohydrate quality, with/without guided imagery; and Study 3 (n = 33, 12-17 years) compared a 6-week mindfulness intervention with cognitive behavioural therapy in adolescents with depressive symptoms at risk of type 2 diabetes. All interventions explored feasibility (intervention group retention 57%-88%, attendance >80%) and reported interventions were acceptable. Studies 1 and 3 reported no change in mindfulness. Study 2 reported an increase (p < 0.05) in intuitive eating following weight-neutral plus guided imagery (0.32 ± 0.36, Hawks' Scale, score 1-4), compared with weight-neutral alone (0.15 ± 0.29). Study 1 reported decreased body mass index (p < 0.001) following mindful eating (-1.1 kg/m2 ), compared with single-session lifestyle education (+0.7 kg/m2 ); Studies 2 and 3 found no change in body mass index or body mass index z-score. CONCLUSIONS Weight-neutral interventions may be feasible and acceptable in adolescents with overweight/obesity in the short term (≤12 weeks), but data are limited.
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Affiliation(s)
- Johanna K Hoare
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Louise A Baur
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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10
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Van Wasshenova E, Boardley D, Geers A, Tull M, Steiner V. A Brief Value-based Randomized Intervention to Promote Physical Activity in Patients Attending Cardiac Rehabilitation. AMERICAN JOURNAL OF HEALTH EDUCATION 2022. [DOI: 10.1080/19325037.2022.2142334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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11
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Hensley-Hackett K, Bosker J, Keefe A, Reidlinger D, Warner M, D'Arcy A, Utter J. Intuitive Eating Intervention and Diet Quality in Adults: A Systematic Literature Review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:1099-1115. [PMID: 36274010 DOI: 10.1016/j.jneb.2022.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/07/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Intuitive eating interventions aim to improve individual health and promote sustainable changes to one's relationship with food. However, there is no evidence-based consensus on the impact of intuitive eating interventions on diet quality. This systematic review aimed to investigate intuitive eating interventions and their impact on diet quality. METHOD PubMed, Embase, CINAHL, PsycInfo, and Cochrane databases were systematically searched to October 2021 for studies reporting interventions that encompassed the principles of intuitive eating and measured diet quality. Other health outcomes were used for secondary analysis. Findings were synthesized narratively. RESULTS Seventeen papers reporting 14 intervention studies (n = 3,960) were included in the review. All studies found a positive or neutral effect on diet quality following an intuitive eating intervention. A favorable change in eating behavior following these interventions was also observed. DISCUSSION Intuitive eating promotes an attunement to the body, which aids in improving diet quality because of increased awareness of physiological cues. The reduction of emotional and binge eating may also increase diet quality. IMPLICATIONS FOR RESEARCH AND PRACTICE Findings from the current review suggest that intuitive eating interventions are most effective face-to-face, in a group setting, and sustained for at least 3 months.
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Affiliation(s)
- Katie Hensley-Hackett
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Josephine Bosker
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Ashleigh Keefe
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Dianne Reidlinger
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Molly Warner
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; My Nutrition Clinic, Robina, Queensland, Australia
| | - Anna D'Arcy
- My Nutrition Clinic, Robina, Queensland, Australia
| | - Jennifer Utter
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; Department of Dietetics and Foodservices, Mater Health, South Brisbane, Queensland, Australia.
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12
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Guerrini Usubini A, Bottacchi M, Caroli D, Castelnuovo G, Sartorio A. Cognitive Fusion and Emotional Eating among Adolescents with Obesity: A Preliminary Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14855. [PMID: 36429574 PMCID: PMC9690408 DOI: 10.3390/ijerph192214855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Cognitive fusion and avoidance are supposed to exert a key role in the development and maintenance of disordered eating behaviors related to obesity, such as emotional eating. A large portion of the research has focused on adult populations, while few data are available on adolescents so far. The current cross-sectional study is intended to explore the association between cognitive fusion, avoidance, and emotional eating in a sample of fifty-six Italian adolescents (13-17 years) with obesity (body mass index > 97th centile). For this purpose, participants attending a 3-week body weight reduction program were assessed using demographical, physical, and clinical data. A multivariate linear regression model was performed in order to preliminarily investigate the predictive role of cognitive fusion on emotional eating, controlling for possible confounding factors. Results showed a significant association between cognitive fusion and emotional eating. Regression revealed that cognitive fusion was a significant contributor for explaining emotional eating (controlling for sex) [R2 = 0.551; Adjusted R2 = 0.534; F(2,53) = 32.5; p < 0.001]. Even if preliminary, our findings suggest a predictive role of cognitive fusion on emotional eating, and also suggest that cognitive fusion can be considered a key component in understanding and addressing of disordered eating behaviors related to obesity. Future replications are required to expand the sample and collect longitudinal data. Intervention programs for childhood obesity could benefit from this line of research.
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Affiliation(s)
| | - Michela Bottacchi
- Psychology Research Laboratory, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20145 Milan, Italy
| | - Diana Caroli
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-Endocrinological Research, 28824 Piancavallo-Verbania, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Psychology Research Laboratory, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20145 Milan, Italy
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-Endocrinological Research, 28824 Piancavallo-Verbania, Italy
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-Endocrinological Research, 20145 Milan, Italy
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13
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Jalo E, Konttinen H, Westerterp-Plantenga M, Adam T, Drummen M, Huttunen-Lenz M, Siig Vestentoft P, Martinez JA, Handjiev S, Macdonald I, Brand-Miller J, Poppitt S, Swindell N, Lam T, Navas-Carretero S, Handjieva-Darlenska T, Taylor M, Muirhead R, Silvestre MP, Raben A, Fogelholm M. Perceived stress as a predictor of eating behavior during the 3-year PREVIEW lifestyle intervention. Nutr Diabetes 2022; 12:47. [PMID: 36335092 PMCID: PMC9637180 DOI: 10.1038/s41387-022-00224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022] Open
Abstract
Background To better support participants to achieve long-lasting results within interventions aiming for weight loss and maintenance, more information is needed about the maintenance of behavioral changes. Therefore, we examined whether perceived stress predicts the maintenance of changes in eating behavior (flexible and rigid restraint of eating, disinhibition, and hunger). Methods The present study was a secondary analysis of the PREVIEW intervention including participants with overweight (BMI ≥ 25 kg/m2) at baseline and high risk of type 2 diabetes (n = 1311). Intervention included a 2-month low-energy diet phase and a 34-month subsequent weight maintenance phase. The first 6 months were considered an active behavior change stage and the remaining 2.5 years were considered a behavior maintenance stage. Eating behavior was measured using the Three Factor Eating Questionnaire and stress using the Perceived Stress Scale. The associations between stress and eating behavior were analyzed using linear mixed effects models for repeated measurements. Results Perceived stress measured after the active behavior change stage (at 6 months) did not predict changes in eating behavior during the behavior maintenance stage. However, frequent high stress during this period was associated with greater lapse of improved flexible restraint (p = 0.026). The mean (SD) change in flexible restraint from 6 to 36 months was −1.1 (2.1) in participants with frequent stress and −0.7 (1.8) in participants without frequent stress (Cohen’s ds (95% CI) = 0.24 (0.04–0.43)). Higher perceived stress at 6 months was associated with less flexible restraint and more disinhibition and hunger throughout the behavior maintenance stage (all p < 0.001). Conclusions Perceived stress was associated with features of eating behavior that may impair successful weight loss maintenance. Future interventions should investigate, whether incorporating stress reduction techniques results in more effective treatment, particularly for participants experiencing a high stress level.
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Affiliation(s)
- Elli Jalo
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland.
| | - Hanna Konttinen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland.,Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Margriet Westerterp-Plantenga
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Tanja Adam
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Mathijs Drummen
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Maija Huttunen-Lenz
- Institute of Nursing Science, University of Education Schwäbisch Gmünd, Schwäbisch, Gmünd, Germany
| | - Pia Siig Vestentoft
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - J Alfredo Martinez
- Centre for Nutrition Research, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Navarra, Spain.,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.,IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain.,Precision Nutrition and Cardiometabolic Health Program. IMDEA-Food Institute (Madrid Institute for Advanced Studies), CEI UAM + CSIC, Madrid, Spain
| | - Svetoslav Handjiev
- Department of Pharmacology and Toxicology, Medical University of Sofia, Sofia, Bulgaria
| | - Ian Macdonald
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK.,MRC/ARUK Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Jennie Brand-Miller
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Sally Poppitt
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Nils Swindell
- Applied Sports Technology, Exercise, and Medicine (A-STEM) Research Centre, College of Engineering, Swansea University, Swansea, UK
| | - Tony Lam
- NetUnion SARL, Lausanne, Switzerland
| | - Santiago Navas-Carretero
- Centre for Nutrition Research, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Navarra, Spain.,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.,IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
| | | | - Moira Taylor
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Roslyn Muirhead
- MRC/ARUK Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Marta P Silvestre
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand.,Centro de Investigaçao em Tecnologias e Serciços de Saûde (CINTESIS), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
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14
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Binge eating disorder and stress level among patients attending nutrition counseling. NUTR HOSP 2022; 39:638-643. [PMID: 35485375 DOI: 10.20960/nh.03899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION binge eating disorder (BED) is characterized by eating much more than what most people would eat under similar circumstances. Inability to cope with stress and emotions may be the reason for BED episodes. OBJECTIVE to assess the level of stress and BED severity based on the number of episodes of compulsive overeating among patients attending nutrition counseling. METHODS a total of 100 people (60 women and 40 men) were taking part in the study. A questionnaire in which subjects answered questions concerning diet, number of meals, and coping with stressful situations was used. A nutritional diary was used to assess the amount of BED episodes and consumed products, and the emotions felt during consumption. PSS-10 was used to measure the response to stressful situations. RESULTS all subjects had episodes of compulsive overeating but the majority of respondents (52 %) had no more than 3 episodes of binge eating per week. During a BED episode patients most often chose sweets (58.2 %). The main way of responding of people on stressful situations was snacking, especially sweets. CONCLUSIONS high levels of stress correlated positively with the number of BED episodes and excessive body weight. The PSS-10 questionnaire could be a useful tool in nutrition counseling.
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15
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Chew HSJ, Lau ST, Lau Y. Weight-loss interventions for improving emotional eating among adults with high body mass index: A systematic review with meta-analysis and meta-regression. EUROPEAN EATING DISORDERS REVIEW 2022; 30:304-327. [PMID: 35460323 PMCID: PMC9320927 DOI: 10.1002/erv.2906] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 03/15/2022] [Accepted: 04/04/2022] [Indexed: 11/15/2022]
Abstract
Objectives To evaluate the effectiveness of weight‐loss interventions on emotional eating among adults with high body mass index (BMI). Methods A systematic review, meta‐analysis and meta‐regression were performed on randomized controlled trials published from inception until 19 March 2021. Results Thirty‐one studies were included, representing 1203 participants with mean ages ranging from 21.8 to 57.3 years old and BMI 27.2–43.5 kg/m2. We found small‐to‐medium interventional effects on emotional eating (n = 18; Hedges' g = 0.22; p = 0.01, I2 = 61.7%), uncontrolled eating (n = 16; Hedges' g = 0.46; p < 0.001, I2 = 71.6%) and cognitive restraint (n = 18; Hedges' g = 0.42; p < 0.001, I2 = 75.8%). Small‐to‐medium interventional effects were only found for emotional eating (n = 8; Hedges' g = 0.45; p = 0.02, I2 = 74.3%) 3‐month post‐intervention, and on BMI (n = 4; Hedges' g = 0.43; p < 0.05, I2 = 33.4%) and weight (n = 6; Hedges' g = 0.36; p < 0.01, I2 < 10.4%) 12‐month post‐intervention. Age, male proportion, baseline BMI, attrition rate and intervention length were not significant moderators of the heterogeneity between studies. Conclusion Interventions improved emotional eating and weight loss along a year‐long trajectory. Weight‐loss interventions such as Cognitive Behaviour Therapy (CBT), diet and exercise, and mindfulness are effective in improving emotional eating, uncontrolled eating/external eating and cognitive restraint/restrained eating. Purely mindfulness‐based interventions showed a higher interventional effect size over a combination of CBT and mindfulness, CBT and diet and/or exercise. Small‐to‐medium interventional effect size on body mass index and weight was only observed 12‐month post‐intervention.
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Affiliation(s)
- Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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16
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Design of a Planner-Based Intervention to Facilitate Diet Behaviour Change in Type 2 Diabetes. SENSORS 2022; 22:s22072795. [PMID: 35408411 PMCID: PMC9002653 DOI: 10.3390/s22072795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022]
Abstract
Diet behaviour is influenced by the interplay of the physical and social environment as well as macro-level and individual factors. In this study, we focus on diet behaviour at an individual level and describe the design of a behaviour change artefact to support diet behaviour change in persons with type 2 diabetes. This artefact was designed using a human-centred design methodology and the Behaviour Change Wheel framework. The designed artefact sought to support diet behaviour change through the addition of healthy foods and the reduction or removal of unhealthy foods over a 12-week period. These targeted behaviours were supported by the enabling behaviours of water consumption and mindfulness practice. The artefact created was a behaviour change planner in calendar format, that incorporated behaviour change techniques and which focused on changing diet behaviour gradually over the 12-week period. The behaviour change planner forms part of a behaviour change intervention which also includes a preparatory workbook exercise and one-to-one action planning sessions and can be customised for each participant.
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17
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Forbes L, Johnson SK. Online Mindfulness Intervention for Inflammatory Bowel Disease: Adherence and Efficacy. Front Psychol 2022; 12:709899. [PMID: 35401288 PMCID: PMC8987583 DOI: 10.3389/fpsyg.2021.709899] [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: 05/14/2021] [Accepted: 12/30/2021] [Indexed: 12/30/2022] Open
Abstract
The impact of stress and other psychological variables on Inflammatory Bowel Disease (IBD) prognosis, treatment response, and functional level is well-established; however, typical IBD treatment focuses on the physiological pathology of the disease and neglects complementary stress-reducing interventions. Recent pilot studies report the benefits of mindfulness-based interventions (MBIs) in people living with IBD, but are limited by small sample sizes. Recruitment challenges to in-person studies may be in part due to the difficulty IBD patients often have adhering to fixed schedules and travel as a result of IBD symptoms such as pain, fatigue, and incontinence. The current study aimed to address this barrier by offering participants access to online mindfulness training, allowing individuals to engage with intervention materials to fit their own schedule. Online mindfulness programs have gained popularity in recent years, as they increase access and flexibility and decrease cost to the user; however, the dropout rate tends to be high. The current study compared the rate of adherence and efficacy of mindfulness training as a function of level of support: self-guided versus supported. Analysis revealed no significant difference in the benefits received between participants in the two groups; however, a significant difference group (χ2 = 15.75; p = 0.000, r = 0.38) was found in terms of rate of completion, with 44.1% of the supportive group completing the protocol compared to 11.7% of the self-guided. Common challenges to meditation were measured, but did not significantly predict adherence to the intervention, and experience of these challenges did not significantly change (increase or decrease) over the duration of the study. Implications of the current research, future directions for the use of MBI for IBD patients, and a discussion of methodological considerations are provided.
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Affiliation(s)
- Leila Forbes
- BASE Cognitive Behavioral, Charlotte, NC, United States
| | - Susan K. Johnson
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC, United States
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18
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Muñoz-Ramírez S, Escribano-López B, Rodrigo-Casares V, Vergara-Hernández C, Gil-Mary D, Sorribes-Monrabal I, Garcés-Sánchez M, Muñoz-Del-Barrio MJ, Albors-Fernández AM, Úbeda-Sansano MI, Planelles-Cantarino MV, Largo-Blanco EM, Suárez-Vicent E, García-Rubio J, Bruijning-Verhagen P, Orrico-Sánchez A, Díez-Domingo J. Feasibility of a hybrid clinical trial for respiratory virus detection in toddlers during the influenza season. BMC Med Res Methodol 2021; 21:273. [PMID: 34865624 PMCID: PMC8645221 DOI: 10.1186/s12874-021-01474-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traditional clinical trials are conducted at investigator sites. Participants must visit healthcare facilities several times for the trial procedures. Decentralized clinical trials offer an interesting alternative. They use telemedicine and other technological solutions (apps, monitoring devices or web platforms) to decrease the number of visits to study sites, minimise the impact on daily routine, and decrease geographical barriers for participants. Not much information is available on the use of decentralization in randomized clinical trials with vaccines. METHODS A hybrid clinical trial may be assisted by parental recording of symptoms using electronic log diaries in combination with home collected nasal swabs. During two influenza seasons, children aged 12 to 35 months with a history of recurrent acute respiratory infections were recruited in 12 primary health centers of the Valencia Region in Spain. Parents completed a symptom diary through an ad hoc mobile app that subsequently assessed whether it was an acute respiratory infection and requested collection of a nasal swab. Feasibility was measured using the percentage of returned electronic diaries and the validity of nasal swabs collected during the influenza season. Respiratory viruses were detected by real-time PCR. RESULTS Ninety-nine toddlers were enrolled. Parents completed 10,476 electronic diaries out of the 10,804 requested (97%). The mobile app detected 188 potential acute respiratory infections (ARIs) and requested a nasal swab. In 173 (92%) ARI episodes a swab was taken. 165 (95.4%) of these swabs were collected at home and 144 (87.3%) of them were considered valid for laboratory testing. Overall, 152 (81%) of the ARIs detected in the study had its corresponding valid sample collected. CONCLUSIONS Hybrid procedures used in this clinical trial with the influenza vaccine in toddlers were considered adequate, as we diagnosed most of the ARI cases on time, and had a valid swab in 81% of the cases. Hybrid clinical trials improve participant adherence to the study procedures and could improve recruitment and quality of life of the participants and the research team by decreasing the number of visits to the investigator site. This report emphasises that the conduct of hybrid CTs is a valid alternative to traditional CTs with vaccines. This hybrid CT achieved high adherence of participant to the study procedures. TRIAL REGISTRATION 2019-001186-33 (EudraCT).
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Affiliation(s)
- Soledad Muñoz-Ramírez
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain.
| | - Begoña Escribano-López
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Vallivana Rodrigo-Casares
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Carlos Vergara-Hernández
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | | | | | | | | | | | | | | | | | | | - Javier García-Rubio
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | | | - Alejandro Orrico-Sánchez
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
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19
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Iturbe I, Echeburúa E, Maiz E. The effectiveness of acceptance and commitment therapy upon weight management and psychological well-being of adults with overweight or obesity: A systematic review. Clin Psychol Psychother 2021; 29:837-856. [PMID: 34802174 DOI: 10.1002/cpp.2695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/29/2021] [Accepted: 11/14/2021] [Indexed: 01/22/2023]
Abstract
Several studies have examined acceptance and commitment therapy's (ACT) effectiveness for addressing physical and psychological distress people with obesity can face. Nevertheless, no review focusing specifically on ACT analysing randomized controlled trials (RCT) has been done up to date in this field. The present systematic review was developed following the PRISMA statement and aimed to examine ACT's effects on weight management and psychological well-being of adults with overweight or obesity. A conjunction of keywords related to ACT and excess weight was searched in four databases (Medline, PubMed, Psycinfo and Scopus) for articles meeting inclusion criteria. The literature search yielded 2,074 papers, and 16 were included in the review, finally. In 71.43% of the studies, ACT was effective to enhance psychological well-being; in 50% effectively targeted process variables and health behaviours related to weight management; in 31.82% of studies, physical variables were improved; and 21.38% of studies showed evidence in favour of ACT for eating behaviour modification. The present review supports ACT for promoting emotional aspects of individuals immersed in such weight-related battles and highlights the benefits of psychological well-being-oriented ACT in the context of obesity treatment. More studies targeting psychological well-being primarily and with longer follow-ups are required.
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Affiliation(s)
- Idoia Iturbe
- Department of Clinical and Health Psychology and Research Methodology, University of the Basque Country UPV/EHU, Donostia-San Sebastian, Spain
| | - Enrique Echeburúa
- Department of Clinical and Health Psychology and Research Methodology, University of the Basque Country UPV/EHU, Donostia-San Sebastian, Spain
| | - Edurne Maiz
- Department of Clinical and Health Psychology and Research Methodology, University of the Basque Country UPV/EHU, Donostia-San Sebastian, Spain
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Chatterjee A, Prinz A, Gerdes M, Martinez S. Digital Interventions on Healthy Lifestyle Management: Systematic Review. J Med Internet Res 2021; 23:e26931. [PMID: 34787575 PMCID: PMC8663673 DOI: 10.2196/26931] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/07/2021] [Accepted: 08/10/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Digital interventions have tremendous potential to improve well-being and health care conveyance by improving adequacy, proficiency, availability, and personalization. They have gained acknowledgment in interventions for the management of a healthy lifestyle. Therefore, we are reviewing existing conceptual frameworks, digital intervention approaches, and associated methods to identify the impact of digital intervention on adopting a healthier lifestyle. OBJECTIVE This study aims to evaluate the impact of digital interventions on weight management in maintaining a healthy lifestyle (eg, regular physical activity, healthy habits, and proper dietary patterns). METHODS We conducted a systematic literature review to search the scientific databases (Nature, SpringerLink, Elsevier, IEEE Xplore, and PubMed) that included digital interventions on healthy lifestyle, focusing on preventing obesity and being overweight as a prime objective. Peer-reviewed articles published between 2015 and 2020 were included. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and a framework for an evidence-based systematic review. Furthermore, we improved the review process by adopting the Rayyan tool and the Scale for the Assessment of Narrative Review Articles. RESULTS Our initial searches identified 780 potential studies through electronic and manual searches; however, 107 articles in the final stage were cited following the specified inclusion and exclusion criteria. The identified methods for a successful digital intervention to promote a healthy lifestyle are self-monitoring, self-motivation, goal setting, personalized feedback, participant engagement, psychological empowerment, persuasion, digital literacy, efficacy, and credibility. In this study, we identified existing conceptual frameworks for digital interventions, different approaches to provide digital interventions, associated methods, and execution challenges and their impact on the promotion of healthy lifestyle management. CONCLUSIONS This systematic literature review selected intervention principles (rules), theories, design features, ways to determine efficient interventions, and weaknesses in healthy lifestyle management from established digital intervention approaches. The results help us understand how digital interventions influence lifestyle management and overcome the existing shortcomings. It serves as a basis for further research with a focus on designing, developing, testing, and evaluating the generation of personalized lifestyle recommendations as a part of digital health interventions.
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Affiliation(s)
- Ayan Chatterjee
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Andreas Prinz
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Martin Gerdes
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Santiago Martinez
- Department of Health and Nursing Science, Centre for e-Health, University of Agder, Grimstad, Norway
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Aittola K, Karhunen L, Männikkö R, Järvelä-Reijonen E, Mikkonen S, Absetz P, Kolehmainen M, Schwab U, Harjumaa M, Lindström J, Lakka T, Tilles-Tirkkonen T, Pihlajamäki J. Enhanced Eating Competence Is Associated with Improved Diet Quality and Cardiometabolic Profile in Finnish Adults with Increased Risk of Type 2 Diabetes. Nutrients 2021; 13:nu13114030. [PMID: 34836283 PMCID: PMC8624442 DOI: 10.3390/nu13114030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 01/15/2023] Open
Abstract
Eating competence (EC) is characterized by positive attitudes towards food and eating, having regular meals, eating a variety of foods, and internally regulated eating. We investigated the associations of changes in EC with changes in lifestyle, anthropometrics and biomarkers of glucose and lipid metabolism in 2291 adults at increased risk of type 2 diabetes as part of the StopDia study conducted in primary healthcare. EC and diet quality were assessed with validated digital questionnaires. During the intervention, the participants received either (1) the digital lifestyle intervention, (2) the combined digital and face-to-face group-based lifestyle intervention, or (3) standard care. EC increased among the participants independent of the intervention type. Increase in EC was associated with an increase in diet quality, high-density lipoprotein (HDL) cholesterol, and with a decrease in body mass index and waist circumference, regardless of baseline EC. Of the subdomains of EC, the contextual skills, food acceptance and eating attitudes were associated with various of these changes. Our results thus suggest that EC could be a potential target in lifestyle interventions aiming to improve the cardiometabolic health of people at type 2 diabetes risk.
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Affiliation(s)
- Kirsikka Aittola
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
- Correspondence: ; Tel.: +358-50-5167269
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
| | - Reija Männikkö
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
- Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Elina Järvelä-Reijonen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
| | - Santtu Mikkonen
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland;
| | - Pilvikki Absetz
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
- Collaborative Care Systems Finland, 00270 Helsinki, Finland
| | - Marjukka Kolehmainen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
- Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland Ltd., 02044 Espoo, Finland;
| | - Jaana Lindström
- Department of Public Health and Welfare, National Institute for Health and Welfare, 00271 Helsinki, Finland;
| | - Timo Lakka
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland;
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, 70029 Kuopio, Finland
- Kuopio Research Institute of Exercise Medicine, 70100 Kuopio, Finland
| | - Tanja Tilles-Tirkkonen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
- Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, 70029 Kuopio, Finland
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Lv N, Lefferts WK, Xiao L, Goldstein-Piekarski AN, Wielgosz J, Lavori PW, Simmons JM, Smyth JM, Stetz P, Venditti EM, Lewis MA, Rosas LG, Snowden MB, Ajilore OA, Suppes T, Williams LM, Ma J. Problem-solving therapy-induced amygdala engagement mediates lifestyle behavior change in obesity with comorbid depression: a randomized proof-of-mechanism trial. Am J Clin Nutr 2021; 114:2060-2073. [PMID: 34476464 PMCID: PMC8634561 DOI: 10.1093/ajcn/nqab280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/04/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Depression hinders obesity treatment; elucidating mechanisms may enable treatment enhancements. OBJECTIVES The aim was to investigate whether changes in neural targets in the negative affect circuit following psychotherapy mediate subsequent changes in weight and behaviors. METHODS Adults (n = 108) with obesity and depression were randomly assigned to usual care or an intervention that delivered problem-solving therapy (PST) for depression over 2 mo. fMRI for brain imaging was performed at baseline and 2 mo. BMI, physical activity, and diet were measured at baseline and 12 mo. Mediation analysis assessed between-group differences in neural target changes using t test and correlations between neural target changes and outcome changes (simple and interaction effect) using ordinary least-squares regression. RESULTS Compared with usual care, PST led to reductions in left amygdala activation (-0.75; 95% CI: -1.49, -0.01) and global scores of the negative affect circuit (-0.43; -0.81, -0.06), engaged by threat stimuli. Increases in amygdala activation and global circuit scores at 2 mo correlated with decreases in physical activity outcomes at 12 mo in the usual-care group; these relations were altered by PST. In relation to change in leisure-time physical activity, standardized β-coefficients were -0.67 in usual care and -0.01 in the intervention (between-group difference: 0.66; 0.02, 1.30) for change in left amygdala activation and -2.02 in usual care and -0.11 in the intervention (difference: 1.92; 0.64, 3.20) for change in global circuit scores. In relation to change in total energy expenditure, standardized β-coefficients were -0.65 in usual care and 0.08 in the intervention (difference: 0.73; 0.29, 1.16) for change in left amygdala activation and -1.65 in usual care and 0.08 in the intervention (difference: 1.74; 0.85, 2.63) for change in global circuit scores. Results were null for BMI and diet. CONCLUSIONS Short-term changes in the negative affect circuit engaged by threat stimuli following PST for depression mediated longer-term changes in physical activity. This trial was registered at www.clinicaltrials.gov as NCT02246413 (https://clinicaltrials.gov/ct2/show/NCT02246413).
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Affiliation(s)
- Nan Lv
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Wesley K Lefferts
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
| | - Andrea N Goldstein-Piekarski
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA,Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Joseph Wielgosz
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA,Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Philip W Lavori
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Janine M Simmons
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Joshua M Smyth
- Departments of Biobehavioral Health and Medicine, The Pennsylvania State University, University Park, PA, USA
| | - Patrick Stetz
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Megan A Lewis
- Center for Communication Science, RTI International, Seattle, WA, USA
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA,Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Mark B Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, Seattle, WA, USA
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA,Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA,Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jun Ma
- Address correspondence to JM (e-mail: )
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Lim SY, Lee KW, Seow WL, Mohamed NA, Devaraj NK, Amin-Nordin S. Effectiveness of Integrated Technology Apps for Supporting Healthy Food Purchasing and Consumption: A Systematic Review. Foods 2021; 10:1861. [PMID: 34441638 PMCID: PMC8392602 DOI: 10.3390/foods10081861] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
A healthy diet is essential for good health and nutrition, though literature showed that there are various factors affecting the intention to purchase and consume healthy food. Technology integration is known to be useful in various aspects, but findings from studies on the efficacy of technology integration to improve healthy food consumption and purchase have largely been inconsistent. Therefore, we aimed to examine the efficacy of interventions that use technology apps to improve healthy food purchasing and consumption in adults. Relevant studies were identified through PubMed, Scopus, CINAHL, SportDiscuss and ACM Digital Library. Twenty studies were included in the systematic review. The majority of studies (n = 18) used a smartphone in the intervention, and only two studies used a personal digital assistant. The results showed that technology integration-based intervention favoured healthy changes in household food purchases, and increased consumption of healthy food and healthy eating outcomes - albeit to different extents. Overall, technology apps are convenient and user-friendly tools to encourage a change in healthy food purchase and consumption among people.
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Affiliation(s)
- Sook Yee Lim
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (S.Y.L.); (W.-L.S.)
- Faculty of Applied Sciences, UCSI University, Cheras 56000, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Kai Wei Lee
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang 43000, Selangor, Malaysia;
| | - Wen-Li Seow
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (S.Y.L.); (W.-L.S.)
| | - Nurul Azmawati Mohamed
- Department of Basic Medical Sciences 2, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Persiaran Ilmu, Bandar Baru Nilai, Nilai 71800, Negeri Sembilan, Malaysia;
| | - Navin Kumar Devaraj
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
| | - Syafinaz Amin-Nordin
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (S.Y.L.); (W.-L.S.)
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Punna M, Lappalainen R, Kettunen T, Lappalainen P, Muotka J, Kaipainen K, Villberg J, Kasila K. Can peer-tutored psychological flexibility training facilitate physical activity among adults with overweight? JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Robert C, Erdt M, Lee J, Cao Y, Naharudin NB, Theng YL. Effectiveness of eHealth Nutritional Interventions for Middle-Aged and Older Adults: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e15649. [PMID: 33999005 PMCID: PMC8167617 DOI: 10.2196/15649] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 03/28/2020] [Accepted: 04/12/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The risk of development of chronic diseases related to poor nutrition increases with age. In the face of an aging population, it is important for health care sectors to find solutions in delivering health services efficiently and effectively to middle-aged and older adults. OBJECTIVE The aim of this systematic review and meta-analysis was to consolidate the literature that reported the effectiveness of eHealth apps in delivering nutritional interventions for middle-aged and older adults. METHODS A literature search from five databases (PubMed, CINAHL, Cochrane, Web of Science, and Global Health) from the past 5 years was performed. Studies were selected for inclusion that used eHealth to deliver nutritional interventions to adults aged 40 years and above, and reported health and behavioral outcomes. Two independent reviewers searched for research articles and assessed the eligibility of studies to be included in the review. A third reviewer resolved disagreements on study inclusion. We also assessed the quality of the included studies using the CONSORT 2010 checklist. RESULTS A total of 70 studies were included for analysis. The study quality ranged from 44% to 85%. The most commonly used eHealth intervention type was mobile apps (22/70, 31%). The majority of studies (62/70, 89%) provided multicomponent health interventions, which aimed to improve nutrition and other health behaviors (eg, exercise, smoking cessation, medication adherence). Meta-analysis results indicated high and significant heterogeneity; hence, conclusions based on these results should be considered with caution. Nonetheless, the results generally showed that eHealth interventions improved anthropometric and clinical outcomes, but not behavioral outcomes such as fruit and vegetable consumption. CONCLUSIONS The use of eHealth apps to deliver health interventions has been increasing in recent years, and these apps have the potential to deliver health services to a larger group of people. Our findings showed that the effectiveness of eHealth apps to deliver health interventions for middle-aged to older adults was supported by the improvement of anthropometric and clinical outcomes. Future work could aim to develop research frameworks in administering eHealth interventions to address heterogeneity in this field of research.
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Affiliation(s)
- Caroline Robert
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Mojisola Erdt
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
- Institute for Infocomm Research, A*STAR, Singapore, Singapore
| | - James Lee
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Yuanyuan Cao
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Nurhazimah Binte Naharudin
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
- Lee Kuan Yew Centre for Innovative Cities, Singapore University of Technology and Design, Singapore, Singapore
| | - Yin-Leng Theng
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
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De Amicis R, Cancello R, Capodaglio P, Gobbi M, Brunani A, Gilardini L, Castenuovo G, Molinari E, Barbieri V, Mambrini SP, Battezzati A, Bertoli S. Patients with Severe Obesity during the COVID-19 Pandemic: How to Maintain an Adequate Multidisciplinary Nutritional Rehabilitation Program? Obes Facts 2021; 14:205-213. [PMID: 33744894 PMCID: PMC8089441 DOI: 10.1159/000513283] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/17/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is spreading all over the world, particularly in developed countries where obesity is also widespread. There is a high frequency of increased BMI in patients admitted to intensive care for SARS-CoV-2 infection with a major severity in patients with an excess of visceral adiposity. Patients at risk of severe SARS-CoV-2 acute respiratory syndrome are characterised by the high prevalence of pre-existing diseases (high blood pressure and cardiovascular disease, diabetes, chronic respiratory disease, or cancer), most of them typically present in severely obese patients. Indeed, the biological role of adipose tissue in sustaining SARS-CoV-2 infection is not completely elucidated. SUMMARY The forced isolation due to pandemic containment measures abruptly interrupted the rehabilitation programs to which many patients with severe obesity were enrolled. People affected by obesity, and especially those with severe obesity, should continue clinical rehabilitation programs, taking extra measures to avoid COVID-19 infection and reinforcing the adoption of preventive procedures. In this review, the available data on obesity and COVID-19 are discussed along with evidence-based strategies for maintaining the necessary continuous rehabilitation programs. Key Messages: Greater attention is needed for obese and severely obese patients in the face of the current COVID-19 pandemic, which represents a huge challenge for both patients and healthcare professionals. The adoption of new strategies to guarantee adequate and continuous multidisciplinary nutritional rehabilitation programs will be crucial to control the severity of SARS-CoV-2 infection in high-risk populations as well as the worsening of obesity-linked complications. Health authorities should be urged to equip hospitals with tools for the diffusion of telemedicine to maintain physician-patient communication, which is fundamental in chronic and complicated obese patients.
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Affiliation(s)
- Ramona De Amicis
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Raffaella Cancello
- Obesity Unit - Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Capodaglio
- Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, IRCCS Istituto Auxologico Italiano, Piancavallo, Italy
| | - Michele Gobbi
- Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, IRCCS Istituto Auxologico Italiano, Piancavallo, Italy
| | - Amelia Brunani
- Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, IRCCS Istituto Auxologico Italiano, Piancavallo, Italy
| | - Luisa Gilardini
- Obesity Unit - Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Gianluca Castenuovo
- Clinical Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Enrico Molinari
- Clinical Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Valerio Barbieri
- Division of Nutritional Rehabilitation, IRCCS Istituto Auxologico Italiano, Piancavallo, Italy
| | - Sara Paola Mambrini
- Division of Nutritional Rehabilitation, IRCCS Istituto Auxologico Italiano, Piancavallo, Italy
| | - Alberto Battezzati
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Simona Bertoli
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy,
- Obesity Unit - Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy,
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Grider HS, Douglas SM, Raynor HA. The Influence of Mindful Eating and/or Intuitive Eating Approaches on Dietary Intake: A Systematic Review. J Acad Nutr Diet 2020; 121:709-727.e1. [PMID: 33279464 DOI: 10.1016/j.jand.2020.10.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Stimuli that promote eating in the absence of the physiological need for food are pervasive and can facilitate excessive energy intake. The practices of mindful eating (ME) and intuitive eating (IE) have been developed to minimize external drivers of energy intake by helping individuals emphasize the sensory properties of foods and internal indicators of hunger and fullness. OBJECTIVE To enhance understanding about the effect of ME and IE interventions on dietary intake, this systematic review included randomized trials of ME and IE interventions that examined dietary intake, defined as energy intake or diet quality, in adults of varying weight status without a diagnosis of an eating disorder. METHODS The selection of literature followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review process, in which PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases were searched for studies published between January 1980 and November 2019. Studies were included if they met the following criteria: randomized trial design in which 1 arm was an intervention with an ME or IE component and there was at least 1 control or active comparison arm; enrolled participants were of a healthy weight or with overweight or obesity and reported not having an eating disorder (ie, anorexia, bulimia nervosa, or binge eating disorder) or other health conditions in which dietary restrictions were applied; were at least 18 years of age; and outcomes of energy intake or diet quality were reported at baseline and post intervention. The modified Downs and Black checklist was used to assess risk of bias for each study that met inclusion criteria. RESULTS A total of 13 studies, including 8 investigating ME interventions and 5 investigating IE interventions, represented in 14 articles, were included in the review. Seven of the 9 articles reporting on energy intake did not find significant group differences. Eight of the 12 articles reporting on diet quality did not find significant group differences. The mean bias assessment score was 13.6 out of 28, indicating poor quality. CONCLUSIONS Little evidence suggests that ME and IE interventions influence energy intake or diet quality. To draw strong conclusions about the effect of ME and IE on dietary intake, future research using study designs of high rigor are needed.
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Affiliation(s)
- Hannah S Grider
- Department of Nutrition, University of Tennessee, Knoxville, TN
| | - Steve M Douglas
- Department of Nutrition, University of Tennessee, Knoxville, TN
| | - Hollie A Raynor
- Department of Nutrition, University of Tennessee, Knoxville, TN.
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Frayn M, Khanyari S, Knäuper B. A 1-day acceptance and commitment therapy workshop leads to reductions in emotional eating in adults. Eat Weight Disord 2020; 25:1399-1411. [PMID: 31541426 DOI: 10.1007/s40519-019-00778-6] [Citation(s) in RCA: 2] [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: 05/30/2019] [Accepted: 09/06/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Emotional eating has been defined as the tendency to overeat in response to negative emotions and is a symptom of emotion dysregulation. Interventions for emotional eating have been developed based on acceptance and commitment therapy (ACT). However, these interventions only address emotional eating in the context of weight loss programs and are therefore not available in a weight neutral context. METHODS The present study aimed to test the feasibility and acceptability of a 1-day ACT workshop that taught skills to reduce emotional eating, without promoting weight loss. The workshop was delivered in a single day and aimed to reduce emotional eating by improving values clarification and commitment, acceptance, and mindfulness. Follow-ups were conducted at 2 weeks and 3 months post-intervention. RESULTS Results suggest feasibility and acceptability of the 1-day workshop; participants described appreciating the brevity of the program and its applicability to their everyday lives. Improvements in emotional eating were found at 2 weeks (t(31) = 5.80, p < 0.001) and 3 months (t(29) = 6.96, p < 0.001). A repeated measures MANOVA revealed a significant main effect of time (F(14, 96) = 4.98, p < 0.001, partial η2 = 0.421), with follow-up ANOVAs indicating that this effect held for all variables. CONCLUSION The results from this study can be used to inform a larger-scale randomized controlled trial to determine the efficacy of the program in a larger sample and eventually disseminate it in other real-world settings. TRIAL REGISTRATION ClinicalTrials.gov, NCT03744780. LEVEL OF EVIDENCE Level IV, evidence obtained from multiple time series with the intervention.
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Affiliation(s)
- Mallory Frayn
- Department of Psychology, McGill University, 2001 McGill College, Montreal, QC, H3A 1G1, Canada.
| | - Sabrah Khanyari
- Department of Psychology, McGill University, 2001 McGill College, Montreal, QC, H3A 1G1, Canada
| | - Bärbel Knäuper
- Department of Psychology, McGill University, 2001 McGill College, Montreal, QC, H3A 1G1, Canada
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Lin X, Yu M, Jelinek GA, Simpson-Yap S, Neate S, Nag N. Greater Engagement with Health Information Is Associated with Adoption and Maintenance of Healthy Lifestyle Behaviours in People with MS. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165935. [PMID: 32824213 PMCID: PMC7460057 DOI: 10.3390/ijerph17165935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/15/2022]
Abstract
Health communication offers an important means for patients to make informed decisions for illness self-management. We assessed how the level of engagement with selected health information at baseline is associated with the adoption and maintenance of lifestyle behaviours at a 5-year follow-up in people with multiple sclerosis (MS). Non-engagers were compared to engagers of information delivered online and print (medium), and with engagers who additionally attended a live-in workshop (high). Engagement was assessed against lifestyle behaviours by log-binomial regression. Information engagers had higher education, and were less likely to have severe disability, clinically significant fatigue, or obesity. Medium and high baseline engagement was associated with adopting healthy behaviours for omega 3 supplementation (RR = 1.70; 95%CI: 1.02–2.84), physical activity (RR = 2.16; 95%CI: 1.03–4.55), and dairy non-consumption (RR = 3.98; 95%CI: 1.85–8.56) at 5 years; associations were stronger among high engagers. Only high baseline engagement was associated with maintaining behaviours from baseline to 5 years, specifically for omega-3 (RR = 1.26; 95%CI: 1.06–1.49) and vitamin D supplementation (RR = 1.26; 95%CI: 1.04–1.54) and dairy non-consumption (RR = 1.47; 95%CI: 1.03–2.10). Health communication that includes face-to-face information delivery and practical tools for implementation in daily living may be optimal for adopting and maintaining lifestyle behaviours in people with MS.
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Affiliation(s)
- Xin Lin
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; (X.L.); (M.Y.); (G.A.J.); (S.S.-Y.); (S.N.)
| | - Maggie Yu
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; (X.L.); (M.Y.); (G.A.J.); (S.S.-Y.); (S.N.)
| | - George A. Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; (X.L.); (M.Y.); (G.A.J.); (S.S.-Y.); (S.N.)
| | - Steve Simpson-Yap
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; (X.L.); (M.Y.); (G.A.J.); (S.S.-Y.); (S.N.)
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - Sandra Neate
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; (X.L.); (M.Y.); (G.A.J.); (S.S.-Y.); (S.N.)
| | - Nupur Nag
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; (X.L.); (M.Y.); (G.A.J.); (S.S.-Y.); (S.N.)
- Correspondence:
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Fakih El Khoury C, Crutzen R, Schols JMGA, Halfens RJG, Karavetian M. A Dietary Mobile App for Patients Undergoing Hemodialysis: Prospective Pilot Study to Improve Dietary Intakes. J Med Internet Res 2020; 22:e17817. [PMID: 32706698 PMCID: PMC7399958 DOI: 10.2196/17817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/05/2020] [Accepted: 06/03/2020] [Indexed: 01/26/2023] Open
Abstract
Background Mobile technology has an impact on the health care sector, also within dietetics. Mobile health (mHealth) apps may be used for dietary assessment and self-monitoring, allowing for real-time reporting of food intakes. Changing eating behaviors is quite challenging, and patients undergoing hemodialysis, particularly, struggle to meet the target intakes set by dietary guidelines. Usage of mobile apps that are developed in a person-centered approach and in line with recommendations may support both patients and health care practitioners. Objective This study is a pilot that aims at estimating the potential efficacy of a dietary intervention using a theory-based, person-centered smartphone app. Results will be used to improve both the app and a planned large-scale trial intended to assess app efficacy thoroughly. Methods A prospective pilot study was performed at the hemodialysis unit of Al Qassimi Hospital (The Emirate of Sharjah). All patients that fulfilled the study inclusion criteria were considered eligible to be enrolled in the pilot study. Upon successful installation of the app, users met with a dietitian once a week. Outcomes were measured at baseline (T0) and 2 weeks post app usage (T1). This pilot is reported as per guidelines for nonrandomized pilot and feasibility studies and in line with the CONSORT 2010 checklist for reporting pilot or feasibility trials. Results A total of 23 patients completed the pilot intervention. Mean energy intakes increased from 24.4 kcal/kg/day (SD 8.0) to 29.1 kcal/kg/day (SD 7.8) with a medium effect size (d=0.6, 95% CI 0.0-1.2). Mean protein intakes increased from 0.9 g/kg/day (SD 0.3) to 1.3 g/kg/day (SD 0.5) with a large effect size (d=1.0, 95% CI 0.4-1.6); mean intake of high biological value (%HBV) proteins also increased from 58.6% (SD 10.1) to 70.1% (SD 10.7) with a large effect size (d=1.1, 95% CI 0.5-1.7). Dietary intakes of minerals did not change, apart from sodium which decreased from a mean intake of 2218.8 mg/day (SD 631.6) to 1895.3 mg/day (SD 581.0) with a medium effect size (d=0.5, 95% CI 0.1-1.1). Mean serum phosphorus, potassium, and albumin levels did not change relevantly. Mean serum iron increased from 7.9 mg/dL (SD 2.8) to 11.5 mg/dL (SD 7.9) postintervention with a medium effect size (d=0.6, 95% CI 0.0-1.2). Conclusions This pilot study showed that the KELA.AE app has the potential to improve dietary intakes. Processes related to procedure, resources, tools, and app improvement for a future trial were assessed. A more extended intervention using a randomized controlled trial is required to estimate parameters concerning app efficacy accurately.
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Affiliation(s)
- Cosette Fakih El Khoury
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Ruud J G Halfens
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Mirey Karavetian
- Department of Health Sciences, Zayed University, Dubai, United Arab Emirates
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Lawlor ER, Islam N, Bates S, Griffin SJ, Hill AJ, Hughes CA, Sharp SJ, Ahern AL. Third-wave cognitive behaviour therapies for weight management: A systematic review and network meta-analysis. Obes Rev 2020; 21:e13013. [PMID: 32181957 PMCID: PMC7379202 DOI: 10.1111/obr.13013] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/28/2020] [Accepted: 02/06/2020] [Indexed: 12/30/2022]
Abstract
This systematic review and network meta-analysis synthesized evidence on the effects of third-wave cognitive behaviour therapies (3wCBT) on body weight, and psychological and physical health outcomes in adults with overweight or obesity. Studies that included a 3wCBT for the purposes of weight management and measured weight or body mass index (BMI) pre-intervention and ≥ 3 months post-baseline were identified through database searches (MEDLINE, CINAHL, Embase, Cochrane database [CENTRAL], PsycINFO, AMED, ASSIA, and Web of Science). Thirty-seven studies were eligible; 21 were randomized controlled trials (RCT) and included in the network meta-analyses. Risk of bias was assessed using RoB2, and evidence quality was assessed using GRADE. Random-effects pairwise meta-analysis found moderate- to high-quality evidence suggesting that 3wCBT had greater weight loss than standard behavioural treatment (SBT) at post-intervention (standardized mean difference [SMD]: -0.09, 95% confidence interval [CI]: -0.22, 0.04; N = 19; I2 = 32%), 12 months (SMD: -0.17, 95% CI: -0.36, 0.02; N = 5; I2 = 33%), and 24 months (SMD: -0.21, 95% CI: -0.42, 0.00; N = 2; I2 = 0%). Network meta-analysis compared the relative effectiveness of different types of 3wCBT that were not tested in head-to-head trials up to 18 months. Acceptance and commitment therapy (ACT)-based interventions had the most consistent evidence of effectiveness. Only ACT had RCT evidence of effectiveness beyond 18 months. Meta-regression did not identify any specific intervention characteristics (dose, duration, delivery) that were associated with greater weight loss. Evidence supports the use of 3wCBT for weight management, specifically ACT. Larger trials with long-term follow-up are needed to identify who these interventions work for, their most effective components, and the most cost-effective method of delivery.
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Affiliation(s)
| | - Nazrul Islam
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Sarah Bates
- School of Health and Related Research, Faculty of Medicine, Dentistry and HealthUniversity of SheffieldSheffieldUK
| | - Simon J. Griffin
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
- Primary Care Unit, Institute of Public HealthUniversity of CambridgeCambridgeUK
| | - Andrew J. Hill
- Division of Psychological and Social Medicine, School of MedicineUniversity of LeedsLeedsUK
| | - Carly A. Hughes
- Fakenham Medical PracticeNorfolkUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | | | - Amy L. Ahern
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
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Yıldız E. The effects of acceptance and commitment therapy on lifestyle and behavioral changes: A systematic review of randomized controlled trials. Perspect Psychiatr Care 2020; 56:657-690. [PMID: 32043617 DOI: 10.1111/ppc.12482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/21/2020] [Accepted: 02/02/2020] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To determine, evaluate, and synthesize the best available evidence about the evidence-based pragmatic effects of acceptance and commitment therapy (ACT) on lifestyle and behavioral changes (LBCs). DESIGN AND METHODS The PICOS formulations were used to improve the search strategy of this systematic review with the aim to find the right evidence and ask the right questions. The assessed articles were subjected to quality assessment using the PRISMA checklist and the Joanna Briggs Institute's standardized critical assessment and data extraction tools. FINDINGS This study involved 30 randomized controlled trials (RCTs) which met the research criteria. Although the included RCTs have several limitations in themselves, the results of this study suggested that the ACT will help maintain long-term LBCs (eg, weight management, effective coping with substance-related and addictive problems, eating and physical activity). PRACTICE IMPLICATIONS Given that ACT is a trandiagnostic approach that promotes health-related LBCs in many diseases and populations, it seems reasonable for clinicians to use and test ACT to achieve pragmatic results.
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Affiliation(s)
- Erman Yıldız
- Department of Psychiatric Nursing, Faculty of Nursing, Inonu University, Malatya, Turkey
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Stapleton A, O’Connor M, Feerick E, Kerr J, McHugh L. Testing the relationship between health values consistent living and health-related behavior. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Järvelä-Reijonen E, Puttonen S, Karhunen L, Sairanen E, Laitinen J, Kolehmainen M, Pihlajamäki J, Kujala UM, Korpela R, Ermes M, Lappalainen R, Kolehmainen M. The Effects of Acceptance and Commitment Therapy (ACT) Intervention on Inflammation and Stress Biomarkers: a Randomized Controlled Trial. Int J Behav Med 2020; 27:539-555. [PMID: 32394219 PMCID: PMC7497453 DOI: 10.1007/s12529-020-09891-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Psychological processes can be manifested in physiological health. We investigated whether acceptance and commitment therapy (ACT), targeted on psychological flexibility (PF), influences inflammation and stress biomarkers among working-age adults with psychological distress and overweight/obesity. METHOD Participants were randomized into three parallel groups: (1) ACT-based face-to-face (n = 65; six group sessions led by a psychologist), (2) ACT-based mobile (n = 73; one group session and mobile app), and (3) control (n = 66; only the measurements). Systemic inflammation and stress markers were analyzed at baseline, at 10 weeks after the baseline (post-intervention), and at 36 weeks after the baseline (follow-up). General PF and weight-related PF were measured with questionnaires (Acceptance and Action Questionnaire, Acceptance and Action Questionnaire for Weight-Related Difficulties). RESULTS A group × time interaction (p = .012) was detected in the high-sensitivity C-reactive protein (hsCRP) level but not in other inflammation and stress biomarkers. hsCRP decreased significantly in the face-to-face group from week 0 to week 36, and at week 36, hsCRP was lower among the participants in the face-to-face group than in the mobile group (p = .035, post hoc test). Age and sex were stronger predictors of biomarker levels at follow-up than the post-intervention PF. CONCLUSION The results suggest that ACT delivered in group sessions may exert beneficial effects on low-grade systemic inflammation. More research is needed on how to best apply psychological interventions for the health of both mind and body among people with overweight/obesity and psychological distress. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01738256, Registered 17 August, 2012.
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Affiliation(s)
- Elina Järvelä-Reijonen
- Institute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Sampsa Puttonen
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00251 Helsinki, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Institute of Clinical Medicine and Clinical Nutrition, Kuopio University Hospital, P.O. Box 100, FI-70029 KYS Kuopio, Finland
| | - Essi Sairanen
- Department of Psychology, University of Jyväskylä, P.O. Box 35, FI-40014 Jyväskylä, Finland
- Department of Social and Psychological Studies, Karlstad University, SE-651 88 Karlstad, Sweden
| | - Jaana Laitinen
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00251 Helsinki, Finland
| | - Mikko Kolehmainen
- Department of Environmental and Biological Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Institute of Clinical Medicine and Clinical Nutrition, Kuopio University Hospital, P.O. Box 100, FI-70029 KYS Kuopio, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35, FI-40014 Jyväskylä, Finland
| | - Riitta Korpela
- Medical Faculty, Pharmacology, Medical Nutrition Physiology and Human Microbe Research Program, University of Helsinki, P.O. Box 63, FI-00014 Helsinki, Finland
| | - Miikka Ermes
- Institute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- VTT Technical Research Centre of Finland, P.O. Box 1300, FI-33101 Tampere, Finland
| | - Raimo Lappalainen
- Department of Psychology, University of Jyväskylä, P.O. Box 35, FI-40014 Jyväskylä, Finland
| | - Marjukka Kolehmainen
- Institute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Institute of Clinical Medicine and Clinical Nutrition, Kuopio University Hospital, P.O. Box 100, FI-70029 KYS Kuopio, Finland
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Mobile Apps for the Management of Comorbid Overweight/Obesity and Depression/Anxiety: A Systematic Review. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:9317179. [PMID: 32047587 PMCID: PMC7003257 DOI: 10.1155/2020/9317179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/18/2019] [Accepted: 01/06/2020] [Indexed: 11/18/2022]
Abstract
Objective This review aimed at searching for scientific literature on mobile apps for the management of comorbid overweight/obesity and depression/anxiety and providing a brief and comprehensive summary of their main features, targeted groups, and relevant results. Methods A bibliographical search was performed in Pubmed, PsycNet, Web of Science, ResearchGate, and Lilacs databases. The terms “obesity” and “overweight” were introduced in combination with “anxiety” and “depression” and “mobile app (application),” “smartphone app (application),” “android app (applicattion),” “iOS app (application),” “mobile health app (application),” and “mHealth app (application).” Results The initial search eliciting 204 citations was reduced to 7 relevant papers (4 original articles, 1 brief communication, and 2 study protocols). All publications were from the last five years, most were produced by research teams from the United States. All had adult samples, and interventions mostly followed a cognitive behavioral framework. Regarding mobile apps, five studies only used one to monitor weight and physical activity, one study to provide therapy to improve psychological wellness, and one study to monitor cognitions and emotions. No mobile app was found for the simultaneous management of overweight/obesity and depression/anxiety. Conclusions The prevalence and costs related to overweight/obesity and depression/anxiety are significant and likely to increase. Very often these conditions overlap; thus, it would be recommendable to treat their comorbidity simultaneously. Nevertheless, no mobile app has been designed for this purpose, which would help to reduce service provision costs and make treatment more easily accessible for patients.
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Tiitinen S, Ilomäki S, Laitinen J, Korkiakangas EE, Hannonen H, Ruusuvuori J. Developing theory- and evidence-based counseling for a health promotion intervention: A discussion paper. PATIENT EDUCATION AND COUNSELING 2020; 103:234-239. [PMID: 31447199 DOI: 10.1016/j.pec.2019.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 08/10/2019] [Accepted: 08/15/2019] [Indexed: 06/10/2023]
Abstract
Although the use of theories and evidence is often stressed in the development of health promotion interventions, this does not guarantee the success of an intervention. Thus, we need to reflect on intervention development processes that use different types of theories and evidence. In this paper, we provide a reflective discussion on how we identified evidence-based behavior change techniques and counseling themes for a health promotion intervention. In addition, we discuss the challenges that we encountered and what we learned during the process: a) a lack of previous research and meta-analyses, b) inconsistencies in evidence, c) integrating evidence and theories that have different starting points, and d) collaborating with researchers who represent different evidence and theories. During the process, we benefitted from having the clear goal of conducting evidence- and theory-based work. We solved the challenges by, for example, utilizing different types of evidence and being reflective about the reasons behind any inconsistencies in the evidence. In retrospect, we would have benefitted from closer collaboration between the teams that worked separately with different evidence. These kinds of reflective descriptions of development processes and the challenges encountered during them may help other researchers and professionals avoid encountering the same challenges.
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Affiliation(s)
- Sanni Tiitinen
- Tampere University, FI-33014 Tampere University, Tampere, Finland
| | - Sakari Ilomäki
- Tampere University, FI-33014 Tampere University, Tampere, Finland
| | - Jaana Laitinen
- Finnish Institute of Occupational Health, 00032 Finnish Institute of Occupational Health, P.O. Box 18, Oulu, Finland
| | | | - Heli Hannonen
- Finnish Institute of Occupational Health, 00032 Finnish Institute of Occupational Health, P.O. Box 18, Oulu, Finland
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Psychological inflexibility moderates the relationship between thin-ideal internalization and disordered eating. Eat Behav 2020; 36:101345. [PMID: 31760368 DOI: 10.1016/j.eatbeh.2019.101345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 11/21/2022]
Abstract
Internalizing ideals of thinness has been related to disordered eating. Thus, it is important to identify potential protective factors that may allow someone to internalize this belief without developing an eating disorder. In this study, we explored psychological flexibility and inflexibility as potential moderators of the relationship between thin-ideal internalization and disordered eating. College women (N = 201) completed the Multidimensional Psychological Flexibility Inventory, the thin-ideal internalization subscale of the Sociocultural Attitudes Towards Appearance Questionnaire, and the Eating Attitudes Test. Psychological inflexibility, but not psychological flexibility, was found to be a significant moderator of the relationship between thin-ideal internalization and disordered eating. Further analyses found that the specific subscales which moderated this relationship were Fusion, Lack of Present Moment Awareness, Lack of Values, and Inaction. Contrary to our hypothesis, disordered eating was positively related to Acceptance. The results suggest that being psychologically inflexible is particularly problematic in the context of thin-ideal internalization. Additionally, increasing acceptance may not be effective if the accepted thoughts are about the importance of thinness.
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Villanueva J, Meyer AH, Rinner MTB, Firsching VJ, Benoy C, Brogli S, Walter M, Bader K, Gloster AT. "Choose change": design and methods of an acceptance and commitment therapy effectiveness trial for transdiagnostic treatment-resistant patients. BMC Psychiatry 2019; 19:173. [PMID: 31182051 PMCID: PMC6558686 DOI: 10.1186/s12888-019-2109-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/10/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Acceptance and Commitment Therapy (ACT) has been successfully established in hundreds of efficacy trials. It is less understood, however, how ACT works in real-world settings. Furthermore, little is known about how contextual variables such as treatment setting (inpatient vs. outpatient), social network and environment of the patient impact outcome. METHODS This paper describes the methods of the Choose Change study that compares transdiagnostic inpatients (n = 85) and outpatients (n = 85) with varying degrees of treatment experience and treatment success (i.e., no previous treatment vs. previous remission vs. treatment-resistant). Patients received ACT during an intensive treatment phase lasting approximately twelve treatment sessions, and were accompanied up to twelve months following intensive treatment. Main outcomes include symptoms, functioning, and well-being. Multiple levels of data are investigated, including treatment context, weekly assessments, a behavioral approach test, multiple follow-up phases, and ambulatory assessment using Event Sampling Methodology, to examine patients' daily context. DISCUSSION We aim to investigate antecedents, consequences, and inherent processes that contribute to the maintenance or fluctuations of psychological disorders and the efficacy of ACT treatment. Furthermore, this study intends to increase understanding of how accurately participants can report on their own experiences, in order to expand our knowledge of how to probe for such information in the future. The results of Choose Change will provide basic clinical theory and clinical care with important and meaningful insights into the effectiveness of ACT, trans diagnostically, in in- and outpatients, and in a naturalistic setting. TRIAL REGISTRATION This study was retrospectively registered in the ISRCTN Registry (registration number ISRCTN11209732 ) on May 20th 2016.
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Affiliation(s)
- Jeanette Villanueva
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
| | - Andrea H. Meyer
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Marcia T. B. Rinner
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
| | - Victoria J. Firsching
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
| | - Charles Benoy
- Center for Psychosomatics and Psychotherapy, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Sandra Brogli
- Center for Psychosomatics and Psychotherapy, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Marc Walter
- Center for Psychosomatics and Psychotherapy, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Klaus Bader
- Center for Psychosomatics and Psychotherapy, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Andrew T. Gloster
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
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Lyzwinski LN, Caffery L, Bambling M, Edirippulige S. The Mindfulness App Trial for Weight, Weight-Related Behaviors, and Stress in University Students: Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e12210. [PMID: 30969174 PMCID: PMC6479283 DOI: 10.2196/12210] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/07/2018] [Accepted: 12/29/2018] [Indexed: 12/19/2022] Open
Abstract
Background University students are at risk of weight gain during their studies. Key factors related to weight gain in this population include unhealthy weight-related behaviors because of stress. Mindfulness holds promise for weight management. However, there has not been any previous trial that has explored the effectiveness of a student-tailored mindfulness app for stress, weight-related behaviors, and weight. There is limited evidence that current mindfulness apps use evidence-based mindfulness techniques. A novel app was developed that combined evidence-based, mindfulness-based stress reduction and mindful eating (ME) techniques that were tailored to university students, with student-relevant themes for targeting weight behaviors, weight, and stress. Objectives The aim of this study was to test the effectiveness, acceptability, and feasibility of a student-tailored mindfulness app for weight, weight-related behaviors, and stress. Testing this app in a rigorous randomized controlled trial (RCT) for these outcomes is a novelty and contribution to this emerging field. Methods A 2-arm RCT of an 11-week duration was undertaken at the University of Queensland. Students were either randomized to the mindfulness app (n=45) or to a behavioral self-monitoring electronic diary (e-diary; n=45) for diet and exercise. Analysis of covariance was used to compare differences in weight, stress, mindfulness, ME, physical activity, and eating behaviors between both groups. Results Neither the mindfulness app group nor the e-diary group lost weight and there were no differences between the groups at follow-up. The mindfulness app group had significantly lower stress levels (P=.02) (adherers only), lower emotional eating (P=.02), and uncontrolled eating (P=.02) as well as higher mindfulness (P≤.001) and ME levels overall (P≤.001). The e-diary group had higher metabolic equivalents of moderate activity levels (P≤.01). However, the effect sizes were small. Regular adherence to mindfulness exercises in the app was low in the group. The majority of students (94%) liked the app and found it to be acceptable. Compared with other exercises, the most helpful reported meditation was the short breathing exercise observing the breath (39.4% [13/33] preferred it). This was the first RCT that tested a mindfulness app for weight and weight-related behaviors in students. The modest level of user adherence likely contributes to the lack of effect on weight loss. However, there was a small, albeit promising, effect on weight-related eating behavior and stress. Conclusions A mindfulness app demonstrated effectiveness for stress, eating behaviors, mindfulness, and ME, but the effect sizes were small. Future studies should be conducted over longer periods of time and with greater participant compliance. Trial Registration Australian New Zealand Trial Registry ACTRN12616001349437; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371370 (Archived by WebCite at http://www.webcitation.org/761cc2K6ft)
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Affiliation(s)
| | - Liam Caffery
- University of Queensland, School of Medicine, Centre for Online Health, Woloongabba, Australia
| | - Matthew Bambling
- University of Queensland, School of Medicine, Centre for Online Health, Woloongabba, Australia
| | - Sisira Edirippulige
- University of Queensland, School of Medicine, Centre for Online Health, Woloongabba, Australia
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Lucivero F, Jongsma KR. A mobile revolution for healthcare? Setting the agenda for bioethics. JOURNAL OF MEDICAL ETHICS 2018; 44:685-689. [PMID: 29907579 PMCID: PMC6173811 DOI: 10.1136/medethics-2017-104741] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/17/2018] [Accepted: 05/30/2018] [Indexed: 05/20/2023]
Abstract
Mobile health (mHealth) is rapidly being implemented and changing our ways of doing, understanding and organising healthcare. mHealth includes wearable devices as well as apps that track fitness, offer wellness programmes or provide tools to manage chronic conditions. According to industry and policy makers, these systems offer efficient and cost-effective solutions for disease prevention and self-management. While this development raises many ethically relevant questions, so far mHealth has received only little attention in medical ethics. This paper provides an overview of bioethical issues raised by mHealth and aims to draw scholarly attention to the ethical significance of its promises and challenges. We show that the overly positive promises of mHealth need to be nuanced and their desirability critically assessed. Finally, we offer suggestions to bioethicists to engage with this emerging trend in healthcare to develop mHealth to its best potential in a morally sound way.
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Affiliation(s)
- Federica Lucivero
- Ethox Centre, Wellcome Centre for Ethics and Humanities, Big Data Institute, University of Oxford, Oxford, UK
| | - Karin R Jongsma
- Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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