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Manana B, El-Jor C, Abi Kharma J, Zeeni N. Effectiveness of a text-messaging intervention on intuitive eating: a randomised controlled trial. Public Health Nutr 2023; 26:1576-1584. [PMID: 37165660 PMCID: PMC10410380 DOI: 10.1017/s1368980023000939] [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: 05/22/2022] [Revised: 03/18/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023]
Abstract
Intuitive eating (IE) is a concept based on mind-body integration of instinct, emotion and rational thought, to improve eating behaviours, physical and mental health. Several attempts were developed to teach IE principles including text-messaging interventions given that they are easy to implement and low cost. OBJECTIVE The present study aimed to assess the effectiveness of a 5-week text message-based IE intervention on IE, while correcting for perceived stress (PS) and self-compassion (SC). DESIGN A randomised controlled trial. SETTING Online, in Lebanon. PARTICIPANTS Adults (n 195) were randomised into one of three groups: the active IE group receiving IE-related messages with a practice exercise, the passive IE group receiving only IE-related messages and the control group receiving general health-related tips. Ten messages were delivered over 5 weeks. Two follow-ups were made: directly post-intervention and 7 weeks later. Baseline data and follow-ups included demographics, nutrition-related variables and measures of IE, SC and PS. RESULTS Results indicated improvements in IE scores in the two intervention groups (P = 0·05), with the passive IE group showing the most improvement. Also, a significant improvement in SC (Λ = 0·88, F (2, 63) = 4·40, P = 0·01) and reduction in PS (Λ = 0·86, F (2, 63) = 5·21, P = 0·008) were observed in the active IE group. CONCLUSION Text-messaging interventions might be efficient in enhancing IE. Results shed light on the need for further large-scale interventions that use visual aids and provide practical guidance to teach IE, while further characterising the relation between IE, SC and stress.
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Affiliation(s)
- Batoul Manana
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, 36-Byblos, Lebanon
| | - Claire El-Jor
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, 36-Byblos, Lebanon
| | - Joelle Abi Kharma
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, 36-Byblos, Lebanon
| | - Nadine Zeeni
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, 36-Byblos, Lebanon
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2
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Theodoulou A, Hartmann‐Boyce J, Gorenberg J, Oke JL, Butler AR, Bastounis A, Jebb SA, Aveyard P. Weight regain and mental health outcomes following behavioural weight management programmes: A systematic review with meta-analyses. Clin Obes 2023; 13:e12575. [PMID: 36623842 PMCID: PMC10909518 DOI: 10.1111/cob.12575] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/05/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023]
Abstract
Behavioural weight management programmes (BWMPs) lead to weight loss but subsequent weight regain may harm mental health outcomes. We searched for randomised trials of BWMPs in adults with overweight/obesity with follow-up ≥12 months from baseline that measured weight change both at and after programme-end. We included only studies reporting mental health at or after programme-end. We meta-analysed changes in various mental health outcomes using a random-effects model by nature of the comparator group and by time since programme end. Subgroup analysis explored heterogeneity. We used mixed models and meta-regression to analyse the association between change in weight and change in depression and/or anxiety over time, with higher scores indicating greater depression and/or anxiety. We included 47 studies. When comparing BWMPs (diet and/or exercise) to control, most estimates included the possibility of no difference, but pooled estimates for psychological wellbeing, self-esteem and mental-health composite scores at programme-end, anxiety at 1-6 months, and depression at 7-12 months after programme-end suggested improvements in intervention arms relative to control, with 95% CIs excluding no difference. Pooled estimates found no evidence that BWMPs harmed mental health at programme end or beyond. Mental health composite scores at programme-end favoured diet and exercise interventions over diet alone, with 95% CIs excluding no difference. All other measures and timepoints included the possibility of no difference or could not be meta-analysed due to high heterogeneity or a paucity of data. Mixed models and meta-regression of the association between change in depression and/or anxiety scores over time, and change in weight, were inconclusive. Despite weight regain after BWMPs, our meta-analyses found no evidence of mental health harm and some evidence that BWMPs may improve some dimensions of mental health at and after programme-end.
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Affiliation(s)
- Annika Theodoulou
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | | | - Jordan Gorenberg
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Jason L. Oke
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Ailsa R. Butler
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Anastasios Bastounis
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
- Division of Epidemiology and Public Health, School of MedicineUniversity of NottinghamNottinghamUK
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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3
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Hartmann-Boyce J, Theodoulou A, Oke JL, Butler AR, Bastounis A, Dunnigan A, Byadya R, Cobiac LJ, Scarborough P, Hobbs FR, Sniehotta FF, Jebb SA, Aveyard P. Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence and Risk: Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes 2023; 16:e009348. [PMID: 36974678 PMCID: PMC10106109 DOI: 10.1161/circoutcomes.122.009348] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/13/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Behavioral weight management programs (BWMPs) enhance weight loss in the short term, but longer term cardiometabolic effects are uncertain as weight is commonly regained. We assessed the impact of weight regain after BWMPs on cardiovascular risk factors, diabetes, and cardiovascular disease. METHODS Trial registries, 11 databases, and forward-citation searching (latest search, December 19) were used to identify articles published in English, from any geographical region. Randomized trials of BWMPs in adults with overweight/obesity reporting cardiometabolic outcomes at ≥12 months at and after program end were included. Differences between more intensive interventions and comparator groups were synthesized using mixed-effects, meta-regression, and time-to-event models to assess the impact of weight regain on cardiovascular disease incidence and risk. RESULTS One hundred twenty-four trials reporting on ≥1 cardiometabolic outcomes with a median follow-up of 28 (range, 11-360) months after program end were included. Median baseline participant body mass index was 33 kg/m2; median age was 51 years. Eight and 15 study arms (7889 and 4202 participants, respectively) examined the incidence of cardiovascular disease and type 2 diabetes, respectively, with imprecise evidence of a lower incidence for at least 5 years. Weight regain in BWMPs relative to comparators reduced these differences. One and 5 years after program end, total cholesterol/HDL (high-density lipoprotein) ratio was 1.5 points lower at both times (82 studies; 19 003 participants), systolic blood pressure was 1.5 mm mercury and 0.4 mm lower (84 studies; 30 836 participants), and HbA1c (%) 0.38 lower at both times (94 studies; 28 083 participants). Of the included studies, 22% were judged at high risk of bias; removing these did not meaningfully change results. CONCLUSIONS Despite weight regain, BWMPs reduce cardiometabolic risk factors with effects lasting at least 5 years after program end and dwindling with weight regain. Evidence that they reduce the incidence of cardiovascular disease or diabetes is less certain. Few studies followed participants for ≥5 years. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42018105744.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Jason L. Oke
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom (J.L.O.)
| | - Ailsa R. Butler
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Anastasios Bastounis
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom (A.B.)
| | - Anna Dunnigan
- Oxford University Hospitals NHS Foundation Trust, United Kingdom (A.D.)
- Royal Free London NHS Foundation Trust, United Kingdom (A.D.)
| | - Rimu Byadya
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
- United Nations World Food Programme, Cox’s Bazar, Bangladesh, India (R.B.)
| | - Linda J. Cobiac
- Nuffield Department of Population Health, Centre on Population Approaches for Non-Communicable Disease Prevention (L.J.C.), University of Oxford, United Kingdom
| | - Peter Scarborough
- Nuffield Department of Population Health, Oxford Biomedical Research Centre (P.S.), University of Oxford, United Kingdom
| | - F.D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Falko F. Sniehotta
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, United Kingdom (F.F.S.)
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
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4
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Morgan-Bathke M, Raynor HA, Baxter SD, Halliday TM, Lynch A, Malik N, Garay JL, Rozga M. Medical Nutrition Therapy Interventions Provided by Dietitians for Adult Overweight and Obesity Management: An Academy of Nutrition and Dietetics Evidence-Based Practice Guideline. J Acad Nutr Diet 2023; 123:520-545.e10. [PMID: 36462613 DOI: 10.1016/j.jand.2022.11.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
Overweight and obesity affect most adults living in the United States and are causally linked to several adverse health outcomes. Registered dietitian nutritionists or international equivalents (dietitians) collaborate with each client and other health care professionals to meet client-centered goals, informed by the best available evidence, and translated through a lens of clinical expertise and client circumstances and preferences. Since the last iteration of the Academy of Nutrition and Dietetics guideline on adult weight management in 2014, considerable research has been conducted and circumstances confronting dietitians have evolved. Thus, updated guidance is needed. The objective of this evidence-based practice guideline is to provide recommendations for dietitians who deliver medical nutrition therapy behavioral interventions for adults (18 years and older) with overweight and obesity to improve cardiometabolic outcomes, quality of life, and weight outcomes, when appropriate for and desired by the client. Recommendations in this guideline highlight the importance of considering complex contributors to overweight and obesity and individualizing interventions to client-centered goals based on specific needs and preferences and shared decision making. The described recommendations have the potential to increase access to care and decrease costs through utilization of telehealth and group counseling as effective delivery methods, and to address other barriers to overweight and obesity management interventions. It is essential for dietitians to collaborate with clients and interprofessional health care teams to provide high-quality medical nutrition therapy interventions using the nutrition care process to promote attainment of client-centered outcomes for adults with overweight or obesity.
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Affiliation(s)
- Maria Morgan-Bathke
- Department of Nutrition and Dietetics, Viterbo University, La Crosse, Wisconsin
| | - Hollie A Raynor
- College of Education, Health, and Human Sciences, University of Tennessee, Knoxville, Tennessee
| | | | - Tanya M Halliday
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah
| | - Amanda Lynch
- Department of Interdisciplinary Health Sciences, Oakland University, Rochester, MI
| | - Neal Malik
- Department of Health Science and Human Ecology, California State University, San Bernardino, San Bernardino, California
| | - Jessica L Garay
- Department of Nutrition and Food Studies, Syracuse University, Syracuse
| | - Mary Rozga
- Academy of Nutrition and Dietetics, Chicago, Illinois.
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5
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Jarraya S, Jarraya M, Engel FA. Kindergarten-Based Progressive Muscle Relaxation Training Enhances Attention and Executive Functioning in 5-6-year-old Children: A Randomized Controlled Trial. Percept Mot Skills 2022; 129:644-669. [PMID: 35090365 DOI: 10.1177/00315125221080334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the present study we assessed the impact of kindergarten-based progressive muscle relaxation (PMR) on attention and executive functioning of 5-6-year-old children. In this randomized-controlled trial, 52 children (26 female; 26 male; M age = 5.4, SD = 0.2 years) from two private Tunisian kindergartens were randomly assigned to experimental and control groups. Over 12 weeks, 18 children performed PMR in two 30-minute sessions/week, another 17 children performed generic physical education (PE) for two 30-minute sessions/week, and 17 children in a control group (CG) had no systematically guided physical activity and engaged in usual self-chosen activities like free play or artisanal activities during Kindergarten hours. Prior to (T0) and after (T1) the 12-week PMR intervention, all participants completed the Visuomotor Precision and Statue subtests of the Neuropsychological Evaluation Battery (NEPSY-2), the Teddy Bear Cancellation Test, and the Rey Simple Figure Test. While there were no significant group differences at T0, repeated measures analysis of variance revealed higher scores for the PMR group relative to both the PE and CG groups on measures of attention, visuomotor precision, memory, and motor inhibition. PMR provided an effective relaxation technique and enhanced attention and executive functioning of these 5-6-year-old children, with important implications for assisting learning and academic achievement among young children.
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Affiliation(s)
- Sana Jarraya
- Research Unit, High Institute of Sport and Physical Education
| | - Mohamed Jarraya
- Research Unit, High Institute of Sport and Physical Education
| | - Florian A Engel
- Integrative & Experimental Exercise Science & Training9190Universität Würzburg
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6
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Cingil D, Göger S. Effect of education and counseling on anthropometric measures and healthy lifestyle behavior among overweight and obese women. Transl Behav Med 2020; 10:1450-1457. [PMID: 31170295 DOI: 10.1093/tbm/ibz084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is extremely important to develop and maintain healthy lifestyle behaviors, particularly in overweight and obese women. PURPOSE This study aimed to evaluate the effect of education and counseling on healthy lifestyle behaviors among overweight and obese women who attend a sports center. METHODS This pretest-posttest interventional study included a total of 60 women aged 18-49 years [intervention (n = 30) and control (n = 30)]. The data were collected using an introductory information form, the Healthy Lifestyle Behaviours Scale II, and an anthropometric measurements follow-up form. The participants in the intervention group were provided with education and counseling. The control group was administered the standard procedure at the sports center. RESULTS In the pretest comparison of the intervention and control groups, values of health responsibility, interpersonal relations, and spiritual development were greater in the control group than in the intervention group, and the difference was statistically significant (p < 0.05). In the posttest comparison, there was no statistically significant difference between the groups in terms of waist/hip ratio, BMI, interpersonal relations, and spiritual development (p > 0.05). It was found in multiple regression analysis: the BMI posttest (β = -0.250, p = 0.028) predict negatively 25% of the HLBS II posttest total score and being in the intervention group (β = 0.486, p < 0.001) predict positively 49% of (p < 0.001). CONCLUSIONS Training and counseling based on the health promotion model are effective in developing healthy lifestyle behaviors. Women aged 18-49 years should be more frequently monitored in terms of obesity.
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Affiliation(s)
- Dilek Cingil
- Nursing Faculty, Public Health Nursing, Necmettin Erbakan University, Konya, Turkey
| | - Seda Göger
- Geriatric Care, Department of Health Care Services, Vocational School of Health Services, Sakarya University, Sakarya, Turkey
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7
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Wiss D, Brewerton T. Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint. Nutrients 2020; 12:E2937. [PMID: 32992768 PMCID: PMC7600542 DOI: 10.3390/nu12102937] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023] Open
Abstract
Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction "diagnosis" among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or "the signal") from the more classic eating pathology (true negatives, or "restraint") that can potentially elevate food addiction scores (false positives, or "the noise"). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.
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Affiliation(s)
- David Wiss
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90025, USA
| | - Timothy Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA;
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8
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Masih T, Dimmock JA, Guelfi KJ. The effect of a single, brief practice of progressive muscle relaxation after exposure to an acute stressor on subsequent energy intake. Stress Health 2019; 35:595-606. [PMID: 31430020 DOI: 10.1002/smi.2891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/04/2019] [Accepted: 08/08/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Given previous research suggests an association between stress and the intake of energy-dense foods, this study investigated whether poststressor relaxation practice can attenuate stress-induced eating. METHODS Twenty-five men and women were exposed to four conditions on separate days: an acute laboratory stressor (S), acute stressor followed by 20 min of relaxation (SR) in the form of Abbreviated Progressive Muscle Relaxation (APMR), relaxation alone (R), and a control condition (C). Physiological and psychological responses to stress and relaxation were assessed, in addition to the subsequent energy intake of high-energy snacks. RESULTS Salivary cortisol, blood pressure, heart rate, and perceived stress were transiently elevated postlaboratory stressor (S and SR compared with R and C; p < .05). Meanwhile, perceived relaxation was acutely enhanced after APMR alone (R) compared with S, SR, and C (p < .05) and in SR (immediately after the APMR) compared with S (p < .05). No difference in mean energy intake was observed between conditions (p > .05). Likewise, no differences in perceived appetite or the levels of ghrelin, leptin, and insulin were found between conditions (p > .05). CONCLUSIONS Much variation exists in stress-induced dietary responses, and APMR either postacute stressor or in isolation does not appear to consistently alter the intake of commonly eaten snacks.
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Affiliation(s)
- Tasmiah Masih
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
| | - James A Dimmock
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
| | - Kym J Guelfi
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
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9
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Di Noia J, Schultz S, Monica D. Recruitment and retention of WIC participants in a longitudinal dietary intervention trial. Contemp Clin Trials Commun 2019; 16:100438. [PMID: 31535056 PMCID: PMC6744523 DOI: 10.1016/j.conctc.2019.100438] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 08/03/2019] [Accepted: 08/21/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND This paper describes strategies and outcomes of techniques to recruit and retain low-income women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in a longitudinal dietary intervention trial. METHODS Community engagement strategies, methods to recruit and retain participants, and recruitment and retention rates are reported. Demographic and lifestyle predictors of loss to follow-up, contacts required to reach participants at each data collection point, participant reactions to the recruitment and retention strategies used, and reasons for drop out (assessed among those who discontinued their study involvement) also were examined. RESULTS Of 1281 eligible women, 744 were enrolled (58% recruitment rate); retention rates were 87%, 70%, and 55%, respectively, 2 weeks and 3 and 6 months post-intervention. Being unmarried, younger, and having low baseline vegetable intake predicted loss to follow-up. Between 4 and 5 contact attempts and 1 and 2 completed contacts were required to reach participants at each data collection point. Participants endorsed recruiting women while waiting for WIC appointments (as they were accessible, perceived the information provided as informative, and wanted to pass the time) and by word of mouth. Lacking time and loss of interest were commonly reported reasons for not completing assessments and dropout. To improve retention, shortening telephone assessments, conducting the assessments in person, and increasing the amount of incentives were recommended. CONCLUSION Despite using recommended strategies, recruitment and retention rates were modest. Research is needed to identify and test approaches to effectively engage WIC-enrolled adults in health intervention trials.
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Affiliation(s)
- Jennifer Di Noia
- William Paterson University, 300 Pompton Road, Wayne, NJ, 07470, USA
| | - Stephanie Schultz
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 W 120th Street, New York, NY, 10027, USA
| | - Dorothy Monica
- Saint Joseph's WIC Program, 185 6th Avenue, Paterson, NJ, 07524, USA
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10
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Fuentes Artiles R, Staub K, Aldakak L, Eppenberger P, Rühli F, Bender N. Mindful eating and common diet programs lower body weight similarly: Systematic review and meta-analysis. Obes Rev 2019; 20:1619-1627. [PMID: 31368631 DOI: 10.1111/obr.12918] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 12/27/2022]
Abstract
Common strategies for reducing body weight rely on limiting energy intake and restricting food choices. However, these strategies have often been proven ineffective in achieving long-term and sustainable weight reduction. More recently, mindful eating as an alternative weight management strategy has gained increasing attention, yet systematic reviews on intuitive or mindful eating published so far present contradictory results. We performed a systematic review and meta-analysis on randomized controlled trials on weight loss programs based on mindful or intuitive eating. We analyzed results using meta-regressions. We included a total of 10 studies and found a significant weight loss effect of mindful/intuitive eating strategies compared with nonintervention controls (-0.348 kg, 95% CI: -0.591 to -0.105, P = 0.005). However, there was no difference compared with conventional diet programs (P = 0.99). Reduction of BMI (-0.137 kg/m2 , 95% CI: -0.365 to 0.091, P = 0.240) or waist circumference (-0.358 cm, 95% CI: -0.916 to 0.200, P = 0.209) were not statistically significant. Mindful/intuitive eating could be a practical approach to weight control. Limitations of this study include the unbalanced sex, origin, place of residence of the participants, and the short duration of interventions. Future research should aim at investigating long-term effects and include a more heterogeneous study population.
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Affiliation(s)
| | - Kaspar Staub
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Lafi Aldakak
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Patrick Eppenberger
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Frank Rühli
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Nicole Bender
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
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11
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Schuette SAP, Cordero E, Slosburg K, Addington EL, Victorson D. A Scoping Review of Positive Lifestyle and Wellness Interventions to Inform the Development of a Comprehensive Health Promotion Program: "HealthPro". Am J Lifestyle Med 2019; 13:336-346. [PMID: 31285713 PMCID: PMC6600616 DOI: 10.1177/1559827617704825] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 11/17/2022] Open
Abstract
Background. Lifestyle medicine has emerged as a transformational force in mainstream health care. Numerous health promotion and wellness programs have been created to facilitate the adoption of increased positive, modifiable health behaviors to prevent and lessen the effects of chronic disease. This article provides a scoping review of available health promotion interventions that focus on healthy adult populations in the past 10 years. Methods. We conducted a scoping review of the literature searching for health promotion interventions in the past 10 years. Interventions were limited to those conducted among healthy adults that offered a face-to-face, group-based format, with positive results on one or more health outcomes. We then developed a new health promotion intervention that draws on multiple components of included interventions. Results. Fifty-eight articles met our inclusion criteria. Physical activity was the primary focus of a majority (N = 47) of articles, followed by diet/nutrition (N = 40) and coping/social support (N = 40). Conclusions. Efficacious health promotion interventions are critical to address the prevention of chronic disease by addressing modifiable risk factors such as exercise, nutrition, stress, and coping. A new intervention, discussed is this article, provides a comprehensive approaches to health behavior change and may be adapted for future research.
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Affiliation(s)
- Stephanie A. P. Schuette
- Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine, Chicago, Illinois (SAPS, EC, KS, ELA, DV)
- Osher Center for Integrative Medicine at Northwestern,
Northwestern Medicine, Chicago, Illinois (SAPS, ELA, DV)
| | - Evelyn Cordero
- Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine, Chicago, Illinois (SAPS, EC, KS, ELA, DV)
- Osher Center for Integrative Medicine at Northwestern,
Northwestern Medicine, Chicago, Illinois (SAPS, ELA, DV)
| | - Katherine Slosburg
- Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine, Chicago, Illinois (SAPS, EC, KS, ELA, DV)
- Osher Center for Integrative Medicine at Northwestern,
Northwestern Medicine, Chicago, Illinois (SAPS, ELA, DV)
| | - Elizabeth L. Addington
- Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine, Chicago, Illinois (SAPS, EC, KS, ELA, DV)
- Osher Center for Integrative Medicine at Northwestern,
Northwestern Medicine, Chicago, Illinois (SAPS, ELA, DV)
| | - David Victorson
- David Victorson, PhD, 2205 Tech Drive, Suite 2-120,
Northwestern University, Chicago, IL 60208; e-mail:
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12
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Langer SL, Soltero EG, Beresford SA, McGregor BA, Albano DL, Patrick DL, Bowen DJ. Socioeconomic status differences in food consumption following a laboratory-induced stressor. Health Psychol Open 2018; 5:2055102918804664. [PMID: 30345065 PMCID: PMC6187431 DOI: 10.1177/2055102918804664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We examined food consumption in response to a laboratory-induced stressor (two challenging neuropsychological tasks) among non-Hispanic White women categorized as lower or higher in socioeconomic status based on education. The two socioeconomic status groups did not differ with respect to current hunger or baseline dietary habits. Perceived stress was measured pre- and post-challenge. Snacks were offered post-challenge; food consumption was measured by weighing snack bowls pre- and post-offering. Perceived stress increased pre- to post-challenge for both groups, but this effect was stronger for women lower in socioeconomic status. In addition, women lower versus higher in socioeconomic status consumed more food overall and more high-fat sweet food in particular (large effect sizes). These findings provide evidence of socioeconomic status differences in food consumption following an acute stressor.
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Emmanouil CC, Pervanidou P, Charmandari E, Darviri C, Chrousos GP. The effectiveness of a health promotion and stress-management intervention program in a sample of obese children and adolescents. Hormones (Athens) 2018; 17:405-413. [PMID: 30099726 DOI: 10.1007/s42000-018-0052-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/26/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Our study aimed to evaluate the effectiveness of an 8-week stress management intervention program that included progressive muscle relaxation, diaphragmatic breathing, guided imagery, and cognitive restructuring in obese Greek children and adolescents. DESIGN Thirty-six patients were prospectively recruited to participate in this randomized controlled study. Of these, 16 participants formed the intervention group and 20 participants the control group. Anthropometric measurements and salivary cortisol, determined serially 3 times a day, were assessed at the beginning and at the end of the study. Participants also completed the state-trait anxiety in children questionnaire (STAIC), the stress in children questionnaire (SiC), and the child behavior checklist (CBCL). RESULTS The intervention resulted in a significant reduction of waist-hip ratio (p = 0.008) in the intervention group compared with the control group. Moreover, school performance was improved in the intervention group (p = 0.025), while both the intervention and the control group adopted healthier daily habits (p = 0.020 and 0.011, respectively). However, there was no statistically significant difference between body mass index (BMI) z-score, stress, anxiety, and diurnal patterns in salivary cortisol. CONCLUSIONS The present study supports the effectiveness of stress management intervention programs on waist-hip ratio reduction. Further research is required to investigate biomarkers able to predict and evaluate the effectiveness of stress management intervention programs.
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Affiliation(s)
- Chrysoula-Christina Emmanouil
- Postgraduate Course Stress Management and Health Promotion, University of Athens Medical School, 4 Soranou Ephessiou Str., GR-115-27, Athens, Greece
| | - Panagiota Pervanidou
- First Department of Pediatrics, University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Evangelia Charmandari
- First Department of Pediatrics, University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Christina Darviri
- Postgraduate Course Stress Management and Health Promotion, University of Athens Medical School, 4 Soranou Ephessiou Str., GR-115-27, Athens, Greece.
| | - George P Chrousos
- Postgraduate Course Stress Management and Health Promotion, University of Athens Medical School, 4 Soranou Ephessiou Str., GR-115-27, Athens, Greece
- First Department of Pediatrics, University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
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Bégin C, Carbonneau E, Gagnon-Girouard MP, Mongeau L, Paquette MC, Turcotte M, Provencher V. Eating-Related and Psychological Outcomes of Health at Every Size Intervention in Health and Social Services Centers Across the Province of Québec. Am J Health Promot 2018; 33:248-258. [DOI: 10.1177/0890117118786326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report the outcomes of a Health at Every Size (HAES) intervention in a real-world setting. Design: Quasi-experimental design evaluating eating behaviors and psychological factors. Setting: The HAES intervention is offered in Health and Social Services Centers in Québec (Canada). Participants: For this study, 216 women (body mass index [BMI]: 35.76 [6.80] kg/m2) who participated to the HAES intervention were compared to 110 women (BMI: 34.56 [7.30] kg/m2) from a comparison group. Intervention: The HAES intervention is composed of 14 weekly meetings provided by health professionals. It focuses on healthy lifestyle, self-acceptance, and intuitive eating. Measures: Eating behaviors (ie, flexible restraint, rigid restraint, disinhibition, susceptibility to hunger, intuitive eating, and obsessive-compulsive eating) and psychological correlates (ie, body esteem, self-esteem, and depression) were assessed using validated questionnaires at baseline, postintervention, and 1-year follow-up. Analysis: Group, time, and interaction effects analyzed with mixed models. Results: Significant group by time interactions were found for flexible restraint ( P = .0400), disinhibition ( P < .0001), susceptibility to hunger ( P < .0001), intuitive eating ( P < .0001), obsessive–compulsive eating ( P < .0001), body-esteem ( P < .0001), depression ( P = .0057), and self-esteem ( P < .0001), where women in the HAES group showed greater improvements than women in the comparison group at short and/or long term. Conclusion: The evaluation of this HAES intervention in a real-life context showed its effectiveness in improving eating-, weight-, and psychological-related variables among women struggling with weight and body image.
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Affiliation(s)
- Catherine Bégin
- Institute of Nutrition and Functional Foods, Laval University, Québec, Canada
- School of Psychology, Laval University, Québec, Canada
| | - Elise Carbonneau
- Institute of Nutrition and Functional Foods, Laval University, Québec, Canada
- School of Nutrition, Laval University, Québec, Canada
| | | | - Lyne Mongeau
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada
- School of Public Health, University of Montreal, Montreal, Canada
| | - Marie-Claude Paquette
- Institut national de santé publique du Québec, Québec, Canada
- Department of Nutrition, University of Montreal, Montreal, Canada
| | - Mylène Turcotte
- Institute of Nutrition and Functional Foods, Laval University, Québec, Canada
- School of Nutrition, Laval University, Québec, Canada
| | - Véronique Provencher
- Institute of Nutrition and Functional Foods, Laval University, Québec, Canada
- School of Nutrition, Laval University, Québec, Canada
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15
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Homan KJ, Tylka TL. Development and exploration of the gratitude model of body appreciation in women. Body Image 2018; 25:14-22. [PMID: 29428332 DOI: 10.1016/j.bodyim.2018.01.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 01/14/2018] [Accepted: 01/30/2018] [Indexed: 02/09/2023]
Abstract
Although researchers and clinicians recognize the importance of positive body image for women's well-being, development of theoretical frameworks for understanding positive body image has not kept pace with research documenting its many benefits. The present study proposed and tested a comprehensive model linking gratitude, contingent self-worth, social comparison, body appreciation, and intuitive eating. Path analysis indicated that this model fit the data for a sample of college and online community women (N = 263). Gratitude was indirectly linked to body appreciation via lower investment in self-worth based on appearance and others' approval, and via lower engagement in eating and body comparison. Gratitude had a strong direct effect on body appreciation, and body appreciation accounted for a large portion (88%) of gratitude's relationship with intuitive eating. These results provide strong preliminary support for the model, revealing that gratitude, which can be improved via intervention, plays a key role in body appreciation.
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Affiliation(s)
- Kristin J Homan
- Department of Psychology, Grove City College, Grove City, PA, USA.
| | - Tracy L Tylka
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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16
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Ulian MD, Gualano B, Benatti FB, de Campos-Ferraz PL, Coelho D, Roble OJ, Sabatini F, Perez I, Aburad L, Pinto AJ, Vessoni A, Victor JC, Lima VK, Unsain RF, de Morais Sato P, Rogero MM, Toporcov TN, Scagliusi FB. The design and rationale of an interdisciplinary, non-prescriptive, and Health at Every Size®-based clinical trial: The "Health and Wellness in Obesity" study. Nutr Health 2017; 23:261-270. [PMID: 29214922 DOI: 10.1177/0260106017731260] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This manuscript describes the design and rationale of a clinical trial that aims to investigate the multiple physiological, attitudinal, nutritional, and behavioral effects of a new interdisciplinary intervention based on the Health at Every Size® (HAES®) approach in obese women. METHODS This will be a prospective, 7-month, randomized (2:1), mixed-method clinical trial. Obese women will be recruited and randomly allocated into two groups. The intervention group (I-HAES®; proposed n = 40) will undertake a novel HAES®-based intervention. Participants will take part in an exercise program, nutrition counseling sessions, and philosophical workshops, all aligned with the principles of the HAES® approach. The control group (CTRL; proposed n = 20) will participate in a program using a traditional HAES®-based group format, characterized by bimonthly lectures about the same topics offered to the experimental group, encouraging the adoption of a healthy lifestyle. The following multiple quantitative outcomes will be assessed pre and post intervention: health-related quality of life, cardiovascular risk factors, anthropometric assessments, physical activity level, physical capacity and function, and psychological and behavioral assessments. Qualitative analysis will be used to evaluate the experiences of the participants throughout the intervention, as assessed by focus groups and semi-structured interviews. CONCLUSIONS The interdisciplinary research team leading this study has varied and complementary expertise. The knowledge arising from this study will help to guide new interdisciplinary interventions with the potential to holistically improve the health of obese individuals. This trial is registered at Clinicaltrials.gov (NCT02102061).
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Affiliation(s)
- Mariana D Ulian
- 1 School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Bruno Gualano
- 2 Applied Physiology & Nutrition Research Group, University of São Paulo, Brazil
| | - Fabiana B Benatti
- 2 Applied Physiology & Nutrition Research Group, University of São Paulo, Brazil
| | | | - Desire Coelho
- 2 Applied Physiology & Nutrition Research Group, University of São Paulo, Brazil
| | - Odilon J Roble
- 4 Faculty of Physical Education, State University of Campinas, Campinas, Brazil
| | - Fernanda Sabatini
- 1 School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Isabel Perez
- 1 School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Luiz Aburad
- 1 School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Ana Jéssica Pinto
- 2 Applied Physiology & Nutrition Research Group, University of São Paulo, Brazil
| | - André Vessoni
- 1 School of Public Health, University of São Paulo, São Paulo, Brazil
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Stress-induced eating and the relaxation response as a potential antidote: A review and hypothesis. Appetite 2017; 118:136-143. [DOI: 10.1016/j.appet.2017.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 07/27/2017] [Accepted: 08/04/2017] [Indexed: 11/15/2022]
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US Registered Dietitian Nutritionists' Knowledge and Attitudes of Intuitive Eating and Use of Various Weight Management Practices. J Acad Nutr Diet 2017; 117:1419-1428. [PMID: 28619668 DOI: 10.1016/j.jand.2017.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 04/20/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Researchers have been advocating for a new weight-inclusive paradigm that focuses on health rather than weight. One important component of this model is intuitive eating. Although registered dietitian nutritionists (RDNs) are the nation's food and nutrition experts, RDNs' knowledge of and attitudes toward intuitive eating and use of traditional or restrictive strategies are unknown. OBJECTIVE The purpose of this study was to characterize RDNs' knowledge of and attitudes toward an intuitive eating lifestyle and describe use of traditional weight management and nonrestrictive lifestyle practices with clients. DESIGN This was a cross-sectional study. PARTICIPANTS A validated survey was distributed using online survey software to 88,834 RDNs. RESULTS There were 18,622 respondents who completed the survey (25%). The majority of RDNs were knowledgeable about intuitive eating, answering 71% of items correctly. The majority of RDNs had a positive view on each attitude item. RDNs who work in weight management reported using nonrestrictive/intuitive eating practices more than traditional/restrictive practices. RDNs who were women (P<0.001), had advanced education (P<0.001), worked in a private practice setting (P<0.001), completed at least one certificate of training in weight management (P<0.001), had more experience in weight management counseling (P<0.001), and had greater intuitive eating knowledge (P<0.001) were more likely to report greater use of nonrestrictive/intuitive eating practices. CONCLUSIONS This study provides evidence that RDNs are using an intuitive eating approach more often than traditional weight management practices.
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Daundasekara SS, Beasley AD, O'Connor DP, Sampson M, Hernandez D, Ledoux T. Validation of the intuitive Eating Scale for pregnant women. Appetite 2017; 112:201-209. [DOI: 10.1016/j.appet.2017.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
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20
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Sampaio CVS, Lima MG, Ladeia AM. Efficacy of Healing meditation in reducing anxiety of individuals at the phase of weight loss maintenance: A randomized blinded clinical trial. Complement Ther Med 2016; 29:1-8. [DOI: 10.1016/j.ctim.2016.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/27/2016] [Accepted: 08/24/2016] [Indexed: 11/26/2022] Open
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21
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Carbonneau E, Bégin C, Lemieux S, Mongeau L, Paquette MC, Turcotte M, Labonté MÈ, Provencher V. A Health at Every Size intervention improves intuitive eating and diet quality in Canadian women. Clin Nutr 2016; 36:747-754. [PMID: 27378611 DOI: 10.1016/j.clnu.2016.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/15/2016] [Accepted: 06/11/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND & AIMS Health at Every Size® (HAES®) interventions focus on healthy lifestyle by promoting behavioral changes related to diet and physical activity while emphasizing self-acceptance and well-being through an empowerment and intuitive approach. The purpose of this study was to investigate the effects of a HAES® program on intuitive eating and diet quality in women. METHODS The HAES® intervention, offered by professionals from Health and Social Services Centers in Quebec (Canada), was composed of thirteen 3-h weekly meetings and a 6-h intensive day. For this study, 216 women (1.9% normal-weight, 21.1% overweight, 77.0% obese) who took part to the HAES program were compared to 110 women (3.9% normal-weight, 23.3% overweight, 72.8% obese) from a control group (waiting list). Intuitive eating was assessed using the Intuitive Eating Scale and diet quality was evaluated through the calculation of the Healthy Eating Index (HEI) from a validated web-based self-administrated food frequency questionnaire. Measurements were performed at baseline, post-intervention, and at one-year follow-up. RESULTS Women who participated in the HAES® program significantly increased their intuitive eating score compared to women in the control group at post-intervention and at follow-up (group by time interaction, p = 0.0002). A significant improvement in diet quality was also observed in the HAES® group in comparison with the control group at post-intervention (group by time interaction, p = 0.0139). The intuitive eating score and the HEI score were positively associated in the HAES® group at post-intervention (r = 0.20, p = 0.0237) and one-year follow-up (r = 0.22, p = 0.0359), but no such associations were noted in the control group (post-intervention, r = 0.04, p = 0.70; one-year follow-up, r = -0.15, p = 0.30). CONCLUSIONS The HAES® program seems effective in improving intuitive eating and also favours improvements in diet quality. However, the association between intuitive eating and diet quality remains unclear, being positive and significant only after the HAES® intervention.
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Affiliation(s)
- Elise Carbonneau
- Institute of Nutrition and Functional Foods, Laval University, Québec, QC, Canada
| | | | - Simone Lemieux
- Institute of Nutrition and Functional Foods, Laval University, Québec, QC, Canada
| | - Lyne Mongeau
- Ministère de la Santé et des Services Sociaux, Québec, QC, Canada
| | | | - Mylène Turcotte
- Institute of Nutrition and Functional Foods, Laval University, Québec, QC, Canada
| | - Marie-Ève Labonté
- Institute of Nutrition and Functional Foods, Laval University, Québec, QC, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Véronique Provencher
- Institute of Nutrition and Functional Foods, Laval University, Québec, QC, Canada.
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22
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Mensinger JL, Calogero RM, Stranges S, Tylka TL. A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial. Appetite 2016; 105:364-74. [PMID: 27289009 DOI: 10.1016/j.appet.2016.06.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/04/2016] [Accepted: 06/06/2016] [Indexed: 12/29/2022]
Abstract
Weight loss is the primary recommendation for health improvement in individuals with high body mass index (BMI) despite limited evidence of long-term success. Alternatives to weight-loss approaches (such as Health At Every Size - a weight-neutral approach) have been met with their own concerns and require further empirical testing. This study compared the effectiveness of a weight-neutral versus a weight-loss program for health promotion. Eighty women, aged 30-45 years, with high body mass index (BMI ≥ 30 kg/m(2)) were randomized to 6 months of facilitator-guided weekly group meetings using structured manuals that emphasized either a weight-loss or weight-neutral approach to health. Health measurements occurred at baseline, post-intervention, and 24-months post-randomization. Measurements included blood pressure, lipid panels, blood glucose, BMI, weight, waist circumference, hip circumference, distress, self-esteem, quality of life, dietary risk, fruit and vegetable intake, intuitive eating, and physical activity. Intention-to-treat analyses were performed using linear mixed-effects models to examine group-by-time interaction effects and between and within-group differences. Group-by-time interactions were found for LDL cholesterol, intuitive eating, BMI, weight, and dietary risk. At post-intervention, the weight-neutral program had larger reductions in LDL cholesterol and greater improvements in intuitive eating; the weight-loss program had larger reductions in BMI, weight, and larger (albeit temporary) decreases in dietary risk. Significant positive changes were observed overall between baseline and 24-month follow-up for waist-to-hip ratio, total cholesterol, physical activity, fruit and vegetable intake, self-esteem, and quality of life. These findings highlight that numerous health benefits, even in the absence of weight loss, are achievable and sustainable in the long term using a weight-neutral approach. The trial positions weight-neutral programs as a viable health promotion alternative to weight-loss programs for women of high weight.
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Affiliation(s)
- Janell L Mensinger
- Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA, 19611, USA.
| | | | - Saverio Stranges
- Department of Population Health, Luxembourg Institute of Health, Luxembourg
| | - Tracy L Tylka
- Department of Psychology, The Ohio State University, USA
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23
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Validation of an instrument to measure registered dietitians'/nutritionists' knowledge, attitudes and practices of an intuitive eating approach. Public Health Nutr 2016; 19:3114-3122. [PMID: 27246613 DOI: 10.1017/s1368980016001336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of the present study was to develop and assess the construct validity of a tool to measure knowledge, attitudes and practices of registered dietitians/nutritionists (RD/N) regarding an intuitive eating lifestyle. DESIGN Cross-sectional study design that utilized a survey administered to a random sample and remaining full population of RD/N. SETTING A national survey conducted via online survey software. SUBJECTS A random sample of 10 % of all RD/N in the USA (n 8834) was invited to participate. Survey completion rate was 22·2 % (n 1897). After initial validation, the survey was distributed to the remaining 90 % of RD/N to confirm validation. RESULTS After removing items with insufficient factor loadings, results were consistent with a four-factor solution: (i) knowledge of intuitive eating; (ii) attitudes towards intuitive eating; (iii) traditional and restrictive practices; and (iv) non-restrictive and intuitive eating practices. Confirmatory factor analysis provided further evidence of the validity of the four factors and the factors had strong reliability. CONCLUSIONS Unlike the hypothesized three-factor solution (knowledge, attitudes and practices), validation analysis revealed that the survey measures knowledge of intuitive eating, attitudes towards intuitive eating, use of traditional and restrictive weight-management practices, and use of non-restrictive and intuitive eating practices. With the landscape of weight management and health promotion undergoing a shift towards a health centred, size acceptance approach, this instrument will provide valuable information regarding the current knowledge, attitudes and practices of RD/N and other health promotion professionals.
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Khasteganan N, Lycett D, Turner AP, Farley A, Lindson-Hawley N, Furze G. Health, not weight loss, focused programmes versus conventional weight loss programmes for cardiovascular risk factors. Hippokratia 2016. [DOI: 10.1002/14651858.cd011182.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nazanin Khasteganan
- Coventry University; Faculty of Health and Life Sciences; Priory Street Coventry Warwickshire UK CV1 5FB
| | - Deborah Lycett
- Coventry University; Faculty of Health and Life Sciences; Priory Street Coventry Warwickshire UK CV1 5FB
| | - Andy P Turner
- Coventry University; Faculty of Health and Life Sciences; Priory Street Coventry Warwickshire UK CV1 5FB
| | - Amanda Farley
- University of Birmingham; Public Health, Epidemiology and Biostatistics; Edgbaston Birmingham West Midlands UK B15 2TT
| | - Nicola Lindson-Hawley
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford Oxfordshire UK OX2 6GG
| | - Gill Furze
- Coventry University; Faculty of Health and Life Sciences; Priory Street Coventry Warwickshire UK CV1 5FB
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Chang MW, Brown R, Nitzke S, Smith B, Eghtedary K. Stress, sleep, depression and dietary intakes among low-income overweight and obese pregnant women. Matern Child Health J 2016; 19:1047-59. [PMID: 25102810 DOI: 10.1007/s10995-014-1604-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study investigated the mediating roles of sleep and depression on the relationships between stress, fat intake, and fruit and vegetable intake among low-income overweight and obese pregnant women by trimesters. Participants (N = 213) completed a self-administered survey including stress (exogenous variable), depression, sleep (mediators), fat intake, and fruit and vegetable intake (endogenous variables). Path analysis was performed to compare mediation effects among pregnant women in each trimester. Consistently across three trimesters, stress was related to depression but not sleep duration, night time sleep disturbance, sleep quality, sleep latency or fat intake. Sleep duration was not associated with depression. Depending on trimester, night time sleep disturbance, sleep quality, and sleep latency were related to depression; night time sleep disturbance and depression affected fat intake; stress influenced fruit and vegetable intake. Sleep duration, sleep disturbance, sleep quality, sleep latency and depression did not mediate the relationships between stress, fat intake, and fruit and vegetable intake in the second and third trimesters. However, depression mediated the relationship between stress and fat intake in the first trimester. Stress management interventions may help low-income overweight and obese pregnant women decrease depressive symptoms and therefore contribute to overall nutritional health.
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Affiliation(s)
- Mei-Wei Chang
- College of Nursing, Michigan State University, 1355 Bogue Street, RM C346, East Lansing, MI, 48824, USA,
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Participant and site characteristics related to participant retention in a diabetes prevention translational project. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 16:41-52. [PMID: 24384689 DOI: 10.1007/s11121-013-0451-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Using multilevel analysis, this study investigated participant and site characteristics associated with participant retention in a multisite diabetes prevention translational project among American Indian and Alaska Native (AI/AN) people. We analyzed data from the Special Diabetes Program for Indians Diabetes Prevention Program (SDPI-DP), a lifestyle intervention to prevent diabetes implemented in 36 AI/AN grantee sites. A total of 2,553 participants were recruited and started the intervention between January 1, 2006 and July 31, 2008. They were offered the 16-session Lifestyle Balance Curriculum from the Diabetes Prevention Program (DPP) in the first 16-24 weeks of intervention. Generalized estimating equation models and proportional hazards models with robust standard error estimates were used to evaluate the relationships of participant and site characteristics with retention. As of July 31, 2009, about 50 % of SDPI-DP participants were lost to follow-up. Those who were younger, male, with lower household income, no family support person, and more baseline chronic pain were at higher risk for both short-term and long-term retention failure (i.e., not completing all 16 DPP sessions and loss to follow-up, respectively). Sites with large user populations and younger staff had lower likelihood of retaining participants successfully. Other site characteristics related to higher risk for retention failure included staff rating of participant disinterest in SDPI-DP and barriers to participant transportation and child/elder care. Future translational initiatives need to pay attention to both participant- and site-level factors in order to maximize participant retention.
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27
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Ulian MD, Benatti FB, de Campos-Ferraz PL, Roble OJ, Unsain RF, de Morais Sato P, Brito BC, Murakawa KA, Modesto BT, Aburad L, Bertuzzi R, Lancha AH, Gualano B, Scagliusi FB. The Effects of a "Health at Every Size(®)"-Based Approach in Obese Women: A Pilot-Trial of the "Health and Wellness in Obesity" Study. Front Nutr 2015; 2:34. [PMID: 26579524 PMCID: PMC4621435 DOI: 10.3389/fnut.2015.00034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 10/12/2015] [Indexed: 12/22/2022] Open
Abstract
This study explored the effects of Health at Every Size(®)-based intervention on obese women by qualitatively evaluating participants' perception toward the program and quantitatively evaluating changes related to psychological, behavioral, and body composition assessments. A prospective 1-year quasi-experimental mixed-method trial was conducted. The mixed-method design was characterized by a spiral method, and quantitative and qualitative findings were combined during the interpretation phase. The qualitative data involved three focus groups; and quantitative data comprised physiological, psychological, and behavioral assessments. Initially, 30 participants were recruited; 14 concluded the intervention. From the focus groups, the following interpretative axes were constructed: the intervention as a period of discoveries; shifting parameters: psychological, physical, and behavioral changes; eating changes, and; redefining success. Body weight, body mass index, total body fat mass, and body fat percentage were significantly decreased after the intervention (-3.6, -3.2, -13.0, and -11.1%, respectively; p ≤ 0.05, within-time effect). Participants reported to be more physically active and perceiving better their bodies. Eating-wise, participants reported that the hunger and satiety cues and the consumption of more frequent meals facilitated their eating changes. Finally, participants reported that they could identify feelings with eating choices and refrain from the restrained behavior. These qualitative improvements were accompanied by modest but significant improvements in quantitative assessments. Clinicaltrials.gov registration: NCT02102061.
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Affiliation(s)
- Mariana Dimitrov Ulian
- Department of Nutrition, Faculty of Public Health, University of São Paulo , São Paulo , Brazil
| | - Fabiana B Benatti
- School of Physical Education and Sport, University of São Paulo , São Paulo , Brazil
| | | | - Odilon J Roble
- Faculty of Physical Education, State University of Campinas , Campinas , Brazil
| | - Ramiro Fernandez Unsain
- Faculty of Philosophy and Letters, National University of Buenos Aires , Buenos Aires , Argentina
| | | | - Bruna Cristina Brito
- Department of Nutrition, Faculty of Public Health, University of São Paulo , São Paulo , Brazil
| | - Karina Akemi Murakawa
- School of Physical Education and Sport, University of São Paulo , São Paulo , Brazil
| | - Bruno T Modesto
- School of Physical Education and Sport, University of São Paulo , São Paulo , Brazil
| | - Luiz Aburad
- Department of Nutrition, Faculty of Public Health, University of São Paulo , São Paulo , Brazil
| | - Rômulo Bertuzzi
- School of Physical Education and Sport, University of São Paulo , São Paulo , Brazil
| | - Antonio H Lancha
- School of Physical Education and Sport, University of São Paulo , São Paulo , Brazil
| | - Bruno Gualano
- School of Physical Education and Sport, University of São Paulo , São Paulo , Brazil
| | - Fernanda B Scagliusi
- Department of Nutrition, Faculty of Public Health, University of São Paulo , São Paulo , Brazil
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Clifford D, Ozier A, Bundros J, Moore J, Kreiser A, Morris MN. Impact of non-diet approaches on attitudes, behaviors, and health outcomes: a systematic review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:143-55.e1. [PMID: 25754299 DOI: 10.1016/j.jneb.2014.12.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine the overall effect of non-diet, weight-neutral interventions on factors such as weight, biochemical measures, food and activity behavior, body image, and mental health. DESIGN Systematic review of intervention literature. SETTING Group classes in community and worksite settings (14 studies), and individual counseling (1) and online education (1) in college settings. PARTICIPANTS Eighteen research articles (representing 16 studies) evaluating non-diet interventions using quasi-experimental and randomized study designs with either a comparison or control group. MAIN OUTCOME MEASURES Anthropometric, physiological, psychological, and dietary intake. ANALYSIS Systematic search of 168 articles and review of 18 articles meeting inclusionary criteria. RESULTS Non-diet interventions resulted in statistically significant improvements in disordered eating patterns, self-esteem, and depression. None of the interventions resulted in significant weight gain or worsening of blood pressure, blood glucose, or cholesterol, and in 2 studies biochemical measures improved significantly compared with the control or diet group. Primary limitations were inconsistent definitions of non-diet approaches and the use of different assessment instruments for measuring outcomes. CONCLUSIONS AND IMPLICATIONS Because of the long-term ineffectiveness of weight-focused interventions, the psychological improvements seen in weight-neutral, non-diet interventions warrant further investigation.
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Affiliation(s)
- Dawn Clifford
- Department of Nutrition and Food Science, California State University, Chico, Chico, CA.
| | - Amy Ozier
- Family, Consumer & Nutrition Sciences, Northern Illinois University, DeKalb, IL
| | - Joanna Bundros
- Department of Nutrition and Food Science, California State University, Chico, Chico, CA
| | - Jeffrey Moore
- Department of Nutrition and Food Science, California State University, Chico, Chico, CA
| | - Anna Kreiser
- Family, Consumer & Nutrition Sciences, Northern Illinois University, DeKalb, IL
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Andrew R, Tiggemann M, Clark L. Predictors of intuitive eating in adolescent girls. J Adolesc Health 2015; 56:209-14. [PMID: 25620304 DOI: 10.1016/j.jadohealth.2014.09.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 09/08/2014] [Accepted: 09/10/2014] [Indexed: 01/25/2023]
Abstract
PURPOSE To examine proposed predictors of intuitive eating, including social appearance comparison, and to test a modified acceptance model of intuitive eating in adolescent girls. METHODS Participants were 400 adolescent girls aged 12-16 years who completed measures of body acceptance by others, self-objectification, social appearance comparison, body appreciation, and intuitive eating. RESULTS Correlations showed that all proposed predictors were related to intuitive eating in the expected direction. In particular, social appearance comparison was negatively related to body appreciation and intuitive eating. After controlling for other predictors, social appearance comparison was shown to explain unique variance in intuitive eating. Using structural equation modeling, an integrated modified acceptance model of intuitive eating yielded an overall good fit to the data. Mediation analyses showed that there was a significant indirect effect of body acceptance by others on both body appreciation and intuitive eating through social appearance comparison and self-objectification. CONCLUSIONS The findings extend the acceptance model of intuitive eating to adolescent girls but also identify social comparison as an important mechanism in this process. Practically, the findings highlight several areas that may be targeted to foster adaptive eating patterns in girls.
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Affiliation(s)
- Rachel Andrew
- School of Psychology, Faculty of Social and Behavioral Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Marika Tiggemann
- School of Psychology, Faculty of Social and Behavioral Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Levina Clark
- School of Psychology, Faculty of Social and Behavioral Sciences, Flinders University, Adelaide, South Australia, Australia
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I Am Pregnant and Want to Do Better But I Can’t: Focus Groups with Low-Income Overweight and Obese Pregnant Women. Matern Child Health J 2014; 19:1060-70. [DOI: 10.1007/s10995-014-1605-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Khasteganan N, Lycett D, Turner AP, Farley AC, Lindson-Hawley N, Furze G. Health, not weight loss, focused programmes versus conventional weight loss programmes for cardiovascular risk factors. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Schaefer JT, Magnuson AB. A review of interventions that promote eating by internal cues. J Acad Nutr Diet 2014; 114:734-60. [PMID: 24631111 DOI: 10.1016/j.jand.2013.12.024] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 12/22/2013] [Indexed: 11/28/2022]
Abstract
Traditional diet programs that encourage individuals to consciously restrict their dietary intake have not only been ineffective in terms of weight outcomes, but have also been counterproductive, promoting psychological distress and unhealthy eating behaviors. Nondiet approaches shift the focus away from weight outcomes to the improvement of health outcomes and psychological well-being. One such approach, intuitive eating, promotes dietary intake based on internal cues of hunger and fullness, body acceptance, and making behavior choices based on health as well as enjoyment. Several studies have implemented such ideas into intervention programs. The purpose of our review was to examine the physical and psychological effects of these programs. Twenty interventions were identified. Overall, studies had positive results, demonstrating improvements in eating habits, lifestyle, and body image as measured by dietary restraint, restrictive dieting, physical activity, body satisfaction, and drive for thinness. Participants also experienced improved psychological health as measured by depression, ineffectiveness, anxiety, self-esteem, negative affect, and quality of life. Several improvements were sustained through follow-up periods as long as 2 years. Completion rates were as high as 92% in nondieting groups. In addition, improvements in eating behaviors and maintaining a nondiet approach, increased self-esteem, and decreased body dissatisfaction were sustained long-term. Overall, studies that encourage individuals to eat intuitively help participants abandon unhealthy weight control behaviors, improve metabolic fitness, increase body satisfaction, and improve psychological distress. Results from our review favor the promotion of programs that emphasize a nonrestrictive pattern of eating, body acceptance, and health rather than weight loss.
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Teufel M, Stephan K, Kowalski A, Käsberger S, Enck P, Zipfel S, Giel KE. Impact of biofeedback on self-efficacy and stress reduction in obesity: a randomized controlled pilot study. Appl Psychophysiol Biofeedback 2014; 38:177-84. [PMID: 23760668 DOI: 10.1007/s10484-013-9223-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Biofeedback application is an evidence-based technique to induce relaxation. A primary mechanism of action is the improvement of self-efficacy, which is needed to facilitate the translation of health behavioral intentions into action. Obesity is often associated with low self-efficacy and dysfunctional eating patterns, including comfort eating as an inexpedient relaxation technique. This is the first study investigating the effects of biofeedback on self-efficacy and relaxation in obesity. In the present experiment, 31 women, mean body mass index 35.5 kg/m², were randomized to a food-specific biofeedback paradigm, a non-specific relaxation biofeedback paradigm, or a waiting list control. Eight sessions of biofeedback of the electrodermal activity were performed while presenting either a challenging food stimulus or a non-specific landscape stimulus. Self-efficacy, stress, ability to relax, eating behavior, and electrodermal activity were assessed before, directly after, and 3 months after the intervention. The food-specific biofeedback predominantly showed effects on food-related self-efficacy and perceived stress. The non-specific relaxation biofeedback showed effects on the ability to relax. Self-reported improvements were confirmed by corresponding decrease in the electrodermal reaction to food stimuli. Biofeedback treatment is effective in improving self-efficacy in individuals with obesity and might therefore be a valuable additional intervention in obesity treatment.
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Affiliation(s)
- Martin Teufel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstrasse 5, 72076, Tübingen, Germany.
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Proeschold-Bell RJ, Swift R, Moore HE, Bennett G, Li XF, Blouin R, Williams VP, Williams RB, Toole D. Use of a randomized multiple baseline design: rationale and design of the spirited life holistic health intervention study. Contemp Clin Trials 2013; 35:138-52. [PMID: 23685205 DOI: 10.1016/j.cct.2013.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/04/2013] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Abstract
Clergy suffer from high rates of obesity, chronic disease, and depression, and simultaneously underestimate the toll these take on their daily functioning. Health interventions are needed for clergy and may be tailored to their occupational context and theological beliefs. Few studies have sought to improve clergy health. No prior studies have utilized a randomized design. Spirited Life is a randomized, multiple baseline study that offered enrollment to nearly all United Methodist Church clergy in North Carolina in fall 2010. A total of 1114 clergy (response rate = 64%) enrolled. Using a multiple baseline design, we randomized participants to three cohorts. Each cohort began the health intervention in one of three consecutive years. The third cohort served as a randomized waitlist control cohort, allowing comparisons between the first and third cohorts. The two-year Spirited Life intervention consists of: 1) a theological underpinning for health stewardship based on incarnation, grace, and response and delivered during workshops; 2) the stress management program Williams LifeSkills; 3) Naturally Slim, an online weight loss program; 4) phone contact with a Wellness Advocate; and 5) $500 small grants for health goals. Metabolic syndrome is the primary endpoint. Stress and depressive severity are secondary endpoints. We measured each construct before, twice during, and at the end of the two-year intervention. Study outcomes, to be published after follow-up data are gathered, will provide evidence of the effectiveness of the combined intervention components of Spirited Life. If successful, the intervention may be considered for use with other clergy and faith populations.
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Affiliation(s)
- Rae Jean Proeschold-Bell
- Duke Global Health Institute and Duke Center for Health Policy and Inequalities Research, Durham, NC 27708-0392, USA.
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Christaki E, Kokkinos A, Costarelli V, Alexopoulos EC, Chrousos GP, Darviri C. Stress management can facilitate weight loss in Greek overweight and obese women: a pilot study. J Hum Nutr Diet 2013; 26 Suppl 1:132-9. [PMID: 23627835 DOI: 10.1111/jhn.12086] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stress and negative emotions have been shown to be critical factors in inducing overeating as a form of maladaptive coping in obese people. METHODS The present study aimed to evaluate the efficacy of an 8-week stress management programme that includes progressive muscle relaxation (PMR) and diaphragmatic breathing on weight loss and eating behaviour in a sample of overweight and obese women who started a weight-loss programme. A total of 34 women with a mean (SD) body mass index of 38.17 (7.19) kg m(-) ² and mean (SD) age 47.35 (11.64) years were recruited from the outpatients Obesity Clinic of a public hospital in Athens. Participants were randomly assigned into a Stress Management (SM) and a control group. Anthropometric measurements were taken before and after the intervention, and the participants completed the following questionnaires: Dutch Eating Behaviour Questionnaire (DEBQ), Eating Attitudes Test (Eat-26), Health Locus of Control (HLC) and Perceived Stress Scale (PSS) before and after the intervention. RESULTS The findings indicated a significant improvement in weight loss in the SM group [4.44 (0.83) kg] after intervention compared to the control group [1.38 (0.78) kg] (P < 0.05). A higher restrained eating behaviour was observed in the SM group after intervention compared to the control group, although there was no significant difference in perceived stress levels. CONCLUSIONS The intervention group showed greater weight reduction, possibly because of the stress management programme, and a greater dietary restraint was demonstrated by them compared to the control group. It is likely that stress management could facilitate weight loss in obese women; however, more studies are needed to confirm this hypothesis.
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Affiliation(s)
- E Christaki
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, University of Athens, Athens, Greece
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36
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Kearney DJ, Milton ML, Malte CA, McDermott KA, Martinez M, Simpson TL. Participation in mindfulness-based stress reduction is not associated with reductions in emotional eating or uncontrolled eating. Nutr Res 2012; 32:413-20. [PMID: 22749177 DOI: 10.1016/j.nutres.2012.05.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 05/13/2012] [Accepted: 05/18/2012] [Indexed: 11/28/2022]
Abstract
The adverse health effects and increasing prevalence of obesity in the United States make interventions for obesity a priority in health research. Diet-focused interventions generally do not result in lasting reductions in weight. Behavioral interventions that increase awareness of eating cues and satiety have been postulated to result in healthier eating habits. We hypothesized that participation in a program called mindfulness-based stress reduction (MBSR) would positively influence the eating behaviors and nutritional intake of participants through changes in emotional eating (EE), uncontrolled eating (UE), and type and quantity of food consumed. Forty-eight veterans at a large urban Veterans Administration medical center were assessed before MBSR, after MBSR, and 4 months later. For all participants (N = 48), MBSR participation was not associated with significant changes in EE or UE. In addition, there were no significant differences in the intake of energy, fat, sugar, fruit, or vegetables at either follow-up time point as compared with baseline. Enhanced mindfulness skills and reduced depressive symptoms were seen over time with medium to large effect sizes. Changes in mindfulness skills were significantly and negatively correlated with changes in EE and UE over time. Overall, there was no evidence that participation in MBSR was associated with beneficial changes in eating through reductions in disinhibited eating or significant changes in dietary intake. Randomized studies are needed to further define the relationship between mindfulness program participation and eating behaviors.
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Cox TL, Krukowski R, Love SJ, Eddings K, DiCarlo M, Chang JY, Prewitt TE, West DS. Stress management-augmented behavioral weight loss intervention for African American women: a pilot, randomized controlled trial. HEALTH EDUCATION & BEHAVIOR 2012; 40:78-87. [PMID: 22505570 DOI: 10.1177/1090198112439411] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relationship between chronic stress and weight management efforts may be a concern for African American (AA) women, who have a high prevalence of obesity, high stress levels, and modest response to obesity treatment. This pilot study randomly assigned 44 overweight/obese AA women with moderate to high stress levels to either a 12-week adaptation of the Diabetes Prevention Program Lifestyle Balance intervention augmented with stress management strategies (Lifestyle + Stress) or Lifestyle Alone. A trend toward greater percentage of baseline weight loss at 3-month data collection was observed in Lifestyle + Stress (-2.7 ± 3.6%) compared with Lifestyle Alone (-1.4 ± 2.3%; p = .17) and a greater reduction in salivary cortisol (Lifestyle + Stress: -0.2461 ± 0.3985 ng/mL; Lifestyle Alone: -0.0002 ± 0.6275 ng/mL; p = .20). These promising results suggest that augmenting a behavioral weight control intervention with stress management components may be beneficial for overweight/obese AA women with moderate to high stress levels and merit further investigation with an adequately powered trial.
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Affiliation(s)
- Tiffany L Cox
- University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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38
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Factors associated with long-term weight loss and weight maintenance: analysis of a comprehensive workplace wellness program. J Occup Environ Med 2012; 53:1236-42. [PMID: 22005396 DOI: 10.1097/jom.0b013e31823401db] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine factors associated with long-term weight loss and maintenance for participants of a comprehensive workplace wellness program. METHODS Data came from Health Risk Assessments completed by 89,746 overweight and obese persons between 2005 and 2010 to examine the association between demographics, improved nutrition, improved exercise and reduced stress and odds of weight loss and weight maintenance, as well as changes in bodyweight at 1 year follow-up. Generalized estimating equations were used to estimate coefficients of interest while controlling for confounds. RESULTS Factors significantly associated with increased odds and amount of weight loss were male gender, older age, reduced psychosocial stress, improved nutrition, and increased exercise when combined with improved nutrition. CONCLUSIONS Comprehensive workplace wellness programs that address weight management through an integrated stress management approach can be effective in addressing the obesity epidemic.
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Phelan S, Jankovitz K, Hagobian T, Abrams B. Reducing excessive gestational weight gain: lessons from the weight control literature and avenues for future research. ACTA ACUST UNITED AC 2012; 7:641-61. [PMID: 22040207 DOI: 10.2217/whe.11.70] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Excessive gestational weight gain is a prevalent problem and an independent predictor of future obesity in both mothers and offspring. Intervention research to prevent excessive gestational weight gain is still in its infancy but results to date have been quite modest. Research in weight control outside of pregnancy over the past 30 years has been more robust and identified several key components of effective programs, including use of caloric restriction, daily diet self-monitoring, self-weighing, behavior therapy and ongoing patient-provider contact. The aim of this article is to summarize intervention components shown to be effective in promoting successful weight control outside of pregnancy and explore potential applications in pregnancy. Available evidence suggests that the strategies shown to be effective for weight control outside of pregnancy may also promote better weight control in pregnancy, but several lines for future investigation remain.
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Affiliation(s)
- Suzanne Phelan
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, CA 93407-0386, USA.
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40
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Teufel M, Becker S, Rieber N, Stephan K, Zipfel S. [Psychotherapy and obesity: strategies, challenges and possibilities]. DER NERVENARZT 2012; 82:1133-9. [PMID: 21833770 DOI: 10.1007/s00115-010-3230-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
One fifth of the German population is obese with increasing prevalence. Psychotherapy plays an important role in weight loss programmes. Cognitive behaviour therapy, targeting lifestyle changes, including exercise and eating behaviour, is the evidence-based treatment of choice. Especially the lack of motivation or absence of weight loss, further weight gain or psychosocial burden makes psychotherapy essential. The treatment of a comorbid binge eating disorder should be initiated prior to focusing on weight loss. Remarkably difficult stages in the treatment of obesity are the initiation of changes as well as the maintenance of the achieved weight loss. Internet-based attempts will become increasingly important.
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Affiliation(s)
- M Teufel
- Medizinische Klinik VI, Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen, Osianderstr. 5, 72070 Tübingen, Deutschland.
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Manson SM, Jiang L, Zhang L, Beals J, Acton KJ, Roubideaux Y. Special diabetes program for Indians: retention in cardiovascular risk reduction. THE GERONTOLOGIST 2011; 51 Suppl 1:S21-32. [PMID: 21565816 DOI: 10.1093/geront/gnq083] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study examined the associations between participant and site characteristics and retention in a multisite cardiovascular disease risk reduction project. DESIGN AND METHODS Data were derived from the Special Diabetes Program for Indians Healthy Heart Demonstration Project, an intervention to reduce cardiovascular risk among American Indians and Alaska Natives with diabetes. In 2006, a total of 1,072 participants from 30 participating sites completed baseline questionnaires measuring demographics and sociobehavioral factors. They also underwent a medical examination at baseline and were reassessed annually after baseline. A Provider Annual Questionnaire was administered to staff members of each grantee site at the end of each year to assess site characteristics. Generalized estimating equation models were used to evaluate the relationships between participant and site characteristics and retention 1 year after baseline. RESULTS Among enrolled participants, 792 (74%) completed their first annual assessment. Participants who completed the first annual assessment tended to be older and had, at baseline, higher body mass index and higher level of physical activity. Site characteristics associated with retention included average age of staff, proportion of female staff members, and percentage of staff members having completed graduate or professional school. IMPLICATIONS Understanding successful retention must reach beyond individual characteristics of participants to include features of the settings that house the interventions.
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Affiliation(s)
- Spero M Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Denver, 13055 East 17th Avenue, Mail Stop F800, Aurora, CO 80045.
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Gourlan MJ, Trouilloud DO, Sarrazin PG. Interventions promoting physical activity among obese populations: a meta-analysis considering global effect, long-term maintenance, physical activity indicators and dose characteristics. Obes Rev 2011; 12:e633-45. [PMID: 21457183 DOI: 10.1111/j.1467-789x.2011.00874.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
As the benefits that regular physical activity (PA) have on obesity are well known, many interventions promote active lifestyle adoption among obese populations. This meta-analysis aims to determine (i) the global effect that interventions promoting PA among obese populations have on their PA behaviour; (ii) variations in the effect of interventions depending on the PA indicator used; (iii) the programme's dose characteristics and (iv) maintenance of the intervention effects after the intervention has ended. A comprehensive search through databases and review articles was completed. Forty-six studies met the inclusion criteria. Calculations of effect size (Cohen's d) and a moderator analysis were conducted. The meta-analysis showed that interventions globally have an impact on the PA behaviour of obese populations (d = 0.44; 95% CI = 0.31, 0.57). The moderator analysis revealed that interventions of less than 6 months reported significantly larger effects than longer interventions. Moreover, the interventions had a stronger impact on the number of steps and the PA indexes (i.e. composite scores reflecting PA practice) than on other PA indicators. Finally, the analysis revealed that interventions succeed in maintaining PA behaviour after the intervention is over. However, relatively few studies addressed this issue (n = 9). Despite global positive effects, further research is needed to determine the optimal dose for interventions and to evaluate the maintenance of intervention effects.
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Affiliation(s)
- M J Gourlan
- Laboratoire Sport et Environnement Social, Joseph Fourier University, Grenoble, France
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43
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Edmonds JC. The Relationship of Stress to Health-Promoting Behaviors of College-Educated African American Women. ACTA ACUST UNITED AC 2010. [DOI: 10.1089/bar.2010.9992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lee HS, Lee JW, Kim JM, Chang N. The Effect of Nutrition Education and Excercise Program on Body Composition and Dietary Intakes, Blood Lipid and Physical Fitness in Obese Women (2) - Relationship between Participation Rates and Effectiveness of Obesity Management Program -. ACTA ACUST UNITED AC 2010. [DOI: 10.4163/kjn.2010.43.3.260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hee Seung Lee
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 120-750, Korea
| | - Ji Won Lee
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 120-750, Korea
| | - Ji-Myung Kim
- Department of Food and Nutritional Sciences, Hanbuk University, Dongducheon 483-120, Korea
| | - Namsoo Chang
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 120-750, Korea
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Non-dieting group interventions for overweight and obese women: what predicts non-completion and does completion improve outcomes? Public Health Nutr 2009; 13:1622-8. [DOI: 10.1017/s1368980009992977] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo determine factors which predict non-completion of group non-dieting interventions for overweight women, and to investigate whether completion improves outcomes.DesignFirst, baseline predictors of non-completion were identified; then changes at 10 weeks and 12 months were compared between completers and non-completers of 10-week non-dieting interventions.SettingGeneral community.SubjectsParticipants were 119 women (aged 25–65 years, BMI ≥ 28 kg/m2) with at least one cardiovascular risk factor. Participants who attended at least eight of the ten sessions were classified as completers, and non-completers were those who attended fewer than eight sessions. Measures included BMI, blood pressure, psychological distress, lifestyle behaviours and eating self-efficacy.ResultsLogistic regression analyses indicated that women were less likely to be non-completers at non-dieting group programmes if, at baseline, they were more highly educated or had healthier nutrition behaviours (controlling for education). Only healthier nutrition behaviour was negatively associated with non-completion in the final model. Twelve months after the intervention, completers showed significantly greater improvements in body weight (mean change −0·53 kg), systolic and diastolic blood pressure (−6·3 and −4·1 mmHg, respectively), stress management behaviour score (+0·5) and psychotic symptoms score (−0·1) than non-completers (all P < 0·05).ConclusionsHighly educated women already engaging in some healthier lifestyle choices were less likely to be non-completers in non-dieting group programmes. Since important treatment outcomes vary according to attendance, future trials of non-dieting interventions should report the effects of completion on outcomes.
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Chang MW, Brown R, Nitzke S. Participant recruitment and retention in a pilot program to prevent weight gain in low-income overweight and obese mothers. BMC Public Health 2009; 9:424. [PMID: 19930587 PMCID: PMC2785793 DOI: 10.1186/1471-2458-9-424] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 11/21/2009] [Indexed: 11/10/2022] Open
Abstract
Background Recruitment and retention are key functions for programs promoting nutrition and other lifestyle behavioral changes in low-income populations. This paper describes strategies for recruitment and retention and presents predictors of early (two-month post intervention) and late (eight-month post intervention) dropout (non retention) and overall retention among young, low-income overweight and obese mothers participating in a community-based randomized pilot trial called Mothers In Motion. Methods Low-income overweight and obese African American and white mothers ages 18 to 34 were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in southern Michigan. Participants (n = 129) were randomly assigned to an intervention (n = 64) or control (n = 65) group according to a stratification procedure to equalize representation in two racial groups (African American and white) and three body mass index categories (25.0-29.9 kg/m2, 30.0-34.9 kg/m2, and 35.0-39.9 kg/m2). The 10-week theory-based culturally sensitive intervention focused on healthy eating, physical activity, and stress management messages that were delivered via an interactive DVD and reinforced by five peer-support group teleconferences. Forward stepwise multiple logistic regression was performed to examine whether dietary fat, fruit and vegetable intake behaviors, physical activity, perceived stress, positive and negative affect, depression, and race predicted dropout as data were collected two-month and eight-month after the active intervention phase. Results Trained personnel were successful in recruiting subjects. Increased level of depression was a predictor of early dropout (odds ratio = 1.04; 95% CI = 1.00, 1.08; p = 0.03). Greater stress predicted late dropout (odds ratio = 0.20; 95% CI = 0.00, 0.37; p = 0.01). Dietary fat, fruit, and vegetable intake behaviors, physical activity, positive and negative affect, and race were not associated with either early or late dropout. Less negative affect was a marginal predictor of participant retention (odds ratio = 0.57; 95% CI = 0.31, 1.03; p = 0.06). Conclusion Dropout rates in this study were higher for participants who reported higher levels of depression and stress. Trial registration Current Controlled Trials NCT00944060
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Affiliation(s)
- Mei-Wei Chang
- College of Nursing, Michigan State University, East Lansing, Michigan, USA.
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Hawley G, Horwath C, Gray A, Bradshaw A, Katzer L, Joyce J, O'Brien S. Sustainability of health and lifestyle improvements following a non-dieting randomised trial in overweight women. Prev Med 2008; 47:593-9. [PMID: 18817809 DOI: 10.1016/j.ypmed.2008.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 08/26/2008] [Accepted: 08/28/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare three non-dieting interventions that focused on lifestyle change rather than weight loss, in terms of the sustainability of improvements in lifestyle behaviors, psychological well-being and medical symptoms at 2 years. METHOD In Dunedin, New Zealand in 2002/2003, 225 obese/overweight women (BMI > or = 28; 25-68 years) participated in a randomised, intention-to-treat trial comparing two group programs (P1, P2) and a self-guided mail-delivered program (P3). Only P1 included intensive relaxation response training. All three non-dieting interventions involved a 10-week program, followed by an eight-month support phase. Participants completed baseline, 1-year and 2-year assessments. Outcomes included behavioral, psychological and medical symptom measures and a composite success score. RESULTS 118 participants completed the 2-year follow-up. Only among P1 participants were the reductions in psychological distress and medical symptoms achieved at 1 year, also maintained at 2 years. At 2 years, P1 participants had significantly greater increases in stress management behaviors than those in P2 (p<0.05), and significantly greater success scores than those in P3 (p<0.05). In all three programs, mean weight was unchanged at 2 years. CONCLUSION Inclusion of relaxation response training in a healthy lifestyle program facilitates long-term maintenance of psychological and medical symptom improvements even in the absence of weight loss.
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Affiliation(s)
- Greer Hawley
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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