1
|
Gravina D, Keeler JL, Akkese MN, Bektas S, Fina P, Tweed C, Willmund GD, Treasure J, Himmerich H. Randomized Controlled Trials to Treat Obesity in Military Populations: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:4778. [PMID: 38004172 PMCID: PMC10674729 DOI: 10.3390/nu15224778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
In recent years, overweight and obesity have reached an alarmingly high incidence and prevalence worldwide; they have also been steadily increasing in military populations. Military personnel, as an occupational group, are often exposed to stressful and harmful environments that represent a risk factor for disordered eating, with major repercussions on both physical and mental health. This study aims to explore the effectiveness of weight loss interventions and assess the significance of current obesity treatments for these populations. Three online databases (PubMed, PsycInfo, and Web of Science) were screened to identify randomized controlled trials (RCTs) aiming to treat obesity in active-duty military personnel and veterans. Random-effects meta-analyses were conducted for body weight (BW) and body mass index (BMI) values, both longitudinally comparing treatment groups from pre-to-post intervention and cross-sectionally comparing the treatment group to controls at the end of the intervention. A total of 21 studies were included: 16 cross-sectional (BW: n = 15; BMI: n = 12) and 16 longitudinal (BW: n = 15; BMI: n = 12) studies were meta-analyzed, and 5 studies were narratively synthesized. A significant small overall BW and BMI reduction from baseline to post-intervention was observed (BW: g = -0.10; p = 0.015; BMI: g = -0.32; p < 0.001), together with a decreased BMI (g = -0.16; p = 0.001) and nominally lower BW (g = -0.08; p = 0.178) in the intervention group compared to controls at the post-intervention time-point. Despite limitations, such as the heterogeneity across the included interventions and the follow-up duration, our findings highlight how current weight loss interventions are effective in terms of BW and BMI reductions in military populations and how a comprehensive approach with multiple therapeutic goals should be taken during the intervention.
Collapse
Affiliation(s)
- Davide Gravina
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK; (J.L.K.); (M.N.A.); (S.B.); (J.T.); (H.H.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56127 Pisa, Italy
| | - Johanna Louise Keeler
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK; (J.L.K.); (M.N.A.); (S.B.); (J.T.); (H.H.)
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK;
| | - Melahat Nur Akkese
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK; (J.L.K.); (M.N.A.); (S.B.); (J.T.); (H.H.)
| | - Sevgi Bektas
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK; (J.L.K.); (M.N.A.); (S.B.); (J.T.); (H.H.)
- Department of Psychology, Hacettepe University, Ankara 06800, Türkiye
| | - Paula Fina
- Faculty of Psychology, Sigmund Freud University Vienna, Freudplatz 1, 1020 Vienna, Austria;
| | - Charles Tweed
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK;
- Royal Navy Reserve, London WC1N 1NP, UK
| | - Gerd-Dieter Willmund
- Bundeswehr Center for Military Mental Health, Military Hospital Berlin, 13, 10115 Berlin, Germany;
| | - Janet Treasure
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK; (J.L.K.); (M.N.A.); (S.B.); (J.T.); (H.H.)
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK;
| | - Hubertus Himmerich
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK; (J.L.K.); (M.N.A.); (S.B.); (J.T.); (H.H.)
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK;
| |
Collapse
|
2
|
Pérez-Muñoz A, Hare ME, Andres A, Klesges RC, Wayne Talcott G, Little MA, Waters TM, Harvey JR, Bursac Z, Krukowski RA. A Postpartum Weight Loss-focused Stepped-care Intervention in a Military Population: A Randomized Controlled Trial. Ann Behav Med 2023; 57:836-845. [PMID: 37061829 PMCID: PMC10498817 DOI: 10.1093/abm/kaad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023] Open
Abstract
OBJECTIVE Postpartum weight retention is associated with adverse health among both civilian and military women. PURPOSE The current study evaluated a stepped-care weight management intervention, Moms Fit 2 Fight, adapted for use in a pregnant and postpartum military population. METHODS Active duty women and other TRICARE beneficiaries (N = 430) were randomized to one of three conditions: gestational weight gain only (GWG-only) intervention (n =144), postpartum weight loss only (PPWL-only) intervention (n =142), or a combined GWG + PPWL intervention (n = 144). Those participants who received the PPWL intervention (i.e., the PPWL-only and GWG+PPWL conditions) were combined consistently with the pre-registered protocol and compared to those participants who did not receive the PPWL intervention in the primary analyses. Primary outcome data (i.e., postpartum weight retention) were obtained at 6-months postpartum by unblinded data collectors, and intent-to-treat analyses were conducted. RESULTS Retention at 6-months postpartum was 88.4%. Participants who received the PPWL intervention retained marginally less weight (1.31 kg) compared to participants that received the GWG-only intervention (2.39 kg), with a difference of 1.08 kg (p = .07). None of the measured covariates, including breastfeeding status, were significantly associated with postpartum weight retention. Of the participants who received the PPWL intervention, 48.1% participants returned to their pre-pregnancy weight at 6-months postpartum, with no significant differences compared to those who received the GWG-only intervention. CONCLUSIONS A behavioral intervention targeting diet and physical activity during the postpartum period had a trend for reduced postpartum weight retention. CLINICAL TRIAL INFORMATION The trial is registered on clinicaltrials.gov (NCT03057808).
Collapse
Affiliation(s)
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Aline Andres
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Nutrition Center, Little Rock, AR, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Gerald Wayne Talcott
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
| | - Melissa A Little
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Teresa M Waters
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, USA
| | - Jean R Harvey
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, USA
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Rebecca A Krukowski
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
3
|
Police SB, Ruppert N. The US Military's Battle With Obesity. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:475-480. [PMID: 35534103 DOI: 10.1016/j.jneb.2021.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
The prevalence of obesity continues to rise among youth and adults in the US and the US military. The US military is negatively impacted by the nation's growing waistline, with drastic reductions in eligible recruits, increasing risks for compromised physical endurance and performance, and ballooning health care costs. This perspective discusses the effects of the obesity epidemic on the US military, previous and continuing research and programming initiatives, the progress made to increase access to healthy foods, and opportunities for future directions in research and practice to combat the obesity epidemic.
Collapse
Affiliation(s)
- Sara B Police
- Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington, KY.
| | - Nicole Ruppert
- Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington, KY
| |
Collapse
|
4
|
Harris JA, Carins J, Rundle-Thiele S. Can Social Cognitive Theory Influence Breakfast Frequency in an Institutional Context: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111270. [PMID: 34769788 PMCID: PMC8582903 DOI: 10.3390/ijerph182111270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 11/19/2022]
Abstract
Breakfast is considered an important meal, especially for people who are about to commence a long or demanding workday, and for roles that may involve physical tasks and a requirement to remain alert and vigilant in potentially high-risk situations. This study looks at breakfast consumption influences within two workplace institutional settings, namely military and mining. Semi-structured interviews were conducted with military personnel (n = 12) and mining employees (n = 12) to understand their breakfast consumption behaviour at work and at home, and the associated behavioural influences. The interview questions were framed by social cognitive theory. Overall, cognitive and environmental influences were the most prominent influences on breakfast consumption, less evident were behavioural influences. A negative stereotype of workplace institutional food services emerged as one of the most significant barriers to breakfast consumption for those already at work. Considerations of environmental influences on behaviour may need to be broadened beyond physical barriers and social influences, to include perceptions of the behavioural environment. Programs that aim to increase breakfast consumption must create areas where their employees want to go. Food systems need to ensure nutritious, quality, and appealing food is available. Interventions need to increase participants’ knowledge, improve their attitudes, and create positive expectations for breakfast.
Collapse
|
5
|
Koehlmoos TP, Banaag A, Madsen CK, Adirim T. Child Health As A National Security Issue: Obesity And Behavioral Health Conditions Among Military Children. Health Aff (Millwood) 2021; 39:1719-1727. [PMID: 33017245 DOI: 10.1377/hlthaff.2020.00712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To build and maintain an effective, agile force that is ready at a moment's notice to deploy for national security missions, the US military must recruit approximately 150,000 new personnel annually while adhering to stringent medical standards. Given a target recruitment population of young adults ages 18-24, the health of the nation's children is critical to US national security. Maintaining a fit population of military dependents is particularly important because this group has a greater propensity to serve than does the broader population of US children. Using TRICARE claims, we examined body mass index and behavioral health diagnoses among adolescents ages 13-18 covered by the Military Health System for fiscal years 2017-18. Prevalence of conduct disorders, which prevent enlistment, was low overall. However, overweight and obesity combined prevalence estimates were more than 30 percent in every census division, and the prevalence of behavioral health disorders ranged from 18.53 percent to 22.90 percent. These prevalence rates are similar to those found in the civilian sector but are high enough to pose barriers to the military's efforts to meet recruitment goals. Interventions to improve nutrition, fitness, and behavioral health among school-age children may improve fitness to serve and guarantee the future readiness of the armed forces and the security of the nation.
Collapse
Affiliation(s)
- Tracey Pérez Koehlmoos
- Tracey Pérez Koehlmoos is a professor of preventive medicine and biostatistics and director of the Health Services Research Program at the Uniformed Services University of the Health Sciences (USUHS), in Bethesda, Maryland
| | - Amanda Banaag
- Amanda Banaag is a senior data analyst in the Comparative Effectiveness and Provider Induced Demand Collaboration at the USUHS and the Henry M. Jackson Foundation for the Advancement of Military Medicine, in Bethesda, Maryland
| | - Cathaleen King Madsen
- Cathaleen King Madsen is the program manager for the Health Services Research Program of the USUHS and the Henry M. Jackson Foundation for the Advancement of Military Medicine
| | - Terry Adirim
- Terry Adirim is senior associate dean for clinical affairs, professor of pediatrics, and chair of the Department of Integrated Medical Science at the Schmidt College of Medicine, Florida Atlantic University, in Boca Raton, Florida
| |
Collapse
|
6
|
Csizmar GT, Irwin M. Efficacy of Weight Loss Interventions in United States Active Duty Military Populations: A Systematic Review. Mil Med 2021; 186:1093-1099. [PMID: 33506251 DOI: 10.1093/milmed/usab012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/02/2021] [Accepted: 01/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Since the beginning of overseas contingency operations, the percent of service members who are considered overweight or obese has tripled to 15% for men and 20% for women. This has implications for national security if the country is unable to staff its military with fit-to-fight individuals. The purpose of this systematic review is to move policy efforts forward by illuminating the efficacy of several lifestyle interventions for active duty service members since 2001. It aims to both identify common aspects of successful interventions and also identify interventions without success so DoD leaders may replace those initiatives. MATERIALS AND METHODS The electronic database PubMed was searched from September 11, 2001 to May 15, 2020. Studies were included if the target population was United States active duty service members from any branch, the study included an intervention, and the measured outcome was weight loss. Seven studies met final inclusion criteria. RESULTS Interventions with corresponding weight loss data are summarized in Table III. This review found that there is not a sufficient body of evidence to determine if interventions to aid active duty service members in losing weight are effective. CONCLUSION However, as a collection, the studies could support the notion that military members get the best results when interventions are convenient, modern, personalized, and accessible. More studies are needed, and future studies with larger sample sizes and longer durations would be valuable in determining efficacy of weight loss interventions. Undoubtedly, enrollment and compliance is difficult with military member moves and competing mission requirements. Ideally, the DoD should work to aggregate the efforts in this field, as many initiatives are not captured, shared, and utilized by other installations or other services. Data silos and unpublished or underdeveloped research reactively addresses issues and does not proactively address them. Policy change will need to be nested in further research, as well as consider the food environment on bases and possible prevention efforts.
Collapse
Affiliation(s)
- Geralyn T Csizmar
- Medical Service Corps, Army, Department of Health Policy, Yale School of Public Health, New Haven, CT 06520, USA
| | - Melinda Irwin
- Associate Dean of Research and Professor of Epidemiology, Yale School of Public Health, New Haven, CT 06520, USA
| |
Collapse
|
7
|
Pine AE, Shank LM, Burke NL, Higgins Neyland MK, Schvey NA, Quattlebaum M, Leu W, Wilfley DE, Stephens M, Jorgensen S, Olsen CH, Sbrocco T, Yanovski JA, Klein DA, Quinlan J, Tanofsky-Kraff M. Examination of the Interpersonal Model With Adolescent Military Dependents at High Risk for Adult Obesity. Am J Psychother 2020; 73:43-49. [PMID: 32050783 PMCID: PMC7286799 DOI: 10.1176/appi.psychotherapy.20190034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Adolescent military dependents may be at higher risk for psychosocial stressors and disordered eating compared with civilian youths, but the mechanisms underlying these risks are unclear. Interpersonal theory proposes that difficult relationships lead to negative affect, thereby promoting emotional eating, which has been linked to and predictive of disordered eating. The interpersonal model may have particular relevance for understanding disordered eating among adolescent military dependents, given the unique stressors related to their parents' careers. This study aimed to examine the premise of the interpersonal model (that negative emotions mediate the association between multiple aspects of social functioning and emotional eating) among a cohort of adolescent military dependents. METHODS Military dependents (N=136; 56% female, mean±SD age=14±2 years, body mass index adjusted for age and sex [BMIz]=2.0±0.4) at risk for adult obesity and binge eating disorder, as indicated by reported loss-of-control eating and/or anxiety symptoms, were assessed prior to participation in a study of excess weight-gain prevention. Bootstrapped mediation analyses were conducted to examine depressive symptoms as a potential mediator of the relationship between social functioning and emotional eating. Analyses were adjusted for age, sex, race-ethnicity, BMIz, and presence of reported loss-of-control eating and anxiety. RESULTS Depressive symptoms were a significant mediator of the relationship between multiple domains of social functioning, including loneliness, social adjustment related to family and friends, attachment to father and peers, and emotional eating (p<0.05). CONCLUSIONS The interpersonal model may contribute to our understanding of excess weight gain and binge eating disorder among adolescent military dependents. Prospective data are needed to determine the utility of interpersonal theory in predicting treatment response and outcomes among this population.
Collapse
Affiliation(s)
- Abigail E Pine
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - Lisa M Shank
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - Natasha L Burke
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - M K Higgins Neyland
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - Mary Quattlebaum
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - William Leu
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - Denise E Wilfley
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - Mark Stephens
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - Sarah Jorgensen
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - Cara H Olsen
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - Jack A Yanovski
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - David A Klein
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - Jeffrey Quinlan
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Pine, Shank, Higgins Neyland, Schvey, Quattlebaum, Leu, Olsen, Sbrocco, Klein, Quinlan, Tanofsky-Kraff); Department of Medicine, Military Outcomes Cardiovascular Research, Uniformed Services University of the Health Sciences, Bethesda (Shank, Higgins Neyland, Tanofsky-Kraff); Department of Psychology, Fordham University, New York (Burke); Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, (Schvey, Yanovski); Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, (Wilfley); Department of Family and Community Medicine, Pennsylvania State University, State College (Stephens); Fort Belvoir Community Hospital, Fort Belvoir, Virginia (Jorgensen, Klein)
| |
Collapse
|
8
|
Kusic DM, Roberts WN, Jarvis JP, Zhang P, Scheinfeldt LB, Rajula KD, Brenner R, Dempsey MP, Zajic SC. rs11670527 Upstream of ZNF264 Associated with Body Mass Index in the Coriell Personalized Medicine Collaborative. Mil Med 2020; 185:649-655. [PMID: 31498392 DOI: 10.1093/milmed/usz216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION the effects of obesity on health are a concern for the military as they affect the fitness to serve of active service members, increase costs to the Military Health System, and reduce quality of life for veterans and beneficiaries. Although obesity can be influenced by behavioral and environmental factors, it has also been shown to be associated with genetic risk factors that are not fully understood. MATERIALS AND METHODS we performed a genome-wide association study of 5,251 participants in the Coriell Personalized Medicine Collaborative, which includes 2,111 Air Force participants. We applied a generalized linear model, using principal component analysis to account for population structure, and analyzed single-variant associations with body mass index (BMI) as a continuous variable, using a Bonferroni-corrected P-value threshold to account for multiplicity. RESULTS we identified one genome-wide significant locus, rs11670527, upstream of the ZNF264 gene on chromosome 19, associated with BMI. CONCLUSIONS the finding of an association between rs11670527 and BMI adds to the growing body of literature characterizing the complex genetics of obesity. These efforts may eventually inform personalized interventions aimed at achieving and maintaining healthy weight.
Collapse
Affiliation(s)
- Dara M Kusic
- Coriell Institute for Medical Research, 403 Haddon Ave, Camden, NJ 08103
| | - Wendy N Roberts
- Coriell Institute for Medical Research, 403 Haddon Ave, Camden, NJ 08103
| | - Joseph P Jarvis
- Coriell Institute for Medical Research, 403 Haddon Ave, Camden, NJ 08103
| | - Pan Zhang
- Coriell Institute for Medical Research, 403 Haddon Ave, Camden, NJ 08103
| | | | - Kaveri D Rajula
- Coriell Institute for Medical Research, 403 Haddon Ave, Camden, NJ 08103
| | - Ruth Brenner
- Immunization Healthcare Division, Defense Health Agency, Falls Church, VA 22042
| | - Michael P Dempsey
- Defense Threat Reduction Agency, 8725 John J Kingman Rd., Fort Belvoir, VA 22060 Presented as a poster at the 2018 Military Health System Research Symposium, August 2018, Kissimmee, FL: abstract # MHSRS-18-1288
| | - Stefan C Zajic
- Coriell Institute for Medical Research, 403 Haddon Ave, Camden, NJ 08103
| |
Collapse
|
9
|
Brown T, Moore TH, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. [PMID: 31332776 PMCID: PMC6646867 DOI: 10.1002/14651858.cd001871.pub4] [Citation(s) in RCA: 275] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
EDITORIAL NOTE This Cochrane review is now out of date and should not be used for reference. It has been split into four age groups and updated. Please refer to the 5‐11 and 12‐18 age group Cochrane reviews which were published in May 2024: https://doi.org/10.1002/14651858.CD015328.pub2 https://doi.org/10.1002/14651858.CD015330.pub2 The 2‐4 age group Cochrane review is planned for publication in September 2024. BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.
Collapse
Affiliation(s)
- Tamara Brown
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Shank LM, Schvey NA, Ekundayo K, Schreiber-Gregory D, Bates D, Maurer D, Spieker E, Stephens M, Tanofsky-Kraff M, Sbrocco T. The relationship between weight stigma, weight bias internalization, and physical health in military personnel with or at high-risk of overweight/obesity. Body Image 2019; 28:25-33. [PMID: 30481680 DOI: 10.1016/j.bodyim.2018.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/17/2018] [Accepted: 11/17/2018] [Indexed: 12/20/2022]
Abstract
Perceived weight stigma is associated with adverse health indices, such as elevated cortisol, lipid/glucose dysregulation, and poorer self-rated health. This relationship may be particularly relevant for military personnel, given the cultural emphasis on fitness and weight/shape. Therefore, we investigated the relationship between weight stigma and physical health in 117 active duty personnel (66.7% male; 56.4% non-Hispanic White; age: 30.8 ± 7.4 years; BMI: 29.5 ± 2.5 kg/m2). Participants reported weight stigma (general and military-specific), weight bias internalization, and the presence (≥1; n = 55) or absence (n = 62) of medical conditions. Logistic regressions were conducted examining the ability of weight stigma (general or military-specific) and weight bias internalization to predict the presence or absence of medical conditions. General weight stigma was not significantly associated with the presence of a medical condition (p > .05). However, individuals with military-specific weight stigma scores twice that of their peers were over three times more likely (p = .04) to report a medical condition. Weight bias internalization was not significant in any model (ps > .20). Longitudinal studies should prospectively examine the relationship between weight stigma in the military setting and health among service members.
Collapse
Affiliation(s)
- Lisa M Shank
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), 6720A Rockledge Drive #100, Bethesda, MD, 20817, USA.
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Kendra Ekundayo
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), 6720A Rockledge Drive #100, Bethesda, MD, 20817, USA
| | - Deanna Schreiber-Gregory
- The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), 6720A Rockledge Drive #100, Bethesda, MD, 20817, USA; Department of Internal Medicine, USUHS, DoD, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Dawn Bates
- Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Douglas Maurer
- Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Elena Spieker
- Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Mark Stephens
- Department of Family and Community Medicine, Penn State University College of Medicine, 1850 E. Park Avenue, Suite 207 State College, PA, 16803, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| |
Collapse
|
11
|
Shepherd E, Gomersall JC, Tieu J, Han S, Crowther CA, Middleton P. Combined diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database Syst Rev 2017; 11:CD010443. [PMID: 29129039 PMCID: PMC6485974 DOI: 10.1002/14651858.cd010443.pub3] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with a wide range of adverse health consequences for women and their infants in the short and long term. With an increasing prevalence of GDM worldwide, there is an urgent need to assess strategies for GDM prevention, such as combined diet and exercise interventions. This is an update of a Cochrane review that was first published in 2015. OBJECTIVES To assess the effects of diet interventions in combination with exercise interventions for pregnant women for preventing GDM, and associated adverse health consequences for the mother and her infant/child. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 November 2016) and reference lists of retrieved studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs, comparing combined diet and exercise interventions with no intervention (i.e. standard care), that reported on GDM diagnosis as an outcome. Quasi-RCTs were excluded. Cross-over trials were not eligible for inclusion. We planned to include RCTs comparing two or more different diet/exercise interventions, however none were identified. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, assessed the risk of bias of the included trials and assessed quality of evidence for selected maternal and infant/child outcomes using the GRADE approach. We checked data for accuracy. MAIN RESULTS In this update, we included 23 RCTs (involving 8918 women and 8709 infants) that compared combined diet and exercise interventions with no intervention (standard care). The studies varied in the diet and exercise programs evaluated and health outcomes reported. None reported receiving funding from a drug manufacturer or agency with interests in the results. Overall risk of bias was judged to be unclear due to the lack of methodological detail reported. Most studies were undertaken in high-income countries.For our primary review outcomes, there was a possible reduced risk of GDM in the diet and exercise intervention group compared with the standard care group (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.71 to 1.01; 6633 women; 19 RCTs; Tau² = 0.05; I² = 42%; P = 0.07; moderate-quality evidence). There was also a possible reduced risk of caesarean section (RR 0.95, 95% CI 0.88 to 1.02; 6089 women; 14 RCTs; moderate-quality evidence). No clear differences were seen between groups for pre-eclampsia (RR 0.98, 95% CI 0.79 to 1.22; 5366 participants; 8 RCTs; low-quality evidence), pregnancy-induced hypertension and/or hypertension (average RR 0.78, 95% CI 0.47 to 1.27; 3073 participants; 6 RCTs; Tau² = 0.19; I² = 62%; very low-quality evidence), perinatal mortality (RR 0.82, 95% CI 0.42 to 1.63; 3757 participants; 2 RCTs; low-quality evidence) or large-for-gestational age (RR 0.93, 95% CI 0.81 to 1.07; 5353 participants; 11 RCTs; low-quality evidence). No data were reported for infant mortality or morbidity composite.Subgroup analyses (based on trial design, maternal body mass index (BMI) and ethnicity) revealed no clear differential treatment effects. We were unable to assess the impact of maternal age, parity and specific features of the diet and exercise interventions. Findings from sensitivity analyses (based on RCT quality) generally supported those observed in the main analyses. We were not able to perform subgroup analyses based on maternal age, parity or nature of the exercise/dietary interventions due to the paucity of information/data on these characteristics and the inability to meaningfully group intervention characteristics.For most of the secondary review outcomes assessed using GRADE, there were no clear differences between groups, including for perineal trauma (RR 1.27, 95% CI 0.78 to 2.05; 2733 participants; 2 RCTs; moderate-quality evidence), neonatal hypoglycaemia (average RR 1.42, 95% CI 0.67 to 2.98; 3653 participants; 2 RCTs; Tau² = 0.23; I² = 77%; low quality evidence); and childhood adiposity (BMI z score) (MD 0.05, 95% CI -0.29 to 0.40; 794 participants; 2 RCTs; Tau² = 0.04; I² = 59%; low-quality evidence). However, there was evidence of less gestational weight gain in the diet and exercise intervention group compared with the control group (mean difference (MD) -0.89 kg, 95% CI -1.39 to -0.40; 5052 women; 16 RCTs; Tau² = 0.37; I² = 43%;moderate-quality evidence). No data were reported for maternal postnatal depression or type 2 diabetes; childhood/adulthood type 2 diabetes, or neurosensory disability. AUTHORS' CONCLUSIONS Moderate-quality evidence suggests reduced risks of GDM and caesarean section with combined diet and exercise interventions during pregnancy as well as reductions in gestational weight gain, compared with standard care. There were no clear differences in hypertensive disorders of pregnancy, perinatal mortality, large-for-gestational age, perineal trauma, neonatal hypoglycaemia, and childhood adiposity (moderate- tovery low-quality evidence).Using GRADE methodology, the evidence was assessed as moderate to very low quality. Downgrading decisions were predominantly due to design limitations (risk of bias), and imprecision (uncertain effect estimates, and at times, small sample sizes and low event rates), however two outcomes (pregnancy-induced hypertension/hypertension and neonatal hypoglycaemia), were also downgraded for unexplained inconsistency (statistical heterogeneity).Due to the variability of the diet and exercise components tested in the included studies, the evidence in this review has limited ability to inform practice. Future studies could describe the interventions used in more detail, if and how these influenced behaviour change and ideally be standardised between studies. Studies could also consider using existing core outcome sets to facilitate more standardised reporting.
Collapse
Affiliation(s)
- Emily Shepherd
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Judith C Gomersall
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen’s and Children’s Hospital7th Floor, 72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Joanna Tieu
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Shanshan Han
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Caroline A Crowther
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
- The University of AucklandLiggins InstitutePrivate Bag 9201985 Park RoadAucklandNew Zealand
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen’s and Children’s Hospital7th Floor, 72 King William RoadAdelaideSouth AustraliaAustralia5006
| | | |
Collapse
|
12
|
Al‐Khudairy L, Loveman E, Colquitt JL, Mead E, Johnson RE, Fraser H, Olajide J, Murphy M, Velho RM, O'Malley C, Azevedo LB, Ells LJ, Metzendorf M, Rees K. Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. Cochrane Database Syst Rev 2017; 6:CD012691. [PMID: 28639320 PMCID: PMC6481371 DOI: 10.1002/14651858.cd012691] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Adolescent overweight and obesity has increased globally, and can be associated with short- and long-term health consequences. Modifying known dietary and behavioural risk factors through behaviour changing interventions (BCI) may help to reduce childhood overweight and obesity. This is an update of a review published in 2009. OBJECTIVES To assess the effects of diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. SEARCH METHODS We performed a systematic literature search in: CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, and the trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of identified studies and systematic reviews. There were no language restrictions. The date of the last search was July 2016 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity and behavioural interventions for treating overweight or obesity in adolescents aged 12 to 17 years. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias, evaluated the overall quality of the evidence using the GRADE instrument and extracted data following the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. We contacted trial authors for additional information. MAIN RESULTS We included 44 completed RCTs (4781 participants) and 50 ongoing studies. The number of participants in each trial varied (10 to 521) as did the length of follow-up (6 to 24 months). Participants ages ranged from 12 to 17.5 years in all trials that reported mean age at baseline. Most of the trials used a multidisciplinary intervention with a combination of diet, physical activity and behavioural components. The content and duration of the intervention, its delivery and the comparators varied across trials. The studies contributing most information to outcomes of weight and body mass index (BMI) were from studies at a low risk of bias, but studies with a high risk of bias provided data on adverse events and quality of life.The mean difference (MD) of the change in BMI at the longest follow-up period in favour of BCI was -1.18 kg/m2 (95% confidence interval (CI) -1.67 to -0.69); 2774 participants; 28 trials; low quality evidence. BCI lowered the change in BMI z score by -0.13 units (95% CI -0.21 to -0.05); 2399 participants; 20 trials; low quality evidence. BCI lowered body weight by -3.67 kg (95% CI -5.21 to -2.13); 1993 participants; 20 trials; moderate quality evidence. The effect on weight measures persisted in trials with 18 to 24 months' follow-up for both BMI (MD -1.49 kg/m2 (95% CI -2.56 to -0.41); 760 participants; 6 trials and BMI z score MD -0.34 (95% CI -0.66 to -0.02); 602 participants; 5 trials).There were subgroup differences showing larger effects for both BMI and BMI z score in studies comparing interventions with no intervention/wait list control or usual care, compared with those testing concomitant interventions delivered to both the intervention and control group. There were no subgroup differences between interventions with and without parental involvement or by intervention type or setting (health care, community, school) or mode of delivery (individual versus group).The rate of adverse events in intervention and control groups was unclear with only five trials reporting harms, and of these, details were provided in only one (low quality evidence). None of the included studies reported on all-cause mortality, morbidity or socioeconomic effects.BCIs at the longest follow-up moderately improved adolescent's health-related quality of life (standardised mean difference 0.44 ((95% CI 0.09 to 0.79); P = 0.01; 972 participants; 7 trials; 8 comparisons; low quality of evidence) but not self-esteem.Trials were inconsistent in how they measured dietary intake, dietary behaviours, physical activity and behaviour. AUTHORS' CONCLUSIONS We found low quality evidence that multidisciplinary interventions involving a combination of diet, physical activity and behavioural components reduce measures of BMI and moderate quality evidence that they reduce weight in overweight or obese adolescents, mainly when compared with no treatment or waiting list controls. Inconsistent results, risk of bias or indirectness of outcome measures used mean that the evidence should be interpreted with caution. We have identified a large number of ongoing trials (50) which we will include in future updates of this review.
Collapse
Affiliation(s)
- Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Emma Loveman
- Effective Evidence LLP26 The CurveWaterloovilleHampshireUKPO8 9SE
| | - Jill L Colquitt
- Effective Evidence LLP26 The CurveWaterloovilleHampshireUKPO8 9SE
| | - Emma Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Rebecca E Johnson
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Hannah Fraser
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Joan Olajide
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Marie Murphy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Rochelle Marian Velho
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Claire O'Malley
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | - Liane B Azevedo
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | | |
Collapse
|
13
|
Murray J, Aboul-Enein BH, Bernstein J, Kruk J. Selected weight management interventions for military populations in the United States: a narrative report. Nutr Health 2017; 23:67-74. [PMID: 28429642 DOI: 10.1177/0260106017704797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Overweight and obesity continues to be a significant public health burden in the US and particularly among military personnel. Although the US Department of Defense mandates standardized physical activity requirements for military members, incidence and prevalence of overweight and obesity among military personnel continue to increase. Each military department controls their own interventional strategies for physical fitness and weight control. However, unique challenges such as geographic transients, lack of central standardization and empirical efficacy data across military departments, and chronic stress associated with military service adversely affect program outcomes. This brief narrative report explores overweight and obesity interventions among military populations from 2006 to 2016 and includes programmatic reviews of eight overweight and obesity interventions: The Prevention of Obesity in Military Community; Health Eating, Activity, and Lifestyle Training Headquarters (H.E.A.L.T.H); ArmyMOVE!; L.I.F.E.; Look AHEAD; Nutrition-focused Wellness Coaching; Go for Green; and LE3AN. A majority of these interventions did not report significant weight loss 6 months post intervention, and did not mention a theoretical foundation within the interventions. Further research to examine the importance of theory-based programming is warranted to improve process and outcome objectives.
Collapse
Affiliation(s)
- Jessica Murray
- 1 College of Professional Studies, Northeastern University, Boston, MA, USA
| | - Basil H Aboul-Enein
- 2 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Joshua Bernstein
- 3 College of Graduate Health Studies, A.T. Still University of Health Sciences, Kirksville, MO, USA
| | - Joanna Kruk
- 4 Faculty of Physical Culture and Health Promotion, University of Szczecin, Szczecin, Poland
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW The objective was to review prevention efforts and approaches attempting to limit the problem of obesity in the military. RECENT FINDINGS Various individual-level initiatives have emerged, including programs promoting healthy cooking, meal planning, and other behavior changes among service members. Importantly, the military is attempting to tackle environmental factors contributing to the rise of obesity, by focusing on many recent environmental-level interventions and initiatives to improve military dining facilities and examine and modify other aspects of installations' built environments. Although published research within the military setting directed towards obesity prevention is limited, many innovative programs have been launched and need to be followed forward. The review of past and ongoing efforts can be an important step in identifying specific areas needing improvement, gaps that should be considered, lessons learned, and characteristics of successful programs that should be disseminated as best practices and further expanded.
Collapse
Affiliation(s)
- Marissa Shams-White
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Patricia Deuster
- Consortium for Health and Military Performance, A DoD Center of Excellence, Department of Military and Emergency Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| |
Collapse
|
15
|
Haibach JP, Haibach MA, Hall KS, Masheb RM, Little MA, Shepardson RL, Dobmeyer AC, Funderburk JS, Hunter CL, Dundon M, Hausmann LR, Trynosky SK, Goodrich DE, Kilbourne AM, Knight SJ, Talcott GW, Goldstein MG. Military and veteran health behavior research and practice: challenges and opportunities. J Behav Med 2016; 40:175-193. [DOI: 10.1007/s10865-016-9794-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 09/09/2016] [Indexed: 12/01/2022]
|
16
|
Abstract
Parallel to rising obesity rates is an increase in costs associated with excess weight. Estimates of future direct (medical) and indirect (nonmedical) costs related to obesity suggest rising expenditures that will impose a significant economic burden to individuals and society as a whole. This article reviews research on direct and indirect medical costs and future economic trends associated with obesity and associated comorbidities. Cost disparities associated with subsets of the population experiencing higher than average rates of obesity are explored. Finally, potential solutions with the highest estimated impact are offered, and future directions are proposed.
Collapse
Affiliation(s)
- Elena A Spieker
- Department of Family Medicine, Madigan Army Medical Center, 9040 Fitzsimmons Avenue, Fort Lewis, WA 98431, USA; Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Natasha Pyzocha
- Department of Family Medicine, Madigan Army Medical Center, 9040 Fitzsimmons Avenue, Fort Lewis, WA 98431, USA
| |
Collapse
|
17
|
Schvey NA, Sbrocco T, Stephens M, Bryant EJ, Ress R, Spieker EA, Conforte A, Bakalar JL, Pickworth CK, Barmine M, Klein D, Brady SM, Yanovski JA, Tanofsky-Kraff M. Comparison of overweight and obese military-dependent and civilian adolescent girls with loss-of-control eating. Int J Eat Disord 2015; 48:790-4. [PMID: 25955761 PMCID: PMC4543400 DOI: 10.1002/eat.22424] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Limited data suggest that the children of U.S. service members may be at increased risk for disordered-eating. To date, no study has directly compared adolescent military-dependents to their civilian peers along measures of eating pathology and associated correlates. We, therefore, compared overweight and obese adolescent female military-dependents to their civilian counterparts along measures of eating-related pathology and psychosocial functioning. METHOD Adolescent females with a BMI between the 85th and 97th percentiles and who reported loss-of-control eating completed interview and questionnaire assessments of eating-related and general psychopathology. RESULTS Twenty-three military-dependents and 105 civilians participated. Controlling for age, race, and BMI-z, military-dependents reported significantly more binge episodes per month (p < 0.01), as well as greater eating-concern, shape-concern, and weight-concern (p's < 0.01) than civilians. Military-dependents also reported more severe depression (p < 0.05). DISCUSSION Adolescent female military-dependents may be particularly vulnerable to disordered-eating compared with civilian peers. This potential vulnerability should be considered when assessing military-dependents.
Collapse
Affiliation(s)
- Natasha A. Schvey
- Uniformed Services University of the Health Sciences (USUHS),Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | - Tracy Sbrocco
- Uniformed Services University of the Health Sciences (USUHS)
| | - Mark Stephens
- Uniformed Services University of the Health Sciences (USUHS)
| | - Edny J. Bryant
- Uniformed Services University of the Health Sciences (USUHS)
| | - Rachel Ress
- Uniformed Services University of the Health Sciences (USUHS),Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | | | | | | | - Courtney K. Pickworth
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | - Marissa Barmine
- Uniformed Services University of the Health Sciences (USUHS)
| | | | - Sheila M. Brady
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | - Jack A. Yanovski
- Uniformed Services University of the Health Sciences (USUHS),Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | - Marian Tanofsky-Kraff
- Uniformed Services University of the Health Sciences (USUHS),Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| |
Collapse
|