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Harenberg S, Sforzo GA, Edman J. A Rubric to Assess the Design and Intervention Quality of Randomized Controlled Trials in Health and Wellness Coaching. Am J Lifestyle Med 2024; 18:82-94. [PMID: 39184269 PMCID: PMC11339769 DOI: 10.1177/15598276221117089] [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] [Indexed: 08/27/2024] Open
Abstract
Objective To collect health and wellness coaching (HWC) literature related to treatment of obesity and Type 2 Diabetes (T2D) for systematic assessment using a novel rubric. Data Source Pubmed, CINAHL, and PsychInfo. Study Inclusion and Exclusion Given 282 articles retrieved, only randomized and controlled trials meeting a HWC criteria-based definition were included; studies with intervention <4 months or <4 sessions were excluded. Data Extraction Rubric assessment required details of two theoretical frameworks (i.e., study design and HWC intervention design) be extracted from each included paper. Data Synthesis Data were derived from a 28-item rubric querying items such as sampling characteristics, statistical methods, coach characteristics, HWC strategy, and intervention fidelity. Results 29 articles were reviewed. Inter-rater rubric scoring yielded high intraclass correlation (r = .85). Rubric assessment of HWC literature resulted in moderate scores (56.7%), with study design scoring higher than intervention design; within intervention design, T2D studies scored higher than obesity. Conclusions A novel research design rubric is presented and successfully applied to assess HWC research related to treatment of obesity and T2D. Most studies reported beneficial clinical findings; however, rubric results revealed moderate scores for study and intervention design. Implications for future HWC research are discussed.
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Affiliation(s)
- Sebastian Harenberg
- Department of Human Kinetics, St Francis Xavier
University, Antigonish, NS, Canada (SH); Exercise & Sport Sciences, Ithaca College, Ithaca, NY, USA (GAS); and Edman Wellness Services, Media, PA, USA (JE)
| | - Gary A. Sforzo
- Department of Human Kinetics, St Francis Xavier
University, Antigonish, NS, Canada (SH); Exercise & Sport Sciences, Ithaca College, Ithaca, NY, USA (GAS); and Edman Wellness Services, Media, PA, USA (JE)
| | - Joel Edman
- Department of Human Kinetics, St Francis Xavier
University, Antigonish, NS, Canada (SH); Exercise & Sport Sciences, Ithaca College, Ithaca, NY, USA (GAS); and Edman Wellness Services, Media, PA, USA (JE)
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Purcell C, Dibben G, Hilton Boon M, Matthews L, Palmer VJ, Thomson M, Smillie S, Simpson SA, Taylor RS. Social network interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease. Cochrane Database Syst Rev 2023; 6:CD013820. [PMID: 37378598 PMCID: PMC10305790 DOI: 10.1002/14651858.cd013820.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Globally, cardiovascular diseases (CVD, that is, coronary heart (CHD) and circulatory diseases combined) contribute to 31% of all deaths, more than any other cause. In line with guidance in the UK and globally, cardiac rehabilitation programmes are widely offered to people with heart disease, and include psychosocial, educational, health behaviour change, and risk management components. Social support and social network interventions have potential to improve outcomes of these programmes, but whether and how these interventions work is poorly understood. OBJECTIVES: To assess the effectiveness of social network and social support interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease. The comparator was usual care with no element of social support (i.e. secondary prevention alone or with cardiac rehabilitation). SEARCH METHODS: We undertook a systematic search of the following databases on 9 August 2022: CENTRAL, MEDLINE, Embase, and the Web of Science. We also searched ClinicalTrials.gov and the WHO ICTRP. We reviewed the reference lists of relevant systematic reviews and included primary studies, and we contacted experts to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of social network or social support interventions for people with heart disease. We included studies regardless of their duration of follow-up, and included those reported as full text, published as abstract only, and unpublished data. DATA COLLECTION AND ANALYSIS Using Covidence, two review authors independently screened all identified titles. We retrieved full-text study reports and publications marked 'included', and two review authors independently screened these, and conducted data extraction. Two authors independently assessed risk of bias, and assessed the certainty of the evidence using GRADE. Primary outcomes were all-cause mortality, cardiovascular-related mortality, all-cause hospital admission, cardiovascular-related hospital admission, and health-related quality of life (HRQoL) measured at > 12 months follow-up. MAIN RESULTS: We included 54 RCTs (126 publications) reporting data for a total of 11,445 people with heart disease. The median follow-up was seven months and median sample size was 96 participants. Of included study participants, 6414 (56%) were male, and the mean age ranged from 48.6 to 76.3 years. Studies included heart failure (41%), mixed cardiac disease (31%), post-myocardial infarction (13%), post-revascularisation (7%), CHD (7%), and cardiac X syndrome (1%) patients. The median intervention duration was 12 weeks. We identified notable diversity in social network and social support interventions, across what was delivered, how, and by whom. We assessed risk of bias (RoB) in primary outcomes at > 12 months follow-up as either 'low' (2/15 studies), 'some concerns' (11/15), or 'high' (2/15). 'Some concerns' or 'high' RoB resulted from insufficient detail on blinding of outcome assessors, data missingness, and absence of pre-agreed statistical analysis plans. In particular, HRQoL outcomes were at high RoB. Using the GRADE method, we assessed the certainty of evidence as low or very low across outcomes. Social network or social support interventions had no clear effect on all-cause mortality (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.49 to 1.13, I2 = 40%) or cardiovascular-related mortality (RR 0.85, 95% CI 0.66 to 1.10, I2 = 0%) at > 12 months follow-up. The evidence suggests that social network or social support interventions for heart disease may result in little to no difference in all-cause hospital admission (RR 1.03, 95% CI 0.86 to 1.22, I2 = 0%), or cardiovascular-related hospital admission (RR 0.92, 95% CI 0.77 to 1.10, I2 = 16%), with a low level of certainty. The evidence was very uncertain regarding the impact of social network interventions on HRQoL at > 12 months follow-up (SF-36 physical component score: mean difference (MD) 31.53, 95% CI -28.65 to 91.71, I2 = 100%, 2 trials/comparisons, 166 participants; mental component score MD 30.62, 95% CI -33.88 to 95.13, I2 = 100%, 2 trials/comparisons, 166 participants). Regarding secondary outcomes, there may be a decrease in both systolic and diastolic blood pressure with social network or social support interventions. There was no evidence of impact found on psychological well-being, smoking, cholesterol, myocardial infarction, revascularisation, return to work/education, social isolation or connectedness, patient satisfaction, or adverse events. Results of meta-regression did not suggest that the intervention effect was related to risk of bias, intervention type, duration, setting, and delivery mode, population type, study location, participant age, or percentage of male participants. AUTHORS' CONCLUSIONS: We found no strong evidence for the effectiveness of such interventions, although modest effects were identified in relation to blood pressure. While the data presented in this review are indicative of potential for positive effects, the review also highlights the lack of sufficient evidence to conclusively support such interventions for people with heart disease. Further high-quality, well-reported RCTs are required to fully explore the potential of social support interventions in this context. Future reporting of social network and social support interventions for people with heart disease needs to be significantly clearer, and more effectively theorised, in order to ascertain causal pathways and effect on outcomes.
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Affiliation(s)
- Carrie Purcell
- Faculty of Wellbeing, Education and Language Studies, The Open University in Scotland, Edinburgh, UK
| | - Grace Dibben
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Michele Hilton Boon
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lynsay Matthews
- School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK
| | - Victoria J Palmer
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Meigan Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Susie Smillie
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Sharon A Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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Jebeile H, Libesman S, Melville H, Low‐wah T, Dammery G, Seidler AL, Jones RA, McMaster CM, Paxton SJ, Hill AJ, Ahern AL, Garnett SP, Braet C, Wilfley DE, Baur LA, Lister NB. Eating disorder risk during behavioral weight management in adults with overweight or obesity: A systematic review with meta-analysis. Obes Rev 2023; 24:e13561. [PMID: 36919475 PMCID: PMC10909435 DOI: 10.1111/obr.13561] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/12/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
This systematic review examined change in eating disorder risk during weight management interventions. Four databases and clinical trials registries were searched in March and May 2022, respectively, to identify behavioral weight management intervention trials in adults with overweight/obesity measuring eating disorder symptoms at pre- and post-intervention or follow-up. Random effects meta-analyses were conducted examining within group change in risk. Of 12,023 screened, 49 were eligible (n = 6337, mean age range 22.1 to 59.9 years, mean (SD) 81(20.4)% female). Interventions ranged from 4 weeks to 18 months, with follow-up of 10 weeks to 36 months post-intervention. There was a within group reduction in global eating disorder scores (20 intervention arms; Hedges' g = -0.27; 95% CI -0.36, -0.17; I2 67.1%) and binge eating (49 intervention arms; -0.66; 95% CI -0.76, -0.56; I2 82.7%) post-intervention, both maintained at follow-up. Of 14 studies reporting prevalence or episodes of binge eating, all reported a reduction. Four studies reported eating disorder symptoms, not present at baseline, in a subset of participants (0%-6.5%). Overall, behavioral weight management interventions do not increase eating disorder symptoms for most adults; indeed, a modest reduction is seen post-intervention and follow-up. A small subset of participants may experience disordered eating; therefore, monitoring for the emergence of symptoms is important.
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Affiliation(s)
- Hiba Jebeile
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Sol Libesman
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | - Hannah Melville
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Timothy Low‐wah
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Genevieve Dammery
- InsideOut Institute for Eating DisordersThe University of SydneySydneyNew South WalesAustralia
| | - Anna L. Seidler
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | | | - Caitlin M. McMaster
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Susan J. Paxton
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Andrew J. Hill
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Amy L. Ahern
- MRC Epidemiology UnitUniversity of CambridgeCambridgeCB2 0QQUK
| | - Sarah P. Garnett
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- Kids ResearchThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Caroline Braet
- Department of Developmental, Personality and Social PsychologyGhent UniversityHenri Dunantlaan 2Ghent9000Belgium
| | - Denise E. Wilfley
- School of Medicine, Washington University in St. LouisMissouriSt. LouisUSA
| | - Louise A. Baur
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Natalie B. Lister
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
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Sforzo GA, Kaye MP, Faber A, Moore M. Dosing of Health and Wellness Coaching for Obesity and Type 2 Diabetes: Research Synthesis to Derive Recommendations. Am J Lifestyle Med 2023; 17:374-385. [PMID: 37304739 PMCID: PMC10248368 DOI: 10.1177/15598276211073078] [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] [Indexed: 09/10/2023] Open
Abstract
Health and wellness coaching (HWC) is an effective intervention for lifestyle disease such as obesity and type 2 diabetes. The evolving HWC profession needs recommendations to guide clinical practice, particularly the appropriate dose of coaching. The purpose of this paper was to systematically review and synthesize HWC literature to derive HWC programming recommendations. Of 102 papers retrieved, 88 were retained with data extracted determining HWC session number, frequency, duration, program length, and total coaching load. Differential analysis yielded no statistical difference in programming variables for randomized control trials and other designs, nor for studies with significant findings v. those not finding statistical significance, allowing these data to be pooled. The HWC intervention for obesity was slightly more intense (15 sessions over 7-8 mo) than the diabetes programming (12 sessions over 9-10 mo). On average, HWC programming applied in the peer-reviewed literature was 12-15 sessions of 35-40 min duration over 7-9 months. These recommendations for HWC programming variables are put forth as initial practice guidelines and should be examined with comparative effectiveness study for optimization. HWC best practice guidelines for other patient groups (e.g., heart disease, cancer, and chronic pain) should also be studied once an adequate literature data base is available.
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Affiliation(s)
- Gary A Sforzo
- Department of Exercise Science and Athletic Training, Ithaca College, Ithaca, NY, USA
| | - Miranda P Kaye
- Survey Research Center, Penn State University, University Park, PA, USA
| | - Aubrey Faber
- Department of Psychology, St John's University, Queens, NY, USA
| | - Margaret Moore
- Wellcoaches Corporation, Wellesley, MA, USA
- Institute of Coaching, McLean Hospital, Belmont, MA, USA
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Birch JM, Mueller J, Sharp S, Logue J, Kelly MP, Griffin SJ, Ahern A. Are there inequalities in the attendance and effectiveness of behavioural weight management interventions for adults in the UK? Protocol for an individual participant data (IPD) meta-analysis. BMJ Open 2023; 13:e067607. [PMID: 36958788 PMCID: PMC10039995 DOI: 10.1136/bmjopen-2022-067607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION It is important to identify whether behavioural weight management interventions work well across different groups in the population so health inequalities in obesity are not widened. Previous systematic reviews of inequalities in the attendance and effectiveness of behavioural weight management interventions have been limited because few trials report relevant analyses and heterogeneity in the categorisation of inequality characteristics prevents meta-analysis. An individual participant data meta-analysis (IPD-MA) allows us to reanalyse all trials with available data in a uniform way. We aim to conduct an IPD meta-analysis of UK randomised controlled trials to examine whether there are inequalities in the attendance and effectiveness of behavioural weight interventions. METHODS AND ANALYSIS In a recently published systematic review, we identified 17 UK-based randomised controlled trials of primary care-relevant behavioural interventions, conducted in adults living with overweight or obesity and reporting weight outcomes at baseline and 1-year follow-up. The corresponding author of each trial will be invited to contribute data to the IPD-MA. The outcomes of interest are weight at 12-months and intervention attendance (number of sessions offered vs number of sessions attended). We will primarily consider whether there is an interaction between intervention group and characteristics where inequalities occur, such as by gender/sex, socioeconomic status or age. The IPD-MA will be conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses of IPD guidelines. ETHICS AND DISSEMINATION No further ethical approval was required as ethical approval for each individual study was obtained by the original trial investigators from appropriate ethics committees. The completed IPD-MA will be disseminated at conferences, in a peer-reviewed journal and contribute to the lead author's PhD thesis. Investigators of each individual study included in the final IPD-MA will be invited to collaborate on any publications that arise from the project.
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Affiliation(s)
- Jack M Birch
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stephen Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jennifer Logue
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Amy Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Vogelsang A, Hinrichs C, Fleig L, Pfeffer I. Study protocol for the description and evaluation of the "Habit Coach" - a longitudinal multicenter mHealth intervention for healthy habit formation in health care professionals. BMC Public Health 2022; 22:1672. [PMID: 36058904 PMCID: PMC9440859 DOI: 10.1186/s12889-022-13986-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The adoption of a healthy lifestyle plays a crucial role for the health and well-being of health care professionals. Previous e- and mHealth interventions relied on deliberative psychological processes (e.g., intention, planning) to target lifestyle changes, while revealing mixed efficacy. The additional potential of non-deliberative, automatic processes (i.e., habits) for behavior change has been understudied in interventions so far. The Habit Coach mHealth intervention combines deliberative and non-deliberative processes to support health care professionals in forming healthy physical activity, nutrition and mindfulness habits in daily life. The aim of this paper is to outline the study protocol including a detailed description of the mHealth intervention, evaluation plan, and study design. The purpose of this trial is to understand healthy habit formation in health care professionals over time. METHODS A one-arm, multicenter mHealth intervention study will be conducted. Behavioral and psychosocial predictors will be collected via within-app questionnaires across a 100-day period at baseline, post, as well as at weekly assessments. To understand habit formation across time, linear mixed models will be used. DISCUSSION This trial aims to unravel the role of motivational and volitional determinants for healthy habit formation across multiple health behaviors in health care professionals embedded in a mHealth intervention. TRIAL REGISTRATION This trial is registered in the German Clinical Trials Register, DRKS-ID DRKS00027156. Date of registration 17 November 2021.
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Affiliation(s)
- Anna Vogelsang
- Faculty of Humanities, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany. .,Faculty of Sport Science - Department of eHealth and Sports Analytics, Ruhr-University Bochum, Gesundheitscampus - Nord 10, 44801, Bochum, Germany.
| | - Clara Hinrichs
- Faculty of Humanities, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany
| | - Lena Fleig
- Faculty of Natural Sciences- Department of Psychology, Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Ines Pfeffer
- Faculty of Humanities, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany
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Michalopoulou M, Ferrey AE, Harmer G, Goddard L, Kebbe M, Theodoulou A, Jebb SA, Aveyard P. Effectiveness of Motivational Interviewing in Managing Overweight and Obesity : A Systematic Review and Meta-analysis. Ann Intern Med 2022; 175:838-850. [PMID: 35344379 DOI: 10.7326/m21-3128] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Motivational interviewing (MI) is potentially useful in management of overweight and obesity, but staff training and increased delivery time are barriers, and its effectiveness independent of other behavioral components is unclear. PURPOSE To assess the independent contribution of MI as part of a behavioral weight management program (BWMP) in controlling weight and improving psychological well-being. DATA SOURCES 6 electronic databases and 2 trial registries, searched from database inception through 24 September 2021. STUDY SELECTION Randomized controlled trials in adults or adolescents aimed at weight loss or maintenance and comparing programs incorporating MI versus interventions without MI. DATA EXTRACTION Two reviewers independently screened studies, extracted data, and assessed risk of bias. Outcomes included weight, anxiety, depression, quality of life, and other aspects of psychological well-being. Pooled mean differences or standardized mean differences were obtained using random- and fixed-effects meta-analyses. DATA SYNTHESIS Forty-six studies involving 11 077 participants, predominantly with obesity, were included. At 6 months, BWMPs using MI were more effective than no/minimal intervention (-0.88 [95% CI, -1.27 to -0.48] kg; I 2 = 0%) but were not statistically significantly more effective than lower-intensity (-0.88 [CI, -2.39 to 0.62] kg; I 2 = 55.8%) or similar-intensity (-1.36 [CI, -2.80 to 0.07] kg; I 2 = 18.8%) BWMPs. At 1 year, data were too sparse to pool comparisons with no/minimal intervention, but MI did not produce statistically significantly greater weight change compared with lower-intensity (-1.16 [CI, -2.49 to 0.17] kg; I 2 = 88.7%) or similar-intensity (-0.18 [CI, -2.40 to 2.04] kg; I 2 = 72.7%) BWMPs without MI. Studies with 18-month follow-up were also sparse; MI did not produce statistically significant benefit in any of the comparator categories. There was no evidence of subgroup differences based on study, participant, or intervention characteristics. Too few studies assessed effects on psychological well-being to pool, but data did not suggest that MI was independently effective. LIMITATIONS High statistical heterogeneity among studies, largely unexplained by sensitivity and subgroup analyses; stratification by comparator intensity and follow-up duration resulted in pooling of few studies. CONCLUSION There is no evidence that MI increases effectiveness of BWMPs in controlling weight. Given the intensive training required for its delivery, MI may not be a worthwhile addition to BWMPs. PRIMARY FUNDING SOURCE National Institute for Health Research Biomedical Research Centre. (PROSPERO: CRD42020177259).
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Affiliation(s)
- Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Georgina Harmer
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Lucy Goddard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Maryam Kebbe
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
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Birch JM, Jones RA, Mueller J, McDonald MD, Richards R, Kelly MP, Griffin SJ, Ahern AL. A systematic review of inequalities in the uptake of, adherence to, and effectiveness of behavioral weight management interventions in adults. Obes Rev 2022; 23:e13438. [PMID: 35243743 PMCID: PMC9285567 DOI: 10.1111/obr.13438] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/12/2022] [Indexed: 12/26/2022]
Abstract
The extent to which behavioral weight management interventions affect health inequalities is uncertain, as is whether trials of these interventions directly consider inequalities. We conducted a systematic review, synthesizing evidence on how different aspects of inequality impact uptake, adherence, and effectiveness in trials of behavioral weight management interventions. We included (cluster-) randomized controlled trials of primary care-applicable behavioral weight management interventions in adults with overweight or obesity published prior to March 2020. Data about trial uptake, intervention adherence, attrition, and weight change by PROGRESS-Plus criteria (place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, plus other discriminating factors) were extracted. Data were synthesized narratively and summarized in harvest plots. We identified 91 behavioral weight loss interventions and 12 behavioral weight loss maintenance interventions. Fifty-six of the 103 trials considered inequalities in relation to at least one of intervention or trial uptake (n = 15), intervention adherence (n = 15), trial attrition (n = 32), or weight outcome (n = 34). Most trials found no inequalities gradient. If a gradient was observed for trial uptake, intervention adherence, and trial attrition, those considered "more advantaged" did best. Alternative methods of data synthesis that enable data to be pooled and increase statistical power may enhance understanding of inequalities in behavioral weight management interventions.
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Affiliation(s)
- Jack M. Birch
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | | | - Julia Mueller
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Matthew D. McDonald
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
| | | | - Michael P. Kelly
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Simon J. Griffin
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Amy L. Ahern
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
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Makin H, Chisholm A, Fallon V, Goodwin L. Use of motivational interviewing in behavioural interventions among adults with obesity: A systematic review and meta-analysis. Clin Obes 2021; 11:e12457. [PMID: 33955152 DOI: 10.1111/cob.12457] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 01/29/2023]
Abstract
This review aimed to identify whether motivational interviewing (MI) (a counselling approach for supporting behaviour change [BC]) helps to reduce bodyweight and BMI in an adult obesity context. This included evaluating effectiveness of MI interventions within this population and reporting the methodology used, including theoretical underpinnings and identification of BC and MI techniques. Eight databases were searched using controlled vocabulary. Eligible studies included adults with obesity (BMI ≥30 kg/m2 ), author-reported interventions using MI aiming to reduce body weight or BMI, and comparator groups not receiving an MI intervention. Data extraction and quality appraisal tools were used to identify study characteristics, intervention content was coded for techniques, and random-effects meta-analysis were conducted to investigate effects. Meta-analysis of 12 studies indicated no overall pooled effect on bodyweight and BMI outcomes between intervention and control groups (SMD = -0.01 [95%CI -0.13 to 0.12, P = .93]). Findings were limited by multiple sources accounting for risk of bias, and poor reporting of intervention fidelity and content. Intervention and control content descriptions indicated similar techniques, with social support, goal setting (behaviour) and self-monitoring of behaviour occurring most frequently across both. Findings do not contribute additional evidence for MI use in this context, however methodological limitations were identified which must be resolved to better identify the intervention effects on obesity-related outcomes.
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Affiliation(s)
- Harriet Makin
- Department of Psychology, Institute of Population Health, University of Liverpool, Merseyside, UK
| | - Anna Chisholm
- Department of Psychology, Institute of Population Health, University of Liverpool, Merseyside, UK
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Merseyside, UK
| | - Laura Goodwin
- Department of Psychology, Institute of Population Health, University of Liverpool, Merseyside, UK
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Carraça E, Encantado J, Battista F, Beaulieu K, Blundell J, Busetto L, van Baak M, Dicker D, Ermolao A, Farpour-Lambert N, Pramono A, Woodward E, Bellicha A, Oppert JM. Effective behavior change techniques to promote physical activity in adults with overweight or obesity: A systematic review and meta-analysis. Obes Rev 2021; 22 Suppl 4:e13258. [PMID: 33949778 PMCID: PMC8365685 DOI: 10.1111/obr.13258] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 12/18/2022]
Abstract
Multicomponent behavior change interventions are typically used in weight management, but results are largely heterogeneous and modest. Determining which techniques (behavior change technique [BCTs]) are more effective in changing behavior is thus required. This study aimed to identify the most effective BCTs for increasing physical activity (PA) in digital and face-to-face behavior change interventions in adults with overweight/obesity. Four databases were searched for eligible studies until October 2019. BCTs were coded using BCTTv1 and MBCT taxonomies. Sixty-two RCTs were included. Meta-regressions were performed to explore BCTs' moderating role. Five BCTs showed significant moderator effects on PA in digital interventions: goal setting behavior, goal setting outcome, graded tasks, social incentive, and self-monitoring of behavior (adjusted R2 's = 0.15-0.51). One BCT showed significant moderator effects on PA in face-to-face interventions, behavioral practice and rehearsal (adjusted R2 = 0.22). Multivariate and sensitivity analysis generally led to similar findings. Effective BCTs for increasing PA in adults with overweight/obesity in digital and face-to-face interventions seem to differ. Evidence suggests that using goal setting, social incentive, and graded tasks might help improve PA in digital interventions while avoiding inconsistent self-monitoring of behavior. In face-to-face interventions, prompting behavioral practice and rehearsal might lead to better PA outcomes. Still, further studies are needed. Implications of the current findings are discussed.
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Affiliation(s)
- Eliana Carraça
- CIDEFES, Universidade Lusófona de Humanidades e Tecnologias, Faculdade de Educação Física e Desporto, Lisbon, Portugal
| | - Jorge Encantado
- Applied Psychology Research Center Capabilities & Inclusion, ISPA - University Institute, Lisbon, Portugal
| | - Francesca Battista
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Kristine Beaulieu
- Appetite Control and Energy Balance Group, School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - John Blundell
- Appetite Control and Energy Balance Group, School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Luca Busetto
- Obesity Management Task Force, European Association for the Study of Obesity, Teddington, UK.,Department of Medicine, University of Padova, Padova, Italy
| | - Marleen van Baak
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Human Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Dror Dicker
- Obesity Management Task Force, European Association for the Study of Obesity, Teddington, UK.,Department of Internal Medicine D, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Andrea Ermolao
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Nathalie Farpour-Lambert
- Obesity Management Task Force, European Association for the Study of Obesity, Teddington, UK.,Obesity Prevention and Care Program Contrepoids, Service of Endocrinology, Diabetology, Nutrition and Therapeutic Patient Education, Department of Internal Medicine, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Adriyan Pramono
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Human Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Euan Woodward
- Obesity Management Task Force, European Association for the Study of Obesity, Teddington, UK
| | - Alice Bellicha
- INSERM, Nutrition and Obesities: Systemic Approaches, NutriOmics, Sorbonne University, Paris, France.,UFR SESS-STAPS, University Paris-Est Créteil, Créteil, France
| | - Jean-Michel Oppert
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Department of Nutrition, Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France
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11
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Carlén K, Kylberg E. An intervention of sustainable weight change: Influence of self-help group and expectations. Health Expect 2021; 24:1498-1503. [PMID: 34089622 PMCID: PMC8369104 DOI: 10.1111/hex.13290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 12/30/2022] Open
Abstract
Background Obesity is one of the most challenging public health problems in Western societies. Group activities are a way to empower individuals to make sustainable lifestyle changes. Self‐help groups enable individuals to share expectations and experiences on an equal basis. Objective The aim was to find a model for sustainable weight reduction for people with obesity and to evaluate the importance of expectations before entering the weight reduction programme. Methods Persons with a BMI >30 and aged over 30 years were recruited. Weekly seminars for 6 months with discussions concerning physical activity, eating habits and how to change one's lifestyle occurred. After the seminars, a self‐help group was initiated. The participants were encouraged to express their expectations before each step in the study. Results Our findings showed that those who had joined a self‐help group had reduced their weight significantly (−6.0 kg) compared with those who had not (−1.4 kg). Further, those who expressed a more mature expectation of the coming change in behaviour towards a healthy lifestyle showed slightly larger weight reduction (−6.1 kg) than those who expressed low expectations (−3.7 kg). Patient or public contribution Participants expressed their thoughts and views, which were considered and included in the programme. Conclusions Our findings indicate that the self‐help group can be an essential part of a weight reduction programme. The self‐help group is a novel strategy to strengthen sustainability in reducing weight. The study also highlights the importance of identifying behaviour change expectations before participating in a programme.
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Affiliation(s)
- Kristina Carlén
- School of Health Sciences, University of Skövde, Skövde, Sweden
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12
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Poudel N, Kavookjian J, Scalese MJ. Motivational Interviewing as a Strategy to Impact Outcomes in Heart Failure Patients: A Systematic Review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:43-55. [PMID: 31502239 DOI: 10.1007/s40271-019-00387-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Heart failure (HF) hospitalization is an expensive healthcare utilization event. Motivational interviewing (MI) has been studied for effects on HF self-management behaviors. OBJECTIVE The objective of this systematic review was to conduct an exploration and report of evidence and gaps in the literature regarding the impact of MI on HF outcomes. DATA SOURCES A modified Cochrane systematic review was conducted via a literature search in the MEDLINE, CINAHL, Cochrane Collaborative Systematic Reviews, PsycINFO, Health Source: Nursing/Academic Edition, and Google Scholar databases. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Randomized controlled trials (RCTs) or controlled experimental studies published in English from January 1990 to February 2019 that included adults (18 years and older) diagnosed with HF New York Heart Association (NYHA) class I, II, II, or IV were eligible for inclusion. Interventions evaluated were an MI-based face-to-face communication or telephone-based conversation provided by any healthcare provider type. STUDY APPRAISAL AND SYNTHESIS METHODS The Cochrane method for assessing risk of bias was used to analyze the methodological quality of retained studies. RESULTS Of 167 initial articles, nine were retained, describing eight unique studies (758 total patients, range 30-241; age range 58-79 years; attrition range 13-36%). The impact of MI was examined for general self-care behaviors (SCBs) (physical activity specifically), quality of life (QoL), and/or hospital readmission prevention. Eight of nine articles reported a positive impact of MI over advice-giving, seven being statistically significant. MI interventions used an initial face-to-face encounter with three to five follow-up telephone encounters. LIMITATIONS This systematic review had the following limitations: most retained studies included intervention activities conducted in hospital/clinic settings, which limits generalizability of the intervention in other care settings; intervention fidelity, blinding, selection, interventionist training, and random assignment were not clear in all studies; retained studies did not include potential covariates such as health literacy, patient age, and perception of disease/health risks; and some retained studies relied on patient self-report of outcomes, which may introduce recall or social desirability bias. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS MI demonstrated a positive effect on the SCB hospital readmission prevention factor and on QoL. MI delivered with greater frequency and over a longer duration may improve the immediate risk of hospital readmission as well as long-term outcomes through better medication adherence and SCBs. However, heterogeneity in the methods, design, intervention type, and structure challenged comparisons across studies and further research is warranted.
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Affiliation(s)
- Nabin Poudel
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL, 36849, USA
| | - Jan Kavookjian
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL, 36849, USA.
| | - Michael J Scalese
- Department of Pharmaceutical Services, Prisma Health Richland Hospital, 5 Medical Park Drive, Columbia, SC, 29203, USA
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13
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Purcell C, Smillie S, Boon MH, Simpson SA, Taylor RS. Effectiveness of social network interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease. Cochrane Database Syst Rev 2021; 2021:CD013820. [PMID: 36743076 PMCID: PMC7611922 DOI: 10.1002/14651858.cd013820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness of social network and social support interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease. As a secondary output of this review, and to assist in conceptualising future research focused on social network and social support interventions, we aim to develop a logic model theorising the relationship between social networks or social support and heart disease outcomes. We will draw on existing models of social support for health (e.g. Berkman 2000), as well as established approaches to theorising and implementing behaviour change (e.g. Michie 2011).
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Affiliation(s)
- Carrie Purcell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Susie Smillie
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Michele Hilton Boon
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Sharon A Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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14
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Centis E, Petroni ML, Ghirelli V, Cioni M, Navacchia P, Guberti E, Marchesini G. Motivational Interviewing Adapted to Group Setting for the Treatment of Relapse in the Behavioral Therapy of Obesity. A Clinical Audit. Nutrients 2020; 12:nu12123881. [PMID: 33353057 PMCID: PMC7765885 DOI: 10.3390/nu12123881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/25/2020] [Accepted: 12/13/2020] [Indexed: 11/16/2022] Open
Abstract
Motivational interviewing (MI) is devised to change unhealthy behaviors by increasing motivation. We adapted MI to a group format for the treatment of relapse during the behavioral treatment of obesity and performed a clinical audit to evaluate its effectiveness in stopping weight regain. The program was structured in seven weekly sessions, plus a 6-month follow-up. Patients (n = 86) completed a questionnaire on motivation to change in both healthy diet and physical activity, and a self-reported measurement of calorie intake and physical activity at baseline, at program end and at 6-month follow-up. The attendance to the program was high, with only 13 patients (15%) not completing the program and 24% not attending the 6-month follow-up. By the end of follow up, the prevalence of patients in either precontemplation or contemplation was reduced from over 60% at enrollment to approximately 20%, whereas the sum of patients in action or maintenance stages was increased from 9.5% in healthy diet and 14% in physical activity to 39.7% and 41.3%, respectively. These changes translated into significant behavioral changes (mean calorie intake, −13%; total physical activity, +125%; sedentary time, −8%) and finally into reduced body weight ( −3%). We conclude that MI programs adapted for groups may be used to stop relapse in individuals following a behavioral intervention for obesity.
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Affiliation(s)
- Elena Centis
- Department of Medical and Surgical Sciences, IRCCS Policlinico Sant’Orsola-Malpighi, Alma Mater University of Bologna, Via Massarenti, 9, I-40138 Bologna, Italy; (E.C.); (M.L.P.)
- Local Health Unit, Department of Public Health, Food and Nutrition Service, Via Altura 3, I-40139 Bologna, Italy; (P.N.); (E.G.)
| | - Maria L. Petroni
- Department of Medical and Surgical Sciences, IRCCS Policlinico Sant’Orsola-Malpighi, Alma Mater University of Bologna, Via Massarenti, 9, I-40138 Bologna, Italy; (E.C.); (M.L.P.)
| | - Veronica Ghirelli
- Alma Mater University, Via Massarenti, 9, I-40138 Bologna, Italy; (V.G.); (M.C.)
| | - Mattia Cioni
- Alma Mater University, Via Massarenti, 9, I-40138 Bologna, Italy; (V.G.); (M.C.)
| | - Paola Navacchia
- Local Health Unit, Department of Public Health, Food and Nutrition Service, Via Altura 3, I-40139 Bologna, Italy; (P.N.); (E.G.)
| | - Emilia Guberti
- Local Health Unit, Department of Public Health, Food and Nutrition Service, Via Altura 3, I-40139 Bologna, Italy; (P.N.); (E.G.)
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences, IRCCS Policlinico Sant’Orsola-Malpighi, Alma Mater University of Bologna, Via Massarenti, 9, I-40138 Bologna, Italy; (E.C.); (M.L.P.)
- Correspondence: ; Tel.: +39-051-2144889; Fax: +39-051-6364502
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15
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Nordmo M, Danielsen YS, Nordmo M. The challenge of keeping it off, a descriptive systematic review of high-quality, follow-up studies of obesity treatments. Obes Rev 2020; 21:e12949. [PMID: 31675146 DOI: 10.1111/obr.12949] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/02/2019] [Accepted: 09/02/2019] [Indexed: 01/10/2023]
Abstract
The aim of this systematic review is to answer the question: Is substantial, stable, and long-term weight loss a viable goal for adults with obesity? To answer this question, we conducted a broad systematic search of non-surgical and non-pharmacological obesity treatment studies with the following strict criteria: (a) minimum 3-year follow-up, (b) 5% body mass lost, (c) no continued interventions in the follow-up-period, (d) prospective design, and (e) less than 30% attrition from the start of the follow-up period. While the search revealed a very large number of published articles, only eight studies met the inclusion criteria. Several of the nonincluded studies report a majority of participants achieving satisfactory weight loss and little regain, especially among studies with continued interventions during the follow-up period. In contrast, the eight high-quality studies included in this study demonstrate a trend of weight regain towards pretreatment baseline. This review concludes that the majority of high-quality follow-up treatment studies of individuals with obesity are not successful in maintaining weight loss over time. The results suggest that excess weight can be lost but is likely regained over time, for the majority of participants.
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Affiliation(s)
- Morten Nordmo
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | | | - Magnus Nordmo
- Department of Psychology, University of Oslo, Oslo, Norway
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16
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Daley A, Jolly K, Madigan C, Griffin R, Roalfe A, Lewis A, Nickless A, Aveyard P. A brief behavioural intervention to promote regular self-weighing to prevent weight regain after weight loss: a RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAlthough behavioural weight loss treatments can be effective, long-term maintenance of this weight loss remains a critical challenge because the vast majority of people will regain their lost weight over time. The period after initial weight loss is the time when people are at the highest risk of weight regain.ObjectiveThe primary aim of this study was to evaluate the effectiveness and cost-effectiveness of a brief behavioural intervention delivered by non-specialist call centre staff to promote regular self-weighing to prevent weight regain after intentional weight loss.DesignRandomised controlled trial.SettingWest Midlands, UK.ParticipantsAdults were recruited if they had attended a local authority-funded weight management programme and had lost ≥ 5% of their starting weight by the end of their weight loss programme.InterventionsThe intervention group received three brief support telephone calls, delivered by non-specialist call centre staff (from a third-sector community organisation), that encouraged setting a weight maintenance target of ≤ 1 kg of weight gain from current weight, which was to be assessed by daily self-weighing and recording weight on a record card, together with regular text messages. Participants were asked to return to their weight loss plan if they gained > 1 kg above their target weight. The usual-care group received a standard weight maintenance leaflet, the infographic EatWell Plate and a list of useful websites pertaining to weight management.Main outcome measuresThe primary outcome was the difference between the groups in mean weight change (kg) from baseline to 12 months. The secondary outcomes included the proportion of participants in each group who had regained < 1 kg in weight at the 3- and 12-month follow-up points.ResultsA total of 813 potential participants were screened, 583 of whom were eligible and randomised (usual care,n = 292; intervention,n = 291). A total of 94% and 89% of participants completed follow-up at 3 and 12 months, respectively. At 12 months, the mean unadjusted weight change was +0.39 kg for the intervention group and –0.17 kg for the usual-care group, an adjusted difference of 0.53 kg [95% confidence interval (CI) –0.64 to 1.71 kg]. At 12 months, 134 (45.9%) and 130 (44.7%) participants regained ≤ 1 kg of their baseline weight in the usual-care and intervention groups, respectively (odds ratio 0.96, 95% CI 0.69 to 1.33). As the intervention was ineffective, we did not pursue a cost-effectiveness analysis.ConclusionsBrief behavioural telephone support delivered by non-specialist workers to promote target-setting and daily self-weighing and recording of weight does not prevent weight regain after intentional weight loss. Specifically, as target-setting and daily self-weighing did not increase conscious cognitive restraint, people may need more intensive interventions to promote the use of behavioural techniques that help people maintain lost weight.Trial registrationCurrent Controlled Trials ISRCTN52341938.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Amanda Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Claire Madigan
- Primary Care Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Ryan Griffin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrea Roalfe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amanda Lewis
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Alecia Nickless
- Primary Care Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Palmeira CS, Mussi FC, Santos CASDT, Lima ML, Ladeia AMT, Silva LCDJ. Effect of remote nursing monitoring on overweight in women: clinical trial. Rev Lat Am Enfermagem 2019; 27:e3129. [PMID: 30916230 PMCID: PMC6432992 DOI: 10.1590/1518-8345.2651.3129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/13/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE to evaluate the effect of remote nursing monitoring on the improvement of anthropometric measurements of overweight women. METHOD controlled, randomized clinical trial, carried out in a reference outpatient clinic for treatment of obesity. The baseline sample was composed of 101 women randomly assigned to two groups, 51 in the intervention group (IG) and 50 in the control group (CG). The IG received remote monitoring through telephone calls and conventional monitoring, and the CG received conventional monitoring. Women were assessed at the baseline and after three months of intervention. A paired t-test and analysis of covariance were used to evaluate intragroup differences in anthropometric measurements, and the statistical significance of 5% was adopted. Eighty one women completed the study. RESULTS in the intergroup comparison after the intervention, a reduction of 1.66 kg in the mean weight (p = 0.017) and of 0.66 kg/m2 in the mean BMI (p = 0.015) was found in the intervention group. There was a borderline statistically significant (p = 0.055) reduction of 2.5 cm in WC with in the intervention group. CONCLUSION the remote monitoring was beneficial in reducing anthropometric measurements. RBR-3hzdgv.
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Affiliation(s)
- Catia Suely Palmeira
- Universidade Federal da Bahia, Serviço Médico Universitário Rubens Brasil, Salvador, BA, Brazil
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Moore GF, Evans RE, Hawkins J, Littlecott H, Melendez-Torres G, Bonell C, Murphy S. From complex social interventions to interventions in complex social systems: Future directions and unresolved questions for intervention development and evaluation. EVALUATION (LONDON, ENGLAND : 1995) 2019; 25:23-45. [PMID: 30705608 PMCID: PMC6330692 DOI: 10.1177/1356389018803219] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Complex systems approaches to social intervention research are increasingly advocated. However, there have been few attempts to consider how models of intervention science, such as the UK's Medical Research Council complex interventions framework, might be reframed through a complex systems lens. This article identifies some key areas in which this framework might be reconceptualized, and a number of priority areas where further development is needed if alignment with a systems perspective is to be achieved. We argue that a complex systems perspective broadens the parameters of 'relevant' evidence and theory for intervention development, before discussing challenges in defining feasibility in dynamic terms. We argue that whole systems evaluations may be neither attainable, nor necessary; acknowledgment of complexity does not mean that evaluations must be complex, or investigate all facets of complexity. However, a systems lens may add value to evaluation design through guiding identification of key uncertainties, and informing decisions such as timings of follow-up assessments.
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Affiliation(s)
| | | | | | | | | | - Chris Bonell
- London School of Hygiene & Tropical Medicine, UK
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Mazzotti A, Caletti MT, Brodosi L, Di Domizio S, Forchielli ML, Petta S, Bugianesi E, Bianchi G, Marchesini G. An internet-based approach for lifestyle changes in patients with NAFLD: Two-year effects on weight loss and surrogate markers. J Hepatol 2018; 69:1155-1163. [PMID: 30290973 DOI: 10.1016/j.jhep.2018.07.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 07/08/2018] [Accepted: 07/16/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Interventions aimed at lifestyle changes are pivotal for the treatment of non-alcoholic fatty liver disease (NAFLD), and web-based programs might help remove barriers in both patients and therapists. METHODS In the period 2010-15, 716 consecutive NAFLD cases (mean age, 52; type 2 diabetes, 33%) were treated in our Department with structured programs. The usual protocol included motivational interviewing and a group-based intervention (GBI), chaired by physicians, dietitians and psychologists (five weekly meetings, n = 438). Individuals who could not attend GBI entered a web-based intervention (WBI, n = 278) derived from GBI, with interactive games, learning tests, motivational tests, and mail contacts with the center. The primary outcome was weight loss ≥10%; secondary outcomes were alanine aminotransferase within normal limits, changes in lifestyle, weight, alanine aminotransferase, and surrogate markers of steatosis and fibrosis. RESULTS GBI and WBI cohorts had similar body mass index (mean, 33 kg/m2), with more males (67% vs. 45%), younger age, higher education, and more physical activity in the WBI group. The two-year attrition rate was higher in the WBI group. Healthy lifestyle changes were observed in both groups and body mass index decreased by almost two points;the 10% weight target was reached in 20% of WBI cases vs. 15% in GBI (not significant). In logistic regression analysis, after adjustment for confounders and attrition rates, WBI was not associated with a reduction of patients reaching short- and long-term 10% weight targets. Liver enzymes decreased in both groups, and normalized more frequently in WBI. Fatty liver index was reduced, whereas fibrosis remained stable (NAFLD fibrosis score) or similarly decreased (Fib-4). CONCLUSION WBI is not less effective than common lifestyle programs, as measured by significant clinical outcomes associated with improved histological outcomes in NAFLD. eHealth programs may effectively contribute to NAFLD control. LAY SUMMARY In patients with non-alcoholic fatty liver disease, participation in structured lifestyle programs may be jeopardized by job and time constraints. A web-based intervention may be better suited for young, busy patients, and for those living far from liver units. The study shows that, following a structured motivational approach, a web-based, interactive intervention coupled with six-month face-to-face meetings is not inferior to a standard group-based intervention with respect to weight loss, adherence to healthy diet and habitual physical activity, normalization of liver enzymes, and stable surrogate markers of fibrosis.
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Affiliation(s)
- Arianna Mazzotti
- Department of Medical and Surgical Sciences, "Alma Mater" University, Bologna, Italy
| | | | - Lucia Brodosi
- Department of Medical and Surgical Sciences, "Alma Mater" University, Bologna, Italy
| | - Silvia Di Domizio
- Department of Medical and Surgical Sciences, "Alma Mater" University, Bologna, Italy
| | | | - Salvatore Petta
- Section of Gastroenterology and Hepatology, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | | | - Giampaolo Bianchi
- Department of Medical and Surgical Sciences, "Alma Mater" University, Bologna, Italy
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences, "Alma Mater" University, Bologna, Italy.
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LeBlanc ES, Patnode CD, Webber EM, Redmond N, Rushkin M, O'Connor EA. Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2018; 320:1172-1191. [PMID: 30326501 DOI: 10.1001/jama.2018.7777] [Citation(s) in RCA: 274] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Overweight and obesity have been associated with adverse health effects. OBJECTIVE To systematically review evidence on benefits and harms of behavioral and pharmacotherapy weight loss and weight loss maintenance interventions in adults to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed Publisher-Supplied Records, PsycINFO, and the Cochrane Central Register of Controlled Trials for studies published through June 6, 2017; ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials through August 2017; and ongoing surveillance in targeted publications through March 23, 2018. Studies from previous reviews were reevaluated for inclusion. STUDY SELECTION Randomized clinical trials (RCTs) focusing on weight loss or weight loss maintenance in adults. DATA EXTRACTION AND SYNTHESIS Data were abstracted by one reviewer and confirmed by another. Random-effects meta-analyses were conducted for weight loss outcomes in behavior-based interventions. MAIN OUTCOMES AND MEASURES Health outcomes, weight loss or weight loss maintenance, reduction in obesity-related conditions, and adverse events. RESULTS A total of 122 RCTs (N = 62 533) and 2 observational studies (N = 209 993) were identified. Compared with controls, participants in behavior-based interventions had greater mean weight loss at 12 to 18 months (-2.39 kg [95% CI, -2.86 to -1.93]; 67 studies [n = 22065]) and less weight regain (-1.59 kg [95% CI, -2.38 to -0.79]; 8 studies [n = 1408]). Studies of medication-based weight loss and maintenance interventions also reported greater weight loss or less weight regain in intervention compared with placebo groups at 12 to 18 months (range, -0.6 to -5.8 kg; no meta-analysis). Participants with prediabetes in weight loss interventions had a lower risk of developing diabetes compared with controls (relative risk, 0.67 [95% CI, 0.51 to 0.89]). There was no evidence of other benefits, but most health outcomes such as mortality, cardiovascular disease, and cancer were infrequently reported. Small improvements in quality of life in some medication trials were noted but were of unclear clinical significance. There was no evidence of harm such as cardiovascular disease from behavior-based interventions; higher rates of adverse events were associated with higher dropout rates in medication groups than in placebo groups. CONCLUSIONS AND RELEVANCE Behavior-based weight loss interventions with or without weight loss medications were associated with more weight loss and a lower risk of developing diabetes than control conditions. Weight loss medications, but not behavior-based interventions, were associated with higher rates of harms. Long-term weight and health outcomes data, as well as data on important subgroups, were limited.
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Affiliation(s)
- Erin S LeBlanc
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Carrie D Patnode
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth M Webber
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan Rushkin
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth A O'Connor
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Hudgel DW, Patel SR, Ahasic AM, Bartlett SJ, Bessesen DH, Coaker MA, Fiander PM, Grunstein RR, Gurubhagavatula I, Kapur VK, Lettieri CJ, Naughton MT, Owens RL, Pepin JLD, Tuomilehto H, Wilson KC. The Role of Weight Management in the Treatment of Adult Obstructive Sleep Apnea. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2018; 198:e70-e87. [DOI: 10.1164/rccm.201807-1326st] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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22
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Hite A, Victorson D, Elue R, Plunkett BA. An Exploration of Barriers Facing Physicians in Diagnosing and Treating Obesity. Am J Health Promot 2018; 33:217-224. [PMID: 29986601 DOI: 10.1177/0890117118784227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine whether primary care physicians can accurately assess body mass index (BMI) by visual inspection and to assess barriers related to the diagnosis and management of obesity. DESIGN Prospective Survey Study. SETTING Hospitals and Clinics. SUBJECTS Primary care providers in the fields of Internal Medicine, Family Medicine and Obstetrics/Gynecology. MEASURES Measures investigated included providers visual assessment of BMI, BMI knowledge, diagnosis and management of obese patients, and perceived barriers to treatment. ANALYSIS Top and bottom quartiles and total scores were determined for responses regarding the reported management of obesity, reported comfort with care, and reported barriers to care and used as the cut point. Statistical analyses were utilized to examine relations and compare groups. RESULTS 206 (74%) of the 280 eligible providers completed the survey. The accuracy of visual assessment of BMI was 52%. Physicians were more likely to underestimate BMI than overestimate (36% ± 4% vs 12% ± 6%, respectively, P < .001). Although 91% of providers report routinely calculating BMI, only 61% routinely discuss BMI. Providers feel comfortable providing exercise (72%) and dietary counseling (61%). However, fewer are comfortable prescribing medical (16.4%) and surgical options (36%). CONCLUSION Visual assessment of BMI is not reliable. Primary care physicians in our study population do not consistently discuss obesity with their patients and many report insufficient knowledge with regard to treatment options. Further studies are needed to determine whether these results are valid for other physicians in various practice settings and to mid-level providers. In addition, research is needed that investigate how collaboration with providers outside the medical field could reduce the burden on physicians in treating patients with overweight or obesity.
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Affiliation(s)
- Ashley Hite
- 1 Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA
| | - David Victorson
- 2 Department of Medical Social Science, Northwestern University, Chicago, IL, USA
| | - Rita Elue
- 1 Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA
| | - Beth A Plunkett
- 1 Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA
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23
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Kouwenhoven-Pasmooij TA, Robroek SJW, Kraaijenhagen RA, Helmhout PH, Nieboer D, Burdorf A, Myriam Hunink MG. Effectiveness of the blended-care lifestyle intervention 'PerfectFit': a cluster randomised trial in employees at risk for cardiovascular diseases. BMC Public Health 2018; 18:766. [PMID: 29921255 PMCID: PMC6009059 DOI: 10.1186/s12889-018-5633-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 05/29/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Web-based lifestyle interventions at the workplace have the potential to promote health and work productivity. However, the sustainability of effects is often small, which could be enhanced by adding face-to-face contacts, so-called 'blended care'. Therefore, this study evaluates the effects of a blended workplace health promotion intervention on health and work outcomes among employees with increased cardiovascular risk. METHODS In this multicentre cluster-randomised controlled trial (PerfectFit), 491 workers in 18 work units from military, police, and a hospital with increased cardiovascular risk were randomised into two intervention groups. The limited intervention (n = 213; 9 clusters) consisted of a web-based Health Risk Assessment with advice. In the extensive intervention (n = 271; 8 clusters), coaching sessions by occupational health physicians using motivational interviewing were added. One cluster dropped out after randomisation but before any inclusion of subjects. Primary outcome was self-rated health. Secondary outcomes were body weight, body mass index (BMI), work productivity, and health behaviours. Follow-up measurements were collected at 6 and 12 months. Effect sizes were determined in mixed effects models. RESULTS At 12 months, the extensive intervention was not statistically different from the limited intervention for self-rated health (4.3%; 95%CI -5.3-12.8), BMI (- 0.81; 95%CI -1.87-0.26) and body weight (- 2.16; 95%CI -5.49-1.17). The within-group analysis showed that in the extensive intervention group body weight (- 3.1 kg; 95% CI -2.0 to - 4.3) was statistically significantly reduced, whereas body weight remained stable in the limited intervention group (+ 0.2 kg; 95% CI -1.4 to 1.8). In both randomised groups productivity loss and physical activity increased and excessive alcohol use decreased significantly at 12 months. CONCLUSIONS There were no effects on self-rated health, body weight, and BMI. However, within the group with web-based tailored Health Risk Assessment including personalized advice body weight reduced significantly. Adding motivational coaching is promising to reduce body weight. TRIAL REGISTRATION Retrospectively registered at the Netherlands Trial Registry with number NTR4894 , at Nov 14 2014.
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Affiliation(s)
- Tessa A Kouwenhoven-Pasmooij
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Na2818, Postbus 2040, 3000, CA, Rotterdam, The Netherlands. .,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of Occupational Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Suzan J W Robroek
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Pieter H Helmhout
- Staff Joint Health Care Division, Command Service Center, Ministry of Defense, Utrecht, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M G Myriam Hunink
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Na2818, Postbus 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA
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Welbourn R, Hopkins J, Dixon JB, Finer N, Hughes C, Viner R, Wass J. Commissioning guidance for weight assessment and management in adults and children with severe complex obesity. Obes Rev 2018; 19:14-27. [PMID: 29024367 DOI: 10.1111/obr.12601] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/26/2022]
Abstract
The challenge of managing the epidemic of patients with severe and complex obesity disease in secondary care is largely unmet. In England, the National Institute of Health and Care Excellence and the National Health Service England have published guidance on the provision of specialist (non-surgical) weight management services. We have undertaken a systematic review of 'what evidence exists for what should happen in/commissioning of: primary or secondary care weight assessment and management clinics in patients needing specialist care for severe and complex obesity?' using an accredited methodology to produce a model for organization of multidisciplinary team clinics that could be developed in every healthcare system, as an update to a previous review. Additions to the previous guidance were multidisciplinary team pathways for children/adolescent patients and their transition to adult care, anaesthetic assessment and recommendations for ongoing shared care with general practitioners, as a chronic disease management pathway.
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Affiliation(s)
- R Welbourn
- Department of Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - J Hopkins
- North Bristol Centre for Weight Loss, Metabolic and Bariatric Surgery, Southmead Hospital, Bristol, UK
| | - J B Dixon
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - N Finer
- UCLH Centre for Weight Loss, Metabolic and Endocrine Surgery, University College London Hospitals, London, UK
| | - C Hughes
- Fakenham Weight Management Service, Norfolk, UK.,University of East Anglia, Norwich, UK
| | - R Viner
- Royal College of Paediatrics and Child Health, UCL GOS Institute of Child Health, University College London, London, UK
| | - J Wass
- Royal College of Physicians, London, UK
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Bostock S. Motivational Interviewing: Its role in physiotherapy practice and changing exercise behaviour. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.12.539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Suzanna Bostock
- Musculoskeletal physiotherapist, Melksham Community Hospital Physiotherapy outpatients Department, Wiltshire Health and Care, Wiltshire, UK
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26
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Petroni ML, Caletti MT, Calugi S, Dalle Grave R, Marchesini G. Long-term treatment of severe obesity: are lifestyle interventions still an option? Expert Rev Endocrinol Metab 2017; 12:391-400. [PMID: 30063435 DOI: 10.1080/17446651.2017.1386551] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Following lifestyle intervention programs based on dietary restriction and habitual physical activity, weight loss, however large, is reported to peak within six months. Despite maintenance protocols, only few cases continue to lose weight thereafter. The majority of cases regain weight and adherence to lifestyle changes are fostered by long-term contact with a supportive team. In general, surgical procedures are reported to produce much larger weight loss and to impact more favorably on long-term weight loss maintenance. Areas covered: We performed a PubMed search on lifestyle modification studies, focusing on the role of behavior programs for the long-term management of obesity in comparison with surgical procedures. Behaviorally-achieved weight loss outcomes can be improved by integrating standard behavior therapy with self-regulation cognitive skills, motivational interviewing and/or phone/internet-based recall systems. Expert commentary: Clinically-important long-term weight loss is achievable by behavior therapy in a small proportion of subjects with obesity, however severe, through personalized programs associating lifestyle modification interventions, with procedures aimed at developing commitment and responsibility skills. A new area of research is the integration of cognitive-behavior therapy with bariatric (metabolic) surgery, either pre- or post-operatively, to exploit long-term adherence to healthy diet and habitual physical activity.
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Affiliation(s)
- Maria Letizia Petroni
- a Department of Medical & Surgical Sciences , Alma Mater University , Bologna , Italy
| | | | - Simona Calugi
- b Department of Eating and Weight Disorders , Villa Garda Hospital , Garda , Verona , Italy
| | - Riccardo Dalle Grave
- b Department of Eating and Weight Disorders , Villa Garda Hospital , Garda , Verona , Italy
| | - Giulio Marchesini
- a Department of Medical & Surgical Sciences , Alma Mater University , Bologna , Italy
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27
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Yoo BK, Hasebe T, Kim M, Sasaki T, Styne DM. Pilot survey of a novel incentive to promote healthy behavior among school children and their parents. Prev Med Rep 2017; 6:286-293. [PMID: 28409091 PMCID: PMC5388936 DOI: 10.1016/j.pmedr.2017.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/08/2017] [Accepted: 03/27/2017] [Indexed: 10/26/2022] Open
Abstract
Reversing the obesity epidemic has been a persistent global public health challenge, particularly among low socioeconomic status populations and racial/ethnic minorities. We developed a novel concept of community-based incentives to approach this problem in such communities. Applying this concept, we proposed a school intervention to promote obesity prevention in the U.S. We conducted a pilot survey to explore attitudes towards this future intervention. The survey was collected as a nonprobability sample (N = 137 school-aged children (5-12 years)) in northern California in July 2013. We implemented multivariable logistic regression analyses where the dependent variable indicated the intention to participate in the future intervention. The covariates included the body mass index (BMI) based weight categories, demographics, and others. We found that the future intervention is expected to motivate generally-high-risk populations (such as children and parents who have never joined a past health-improvement program compared to those who have completed a past health-improvement program (the odds-ratio (OR) = 5.84, p < 0.05) and children with an obese/overweight parent (OR = 2.72, p < 0.05 compared to those without one)) to participate in future obesity-prevention activities. Our analyses also showed that some subgroups of high-risk populations, such as Hispanic children (OR = 0.27, p < 0.05) and children eligible for a free or reduced price meal program (OR = 0.37, p < 0.06), remain difficult to reach and need an intensive outreach activity for the future intervention. The survey indicated high interest in the future school intervention among high-risk parents who have never joined a past health-improvement program or are obese/overweight. These findings will help design and implement a future intervention.
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Affiliation(s)
- Byung-Kwang Yoo
- Department of Public Health Sciences, School of Medicine, University of California, One Shields Ave., Medical Sciences 1C, Davis, CA 95616, USA
| | - Takuya Hasebe
- Department of Public Health Sciences, School of Medicine, University of California, One Shields Ave., Medical Sciences 1C, Davis, CA 95616, USA
| | - Minchul Kim
- Department of Public Health Sciences, School of Medicine, University of California, One Shields Ave., Medical Sciences 1C, Davis, CA 95616, USA
| | | | - Dennis M. Styne
- Yocha Dehe Endowed Chair in Pediatric Endocrinology, Director of the Newborn Screening Program, University of California, Davis Children's Hospital, University of California, Davis, CA, 2521 Stockton Blvd, Sacramento, CA 95817, USA
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Sforzo GA, Kaye MP, Todorova I, Harenberg S, Costello K, Cobus-Kuo L, Faber A, Frates E, Moore M. Compendium of the Health and Wellness Coaching Literature. Am J Lifestyle Med 2017; 12:436-447. [PMID: 30542254 PMCID: PMC6236633 DOI: 10.1177/1559827617708562] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 11/16/2022] Open
Abstract
Health and wellness coaching (HWC) for lifestyle behavior change is emerging as a
practice, role, and profession, in diverse health care, employee wellness, and
community settings. Health care professionals apply HWC as a behavior change
methodology for the prevention and treatment of diabetes, hypertension,
hyperlipidemia, heart disease, cancer, and other chronic disorders. The purpose
of this systematic review was to provide a comprehensive and organized
compendium of HWC literature. To date, extant HWC literature remains scattered
with no meaningful summary accessible. Lack of comprehensive summary stems from
lack of consensus on HWC definition and standards. We applied a recently
proposed, standardized definition of HWC to determine compendium inclusion
criteria for peer-reviewed, data-based literature from relevant search engines
(ie, PubMed, PsychInfo, and CINAHL). A systematic review process was executed
and ultimately yielded 219 articles meeting HWC inclusion criteria. Of these,
150 were data-based and the remainder were expert opinion or review-style
articles. A summary of results generally reveals HWC as a promising intervention
for chronic diseases though further research is needed in most categories. The
resulting HWC compendium organizes and describes the quantity and quality of
available literature for the use and benefit of HWC practitioners and
researchers.
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Affiliation(s)
- Gary A Sforzo
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Miranda P Kaye
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Irina Todorova
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Sebastian Harenberg
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Kyle Costello
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Laura Cobus-Kuo
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Aubrey Faber
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Elizabeth Frates
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Margaret Moore
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
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Kouwenhoven-Pasmooij TA, Robroek SJ, Ling SW, van Rosmalen J, van Rossum EF, Burdorf A, Hunink MGM. A Blended Web-Based Gaming Intervention on Changes in Physical Activity for Overweight and Obese Employees: Influence and Usage in an Experimental Pilot Study. JMIR Serious Games 2017; 5:e6. [PMID: 28373157 PMCID: PMC5394263 DOI: 10.2196/games.6421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/23/2016] [Accepted: 02/09/2017] [Indexed: 12/16/2022] Open
Abstract
Background Addressing the obesity epidemic requires the development of effective interventions aimed at increasing physical activity (PA). eHealth interventions with the use of accelerometers and gaming elements, such as rewarding or social bonding, seem promising. These eHealth elements, blended with face-to-face contacts, have the potential to help people adopt and maintain a physically active lifestyle. Objective The aim of this study was to assess the influence and usage of a blended Web-based gaming intervention on PA, body mass index (BMI), and waist circumference among overweight and obese employees. Methods In an uncontrolled before-after study, we observed 52 health care employees with BMI more than 25 kg/m2, who were recruited via the company’s intranet and who voluntarily participated in a 23-week Web-based gaming intervention, supplemented (blended) with non-eHealth components. These non-eHealth components were an individual session with an occupational health physician involving motivational interviewing and 5 multidisciplinary group sessions. The game was played by teams in 5 time periods, aiming to gain points by being physically active, as measured by an accelerometer. Data were collected in 2014 and 2015. Primary outcome was PA, defined as length of time at MET (metabolic equivalent task) ≥3, as measured by the accelerometer during the game. Secondary outcomes were reductions in BMI and waist circumference, measured at baseline and 10 and 23 weeks after the start of the program. Gaming elements such as “compliance” with the game (ie, days of accelerometer wear), “engagement” with the game (ie, frequency of reaching a personal monthly target), and “eHealth teams” (ie, social influence of eHealth teams) were measured as potential determinants of the outcomes. Linear mixed models were used to evaluate the effects on all outcome measures. Results The mean age of participants was 48.1 years; most participants were female (42/51, 82%). The mean PA was 86 minutes per day, ranging from 6.5 to 223 minutes, which was on average 26.2 minutes per day more than self-reported PA at baseline and remained fairly constant during the game. Mean BMI was reduced by 1.87 kg/m2 (5.6%) and waist circumference by 5.6 cm (4.8%). The univariable model showed that compliance, engagement, and eHealth team were significantly associated with more PA, which remained significant for eHealth team in the multivariable model. Conclusions This blended Web-based gaming intervention was beneficial for overweight workers in becoming physically active above the recommended activity levels during the entire intervention period, and a favorable influence on BMI and waist circumference was observed. Promising components in the intervention, and thus targets for upscaling, are eHealth teams and engagement with the game. Broader implementation and long-term follow-up can provide insights into the sustainable effects on PA and weight loss and into who benefits the most from this approach.
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Affiliation(s)
- Tessa A Kouwenhoven-Pasmooij
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Occupational Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Suzan Jw Robroek
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sui Wai Ling
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Elisabeth Fc van Rossum
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Obesity Center CGG, Rotterdam, Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - M G Myriam Hunink
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Harvard T.H. Chan School of Public Health, Center for Health Decision Sciences, Harvard University, Boston, MA, United States
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Cadegiani FA, Diniz GC, Alves G. Aggressive clinical approach to obesity improves metabolic and clinical outcomes and can prevent bariatric surgery: a single center experience. BMC OBESITY 2017; 4:9. [PMID: 28239482 PMCID: PMC5320647 DOI: 10.1186/s40608-017-0147-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/03/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The number of bariatric procedures has exponentially increased in the past decade, as a result of the lack of successful clinical weight-loss interventions. The main reasons for the failure of clinical obesity management are: (1) anti-obesity medications are administered as monotherapies (or pre-combined drugs); (2) lack of combination between pharmacotherapy and non-pharmacological modalities; (3) short duration of pharmacotherapy for obesity; (4) lack of weight-loss maintenance strategies; (5) misunderstanding of the complex pathophysiology of obesity; and (6) underprescription of anti-obesity medications. We developed a protocol that can potentially overcome the drawbacks that may lead to the failure of clinical therapy for obesity. The aim of this study is therefore to report the clinical and metabolic effects of our proposed obesity-management protocol over a 2-year period, and to determine whether this more intensive approach to obesity management is feasible and a possible alternative to bariatric surgery in patients with moderate-to-severe obesity. METHODS This retrospective study involved 43 patients in whom bariatric surgery was indicated. Patients underwent an intensive anti-obesity protocol that included pharmacotherapy with multiple drugs; intense surveillance with monthly body analysis by air-displacement plethysmography, electrical bioimpedance, and 3D body scans; weekly psychotherapy; diet planning with a dietician every 2 months; and exercises at least 3 times a week with exercises prescribed by a personal trainer at least once a month. Body weight (BW), total weight excess (TWE), obesity class, body mass index, fat weight, muscle weight, waist circumference, and visceral fat were analyzed. Markers of lipid and glucose metabolism, liver function, and inflammation were also evaluated. Therapeutic success was defined as >20% BW loss or >50% decrease in TWE after 1 year. RESULTS Significant improvements were observed in all clinical and metabolic parameters. Thirty-eight (88.4%) patients achieved 10% BW loss, and 32 (74.4%) achieved 20% BW loss. TWE decreased by >50% in 35 (81.4%) patients. Forty (93.0%) patients were able to avoid bariatric surgery. CONCLUSION An intensive clinical approach to obesity management can be an effective alternative to bariatric surgery, although further randomized controlled studies are necessary to validate our findings.
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Affiliation(s)
- Flavio A Cadegiani
- Division of Endocrinology and Metabolism, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, R. Pedro de Toledo 781, 04039-032 São Paulo, SP Brazil.,Corpometria Institute, an Obesity and Endocrinology Center, SGAS 915 Centro Clínico Advance Salas 260/262/264, 70390-150 Brasilia, DF Brazil
| | - Gustavo C Diniz
- Corpometria Institute, an Obesity and Endocrinology Center, SGAS 915 Centro Clínico Advance Salas 260/262/264, 70390-150 Brasilia, DF Brazil
| | - Gabriella Alves
- Corpometria Institute, an Obesity and Endocrinology Center, SGAS 915 Centro Clínico Advance Salas 260/262/264, 70390-150 Brasilia, DF Brazil
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Copeland L, McNamara R, Kelson M, Simpson S. The development of a coding system to code planning talk within motivational interviewing. PATIENT EDUCATION AND COUNSELING 2017; 100:313-319. [PMID: 27637286 PMCID: PMC5332025 DOI: 10.1016/j.pec.2016.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Understanding mechanisms of motivational interviewing (MI) could improve practice. Planning is important for behavior change, and a component of MI. We aimed to develop a scale to measure planning talk within MI and explore the potential association between planning and weight loss maintenance (WLM). METHODS A literature review and thematic analysis was used to develop the coding system. Reliability was tested using MI examples and a transcript. It was applied to 50 sessions and associations between planning and WLM were analyzed using logistic and linear regression. RESULTS The coding system included: past, continuing, future and hypothetical plans and goal setting, varying on specificity and commitment. The percentage agreement was 86% and 75% for examples and transcript reliability respectively. Frequent planners, potentially decrease their weight 2.8kg(-9.7, 0.6) and BMI 1.2kg/m2(-3.1, 0.4) more compared to less frequent planners. Frequent goal setters increase their BMI(3.6kg/m2, 1.5, 5.7) and weight (9.5kg, 3.4, 15.6) compared to non-goal setters. CONCLUSION It is feasible to measure planning, with acceptable agreement. Limited conclusions for the potential associations were demonstrated. PRACTICE IMPLICATIONS This is the first scale to measure planning, an important aspect of MI which has received less attention.
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Affiliation(s)
- Lauren Copeland
- Division of Population Medicine, Cardiff University, School of Medicine, Cardiff, UK.
| | - Rachel McNamara
- South East Wales Trials Unit, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
| | - Mark Kelson
- South East Wales Trials Unit, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
| | - Sharon Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, UK.
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Montesi L, El Ghoch M, Brodosi L, Calugi S, Marchesini G, Dalle Grave R. Long-term weight loss maintenance for obesity: a multidisciplinary approach. Diabetes Metab Syndr Obes 2016; 9:37-46. [PMID: 27013897 PMCID: PMC4777230 DOI: 10.2147/dmso.s89836] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The long-term weight management of obesity remains a very difficult task, associated with a high risk of failure and weight regain. However, many people report that they have successfully managed weight loss maintenance in the long term. Several factors have been associated with better weight loss maintenance in long-term observational and randomized studies. A few pertain to the behavioral area (eg, high levels of physical activity, eating a low-calorie, low-fat diet; frequent self-monitoring of weight), a few to the cognitive component (eg, reduced disinhibition, satisfaction with results achieved, confidence in being able to lose weight without professional help), and a few to personality traits (eg, low novelty seeking) and patient-therapist interaction. Trials based on the most recent protocols of lifestyle modification, with a prolonged extended treatment after the weight loss phase, have also shown promising long-term weight loss results. These data should stimulate the adoption of a lifestyle modification-based approach for the management of obesity, featuring a nonphysician lifestyle counselor (also called "lifestyle trainer" or "healthy lifestyle practitioner") as a pivotal component of the multidisciplinary team. The obesity physicians maintain a primary role in engaging patients, in team coordination and supervision, in managing the complications associated with obesity and, in selected cases, in the decision for drug treatment or bariatric surgery, as possible more intensive, add-on interventions to lifestyle treatment.
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Affiliation(s)
- Luca Montesi
- Unit of Metabolic Diseases, S Orsola-Malpighi Hospital, “Alma Mater Studiorum” University, Bologna, Italy
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Verona, Italy
| | - Lucia Brodosi
- Unit of Metabolic Diseases, S Orsola-Malpighi Hospital, “Alma Mater Studiorum” University, Bologna, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Verona, Italy
| | - Giulio Marchesini
- Unit of Metabolic Diseases, S Orsola-Malpighi Hospital, “Alma Mater Studiorum” University, Bologna, Italy
- Correspondence: Giulio Marchesini, Unit of Metabolic Diseases, S Orsola-Malpighi Hospital, “Alma Mater Studiorum” University, Via Massarenti, 9, I-40135 Bologna, Italy, Tel +39 05 1214 4889, Fax +39 05 1636 4502, Email
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Randell E, McNamara R, Shaw C, Espinasse A, Simpson SA. Challenges of a community based pragmatic, randomised controlled trial of weight loss maintenance. BMC Res Notes 2015; 8:802. [PMID: 26683473 PMCID: PMC4684604 DOI: 10.1186/s13104-015-1791-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/04/2015] [Indexed: 02/05/2023] Open
Abstract
Background Randomised controlled trials (RCTs) have a reputation for being inherently difficult to deliver as planned and often face unforeseen challenges and delays, particularly in relation to organisational and governance difficulties, participant interest, constraints due to allocation of costs, local investigator interest and lengthy bureaucracy. Recruitment is often difficult and the challenges faced often impact on the cost and delivery of a successful trial within the funded period. This paper reflects upon the challenges faced in delivering a pragmatic RCT of weight loss maintenance in a community setting and suggests some potential solutions. Methods The weight loss maintenance in adults trial aimed to evaluate the impact of a 12 month, individually tailored weight maintenance intervention on BMI 3 years from randomisation. Participants were recruited primarily from participant identification centres (PICs)—GP surgeries, exercise on referral schemes and slimming world. The intervention was delivered in community settings. A recruitment strategy implementation plan was drafted to address and monitor poor recruitment. Results Delays in opening and recruitment were experienced early on. Some were beyond the control of the study team such as; disagreement over allocation of national health service costs and PIC classification as well as difficulties in securing support from research networks. That the intervention was delivered in community settings was often at the root of these issues. Key items to address at the design stage of future trials include feasibility of eligibility criteria. The most effective element of the recruitment implementation plan was to refocus sources of recruitment and target only those who could fulfil the eligibility criteria immediately. Conclusions Learnings from this trial should be kept in mind by those designing similar studies in the future. Considering potential governance, cost and research network support implications at the design stage of pragmatic trials of any community-based complex intervention is paramount. The appropriateness and viability of inclusion criteria also require careful consideration as does use of a targeted advertising strategy. Trial registration: ISRCTN35774128, 12/01/2010
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Affiliation(s)
- Elizabeth Randell
- South East Wales Trials Unit, Heath Park, Cardiff University, Cardiff, Wales, UK.
| | - Rachel McNamara
- South East Wales Trials Unit, Heath Park, Cardiff University, Cardiff, Wales, UK.
| | - Christine Shaw
- South East Wales Trials Unit, Heath Park, Cardiff University, Cardiff, Wales, UK.
| | - Aude Espinasse
- South East Wales Trials Unit, Heath Park, Cardiff University, Cardiff, Wales, UK.
| | - Sharon Anne Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, Scotland, UK.
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